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Home My WebLink AboutBLDE-21-006496 CommonwealthOfficial Use Only of iliti- „E -g' Massachusetts Permit No. BLDE-21-006496 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:5/10/2021 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) 8 WARBLER LN Owner or Tenant VENICE CHRISTOPHER Telephone No. Owner's Address VENICE JOYCE, 9 STONEBRIDGE RD, OXFORD, CT 06478 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd 0 No.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: Air conditioning installation. 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 Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No No.of Devices or Equivalent HeatersWater KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 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 (Specify:) I certify,under the pains and penalties of perjuly,that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIl. NO.: 21829 (If applicable,enter"exempt"in the license number line.) Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 A . Tel. o.:: Alt. *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Tel.No.: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But signature below,I hereby waive this requirement.I am the(check one)) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. I ECSI PERMIT FEE:$50.00 Commonwealth of Massachusetts Official Use Onl �._**_ , `2l q c � ` �`- Permit No. +-- :=_;ii_=0 Department of Fire Services t�= Occupancy and Fee Checked ?v.,.-.�� BOARD OF FIRE PREVENTION REGULATIONS [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 T PE ALL INFORMATION) Date: 5 / 3 ` Z I B City or Town of: yWoVlotl 1-L To the Inspector of Wires: y this application the undersigned gives notice of his or her intention to�/erform the electrical work described below, Location(Street&Number) Co1 b l'�( I, ie 1 a o() OZ6 1 3 Owner or Tenant (In"(5 VeflF CC Telephone No. 5C IS 3 41 y/5 3 Owner's Address 16 (gip pCv t3(0,k C ,Glt Is this permit in conjunction with a building permit? Yes p� �t(`� ❑ No (Checic Appropriate Box) Purpose of Building J \l Utility Authorization No. Existing Service Amps ) / Volts Overhead I I Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: l. , _ n 5 i-otI 1(a (ee t/ Completion of the followintable may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs • Generators KVA No.of Luminaires Swimming Pool r Above I I grnd. I I Battery Units Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches • No.of Gas Burners Na,of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump I Number'Tons IKW No.of Self-Contained Totals: J Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal I • Focal) I Connection Other No.of Dryers Heating Appliances KW Secuxity'Syystems:* No.of Water No. of No.of Devices or Equivalent Heaters KWNo,of Data Wiring: Signs Ballasts No.of Devices or Equivalent No,Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: O OTHER: No.of Devices or Equivalent V) 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; Inspections 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 VA BOND ❑ OTHER ❑ (Sp eci I certify,under the pains and penalties oinformation ) fper fury,that the on this ap lication is true and complete. t_il c. --n F1RM NAME; E.F. WINSLOW PLUMBING & HEATING CO,, Ij I Licensee: 1ZICHARD MELVIN • .MC.NO.:328 I C Signature • LIC.NO.:21829A of applicable, enter "exempt"in the license number line.) Address; 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No,:5o8-394 7778 Alt.Tel.*Security System Contractor License required for this work; if applicable,enter the license number here:No: --I' 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)Downer D owner's agent, Own er/Agent Signature Telephone No. !PERMIT FEE: $• E.F. Winslow Inspection Department email: inspections@efwinslow.corn The Commonwealth of Massachusetts Department of IndustrialAccidents 11= Office of Investigations ru _�; � �; Lafayette City Center e 2 Avenue de Lafayette,Boston ,MA 021II-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses A licant Information Please Print Le lb! 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.WEI am a employer with 90 employees (full and/ 5• El Retail or part-time).* 2.I I I am a sole proprietor or partnership and have no 6. ❑Restaurant/Bar/Eating Establishment 7. ❑ 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.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 no employees. [No workers' comp. insurance required]** 10 0 Manufacturing 4.I I 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: 01/ Policy#or Self ins. Lic.#1964A Expiration Attach a copy of the workers' compensation policy declaration page(showing the policyDnumber ando22 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 cer • e the ins and penalties o //�`,/ P of perjury that the information provided above is true and correct. Si nature: j/�.a 01/02/2021 Date: 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): 1.JBoard of Health 2.0 Building Department 30 City/Town Clerk 4.[]Licensing Board 50 Selectmen's Office 6.[]Other Contact Person: Phone#: www.mass.gov/dia