HomeMy WebLinkAboutBLDE-23-15847 r Commonwealth of Massachusetts :ov•1'40
* Town of Yarmouth
ELECTRICAL '
PERMIT :x {.
Job Address: 32 BETTYS PATH Unit:
Owner Name: ARSENEAUX RICHARD (LIFE EST)ARSENEAUX SUSAN S (LIFE EST)
Owner's Address: 32 BETTYS PATH Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15847
Existing Service Amps/Volts Overhead 0 Underground 0 No.of Meters:
New Service Amps/Volts Overhead 0 Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Ductless heat pump with 5 heads
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: 1 Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool: ln-Grnd.0 Above-Grnd.0 Hot Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3 0 Rating:
Estimated Value of Electrical Work: $ 19,000 Work to Start: May 17, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: RICH M MELVIN License Number: 21829
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: South Yarmouth, MA, 026641207 South Yarmouth MA 026641207
Email: inspections@efwinslow.com Business Telephone:
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.
INSURANCE:
Commonwealth of Massachusetts Official Use Only
C -* `i'__ 't Department of Fire Services Permit No. ( 3- 5 A
1( �`� .BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
�`� � 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:5/3/23
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)32 Bettys Path
Owner or Tenant Richard Arseneaux Telephone No. 774-212-2031
Owner's Address same
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building dwelling Utility Authorization No.
___- _ Existing Service_ -_—_-_Amps / Volts Overhead❑ Undgrd El No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: install ductless heat pump system: 5 indoor units, 1
outdoor unit.
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 In- No.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 o.of Detection and
Initiating Devices
Tot
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
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
❑Connection ❑Other
No.of Dryers Heating Appliances KW ecurity ystems:
No.of Water No.of Devices or Equivalent
No.of No.of Data Wiring:Heaters KW
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring
Aft.of Devices or Equivalen
OTHER: I
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 1 9000 (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 ® BOND ❑ OTHER ❑ (Specify:)
I certify,under thepains andpenalties operjury,that the information on this ap lication is true and complete
fY, f f
FIRM NAME: E.F.WINSLOW PLUMBING& HEATING CO.:oil
Licensee: RICHARD MELVIN LIC.NO.:3281 C
Signature LIC.NO.:21829A
(Ifapplicable,enter "exempt"in the license number line.)
Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02864 Bus.Tel.No.:508-394-7778
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 imtrance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)llowner nowner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ I
E.F. Winslow Inspection Department email : inspections@efwinslow.corn
The Commonwealth of Massachusetts
way
�'Department of Industrial Accidents
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Office of Investigations
I a-v.=llir= '_ Lafayette City Center
C=u1? - " 2 Avenue de Lafayette,Boston,MA 02111-1750
ow c 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 120 employees (full and/ 5. 0 Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. Q 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. 0 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, MO 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:23 Commonwealth Avenue
City/State/Zip: Chestnut Hill, MA 02467
Policy#or Self-ins. Lic. #2019A Expiration Date:01/01/2024
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 ce '�y-u�t� r the �insr and penalties of perjury that the information provided above is true and correct.
Signature: / Y 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):
1.0Board of Health 2.0 Building Department 3.❑City/Town Clerk 4.❑Licensing Board
5.❑Selectmen's Office 6.0 Other
Contact Person: Phone#:
www.mass.gov/dia