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Home My WebLink AboutBLDE-23-15849 #317 Commonwealth of Massachusetts Gov•• Y.4. 9 * Town of Yarmouth A aO, � ,, H r ,.., . t ELECTRICAL PERMIT �' '` ` Job Address: 237 NORTH MAIN ST Unit: Owner Name: DAVENPORT DEWITT TR DAVENPORT REALTY TRUST Owner's Address: 20 NORTH MAIN ST Phone: Email: Purpose of Building Commercial Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15849 Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters: New Service Amps/Volts Overhead 0 Underground 0 No.of Meters: Description of Proposed Electrical Installation: Replacement NC system (ROOM 317) 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 ❑ No.of Devices: No.Air Conditioners: 1 Total Tons: 1.5 Telecom System ❑ No.of Outlets: No. Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $ 7,300 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 l 1. it Department of Fire Services PermitNo6-23 j q €�__I_(- Occupancy and Fee Checked ,� J 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: 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)237 North Main Street Unit 317 Owner or Tenant Thirwood Place Telephone No. 508-398-8006 Owner's Address same Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Commercial Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ 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 replacement 1.5-ton AC system for unit 317. Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf 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 i 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. Total No.of AlertingDevices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal ❑Other Connection No.of Dryers Heating Appliances KW ecurity Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 7300 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. CHECK ONE: INSURANCE ® BOND E 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 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.No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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 ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts ._ Department of Industrial Accidents 9 _ , __._,(F Office of Investigations 4 4, >1 Lafayette City Center Tf A 2 Avenue de Lafayette, Boston,MA 02111-1750 m 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. ❑ 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. 8. D Non-profit [No workers' comp. insurance required] 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.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, 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 MCL 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 ' Iee the ins and penalties of perjury that the information provided above is true and correct. Signature: 0 ,...,4.,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.DBoard of Health 2.0 Building Department 30 City/Town Clerk 4.0 Licensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia