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0081 ABBEY GATE
d 1 1 1 1 Town of Barnstable Building RAM Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept A. �0$ Posted Until Final Inspection Has Been Made. PeY'illit 3 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Jl m 1. Permit No. B-19-3353 Applicant Name: John Vreeland Approvals Date Issued: 10/23/2019 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 04/23/2020 Foundation: Location: 81 ABBEY GATE,COTUIT Map/Lot: 021-020 Zoning District: RF Sheathing: Owner on Record: KEHRL, BRIAN H & KATELIN P J T Contractor Name:' HN VREELAND Framing: 1 Address: 81 ABBEY GATE C Contractor License: CS-107947 c 2 COTUIT, MA 02635 Est. Project Cost: $23,896.00 Chimney: Description: Remove existing roof mounted PV solar system and upgrade to new Permit Fee: $ 171.87 PV solar system. New system to consist of twenty 370 watt iI Insulation: modules connected with microinverters. Total system size'is 7.4 kW Fee Paid: S 171.87 DC. Date: 10/23/2019 Final: Project Review Req: WX Plumbing/Gas Rough Plumbing: i Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months after`issuance. All work authorized by this permit shall conform to the approved application and the approvedconstruction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. F I Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. "/ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �� rTR�r.+. a.:_G�'h�+.. ..2�:+R.-fi..r., F r �3�'�"'. ..n^'r^:tea*' .'T,�"�z�.�rT- ._��,'-31C"'sl,��c srww�--�z'- �'�.^s-.�R'►•�� _'"1 TOWN OF BARNSTABLE Permit No. _-_24014_ Building Inspector&ARM cash ,MMa a — °"Y� OCCUPANCY PERMIT Bond x-__ __- � Issued to George Gibson Address ° Lot 6, 81 Abby Gate, Cotuit �, Wiring Inspector U� Inspection date Plumbing InspectorX�f j� � �� Inspection date Gas Inspector V /- 0 n Inspection date XEngineering Department Inspection date Board of Health Inspection date -7 I -;k. THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0,OF THE MASSACHUSETTS STATE BUILDING CODE. CODE. ....... �/ ',�.... ... 19 — .......... Buildin Inspector i .,as (- —46 F. ��..°` '°•�e� TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 sesa�r = TOWN OFFICE BUILDING rum HYANNIS, MASS. 02601 �o r�r�• MEMO TO: Town Clerk FROM: Building Department DATE: An 'Occupancy Permit has been issued for the building authorized by BuildingPermit #.............."�.... f _.._............._................................................................_........... � M.._..... �......�._. . issued to ... ._... EO�9- ...._._V,,/ s� .......................... • l Please release the performance bond. Assessor's map and lot number . ... '$��T'C��/��E P Of THE TOE ►�_ f"YST Sewage Permit number ....cF17-.....Y,3........... .... ............ �, fit} III ® %AIc �r s�ITH TITL Z BARESTADL�E, i ��✓ House number .O L..... ................................. Elyw SIT 40O �M6 9 0 i. TOWN g. I a O RE G U C�.�Oj�i O M'0 TOWN OF B�ARNSTA E LATE°i '?NSrA ft E c®P,�®vAL as BUILDING INSPECTOR.t; °"'�Issov �A 7,°lv .... ;.APPLICATION FOR PERMIT TO .........:� ....�,�^..5�..��......... .........V\.. ...'................................ TYPE OF CONSTRUCTION .......... ,5.��0�-�,..`? . ..... ........................................................... ................ ............................... 9. ..� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .."!.�.. ... !�!`...........AS 4.... .........`!\:.`r.... 0 �.�,�. .. ProposedUse .......... � `r �11............................................................................................................................ Zoning District .�....SJ ,� ........ �� .� `e \......Fire District ....... stl' .l..l.............................................. Name of Owner - ..... `.. .. ....... ......................Address .. �1 ... .�.�....t.. �....�..... Name of Builder (�.Address .� o..`� 4r��`"5.. `'`.?... ....Address' Name of Architect .............................................................. .................................................................................... Number of Rooms .........%.....................................................Foundation .... �V ......................t.� e ...... l ......... ...................... Exterior ..�,�° C. r.....s -.. �"�.................Roofing .......lSl( �Z\ ..................................................... Floors i'!"""".(20."V�w 4 ...................................Interior .... ..�W .......................... ...................................... Heating . .......................................................Plumbing .. :.........:...................................... V Fireplace .!'�K� ... Yd �`rC9 .. ...... «"S�1Qpproximate Cost ...........?.5 .:............................ ....... Definitive Plan Approved by Planning Board ---------------____-----------19_______ . Area 0 Diagram of Lot and Building with Dimensions Fee ........... .r..... .......................... SUBJECT TO PPROVAL OF BOARD OF HEALTH Owner .�tJ. . .. . . . . . . .. . I hereby agree to conform to all the Rules and Regulations of the T wn of Barnstable regarding the above construction. f Name ... ............:....................... .................... GIBSON, GEORGE 1 24014 1�2 Story 4o ................. Permit for .................................... Single Family Dwelling ............ Location L.o...t........#.....6.........8..1.. J�a...t..e............. vw!P' ) c6tuit............................................... .. Owner ...... ...Gibson. .......................................... Type of. Construction ........Frame....................... .. ....... ;> 1*. ...............:................................................ ........................Plot .... Lot ................................ May 5, 82 Permit Granted ............................ .........144 -Date of lnspection7—/ ..... .....19 76� Date Com7l!te F5 .19 ........... PERMIT REFUSED 4, t' ....................................................... ... 19 n. 4" > .................................................................................. .................... ................... . ........................................ Cj . .................................................... ......I. .................. 0. C .................... >....................................... . i I N �A Approvecl ............................................... 19 ............................................................................... ............................................................................... f 1` _ •ter A Y��(� � "' / " �' O 1q aa Z p � p 14 La LA c t f w p � n 0 F-I '� '4 D"EIMWD CERTIFICATE OF LIABILITY INSURANCE os/„20,9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 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 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 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 endorsements. PRODUCER NAME CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE I HOME OFFICE:P.O.BOX 328 (A C. .. EXt):888-333-4949 FM No):507-446-4664 OWATONNA,MN 55060 ADDRESS,CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 173-553-9 INSURER B: M.C.E DIRTWORKS INC. INSURER C: 3 MAIN ST UNIT 5 EASTHAM,MA 02642-2194 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:164 REVISION NUMBER:0 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 BY PAID CLAIMS. INSR TYPE OF INSURANCE DL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYV,. MMIDOIWYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,()00,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $,OO,000 PREMISES a occurnence MED EXP(Any one person) EXCLUDED A Y N 6085963 10/19/2019 10/19/2020 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑1E�T ❑LOC PRODUCTS-COMPIOPAGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT acclden $1,000,000 Ee X ANY AUTO BODILY INJURY(Per person) A OWNED AUTOS ONLY AUTOSU�D N N 6085962 10/19/2019 10/19/2020 BODILY INJURY(Par accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $3,000,000 A EXCESS LIAR CLAIMS-MADE N N 6085965 10/19/2019 10/19/2020 AGGREGATE $3,000,000 - DED RETENTION WORKERS COMPENSATION X PER STATUTE I OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $500,000 A OFT'ICERIMEMBER EXCLUDED? NIA N 6085966 1O/26/2D19 ,Q/26/2020 E.L.DISEASE-EA EMPLOYEE (Mandatory in NH) $500,ODO It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,0DO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be atmdled it more space is required) 2019 ROADWAY AND SIDEWALK IMPROVEMENTS; VARIOUS LOCATIONS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. I CERTIFICATE HOLDER CANCELLATION 173-553-9 1640 TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 230 SOUTH ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601-3935 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD } i i i , . COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or added as an additional insured on your policy. "Personal and advertising injury" arising out Such person or organization is an additional of the rendering of, or the failure to render, insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders,change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, the additional insured. P ry, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims against additional insured: i any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others by 2. Will not be broader than that which you are that insured, if the "occurrence" which caused the required by the contract or agreement to "bodily injury" or "property damage", or the provide for such additional insured. offense which caused the "personal and A person's or organization's status as an advertising injury", involved the rendering of or additional insured under this endorsement ends the failure to render any professional -- -when-your-operations-for that:additional--insured--_ _ architectural, engineering or surveying services. are completed. © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 33 04 13 Policy Number: 6085963 Transaction Effective Date: 10-19-2019 2. "Bodily injury" or "property damage C. With respect. to the insurance afforded to these occurring after: additional insureds, the following. is added to a. All work, including materials, parts or Section III - Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such .work, on the project (other than insured is the amount of insurance: service, 'maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under. the applicable Limits of b. That portion of "your work" out of which Insurance shown in the Declarations; the injury or damage arises has been put whichever is less. to its intended use by any person or organization other than another contractor. This . endorsement shall not increase the or subcontractor engaged in performing applicable Limits of Insurance shown in the operations for a principal as a part of the Declarations. same project. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13 Policy Number: 6085963 Transaction Effective Date: 10-19-201.9 • i 173-553-9164 XWXW0021XXXXXXX5# BC001.01-ores �OBWNDI—IBS WN OF BARNSTABL 200 MAIN ST HYANNIS MA 02601-4002 Town of Barnstable Building g •aaxsr�►au Post-This,Card So-That it is:Uisible From the Street-Approved'Plans Mustpbe Retained on Job and this:Cerd Must be Kept 6' Poste39. d Until Final Inspection Has Been Made •' '.x � Permit ° Where a Certificate of Occupancy is-Required,such Building shall il Not be Occupied'until a�Final Inspection has been made ~ . . . Permit No. B-18-1782 Applicant Name: RICHARD P CAZEAULTJR Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation: Location: 81 ABBEY GATE,COTUIT Map/Lot: 021-020_ -- _ Zoning District: RF Sheathing: Owner on Record: KEHRL, BRIAN H& KATELIN PJ Contractor Name.•`-,.,RICHARD P CAZEAULTJR Framing: 1 Address: 81 ABBEY GATE Contractor License: 168607 2 COTUIT, MA 02635 >_ t Est. Project Cost: $8,000.00 I � Chimney: Description: reroof Permit-Fee: $40.80 i Insulation: Project Review Req: Fee Paid:,` $40.80 Date: / 6/8/2018 Final: Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: i . This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. -� '. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access fo the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT O� Application number............... ............................... . 11 .. � Date issued............ �:�...... ....................... AF X-PRES PRO) SF Building Inspectors Initials...... ..... ...:................... JUN 0 4 2018 Map/Parcel............. TOWN O� BARNSTABLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION L Address of Project: a'N9, 6- ER STREET VILLAGE Owner's Name: al`i i t /�e�Y Phone Number Email Address: Cell Phone Number Project cost$ Check one Residential y Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding a Windows (no header change)# © Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) ` Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name �C' r1 0-0 Home Improvement Contractors Registration(if applicable)# 0 ( (attach copy) Construction Supervisor's License# d d 3 (attach copy) ell- Email of Contractor CSC -2 tC d(, �� "'� r Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. #A# i - n 000nve► RFCnRF d PERMIT CAN BE ISSUED. f APPLICATION NUMBER...........................................:.............:.. *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am--9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date �i���� All permit applications are subject to a building official's approval prior to issuance. CA ZEAULT aY ROOFING & REPAIRS PROPOSAL Proposal No. 18-3218 May 10,2018 To: Katie Kehrl Work to be performed at 81 Abbey Gate Cotuit MA. We hereby propose to furnish the materials and perform the labor necessary for the completion oh. NEW ROOF (Right side of Main House Only) Respectfiilly submitted, Richard P.Cazeault,Jr. HIC#168607 CSL#100393 198 Five Comers Road Worb mns Comp and Liability with Centerville,MA 02632 Leonard Ins of Ost (508)420-5482 Acceptance of proposal No.18-3218 The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment is outlined above. Signatare Date The Commonwealth of Massachusetts Department of IndustridAccidents Office of Investigations 600 Washington'Street Boston,MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/FIectriciam/Plumberrs Please A licant Information e i I c q 1�—T Name(Business/organization/Individual): a � Address: 7 J t_Z11 ( `-a City/State/Zip: Phone#: Are.you an employer?Check the appropriate boa: r8. of project(required): 4, am a general contractor and I New construction 1.❑ I am.a employer with hired the sub-contractors employees(full and/or part-time).* Remodeling listed on the attached sheet. 2.❑ I am a sole proprietor or partner- ,��e sub-contractors have . Demolition ship and have no employees employees and have workers' Building addition working for me in any capacity re a corporation insurance.: [No workers'comp.bsur-ance 5. C0 we a a corporation and its 10.0 Electrical repairs or additions ❑ required.] officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all workright of exemption per MOL 12.❑Roof repairs myself[No workers'comp. c.152,§1(4),and we have no �—X-� Aa!e— insurance required.]t employees.[No workers' 13.[ Other comp.insurance required.] on policy information *Any applicant that obeds box#1 must also fill out the section below showing their workers'compensati t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors that cbeck this box must�obcd additional ��°�provide showing it workers'comp.pol�royntraCtOrsnumber aud state whether or not those entities have empioyees. If the sub-cont�ado �P p ��ob Site I am an employer that is providing workers'compensation insurance for my employees. Below is the oflq J information. Insurance Company Name: Expiration Date' Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: the policy number and expiration date). Attach a copy of the workers' compensation policy declaration page(showing P P penalties of a Failure�secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonment,as well as civil pe m the form of a STOP WORK ORDER and a fine may be forwarded to the Office of of up to$250.00 a day againstthe violator. Be advised that a copy of this statement verification. Investigations of the DIA for insurance coverage an penalties o erJuiy that the information provided above is true and correct I do hereby certify under the p P /�� !/ . Date: Si afore: �� 10 Phone#: do be co feted by tidy or town official - [fflc,Wjuse not write in this area, mP Permit/License# cle one): ector 5.Plumbnag Inspector .Building Department 3.City/Town Clerk 4.Electrical InspPhone#: .i1►. ,.. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person id the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or aizyy two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter•152, §25C(6)also states that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to operate_a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage"required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.,, Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number:on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided,to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The CammMwealth ofMmachusetts Department of Industdal Accidents Qfte of Investipdow 60.0 Washington Street rostra,MA 02111 i Tel.#617-727-4M ed 406 or 14 -MASSA Revised 4-24-07 Fax#617_727-7749 vlww.ma .gov/d1a DATE(MMIDDIYYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 4/12/2018 THIS CERTIFICATE IS ISSUED AS A HATTER OF INFORMATION ONLY 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 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the pollcy(iles)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject tD 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). PRICER GOWACT NAB Maria DeOliveira Help-U-Insure - qI N Ell: (508)998-0321 (a1017 c No): Insurance Agency,Inc. ADDRESS: maria@hclpyouinsure.net 2148 Acushnet Avenue INSURER(S)AFFORDING COVERAGE NAIC s New Bedford MA 02745 INSURER A: Travelers INSURED INSURERS: Father&Son Enterprises,Robert DeMello DBA INSURER C: 160$court Neck Road INSURER D: INSURER E: Fairhaven MA 02719 INSURERF: 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. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/OWWYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S MED EXP(Any are person) S PERSONAL SADVIWURY S GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY E� LOC PRODUCTS-COMPIOP AGG S OTHER: $ AUTOMOBOJeLUABILITY (Ea�donq S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS URED NON-OWNED 1PR0PERTrUAF=E UTOS ONLY AUTOS ONLY (Per aaSderd) S A S UMBRELLA e LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ S ORKERS COMPENSATION X STATUTE ER ND EMPLOYERS'LIABILITY ITV YPROPRIETORIPARTNERIEXECUitVEYIN ELEACHACCIDENT $ 100,000 A FFICERIMEMBEREXCLUDED? NIA 8HO1971 04/05/18 04/05/19 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 yes describe under ESCRIPTION OF OPERATIONS tow EL DISEASE-POLICY LIMIT S 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional RemaAm Schedule,maybe atlachad if mme space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN R Cazeault Roofing and Repairs ACCORDANCE WITH THE POLICY PROVISIONS. 198 Five Comers Road AUTHORIZED REPRESENTATIVE Centerville,MA 02632 ,-!