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Home My WebLink AboutBLDE-23-001254 t- Commonwealth of Official Use Only � 'I [ Massachusetts CAIP Permit No. BLDE-23_001254 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) City or Town of: YARMOUTH Date:9/9/2022 To the7I7ecto By this application the undersigned gives notice of his or ier intention to perform the electrical work described below r of Wi;es: Location(Street&Number) 16 PLEASANT ST �J Owner or Tenant AUSTIN STEVEN A �� / r? Telephone No. Owner's Address AUSTIN DOREEN, 16 PLEASANT ST, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Existing Service Amps head 0 0 No.o Utility Authorization No. New Service Volts Over Amps VoltsUndgrd f Meters Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Installation of A/C s stem. 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 No.of Luminaire Outlets Transformers Total No.of Hot Tubs VA No.of Luminaires Generators KVA. Swimming Pool Abovernd. ❑ In-rnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets No.of Oil Burners Batter Units FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. 1 Total Initiatin. Devices No.of Waste Disposers Heat PumpNumber Tons No.of Alerting Devices Totals: Tons ®No.of Self-Contained No.of Dishwashers I�Detection/Alertin, Devices Space/Area Heating KW No.of Dryers Local 0 Municipal 0 Other: Heating Appliances Connection No.of Water KW Security Systems:* Heaters KW No.of No.of Devices or E i uivalent Si ns No.of Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E•uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E l uivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) in accordance INSURANCE COVERAGE:Unless waived lbypthe owner,no permit for the performance�of electrical MEC Rule work mayorsissue unless t 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. unless the licensee provides CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 I certify,under the pains and penalties o (Specify:) FIRM NAME: .!`perjury,that the information on this application is true and complete. E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN (If applicable,enter"exempt Bus.Tel.No.:"in the license number line.) Signature Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 LIC.NO.: 21829 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safe S OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance tY° "License: coverage normally required by law. But my Alt.Tel.No.: signature below,I hereby waive this requirement.I am the(check one Owner/Agent ) ❑ owner 0 owner's agent. Signature Telephone No. , / PERMIT FEE:$50.00 A qZZet 7j.'3 ,#m Lt'�A,O Commonwealth of Massachusetts Official U 1 —* - i Department of Fire Services Permit No. Use Only rr '.+�_= � -� 2c ,__ '�,. �,� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [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 WORK(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of: YARMOUTHTo the Inspector of ires: Date: 9/2/22 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)16 PLEASANT STREET Owner or Tenant STEVE AUSTIN Owner's Address SAME Telephone No. 508-726-8855 Is this permit in conjunction with a building permit? Purpose of Building DWELLLING Yes El No ❑✓ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Undgrd _._____Volts Overhead 0 New Service 0 No.of Meters Amps / Volts Overhead Number of Feeders and Ampacity 0 Undgrd ❑ No.of Meters Location and Nature of Proposed Electrical Worli: AC INSTALL Com.letion o the ollowin_table ma be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total No.of Luminaire Outlets N Transformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Above Swimming Pool ❑ In- `o.o mergency ig ing No.of Receptacle Outlets rnd. .rnd. ❑ Batte UnitsNo.of Oil Burners No.of Switches FIRE ALARMS No of Zones No.of Gas Burners i No.of Detection and No.of Ranges Initiatin. Devices No.of Air Cond. ota No.of Waste Disposers Heat PumpTons No.of Alerting Devices Number Tons ®'No.of Self-Contained Totals: No.of Dishwashers 'Detection/Alertin. Devices Space/Area Heating KW Local❑Municipal No.of Dryers Heating Appliances C onnection ❑Other KW Security Systems:* No.of Water No.of Devices or E•uivalent Heaters KW No.of No.of Si_•ns Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP of eleco o f ations irmg: OTHER: No. Devices or E,uivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy,) 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 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuingoffice.may issue unless CHECK ONE: INSURANCEequivalent. The I certify,under the pales and penalties BONDe�r OTHER ln�formation on this a fP perjury, p )FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., I p licalion is true and complele. Licensee: RICHARD MELVIN LIC.NO.:3281C (lfapplicable, enter "exempt"in the license number line.) Signature -______�_ Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 LIC.N'O.:21829A *Security System Contractor License required for this work;if applicable,enter the license numbAlt.Tel.er here:e. No.uos-ssa-7— 77� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityinsurance No.: required by law. By Owner/Agentd my signature below,I hereby waive this requirement. I am the(check one coverage normally Signature owner •owner's a:ent. Telephone No. PERMIT FEE: $ E.F. Winslow Inspection Department email: inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents 9 a 11 '- Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 r , 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 99 employees (full and/ 5. ❑ Retail or part-time).* 6. Uj 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.Li 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]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *My 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:01/01/2023 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 cer ' R the ins and penalties of perjury that the information provided above is true and correct. Signature: Y Date: 12/01/2021 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): 1.111Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.El Licensing Board 50 Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia