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HomeMy WebLinkAboutBLDE-22-007396 Commonwealth of Official Use Only de.•, Massachusetts Permit No. BLDE-22-007396 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:6/24/2022 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) 106 POND ST Owner or Tenant James Mistrik Telephone No. Owner's Address 106 POND ST, SOUTH YARMOUTH, MA 02664 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(20 Panels 6.8 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 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 Connection 0 Other: 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 Signs 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: Philip Mccarron Licensee: Philip Mccarron Signature LIC.NO.: 14068 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:2 SHAYLEE LN, LAKEVILLE MA 023471852 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 ---, CZ — — - Corwrionivealg a/Masdachat3oth Official Use On!' lil cv --tirlirg I r cv ---MIEllil- 2epartment of.gire—S'ervice6 Permit No.f/A/1- 'fr 414, > G=0 .'7-----at /,t.--=- fct04-7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS i cvp :.7%,----00. (leave Hank) LU GNI LI " C..) ! = S) A PPLICATION F • ' - PE - - ITT. PE - 0 ' . ELECTRICAL ORK = , w ---) E All work to be performed in accordance with the Massachusetts Electrical('ode(MEF.cA 527('MR 12.(t0 Cr 44.-SE PRINT IN INK OR TYPE ALL INFORMATION) CA al Date: 6/16/2022 City or Town of: Yarmouth MA 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) 106 Pond Street Owner or Tenant James Mistrik Telephone No. Owner's Address Same Is this permit in conjunction with a building permit? Yes 411 . No (Check Appropriate Box) Purpose of Building Residential Utility Authorization No. Existing Service 150 Amps 120 / 240Volts Overhead VI Undgrd I I No.of Meters New Service Amps / Volts Overhead I I Undgra i I No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of 20 solar PV modules of existing roof. 6800 kW ...). Completion of the Allowing table may be waived by the Inspector of Wires. No. of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans Transformers KVA 1 No.of Luminaire Outlets No. of Hot Tubs Generators KVA Above r-i In- n No.of Emergency Lighting No. of Luminaires Swimming Pool grnd. '—' grnd. 1-1 Battery Units CA 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 0 Total ...) No.of Ranges No.of Air Cond. Tons No.of Alerting Devices ,g Heat Pump Number Tons I KW No. of Self-Contained ...\) No.of Waste Disposers Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local EI Municipal r--, Connection 1I Other QD4 No. of Dryers Heating Appliances KW Securityof Systems:* No. Devices or Equivalent No.of Water KW No.of Signs No.of Data Wiring: Heaters Ballasts No.of Devices or Equivalent ' E No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent . ... OTHER: Solar PV Installation Ctr).... 15000 .4tlach additional detail ij desired, requi red 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 I BOND 0 OTHER El (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is.true and complete. FIRM NAME: Beacon Solar Construction LIC.NO.: Licensee: Philip McCarron Signature X . LAC.NO.: A14068 (it applicable. enter -exempt'.in the license number line„) Bus.Tel. No. 401-203-4854 Address: 2 Sha lee Lane Lakeville, MA 02347 Alt.Tel. No. *Per M.G.L. c. 147,s. 57-6I,security work requires Department of Public Safety"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)Li owner 111 owner's agent. Signature Owner/Agent n v..,____.----- Telephone No.401 203 4854 PERMIT FEE: $ l . ! The Commonwealth of Massachusetts A •---.-- .4..wir, Department of Industrial Accidents . =.•;',0 ,.......,..: dr 67--„,-r=z — t, I Congress Street,Suite 100 Boston,MA 02114-2017 -tp,"", • www.rnass.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): Beacon Solar Inc./Bay State SolarConstruction Address: 2 Shaylee Lane City/State/Zip: Lakeville,Ma 02347 Phone#: 401-203-4854 Are you an employer?Check the appropriate box: Type of project(required): 1.01ain a employer with 20 ,employees(full and/or part-rune).