&ria,T. PeOkwe f„ro- ©1988-201S ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I � 7 >ta7 of Maachusens ot s'�ri s a�rd Standards Board It gntldtngRe9!ttaVisor ;res_07Jp3I2020 CS 1oO393 UtZ; col— n�T -- z - ��— •cZ�i� '.:. :�J j�•.-'C7R��-W1dYiidsY.C'a�'i � - _ _ _ __ .. _ _. _....... ... ... ' d-.,__... y �Ty!ti 4 •ZV .�.iy�y� i-ii�t ID E i/6iS113'.tltL'�1i1� 'F v--Gd`p_ ilfpOY{iO pwardY OtCmv ilLLif:,1Affaimand Regdaffm TG . Sit - DJBlARCFtt, _.. _ R^ICQHCA,FED CAZEApU�yET-.ak " flat Hj s7• RRV,, cp��w'�' _X (*a...+r3 .kT''� 41x ��- s-• y, `i'' ust Ram . ' .� TP1 toown of Barnstable Building Post This.Card:So That it is Visible From the Street-Approved Plans Mt stbe Retained�oh-i;b and this Card Must be Kept MAE& PostedtUritil Final Inspection.Has Been Made. - - = F •- -` ' -. K .. Permit ' Where a Certificate of Occupancy is Required,such Building shall Not be occupied,until a final lnspection.has been made.- Permit y No. B-17-281 Applicant Name: KEHRL, BRIAN H &KATELIN P J Approvals Date Issued: 02/13/2017 Current Use: Structure Permit Type: Building-Deck Expiration Date: 08/13/2017 Foundation: Location: 81 ABBEY GATE,COTUIT Map/Lot: 021-020 _ Zoning District: RF Sheathing: Owner on Record: KEHRL, BRIAN H&KATELIN Pi Contractor Name: Framing: 1 i Address: 81 ABBEY GATE X� ry Contractor License 2 COTUIT, MA 02635 ""` Est. Project Cost: $10,000.00 Chimney: Description: replace existing deck 21x12. increase footprint extend out 4' \' Permit Fee: $ 110.00 Insulation: additional and add stairs Fee Paid: $ 110.00 Project Review Req: replace existing deck 21x12. increase footprint extend out 4' Date: `j 2/13/2017 Final: additional and add stairs f �� � Plumbing/Gas Rough Plumbing: - - - _- `\Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'ix months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. t -- ----- f Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: ` 1.Foundation or Footing Rough: 2.Sheathing Inspection ----- — - -- -- 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division - Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board V - Historic - OKH _ Preservation/ Hyannil 1W Project Street Address Village Owner_K' G�,'�"�P. .� �11� Address Telephone c, Od 1, 6 - 2-1 ILI ►Z. Permit Request G YZxkrwlou �Lfi�a�arr� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ) Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1�11 Two Family ❑ Multi-Family(# units) Age of Existing Structure �f 1� Historic House: ❑Yes N No On Old King's Highway: ❑Yes cal No Basement Type: ELFull ❑ Crawl Q Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) W W ILC. ISM &rarer Number of Baths: Full: existing new Half: existing new Number of Bedrooms: _,7 existing _new Total Room Count (not including baths): existing e_new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil -9 Electric tll Other (,C Central Air: ❑Yes �No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization . ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION „ ,.(BUILDER OR HOMEOWNER) Name - (16 �/1,t( o Telephone Number Cl Ll 00• Address �� C _ License # ff /� Home Improvement Contractor# Email L Gl- e, Le k I t u� G� W1 GA,( � . C Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 29 L �fiw�1 SIGNATURE DATE 4� eq2/70t+r J { FOR OFFICIAL USE ONLY ' APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS w VILLAGE c OWNER' DATE OF INSPECTION: FOUNDATION FRAME INSULATION - '-FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING pv�ldAd • - DATE CLOSED OUT ; ASSOCIATION PLAN NO. { f O 7 �o 24$Soo 5r � i d' o t R ' x sT�^a� Co N z N �o Aj�T,pN � N f _ m 1 CERTiFY T:f-V HE FC'�)N' SHOWN DOES i-40T VIOLATE UjSTH(j- IONING REGULATiON GF `g -OWS OF F3AeM STABLE C o T u t 7- Town of Barnstable Regulatory Services �oFTM TO Richard V.Scali,Director Building Division r a SARN5rAULF. ' Tom Perry,Building Commissioner Mass. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Z'2 Please Print DATE: ' JOB LOCATION: Yj A num er street village t,, I G, g� R u �/ "HOMEOWNER": /���, YI v "1 �U y QQ tJr 2'6 500 R2V "1 L4 name home`phone# work phone# . CURRENT MAILING ADDRESS: Cd � XAA= 0263� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The.undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner" ertifies that he/she understands the Town of Barnstable Building Department minimum inspection procedure ®reome that he/she will comply with said procedures and requirements. Sign f Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 oF�rqy • saaivsrasLK "s^9 1659. Town of Barnstable ���. Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms=RESS.dOC Revised 040215 i 27ze Commonwealth of Massachusetts Department oflrnclrrstria1Acciclerds 0}fire of ImwfigatiOnS e 600 Washington,street _=y Boston,CIA 02111 iPvmv_nmmgov1dia '"turkers' Compensafian Insurance Affidavit:B•gilders/ContractursAFIectricians/Plumbers APPEcant Information Please Print fe�ti1 Nat=tSusmess�DCrgan ianllndi t3na1}: /� �—Address: U 63� City/Statcl Q ;UAFPhone 66/,rZ�o Are you an employer?Check the appropriate box: Type of project(required): T_❑ I am a employer urith 4 ❑ I am a general contractor and I 6. ❑New construction.(felt and/or part-time).* 'have hired-the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed oathe attached sheet. 2- ❑Re ode1mg ship and have no employees These sub-confractor.s have 8. ❑Demolitioa wodr ng for nie in any capacity- employees and have wodcers' [No n;orbars' comp.insurance comp-insurance.$ 9. .❑Building addition required] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3,6 I am.a homeoumer doing all work officers have exercised'their I L❑Plumbing repairs or additions sel€ o workers' tight of exemption per MGL �' � �F- 12_❑Roof repaim insurance req iced-j 7 c. 152,§1(4),and we have no employees.[No workers' 13)9 Other comp.insurance required.) 'Aay W icsud;diistchecksbox Al r3st also Ma tthe sectioubelowshawmg iheirworkere compevsa5uupoyeyiuffinnedan_ t Homeowners who submit d is sffid2vu indxxting they are dGmg au waak ant dim hire outside coutractorsamst submit anew affidavit indxmng sucb LCantracinrs that chxSr this boa mast sttarhed as additional sheet showing the name of the sub-contrsctars and state whether or not those entities have employees. If the sub-cons actarshave empIcyen,theynmstprmm-ide their nvrkrss'comp.policy number_ I am are erlipLoj�er fhat is prair ding workers'congwisat:'ort inmiraizce.f br my enrpiny-ees. $eioly it file palicy and job site information. Insurance Company Name: Policy 4 or Self-ins-Lic.4: F-Kpiration Date: Job Site Address~ City/State/Zip: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c,152 can lead to the imposition of criminal penalties of a fine up to$l,.OUG and/or one-year imprisonment,as well as civil penalties,in the foam of a STOP WORK ORDER and a fine o€rip to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hemby c ,render 'is and reaps ofperj'uiy StatAe informafiarrprmided abm�s is trice acid correct ' �$itaature: Date: � Z �Phane "t I4(4006 IS OBkial use areay. �Da not wrote in this area,to be campLetesd by city artown offieiaL City or Tbnm: Permit/I,icense;9 Issuing Authority(circle one): L Board of D:eg& 2.Building Department 3.Citpl own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and lastructions Massachuse#ts Gerimal Laws chapter 152 regrums all mmployers to provide workers'compensation far their employees. puisuantto this sfi�,an�Ly�is defined as."-.every person in the service of another ceder any contract of hire, express or implied oral or wiiti m" An errIpIoyer is defined as"an individual,pm tnersbip,assodalian,corporation or other legal entity, or any two or more of the foregoing engaged in a Joint enteiprsse,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees: However the, owner of a.dwelling house having not more than three apartments and who resides therein,or the occapant of the - dwPslling house of another who employs persons to do maitmmce,construction or reps woik.on such dwelling house 'or on the grounds or building appurtenmit thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(17 also staffs that"every state or local Ticensing agency shall withhold flee issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of cdmpliance with the bimr-an ce,coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth.nor airy of ifs political subdivisions shall enter mb any contact for the perfoimance ofpnbhc work until acceptable evidence of compliance with the i„SUr2. ce.. reguseuiants of this chapter have been presenfi--d to the contracting;nTffi Applicants Please fill oil the workers'compensation affidavit completely,by checkin g th e boxes that apply to your situation and,if necessary,supply sub-coutractor(s)name(s), address(es) and phone numbers) along with their certif cate(s) of insurance. Limitrd Liability Compa its(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not regimed to tansy workers' compensation insurance. If an LLC or LLP does have empToyees, a policy is required. Be advisedthaf this of idayitmay be submitted to the Department of Industrial Accidents for confirmation of Tnsurah:e coverage. Also be sure to sign and date-he a.fadavit. The affidavit should be rt�frmmed to the city or town that the application fur the permit or license is being requested,not the Department of Lxhi.efrial A ccideufs. Shouldyon have any questions regarding the law or ifyou are mquzire to obtain a workers' compemsation policy,please call the Department at the number listed below. Self-rosined companies should enLa.their s elf-m sui�a ce license number an the appropriate line. City or Town OfEiciaTs Please be sure that the affidavit is complete and pruned.legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you mgm'ding the applicant Please be sure to fill in the pe�itl icease nwmber which will be used as a reference number. In addition,an applicant that must submit multiple p=:rUhcse applications in any given year,need only submit one affidavit mdicatmg cureat en p olicy information of necessary)and under"Job Site Address"the applicant should write"all locations in (chY or_ town) "A copy of the-affidavit that has been officially stamped or marked by the city or town may be.provided to the ' applicant as proof that a valid affidavit is oa file for future permits or licenses. A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is adv-anca for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's a.d�ss,telephone and fax nmozber: - • ' Thu- lh-of Massachnsatts Department cif lades dal Accidents dice af�t.�e�gatio.� . �Q4�asbingtan Stz . BQstac=MA EMI 11 Tf,-L 4 617 -4900 cxt 4-06 or 1-97 MASaAFE Fax#f 17-'27 7M Revised 4-24-07 masg-gQgId l ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C Parcel y .,-Application #Q 6 [-1 U g�p Health Division Date Issued �--! Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board tG Historic - OKH Preservation / Hyannis f1 Project Street Address Village r f Cu rr Owner �-j�1 Fit 2 L-- Address Telephone Permit Request 41>10 CFO_,U LnS E 1 N SU LAr"b CTD voeN pf�L ' 5eace Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new , Zoning District Flood Plain Groundwater Overlay Project Valuation '21 3D D Construction Type Lot Size Grandfathered: ❑Yes ❑'No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Cl Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: y o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use �O rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name, e;QTy4�VZ � Telephone Number ���" '352 Address 3D b ATE 13-b License # 1 D 1 l Lb+ A/W Home Improvement Contractor# 16 b(r S y Worker's Compensation # 6 D I ZAS LID 12b)2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO P1 Li- SIGNATURE eel v _b DATE 9 t l FOR OFFICIAL USE ONLY GiA Z� -APPLICATION# DATE ISSUED 5 s MAP/PARCEL NO.. ADDRESS VILLAGE OWNER l DATE OF INSPECTION: 1�4 i, FOUNDATION: FRAME f INSULATION., FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL ` :GAS: ��r w} < ROUGH t'�',) FINAL ; .1 `FINAL BUILDING# � DATE CLOSED OUT' - ASSOCIATION PLAN NO - ;s77 • ' The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)' FRONTIER ENERGY SOLUTIONS Address:376 ROUTE 130,SUITE C City/State/Zip:SANDWICH, MA 02563 Phone#:339-832-2823 Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with 8 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 g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance.; required.] S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l 1.❑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.❑✓ Other employees.'[No workers 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:AIM MUTUAL INSURANCE Policy#or Self-ins.Lic.#:6012954012012 Expiration Date:7/25/2012 Job Site Address: 81 ABBEY GATE City/State/Zip: COTUIT MA 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 hereb certi. under the pains and penalties 32fedury that the in ormadon provided above is true and correct —]Date]. 11/21/11 Phone#: 339-832-2823 Official use only. Do not write in this area,to be completed by city or town oJjiciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE10/18/2011 , ionaizoi i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 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 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 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). . _ PRODUCER CONTACT Rogers & Gray Insurance Agency Nam: PHONE FA: Inc IA/C. No. E:t): (A/C. No): a-MAIL PO Box 1601 ADDRESS: PRODUCER South Dennis, MA, 02660 CUSTOMER IDS. INSUREDS) AFFORDING COVERAGE NAIC 8 INSURED INSURER A: A.I.M. Mutual Insurance Co 33758 Frontier Energy Solutions LLC \INSURER B: 39 Siasconset Drive INSURER C: Sagamore Beach, MA 02562 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION .NUMBER: THIS IS TO CERTIFY THAT THE,POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAND 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 BY PAID CLAIMS. POLICY NUMBER POLICY EFF. POLICY EXP atrr TYPE OF INSURANCE OnJ®/—n O.V./Yrm LIMITS GENERAL LIABILITY RAM OCCURANCE 6 ❑COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 6. DREMISHS(E----en— ❑❑CLAIMS MADE ❑YL-UP, MED EZP (Any one person) 6 ❑ , PERSONAL G ADV INJURY 6 GE❑H'L AGGREGATE LIMIT APPLIES ER: GENERAL AGGREGATE 6 ❑PJLICY ❑PROJFf.'T❑1!C PRODUCTS-C@@/OP ADO 6 6 AUTOMOBILE LIABILITY - COMIDIN®91HOLE LIMIT - ❑,N ,� (ee eOid t) 6 ❑ALL OWED AUTOS BODILY INJURY (per person) S ❑SCHEIULED AUTOS BODILY INJURY(per accident) 6 . ❑HJRED AUTOS - PROPERTY DAMAGE (per idsnt) 6 ❑NON-CWIED AUTOS' ❑ 6 6 ❑UMBRELLA LIAR ❑ clam EACH OCCURRENCE 6 ❑EXCESS LIAB ❑ CLAIMS MADE - AGGREGATE $. . ❑DERX-TIBLE 6 ❑RETENTION WORKERS COMPENSATIONAND EMPLOYEES EMPLOYEES LIABILITY sR THE PROPRIETOR/PARTNERS/ E.L. EACH ACCIDENT 6 1,000,000 A EXECUTIVE OFFICERS ARE ❑ inCl ® excl 6012 95 4012 011 E.L. DISEASE -POLICY LIMIT 6 1,000,000 07/25/2011 07/25/2012 E.L. DISEASE-EA EMPLOYEE 6 1,000,000 CODXHNTB i DESCRIPTION OF OPERATIONS OR LOCATIONS: ALL MEMBERS ARE EXCLUDED FROM THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION CONSERVATION SERVICES GROUP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE � EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 50 WASHINGTON STREET POLICY PROVISIONS. WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVH OWNER AUTHORIZATION FORM 1, (Owner's Name) owner of the property located at ! (Property/Address.) Cv 1Vi.k MA Z�.3S (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Sigriature Date N1<<ssuchusetts=Department of Public fefi Board of Building Reu ndar lutions.and Stad .Construction Supervisor S s." License: CS SL id2778 Specialty License Restricted.to: IC CONOR :MCINERNEY 39 SIASCONSET bi4iv . SAGAMORE.BEACH, MA 02562 1; Expiration: 8/19/2012. Cummissiunci :....-... Tr#: 102778 _T1ze C/Joavrnauuea/l�i a�,/�aaaac�ivaetla ! Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 4kJ60854 Type:' Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Expiration: L8/2012 LLC � - _• Boston MA 02116- TTIERENEK.1050;t UTl3NS=jf. ! MCINERNEY COKj;Ot?�-,•_� .��i 135 STATE RD SUITE`#4;�-��s` ����;_ •. 'V�^."p�^• ; SAGAMORE BEACH; UndersecretaryNot-Valid without signatu ' I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel --..�.-AwlicatiOn # A5 Health Division ."Date Issued Conservation Division :.Application F Planning Dept. ...Permit Fee. Date Definiti4 Plan Approved by Planning Board 0 . Historic - OKH Preservation Hyannis Project Street Address Village '.CC��"t X1� Owner B Y_ I bLh 4 JeVX+P Y-1 k e,,.h Address Iq 6-6f, Telephone o(95 r ro C,_0,11 ft-h on 4` Y_ 16" o1a Permit Request rn S�1 un Ear 44-;) +1 1�`a ed'g 4-ralm ILAPO-P-P: ro� S'q'uare feet: 1 st floor: existing proposed 2nd floor: existing—proposed —Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5L-Construction Type Lot Size Grandfathered: L]Yes Q No If yes, attach sip orting C um8lation. " Dwelling Type: Single Family Two Family U Multi-Family (# units) :4 C�l Age of Existing Structure Historic House: Ll Yes LJ No On Old King's3i ghway: Q Yes No Basement Type: L] Full L3 Crawl El Walkout LJ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing* new Half: existing _never m Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Ll Gas LJ Oil L3 Electric Ll Other Central Air: Q Yes L] No Fireplaces: Existing New Existing wood/coal stove: Q Yes CJ No Detached garage: U existing Onew size—Pool: Ll existing Onew size Barn: Llexisting Onew size Attached garage: EJ existing Unew size —Shed: Q existing U new size Other: Zoning Board of Appeals Authorization U Appeal # Recorded U Commercial Q Yes Q No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -` Name eoywad Telephone Number OU2- Address _P0 License# MAn2( OS15 Home Improvement Contractor# ( LI 6 Z -7 Worker's Compensation # 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /-7/#f 4 FOR OFFICIAL USE ONLY F APPLICATION# DATE ISSUED MAP/PARCEL NO. _. !Fy' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r _ GAS: ROUGH FINAL FINAL BUILDING 3 0t l04p � DATE CLOSED OUT - ASSOCIATION PLAN NO. ' t it PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Don Bunker Insurance Agcy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 320 Washington St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW ` Norwell,MA 2061 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Cotult Solar Llc I Po Box 88 I 84 OLD SHORE RD I Cotult, MA 02633-0000 I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE I POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co LTR TYP!OP Oi✓DIRANCE POLICY NUMBER POL10YEFFECTRI!DA7! POLICY EV IRATION VAT! ANUAl ION ANDEMPLOYERS'LIABILITY LIMITS E PROPRIETOR/ PARTNERSIMCUTWE, OFFICERS ARE: INCL❑EKCL❑ 7422389 3/26/2009 3/26/2010 ATUTORY LIMBS EK CorempeAppllmIoMAOperdaie0*. CH ACCIDENT $ 500,00 ISEASE POLICY LIMIT $ 500,00 ISEASE-EACH EMPLOYEE $ 000.00 DESCRIPTION OF OPERATIONSIVEHICLESISPECIAL ITEMS RE:NO'PARTNERS ARE COVERED BY THE WORKERS COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION <'m TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL IQ BARNSTABLE,MA 02634 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 06/15/09 09:47 AM AIG Sma11BuSComp ,C4 Page 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w►vlv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): To-10-rLL C yad Ge ��r- Address: vo zo-< / City/State/Zip:co l U J, W 02(o3,5 `Phone.#: 5QPj— Ar�you n employer?`Check the appropriate.box: Type of project(required): r a employer with _ 4. C] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑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.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers'crimp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their Workers'comp.policy number. 1 an; an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,�� Si Insurance Company Name: / 2 �} T7nRurb_rre_ Policy#or Self-ins. Lic.#: 1 J [ Expiration Date: a2(p Job Site Address: 01 rl 66N Ga e City/State/Zip: 0 "0-tU I �, 2(Q 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 MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year impriscrurnent,as:ve11 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 hereb cert under he pains d penalties of peijrrry that cite information provided above is trite and correct. Si nature: Date: 0 _ Phone#: 29 1/- S7-Z( — 7 Lp 3 1 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.Building Department 3.City/Town Clerk C Electrical Inspector 5.Plumbing Inspector 6.Other 6 Contact-Person: Phone#: Town of Sandwich-Revised March 2008 16 Q .. _� � ulao�ns�an tan�.ars Boar ui ><ng eg One•Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement-;Contractor. Registration Registration: 146276 Type: DBA -.Expiration: 4/8/2011 Tr/* 282763 COTUIT SOLAR CONRAD GEYSER P.O. BOX 89 COTUIT; MA 02635 �r= Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0 40M-08/08-DBSLIFORMCA108212008 .. ..';/� I J2luP.Q� 4�a./I�LQadILCdLIIbP.� .. Boar o uildingtd Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 146276 One Ashburton Place Rm 1301 ExpraE[oc";_4/8/2011 Tr# 282763 Boston,Ma.02108 COTUIT SOLAR'" CONRAD GEYSER.c=; 3800 FALMOUTH RD` -_'} � � MARSTONS MILLS, Mi4'021i48 Administrator Not valid without signature ICI �1 - - IIi L it Ii ili ! I i II A(c o� I_ I COTUIT SOLAR P.O. Box 89•Cotuit, MA 02635. 508-428-8442•Fax 508-428-8450 Uwe Mou =�G /�o D��� I°rwM.��.►v� C H-r�-u a� Fo o'er Gpn v Lf`A L-k6 r Structural Certification Collector Manufacturer and Address: sun Ear Inc. 4315/Santa Ana Street Onario, CA 91761 4 Collector Model Number: Empire E - Gross Area: 40.8 Sq Ft Transparent Area: 37.3 Sq Ft Type of Glazing.. Low Iron Tmpr Thickness of Glazing: 5/32 -in (4.Omm) Yp 9 . The undersigned, an engineer registere in the state of Florida does certify that, having used generall accepted procedures, he/she has determined that the wind load that m- be sustained by the solar collector identified in the heading above wit out structural damage is at least 2Q74 Pa { 30 psf). Signed: _. Date May 3, 1994 1 - Typed Name oHenry Healey, P.E. Registration No. 35056 SEAL FLORIDA SOLAR ENERGY CENTER TEsting & OpErations Division 77�^r�C 300 State Road 401. Cape Canaveral. Florida 32920 I COTUIT SOLAR P.O. Box 89 • Cotuit, MA 02635 • 508-428-8442 • Fax 508-428-8441 • www.cotuitsolar.com 81 Abbey Gate, Cotuit- Brian &Katelin Kehrl 6: 4'x 10'solar thermal panels to be tilt mounted 3 on each side of chimney 3 1/2 Ibs/ft2 iwl l Z. Quality renewable energy "'ot=""41 '�� solar P systems since 1988 MMfl C Installer/ *0 Installer Design, installation, service CerW031409-40 Solar Thermal, PV, Wind '4�...• Conrad Geyser Cert#ST032407-B Conrad Geyser THE OEM SERIES It ModelsE C and P SPECIFICATION FLAT TSOLAR UPIRRIH SHEET THE VALUE LEADER IN SOLAR WATER HEATING TECHNOLOGY Stainless Steel Fasteners I Riveted Comers Low Iron Tempered Glass Low-Binder Fiberglass Insulation Rigid Foam Insulation jok Secondary Silicone Glazing Seal • Black Chrome Moderately Selective Black Paint Paint Absorber Coating "" -- • Copper Absorber Plate Integral • Type M Copper Riser Mounting Tubes and Manifolds Channel Extruded Anodized Aluminum Casing and • EPDM Grommets Capstrip Vent Plugs Primary EPDM Glazing Seal • 15%Silver Brazed Joint Aluminum Backsheet i i PROTECTING OUR ENVIRONMENT-SINCE 1978 URIORTH101. EMPIRE SERIES SPECIFICATIONS r� c c`r' cY' a c cor a?$\r° c� c c hero 3\ v� p EC/EP21 40 76 3 1/4 21.12 18.70 70 0.72 0.54 0.003 12 160 43 3/8 1 71.25 EC/EP24 36 1/8 98 1/4 3 1/4 24.61 21.88 80 0.78 0.62 0.005 12 160 39 3/4 1 93 5/8 EC/EP32 48 1/8 98 1/4 3 1/4 32.79 29.81 106 1.00 0.83 0.006 12 160 51 3/8 1 93 5/8 EC/EP40 48 1/8 122 1/4 3 1/4 40.81 37.33 141 1.20 1.04 0.009 12 160 51 3/8 1 115 5/8 EC/EP40-1.5 48 1/8 122 1/4 3 1/4 40.81 37.33 150 1.61 1.04 0.006 25 160 51 3/8 1 112 115 5/8 MODEL EC THERMAL PERFORMANCE RATINGS' MODEL EP Btu/ft/Day Btu/ft2/Da Category CLEAR MILDLY CLOUDY Category CLEAR MILDLY CLOUDY (r-Ta) DAY CLOUDY DAY DAY (11-Ta) DAY CLOUDY DAY DAY Ti-Inlet fluid temp 2000 1500 1000 TI•inlet fluid temp 2000 1500 1000 Ta-emblem air temp Btu/ft2/Day Btu/ftz/Day Btu/ft2/Day Ta-amblem air temp Btu/ft2/Day Btu/ft2/Day Btu/ft2/Day A(-9°F) 1,332 1,005 680 A(.9°F) 1,284 971 659 B(9-F) 1,218 890 565 8(9°F) 1,169 854 542 C(36°F) 1 1,040 1 720 1 402 C(36eF) 1 984 1 677 372 D(90°F) 1 699 1 405 1 127 D(90°F) 1 619 1 343 1 89 E(144°F) 1 390 1 137 1 - E(144°F) 1 280 1 62 1 - A-Pool Heating(Warm Climate) B-Pool Heating C-Water Heating(Warm Climate) D-Water Heating(Cool Climate) E-Air Conditioning/Industrial Process Heat. Thermal performance is obtained by multiplying the collector output for the appropriate application and insulation level by the total gross collector area. 'Collector ratings are derived from the Solar Rating&Certification Corp(SRCC)Document RM-1 and Standard OG-100. ENGINEERING SPECIFICATIONS (Performance specifications subject to testing error of+/-3%) The following shall be the specifications for the solar collectors.Collectors thermal isolation of the foam from the absorber plate.Total thermal resis- shall be SunEarth Empire model ,and shall be of the glazed liq- tance shall be a minimum of R-12.The sides and ends of the collector shall uid flat plate type.Collectors shall be tested in conformance with ASHRAE 93- be insulated with a minimum of 1 inch foil-faced polyisocyanurate foam 1986 and SRCC 100.81.The collectors shall be certified by the Solar Rating and sheathing board. Certification Corporation(SRCC)and the Florida Solar Energy Center(FSEC). ABSORBER PLATE AND PIPING GENERAL The absorber shall consist of a roll-formed copper plate of no less than.008 The dimensions of the collector shall be inches in length, inch thickness.Risers shall be a minimum of 112 inch O.D.Type M copper inches in width and 3 114 inches in depth.The collector casing tubing on no more than 4 112 inch centers continuously soldered to the shall be an anodized aluminum extrusion(alloy 6063 T5),minimum thick- plate utilizing a non-corrosive solder paste with a melting point of 460'F ness .060 inch, with an architectural dark bronze Finish.The casing shall The risers shall be brazed to 1 1/8 inch 0. D.Type M(1 5/8 inch O.D.on have notched framewalls for ease of plate removal and reinstallation.Sheet EC/EP40-1.5) copper manifolds utilizing a copper phosphorous brazing metal screwed fasteners shall be stainless steel(18-8#10).The backsheet alloy with no less than 15 percent silver content, and conforming to the shall be textured aluminum not less than.014 inch thickness.A 1 inch vent American Welding Society's BCuP-5 classification.EPDM grommets shall iso- plug shall be installed in each of the four corners of the backsheet to min- late the manifold from the aluminum casing. The absorber plate shall be imize condensation. designed for 160 psig maximum operating pressure. GLAZING ABSORBER COATING AND PERFORMANCE CURVE The collector glazing shall be one sheet of low iron tempered glass,with A)Black Chrome(EC Series):The absorber coating shall be black chrome on a minimum of 1/8 inch thickness(5/32 inch on EC/EP 40), and a mini- nickel with a minimum absorptivity of 95 percent and a maximum emissivity mum transmissivity of 91 percent(89 on EC/EP 40).The glazing shall be of 12 percent.The instantaneous efficiency of the collector shall be a minim thermally isolated from the casing by a continuous EPDM gasket.There mum Y-intercept of 0.714 and a slope of no less than-0.7271 (BTU/ftl-hr)/F. shall be a continuous secondary silicone seal between the glass and cas- ing capstrip to minimize moisture from entering the casing. B)Moderately Selective Black Paint(EP Series):The absorber coating shall be INSULATION a moderately-selective black paint with a minimum absorptivity of 94 per- The insulation shall be foil-faced polyisocyanurate foam sheathing board of cent and a maximum emissivity of 56 percent.The instantaneous efficiency a minimum 1 inch thickness,siliconed in place to the aluminum backsheet, of the collector shall have a minimum Y-intercept of 0.682 and a slope of covered by low-binder fiberglass of a minimum 1 inch thickness,providing no less than-0.7995(BTU/fte-hr)/F. Due to SunEarth's policy of continuous product improvement,specifications are subject to change without notice. MANUFACTURED eY. AVAHAEUE FROM: SORERR k tr Fr, 8425 Almeria Avenue-Fontana,CA 92335 (909)434.3100 fax(909)434.3101 O O Vt/UfUt/sunearthine.COnI f RFC YClFO PAPER-SOY BASED INK kenn N i i �oF rohti Town of Barnstable Regulatory Services • EiA,RNSTAfl4F � . rAS& Thomas F.Ceiler,Director Building Division Tom ferry, Building Commissioner 200 Main Strut, 14yannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-862-4038 _ pax: 508-7r90-6230 Property Owner Must Complete and Sign This Section If Using'A Builder I I ,as Owner of the subject property hereby authorize / L J/�l i,/�� �T to act on my behalf, in-A.matters relative to work autkb.orizcd by this building permit application for: (Addre s o ob) signatuv4 of ner Date 4kjzz p a �te1a rt. Print Name If Property Owner is applying for permit please complete the Homeo'vmers License Exemption form on the reverse side. fernmit:0 � S 7�o Town of Barnstable Regulatory Services prr > Thomas F.Geiler,Director Building Division Mmas>�. = Tom Perry, Building Commissioner � 1659. 200 Main Street, Hyannis,MA 02601 QED www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT N -; Owner: Leh ifIT Jol Phone: 5502� J-120�i Can; _ Z7n w Install at: A -e-,�j 7&4-f- Village: Map/Parcel: /1 - Q5 .Date: Stove cn m N A. New Use B. Type: adiant/ irculating C. Manufacturer: Lab.No. D. Model No.: Chimney A. New/Existing (If existing,please note date of last cleaning at j Pi SG j°l Fdcl(,t d B. Flue Size /9 5" ? FrWii� C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: UL s4yae' B. Sub Floor Construction: Installer Name: Address: Phone: " Location of Installation: H.I.0 Registration# Construction S ervisor# OR check Homeowner Installing,no license required J APPLICANTS SIGNATURE APPROVED BY: `l 7Z s/ '9e J• Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 103107 Town of Barnstable �pf THE Tp�� Regulatory Services ELASTABLF Thomas F. Geiler, Director MASS g .1.19. Building Division PTFD I'"p�A Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.town.barnsi2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 1 ak number street village "HOMEOWNER': ko- k r 5-D?1 y20 Q 6 S_.6 �I 70 �IC'0_ /.�g 2.6 name v home phone# work phone# (� CURRENT MAILING ADDRESS: ( 0 box -(;- 13 r_ aTul7— 4114 c72_4� !3 _ city/town state zip code The current.exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OR HOMEONVNER Person(s) who owns a parcel of land on•which he/she resides or intends to reside, on which there is,or is intended to- be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to.the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature ot Ho er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be.required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is rcquircd shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of constiuction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." .Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/ccrtification for use in your community. L oFtHETp Town of Barnstable Regulatory Services awaxsresce, Thomas F. Geiler,Director rFo JA Building Division Tom Perry, Building commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work aud-iorized by this building permit application for: (Address of Job) signature'of Owner Date _ } i Print Name ` If Property Owner is applying for permit please complete the.Horn eow-hers License Exemption Form on the reverse side. x- � x 7� ti w s y x s. �i M 3 = TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 2 \ Parcel 0 2 D Application# r 7 Health Division Conservation Division Permit# Tax Collector Date Issued t 2,0 k$ Treasurer Application Fee ID Planning Dept. Permit Fee 57,6�) Date Definitive Plan Approved by Planning Board nnnn,, Historic-OKH Preservation/Hyannis `1v Project Street Address Gi A i Village CpT✓ i-r' Owner K- 1-1 r:l.« I-�, gi�,l vi m, AddressT( A to r-V Cc; y j — Telephone Permit Request—'I" c, gE y L.Z C .-P „L--e_ 3.f ki Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuat' 6G`0'.Oh Construction Type Lot Size Grandfathered: &gYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 41/ Two Family ❑ Multi-Family(#units) Age of Existing Structure 2-P Historic House: ❑Yes ONo On Old King's Highway: ❑Yes Q�(N o Basement Type: Difull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count -Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing Clnew size Shed:❑existing ❑new size Other: m xr Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ <f co cn ;> Commercial ❑Yes ❑No If yes, site plan review# o Current Use Proposed Use BUILDER INFORMATION Name LaT u 1 -1- SU i-A-r2 Giyga !&LDS &Telephone Number 5 Address T- License# — — 2 Home Imp-rovement Contractor# % '7(42 y��� , Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � �.. ��;� ►,u, ( ca,u eT SIGNATURE DATE V-- r FOR OFFICIAL USE ONLY ! P&RMIT NO. a s DATE ISSUED E MAP/PARCEL NO. ADDRESS VILLAGE r e OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT • - a ASSOCIATION PLAN NO. 4' °FTFIE Z Town-of Barnstable Regulatory Services S is gaBLr, z Thomas F.Geiler,Director 9 MASS. $ 't .19- Building DiVISIOII Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 509-862-4038 Fax; 508-790-6230 Permit no. AFFIDAVIT. HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, •improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work i� f e_ut' 2al—A-215 Estimated Cost b 6- d .-6 d Address of Work: �� t" i" ^v - -A- AA-4- Owner'S Name: . - C Date of Application: I I I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 QBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNRI'EGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE .ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PEN krS.OF P Y I hereby apply for a permit as the agent of the owner Pat Contractor Name Registration No. OR Date Owner's Name Q:fmms]iomeLffidsv g-r...a'_'-^ �d ri`✓ 'i✓Vi''4�Y%96'� e�'�c. " ✓ / ✓anT..v L�+ liwo+� '✓vL� Board of Building Regulaons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 146276 Type: DBA Expiration: 4/8/2009 TO 131107 COTUIT SOLAR CONRAD GEYSER P.O. BOX 89 COTUIT, MA 02635 Update Address and return card.Mark reason for change: 5oon-05/06-PCO490 � Address Renewal Employment Lost Card . GTc�a•rrr�ruorcu�eal�/.c�:.•�liia��r�ridvk2• • Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 146278 0 , One Ashburton Place Rm 1301 Expiration: 4/8/2009 Tr# 131107 Bo toy Ma.02108 Type: DBA AT SOLAR !' SAD GEYSER , FALMOUTH RD: �y..aCl.e�.� "-' STONS MILLS,MA-02648 Administrator Not valid without signature JUN-21-07 01 _34 PM TALANIAN BUNKER INS AGCY 781 659 2499 P. 01 vas — via — a T C I = Wmij • .x. GAT!IhTM/OD c� 6/O5/0 THIS CERTIFICATE IS ISSUED A8 A MA R INED I 0 Bunker In6urance Agency ONLY AND CONFERS NO RIGHTS UPON E CC 2 Washington Street . HOLDER THIS CERTIFICATE DOES Nor D, . R;� ALTER THE COVERAGE AFFORDED BY E LILIES BELO W@ 1 COMPANIES AFFO�DI�10 _ E. Gf MA 02 0 61- COMPANY 81 ..659-0400 A( ) Scottsdale Ins. Co_ _ , o uit Solar 00M''A"Y Box 89 t f .a Granite State Insurande mpan= :i _. .�-- - COWANY 4 Old Shore Rd. A bells Protection Ins , o uit MA 02635- ..COWAI,, 428-8442' p I$19 TO CERTIFY THAT THE POLICIES OF INSURANCE L18TED BELOW HAVE BEEN 188UE0 TO THE INSURED NAMED ABOVE FOR TH vOOUCY PERIQ 1 DfiCATED, MAY 1 HB?ANOMIO ANY REGUlREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RISPE TO WHICH T HITiFICATE MAY BE 18SUEp OR MAY PERTAIN,THE INSURANCE AFFOgDED BY THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE 1ER; .;1 CLLI9lONS AND CONbRI0N8 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :1 TYPE Oi INSURANCE F AOtICII NUMBER - �pA (MM/001tlY! DALMY TE QIIMlDRAD —--`U umn _. LIABILITY ' COMMERpAI GENERAL UA87LRY CI;S 13 B 4 0 5 6 GENERAL ACOREGAjE Q,0 0 0 06/01/07 06/01/08 121000 CLAIMS MADE [$ OCCUR PERSONAL a ADi IN,NAY s 1,ON 0: OWNW6&CONTRACTOR'S PROT EACM OCCURRENCE /1 0 ' FlRE DAMAGE WQ orjeen) b 50 IVIED EKP en. )- 9 :5 0 0: ff(OMODILE UABIurf' ANY AUTO T/B/A 04/30/07 04/30/08 COMB1NEo s+NCILE LIM• IT i ` 1,00:0�0 0° ALL OWNED AUTOS I - BCHEOULEDAUT0.9 BODILY INJURY • b (Pei p9mom ! , HIRED AUTOS —_— • ""— NON OWNEOAUTOS BODILY INJURY 8 (Per weidu+p — PROPERTY DAMAGELOAA i OEUABIUTY AUTO ONLY:EAAOODENT I i ANY AUTO !— -- / OTHER THAN AUTO ONLY: - EACH ACGDENT i_...... AGGREGATEWig"LIABILITY EACHOCCURRENCE i • UMBRELLA ROAM 'I / I I ACiDREDATE_----• 8 , OTHER THAN UMBRELLA FORM PLO FR8' IABIOLMUTY COMPENSATION no I X - ._ I _ t/b/a 06/05/07 06/05/08 ELrAACHncaoeNT _ 6500 00 POR9�UTV INCL ELOBEASE-POUCY.LNNIT 0500L00 CERB ARE: X EXCL EL DISEASE-EA EMAAME $5 0 O 0 0 0 6R DNOFOPERATIONSILOCAMNBNEHWU[S wAIITEMS ....... m... . SHOULD ANY OF THE ASOV! DEEMSE0 POUCIED BE ELLEO WOKE I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO L . XL GAT!WRITTEN NOTICE TO THE CERTIFICATE HOLM AHED TO THE LEVY. f ( BUT PAILIM TO MAIL SUCH NOTICE SHALL IMPOSE NO COL TION OR UABI OF ANY KID UPON THE COMPANY, RB AGIVS 01 REPREBBNTATIV i AUTOO ATIYB i. �.. - ex � ( 1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 = wwK.massgov/dia Workers'Compensation Insurance Affidavit:Bngders/CoutractorsMectricians/Plumli rm Ap]&cant Information Please mint Let=l'bIV Name(Bnsi�Orttiao : Address: P. City/Stawzip: Phone#-- Are S �•4 Z "z $`t 'Z- �,,(�on an employer?Check the.appropriate boa: Type of project(required): L M I am a employer vi►ith '� 4. ❑ I am a general contractor and I- 6.' ❑New constraetion employees AMR anatoi pail time). have wed�e sub-couszaciurs 2.❑ I ama-s sale pmpii boi orpaitneer listed-on the attached sheet$• 7. []Romodelmg strilf ave to emp1mices These sab-contractors have 8. ❑Demolition worlemg for me in any capacity. workers' comp.msmamce. 9_ �fti.cil-r-epairs g additiori'(NowozkeW cbmP=insurance 5- ElWe are a c orpo�on and its-] officeis have exercised flieslU. eit or additions 3.❑ I am.a homeowner doing all work right of exemption per MGL 11_❑Plumbing repam;or additions .Rysel£ jl�To>workers':qp ' c. 152,§l(4),and we have no. 12.0 Roof repairs enobyeeS-[N. ,. o workers 13.0 Oflmer ��-insurance likailrbil-] 'Any appliw�8�st checks b9a mNst a15o 511�!&e section below shawiag @yea wa'ts' au Po9a t Haaxow�s wLo snl�mit8as e�dnvrt m 8tey me aemg`nII warlcmmdBun 1�cede oisn estsn7:mit anew affidvit m sac k - zCCUMMWn ant chcctta6slim ion at oa ri add'[Qonel�cet s�awiag rename ofmasnb- sad t�ir worms' I am an mWloyertliQit#prov AW workers'cmwwsatwn insurmrce for dry employees .Below ispoluy the 'obsite Insurance Compar}c C C-66tt PA +•r°}` Policy#or Self-ins-Lis#:_ -y r CT 2 y V - 91- 7 S Eamon Date: /30�2--'P Job Site CILY/Slatelzip: Attach a copy of th,.rorkers°compeosationpolicy dedaration page(showingthe poficy number add aspiration date). Fal-h=to swmGe coverage as required under Section 25A of MGL a 152 can lead to the imposition of cai»nal penaldes.of a:,, fine up to.