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HomeMy WebLinkAboutBLDE-22-000149 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-000149 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:7/9/2021 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) 31 EILEEN ST '_/_� Owner or Tenant WITHERELL SCOTT A Telephone No. Owner's Address WITHERELL MARCIA L, 31 EILEEN ST, YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec ;y.r e . Purpose of Building Utility Authorization No. Alle' Existing Service Amps Volts Overhead ❑ Undgrd ❑ o.o New Service Amps Volts Overhead ❑ Undgrd ❑ Mee1.40Plop Number of Feeders and Ampacity / r a Location and Nature of Proposed Electrical Work: Installation of solar PV system (23 Panels 7.82 KW)(WOR DQ�J -24- , 446 Completion of the following table may be waived by the Inspec or 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 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 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: VS SUB I, LLC Licensee: John Rodrigue Signature LIC.NO.: 100073 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 198 Ayer Road, Harvard MA 01451 Alt.Tel.No.: 8562421295 *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: $400.00 PLAY G :49 Car (2/ w6 . ENE) Commontvaa/g.of Mae,ackanctte l!OOfSfficial Use Only .,n 711X-0 `x cc77 (� Permit No. �Z��lv'4T -Y,�r y 2epartment of Jiro Jervicee Occupancy and Fee Checked " ���'`' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] '- (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed m accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6/7/2021 City or Town of: Y ARMOUTH 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)31 Eileen St,Yarmouth,Massachusetts 02675 Owner or Tenant Scott A Witherell 3Q I{—itilli Telephone No. 8562421295 Owner's Address 31 Eileen St,Yarmouth,Massachusetts 02675 Ia this permit in conjunction with a building permit? Yes© No ❑ (Check Appropriate Box) Purpose of Building RESIDENTIAL SOLAR Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead El Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: INSTALLATION OF 23 ROOF MOUNT SOLAR PANELS -7.82 KW SYSTEM Completion of thefollowingtable may be waived by the Inspector of Wires. No.of Total Ui No.of Recessed Luminaires No.of CelLSosp.(Paddle)Fans Transformers KVA C No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting 4- No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units J 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 II' No.of Ranges No.of Air Cond. Totalo No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area HeatingKW Local❑Municipal ❑other P Connection No.of DryersHeating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent WiNo.Hydromaasage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent OTHER:Se LA 1g 7000 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: 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 4 BOND❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: VS SUB I,LLC ( LIC.NO.: 8108 Al Licensee: JOHN RODRIGUE Signature('` ryse._e___..--" LIC.NO.: 100073 MR f applicable.98 AYER�ROAD,tH RVAR/Det�1A 01451 Bus.TeL No.•8562421295 Address: 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 am aware that the Licensee does no!have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. , The Commonwealth of Massachusetts Aro _ ` /, Department of Industrial Accidents 1E0 .l; 1 Congress Street, Suite 100 .: VII , Boston, MA 02114-2017 ib www.mass.gov/dia mass.gov/dia in Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 'Please Print Lt.-c.-iblv Name inusimcss!Organi,ation/1nrlividual). VS SUB I, LLC Address: 198 Ayer Road City/State/Zip: Harvard MA 01451 Phone #: 856-242-1295 ` Are von an employer?Check the appropriate boy; Type of project (required): I. I am a employer with 15 employees(full and/or part-time).* 7_ Q New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling any capacity. [No workers' comp. insurance required.] 9. 0 Demolition 3.D l am a homeowner doing ail work myself. [No worker'comp. insurance required.j ` 10 I 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 t l 1.117 Electrical repairs or additions proprietors with no employees. 12. n Plumbing repairs or additions 5.El 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. {i Roof repairs SOLAR 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c_ 14.[Sher 152, §I(4),and we have.no employees. [No workers' comp. insurance required.' *Any applicant that checks box if 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. Brown and Brown Insurance insurance Company Name: Policy # or Self-ins. Lic. #: WC202000017772 Expiration Date: 8/24/2021 fob Site Address: ALL LOCATIONS WITHIN YARMOUTH 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 $1,5OO,0 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 tit• pains and penalties of perjury that the information provided above is true and correct 6/26/2021 Signature: J Date: Phone #: 9 8-479-7331 Official use only. Do not write in this area, to be cons feted by city or town official. ft i3 11 City or Town: _ Permit/License # issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector S. Plumbing Inspector 6. Other , n: Phone #: Contact Person: ii�' 4