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Home My WebLink AboutBLDE-23-000025 „4Commonwealth of Official Use Only At: 'N. ,1�\ Massachusetts Permit No. BLDE-23-000025 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:7/2/2022 City or Town of: YARMOVTH 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) 71 OLD HYANNIS RD Owner or Tenant Ajay Roy Telephone No. Owner's Address 71 OLD HYANNIS RD,YARMOUTH PORT, MA 02675-1767 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(25 Panels 8.875 KW) 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 %rnd. 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 Initiatine 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/Alertine 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 Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 ❑ 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: Matthew T Markham Licensee: Matthew T Markham Signature LIC.NO.: 1136 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:24 SAINT MARTIN DR,BLDG 2 UNIT 11,MARLBOROUQH MA 017523060 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) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $150.00 A ro 4� a-1°1'M qc.00 , +a RE C _ W t�ommonwealth oi///a9aachu4ett9 Official Use Only JUN 2 � ,-�__ �/ 2epartment o/ }ire Jerviced Permit No. 2� "�� 9` i- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked `� [Rev. 1/07] (leave blank) BUILDING DEPAR B -- 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: 06/28/2022 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)71 Old Hyannis Rd. Owner or Tenant Ajay Roy Telephone No. 312-929-6348 Owner's Address 71 Old Hyannis Rd.,Yarmouth, MA 02675 Is this permit in conjunction with a building permit? Yes n No (Check Appropriate Box) Purpose of Building residential Utility Authorization No. Existing Service 200 Amps 120 /240 Volts Overhead❑ Undgrd g ri No.of Meters 1 New Service 200 Amps 120 /240 Volts Overhead n Undgrd g n No.of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: roof mounted pv solar panels-8.875Kw system-25 total panels-200A 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 INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ M Connectiounicipaln ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER:roof mounted pv solar panels- 8.875Kw system- 25 total panels-200Aevices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 20,000.00 (When required by municipal policy.) Work to Start:upon approval 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 El (Specify:) I certify,under the pains and penalties operjury,that the information on this application is true and complete. f FIRM NAME: Freedom Forever Massachusetts LLC Licensee: Matthew Markham �A� LIC.NO.:MA 902-EL-Al Signature �rG. �'��G ,` , LIC.NO.:1136MR (If applicable,enter "exempt"in the license number line.) Address: 135 Robert Treat Paine Dr.,Taunton,MA 02780 Bus.Tel.No.:774-320-5539 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt 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. I am the(check one ❑owner El owner's a_ent. Owner/Agent Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts Department of Industrial Accidents } �; Office of Investigations Lafayette City Center -'1r� 2Avenue de Lafayette, Boston,MA 02111-1750 cf\9y tf fi _ www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Matthew Markham/Freedom Forever Massachusetts LLC Address: 135 Robert Treat Paine Dr. City/State/Zip: Taunton, MA 02780 Phone#:774-320-5539 Are you an employer? Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I New construction employees (full and/or part-time). 1.El I am a employer with 7 * have hired the sub-contractors 6. ❑2.❑ 7.I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition employees and have workers' Buildingaddition working for me in any capacity. 9. ❑ [No workers' comp. insurance comp. insurance.* 5. II] We are a corporation and its 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.0 Other pv solar panels employees. [No workers' comp. insurance required.] *My 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: Milestone Risk Management& Insurance Services Policy#or Self-ins. Lic. #: WCC334024A Expiration Date:06/01/2023 Job Site Address: 71 Old Hyannis Rd City/State/Zip:Yarmouth, MA 02675 Attach a copy of the workers' compensation policy declaration page(showing the policy number and 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. ?,�14-4 i ,yL Date: 06/28/2022 Signature: Phone#: 774-320-5539 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): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5.CIPlumbing Inspector 6.1:Other Phone#: Contact Person: