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Home My WebLink AboutBLDE-21-005192 0. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-005192 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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:3/12/2021 City or Town of: YARMOUTH To the Inspector of Wires: 3y this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 135 WEST YARMOUTH RD Dwner or Tenant WHITTY ROBERT D Telephone No. Dwner's Address WHITTY CLAIRE, 135 W YARMOUTH RD,WEST YARMOUTH, MA 02673 Es this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 150 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 150 Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement 150 amp service. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices 0 Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW LocalConnection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or No. No.of Water No.of No.of Data Wiring: KW Signs Ballasts No.of Devices or Equivalent Heaters Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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 perjury,that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC LIC.NO.: 21829 Licensee: RICH M MELVIN Signature (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:Alt.Tel.No.: Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 *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❑s insurance coverage normally required by law.But s signature below,I hereby waive this requirement.I am the(check one) owner t. Owner/Agent PERMIT FEE: $50.00 Signature Telephone No. `" `R, (11017A le. (6' ? 7( Commonwealth of Massachusetts O ial se onl Permit No. 5j 91� 1=_** M= ,,,_ Department of Fire Services •='!VI Occupancy and Fee Checked %,= 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 TYPE ALL INFORMATION) Date: 3 li O f `Z I City or Town of: Yarrn pv hri 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) 1 3 �j JCS,- yatienaciA K U We 5 >- Ya✓inc1, ill 026 75 Owner or Tenant (la j/e IA)k i-'4-1 Telephone No. 5' 7)/ //S Z Owner's Address 5 l ✓ice!e Is this permit in conjunction with a building permit? Yes ❑ No 0----1-C-heck Appropriate Box) Purpose of Building Dv e 11; 9 Utility Authorization No. Existing Service / $^D Amps /ZD / 2...y6 Volts Overhead Undgrd❑ No.of Meters / New Service /$-D Amps /20 / pia Volts Overhead J1 Undgrd 0 No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 49�y/APzyn6ti f- /c G AOH Ssit-ctic,.&- Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf T Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool 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 Detectionand Initiating Devices No.of Ranges No.of Air Cond. 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 Municipal 0 Other Connection No.of Dryers Heating Appliances KWSecurity Systems:* No.of Devices or Equivalent No.of Water Kam, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications NofDeicer Wiring: No. 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: 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 Ai undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. ,� (/ �' CHECK ONE: INSURANCE ® BOND El OTHER ❑ (Specify:) . I certify,under the pains and penalties of pedury,that the information on this ap lication is true and complete. FIRM NAME: E.F.WINSLOW PLUMBING & HEATING CO., I LIC.NO.:3281C Licensee: RICHARD MELVIN Signature 0 IV\ LIC.NO.:21829A It (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 t N Address; 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.No.: *Security System Contractor License required for this work; if applicable,enter the license number here: (X . 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. 1 am the(check one)Downer Downer's agent. Owner/Agent 1 Signature Telephone No. PERMIT FEE: $ • • E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts I Department of Industrial Accidents Office of Investigations '� Lafayette City Center �,=,o 2 Avenue de Lafayette,Boston,MA 02111-1750 �``'• 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.❑ I am a employer with 90 employees (full and/ 5. ❑Retail or part-time).* 6. El Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership 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] 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.ElWe are a non-profit organization, staffed by volunteers, 11.[]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 cert�7 . the ins and penalties of perjury that the information provided above is true and correct. Signature: y ". .,...0/0,..+0. 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.DBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.[]Licensing Board 50 Selectmen's Office 6.(]Other Contact Person: Phone#: www.mass.gov/dia