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Home My WebLink AboutBLDE-23-002482 - Commonwealth of Official Use Only 4 `; Massachusetts Permit No. BLDE-23-002482 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:11/6/2022 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) 12 WITCHWOOD RD Owner or Tenant QUIRK JANET L Telephone No. Owner's Address 12 WITCHWOOD RD, SOUTH YARMOUTH, MA 02664 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: Install generator 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 1 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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 ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 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 Licensee: RICH M MELVIN Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Alt.Tel.No.: *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 Signature Telephone No. PERMIT FEE:$50.00 Commonwealth of Massachusetts Official Use Only -. _ r p Permit No. 23 "Z`f Ez--- t=_-,�__=_ Department of Fire Services t? —_( Occupancy and Fee Checked _ ., � 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: 10/28/22 City or Town of: SOUTH YARMOUTH To the By this application the undersigned gives notice of his or her intention to perform the electrical trical wector oork described below. Location(Street&Number)12 WITCHWOOD ROAD Owner or Tenant JAN QUIRK Owner's Address SAME Telephone No. 774-268-9322 Is this permit in conjunction with a building permit? Yes 0 No Purpose of Building DWELLING ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps _ / Volts Overhead El UndgrdEl No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity ❑ Undgrd ❑ No.of Meters Location and Nature of Proposed Electrical Work: GENERATOR 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 No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- No.of Emergency Lighting grnd. ❑ grnd. 0 Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No,of Detection and No.of Ranges Initiatin Devices No.of Air Cond. o Tona No.of Alerting Devices Heat Pump Number Tons s KW INo.of Self-Contained No.of Waste Disposers Totals: Detection/Alertin. Devices No.of Dishwashers Space/Area Heating KW Local Municipal No.of Dryers L Connection ❑Other rY Heating Appliances KW SecurityS stems:* No.of Water No.of No.of Devices or E uivalent Heaters KWNo.of Data Wiring: Si ns Ballasts No.of Devices or E 1 uivalent No.Hydromassage Bathtubs No.of Motors Total HP e ecommunications iring: OTHER: No.of Devices or E 1 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 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 I certify,under thepains andpenalties o perjury,that the information on this ap lication is true and complete. fP J y, FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., I Licensee: RICHARD MELVIN LIC.NO,:3281C Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.:508-394-7778 *Security System Contractor License required for this work; if applicable,enter the license number here: Alt.Tel.No.: 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 II owner II owner's a:ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ E.F. Winslow Inspection Department email : inspections@efwinslow.com .:, The Commonwealth of Massachusetts x mil'---- Department of Industrial Accidents ••••« l Office of Investigations t Lafayette City Center • �/ 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses A licant Information Please Print Le ibl 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: LE] I am a employer with 99 employeesBusiness Type(required): (full and/ 5. Retail or part-time).* 2.❑ I am a sole proprietor or partnership and have no 6. ❑Restaurant/Bar/Eating Establishment 7. ❑ Office any'/- "-,.les(incl. real estate, auto, etc.) employees working for me in any capacity. 3.❑ [No workers' comp. insurance required] 8. ❑Non-profit We are a corporation and its officers have exercised 9. D Entertainment their right of exemption per c. 152, §1(4),and we have no employees. [No workers' comp. insurance required]** 10 [�Manufacturing 4.❑ We are a non-profit organization, staffed by volunteers, 11 0 Health Care 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#I. 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 upto $250.00 a dayagainst the violator. Be advised that a copy g of this statement may be forwarded to the Office of Investigations of the DIA and insurance coverageva verification. I do hereby cer ' e the ins and penalties o f perjury that the information provided above is true and correct. Si nature: Y . . 12/01/2021 Phone#: Date: 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): I°Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.['Licensing Board 5.[]Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia