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0191 WEST WIND CIRCLE
�� u .a, .� � � o �, p � ,i. � �� � ', o � a'. o ,. .. i�. � i j � i. ,. Y ,� IF '' 71 �� ,� �� i, ,. .. r.11 ., � � ,. I � � n i • � ... � .I � r � �� � ,' ., � ., ... .,u - � �. ., l� �,. .. �� a ,n .�. � o � .. .:.mow-.-...-.�...,.�,,,�..,�,�,e,,•,.�,,, "----,..-..na _� _.. �� �, ., � .� Town of Barnstable Building • BAWWA Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. ^� �� a �A Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-3138 Applicant Name: THOMASJ LEE Approvals Date Issued: 10/02/2019 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 04/02/2020 Foundation: System Map/Lot: 121-011-039 Zoning District: RC Sheathing: i Location: 191 WEST WIND'CIRCLE,OSTERVILLE ''-� Contractor Name: THOMAS J LEE Framing: 1 Owner on Record: LEBLANC,JAMES A&WULFING, ROBERT B Contractor License: 172 2 Address: 191 WEST WIND CIR Est. Project Cost: $0.00 OSTERVILLE, MA 02655 z Chimney: Permit Fee: $35.00 Description: INSTALL WIRELESS SMOKE DETECTORS WITH SOUNDER TO Insulation: E Fee Paid: $35.00 EXISTING SYSTEM Date: 10/2/2019 Final: Pro Review Re 1 q � y Q Plumbing/Gas�- 'YID .............. `� G"�'✓ Rough Plumbing: } �`'�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"yissuance. All work authorized by this permit shall conform to the approved application and the approved construction 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. 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 Final Gas: work until the completion of the same. I Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 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 Final: 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). r Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: a I - �` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i ' Map v ( Parcel `� � Application #:. pp U ►,.'�alth Division BUILDING, DEPT• Date Issued o ,7 Conservation Division i Application Fee { SEP 2 3 2419 Planning Dept. Permit Fee Date Definitive Plan Approved by Plainning Board �� 16N OF gp►RNS1R�1 _ .,M Historic -bKH Preservation/ Hyannis Project Street Address Village 05'1*�-N-\f,;UL E MA . O 1.L S.5 Owner 1�o b WU..L _I'L 6- Address- Telephone So g_ Cs 91- %O;4 , Permit Request T.*.4.stwy- �- w�n+� �t 5...or4:o�'�C.�mt�J u�'fN �e.+►�aEb� to w C rry L —'tyre. C ' i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay I ,project V iluation 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 1 0 Walkout ❑ Other Basemer IL Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I 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 0 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached!garage: ❑ existing 0 new size—Pool: 0 existing ❑ new .size _ Barn: ❑ existing ❑ new size_ i Attached garage: ❑ existing ❑ new 4 size _Shed: ❑ existing ❑ new size _ Other: 1 t Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �, ommercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use { i - I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) —>qame rl�rv� I Telephone Number Address License# 01 i { Home Improvement Contractor# i Email 1 { Worker's Compensation # h%WC- 7Iy 3 n so a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -'�--. Al SIGNATU E / DATE Q Z3 1 i i 1 i .,All The Comreaonweafth of PTassachuseits ._ Delrpartment of In,dustrial Accidents 4� .01 _ _ � ..- Office of Investigations 600 Washington Street ` Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractolrs/)Elect>rleians/Pla><mbers _applicant infer-mation Please Print Le ib Name (Business/Organization/Individual): LL( Address: � C S' Vi<is` 6 !p_, 7i�E s�. L. La��� City/State/Zip: " . F S' Phone Are you an em-pIoyer? Check the appropriate bog: Type of project{required): 1.��am a employer with Q'-15 4. ❑ I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. 0 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 S. ❑ 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.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13.[3Other 0 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. !Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. 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: 0 L Policy#or Self-ins.Lic. #: rh\M C :3 1 4 3 1-7 0 0 Expiration Date: �/ I Job Site Address: r(q j V) WIG" 0 4lu"-L4 City/State/Zip: ®S fEP_N.4 LV4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify gader the pains _ e, a er' y at the in rm n provided above is true and correct. Si atufr'e: / Date: lc Phone#: 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 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: l DATE(MMIDD/YYYY) CER ITpG�pc ATE OF �pA[�UTY ��SURANCE 10/01/2018 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 endorsement(s). CONTACT PRODUCER NAME: Marsh USA Inc. PHONE FAX 1560 Sawgrass Corporate Pkwy,Suite 300 c o •t (A/C.No Sunrise,FL 33323 E-MAIL ADDRESS: Attn:FtLauderdale.Certs@marsh.com INSURERS AFFORDING COVERAGE NAIC# CN109418288-ADT-GAW-18-19 INSURER A:Old Republic Insurance Co 24147 INSURED INSURER B: ADT LLC ADT Security Services INSURER C: 245 Winter Street,Suite 200 INSURER D: Waltham,MA 02451 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004803800-07 REVISION NUMBER: 3 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY MWZY314318 10/0112018 10101/2019 EACH OCCURRENCE $ 2,000,000 DAMAG TOR NTED 1,000,000 CLAIMS-MADE FD OCCUR PREMISES Ea occurrence $ X SIR:$500,000 MED EXP(Any one person) $ X Professional-Llab Included PERSONAL&ADV INJURY $ ,000,000 4 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ,000,000 X POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ 4,000,000 JECT OTHER: A AUTOMOBILE LIABILITY MWTB314319 10/0112018 10101/2019 (E.- ccdentSINGLELIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULEI5 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Per accident) $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ _ $ A WORKERS COMPENSATION MWC31431700 10/01/201�8 10/01/2019 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 2,000,000 ANYPROPRIETORIPARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 2,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ,,yes describe under E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ADT LLC dba ADT Security SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 245 Winter Street,Second Floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Waltham,MA 02451 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Vincent Zollo —7��-5 -� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I rr Fold,Then Detach Along All Perforations C®MG�Ii®NWEALTH OF M ELECTRICIANS _ 2 ISSUES_T11E FOLLOWING LICENSE REGISTERED SYSTE_M-CORTRA.CTOR THOMAS J LEE - z ADT LLC GBAADViSECURITY 31 CA.PTIUR_RD z Wi4tEOLE. MA 02081 2042 � , 172 C + 0713112022 640581 - EL In M1au i Commonwealth of Massachusetts C Division of Professional Licensure V Sec u rV.,ijfstei"-,-&�-License 7. SS-001779 _I 'tiXpires: 0511612020 THOiAS J LEE�� Employed by' ADT SECURITY Commissioner C14 a - Narrative Report Fire Alarm System 191 Westwind Cir Osterville SCOPE OF WORK ADT is upgrading our burglary and fire system at the above location. We are installing six [6] RF smoke detectors. Please see the attached plans. BUILDING DESCRIPTION This is a single family home with one level of living space and an unfinished/finished basement. FIRE PROTECTION SYSTEMS TO BE INSTALLED The ADT COMMAND panel is to be installed, Honeywell SEQUENCE OF OPERATION The fire alarm control panel will signal two types of alarms.Supervisory alarms will be silent(tone at the panel).A signal will be sent via the Cell Guard wireless signal to the ADT Customer Monitoring Center. The panel also has a backup communicator through the internet as well.The proposed system when triggered will notify all floors.ADT will, upon receipt of a supervisory signal, notify the call list on file and dispatch the appropriate safety personal. Fire alarms, if activated either manually or automatically will sound audible devices along with sending a signal to ADT's Monitoring Center. Per Barnstable Fire Dept., ADT in order will, upon receiving the fire signal,immediately contact the customer then per NFPA 72 sec 2-4.9.2 after receiving confirmation of the alarm or getting no response from the premises,ADT will then contact the Barnstable Fire Dept. TESTING CRITERIA ADT will perform a complete system pre-test prior to scheduling and arranging the final test with an inspector from the Barnstable Fire Department.ADT will have technicians and all necessary equipment available. Upon successful completion of the acceptance test,ADT will furnish the inspector with all documentation that has riot already been supplied. SUMMARY AND CONCLUSION We take our positions and responsibilities in situations such as the design,specification,and installation of Fire Alarm Systems very seriously. If there is anything I left out of this narrative, please let me know as soon as possible. My responsibility to my client is to make the approval process go as smoothly as possible. I will endeavor to do everything I can to fulfill any request for information. Sincerely Leo F. DeMars ,Jr. Custom Home Services Consultant ADT Security Services 245 Winter St, 2"d. Floor Waltham, MA 02452 Cell: (508) 685-8583 Email:ldemarsh@adt.com p P,C i Residential Fire Alarm System Plan IIIIIIIIIII5Ill0lllllllUllllilllllllll2llllll Customer Information Branch Information Install Completion Date: Bt. Name: Name: Rog, "L-;rttA e- Phone#: -1 t&L. 4g-L Address: ! Ne./i S i Vy too —ta? Certificate of Registration#: ACR-1761536 City/ZIP: dlg3gg1Q k,LL L 1941 / Legend: Use the following symbols to create the customer's fire alarm system plan. CP F ��I n O S� SE Control Heat Smoke Smoke HVAC Panel Keypad Sounder Strobe Detector Detector Smoke Register Detector VZAJ I 1 t 't I I 1 /s s LE E,UILI ING DEP . WE ACustomerNam4ed,©(� W i.�1i.1 1 nA� Customer Sign t re: FIRE DEPARTMENT DATE G ADT Representative Name: L —p po WA, APS/RAS Licensee Name: License#: APS/RAS Licensee Signature: ©2016 ADT LLC dba ADT Security Services.All rights reserved.(01/16) Original(ADT) Copy(Customer) L Town of Barnstab N-OF BARMAN Building Department Services Brian Florence,CBO M q' 25 R i6l �`� Bwlding'Commissioner ; 200 Main Street,Hyannis;MA 02601 www.town.barnstable.maas" Office: 509-862403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If UsunvAB,wilder, I, L O e-�l Al e _,as Owner of the subject property hereby authorize 1ID/ to act on my behalf in all matters relative to work authorized by this building permit application for. f(c) r ty- C (A-- T672,Vl L ten=/V1"} (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fenc is installed and all final inspections are performed and accepted. Signature of Owner Signature o A licant Print Name Pr ' ame _23-/:Z Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/160 Town of Barnstable - Building Department Services Brian Florence,CBO Building Commissioner _ 200 Main Street, Hyannis,MA 02601 NAM www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE F.XE1V MON Pleue Print DATE: JOB LOCATION: numbs streCt v7lage "HOMEOWNMR": .,1.,„,' name home phone# WWk phone S CURRENT MAILING ADDRESS: citYhoan state. zip-code The current exemption for"homeowners"was extended to include owneried dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,Rrovided that the owner acts as supervisor. DEFEUMN 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 helshe shall be responsible for all such work performed under the buiildingpermit. (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 mspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homwwna 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 E MAMON -y 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 helshe understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QAWPFnM\FORMSIbuilding permit&=\E URESS.doc 09/16/17 F� Town ®f Barnstable *Permit# d 2-F P . Gpires 6 marulrs froin issue dare s a Regulatory Services Fee /ARNSrABM ^� 9$' 1659. NAM ' Richard V.Scali,Director �fD pNA't� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www_town.bamstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PE&NUT APPLICATION - RESIDENTIAL ONLY Not Valid ividrout Red X-Press Imprint Map/parcel Number /-0/1—O .39 Property Address /� �J / (�/ t hd'�r DS�eCyi /lam [Residential Value of Wnik$ S� — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 6e Le IAQil/� Contractor's Name 'lldcJ,,,/ 1'8r7/1 / /I r:5011 Telephone Number Lq o( 2.ZJ- 1 kQ 0 Home Improvement Contractor License#(if applicable) 73 s Email: Construction Supervisor's License#(if applicable) 7 c7 [�Norkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ jar&the Homeowner I have Worker's Compensation Insurance Insurance Company Name F; r a'1'1p_ n& Ejnsl.ArQr,N C 9- -3 Workman's Comp.Policy# art/C A 1 7 2 9 — 2 D Copy of Insurance Compliance Certificate must accompany each permit. p Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [Replacement Windows/doors/sliders.U-Value (maximum_32)#of windows of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property caner must sign Property Owner Letter of Permission. A copy thL�ome mprovement Contractors License&Construction Supervisors License is require _ SIGNATURE: " C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\2P10I DHR\EXPRESS.doc Revised OQ0215 i Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England Y g Bob Wulfing&Jim Leblanc AU.M..� Legal Name:Southern New England Windows,LLC 191 Westwind Cir. RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Osterville,MA 02655 WINoo 10 Reservoir Rd I Smithfield,RI 02917 H:(508)681-8594 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Bob Wulfing &Jim Leblanc Contract Date: 11/11/17 Buyer(s)Street Address: 191 Westwind Cir. , Osteryille, MA 02655 Primary Telephone Number: (508)681-8594 Secondary Telephone Number: Primary Email: wulfing@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $4,453 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $1,484 Balance Due: $2,969 Estimated Start: Estimated Completion: Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Depo paid by Check Bal paid by check Buyers)agrees and understands that this Agreement constitutes1he entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/15/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen f Southern New England Buyer(s) Signature of Sales Person Signature Signature Cory Scanlon Bob Wulfing Jim Leblanc Print Name of Sales Person Print Name Print Name UPDATED: 11/11/17 Page 2 / 10 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor ;. BRIAN D DENNISON 7 LAMBS POND CIRCLES ` CHARLTON MA 01507. ,F Expiration: Commissioner 09/08/2018 _ � ��2e �0��2o�rr�ea� oC>G?rz�aG,c��• Office of Consumer Affairs And Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improver'n"'Contractor Registration Registration: 173245 Type: Supplement Card .A` >''�`� Eviration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS'' BRIAN DENNISON ! t 26 ALBION RD - LINCOLN, RI 02865 -fP Update Address and return card.Marl:reason for change. scn mw; C3 Address ❑Renewal ❑Employment [j—Lost Card � C-�/,•�nuzaivaa.///nr/<�i�/urnc/rr;dL• face of consumer Affoirs&.Business Regalado. Registration valid for individual use only before the rOME IMPROVEMENT CONTRACTOR expiration date If found returnto: OfricenrConsumer Affairs and Business Regulation Reglstradon::75 j_3py5 Type: 10.1arA Plow-Suite 5170 Expiratlon:�9/791/201 C. Supplement Card Boston,MA 02116 SOUTHERN NEW FNgLAND;WINDOWS LLC. RENEWAL BY ANDERiS BRIAN DENNISON 26 ALBION RD LINCOLN.RI 02865 l.pbde ry Not valid without signature 51-1 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass-gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information v Please Print Le 'bl dame (Business/Organization/Individual): e wo -Ewa 1A4 Address: 2& AL&1120 I City/State/Zip: /J Phone 4: 'f,0E Are you an employer?Check the appropriate box Type of project(required): 1�l am a emplover with AZO templovees(full and/or par-time).' ?. ❑New construction 2.F-1 I am a sole proprietor or partnership and have no employees working for me ir. S. ❑Remodeling any-capacity.[No worker`'comp.insurance required.) ❑l am a homeowner doing a:,!work myself.[No workers'comp.insurance required.;; 9. ❑Demolition 10 ❑Building addition 4.❑I am a homeowner and wlli be hiring contractors to conduct all work or:in,,property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I-[]Electrical repairs or additions proprietor urith nc employee's. 12.❑Plumbing repairs or additions -•❑1 am a genera`•contractor and I have hired the subcontractors listed or.the attached sheet. 1=_❑Roof repairs These sub-contractor have employees and.beve worker'comp.Insurance.' E.❑we are a corporation anc to orrcer have exercised their right or exemption per MGL c. 14. her OU );2 El(4).and we have ne emplovees.[No worker'comp.insurance required.i I re 'Any applicant that checks box.r'.must also fill out the section below showing their worker'comperismioc policy information,. Homeowner who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit a new affidavit indicating such. lCont-actors that check this box must attached at..additional sheet showing the name of the sub-contractors and state whether or nor those entities have employees. Lithe sub-contractor have employees;they must provide their workers'comp.policy nu mbe. I am an emplover that is providing workers'compensation insurance for my employees. Belo" is the policy and job site information. Insurance Company Dame: Ire M9 S oom — Policy#or Self-ins.Lic.4: �A-3; 7 Z•q — Z- Expiration Date: l I O Job Site Address: I q �e srl 1-/,'hJ rr. City/State/Zip: (9:4Pr✓,•6(e. M,4 Attacb a copy of the workers' compensation policy declaration page(showing the police number and expira 'on date). Failure to secure coverage as required under MGL c. 152,E25A is a criminal violation punishable by a fine up to SI,500.00 and/or one-vear imprisonment as well as civil penalties..in the form of a STOP urORK ORDER and a fine of up to$250.00 a day against the violator_A copy ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification_ I do hereby certify under theains andpenalties ofperjun°that the information provided above,is true and correct Signature: Date: Phone P: Official use only. Do not write in this area,to be completed by city°or town off dial Citv or Town: Permit/License 4 a Issuing Authority(circle one): 1.Board of Health 2.Building Deparmrent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ESLERCO-01 SANDERSO DATE(MmiDian-y'Y) CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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 endorsement(s). PRODUCER CONTACT OMF CoBiz Insurance,Inc.- PHO FAx 303 988-0804 1401 Lawrence St,Ste.COO PH 3)988-0446 (ac,No):( ) Denver,CO 80202 E-Mit cobizinsurance.com ADDINSURERS AFFORDING COVERAGEINSdia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 i Southern New England Windows,LLC.dba Renewal by INSURER c:Libe Su lus Insurance 1072EEEF�5 Andersen of Southern New England 26 Albion Road,Suite 1 INSURERD: Lincoln,RI 02865 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: l CERTIFYTHIS IS TO 13ELOVV HAVE ED NDICATED. NOTWITHSTAND NG ANY C REQUIREMENT. TERM ORLISTED N ISSUED CONDITION OF ANYCO NTRACTT OR OTHER DOCUMENT ABOVE POLICY ENT WITH RESP CTTO PERIOD WHICH 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 I ADDL SUBR POLICY NUMBER NIpD EFF MNDI/LIDD EXP LIMITS TYPE OF INSURANCE INSD NND 1 �QD D00 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED S 300,000 j CLAIMS-MADE F OCCUR CPA3158728 01/0112017 01101/2018 PREMI E Eacccurrenlx I—� MEND An ane erson S 5'000I lI PERSONALS ADV INJURY S 1'000'OOO 2,000,000) GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: 1 X POLICY❑jRei ❑LOC PRODUCTS-COMP/OF AGG I S 2,000,OOOI 7T. EBL AGGREGATE 2.01XI,UU01 OTHER: COMBINED SINGLE LIMIT S 110001000I A AUTOMOBILE LIABILITY Ea amdent j t X j ANY AUTO CPA3158728 01101/2017 01/01/2018 BODILY INJURY Perperson) S (— OWNED SCHEDULED BODILY INJURY Peraccident S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Per amdent AUTOS ONLY AUTOS ONLY s VAN, B X OCCUR S 1,000,OOOI EACH OCCURRENCE CLAIMS-MADE CPA3158728 0110112017 01/0112018 AGGREGATE s 1 0 Aggregate s 1,000,000� ETENTIONS PER "ISATION X STATUTE ER ABIIJTY y/N CA3158729-20 01101/2017 0110112018 1,000,000� ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L EA ACCIDENT S OFFICERIMEMBER EXCLUDED? N 1 A (Mandatory in NM) E.L.DISEASE-EA EMPLOYE i S 1,000,000 tt yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below• E.L DISEASE-POLICY LIMIT S B Workers Compensatio CA3158730-20 01101/2017 01/01/2018 1,000,0001 117 01/01/2017 01/01/2018 1,000,000 I DESCRIPTION Workers Comp IONS I LOCATIONS O Inc Includes- stat(ACORD s O ept,ND O Additional Re aWVSWYele,may be attached if more space is reylrired) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS. 1 I AUTHORIZED REPRESENTATIVE I F R iTrintionalPurposes ©1988-2015 ACORD CORPORATION- All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ti Town of Bitable =Permrt��►5��D31� E*h=6rrmrdLsfronrBsuedate s Regulatory Se»aces Fee annt�sxn8 � , 7$ i46 ,� Richard V.•Scali,Interim Director �Q N!p'ip "Ruilding Divisiva Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 ivy;W-town bamstable.ma.us T® ®EC 3 02015 Office: 508-862-4038 ��OF� ax:508-790-6?30 F"RESS P.�SUI CO2�X-A - SYDEl�`�� �A . if nprirrt ��� Map/parcel Number�/- D/ �— (�3�j Propty'=Address_ICI l Al,-fAl C57 e( V t I esidential Valued Work.S_ Minimum fee of 535.00 for work under$6000.00 Owner's Name&Address.90b&_r 3. V/U I /_91 6r/es tend arc 1 OS4er v i I tC M (A ®z(o s 5- Contractor's Name_ ,{ -n a�.�-t.);,v�„ S / r;�,,, �n n i�n t Telephone Number fiig 1))3-2 E-G k_b i Home Improvement Contractor License--*'(if applicable) / Email: Construction Supervisor's License 1(if applicable) p 5 S 7 O OfWorktnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I-am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Worlanan's Comp.Policy _ 1r1lC 9 7,80 8 3,,52 3 G y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stopping Going over wasting. •. J Elide S�y of Replacement Wmdoviddoors/sliders.U Vahte . 30 (maximum 3'r of windows �of doors: - ❑ Snloke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate EI&6ical&Fire Permits required. •WhiA required: Issuance of this permit does not exempt compliance with other tmvn department regulations,i.e.Historic.Conservation,eta '=Note: Property.,Pwner must sign Property Onmer Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. SIGtNATURE• - Q:1RrPFILES1FORMSlbuildiin g pentut fottmlEXPRESS.doc Revised 061313 By EN 25 A9ta.�t . • l* }tl 02865 �• ?e �� Banc 8M563,1235-Ax 4-01.6316GO2 REM Ewa],iibyhaermm of Sautes New E gfind. ;� t 3. C1 4 @OIpTA DOOR E Ob CAtJ3tMilL rtA a® ip -SRO_' -0 t 'off uy ht? t je dy.atd t ry,des to pumchaw&e:pTedum aR&oa senieft of 30kilhtmNew d Wgdgw_ .LTC d/b/a Pinemmi by Andri-te;b cd'S=,*i;ao:h v Mlillaind C Wa!MM�,�� ,p'n,a mw vf�l tdta aye-gas; .•o� "tvoas dwct�ed maw dw(x�R sd the:mmzvq of dhis.�,S;t rnoac a,3d 4 Vt eaieBCM43. a 5"'�+"�ir;��'i S +l CecM' QVifttic !® Gattdo (9.fl i ToWIa&.i fi 0vW � aBtty Arta MedSad d � :� Ej Cub-. #d ./ 3 41e+fk e,ewee r 'd- V3qjft fthdeeat Sun d (33 VC�� �sl'nea� - d3eu :Dom, daft Eire; e ofl4addie Mme.a►q&6, ev tZ 1,eif��aoSp a�+os�of� ter b'r ' t� !�tcti3, - ���a�c��•r.�de.l�'�I �7ae ?k,ar mere arc zw Vcr atL ode n4az din set' ,g a o csf'tote st et s•of ikas A re aacztt*. c) aclr.�.owtedges &W.B',evfs) M l "•� ameut, emtotat�-the tc of A:� ezt,�. jved a opmipteted..,JV&ed,, , dated Copivrows Agreement, $hot ,cltsd x0ticts at a eti sn,an I&c dAtc Psc aiett .a a e jk w ' s r etL e " . "deice do Sci p�.�p n�€o s t11 A e e S;:� ,Q tiro spas$a a &r tltc: d te.,=o toxbst�eue�t tlY n lstea o ttledarsOtt � 16oaareAfiMllesig:.tcuWgtthlM eeinendA#t t r4 3) a at try ums Pam'off t sa M4. ouh ac tomes:fie ceet ,s_.: 'fie K tt E!6e aotd ifeA. i relive a P.-tidal of 'Ilttve a imfi(4j) o se1TtP dsa na rg �t rsr`,r�i erg .,€•;,; , dr Cc itir tv t*07 JsTq=k of thap escm to:mpgosess ASteement..P)I'ta d d ftm ematttE 1117:i c Vie, iSaad it Mom,owe ac s<! iia a a fame aE .ac PMvjded :o4 y g8 to etr > orb e-.Mia ;office arbnntr: cgowalwtdc.A go,ett isiexredr,.r,aerd Ada a�la of il'bo asi � IIaZ .a�ii .dam cf.t"tl d caend&i�days&-r �on twhtth&L-,bt W' sips&e sggvmcr ; elod�ia 'Sn sale olldg ram . t ewike mia iiefit�e�ies arengt madam 9�ee dies pa. 9soot,-ae at aD f6im f ems.r3WEftn.; g. 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'CIE A CMEM WO-nm iDr 0 Y O of rrmta�ort tktt C"Well ,,N Dated of Transaction lftru � c�crd�l = f s transaction,Wit' ifii �p�enlAy or tyltl lad„' tip t#rlo:�atlt whhout � dree busy ti Bann.tlte.abaYo d'a «flfjI Pra11+j , IMaematl thr �bta nsss t±i tlta ab�daft.if 8� : ivteetts trd�s �► u �, t`#hm Pc tadedl l' a�j► tftO nude $ll 1 �rtdc tJ Co kawft or Salto I W.w:ne�avdta�la imtr tt nt er d t C04itrs�or SWe,.and a f�em ,ruled by you will b t -11--- thf #.tr butt drp.t`onbw Ing y.lam WM lie rgtLLMed w ltrfi taro buslnttss ,dayj.*Mawtin,S ) receipt by the 3effer of your cau cOzd on ,aodce� and r � ir+e the ti r of'your a laif'on notim any security at t aAs3n Out of the ramact>ion va bet security ro i; arisijtg out of tlta t eacdort will ba 19 nMCC�.Ilya EaffwCkya'u Must m#&t la la#m the sllor canteted. f aaoce� U Hale Maw,a ilable t the 5�!hr at your me detrca., sri tantiatl f A$good tsan4atjgrr»amain i at yoa�r x�(denra ii��t "ntiAlar as jan�i condition as arlien s..m�,..Ja!&-.1 .. V4 i'e Q<iieblr .r7 9 rqRrni'vAA anow o-w. 14 r+i'wl6ovwbA-w.ea;.. a$'.— r f Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-095707 BRIAN D DEND11016 7 LAMBS POND' Charftton MA 01507 Expiration Commnissioner 09l01=16 Office of Consumer Affairs dud Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Reglstrflfbn: 175245 Type: Supp1w tend Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2016 DENNISON BRIAN — 26 ALBION RD — LINCOLN,RI 02865 + 'Updare Address and return card.Mark reason for change. WA 1 0 21MA45M, p Address ❑Renewal p Employment p Last Card �i�o�owrowwrcr�/.0(1.i1� Ing -- IBee of Coasem ARaln @ Bastuns Regulation License or registration valid for tndividul an only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Afain and Business Regulation suall n: 773i45 Type. 10 Park Plan-Suite 5170 v991zpimfion. 9/1912016 Supplemera'Lard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS U.C. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Uaevureretary of valid without signature i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 '^ S• www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name (Business/OrWization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone #:401-228-9800 Are you a_n employer? Check the appropriate box: Type of project(required): 1.Q■ I a> a employer with 20+ 4. 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 t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] T c. 152, §1(4),and we have no / 13.�ther employees. [No workers' rr /1 Q U t.✓ comp. insurance required.] re (d cP e/i t *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. b f 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/2/1/2016 Job Site Address: /it Gt/e S t' 0flOi' t�i rd e City/State/Zip: 6s-4J; f fe - M A 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't}fMGL 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\nsurance coverage verification. I do hereby certi under the and penalties of perjury that the information provided above is true and correct. Signature: Date: — — Phone#• 4012289800 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 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I SOUTNEW-01 SHETTYSHT CERTIFICATE OF LIABILITY INSURANCE DATE81191219/2015D NYYYl 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 NAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE 877 945-7378 FAX c/o 26 Century Blvd E-MAILI E,:( ) A/c No): 888 467-2378 P.O.Box 305191 EMAIL S:certificates Ilis.com Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC q INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen INSURER D: 26 Albion Road Lincoln,R102865 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADOLSUBK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MWDDfYYYY) (MWDpnrrM LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE a OCCUR S 2029459 08/10/2015 08/10/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a JET a LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Peracadent $ X UMBRELLA LUIB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE S 2029459 08110/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X I STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑N NIA 0000068028 08121/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 C Workers Compensation C928058352394 08/21/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6 k 11 D Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 0 Date Definitive Plan Approved by Planning Board p Historic - OKH WO _ Preservation / Hyannis Project Street Address \q\ blest` w i nA C�rC.�-e., t 1 C UD Village TOWN OF BARNSTABLE Owner o\�_'E� •1N k lqkn C JAme_5 6kkeAddress WeS�_ 6Q 114 r_ Telephone "5U� I Permit Request cj_)M a �M Sul anQ( Square feet: 1st floor:,existing � proposed --- 2nd floor: existing ' proposed Total new Zoning District 91(" Flood Plain Groundwater Overlay Project Valuation TkA Construction Type Lot Size Grandfathered: ❑Yes ANo If yes, attach supporting documentation. Dwelling Type: Single Family ,�. Two Family ❑ Multi-Family(# units) Age of Existing Structure l Historic House: ❑Yes O-No On Old King's Highway: ❑Yes XNo 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing/�New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new sizool: ❑ existing ❑ new size/& Barn: ❑ existing ❑ new sizfk__ Attached garage: ❑ existing ❑-new sioShed: ❑ existing ❑ new sizeA�Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ANo If yes, site plan review# Current Use f:y4G6 I A ` Proposed Use NO VX APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nam " I� ' Ur�� Telephone Number Address Ila 14t oae� License # Ok �V1 1 U Home Improvement Contractor# Email 64W Worker's Compensation # JX e 1961-5- 'L�b ALL CO TRUCTION DEBRIS RESULTIN FROM THIS PROJECT VVLL BE TAKEN TO a dam IASicx1� SIGNATURE DATE FOR OFFICIAL USE ONLY- APPLICATION # DATE ISSUED i MAP/ PARCEL NO. ` t « r ADDRESS VILLAGE :OWNER ' DATE OF INSPECTION: } FOUNDATION * - FRAME INSULATION w FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i ocuSign Envelope ID:93473C4C-2EOC-4F44-A44C-5E9BF083166D ; SolarCity PPA Customer Name and Address Installation Location Date James Leblanc 191 Westwind Cir 