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Home My WebLink AboutBLDE-22-002693 Commonwealth of Official Use Only 60410 � Massachusetts Permit No. BLDE-22-002693 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:11/10/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her inte',bog to perform the electrical work described below. Location(Street&Number) 300 BUCK ISLAND Owner or Tenant ROSENBERG PAUL A Telephone No. Owner's Address MOSS HARRIET C, P 0 BOX 610229, NEWTON HIGHLANDS, MA 02161-0229 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ o. New Service Amps Volts Overhead 0 Undgrd 0 Me Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. </eZ I 7 Completion of the following table may be w y AZ4e Tres. No.of Recessed Luminaires No.of Ceil:Sus . Paddle Fans No.of A p( ) Transformers :' 91 No.of Luminaire Outlets No.of Hot Tubs Generators4), No.of Luminaires Above In- No.of Emergency Light Swimming Pool grnd. ❑ rnd. ❑ Battery Units g g 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 Initiatine Devices No.of Ranges No.of Air Cond. 1 Ton l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Sims 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 perjury,that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 Ce, )171 rC "Wz1) ACommonwealth of Massachusetts Official Use Onb, . el t Department of Fire Services Permit No. GZZ 24 Y3 •€'��(e,<; BOARD OF FIRE PREVENTION REGULATIONS Occupancyev.9/05] and Fee Checked (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: 11/03/2021 City or Town of: YARMOUTH(WEST) 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)300BUCK ISLAND RD, UNIT 4-F,W YARMOUTH, MA 02673 (HALCYON) 0 Owner or Tenant PAUL ROSENBERG Telephone No. (617)470-7941 0 Owner's Address PO.t O>t Ce10'. - e 14f v'- r 44-O 4 fpf Is this permit in conjunction with a building permit? Yes LI No U (Check Appropriate Box) Purpose of Building RESIDENTIAL DWELLING Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd El No.of Meters --- ------- New Service Amps / Volts Overhead El Undgrd El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: GAS FURNACE, COIL&CONDENSER REPLACEMENT ti isn Completion of the following table may be waived by the Inspector of Wires. c No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Trr aa KVATota T of nsformers KVA gNo.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- No.of Emergency Lighting grnd. ❑ grnd. 0 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. TotaTons! No.of Alerting Devices In 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 ❑Other Connection t No.of Dryers Heating Appliances KW Security Systems:* -.. No.of Devices or Equivalent 04 No.of Water Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin 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: 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. CA CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) �, I certify,under the pains and penalties of perjury,that the information on this ap lication is true and complete FIRM NAME: E.F. WINSLOW PLUMBING &HEATING CO., I LIC.NO.:3281C irr Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.*Security System Contractor License required for this work;if applicable,enter the license number here:No. 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_Downer's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ I E.F. Winslow Inspection Department email : inspections@efwinslow.corn The Commonwealth of Massachusetts _ Department of Industrial Accidents c 'IT) Office of Investigations =ach �1 =—, Lafayette City Center — 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): 1.0 I am a employer with 90 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. 7. El Office and/or Sales (incl. real estate, auto, etc.) [No workers' comp. insurance required] 8. ❑Non-profit 3.0 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.IDWe 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 cery-nn the ins and penalties of perjury that the information provided above is true and correct. Signature. •}► ' /�- 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): 10Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.OLicensing Board 5.0 Selectmen's Office 6.0Other Contact Person: Phone#• www.mass.gov/dia