$1,Soo.00 and/or one-year io>irrisomne as weIl as civil penalties in the form of a STOP WORK ORDER and a_fine of Up to$250.00 a day aphistthe violaim Be advised 9W a copy of1his statenuntmaybe forwardal to�c Officc.of- :t.,. Investigations ofibe DIAft-insmanee coverage vim,. I do hereby under ppna S ofpgrJlziy the ixf p above is •.and. . Simatore- - Phone ( � O,�cW use only. Do not write in As area,to be completed by city or town ofieiaL City or Town: Piiifllacense# Issuing Authority(circle one): L Board of Health 2-Buflding Deparbneut 3.City/Town Clerk 4.Electrical Inspector S_Plumbing Inspector 6.Other Contact Person- Phone#: • ..gin evergreen Think Beyond. SPRUCE LINE TM New 195W module photovoltaic modules • Highest power and efficiency yet • Best available tolerance -0 / +2.5% A range of high quality poly-crystalline solar panels for on-grid markets offering exceptional performance,extraordinary versatility and industry- leading environmental credentials based on our cutting-edge String Ribbon'"wafer technology. • Best-in-class performance ratings proven by field installations • 98%of rated power guaranteed for 180,190W product; 100%guaranteed for 195W product 5 year workmanship and 25 year power warranty for ultimate peace of mind' • More installation versatility with our extensive range of mounting options • Higher strength with wind and snow loads guaranteed up to 80 Ibs/ft2 • Qualified to all major industry certifications and regulatory standards • Smallest carbon foot-print leading the fight against global warming • Quickest energy payback time for the maximum energy conservation • Cardboard-free packaging for minimal on-site waste a c® Div O C E and disposal cost 'For full details see the Evergreen Solar Limited Warranty available on request or online. This product is qualified to LIL 1703,LIL Fire Safety Class C,IEC 61215 Ed.2,TOV Safety Class 2 and CE String Ribbon and Spruce Line are trademarks of Evergreen Solar Inc.String Ribbon is also a patented technology of Evergreen Solar Inc. s r 0 • Electrical Characteristics Mechanical Specifications Standard Test Conditions(STC)1 37 ES-180 Es-190 Fs-195 -- ---S.s 0.16 AL.SL TL mVV RL,SL,TL w VV RL,St,TL or VL• I II GROUNDING HOLE 3.5 Pmp2 (W) 180 190 195 Ptcleranee (%) -2% -2% -0% - Pmp,max W 186.1 194.9 199.9 I Pmp,min (W) 176.4 186.2 195.0 Pptc3 (� 159.7 168.8 173.3 d FOR�ira-6BOLT Vmp M 25.9 26.7 27.1 �U PN5M1C)TION BOX Imp (A) 6.95 7.12 7.20 CABLES(AWG12) V. M 32.6 32.8 32.9 . Ix (A) 7.78 8.05 • 8.15 m A�M NUMODIZED FRAME Nominal Operating Cell Temperature Conditions(NOCT)" . Pmp (W) 129.0 136.7 140.1 Vmp M 23.3 23.8 23.9 C©CONNECTORS Imp (A) 5.53 5.75 5.86 (Type 3) V. M 29.8 30.3 30.5 t N Isc (A) 6.20 6.46 6.59 5.8 GROUNDING HOLE TNocr (°C) 45.9 45.9 45.9 �.1s '1000 W/m°,25°C cell temperature,AM 1.5 spectrum; GROUNDING NO ,Maximum power point or rated power 1.6 35. 'At PV-USA Test Conditions:1000 W/m2,20°C ambient temperature,1 m/s wind speed All dimensions in inches;module weight 40.1 Ibs 800 W/m',20°C ambient temperature,tm/s wind speed,AM 1.5 spectrum *RL model made in Germany without cell texturing;SL model made in USA Product constructed with 108 polycrystalline silicon solar cells, anti-reflective without cell texturing;TL model made in Germany with cell texturing;VL tempered solar glass,EVA encapsulant,Tedlar®back-skin and a double-walled model made in USA with cell texturing anodized aluminum frame.Product packaging tested to International Safe Transit Association(ISN Standard 2B.All specifications in this product information sheet conform to EN50380.See the Evergreen Solar Safety,Installation and Opera- Low Irradiance tion Manual and.Mounting Design Guide for further information on approved The typical relative reduction of module efficiency at an installation and use of this product. irradiance of 200W/m2 in relation to 1000W/m2 both Due to continuous innovation,research and product improvement,the specifica- tions in this product information sheet are subject to change without notice.No at 25 C cell temperature and spectrum AM 1.5 is 0/o. rights can be derived from this product information sheet and Evergreen Solar assumes no liability whatsoever connected to or resulting from the use of any Temperature Coefficients information contained herein. a Pmp (%/°C) -0.49 Partner: a Vmp (%/eC) -0.47 a Imp (/o/*C) -0.02 a V. MY*C) -0.34 a Ix (%/°C) 0.06 System Design Series Fuse Ratings 15 A UL Rated System Voltage 600 V 'Also known as Maximum Reverse Current , ELECTRICAL EQUIPMENT CHECK WITH YOUR INSTALLER S195_US_010707;effective July 1 st 2007 Worldwide Headquarters Customer Service-Americas and Asia 138 Bartlett Street,Marlboro,MA 01752 USA 138 Bartlett Street,Marlboro,MA 01752 USA Evergreen Solar Inc. T:+1 508.357.2221 F:+1 508.229.0747 T+1 508.357.2221 F:+1 508.229.0747 www.evergreensolancom info@evergreensolar.com sales®evergreensolar.com ' - THE Town of Barnstable. T°�y y Regulatory Services sB MASS. Thomas F.Geiler,Director �AlFGMAKA� ]Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ",w.town.b arnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property ze ior auth hereb Y : r L� L � to act on my behalf, in all matters relative to.work authorized by this building permit application for: . n r (Address of Job) 1 Q oy Signature of Owner ! ate 999 Print Name Q10RI iS:OwNERPERMISSION Nov 28 06 09: 11a Cotuit Solar 5084288450 p. l j . J � oL 0 (L 4i , !JDL / �• J .j /x/ � ..` • .. ':� v 10 / y oo r. w a � Engineering Dept.(3rd floor) Map 0 02 l Parcel O ad Permit# p 7 House# Date Issued -7— Fee N IKE Ty Planning Soar ' BARNSTABLE. TOWN OF BARNSTABLE Building Permit Application 7roject'Street Address S /9' Village Owner /1/1/j . (^j�S0-)� Address Telephone Permit Request First Floor square feet Second Floor square feet Construction Type 2 Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name (`bey) �itc�ye� Telephone Number Address 7 / D" &-)-i CIA License# Home Improvement Contractor# Worker's Compensation# &V/ l� ZZR 563 oiy NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE j�/ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 1 1 .! - �4ffi„tsaas? �'��3�t�ie�er+aas5xr�aa�raz�a�a�m�utur•�ag;y�,ix> " � l:9fF"4D��:"�3�a ��.r:+GFf.6372�7i33Ct�'7$K53Gr7�y ygp,¢�p�CC'+348,C�.,' , f 1 + t M . The Conintonn-calth of Afassachusctts Department of Industrial Accidents a / fi t 0 ice o!/ttvestiyations - •: 600 Il uAin,�ton Street Boston,Maaa. 02111 Workers' Compensation Insurance Affidavit A _..�.. .._ b.t.l _ ._..___.....-.__.... ._ ...._._!._._.._-. __.-_...-__... w nlicant tntorniation: �'�• ' -• Please PRIIVT•le •...........d..-•---�,aYr..-,..._,.,,.,,..,`.1...,�.._��,., __� name• �ey�y 1`�.�.z�/� location: 7 f i j/9-YZ ✓�QC/on �JsQ. pity 6 phone c� 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity • ._.ra..:•..m.-•,S-'-^--t•-`-r-.�'-sC!!'�glAe��.._-...+i7«.•-1R..e�.r:�,.•P�!'.�.!.-. .,...�y,.,.....,..�-r,,.-•......�p�..�.,.;..,....,.,•rr.-�-•—,.a•ay. ". ....."...�w..a1..- --'-- -.z.a:�"�- 1 �e1..L.,:a. '--:.Lal..`ii..i�l3r.+=a.�.: ...:.: - — .�6L:h•- -�:.�� I am an employer providin"workers' compensation for my employees working on this job. company n•rng: Fl/l C( S �/ppP'1 C�n� address: Y/�isP city: phone#• insurance Po )o. � lie•# o� c - - �—e 1- .. .�, ,�y,. .....es;nor•....«:.www...�+!.Iw+h�•.'�+•..�.m...rr........ .n►•.N.s ;�..._..,�..,..'.':"..""".' .. I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name- address: cih phone#• insurance co. Policy# 1- - .. __ - _... K.Rt:. ':7��'o..vr,r;•:.'�'�ct��'f"a:��:_.�•,---ue•rrre,.��1��'T:!:►.�"".•a'.gf+:.:`.�n.;':,s���:�:rr•rr..-:�.;:moi•^'e--�..-r-e. company name- address: rih•: phone 0- insurance co. nolicy# :Attach additional'sheii if necessary" %.�"' w_ �_- +` ��r• - _ %�: _ _ _ ..-._. ar:.i��..a- - _ _ -- -:riJ Vi` �SrL10l•"M�iY`...itL..lNci.�iR1'Y Failure to secure�....covera�.---ge as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Of ice of Investigations of the DIA for coverage verification. 1 do hereby certif in the pains ta/ erjun•that the information provided above is true and correct. Sicnaturc Date �l Print name I -)e-M?tij f��`��'� Phone# official-use only do not write in this area to be completed by city or town ofriciai city or town: permitAicense# r Building Department C3Liccnsing Board,, check if immediate response is required ❑Selectmen's Office [311calth Department contact person: phone#: rJOthcr (re,'Iscd 3,15 rtA) • Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted From the "law", an eynploree is defined as every person in the service of another under anv contract of hire, express or implied. oral or written. An enrp/orer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or more . the foregoing, engaged in a.joint enterprise, and including the legal representatives of a deceased employer, or the recciver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling_ house having not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or on the `_rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe-. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance of- renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally- neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with.the insurance requirements of this chapter ha-, been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers compensation policy, please call the Department at the number listed below. Cite• or To-wris Please be sure that the affidavit is complete and printed legibly. Tile Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate'to Give us a call. I _ The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone 9: (617) 727-4900 ext. 406, 409 or 375 w J �VIE! d The Town of Barnstable • esaNerne�. s _. ���' Department of Health Safety and Environmental Services 1"9ram, . Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen ' Building Commissioner Fax: 508-790-6230 For office use only Permit no.__ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost 00e Address of Work: Owner's Name �� S Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the en of the owner. ate Contractor Nhme Registration No. OR' Date Owner's Name Assessor's offioe (1st floor): . Assessor's map and lot number THE � Qa�Q of To Boarl of. Health (3rd floor): Sewage Permit number ......... �'.✓r ,�........................:.... r 2 BABD9YADLE, S E+hgineering Department (3rd floor): SAea House number ............................................ op,1639. * APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only' I TOWN OF BARNSTABLE BUILDING .INSPECTOR APPLICATION FOR PERMIT TO. �� t'` . ................. TYPE OF CONSTRUCTION ..... 0 ........... ..�......................19.TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follor. ................N wi information: Q' L Locatiort ..... -J�. 2- Proposed Use ......Pes.f-....AQ ................................................................................ .........,,........................................ ZoningDistrict .......... ................................................Fire District ...... .`�.. .. ...................................................... Name of Owner .. .... . ............. ......... . `�..........Address .................................................................. ................ ................ Q� ` � ��t? � 2 Name of Builder ke t. :................Address [.......................... Nameof Architect ................................................:.................Address ................/............................................. ....................... Number of Rooms ............../..................................................Foundation ......�Q"4.� ,................,..... Exterior ......./...........J./.:..... .....�s✓.... C . 2,�� ..........i..Roofing ..... ..... Z Floors 779 •`•.C, ...............................................................Interior .................. . ......... ....... ........................................... Heating ...............10k........................................................Plumbing ................04.4.................................................... Fireplace ............... .......................................................Approximate Cost .............1,0%OGG................:.... . Definitive Plan Approved by Planning Board _-------------------------------19________ . Area ....../. , ....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH . _StAk to ,7 � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the T of Barnstable regarding the above construction. Name . .............. ... .......4................. . ............................. Construction Supervisor's License ............ Nm...... GIBSON, GEORGE & MARGE No .... Permit for ...Bul.ld...S.u.n..R.o.oa. SinglSingle Family Dwelling................. . e ...................... Location .....§L�lala ..Gate Road ......................................... Cotuit .................................. Owner .....George & Marge Gibson............... Type of Construction .....Frame.......................... ............................................................................... Plot .......... Lot ................................ Permit Granted .......August 18,.................................19 06 _Date of Inspection ....................................19 Date Completed ............. ............19 Assessor's offioe (1st floor): Assessor's map and lot number ... �........Qo?Q........., e�oFTNETo�` �9� i - Board of Health (3rd floor): �/_✓r ewage Permit number ........................ .......................... '••" Z BABd9TGDLE, i Engineering Department (3rd floor): 'moo 1639. House number ........................:................................................ 0�0 6�0 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.-2:00 P.M. only" TOWN OF BARNSTABLE ,BUILDING INSPECTOR APPLICATION FOR PERMIT TO i............... L.h-- ........................................................... TYPE OF CONSTRUCTION ...... ?ad..C` Y2k.t, � �� ..'��` ............ . ..� ................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: I LocotioQ l.................. ......................................... .................................`...........................................................:..................... J�J ProposedUse ......I. .. .................... ................................................................................<......................... ZoningDistrict .......... ......................Fire District c ................. G .................................................... �' ivc . z G��sPL• ...................................................................I................ Ak Name of Owner ....,.......... ................ ......... . -�Q� ................A Address I Name of Builder .... . \........... ..... . t. j..:................Address .................. 7........ � ,. ....If........................... � Nameof Architect .........................................Address .....................,.............................................................. Number of Rooms ..............,..................................................Foundation d.!5. .........(�`14,Cl/......... .......... Exterior , ./ .l.. ...... ...............................Roofing ..... .5 A, ,2,'� ........ ................. Floorsr� .. ,...............................................................Interior ..................`!............ .............................................. Heating .............1J! (.........................................................Plumbing ................1�6."......`�. .................................................... Fireplace ...............ha.44.......................................................Approximate Cost .............0,06G........................ Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ......� ........ ............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH to i Rot V4 rat OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ .A........`................ ........................... Construction Supervisor's License ............OHM...... GIBSON, GEORGE & MARGE A=021-020 A, No Room ..... Permit for ..Build Sup .................................. Single Family Dwelling ..................... y ...Location 81......... ..�.9.a t e...Road... ..................... .. . ...... ... .... Cotuit ........................................................................ Owner ........Ge.o.r.ge...&...Mar.g.e...Gibson. . ............ . .... . . .... . ...... . . ...... . .... Type of Construction ................Frame.......................... .......................................................................... Plot`............................ Lot ................................ Permit Granted ......Avzu5t...1 ............1986 Date of Inspection .....................................1 9 Date Completed ........................................19 7Yu 2 $I.6H x ^` m ; O xo Q� m � �n co �N it bM b mr •'� z . r � O T z i Z �, --Jv m C2 \N. ;D ;m ;.� �o b� z N 0 m m c� r O ' z MM o t1'I A RENOVATION/ADDITION FOR: I •• r — m c 831 Main Street D U) KATIE & BRIAN KEHRL X Q3 arch itects, i nc Dennis.MA 0phon U) j 81 ABBEY GATE 508.694.7887 phone 0 Residential Commercial Net Zero www.a3architectsinc.com Z COTUIT MA 02635 N NOTICE OF COPYRIGHT: THIS DRAWING 5 THE PROPERTY OF THE ARCHITECT HAS BEEN PREPARED SPECIFICALLY FOR THE OWNER FOR TH6 PROJECT AT TH6 WE AND IS NOT CF) TO BE USED WITHOLJT WRnTEN CONSENT OF THE ARCHrEC'T 0 AB ARCHREM. INC 2016 C/ v 1. z I C2m 0xK K � � c ? a-) C O Co0 . r N o im m > c X m 00 X D_ vm � -n � X m � G) n m90z Imo Z DZ -0 co 0 G) G) v n mcv M � x v m � � zA � � m z ; m Q, cn —F --F 11 I I I I I I I I I I I I I II I I I I I I I I I I I I I -� I-1101 -2 I�`I I J I I IV I o I - I I I 0 I O ON bU 0Xn I gm x I y .� • nr. o z I. 0 < I o � 0 I I X z I z I I I I+ I -4 I I o_ I I 1 I 8'-611 4E-0EE 4E-01I v v A RENOVATION/ADDITION FOR: m 0) -i 831 Main Street m KATIE & BRIAN KEHRL Dennis,MA 02638 A3 architects, inc 508.694.7887phone D n O 81 ABBEY GATE o Residential Commercial Net Zero www.a3architectsinc.com -0 COTUIT MA 02635 Z � � W O o � N NOTICEOf NPYRIGHT. C? TH6 OMWMG6 THE PROPERTY OF THE ARCHITECT HAS BEEN PREPARED SPECINCALLY FOR THE OWNER FOR THIS PROJECT AT THIS SffEAND6NOT E"�'� TO RE USED WITHOIFF WRITTEN NNSEM OF THE ARCHITTU 1 1 1 0 A7 ARCHIFECIM,INC 2016 1171 r O u Z J O � H _ p Y M O Q Q o co NEW CEDAR RAIL WITH < cd w CEDAR POSTS (NATURAL) 0 w m w QQ -4 0O Q Y O0U NEW 4X4 PT POSTS TITLE: TRIMMED OUT AT DECK ELEVATIONS NEW CEDAR RAIL WITH CEDAR POSTS (NATURAL) EW 2X10 PT FLOOR JOISTS WITH (3)2X10 e NEW 4X4 PT POSTS DROPPED BEAM, ° g TRIMMED OUT AT DECK COMPOSITE DECKING BY Goo •S rLl OWNER d r a d v Q ao G c r e A N P O C O N M y C F COS H 3 NEW 2X10 PT FLOOR JOISTS WITH (3)2X10 C o DROPPED BEAM, y COMPOSITE DECKING BY • N s OWNER ^+' a� v �t NEW STAIR& RAILING TO GRADE,VERIFY EXACT •PP _ RISER NUMBER WITH ivo EXISTING GRADE i VU 08 _2 08 as �- I 10'-4" c �5� 11 e€ I I Iiioa ZL NEW 12"0 CONC. PIERS, NEW STAIR& RAILING Date: 48" BELOW GRADE, MIN. TO GRADE,VERIFY PERMIT 09.30.2016 EXACT RISER NUMBER WITH EXISTING GRADE LJ LJ LJ LJ NEW 12"0 CONC. PIERS, . A-2 48" BELOW GRADE, MIN. I 1 SECTION/SIDE ELEVATION 2 DECK ELEVATION