12/11/2015 Robert Wulfing Osterville,MA 02655 191 Westwind Cir Barnstable,MA 02655 - r Here are the key terms of your Power Purchase Agreement $0 a 20yrs System installation cost Electricity rat g kWh ! Agreemen glm Initial here Initial here os The SolarCity Promise 3 •We guarantee that if you sell your Home,the buyer will qualify to assume your Agreement. ......................................................................... Initial here •We warrant all of our roofing work. DS •We restore your roof at the end of the Agreement. J� •We warrant,insure,maintain and repair the System. .................................................................................................................................................................................................................. Initial here — •We fix or pay for any damage we may cause to your property. •We provide 24'/•7.web-enabled monitoring at no additional cost. •The rate you pay us will never increase by more than 2.90%per year. •The pricing in this Agreement is valid for 30 days after 12/11/2015. Your SolarCity Power Purchase Agreement Details Your Choices at the End of the Initial Options for System Purchase: Amount due at contract signing Term: •At certain times,as specified in $0 •SolarCity will remove the System at no the Agreement,you may Est.amount due at installation cost to you. purchase the System. $0 •You can upgrade to a new System with •These options apply during the 20 the latest solar technology under a new year term of our Agreement and Est.amount due at building inspection$0 contract. not beyond that term. � —� •You may purchase the System from Est.first year production SolarCity for its fair market value as 11,050 kWh specified in the Agreement. •You may renew this Agreement for up to ten(10)years in two(2)five(5)year increments. 3055 Clearview Way, San Mateo, CA 94402 888.765.2489 solarcity.com 1401591 Power Purchase Agreement,version 9.1.0,November 11,2015 SAPC/SEFA Compliant Contractors License MA HIC 168572/EL-1136MR Document generated on 12/11/2015 Copyright 2008-2015 SolarCity Corporation,All Rights Reserved �• • P rt` L ; DocuSign Envelope ID:93473C4C-2EOC4F44-A44C-�E9BF083166D 1. Introduction. will debit your bank account on or about the 15t day of This Power Purchase Agreement(this"Power Purchase the next month following invoice(e.g.January invoices Agreement,""Agreement"or"PPA")is the agreement are sent in early February and debited on or about March 1). Monthly Payments will change as your price between you and SolarCity Corporation(together with its successors and assigns,"SolarCity"or"we"),covering the per kWh changes over the Term of this PPA and as sale to you of the power produced by the solar panel System production varies(e.g.,summer has higher production).You will have regular access to the system(the"System")we will install at your home. SolarCity agrees to sell to you,and you agree to buy from System's production via your SolarCity online account. SolarCity,all of the power produced by the System. The Payments due upon installation,if any,are due System will be installed by SolarCity at the address you immediately prior to commencement of installation. „ You will make no Monthly Payments if you are fully listed above(the Property"or your"Home"). This Power Purchase Agreement is eight(8)pages long and has up to prepaying this PPA. In this case,you will pay only the amounts listed in the key terms summary on page one three(3) Exhibits depending on the state where you live. of this PPA. SolarCity provides you with a Limited Warranty(the "Limited Warranty"). The Limited Warranty is attached as (c) Estimated Production. If(i)the System is shut down for Exhibit 2. If you have any questions regarding this Power more than seven(7)full twenty-four(24) hour days Purchase Agreement,please ask your SolarCity sales cumulatively during the Term because of your actions; consultant. or(ii)you take some action that significantly reduces THIS AGREEMENT SUPERSEDES ALL PRIOR EXISTING the output of the System; (iii)you don't trim your CONTRACTS BETWEEN YOU AND SOLARCITY THAT PERTAIN bushes or trees to their appearance when you signed TO THE"SYSTEM" DEFINED IN THIS AGREEMENT. this PPA to avoid foliage growth from shading the System;or(iv)your System is not reporting production 2. Term. to SolarCit y(e.g.you have disconnected the SolarCity agrees to sell you the power generated by the PowerGuide system or the internet connection at your System for 20 years(240 months), plus,if the Home goes down on the reporting day),then SolarCity Interconnection Date is not on the first day of a calendar will reasonably estimate the amount of power that month,the number of days left in that partial calendar would have been delivered to you during such System month. We refer to this period of time as the'Term." The or reporting outages or reduced production periods Term begins on the Interconnection Date. The ("Estimated Production")and shall consider Estimated "Interconnection Date"is the date that the System is Production as actual production for purposes of this turned on and generating power. SolarCity will notify you paragraph. In the first year of the Term, Estimated when your System is ready to be turned on. Production will be based on our production projections. After the first year of the Term, Estimated Production 3. Intentionally Left Blank. will be based on historical production for that month in 4. Power Purchase Agreement Payments•.Amounts. the prior year. If we bill you for Estimated Production (a) Power Price. During the first year of the term,you are because your System is not reporting production to SolarCity,and we subsequently determine that we have purchasing all of the power the System produces for either overestimated or underestimated the actual $0.1250 per kWh. After the first year,the price per production,then we will adjust the next bill downward kWh will increase by 2.90%per year.There are no installation costs. (to refund overbilling)or upward(to make up for lost billing). You will not be charged for Estimated (b)Payments. Production when the System is not producing electricity Your monthly payments will be the product of(A)the due to SolarCity's fault,or if it's due to grid failure or price per kWh multiplied by(B)the actual kWh output power outages caused by someone other than you. for the calendar month("Monthly Payments"). Invoices S. Power Purchase Agreement Obligations. for Monthly Payments will be mailed or emailed no (a) System,Home and Property Maintenance later than ten(10)days after the end of a calendar month.If you are paying your invoice by automatic You agree to: debit from your checking or savings account(ACH)we 0�Power Purchase Agreement,version 9.1.0,November 11,2015 1401591 � R lz DocuSign Envelope ID:93473C4C-2EOC-4F44-A44C-5E6BF083166D 23. NOTICE OF RIGHT TO CANCEL. I have read this Power Purchase Agreement and the Exhibits in YOU MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR their entirety and I acknowledge that I have received a TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE complete copy of this Power Purchase Agreement. DATE YOU SIGN THIS CONTRACT. SEE EXHIBIT 1,THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN Customer's Name:James Leblanc EXPLANATION OF THIS RIGHT. �e�der 24. ADDITIONAL RIGHTS TO CANCEL. Signature: IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL THIS PPA UNDER SECTION 23,YOU MAY ALSO CANCEL Date: 12/11/2015 THIS PPA AT NO COST AT ANY TIME PRIOR TO COMMENCEMENT OF CONSTRUCTION ON YOUR HOME. 25.,Pricing The pricing in this PPA is valid for 30 days after Customer's Name: Robert Wulfing . Docusignea by: 12/11/2015. If you don't sign this PPA and return it to us //''►►'�f�1�u► 'on or prior to 30 days after 12/11/2015,SolarCity reserves Signature: _4� the right to reject this PPA unless you agree to our then current pricing. �� Date: 12/11/2015 Power Purchase Agreement SolarCity approved Signature: Lyndon Rive, CEO Date: 12/11/2015 Power Purchase Agreement,version 9.1.0,November 11,2015 a 1401591 DocuSign Envelope ID:93473C4C-2EOC-4F44-A44C-5E9BF083166D ' • t EXHIBIT-1(SOLARCITY COPY) NOTICE OF CANCELLATION STATUTORILY-REQUIRED LANGUAGE Notice of Cancellation Date of Transaction:The date you signed the Power Purchase Agreement. You may CANCEL this transaction,without any penalty or obligation,within THREE BUSINESS DAYS from the above date. If you cancel,any property traded in,any payments made by you under the contract or sale and any negotiable instrument executed by you will be returned within TEN DAYS following receipt by the seller(SolarCity Corporation)of your cancellation notice,and any security interest arising out of the transaction will be canceled. If you cancel,you must make available to the seller(SolarCity Corporation)at your residence,in substantially as good condition as when received,any goods delivered to you under this contract or sale,or you may,if you wish,comply with the instructions of the seller(SolarCity Corporation)regarding the return shipment of the goods at the seller's(SolarCity Corporation's)expense and risk. If you do make the goods available to the seller (SolarCity Corporation)and the seller(SolarCity Corporation)does not pick them up within 20 days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller(SolarCity Corporation),or if-you agree to return the goods to the seller(SolarCity Corporation)and fail to do so,then you remain liable for performance of all obligations.under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice,or any other written notice,or send a telegram to SolarCity Corporation,Document Receiving,6611 Las Vegas Blvd.S.,Unit 200,Las Vegas,NV 89119 NOT LATER THAN MIDNIGHT of the date that is THREE BUSINESS DAYS from the date you signed the Power Purchase Agreement. I,James Leblanc,HEREBY CANCEL THIS TRANSACTION on [Date]. Customer's Signature: Customer's Signature: Power Purchase Agreement,version 9.1.0,November 11,2015 •� 1401591 M�ftarsnuaafts oleawmoM of P+,buc 8afey flosm of Ouilong Rp,aatana ina Stafrfdc►ma o tsna« CS-108615 JASON PATRY 821 SMWART DRIVE 4 Abington MA 02351 ` �...»......., 02=10119 .�%.�. f:«a,.wwa..(f� f•rawr•�rLp .