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Home My WebLink AboutBLDE-23-004863 Commonwealth of Official Use Only iiii�or or t,Iti tet Massachusetts Permit No. BLDE-23-004863 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:3/4/2023 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) 11 JOHNSON LN Owner or Tenant KATHLEEN DOWNING Telephone No. Owner's Address 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 0 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: First floor laundry room. 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 v ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool Abo grnd.e ❑ In-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 Initiatinn Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Ton Heat Pump I l Number I Tons KW No.of Self-Contained .-0 No.of Waste Disposers Totals: Detection/Alertine Devices Local 0 Municipal 0 Other: No.of Dishwashers Space/Area Heating KW Local Security Systems:* 7 No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Siens 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 Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No o. 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 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. Owner/Agent I PERMIT FEE: $50.00 Signature Telephone No. ti i Al ( (23 t 66:04411 L(A)) l A-t_. / 17%31- Commonwealth of Massachusetts Official Use Only i _*-_— d Permit No. �Z� � ..J �_,��= Department of Fire Services cur— Occu9/pancy5] and Fee Checked ° =� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 0 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 ,•3/d 3 City or Town of: t//1, -Jfl/2 � ( sr ) To the Inspector of Wires: By this application the undersig ed gives notice of his or her inten n to perform the electrical work described below. Location(Street&Number) // J67/1X256a/ / L/.&'6 Owner or Tenant /4/ -7-;I L .,zt./ , 6,-)0//L//t .- Telephone No. Owner's Address Sfitl'7 Is this permit in conjunction with a building permit? Yes [I No I I'" (Check Appropriate Box) Purpose of Building L2 ) /L--//!'l-- Utility Authorization No, Existing Service Amps / Volts Overhead[1 Undgrd I I No.of Meters New Service Amps / Volts Overhead Li Undgrd I I No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /57 `iI.X.)/L L O y / .0 i/Zf Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tr of T Transformers VA No.of Luminaire Outlets No.of Hot Tubs • Generators IKVA No.of Luminaires Swimming Pool Above In- No.of'Emergency Lighting No.of Receptacle Outlets No.of Oil Burnersgiiid. grnd. Battery Units FIRE ALARMS No.of Zones 1 ... No._of.Detection.and:_.__...r...�.•..,.�_..__ _.._._��.��.._.:..._.,. .,h_._,,._�.•..__.,-:...2._.._.... No:"ofS•vvitcli'es_.....____..._.__..._ ___.... __........No:o£Gas"Burners" Initiatigg Devices No.of Ranges • No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump NumberTons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local— Municipal n Other p Connection No.of Dryers Heating Appliances KW Seeuiity'Systerzis:* No.of Devices or Equivalent No.of Water IOW No.of No.of Data Wiring: Heaters. ... . ...._. _. .... . Signs Ballasts . No.of Devices of lEquivalent No.H drornassa e Bathtubs No,of Motors Total HP Telecommunications N . fDeice orq l y g No.of Devices 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 IVIECRule 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 ® BOND ❑ OTHER ❑ (Specify:) . I certify,under the pains and penalties ofpeijury,that the information on this ap llcation is true and complete. FIRM NAME: E.F.WINSLOW PLUMBING& HEATING CO., IV .LIC.NO.:3281 C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:508-394-777a 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: OWNER'S INSURANCE WAIVER: Tam 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)LI owner U owner's agent. J Owner/Agent d Signature Telephone No. PERMIT FEE: $ (‘ • E.F.Winslow Inspection Department email : inspections@efwinslow.com e,\ The Commonwealth of Massachusetts Department of Industrial Accidents i - " —E Office of Investigations ��,j Lafayette City Center ' l 2Avenue 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 I am a employer with 99 employees (full and/ 5. ❑Retail or part-time).* — 2. —I am-agile proprietor or partnership and have nu 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.❑ We area corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152, §1(4),and we have 10,E Manufacturing no employees. [No workers' comp. insurance required]** 4.IDWe 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:01/01/202 Attach a cop y 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 cer 3 -un e the ins and penalties of perjury that the information provided above is true and correct. Signature: c 7' L /(/,.....b. Date: 12/01/20 ' 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 4.0Licensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia