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BLDE-23-001512
Commonwealth of official Use Only ill% Nii Massachusetts Permit No. BLDE-23-001512 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:9/21/2022 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) 41 COTTAGE DR Owner or Tenant KOHNFELDER DANIEL A TRS Telephone No. Owner's Address KOHNFELDER MARGARET P TRS,41 COTTAGE DR,WEST YARMOUTH, MA 02673 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: Installation of solar PV system(24 Panels 8.4 KVVMSUPPORT PAPER '7A` it;a� . 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- ❑ 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. Tootal 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 Local 0 Municipal 0 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 Eauivalent 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:) c —2, j�— I , I certify,under the pains and penalties of perjury,that the information on this application is true and complete. y �o FIRM NAME: Brett A Duguay Licensee: Brett A Duguay Signature LIC.NO.: 22079 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:41 ELK RUN, MIDDLEBORO MA 023463065 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 ❑ owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$150.00 NC 0-Gt-4 Ce12:7 6'2— KE' qi Es \ 0 ' 0 0 �q� w z • 1 faa W CI o ,� \ '\i) 0 0 p z F. .17, W O F- s CI 0 2 ,' z I W o N z 3 0 0w 0 �-0 o n ' 3 0 Yd ce a n 0 t/q� W y Q �p e o w d N i� th p a F WIn wo u Z K�K p 5 yE L o W �' I< N a m O O "� ' Q 0 0Ou} a ' § ' , 0 Q .,o d w W W U a U F H a w 2 W a CO W F j p x } I- 't w z u 3 w `� w WI1 N � � z w 0 2Q 0 - a a a 0 » " < N e n m o x w a 1 )( I Il Um a 0 a,co - WZWF_ W ¢ LL WI i �z WV LL. 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O 0-) a o W W 00 z w > ❑ z 7 n• CC Z Z 7 O I-to cc W W aco W O w H Y OLL Z z -I a H O V) W ❑ U H W z a a CO Y Z 2 O 2 W U a V) 2 I- a Z H W 0 Jam' w H a w 0 W (5 N Z OH f ce 0 0 ) 0 I 2 z o N CO 2 O a W m z o 2 m P W K (0 w I w 2 O O F a o a 7J a a 1- a a a> -, U co ❑ 0 U > > a a w w 2 J Z Z Z Z Z Z Z Z Z Z Z H 3 Ili W O as • Cmsmonweata el Maeeaclivaeta Official Use Only ts • �� .[JsParfi»�f�l Son/iota Permit No. 1 �� +a _ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical9tde(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL ORMATION) Date: <X!' lli,2 x Ito I ,bn City or Town of: VV?S.� -N X(('c\ Ul,4-�/\ To the Inspector of Wires: By this application the undersigned gives no' of his or her intention to perform the electrical work described below. Location(Street&Number) 141 C ( L 1V1- Owner or Tenant VX;t.(\ Y101y 'rP\(il Telephone No. Owner's Address �\ (:Qo eio . .I V., \Iz5� \\Ci`CMS)1., n �' C (S?�3 Is this permit in conjunction with a b,« permit? Yes No 0 (Check Appropriate Box) Purpose of Building �i;s(),QA*\Q A Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a \ Y .. affok) - 9R(N.,\ are. L\C ) co . \—A ‘ ' I(o(SirVJ NC . Comp! ' of thefollowingtable may be waived by the Inspector of Wires. VI lbo.No.of Recessed Luminaires No.of CeiL-Snap.(Paddle)Fans Tranfsformers Total KVA CI No.of Luminaire Outlets No.of Hot Tubs Generators KVA a Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grad ❑ grad ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones zt No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 11J No.of Ranges No.of Air Cond. Tun l No.of Alerting Devices No.of Waste Disposers HeatTotals:p Number Tons �KW �o�d�nIngf De evices No.of Dishwashers Space/Area Heating KW Local 0 Connection 0 Otiler No.of Dryers Heating Appliances KW Security Systems:*No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Beaten Signs Ballasts No.of Devices or ` «uivalent No.Hydromassage Bathtubs No.of Motors Total HP Tel No.of Devices or Eq, eat OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: i( � ),06 (When requited by municipal policy.) 2 Work to Start:gullInspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability. ce including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I certify,under the its and penaldes of perjury,that the information on this application is true and complete. FIRM NAME: D h'\( \Y\( ( Cf'r V t C.Q\_ k ' ("` LIC.NO.: 1`ai3 e�- A Licensee: Signature LIC.NO: (If applicab er" t in t icense nu r line.) s.Tel.No.. 0 00 Address: it.Tel.No.: \ *Per M.G.L.c. 147,s.57-61,security work requ' Department of Public Safety"S"License: Lic.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. 1 am the(check one)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE:$ \50.Q(� Signature Telephone No. K 0 - 0 Z o -1 Z -I -/-/ / 1 z Z o z N r- D ---- 1 I Z m 0— —0 —♦— — cn m I b N I I I 1 C 1— ID_ W m }— — — I— — m cn 1 1 I n / / I, N - -� - - — IrNn O/ N I /p � V � N O ��� 9 rillM111111 1 = 1 1 O —I _ C 1— I A 1 1 I @ L -t — -f I '13 I ro N 1 I II .p. 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U) t .s , 01 A N ) m I 0 ° m � ° ° & k@ nl * � n ! « w § § 7 § 2ma2 t2m ; ; tu2@Xm k2@2m2 � ? omC o - 0 m kk \ � ) \ [ ) � 2 kk ) \ { § § q < § R R 2 g R Qf ° 0 F. c § § Z Z 3 Z § z n Z o U) 2 § e -I \ / 0 t § 0 z zo z 2 ! \ o > '- 2 > > X CO $ ; ( jf / 7 n8§ q d § \ j § k § ) k f § ) 2 co m2 , , ; 9) Fm , o - ; � § - no oz ; 0 ® o g Mom> § mmz 2r \ k ` ° m > , 22K ® k � ft ®§ ! o § q , 9 � e / , z k2 � 3 �; m \ \ ( m z 0 z ƒ m � m� m � ; � 0 z § ` z 0 6 § \ F. ) b CD m 0 F. . z \ C 2 ƒ 9 2 >- , . a . . . o | 2 § @ ! $ — § n > co m2 = g co m Na _m \ e e § » 2 ¢ i < ) /§ / CO \ § � ` \a/ a j S < .9 0 k j ) 2 M 2 o 3x - 0, , I ) } � | 0>o, ) 7 g � ° � \ / \ RI m 0 ; . 2 0,I>co § / ? \ \ § � ! �§t� = A/\ \ ( \ ( I - T 0 \. 04 2 ! ! � �- " 7' ! ` ■ . | ) ^ - | __ The Commonwealth of Massachusetts *�' 411 Department of Industrial Accidents 1 Congress Street, Suite 100 =S ;L Boston, MA 02114-2017 .�_ www.mass.gov/dia mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): � \ekkr k .c 4 SP. i i C f S LLL Address: or C__D tY'QX'C,P \NI Sf MA- ('`A?)--id City/State/Zip: Phone#: '5( % - (.01'1 - ()MOO Are yo an employer?Check the appropriate box: Type of project(required): 1. I am a employer with C4 employees(full and/or part-time).* 7. El New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑ Building addition • 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.D of repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.N. I •er S1\GC 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ' Insurance Company Name: \/f Cr\(y \�q,1 r(�f(1C SL. .AsciNO j,(j,4-c IJI..r�./� Policy#or Self-ins.Lic.#: cwC4(o-Q3(c 434p aQa'4. Expiration Date: a 4 Job Site Address:"M C :JrW2, City/State/Zip: bawl Attach a copy of the workers' com nsation policy declaration page(showing the policy numbe and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the painsand penalties of perjury that the information provided( correct. � above is true and Signature: 63�)Q �1�Li( �A. 1 Date: —1 j L `dD % Phone#: � )0 0• to f Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: P > > > 0 -IOC- n o00i v � ‘ A Ostoo Dmc. z f OXAInOcn V A 0 - c O °DToZ3m •VN1 •UN1Q 0TOAA M V z Q tOiy r.i C r0 , 74 f nioDTm AC D00 XOOT XXc p 00 m0 0 C) 0 '•' o o O _ rci Z ocC . cocc m0� Z i0 o O Oc) a A w � OA X -1 '•I3 boi - 0m $ � C =i =1 zi z �I :r-z O O Iv i � m 1 •1 0 z m 'n in 3 3� r 1 u ,, km0Om 30 m OZ C_ xOi1 .z01D D ?- 0 AOO W pz 0m Oyi fiZ 0 �.- 1k O C 0 D w r A 0 r m m W C Q m m 2 z <O ' NZ01 � ›. - Dcx 0 . 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