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HomeMy WebLinkAboutEversource Alalib ATTACHMENT 2 CERTIFICATE OF COMPLETION SIMPLIFIED PROCESS INTERCONNECTION Installation Information Check if owner-installed Interconnecting Customer: Sunrun,Inc. Contact Person:Gina Miranda Mailing Address:595 Market St,29th Floor,San Francis n.5.,.4 Location of Facility(if different from abo , City:Yarmouth State:MA Zip Code:02673 Telephone(Daytime):(8o5)54o-5490 (Evening): Facsimile Number: E-Mail Address:northeast-nem©sunrun.com Electrician: Name: Sunrun Installation Services Mailing Address: 734 Forest St,Ste 400 City:Marlborough State:MA Zip Code: 01752 Telephone(Daytime):(805)540-5490 (Evening): Facsimile Number: E-Mail Address: northeast-nem©sunrun.com License number: Date Approval of Install Facility granted by the Company: Application ID number: Inspection: The system has been installed and inspected in compliance with the local Building/Electrical Code of: X012-646 Lfrlf (City/County) Signed: Local Electrical Wiring Inspector,or attach si ned electrical inspection Name(printed): Date: (O-z—(5 As a condition of interconnection you are required to send/fax a copy of this form along with a copy of the signed electrical permit to(insert Company's name below): Name: Pyong"Bruce"Kim Company: EVERSOURCE Electric Mail 1: One NSTAR Way Mail 2: Mailstop: SW390 City, State ZIP: Westwood, MA 02090 Fax No.: 781-441-8531 Transmission Report Date/Time 11-01-2019 06:52:12 a.m. Transmit Header Text Local ID 1 5083980836 Local Name 1 TOWN OF YARMOUTH CONSERVATION This document : Confirmed (reduced sample and details below) Document size : 8.5"x11" EVE RSURCE ATTACHMENT CERTIFICATE OF COMPLETION SIMPLIFIED PROCESS INTERCONNECTION Installation Information Check if owner-installed Interconnecting Customer:&mmn.014. Contact Person:Gina Miranda Mailing Address:ss5 mama St 29110 Few,S.n Fes.Ca 94105 Location of Facility(if different from above):ea Horse Pond Rd City:Yarmouth State:MA Zip Code:021373 Telephone(Daytime):laps)340 04aa (Evening): Facsimile Number F.-Mall Address:nomataal-neme,unrun.com Electrician: Name:swwN liudallabon servlwc Mailing Address:734 Fort St,ate 409 City:M0000,0900 State:MA Zip Code;01752 Telephone(Daytime):MOM 5404490 (Evening): Facsimile Number: F.-Mail Address:0e0e+e94 e4nti"cem License number: Date Approval of install Facility granted by the Company: Application ID number: Inspection: The system has been installed and inspected in compliance with the local Building/Electrical Code of: 71$12-Nt e lJ'i'11 (City/County) 1 Signed: Local Electrical Wiring Inspector,or attach signed electrical inspection Name(printed): • f�.(�i£s 77— Date: te'Z.S—f As a condition of interconnection you are inquired to send/fax a copy of this form along with a copy of the signed electrical permit to(insert Company's name below): Name: Pyong"Bruce"Kim Company: EVERSOURCE Electric Mail l: One NSTAR Way Mail 2: Mailstop:SW390 City,Stale ZIP: Westwood,MA 02090 Pax No.: 781-441-8531 Total Pages Scanned: 1 Total Pages Confirmed: 1 No. Job Remote Station Start Time Duration Pages Line Mode Job Type Results 001 034 15087306577 06:51:16a.m. 11-01-2019 00:00:36 1/1 1 G3 HS CP14400 Abbreviations: HS: Host send PL: Polled local MP: Mailbox print CP:Completed TS:Terminated by system HR: Host receive PR: Polled remote RP: Report FA: Fall G3:Group 3 WS:Waiting send MS: Mailbox save FF: Fax Forward TU:Terminated by user EC: Error Correct Transmission Report Date/Time 10-25-2019 09:20:56 a.m. Transmit Header Text Local ID 1 5083980836 Local Name 1 TOWN OF YARMOUTH CONSERVATION This document : Failed (reduced sample and details below) Document size : 8.5ttx11 tt EVER : URCE ATTACHMENT 2 CERTIFICATE OF COMPLETION SIMPLIFIED PROCESS INTERCONNECTION Installation Information Check if owner-installed Interconnecting Customer:s..". a Contact Pewit:Gina Miranda Mailing Address:sat MakM Si.29Ih Floor.SA.F CA 941o5 Location of Facility(if different from above):66 Horse Pond Rd City:Yarmouth State:MA Zip Code:02673 Telephone(Daytime):to0a>s4asiw _(Evening):_._._-_.__._.-. __. ..._ Facsimile Number E-Mail Address:northeast-eem[amrun.eom Electrician:Name:svrw,'retaliation Services Mailing Address: 734 Forest to Sao 400 City:Marlborough State:MA Zip Code:01752 Telephone(Daytime):PM)540-5490 (Evening): Facsimile Number: E-Mail Address:.any-nem®.unrunoan License number: Date Approval of Install Facility granted by the Company: Application ID number: Inspection: The system has been installed and inspected in compliance with the local BuildingfF.lectrical Code of: I!AgMou��y, (City/County) /Y/r Signed: . —a _.__._...........