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Home My WebLink AboutBLDE-23-15848 e \'-o * Commonwealth of Massachusetts ,�� „ Town of Yarmouth r y ELECTRICAL PERMIT Job Address: 11 CYPRESS POINT WAY Unit: Owner Name: BOLGER PHILIP M BOLGER CATHERINE M Owner's Address: 77 CHARLES ST Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15848 Existing Service Amps I Volts Overhead 0 Underground 0 No.of Meters: New Service Amps I Volts Overhead 0 Underground 0 No.of Meters: Description of Proposed Electrical installation: replacement air conditioner 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: Total KW: Total Tons: Fire Alarm System 0 No.of Devices: Swimming Pool: In-Grnd.❑ Above-Grnd.0 Hot Tub❑ No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System El No.of Devices: No.Air Conditioners: 1 Total Tons: 3 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: I Estimated Value of Electrical Work: $7,200 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: C & / f2 Official Use Only _ PermitNo x . r h _ `�,� Commonwealth of Massachusetts �t .-: =111 t Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leave blank APPLICATION FOR PERMIT hTOaPERFO EleeReM�ode ELECTRICAL WORK All work to be performed in accordanceDate:5/3/23 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) To the Inspector of Wires: City or Town of: Yarmouth By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)11 Cypress Point Way Telephone No. 410-279-4956 Owner or Tenant Philip Bolger Owner's Address Same Appropriate Box) Is this permit in conjunction with a building permit? Yes ❑ No 0 Util ty Authorization(Check No ppro p Purpose of Building dwelling No.of Meters / Volts Overhead El Undgrd❑ Existing Service Amps — No.of Meters / Volts Overhead❑ Undgrd D New Service Amps _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: install replacement 3-ton AC s stem Completion o the ollowin- table ma be waived b the Ins#ec or o Wires, o.of Tota llo.of Recessed Luminaires No. of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA Above n- `o.o mergency ig mg No.of Luminaires Swimming Pool ,rnd. ❑ Lrnd. ❑ Batte Units No.of Oil Burners 'FIRE ALARMS No.of Zones No.of Receptacle Outlets , o,0 1 etectton an• No.of Switches No.of Gas Burners Initiatin. Devices -ota No,of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump umber ons r i� ` o.o elf- ontaine• No.of Waste Disposers Totals: ;Detection/Alertin_Devices No.of Dishwashers Space/Area Other Space/Area Heating KW Local0 C onnectaon ❑_ ecurity ystems• No.of Dryers Heating Appliances KW No.of Devices or E•uivalent No.of Water No.of No.of Data Wiring: Heaters KW Ballasts No.of Devices or E'uivalent Si Ins e.communications j.inn No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 7200 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:lia liabi waived by the owner,no permit for the performance of electrical lity including"completed operation"coverage or its substantial equork ivalenty . The ss the licensee provides proof of ty 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 of perjury,that the information on this ap lication is true anIC.Note 3281 C____ FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO., I LIC.NO.:21829A Licensee: RICHARD MELVIN Signature 506-394-7778 �-- (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:Alt.Tel.No.:�---- Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 *Security System Contractor License required for this work;if applicable,enter the license number here: -- OWNER'S INSURANCE WAIVER: I am aware that below,I hereby waive tp this requirement. I am the(check one owner urance owner's normally Elowner's aen required by law. By my stgPERMIT FEE: $ Owner/Agent Signature Telephone No. E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents ��- ►— Office of Investigations �l _ �,_ �� ,., � 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.❑■ 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. ❑ 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]** 11.0Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑ 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. l 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 ' e the ins and penalties of perjury that the information provided above is true and correct. nSignature: Y A- 1'- 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 30 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mas:,.gov/dia