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Home My WebLink AboutBLDE-22-000426 Commonwealth of Official Use Only r�. .*�. Massachusetts Permit No. BLDE-22-000426 r 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:7/22/2021 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) 40 HEADWATERS DR Owner or Tenant RESIDENTIAL REHAB HOUSING INC Telephone No. Owner's Address 14 LOTS HOLLOW RD, ORLEANS, MA 02653 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap' alp , Box)I/ Purpose of Building Utility Authorization No. 2 Existing Service Amps Volts Overhead 0 Undgrd 0 o . 0 New Service Amps Volts Overhead 0 Undgrd 0 to . rf A Number of Feeders and Ampacity o 171/2 Location and Nature of Proposed Electrical Work: Renovations& panel upgrade. 11:Completion of the following table stay be s‘ . of Wires. No.of Recessed Luminaires 49 No.of Ceil.-Susp.(Paddle)Fans 4 No.of Transformers • 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 50 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 30 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges 1 No.of Air Cond. 2 Total 4 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 8 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 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: $180.00 -r_ Commonwealth of Massachusetts Official Use Only �10 Department of Fire Services Permit No. 22 �� e?.-— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Pee Checked ��:.;.,. (Rev.9l05j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO RK ` All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE IPJ1\TrN]J'rK OR TYPE ALL JNFOJWATIQN) Date: —2//s c2I 0 City or Town of: l��p0QU7" To the Inspector o.j Wires: `) By this application the undersignedgives notice OEMs or her intention to perform the electrical work described below, Location(Street&Number) eito hits-,R0 u>10/ S Druvs Owner or Tenant SS-)—e hcAJ a),I2,S'LOGo Telephone No.,�g 3/0 7 73O s ' Owner'sAddress ,5pitin et }ice •1:1b0(76— ,-L Is this permit in conjunction with a building permit? Yes,Ri No n (Check Appropriate Box) Purpose of Building D LADS-Lc...l N 1 Utility Authorization No. Existing Service Amps • r Volts Overhead E Umdgrd Ti No.of Meters / New Service Amps / Volts Overhead❑ lludgrd,� No.of Meters V Number of Feeders and Ampa city Location and Nature of Proposed Electrical'Work: 4 �170/.�— ',q_ eiAA) C C JCompletion of the followin•table may be waived by the Inspector'of Wires, No.of:Recessed Luminaires giq No.of Ceil,-Susp.(Paddle)Fans No. of Total Transformers KVA No,of Lu.minaire Outlets No.of Hot Tubs • Generators XVVA No.of Luminaires Swimming Pool grnd.e I 1 Igrnd. 1 l Battery Units Lighting No.of Receptacle Outlets c_rrj No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches • 36 No.of Gas Burners No.of Detection and Initiating Devices . No.of Ranges / No.of Air Cond. Total (J 'Pons PXNo.of Alerting Devices # { No.of Waste Disposers eatP l? Number Tons £Vy No.ofSel Contained Totals: "...' Detection/Alerting Devices N No.of Dishwashers / Space/Area Heating KWLocaln Municipal Other (� ConnectionNo.of Dryers / Heating Appliances KW Security'Svpstenis:* `� No:of WaterNo,of Devices or Equivalent t No. of No. of I/) Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No,d3(ydx ornassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTHERS Attach additional detail if desired,or as required by the Inspector of Wires. \a13 Estimated Value of Electrical Work: fyLA-( (When required by municipal policy.) Work to Start; ,Kj s I9 p 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 xnay 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 ❑ OTHER 0 (Specify:) I certify,wider the pains and•penalties of petittry, that the information on this ap lication is true and complete. F1,'RM[NAME; E.F, WINSLOW PLUMBING & HEATING CO I .',IC.NO.:328.1 C Licensee; RICHARD MELVIN Signature .. .' • LIC.NO.:21829A (If applicable, enter"exempt"in the license number line) Bus.Tel.No,:5o6-394�777e Address; e REAROON 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)I 'owner n owner's agent, Owner/Agent Signature Telephone No, PERMIT FEE: $ ' E.F. Winslow Inspection Department email : inspections@efwinslow.com efwinslow.com + The Commonwealth of.Nlassach usetts • Department of IndustrialAccidents 1-- LafayetteOffice of Investigations S — City Center '" Il 'r N 2 Avenue de Lafayette,Boston,MA 02111-1750 e a_u , _ii=r o °' ' www.mass.gov/dia Workers' Compensation Insurance Af idavit: General Businesses Applicant Information Please Print Legibly Business/Organization Naroe: 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.n I am a employer with 90 employees (full and/ 5. n 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]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, . with no employees. [No workers' comp.insurance req.] 12.E Other . ' *Any applicantthat 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. X 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:01/01/2022 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 off Investigations of the DIA.for insurance coverage verification. l X do hereby cer •the ins and penalties of pedury that the information provided above is true and correct. 01/02/2021 Signature: 10 /U••�•p<^"-~" 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): X.[]Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.[(Other Contact Person: Phone#: • www.inass.gov/dia