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Home My WebLink AboutBLDE-22-007174 I aTh \' 7 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-007174 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of: YARMOUTH DaTo the te: Inspector of Wires: 022 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 16 EAGLE LOOP Owner or Tenant BUTLER THOMAS F JR Owner's Address 16 EAGLE LOOP,YARMOUTH PORT, MA 02675-1106 Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Utility Authorization No. Existing Service Amps Volts Overhead 0 New Service Undgrd 0 No.of Meters Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler&water heater Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers Total No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming Pool g bovend. ❑ RIrnd ❑ No.of Emergency Lighting r Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS ,No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and No.of Ranges Initiating Devices No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water 1 KW No.of No.of Devices or Equivalent Heaters No.of Ballasts Data Wiring: Signs No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Eauivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) Inspection to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 I certify,under the pains and penalties operjury,that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature Tel. NO.: 21829 (If applicable,enter"exempt"in the license number line.) Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Bus.Tel.No.: Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one ) 0 owner 0 owner's agent. Signature Telephone No. PERMIT FEE:$50.00 k 0 7I , - Commonwealth of Massachusetts Official Use Only _ _ Department of Fire Services Permit No. ��t __ _ J =[I- �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of: YARMOUTHTo the Inspector of Date:6/2/22 By this application the undersigned gives notice of his or her intention to perform the electrical work dtescribed below. Location(Street&Number) 16 EAGLE LOOP YARMOUTHPORT MA 02675 Owner or Tenant THOMAS BUTLER Owner's Address SAME Telephone No. 5083626840 Is this permit in conjunction with a building permit? Yes ❑ No ❑✓ (Check Appropriate Box) Purpose of Building DWELLING Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity 0 Undgrd❑ No.of Meters Location and Nature of Proposed Electrical Work: BOILER AND WATER HEATER INSTALLATION Completion o the ollowin•table ma be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- `o.o mergency ig ing rnd. ❑ .rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners 'FIRE ALARMS No.of Zones • No.of Switches No.of Gas Burners ; o.o Detection an No.of Ranges 1 Initiatin: Devices No.of Air Cond. Tota No.of Waste Disposers Tons :No.of Alerting Devices Tops_ KW ; Heat Pump Number T No.of Self-Contained Totals: Detection/Alertin. Devices No.of Dishwashers Space/Area Heating KW ;Local Municipal No.of Dryers Connection ❑Other Heating Appliances KW Security Systems:* No.of Devices or El uivalent No.of Water No.of Heaters KW No.of Data Wiring: Si ns Ballasts No.of Devices or E•uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E•uivalent L11 Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to Start: (When required by municipal policy.) d in accordance with INSURANCE COVERAGE: Unless Inspwaived by ections to the ownere ,no permitfor the performanceC lof electricalupone 10,and work aytissu t!� the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The work may issue unless f -' undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. �c CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (1 k.--' I certify,under the pains and penalties ofpeijury,that the information on this ap lication is true and complete. FIRM NAME: E.F. WINSLOW PLUMBING &HEATING CO., ! �_ c�P Licensee: RlCHARD MELVIN LIC.NO.:3281C l h Signature (If applicable,enter "exempt"in the license number line.) LIC.NO.:21829A Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel,No.:508-394-7778 Alt.Tel.No.:*Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑ Owner/Agent Signature owner �owner's a:ent. Telephone No. PERMIT FEE: $ E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents „." • �.az_ ` Office of Investigations ,,t.! . j Lafayette City Center _ ` 2 Avenue de Lafayette, Boston,MA 02111-1750 m" www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: E.F. WINSLOW PLUMBING & HEATING CO, INC. Address: 8 REARDON CIRCLE City/State/Zip: SOUTH YARMOUTH, MA 02664 Phone #: 508-394-7778 Are you an employer? Check the appropriate box: Business Type(required): 1.0 I am a employer with 90 employees (full and/ 5. ❑Retail 2.0or-part time* 6. 0RestaurantBar/Eating Establishment I am a sole proprietor or partnership and have no7 -_ ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 4.❑ We are a non-profit organization, staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address: City/State/Zip: Policy#or Self-ins. Lic. #1964A Expiration Date:01/01/2022 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under§ 25A of MGL c. 152 can lead to the imposition of criminal penalties-of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ' 7 the ins and penalties of perjury that the information provided above is true and correct. Signature: -•• âL�- 01/ g r Date: 02/2021 Phone#: 508-394-7778 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.OLicensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia