Loading...
HomeMy WebLinkAboutBLDE-21-003643 Commonwealth of Official Use Only Permit No. BLDE-21-003643 f �,� Massachusetts `"'�� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:1/4/2021 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) 7 HIGH GROVE RD Owner or Tenant Robin Gigante Telephone No. Owner's Address 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 r. No New Service Amps Volts Overhead 0 Undgrd ❑ i e► ) ‘...fr Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement oil boiler. A iN ..0? Completion of the following table�qy be v s•, for of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 3 / Transformers gt No.of Luminaire Outlets No.of Hot Tubs Generators 3 KVA No.of Luminaires Swimming Pool Above ❑ In- I: No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners 1 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security 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: 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 he 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 0 OTHER ❑ (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 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 'v )A 24(4(24 C. KIM ({((u c4_ L/AJ <<<<. ) km-- wiir-2 f4 (rz: 2 ) _.-.,_ commonwealth of Massachusetts Official Use Only Permit No. GZt— 3(,`t 3 raliiN_v�+, � Department of Fire Services — Occupancy and Fee Checked „ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) • C ?I-'` 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 TYP ALL INFORMATION) Date: 17I Z /Z 0 City or Town of: ( 00(44Q0-\--\A To the Inspector of Wires: By this application the undersigned'gives notice of his orher intention to perform the electrical work described below. Location (Street&Number) V'11 (V0ve R- 5 " ()LG6 k J /aY/YtoJ Owner or Tenant R��jli.1(\ U N C(I/I+-Q f Telephone No. 1 /y s 3 to.c,:z Owner's Address �(46\ kai Cu�J S'h'e •# TP.v,I KS YI UJ,"' 1111 A (�t q 7 6 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building �t)J���,Ai Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead Undgrd n No. of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Work: 0 i l ' 0;t e✓ (�S�lict,17 pUj • 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 KVA No.of Luminaires Swimming Pool Above ❑ In- 0 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 DCted;wi dud Initiating Devices Totallo.of Ranges No. of Air Cond. Tons No. of Alerting Devices 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❑ Municipal El.Other Connection No. of Dryers Heating Appliances KW Security Systems:3' - - No. of Water No.of Devices or Equivalent No.of No. of Heaters KW Signs Ballasts Data Wiring: 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: 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 ❑ (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., IN LIC.NO.: 3281C M Licensee: RICHARD MELVIN Signature LIC.NO.:21829A . - `J` (If applicable, enter "exempt"in the license number line) 508-394-7778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664Alt Bus.Tel.No.: t -�- *Security System Contractor License required for this work;if applicable,enter the license number here:No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally Q required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ m.@= Department of IngustrialAeoidents ' r5_>r •° •Office oflnvestigations ' E a Lafayette City Center '1�" 2Avenue de.Crrfayeue,Boston,MA 022121750 V... .+ Twww.mass.gov/dda. • Workers'Compensation Insurance Affidavit:General Businesses Annlican1rInformati.on • Please Print Legibly Business/Organization Name;E.F.WINSLOW PL'UMBINO&HEATING CO,INC. • Address:8 REARDOtN CIRCLE • City/State/Zip:SOUTH YARMOUTH,MA 02664 Phone#:608-394,7778 I Are you an employer?Check the appropriate box: Business Type(required): I.El I am a employer with 00 employees(tall and/ 5..0 Retail . or part-time).* 6. D Restaurant/BarIEating Establishment 2,❑ lama sole proprietor or partnership and have no 7. 0 Office and/or Sales Qsrol,real estate,auto,eio,) 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. 0 Entertainment their right of exemption per c,152,§1(4),and we have 10.0 Manufacturing no employees.(No workerg'comp.Insurance required]** 11.©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 thatoheoks box#I must also fill out the section below showing their workers'vompensatlon policy infbrmatiori, **1f the corporate officers have exempted'themselvos,but the corporation has other employees,a workers'compensation policy is required and such an organization should check bqx#1. 1 ma as employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Numb:ARROW MUTUAL INSURANCE COMPANY Tngerer'a akir,ee, City/State/Zip: , Policy#or Selkns.Lie.#1909A , Expiration Date:01/01/2021 Attach a copy of the workers'gompensatiofs policy declaration page(showing the policy number and expjration date), • Failure to secerd,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 wall as civil penalties In the.form of a STOP WORD ORDEli,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 instidinee coverage Verification, • 1 do hereby der't lei thelittdt:8 and penalties ofperJury that the information provided above ds true and correct. ,igitature: i' `* ,�/•�*.A_-. Data:01/02/2020 . mom#:608-394.7778 Official use okty.Do not write in this area,to be completed by city or&WWSa o fficial. City or Told, ' Permit/license# issuing Authority(check(me); • lljnoerdof*ealth 2,1:313ulldingDepartment 3,D City/Town Clerk 4.DX,icensingBoard ' 51J Seleetmdn's Office 6.DOthick_ ContactPgrsgm. Phone if: www,mass,gov/din .