- Local Electrical Wiring lns,{ .etor,or attach si red electrical inspection Name(printed): K- L%LL.rC17 Date: CI 2.b ( � f As a condition of interconnection you are required to send/fax a copy of this form akhtg with a copy of the signed electrical permit to(insert Company's name below): Nome: Pyong"Bruce"Kim Company: EVEKSOUKCE Electric Mail 1: One NSTAR Way Mail 2: Mailstop:SW390 City,Store 7_!P: Westwood,MA 02090 Fox No.: 781-441-8531 Total Pages Scanned: 1 Total Pages Confirmed:0 No. Job Remote Station Start Time Duration Pages Line Mode Job Type Results 001 029 915087306577 08:48:23 a.m.10-25-2019 00:00:00 0/1 1 -- HS FA Abbreviations: HS: Host send PL: Polled local MP: Mailbox print CP:Completed TS:Terminated by system HR: Host receive PR: Polled remote RP: Report FA: Fail G3:Group 3 WS:Waiting send MS: Mailbox save FF: Fax Forward TU:Terminated by user EC: Error Correct Commonwealth of Official Use Only or lE Massachusetts Permit No. BLDE-19-002354 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:10/19/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention fo perform the elechical work described below. Location(Street&Number) 11 HUNTERS CIR Owner or Tenant MCNEILL JACQULYN Telephone No. Owner's Address P 0 BOX 623,WINCHESTER, MA 01890 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 • •44, i f Meters New Service Amps Volts Overhead 0 UndgrO4 + e ters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install generator Completion of the following tab b e 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KWSecurity 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 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: RICH M MELVIN Licensee: Rich M Melvin Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIR, S YARMOUTH MA 026641207 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: $75.00 Corn r A c(t7let Commonwealth o/Kmachuzetts O ci Js Only 755 ►*__ t c� Permit No. ', j 2epartment o/31re seruice6 —:_ 4 Occupancy and Fee Checked — BOARD OF ARE PREVENTION REGULATIONS R ey.1/07j[ (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C 12.00 (PLEASE PRINT IN INK OR TYP ALL INFORMATION) D ate: I n i 16 City or Town of: armov+In To the Inspector of Wires: By this application the undersigne gives notice of his or h r inter n to er orm the electrical work described below. L'o'dation(Street&N ber) ` N J fl. ( Circle •e 5t l afmo u 7 N d;613_-- Owner or Tenant J NC V A ` n • 1 Telephone No. 1'9 y 6 Owner's Address le heS kf M A O 1 gllr-- Is this permit in conjunction with a building permit? Yes L No I (Check Appropriate Box) Purpose okBuilding ()we1It n Utility Authorization No.____________— _, Existing Service Amps / Volts Overhead E. Undgrd_, No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Work: Genera r I A an Gek • Completion of the following table Wray be waived by the Inspector o Wires. • No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In No.ofEmergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ 13!!..„tery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total No.of AIerting Devices Tons No.of Waste Disposers Heat Pump Number Tons _KW._....... No.of Self-Contained P Totals:I ( I ,Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local r—I❑ MC Municipal Other No.of Dryers HeatingAppliances KW Security DevicesNo. or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWSigns Ballasts No of Devices or Equivalent No.II dromassa aBathtubs No.of Motors Total HP Telecommunications Wiring: Y g 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. CC a CHECK ONE: INSURANCE II BOND ❑ OTHER ❑ (Specify:) NI . Icertify,under the pains and penalties of perjury,that the information on this application is true and complete. �— 7' .+, FIRM NAME: �c- I0tIUSLrjtcl PLtE.t�Y11Jtioto 4" tTG`i=-1-1.P43 (P, (tom` ' LIC.NO.:_ t� • • Licensee: �, ll m 114 f/.V if) Signature 7. LIC.NO.:9 15a �I� �' ' (If applicable,entgr"exem t"in the license nm fiberline.) Bus.Tel.No.: G�'3 al ..W 1/4--) Address: 1 ,tt-g- 0IU 6,1 gat 5vla l �l r �raai-tJ114i� -4 Alt.TeL No.: *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety O"S"License: Lie.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)❑owner ❑owner's agent. Owner/Agent 11,ERMIT FEE:Signature Telephone No. ,y l4\_ b 1 S • The Commonwealth of Massachusetts 5112=t • Department of Industrial Accidents 1 Congress Street,Suite 100 � Boston,MI 02114-2017 • . www mass gov/dia Workexsi Cbmpensatton Insurance Affidavit:General Businb3'ses.. , - TO BE MED WITH THE PERMITTING AUTHORITY. - A Remit Information Please Print•LegalslY ' , 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: 1.El am a employer with Business Type(required): or part-time).* employees(full and/ ` 5. Retail 2.Ef 1 am a sole proprietor or partnership and have no 6. 0 Restaurant/Bar/Eating Establishment employees working for in any capacity. 7• 0 Office and/or Sales(incl.real estate,auto,etc.) 3.❑ [No workers'comp,insurance required] 8. ❑Non-profit We are a corporation and its officers have exercised 9. 0 Entertainment • their right of exemption per c.152,§1(4),and we have no employees.[No workers'comp.insurance required]** 10.0 Manufacturing 4.0 We are a non-profit organization,staffed by volunteers, 11 ❑Health Care with no employees.[No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infoimation. **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:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 • Policy#or Self-ins.Lie.#1821A Eiration17 Attach a copy of the workers'compensation policy declaration page(showing the policy numberate: 0and expiration date). Failure to secure coverage as required under Section 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. 1 do hereby certi , the a' s and enalties o perjury that the information provided above is true and correct. Si nature "a 1 , .� .. Date: i j /31 / I "7 Phone 15083947778 . =al use only. Do not write n this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wwwtmass.gov/dia