� Omaorfo.mmerAtlafr��[imiaenRegslnioo . HOME IMPROVEMENT CONTRACTOR f 1 yf Rogl°bauon: loam T7Po Exotmtton: 3181T017 Supptei+ca SOLAR CITY CORPORATION JASON PATRY 24 V MAKIN STREET BLOWN &Al&6ORO1PaH,MA 01752 UoAeReerebry Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement_.Contractor Registration Registration: 168572 Type: Supplement Card SOLAR CITY CORPORATION Expiration: 3/8I2017 CHERYL GRUENSTERN - - - -- — 24 ST MARTIN STREET BLD 2UNIT 11 - -- ------ - --- - MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. scA, r, 20k9.05 fF Address Renewal ? j Employment r-''• Lost Card �r1�'r'�liurcvir{•rn�/�r.�"��'r;3.dir�ic:P//, frice of Consumer Affairs&Business Regulation License or registration valid for individul use only SOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation Registration: 168.572 Type: 10 Park Plaza.-Suite 5170 ' Expiration: 3/8127017 Supplement Card Boston,MA 02116 SOLAR CITY CORPORATION CHERYL GRUENSTERN 3055 CLEARVIEW WAY SAN MATEO,CA 94402 --- Undersecretary Not valid without signature l The Commonwealth of Massacfurrelts Deparlent of Induylthil Accidents 1 Congrlels Street Suite 100 Boston,M 02114 2017 www mass gov/dM Workers'Compensation Insurance AfMa%rit:Bnilders/Contractors/EleetrietamMumbem TO BE FILED WITH THB PERMrrr[NC AUTHORITY. aptlllteent Infortaaatiort Flease Print I,eeft NaMe(BusinessIDWuhmiionAndividuat): SalerCity Corporation Address: 3055 Clearview Way City/Stair:/Zip: Sari Mateo,CA 94402 Phone#: (888)785-2489 Are you•=employer?Check the uppropriate boo Type of project(required): 1.01 am aemplo w wM 15,000=ploy=(lirll andlorpan4ime).•, 7. ❑]Vew cortstrttctiott 701 am a sole proprietor or pm4tership and have no crWloyax v or drg for au in 8. Remodeling nay capacity.[No wmkw'comp.insurance required.] 9.3.JJ1amatxnneowacrdoing•allw ark raysdrINowozkcrs'cam 1p.iasnrarhoerogniredlr. El Demolition 4.❑ lu 1 am a mcowncr and win be hiring curtractnra to wndutx all work on my property. 1 ivil1 0[]Building addition awn that all auAnatrxs aid=have heoruw compenoation IasuroceOrare sole 11.❑Elechieal repairs or additions propriaors with no cuq&ycc& 12.Q Plumbing repairs or additions so I am a pxrai•contractor end 1 have tired the sub amtractors listed on the attached sheet. rs These sub-contra im have empl%=and have w im*camp,irta umm t 14.ElOthe(solar 6.Q We are a aupor uion and its officers have exerci�rkcir right of exemrim per Mill.c. 14.QOt}ter rats panels 15Z§1(41 caul we have w employees.[No wexkeus'camp.iasurancc nphed•l *Any apgllcm that chcob box 91 mast rdso all out the sceiieu below showing their workars'compensation policy lormustion. •t lone mmrxs mU submit tole affidavit indicaft they are dofng all work and then hue outside.contractors must submit a now nMdavit 1nffica ft such tConuat un that that lbb box must attochrd as addilmnat shed sbowW the mate of the sub-owgradon and owe whet her or imt tuns entift have emptoyces. If the sub-cwtMolors have anplovccs,they meat ovfde their wdrkere camp.policy aun1mr. I arm an employer t/tat is providing workers'compensation insurance for my employra?s. 8dow is the palicy and%ob sfte InforimWan. Insurance Company Name:American Zurich Insurance Company Policy#or Self iris.Lic.1i: WC0182015-•00 Expiration Date: Mole e Job Site Address: 191 West Wind Circle City/Sip: Osterville,MA 02655 Attaeb a copy of the workers'compensation pow declaration page(showing the policy number and ezpbUtfoa date). Failure to secure coverage as required under MOL c. 152,§25A is a crimirtal violation punishable;by a fine up to S 1,500.00 wWor one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a Irma of up to MOM a day against the violator.A copy of this statement may be forwarded to the Offree of Investigations of the DIA for insurance coverage vori6cation. I do hereby cerg&mn(kr the pains anti pena/Aes of perJury that the b(rormadon provided above Is true and carrect. (Jason Pa : December 18,2015 OfJicid use on(y. Do not write in Ms+smea,m be completed by etty or town o,(fMaL City or Town: Permit/Lieeaso# Issuing Apthotrity(circle oue): 1.Board of llesalth 2.Building Departmanl 3.City/Town Clark 4.Electrical Inspector S.Plumbing Inspecoor 6.tither Contact Person: Phone M • .4evKt� CERTIFICATE OF LIABILITY INSURANCE °W17mis `� �r,7na,s 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 paNcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condltlons of the policy,certain policies may require an endorsement A statement on this certificate does not confer rlghte to the certificate holder in Beu of such endorsemerrt(s. PRODUCER CONTACY MARSH RISK&INSURANCE SERVICESPHONE 346 CALIFORNIA STREET,SUITE 13M 1t?+l.me CALFORNIA LICENSE NO.OLVI53 E4AAIL __...... . SANFRANCISCO,CA 94104 •A1>tim :""'""' -_....__.._...-_ •----- _.._....__.._ Aft Shannon SM415-7438334 _._....... _...........!!!suRergs)nFwimDaocovew►BE..... .. ..__._.. NAIce 9W301-STND-GAWUE-15-16 _.._ __.. INSURER A.ZIeteh AMErk-UMffa=Canpany 1,6535 ty Owporduan DasuRer s:NIA �N1A 3065 aearvfaw Way INSURER C:NIA A San lAeleo,GA 94402' _.�.-._—.._._._.....__....... ................. INSURER D:MOICan bItCh IMrJ=Canpany 40142 IMRER F: COVERAGES CERTIFICATE NUMBER: SEA-002713836.08 REVISION NUMBER 4 THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P(XICY 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. -.—rAbbl fflN .. .................. E N.. vaLwwlm —. ....._.._.._ TYPE OF INSURANCE ..... A X COMMERCIAL GENERAtUAB1LITY 6L001620164D0 09A1/1015 Owl/1016 EACH OCCURRENCE s 3.000_000 F. .�CLAIMS41ADE n OCCUR DAMAGETO $E,S„(€e cr gJ•,• $._....._._—._ 3,000,0110 X SIR E2WAD 1 LIED aae S 6,000 PERSONAL&ADd INJURY S 3.00,000 GEWL AGGREGATE UMJT APPLIES PER GFJNERAI Ax30REOATE $ 6X00.0,00 Al POLICY PRO- JECT L(X PRODUCTS.-COENP/OPACG 5•„ -.---. 6AM_000 OTHER. S A AuToMoeiLELIAsaiTY BAP0162017.00 0W11M5 M ED S OD0,00DANYAUTO 109)0112D16 B%xLY INJURY(Per pemcn) S ALL OWNED UX SCHEDULEDAUTOS AUTOSINJURY(Per accident) S �� D I I PROPERTY DAhMAGE S............................ HIRED AUTOS I @f !Ml...__1 .. ._...._.._ COGPICOLL OED: S $5,D00 UMBRELLA L1A9 OCCUR ! EACH OCCURRENCE 5 EXCESS LUID CLNbIS-DMDE � i � AGGREGATE ...__._.......- s---.................. oEo •RerwnON s 8. D WORKERS COMPENSATION ; IWC01W4-00(AOS) 09N1/8115 10901/1016 X R A AND EMPLOYERS'LIABBY �YIN 0R15 101101016 PROPRI RIPARTN CUTlE -WC82015-W(AA) E.L. EACH DE._M..SR _ _.1._1 .0.0.0,0 .0 .0 MS EXCLUDED? MIA!(Mandataty In NH) _ WC DEDUCTIBLE:S500,0W EL DI .EAEMPLOYEE S 1000,W0 R O TIONSbekiw E.LDISEASE-POUCYUNrt $ 1,000,000 i 1 i DESdMPTtON OF OPERATIONS I LOCATIONS I VMCLES IACORD 191,Addrttonal Remarks Schedaia,my be aMaotwd I mow Mmm Is regWred) EYldalda of klswanJe. CERTIFICATE BOLDER CANCELLATION SdarCA9 Corp=U- SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE 30M Cleaniew Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo.CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE or Mwah Rlsk 6lnsurance SerAces ChetlesMamrolejo �!/�---- 01980-2014 ACORD CORPORATION. All rights reserved. ACORD 2612014101) The ACORD name and logo are registered marks of ACORD i Version*53.6-TBD ,...SolarCity. December 17,2015 RE: CERTIFICATION LETTER ��ZNOF Project/Job#0262412 V&AA A. Project Address: Wulfing Residence g Ift SOBii• 191 Westwind Cie �p Osterville, MA 02655 pJST�" AH) Barnstable ��- SC Office Cape Cod Design Criteria: -Applicable Codes= MA Res.Code,8th Edition,ASCE 7-05,and 2005 NDS - Risk Category = II -Wind Speed = 110 mph, Exposure Category C -Ground Snow Load = 30 psf . - MPi: Roof DL= 10.5 psf, Roof LL/SL= 21 psf(Non-PV Areas), Roof LL/SL = 13.5 psf(PV Areas) - MP2: Roof DL= 10.5 psf, Roof LL/SL= 21 psf(Non-PV Areas), Roof LL/SL= 13.5 psf(PV Areas) Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.19053 < 0.4g and Seismic Design Category(SDC) = B < D To Whom It May Concern, A jobsite survey of the existing framing system of the address indicated above was performed by a site survey team from SolarCity. Structural evaluation was based on site observations and the design criteria listed above. Based on this evaluationI certify that the existing structure directly supporting the PV system is adequate to withstand all loading indicated in the design criteria above based on the requirements of the applicable existing building and/or new building provisions adopted/referenced above. Additionally, I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the manufacturer's specifications and to meet and/or exceed all requirements set forth by the ASCE 7 standards for loading. The PV assembly hardware specifications are contained in the plans submitted for approval. Additionally a summary of the structural review is provided in the results summary tables on the following page. William A. Eldredge, P.E. Digitally signed by William A. Eldredge Jr. Professional Engineer Date:2015.12.171947:24-05W T: 888.765.2489 x58636 email: weldredge@solarcity.com 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AZ ROC 243771.CA CSLB 888104.CO EC 8041,CT HIC 0632778.DC HIC 71101486,DC HIS 71101488.HI CT-29770.MA HIC 188072.MD MHIC 128948,NJ 13VH06160600. OR CCB 180498.PA 077343.TX TDLR 27006.WA GCL:SOLARC'91907.O 2013 Solm0ty.All rights reserved. I « I I � Version#53.6-TBD ' SolarCity. HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware-Landscape Modules'Standoff Specifications Hardware X-X Spacing . X-X Cantilever. Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1 64" 24" 39" NA Staggered 76.9% MP2 64" 24" 39" NA Staggered 76.9% Portrait Hardware-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1 48" 17" 65" NA Staggered 95.9% MP2 48" 17" 65" NA Staggered 95.9% Structure Mounting Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MP1 Stick Frame @ 16 in.O.C. 320 Member Impact Check OK MP2 Stick Frame @ 16 in.O.C. 32e Member Impact Check OK Refer to the submitted drawings for details of Information collected during a site survey. All member analysis and/or evaluation is based on framing Information gathered on site.The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC. 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AZ ROC 243771,CA CSLB 888104.CO EC 8041,CT HIC 0632778,DC HIC 71101486.DC HIS 71101488,HI CT-29770.MA HIC 168572,MD MHIC 128948,NJ 13VH08160600. OR CCB 180498,PA 077343.TX TDLR 27006,WA GCL:SOLARC'91907.0 2013 SolerClty.All dghlo reserved. Y , STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK - MP1 Member Properties Summary MPi Horizontal Member Spans Rafter Pro erties Overhang 0.82 ft Actual W 1.50" Roof System Pro erties San 1 12.84 ft Actual D 7.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 10.88 in.A2 Re-Roof No San 4 sx 13.14 in.A3 PI ood Sheathing Yes San 5 I 47.63 in.A4 Board Sheathing None Total Rake Span 16.11 ft TL DefPn Limit 120 Vaulted Ceiling No PV 1 Start 1.42 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 11.58 ft Wood Grade #2 Rafter Sloe 320 PV 2 Start Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing At Supports PV 3 End Emin 510000 psi Member Loading mary Roof Pitch 8 12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 10.5 psf x 1.18 12.4 psf 12.4 psf PV Dead Load PV-DL 3.0 psf x 1.18 3.5 psf Roof Live Load RLL 20.0 psf x 0.83 16.5 psf Live/Snow Load LL SLI,Z 30.0 psf x 0.7 1 x 0.45 21.0 psf 13.5 psf Total Load(Governing LC I TL 1 1 33.4 psf 1 29.4 psf Notes: 1. ps=Cs*pf,Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf= 0.7(Ce)(Ct)(IS)pg; Ce=0.9,Ct=1.1;IS=1.0 Member Design Summary(per NDS Governing Load Comb CD CL + CL - CF Cr D+ S 1.15 1.00 1 0.40 1 1.2 1.15 Member Anal sis Results Summary Governing Ana sis . Pre-PV Demand Post-PV Demand I Net Im act Result Gravity Loading Check 832 psi 734 psi 0.88 Pass I Y CALCULATION'-OF'DESIGN-WIND LOADS=MP1_ _ __ _ Mounting Plane Information Roofing Material Comp Roof PV System Type SolarCity_SleekMount— Spanning Vents No Standoff Attachment Hardware Comp Mount Type C Roof Slope 320 Rafter_Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin Spacing_ __ _ - __ _X-X Purlins Only NA Tile Reveal Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA _ Standing Seam[Trap Spacing �SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design.Method Partially/Fully_Enclosed Method Basic Wind Speed V 110 mph Fig. 6-1 Exposure.Category C _Section.6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic Factor Krt' 1.00 _Section 6.5.7 Wind Directionality Factor ICd 0.85 Table 6-4 Importance Factor I� 1.0 Table 6-1 Velocity Pressure qh qh =0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 24.9 psf Wind Pressure Ext. Pressure Coefficient U G „ -0.95 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down G wn 0.88 Fig.6-11B/C/D-14A/B Design Wind Pressure p p= qh(GC ) Equation 6-22 Wind Pressure U -23.7 psf Wind Pressure Down 21.8 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max.Allowable.Cantilever Landscape_ 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary_Area— Trib 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff Tactual_ 384 Ibs Uplift Capacity of Standoff T-allow 500 Ibs Standoff Demand Ca aci DCR 76.9% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 17" NAB Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib_ 22 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind.Uplift at Standoff T-actual_ -479 Ibs Uplift Capacity of Standoff T-allow 500 Ibs Standoff Demand/Capacity DCR 95.9% STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK - MP2 • Member Properties Summary MP2 Horizontal Member Spans Rafter Pro erties Overhang 0.82 ft Actual W 1.50" Roof System Properties San 1 12.85 ft Actual D 7.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 10.88 in.A2 Re-Roof No San 4 Sx 13.14 in.A3 PI ood Sheathing Yes San 5 I 47.63 in.A4 Board Sheathing None Total Rake Span 16.12 ft TL Defl'n Limit 120 Vaulted Ceiling No PV 1 Start 1.17 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 12.25 ft Wood Grade #2 Rafter Sloe 320 PV 2 Start Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F. 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Pot Lat Bracing At Supports PV 3 End Emig 510000 psi Member Loading mary Roof Pitch 8 12 Initial Pitch Ad'ust Non-PV Areas PV Areas Roof Dead Load DL 10.5 psf x 1.18 12.4 psf 12.4 psf PV Dead Load PV-DL 3.0 psf x 1.18 3.5 psf Roof Live Load RLL 20.0 psf x 0.83 16.5 psf Live/Snow Load LL SL1,2 30.0 psf x 0.7 1 x 0.45 21.0 psf 13.5 psf Total Load(Governing LC I TL 1 1 33.4 psf 29.4 psf Notes: 1. ps=Cs*pf; Cs-roof,Cs-pv per ASCE 7[Figure 7.-2] 2. pf=0.7(Ce)(C0(IS)pg; Ce=0.91 Ct=1.1,I5=1.0 Member Design Summary(per NDS Governing Load Comb CD CL + CL - CF Cr D+ S 1.15 1.00 1 0.40 1 1.2 1.15 Member Anal sis Results Summary Governing Analysis Pre-PV Demand Post-PV Demand Net Im act Result Gravity Loading Check 833 psi 732 psi 0.88 Pass L CALCULATION OF DESIGN WIND LOADS=MP2 Mounting Plane Information Roofing Material Comp Roof PV System Type _ SolarCity_SleekM_ount•" Spanning Vents No Standoff Attachment Hardware Comp Mount Type C Roof Slope 320 Rafter_Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin.Spacing _X-X Purlins_Only NA Tile Reveal Tile Roofs Only NA Tile,Attachment System Tile.Roofs.Only_ NA StandingSeam ra Spacing �SM Seam On NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind.Design Method Partially/Fully_Enclosed.Method Basic Wind Speed V 110 mph Fig. 6-1 Exposure.Category ___ C_ _ Section 6.5.6.3_ Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Height h 25 ft Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 Topographic_Factor &t 1.00 Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor I 1.0 Table 6-1 Velocity Pressure qh qh = 0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15 24.9 psf Wind Pressure Ext. Pressure Coefficient U G -0.95 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GC w 0.88 Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh(GC ) E cation 6-22 Wind Pressure U -23.7 psf Wind Pressure Down 21.8 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever Landscape 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary_Area __ _Trib 17 sf PV Ass embly Dead Load W-PV 3.0 psf Net.Wind:Uplift at Standoff_ Tactual -384 Ibs Uplift Capacity of Standoff T-allow 500 Ibs Standoff Demand Ca acity DCR 76.9% X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 17" NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area _ Trib __ 22 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind.Uplift at Standoff Tactual _ _ -479'lbs Uplift Capacity of Standoff T-allow 500 Ibs Standoff Demand/Capacity DCR '95.9% i �.►+�►�„� Town of Barnstable *Permit# Expires tS mgnttu from issue d t Regulatory Services Fee BAPJMABM MASS9. Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number �l � Not Valid without Red X-Press Imprint �� � �' �el ( n Property Address J� t \t kkA Residential Value of Work. ll j002 .5OZ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �nb wk tri tic. Contractor's Name VC*\ca^+- Telephone Number <s0`6> a�a-Oa(o3 Home Improvement Contractor License#(if applicable) b 0 5 c\ Construction Supervisor's License#(if applicable) CS - O cl I $`�6y ❑Workman's Compensation Insurance Check one: APR 1 20�3 ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's -Compensation Insurance Insurance Company Name 1�o�uc`�tc „&r•c,—LQ TOWN OF BARNSTABLE Workman's Comp.Policy# Co K kAT� 0k C 1 tQ 0 36- 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value . 3b (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r q fired. SIGNATURE: C C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 The Coniniotnvealth of Massachusetts Department of Industrial Accidents Offnce of Investigations 600 Washington Street Boston,MA 02111 1v1v1s.nmmgov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le:?ibly Name(Businesdorganintionllndividaal): Address: 12A Dr n S City/State/Zip: 1�,4,,..c..LA', �AA bg5 Phone, -�q.Oci00 Are you an employer?Check the appropriate box: Typegeneral contractor of project(r���: 1.X I am a employer with 13 ❑ I al d I g6. ❑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 S. ❑Demolition woAing for me in anycapacity. employees and have worms' I 9. ❑Building addition [No workers'comp.insurance camp.insurance required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.[:1 Roof repairs insurance required.]f c.152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks ban Rl mast also fill out the section below sbowing theuworkers'campensatioa policy inforumdon. T homeowners who submit this affidavit indicating they are doing all weak and&en hue outside contractors mast submit a new affidavit indicating sacb. tcontmctors that check this box must attached an additional sheet showing the ttame of the sub-contractors and state whether or not those entities have employees. If the anb-coanactots have employees,they must provide their workers'comp.policy number. I am an ernployer that is providing workers'compensation insurance for my employee Below is the policy and f ob site information. Insurance Company Name: .-X c e Policy#or Self-ins.Ile.9: �L h�� O 1(o 1 t1 O��1 D1 Expiration Date: Job Site Address: 1-l 1 U e s7 w i J uc(e_ City/State/Zip: 04I o f-1,1 I e, 140 d;*sx Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cetWffjy wider the pains and penalties of perjury that the information provided above is true and correct Simrature: /� ��/ Date: 3^oq i Phone#: C�u�) Act oZ- 01 (o 1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# 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 9: 6 3/8/2013 8:36:06 AM PST (GMT-8) FROM: 100005-TO: 15087716279 Page: 2 of 2 ACORv® CERTIFICATE OF LIABILITY INSURANCE DATE D1YY1rl) 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(les)must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,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 Risk Strategies Company corfrAcT NAME,Christina 15 Pacella Park Drive.Suite 240 PHONE cNo.- 781-336-4445 Randolph, MA 02368 E- DRESS• DISURER 8 AFFORDING COVERAGE NAIC e dsk-strategies.com INSURERA: INSURED INSURERB: Travelers Marine Lumber Operator, Inc. DBA Marine Lumber Co., Inc. INSURERC: 134 Orange Street wsURERD: Nantucket MA 02554 INSURERE: INSURERF: ::J COVERAGES CERTIFICATE NUMBER: 15686723 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. EXP LLTTRR TYPE OF INSURANCE D B POLICY NUMBER MM DDPOLICY EFF MP�pY YYY FRB A GENERALLMILIY 7140075780000 8/22/2012 6/30/2013 EACH OCCURRENCE $ 1000000 ✓ COMMERCIAL GENERAL LIABILITY IS Jrccur enm $ 50000 CLAIMS-MADE D OCCUR MEDEXP(An one Person) $ 5000 PERSO WU,&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENLAGGREGATELIMRAPPLIESPER: PRODUCTS.COMPIOPAGO $ 2000000 POLICY PRO• ✓ L 0 C $ A AUTOMOBILE uABmm ADN-8739221 8/22/2012 6/30/2013 We Mce'V,ent S 1000000 ✓ ANY AUTO BODILY INJURY(Per person) f ALL OS OWNED SAUTOSULED BODILY INJURY(Per seddert) $ ✓ HIRED AUTOSAUT ✓ NON-OWNED AUTOS Pera cRTY 1 ent A G t f A UMBRELLA I" H OCCUR 7140076780000 8/22/2012 6/30/2013 EACH OCCURRENCE S 1(),000,00 EXCESS LIAe CLAIMS-MADE AGGREGATE S 10,000 000 DED RETENTIONS S $ S B WORKERS COMPENSATION 6KUB0167NO3512 12/18/2012 12118/2013 WOC STA U. t r N- ANDEMPLOYERS'LIABILIY YIN OFFICEwME 6ERPEJ(CLUDED?ECGIVE❑N NIA E. EACH ACCIDENTS 500,000 (Mandawry in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 II yes,deserbe under DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT 1$ 500.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Ifnrore apace Is required) Certificate Holder Is additional Insured where required by written contract or agreement. CERTIFICATE O D CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marvin Design Gallery THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �,,� j /�p•- BemardGltiin �"`�'`'� 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CERT a0.: 15686723 CLIENT CODE: K&RIN-2 Christine tratson 3/8/2013 0:32:36 AN Page 1 of L • I i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ' License:CS-091884 VINCE"J MAR)NO 58 LIBERTY LAM MARSTONS MIIIS Expiration commisssionneer' 01/2412015 r -- - -- ✓,,, way•:.r� ;<e..'�„LG nisi ::,: t)dte:of;Cogsuluer. ffaira.&;$us .:,..,, `,� � icet►se of regisfcatdii lid:f , r. '.va or indivi'dnl use only QME IIVI ROV MENT CO@iTRAG1 OR'\ ' before the eiprr�trod date If foutt�`ietue to: !: 1 - y � x:, ` -,Ft a,:.: ,._ Office of Consumer..Aliarrs n�.$tininess R"gulation eglstrdUon991` I n e I) Typ e 1 p f$ 1914 r: .`SUPPIer►Iel aFd Boston,llA.:OZ)1'1G t' , 9 fNA';6N f t 4 LOItUER a` ............ nder�0 1+ �houtsP ,4 s g, 'r 1 i MARVIN DESIGN GALLERY a complete window and door showroom by MHC Permit Authorization as Owner of the subject . property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St., Nantucket, MA and hereby authorize y� ok io to act on my behalf, in all matters relative to work authorized by this building permit application for: ��1 WQS�li-� .�C � �c12 , VSTcd✓��lC� 1 V"l�1 (Address of Job) Signature of OwneP Date Print Name 73 Falmouth Road Hyannis,.MA 026011(508)771-62781(508)771-6279(Fax) www.marvi'ndesignga'llerybymhc.com i TOWN OF BARNSTABLE Permit No. 1.8565 Building Inspector cash -------------------- � �YL ,era OCCUPANCY PERMIT Bond _1:____- Issued to Rc a1 C V Trti:3 t Address Lot 1146, 191 :'w ,t .:ir d Circle. 0:.tcry111n Wiring Inspector Inspection date Plumbing Inspector \ Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. //,,___ ,. .... . ..... �... Building"Inspector oF'THE r Town of Barnstable er t O 1 1 0 Expires 6 neon sfrctln t dale Regulatory Services Fee �- • BARNSTABI.E, s 9c� 039. Thomas F.Geiler,Director A�fD MA'!A cok) 3/j9 J!o�14— Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY f Not Valid without Red X-Press Imprint Map/parcel Number D 3q Property Address g&_sid'ential Value'of Work (/(/ t Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ����lJ �Cj Contractor's Name ' ., Telephone Number !�JQ� L F94 Home Improvement Contractor License#(if applicable) Ion '-:7 n ga PERMIT Construction Supervisor's License#(if applicable) -�"�k(/� IVIPAR b A 201 ❑Workman's Compensation Insurance Check one: TOWN OF BARNSTABLE ❑ I am a sole proprietor I am the Homeowner I ve Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# q F9 9, V_ js p Copy of Insurance Compliance tertificaie must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Q' #of doors Replacement Windows/doors/sliders.U-Value ! 30 (maximum.44)#of window *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. `*Note: Pr perry Own must sign Property Owner Letter of Permission. opy oft me Improvement Contractors License&Construction Supervisors License is re uire SIGNATURE: Q:\WPFILESTORMS\building permi form\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name(Business/Organization/Individual): Lax a 2' ,,} Address: �/�ll�tc�12Y >✓ • �� City/State/Zip: Phone.#: Ay.re an employer? Check the ap r priate box: Type of project(required):. 1. a employer with 4. ❑• I am a general contractor and I employees(full and/or pP e). * have hired'the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.#. 9. ❑Building addition comp.[No workers' comp. insurance required.] 5. ❑ We are a corpoiation and its' 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. 9ther f 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insirrancefor my employees. Below is the policy and job site information. jl Insurance Company Name:_ a4 L Policy#or Self-ins. Lic.#: L „© Expiration Date: - . ♦� i �^ 1-��� Job Site Address: 1. I I/V�S-�' � r C]YL City/State/Zip: 2 foU S 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' ce covera a verification. I-do-herebyc-er-tify- . ..depth ins-and enalties-afparjury-that-the-infor-mation-provider-above-is-tr-ue-and-corr-ect Si ature: Date: _ Phone#: �—. — 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 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE 01105/;o°"YYY' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Nat'l Grange Mutual Insurance Co. Capizzi Home Improvement,Inc. INSURER B: ACE Property&Casualty Ins.Co. Capizzi Enterprises,Inc. INSURERC: 1645 Newtown Road INSURER D: Cotuit,MA 02635 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/09 06/08/10 EACH OCCURRENCE $1 000 000 - NCOM MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 000 CLAIMS MADE FR OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 00O 000 GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 000 POLICY ROOT LOC A AUTOMOBILE LIABILITY M7 M28044 06/08/09 06/08/10 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $500,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10 EACH OCCURRENCE s5,000,000 X1 OCCUR CLAIMS MADE AGGREGATE s5.000.000 $ DEDUCTIBLE $ X RETENTION $1 O 000 $ TH- B WORKERS COMPENSATION AND NWCC45843208 12/25/09 12/25/10 X DR LIMIT ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 OOO OOO ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 000 000 1I yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL l0_ DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #S48108/M48107 KW © ACORD CORPORATION 1988 r CAPIZZI HOME IMPROVEMENT INC. Page 7 of 7 t SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PE RMIT OWN THE PROPERTY LOCATED AT / i!. IN MASSACHUSETTS. . I HAVE AUTHORIZED CAPIZZI HOME RVIPRO) EMENT TO ACT AS A BUILDING PERMIT IN ACCORDANCE WITH 780 C MY AGENT TO APPLY FOR CODE. MR, THE MASSACHUSETTS STATE BUILDING I GIVE My PERMISSION TO TO APPLY FOR A BUILDING PERMIT IN ACC RDANCE WITH 780 C LESSEE STATE BUILDING CODE. MR, THE MASSACHUSETTS SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 LPPLICANT'S TELEPHONE: 508-428-9518 ESPONSIBLE OFFICER: ESPONSIBLE OFFICER ADDRESS: ESPONSIBLE OFFICER TELEPHONE: I , ✓�ce •tooy�.7no�uuea.�� o�./vGaaaac�wer.C� (LN. Board of Building Regulations and Standards License or registration valid for individ.ul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards ReglstX%j by 100740 One Ashburton Place Rm 1301 —1td >w7 23/2010 -pC -- Boston,Ma. 02108 plement Card CAPIZZI HOMES/ fl�� ' NARY GUSTAFS'Ot 1645 Newton Rd. Cotuit,MA 02635 Administrator No vali itho• ' "le nature ::>Ia•�.tcjiu.�rtt�- lla l>urtt�tcnt of Ptiblic Safetl -- — — ' Board of Buildi,-11 lZeoulittitills and Standards .'Construction Supervisor License License: CS 74640 .., __ t °z ; Restricted Yo: GARY.',GUSTAFSQN— �- 8 SH SAORT VNgY NDWICH, MA 02563 ,iF 11/29/2010 7755 Assessor's Office(1st f1. f Par ermit#LAVI L Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Ag6ate Issued Board of Heath(3rd floor)(8:15 -9:30/1:00-4:45) '' Engineering Dept. (3rd floor) House# t� na,,,:,. SEPTIC IV S AB T BE o � � WI TALLED 19 � TOWN OF BARNSTABE']&® "E�k'-FAg- R Building Permit Applicationy Proje t*tAdss . ���. Village 6.=)/ F-R l L f Owner L AVA)6�-- Address Telephone z4 ZU 2 Permit Request Psi d First Floor square feet Second Floor square feet Estimated Project Cost $ fT 3 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded • Current Use Proposed Use Construction Type r Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached y f Barn None Sheds Other Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# 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 SIGNATU DATE J �`��� BUILDIN ERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED a MAP/PARCEL NO. A RESS t VILLAGE t OWNER DATE OF INSPECTION: r _ FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL lt PLUMBING: ROUGH - FINAL GAS: Riall-q,. FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. • TOWN OF BARNSTABLE BUILDING DEPARTMENT . HOMEOWNER LICENSE EXEMPTION Please print. DATE �.�J ... JOB. LOCATION Number Street address Section of town "HOMEOWNER" Y. N e Home phone Work phone - ' 1 f PRESENT MAILING ADDRESS 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sY who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 Offici; on a form acCeptAble to the Building Official, that he/she shall be responsib. for all such work performed under the building permit. (Section 109. 1.1) The undersigned "homeowner" assumes . responsibility for compliance with the Stz Building Code and other applicable codes, by-laws, 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 comp3 witch said p�ocedur s an r qu'r ments. HOMEOWNER'S SIGNATURE ' APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home 'bwner acti as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma. communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. ' � . The Commonwealth of Massachusem Department of Industrial Accidents 41111 !t ashingron Street Banton.Afom. 02111 Workers' Compensation Insuranee Affidavit PI insepRiNrI7=hIj-� /namel !/�V7,70—Le city C) �/ tom` 1/I «-& Rhone 0 13 1 am a homeowner performing all work myself. .