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Home My WebLink AboutBLDE-22-001279 0 CommonwealthMassachusetts of Permit No. Offici BLDE-22-001279al Use Only 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) Date:9/6/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 6 EIDER ST Owner or Tenant STEVE LAMONTAGE Owner's Address 6 EIDER ST,YARMOUTH PORT, MA 02675 Telephone No. Is this permit in conjunction with a building permit? Yes 0 No 0 Purpose of Building (Check Appropriate Box) Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 gNo.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. 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 HotKVA Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ grnd ❑ No.of Emergency Lighting No.of Receptacle Outlets Battery Units No.of Oil Burners FIRE ALARMS I No.of Zones ( No.of Switches No.of Gas Burners 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. 1 Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained - Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Ballasts Siens Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: 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 istrue 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 Owner/Agent ) 0 owner 0 owner's agent. Signature Telephone No. �f / PERMIT FEE:$50.00 L}4 ( li B i2SL(�E, (( .La) bizq 4 28 Commonwealth of r�SScI Cal CYS4 S Official Use Only i• _ 1, _* Department=: = P met ofFire Services Permit No. "L2-(2 _ E-- "+'- BOARD OF SIRE PREVEN C7 Occupancy and Fee Checked TI N REGULATIONS [Rev.9/051 (leave blank �— APPLICATIONFOR PERIVIIT TO PERFORM All work to be performed In accordance with the Massachusetts Electrical Code ELECTRICAL WORK (P.L ASB.,2)RZNTXN.I7YX OR TYPE ALL XN. 'O (zt c),527 cMlz 12.00 City or Town of: It .RMATION) Date: � ) �'� �Z I By this application the undersigned gives notice ofhjs or her intention to perforTo m the e Inspector tr toy p work described Location(Street&N tuber•) ' ` Si- zcal described below, �� N ►7iU1/ -li 0/4 2G 75 Owner or Tenant 5-Qv vt20yd-yt e Owner's Address L I I- Y10 Telephone No, ( � 7 �f SvC l� kJ o�Ps� �� Is this permit in conjunction with a boil ng permit? Yes Purpose of Building G ❑ N0 ljiLam' (Check Appropriate Box) Existing Service Utility Authorization No. - -- Amps •/ 'V'olts Overhead Nev✓Servxce ❑ -Llndgxd] No.of Meters Amps / Volts Overhead Number of Feeders and Arnpacity YTndgrd El No.of Meters Location nod Nature o Proposed Electrical'Work: ace G�. ( l'aehph Comrletion o the allowirr.table ins be waived b the Ins',actor o Wires, No.of)Recessed Luminaires No.of Ceil.-Susp,(Paddle)sans No. of KVA No.of Lurrtinaire Outlets Transformer's Na. of Hot Tubs Generators x 'VY.A, No.of Luminaires Ab swimming pool :r,ndov,e ❑ zn ❑- `0.0e f rraergency iv.•rng • No.of receptacle Outlets .rid. Batt Units No.of Oil Burners No,of Switches • FIRE ALARMS No,of Zones No,of Gas:BurnersNo.of Detection and No.of Ranges Initiatin-Devices No.o:fAir Cond. ota Tons No. o No.of WasteDisposers $eaGpum i'Alerting Devices Totals: Number To ns No. ofSelf Contained X41• ,.,.,..... No. of Dishwashers Detection/Alex-tin:Devices Space/Area Heating Iry Local❑N{unicipal I • Xleating Appliances KW Connection 0 Other No,of Water Security',Systems:* No. of Dryers Heaters IN/ No. of No, of No.of Devices or .uivalent Si us Ballasts Data Wiring: • No,Rydromassage Bathtubs No. of Motors Total}p No.of D evices or•JO•uivalent Telecommunications Wiring: OTC' 2: No,of Devices or l P.uivalent Estimated Value of Electrical Work: Attach additional detail if desii'ecl,or as required by the Inspector of Wires, Work to Start; (When required by municipal policy,) INSURANCE; COVERAGE: Inspections to be requested in accordance with MEC Rule 10,and upon completion. L� RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof ofliability insurance including"completed operation"coverage or its substantial undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit CHECK ONE: equivalent. The I HE K under:the painsncl ldNCE cd BOND ❑ OTHER issuing office, p ❑ (Specify;) Z+XIgIVx ofnerjzny, that the irzfo�n1atton on this aye Xicrttiorz is true and complete. NA14dl; �,F, WINSi QTII/PLUMBING &HEATING CO,, I s Licensee; RICHARD MELVIN Signature •Lie,NO,;S28'10 �-� r) (jl�applicgUle, enter„exempt"in the license -"-'�_ Address; 8 REARpON CIRCLE SOUTH YARMOU Der line.) --�T LXC, j�0,;21$z9/� *Security System Contractor License tequireFd for this work;if Bus.Tel.No,:sob-as4-'777e �� OWNER'S INSURANCE WAIVER: e Alt.Telnumber .No,; I amh aware that the Licensee does notch ye the liability insurance coves T required r bylaw, By my signature below,I hereby waive this requirement. I atn the(check one � Owner/Agent ge normally Signature ( owner Telephone No, ! aM'�= -ztei's aeizl • X' E.i. W Department inslow inspection De ZTE, email: inspections cr efwins[ow.com • The Commonwealth of Massachusetts • me---. Department oflndustrialAccidents Office of Investigations Lafayette City Center --- W 2 Avenue de Lafayette,Boston,MA 02111.4750 °"'�+`t, 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): i.iE1 I am a employer with90 employees (full and/ 5. ❑Retail or part-time).* 6. U Restaurant/Bar/Eating Establishment 2.1 I I am a sole proprietor or pal trrership and have no 7. [ Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] $ ❑Non-profit 3.I I We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]** 4.I I We are anon-profit organization, staffed by volunteers, 11•Q wealth Care - with no employees. [No workers' comp.insurance req.] 12.0 Other . • *Any applicantthat 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 faun 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. X do hereby cer .yr-am e.the ins and penalties of perjury that the information provided above is true and correct. , / Signature: 1; A,I.,, � Date: 01/02/2021 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): L.[(Board of Health 2.0 Building Department 3.11]City/Town Clerk 4.[Licensing Board 5.1 Selectmen's Office 6.[Other Contact Person: Phone 4: www.lnass.gov/dia