Loading...
HomeMy WebLinkAboutBLDE-22-001283 of Commonwealth of Official Use Only IlC Massachusetts Permit No. BLDE-22-001283 ' 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:9/6/2021 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) 30 LOWER BROOK RD Owner or Tenant BOWEN ALICE F Telephone No. Owner's Address 30 LOWER BROOK 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 Ai New Service Amps Volts Overhead 0 Undgrd 0 Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install generator. 0 73 Completion of the follote /al of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of �� Transformersq 'i No.of Luminaire Outlets No.of Hot Tubs Generators 1 �'A No.of Luminaires Swimming Pool Aboved. ❑ In- ❑ No.of Emergency Lighting a grn 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 p Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent 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. PE IT FEE: $50.00 ( k G� tit(��� c4iv, n TSO Commonwealth of Massachusetts Official Use Only 0nl.1* Department of Fire Services Permit No. 'L-Z,lZ�p�j i BOARD OF FIRE PREVENTION RGU�ATIONS Occupancy and pee Checked ''•��� (Rev.9/05j (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 1RXId•T.ThfINIC OR T_.IPE ALL 1N.FORMATIO11) Date: {j/ 13 17 I City or Town,of: nt/M flcl tiA To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform thele`leotrioal work described below, Location(Street&Number) 50 LQ�►J/ flotli' Id Sou1-1/1 Voiir/Nd1 -1 0266 I Owner or Tenant 'N\Sc 1j0, Telephone No.S0 56(yG19 S Owner's Address C/i�'Zg. Is this pernnit in conjunction with a building permit? Yes n No 11'(CheckAppropxiate Box) Purpose of Building b 6l Vll Utility Authorization No. Existing Service Amps / Volts Overhead I I 'Undgrd n No.of Meters New Service Amps / Volts Overhead t__! Undgrd n No,of Meters Number ofReeders and Atnpacity Location and Nature of Proposed Electrical'Work: Ix ,-fislr/&/4©cn • Completion of the followingtable may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of Ceil.-Susp,(Paddle)Pans No.of Total Transformers KVA. No.of Luminaire Outlets No.of Hot Tubs • Generators XKVA No.of Luminaires Swimming Pool Above n grnd. ri Battery Uni sency Lighting 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 Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Localn Co lYlunicipnnecti alon n Other y No.of Dryers HeatingA.ppliances IOW Security'Syysterns;* No,of Watero No,of Devices or Equivalent $eaters IOW No, Sims No,Bal of Data Wiring: No.of Devices or)Jciuivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: (f 1 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; Inspections to be requested in accordance with 11/JEC 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 lA Oo undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE ® BOND ❑ OTHER 0 (Specify:) 1 I Certify,under the pains andpenaltles of perjury, that the information On this ap licatiory is true and complete. MR1vI1VAME; E.F. WINSLOW PLUMBING &HEATING CO,, I N �� LIC,NO.;328'l C �J Licensee: RICHARD IVIELVIN'.,--- Signature . , (If applicable,enter"exempt"in the license number line.) LIC.NO.:21829A Address; a REAaboN CIRCLE SOUTH YARMOUTH,MA o2sa4 Bps,Tel.No,:50e 394.7776 Alt*Security System Contractor License required for this work;if applicable,enter the license number hTel. e.1Vo,; 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 fl owner's agent, Owner/Agent Signature Telephone No, PERMIT FEE; $ • 1 ' E•F. Winslow inspection Department email: inspections@efwinslow.com T The Commonwealth of Massachusetts Department of inclustrialAccidents _:,, .�e Office of Investigations Id i Nr Lafayette City Center .. <H .. 2 Avenue de Lafayette,Boston,MA. 02111-1750 ',„5' " 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: I Business Type(required):1. am a employer with 90 employees (full and/ 5- 0 Retail _ or part-time).* 6. ❑Restaurant/Bar/Eating EstabIishrr:_ 2.1 1 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-pi,.. _ 3.❑ We axe 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 ❑Health Care 4.❑ We are a non-profit organi7ation, staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.LI Other . • *Any applicantthat checks box#1 must also fill out the section below showing their workers'compensation policy information. 4°°'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.452 can lead to the imposition of crirnivalpen9lties 01afine 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• ' e.the ins and penalties of perjury that the information provided above is true and correct. ` / 01/02/2021 �� �/. � Date: . Signature: 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.OBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.❑Licensing Board 511 Selectmen's Office 6.[ Other . Contact Person: Phone#: _ www.inass.gov/dia