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HomeMy WebLinkAboutBLDE-23-004327 _ 4.,; _, .... .cillk, <PP-- Commonwealth of Official Use Only Permit No. BLDE-23-004327 Massachusetts B e :RD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 2 [Rev.1/07] V 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:2/6/2023 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) 4 MELVA ST Owner or Tenant CAMILLA FLANNERY Telephone No. Owner's Address 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(12 Panels 4.68 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 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 p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Munici al 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: MICHAEL A CHIONCHIO Licensee: Michael A Chionchio Signature LIC.NO.: 20290 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:730 SCOTT RD, OAKHAM MA 010689543 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. I PERMIT FEE: $150.00 L..H i : 1.4 1 i A, Cf-IC ( S,b 3 2CoCap.Com _ ___._.._ Commonwealth of Massachusetts Official Use Only I ' I r / Permit No. 3 — 3 2 7 1-•�-tl- - µ----�..� _s Department of Fire Services «l 1 v Occupancy and Fee Checked 1 FEB 03 2i �, BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/OS] (leave blank) 1 BUILDING DEPART••! LICATION FOR PERMIT TO PERFORM ELECTRICAL WORK -, 1 All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASEAPRINT IN INK OR TYPE ALL INFORMATION) Date: 02/02/2023 City or Town of: Yarmouth To the Inspector of Wires: By this application the undersig ed_g ves notice Str@@h of is or her intention to perform the electrical work described below. 4elva Location(Street&Number) M Owner or Tenant Camilla Flannery Telephone No. (917)647-1667 Owner's Address 4 Melva Street Yarmouth MA 02090 Is this permit in conjunction with a building permit? Yes NZ No I I (Check Appropriate Box) Purpose of Building PV solar installation Utility Authorization No. Existing Service 200 Amps 120 / 240 Volts Overhead Undgrd n No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd C No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4 Melva Street Yarmouth MA 02090 INSTALLATION OF ROOF-MOUNTED PV SYSTEM—4.68 KW(12 MODULES) Completion of the followingiable may be waived by the Inspector of 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 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 Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Solar Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $6,464.64 (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 cove e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury, hat the information on this application is true andC NO 1 complete. yy S FIRM NAME: S LIC.NO.:a oa,Qp A Licensee: MICHAEL A CHIONCHIO Signatur If pp Bus.Tel.No.: (512)735-0305 I a Itcabte, relvareeYarmouhnAei01�L �0 Alt.Tel.No.: Address: *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance covera rmally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner o 1n is agent. Owner/Agent Telephone No. I PENT FEE: $ I Signature The Commonwealth of Massachusetts Department of Industrial Accidents _c Office of Investigations =az-- Ill i l' Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):SunPower Corporation Systems Address:50 Rockwell Road City/State/Zip:Newington CT 06111 Phone#:512-735-0322 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 10 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no Solar employees. [No workers' 13.0 Other 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. tContractors 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:Trumbull Insurance Company(Hartford) Policy#or Self-ins.Lic.#: 57 WV W00015 Expiration Date:4/1/23 4 Melva Street Yarmouth MA 02090 Job Site Address: 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 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. 02/02/2023 Signature: z '"' L Date: 2)735-0305 Phone#: (512) Official use only. Do not write in this area,to be completed by city or town official. 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