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HomeMy WebLinkAboutBLDE-23-005026 ( 47) Commonwealth of Official Use Only (\ Massachusetts Permit No. BLDE-23-005026 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:3/13/2023 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) 50 HEMEON DR Owner or Tenant HENDERSON JOHN W Telephone No. Owner's Address HENDERSON LISA B,4 PICARDY LN, DOVER, MA 02030 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 (14 Panels 11.6 KW DC)(NO ESS) 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 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 ❑ 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 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: Erik H Wilkinson Licensee: Erik H Wilkinson Signature LIC.NO.: 21579 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 1765 DIAMOND HILL RD, CUMBERLAND RI 028645518 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. PERMIT FEE: $150.00 Commonwealth of Ma:aclzt a& Official Use Only {0,31,E c7� �'/ Permit No. VZ3 — Si Z `i � 2epardmont o`..ies Srnricr4 1{_: Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev.1/07] (leave blank E APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK $ All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 g (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/3/2023 0 m City or Town of: Yarmouth MA To the Inspector of Wires: if By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 50 Hemeon Drive,West Yarmouth MA,02673 E Owner or Tenant Bill&Lisa Henderson Telephone No. 617-816-5412 a Owner's Address 50 Hemeon Drive,West Yarmouth MA,02673 o Is this permit in conjunction with a building permit? Yes Q No ❑ (Check Appropriate Box) • Purpose of Building Residential Utility Authorization No. ER Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters G New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Residential roof mounted PV system,14 solar panels. No ESS,no structural upgrades required.System size-11.6kW DC/8.41kW AC. Completion of'the followin•table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil.-Sus (Paddle)Fans -No.oof KVA P• Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grad, grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners No.In Initiatinngg Detection Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices ge Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �° Totals: Detection/Alerti g Devices Muspal No.of Dishwashers Space/Area Heating KW Local 0 Conneoicction ❑other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KN, 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: 14 solar panels $4,916.80Attach additional detail if desired or as required by the Inspector of Wires Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stan: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E BOND ❑ OTHER❑ (Specify:) I certify,under the pains and Renalties ofperjury,that the information on this application is true and complete. FIRM NAME: Erik H.Wilkinson �� //DD�� LIC.NO.: 21579 A Licensee: Erik H.Wilkinson Signature � /6(.111 ut4B)r. LIC.NO.: 12718 B ilfapplicable,enter"exempt"in the license number line) Bus.Tel.No..401-617-0865 Address: 1765 Diamond Hill Rd,Cumberland RI,02864 Alt.Tel.No.: "Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent. Owner/AgentPERMIT FEE:$ SignaatureureTelephone No. R - - 1 -. . The Commonwealth of Massachusetts _.w, =�1, Department of Industrial Accidents ....An—. 1 Congress Street, Suite 100 %sl�=: Boston, MA 02114-2017 �;S.' www.mass.gov/dia Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organizationflndividual): Erik H. Wilkinson Address: 1765 Diamond Hill Rd City/State/Zip: Cumberland RI 02864 Phone #: 401-617-0865 Are you an employer?Check the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.[]1 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself t 9. ❑ Demolition ❑ Y [No workers'comp.insurance required.] I am a homeowner and will be contractors to conduct all work on my10 Building addition 4. ❑ hiring property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.E We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other solar install 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I *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. lithe 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 50 Hemeon Drive City/State/Zip: W. Yarmouth MA 02673 Attach a copy of the workers' compensation policy declaration page(showing the policy number 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 painsains and penalties of perjury that the information provided above is true and correct. Sigj ature: 2 "" "" 4 ' Date: 3/3/2023 Phone#: 401-617-0865 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. 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