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any cavacity.[No workers'coinp.insurance required.) 9. Ei Demolition 3,0 I am a homeowner doing all work myself.[No workers'comp,insurance required.]t , . 10 0 Building addition &El lam a tummy/ire,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 11.0 Electrical repairs or additions proprietors with no employees, 12.1:1Plumbing repairs or additions 5411 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp,insuranee.1 14.0 Other Solar pv module install 6,0 We are a coipuration and its officers have exercised their right of exemption per MCIL c. 152,§I(4),and we have no employees.[No workers'comp.insurance required.] i t *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy intOmnation. it I t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have 1 employees, lithe sub-contractors have employees,they must provide their workers'comp,policy number. t , 1, - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Hartford Policy#or Self-ins,Lie.#: UB-4N53441A-19 Expiration Date: 08/03/2022 Job Site Address: 106 Pond Street Yarmouth, MA 02664 City/State/Zip: 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. . . t I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct • Signatore: nt (,------ Date: 6/16/2022 Phone#: 401-203-4854 _...._ • . Official use only. Do not write in this area,to be completed by city or town official I i City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other_ .. IContact Person: Phone#: . t ' �CVI<©® CERTIFICATE ,<..B AG3 T INSURANCE. DATE(MMIDDIYYYY) I .� 08/10/2021 t s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O.,;._.' AND CONFERS NO RIGHTS UPON "-.%'E CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAITED, subject to I the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the 1 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT .... NAME; Deslrae Mitchell RUA-DUMONT-AIUUET INSURANCE AGENCY INC PHONE 508 673 5808 FAX LAIC,Na,Extl ( (AIC,Nol ......... E-MAIL ADDRESS: dmitchell@rda-Insurance.com 155 NORTH MAIN ST INSURER(S)AFFORDING COVERAGE i NAIC# FALL RIVER MA 02720 INSURER A: HARTFORD UNDERWRITERS INS CO +1 30104 INSURED ----......_. ......... _...._------ —........ INSURER B BEACON SOLAR CONSTRUCTION INC INSURER C INSURER 0 ! 2 SHAYLEE LANE INSURER E: LAKEVILLE MA 02346 INSURER F: COVERAGES CERTIFICATE NUMBER: 683839 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED EY PAID CLAIMS. INSR iADDL SUBR'-� -- -__-- ___-- ,, POLICY EFF POLICY EXP LTR ";`iPE OF INSURANCE INSD WVD I POLICY N Im FE* (MMiDE:YYYY1!(MMiDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE_ $ CLAIMS-MADE .........'OCCUR ! r DAMAGE TO RENTED ..._ ........ ____. __ : PREMISES 1 aoccurrence) $ ' MED EXP(Any one person) I $ N/A PERSONAL 8 ADV INJURY i $ GENI.AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE___._ ;POLICY , PRO- ! LOG -- --.._ ----_A..__ ....... ........------_-- JECT PRODUCTS COMP OP AGG $ OTHER. I.$ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT $ a accident) _ • • BODILY v INJURY(P r I ersoln)ANY AUTO .... ---_--- .....J ALL OWNED SCHEDULED BODILY INJURY(Per eccitent,! $AUTOS ALTOS I I N/A NON-OWNED i 1 PROPERTY DAMAGE ....._ HIRED AUTOS A'`roe ''SPI raccidenl $ • UMBRELLALIAB OCCUR • EACH OCCURRENCE j$ EXCESS LIAB CLAIMS-MADE; NIA • AGGREGATE . $ DED RETENTION$ ; $ WORKERS COMPENSATION PER OTH- !AND EMPLOYERS'LIABILITY X(STATUTE ER 'ANYPROPRIETORIPARTNER!EXECUTIVE Y N i El,EACH ACCIDENT i $ 1,000,000 A ;OFFICER MEMI3EREXCLUDED? N/A N/A N/A :6S60UB5R99184221 07/21/2021 107/21/2022 -- __- -- -_-- -_ (Mandatory in E.L.DISEASE-F.A.,MPL.OYEE $ 1,000,000 IDESCRiPT!ON OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $ 1,000,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) . Workers'Compensation benefits will be paid to Massachusetts employees only,Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in slates other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification! Search tool at www.mass.gov/IwdA,vorkers-compensationiinvestigations/. ` CERTIFICATE HOLDER CANCELLATION ( _ t SHOULD ANY OF THE ABOVE OE.SOMBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I Daniel M.Croiyy�ey,CPCU,Vice President--Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25'2'14/01) The ACORD name and logo are registered marks of ACORD i--"*, BEACO.3 OP ID: DE A,MRCP A >r r' q a y i j DATE(MM/DDIYYYY) �� i ,,,,,,l' 3 („„, OF Li�'i ,,,,,,4 > a t'a .,,� 44C 810512021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON'. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), i PRODUCER 508 673-5808 CONTACT Jason Rua, LIA,CIC,AAI NAME: I Rua-Dumont-Audet Ins.A ry.In 6 155 North Main Street 3 PHONE 50$ m73 5808 FAx 508-677-0$28 (AIC No Ert): __. _._ ..... (A/C,No) ...... !Fan River,MA 02722 E-MAIL mason WI,Rua,LIA,CIC,AAI ADDRESS .... INSURER(SI AFFORDING COVERAGE ! NAIC__ INSURER A;MAPFRE Insurance 134754 1 INSURED Beacon Solar Construction Inc.2 Shaylee Lane INSURER B c Nautilus Insurance Company . Lakeville,MA 02346 ,INSURER C:Hiscox Pro ,INSURER D: ---- ---- iINSURER E: .... : L<.__..... __ INSURER F: . _....... _....... COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE E BEEN REDUCED BY PAID CLAIMS iNSR 1 ,TYPE OF INSURANCE ADDL SUER POLICY .� POLICY EFF POLICY EXP LIMITS LTR INSE, WVD (rtFliIDDI°.YYY) J(MM,DD/YYYYP B X : COMMERCIAL GENERAL LIABILITY ; EACH OCCURRENCE -_--_ ,S _--_ 1,000,000_ DAMAGE TO RENTED 100,000 CLAIMS-MADE X 1OCCUR NN11 4349 08/03/2021 08/03/2022 pREMiSES,Eaoccurrer ce)...... ,S MED EXP An one person), $ 5'000' !. ,PERSONAL S ADV INJURY 1,000,000' GEN'L AGGREGATE LIMIT APPLIES PER. ! I GENERAL AGGREGATE 2,000,000 X POLICY PRJE T CO` ; LOC • PRODUCTS COMP,OPAGG $ 2,000,000 , OTHER: • _..__ COMBINED SINGLE LIMIT_...... 1 1,000,000 A AUTOMOBILE LIABILITY ', (Ea accident) ......... ,$ ..._.... _..__ ANY AUTO1 1 1BQZ650 1 02/13/2021 02/13/2022 1 BODILY INJURY(Per person) ,$ OWNED SCHEDULED : !. . AUTOS ONLY X AUTOS . '' ,BODILY INJURY(Per a ccident) $ PROPERTY DAMAGE HA,RT S ONLY X OOO ONN LY j ,(Per.acadent) I$ B UMBRELLA LIAB i X'i, OCCUR ,EACH OCCURRENCE .............. • $ ... 3,000 OOO' X EXCESS LIAB CLAIMS-MADE ANG91(<ft6 08/0312021 08/6312022 $ 3,000,000 AGGREGATE_....._. DED 1 1 RETENTION 5 WORKERS COMPENSATION PER - AND EMPLOYERS LIABILITY STATUTE ERH _-.... .... YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDEN i $ QFF!CER,MEMBER EXCLUDED? :N/A ! - -- (Mandatory In NH) ,E L DISEASE-EA EMPLOYEE $ yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ C 1PROFFESSIONAL 1 I IANE470779121 1 01/22/2021 01/22/2022 OCCUR 1,000.000E AGGREGATE • 3 000,000 HD ESCRIPT:o' OF OPERATIONS I LOCATIONS i VEHICLES {ACORD let,Additional Remarks Schedule,rray bye attached if more space is required) Subject to actual policies'terms,conditions, definitions,coverages& exclusions, g3, CERTIFICATE HOLDER CANCELLATION I @ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORD 25(2016103) 1 1988-2015 ACORD CORPORATION, Ali rights reserved. The ACORD name and logo are registered marks of ACORD i , rr > r ,i/i,�aia 'aa m BOARD O ELECTRICIANS S ISSUES THE FOLLOWING LICENSE REGISTERED ELECTRICAL BUSINESS MCCARRON ELECTRIC j S YLEE LIV � L .. EVILLE, MA 0234 -18 2 3534 Al 07131/ 025 267299 04 wavd //�r�/, a // r //�v � „K,y v / �d /d � ' �o,j ' v OG'6;664/ ll�� 0,40,0 ELECTRICIANS '' -3',,,//X te, ' ISSUES THE FOLLOWING LIC / REG JOURNEYMAN ELECTRIC/ / %/; ', PHILIP MCCARRON .SYLEE.L y L KEVILL , MA 02347-1852 �`u//77 / , ,i 713I12 2 269018 .:% A ' / ,; ' CTII ,NS i % d,`, ;, / �M y , %/ j - „ ES ` / LL WII LICENSE. ' ` j'%%,i S I ELE I I/ ; '"4,,, , • 7,4 t y rAF' 11'1 r s' o/ ,o)''„ /,/ ." , r s ) ,,,"?'",/,',; ',;/;/4 , D. V0/ems ; y / �� , 715p7111,flot,,,#,;44, ',,,1'.r,...,;.i,f0,,t,.,,0.t44,,'.0,„,A;..0,0,,;.41,,44,,//:o1,,7..-/,/,',,„,-',,-,,W/-.;/-',/-:e//,,/,A,/7;', /;',/,„',%':""6 a� a� j,,', Y3 / / / ,�j�, s // 272 3 , / 6 �H i , •., W 0 LI'W Z ± a i••• < W ..;:' I-- c Ili w a w 5.,' 6 z < w 0 D 0 Z 0 0 . 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