❑ I am a sole proprietor and have no one working in any capacity I am an empiover providin;workers' compensation for my employees working on this job. crrmmmny nnme: Address• ciri•• phone# inarr�nce co policy 0 I am a sole proprietor,general contract , or homeowner rcle one)and have hired the contractors listed below who the following workers' compensation poitc comn•rnv n•rmc• address! cih•r Rhone#* incurnncc co notieytf _ �_ '� w• �- Kif!il+:.F�'.i�RwT�T�"TR;p.i��is __ _ _ ___ _ .�TlQ7�'��=�•7T�7�Z �•�_ _-- comnany name• address: city. phone insurance co policy a :Attach addidiisfshee!lCtieee—a =: •ram^�<:+i`-�'r..�"�--.•:.: :�"'.:' :• .�""' Failure to secure coverage as required under Section 25A of 111GL 152 no lead to the imposition of criminal penaldn of a fine rep to S1.500.00 and one years'imprisonment as well as civil penaltles in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. 1 understand the COPY of this statement may be forwarded to the Ofiice of Investigations of the DIA for coverage Verification. do hemhr cenify under the airs and penalties o 'u t at the'j ion pmrided abovr is lore and cornet Signature </ iu a2- 7Z ZMnt name �- v one# r 7dfvor nly do not write is this area to be completed by city or town oMcial ltermit/ltt cogs d nBuilding Department DUcensing Board check if immediate response is required oSeleetmea's Ofnce (]liesith Department contact person: phone 1h —Other. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tl employees. As quoted from the "1a�v", an employee is defined as every person in the service ofanother under all, contract of(tire, express or implied. oral or%vritten. An emplorer is defined as an individual. partnership, association. corporation or other legal entity. or any two or me the foregoing eng,a,:cd in a joint enterprise, and including, the legal representatives of a deceased employer. or tite receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However i owner of a dwelling, house having not more than three apartments and who resides therein. or the occupant of the dwelling !rouse of another who employs persons to do maintenance, construction or repair work on such dwelling, h or on the grounds or building,appurtenant thereto shall not because of such employment be deemed to be an empio\ •state or local licensing agency shall withhold the issuance or MGL chapter 152 section _'S also states that eti•en renewal of a license or permit to operate a business or to construct buildings in the commoni•ealth for any applicant who Itas not produced acceptable evidence of compliance with the insurance coverage required. Additionallv. 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 been presented to the contracting authority. I .. ..r�...��. .. '1!l::r.{i � _ • .y...✓.�y.t:iaT�:.w�'�7 i.r.9.'• a`D�':.. .au�•rrt•a:.�';�.�_'..� :\:_•a. .�\.u.•._. Applicants Please `ill in the workers' compensation affidavit compietely, 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 affdavit. 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 require to obtain a workers' compensation policy, please call the Department at the number listed below. �—. .•�w'r.:.D' :.�5 '.. .. �.�.Mi....r.�i.'.!!�.•.,.-�.1..•� twa[�.�w�-�f IZSY..... Cin• or Tmvns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. PI be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returnee 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 questic please do not hesitate to give us a call. �..r.�w�. .....��r�••r,....►o. _ • «�::3:�•. _aria •' _ .��_. _ ..:Sir:_ ..a.•s�_ , The Department's address. telephone and fax number. The Commonwealth Of?Massachusetts Department of Industrial Accidents r- Office of Investigations 600 Washington Street Boston,Ma. 02111 j fax#: (617) 727-7749 • dam / . . . _ The Town of Barnstable � 1�P Department of Health Safety and Environmental Services Binding Division 367 Main Street.Hyaanis MA 0=1 Ralph Crosses Ofr= 508-790-6227 Big Commi Fax 508-775 33" For aice use only , Permit no. Date AFFIDAVIT HOME nffROVEMENTCONTRACTORLAW SUPPLEMENT TO PERMET APPLICATION MGL c. 142A requires that the"tecanstruction,altcMtions;renotradon,repair,mode+conversion, eo=rncdon of an addition t4 ed unprvvemetrt,.rentrnat, demolition. or �Y Pm'°� °� a� ding containing at least one but not more than four dandling units or to soruc�tues which are adpz� other g to such resideaee or building be done by registered===M with=tain=7dons, along with tegrtiremests- J, ��� at.Cost S � Type of Work: /� Address of Work:'/7 / '� r Owner. c: • � Date of Permit Applieuion: — 9 I hereby certify that: Registration is not required for the following zmson(s): Work coduded by law Job wader SI,000 Building not courts-ooeapied Al, 0W=pul1ingo=Pc=dt Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING a WORK Do NOT �S TOCTORS FOR APPLICABLE HOME BeROVEMh�Ti' THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c- 142A SIGNED UNDER PENALTIES OF PER.IURY I hereby apply for a permit as the agent of the owner: / contractor name No. Date OR�R-r-0- �Ezd, �3Ezzy cSm.a ff 3uidny 1,_q►c. 3 Industrial Drive • Hudson, NH 03051 • Tel: (603) 883-1362 • Fax: (603) 882-9566 PRICE LIST SIZES AVAILABLE IN THESE MODELS AMERICAN COUNTRY TRADITIONAL #1 #2 #3 #4 #5 #6 CLASSIC CARRIAGE GAMBREL 6 x 8 929.00 1029.00 6 x 10 1089.00 1199.00 8 1109.00 1219.00 1219.00 8 x 10 1359.00 1479.00 1479.00 • 1579.00 1739.00 1739.00 8 x 14 1789.00 1969.00 1969.00 8 x 16 2059.00 2259.00 2259.00 10 x 10 e a 1609.00 1769.00 1769.00 10 x 12 0 0 1839.00 2029.00 2029.00 10 x 14 0 0 2119.00 2329.00 2329.00 10 x 16 0 0 2469.00 2709.00 2709.00 10 x 18 2679.00 2969.00 2969.00 10 x 20 2999.00 3279.00 3279.00 12 x 12 2189.00 2449.00 12 x 14 0 2579.00 2889.00 12 x 16 0 2949.00 3299.00 12 x 18 0 3329.00 3729.00 12 x 20 3699.00 4139.00 OPTIONS-AVAILABLE ON ALL BUILDINGS Custom Hole in Floor for Pool Filter... . .. . .. . . . . .. . $75.00 Dutch Door 3'ONLY . . . . . . ... .. . .. . . . . . .. . . . . . . $50.00 2 x 8 P.T. Floor Joist per sq.ft.of Floor . . . .. . . . . . . . .. .750 To change existing Door to Arch . . . . . . .. . . . . .. . . . $50.00 Pressure Treated Plywood Flooring per sq.ft. . . . . . . .. . .50c Black Wrought Iron Hinges . . .. .. .. . .. . .. . . . .each $12.00 Pine Partitions per lin.ft. . . . . . . .... . . ... . . . . .. . . . $12.95 Relocate Doors&Windows . . . ... .. . . . . .. . . . . . .. . . . .N/C Additional Wall Ht.per lin.ft. . . . . . . ... . . . .. . . . . . .. $2.00 Loft 4'x 8' . . . . . . . . . . . ... . . . . . .. . . . . . .. . . . $64.00 Cupola . . . . . . . . . . . . .. . . . . . .. . . . ..... . . . . . . . . $95.00 Loft 4'x 10. . . . . . . . . . .. . .. . . . . . . . . . . . . .. . . $80.00 Additional Window(s) . . . . . . .. . . . . .. .. . . . .. . . . . . $70.00 Loft 4x 12 . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . $100.00 Additional Custom Windows" . . . . . . .. . . . . .. . . . . $120.00 Ramps 3'x 4' . . . . . . .. . . . . .. . . . . . . . . . . . . .. . . . $50.00 To change existing Window to Custom .. . . . . . . . . . . $50.00 Ramps 4'x 5' . . . . . ... . . .. .. . .. . . .. . . . . . .. . . . $75.00 Additional Door(s)3'or 5. . . .. . . .. . ... .. . . . . . . . . $100.00 Window Screens . . . . . . .. . . . . .. . . . . . .. . . . .each $10.00 Additional Arch Doors 3'or 5. . . . . . . ... . . . . . . . . . . $150.00 Custom Window Screens . . . . . . .. . . . . . . . . . .each $15.00 "Window Box&Shutters included with all Windows. Limited Wamnty Authorized Dealer:EAGLE FENCE CO. Reeds Ferry Small Bulldings,Inc.warranties your small building OF FALMOUTH for 10 years from date of purchase against defects in workmanship 570 E.Falmouth Hwy. (Rt.28) and material.This warranty does not include doors and windows.The E.Falmouth,MA 02536 roof shingles are separately warranted for 20 years against leakage Phone 50$ 540� ).�a l (natural disaster,damage by accident or neglect are excluded).This warranty extends only to the original purchaser.There are no other Prices include Installation In New Hampshire and Massachusetts. warranties give either express or implied, either orally or in writing. Tax NOT Included. Prices Sublect to Change Without Notice. Effective February 1,1996 -..yam .i ... v �..� ✓� Assessor's map and lot number ....... ... .......: ......... FINE Sewage Permit number ............... ..................... /ry�� Z BABHn90TABLE, i Blouse number ..................:/..: ...!.......R.•..�....C!.....:............. 9 a _ �p 1639, o TOWN OFe BARN STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................. .!. ...... ... .... ..............................................................:.......:.. TYPE OF CONSTRUCTION ....,....!. K.. .Q..�l...... 1:... ......�. !I<,/:. .c,J ..f ....................... ,� 7 ..............zo...-:...�Q.......19.1J.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...A...-r. ..... �..G'J........ !... 1.. ,f ... ...f!1�.�.��. ���.1 :��. ..... ... .� ;,Il�GG ProposedUse ....... ..�!!�... ./�.. /.,1h�.. ................................. ..................................................:.......................... 1 Zoning District .......... :..�---'.......................................Fire District ............:....�........ Name of Owner .T........M.1.......Y.14/..�i1�J�..OZ ..ZZ'�.. Name of Builder .. ,.., C)�...... /f.�l ./.Q/htddress ..................."L.^...... f.?.. .Y�f/ :1 ..... Name of Architect .....:.......................................:::..................Address .........................................-.-..•.r.............................................. I Number of Rooms .<J.. .. ...fJ.. >. .:��a.... �/V... �.7..Faundatian ......y��:Lj .....�...•.. �`1����. .7.F^ '� i Exterior ......�11�.� .�.. ..(r. 4.......f�1 C.! .. .Roofing ..... .> ,/,,T.GT......�. ,� C�. ...0 =-: .+..... Floors ..................a . .. ....� .. ........................Interior .......... .. ....y......��.11 .4.,--f.................... . .. Heating .............. . .,...... P►.......••,.......Plumbin .:..... ....... .............. Fireplace .............. .. ..•.,/j l.. .................................. Approximate. Cost ;" ... ..4/.. . �.... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .................... [�.ragram of Lot and Building with Dimensions Fee � ' !" f SUBJECT TO APPROVAL OF BOARD OF HEALTH D � � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above ;r construction. Name ! 4....... �.: r.....1`��..- -- lam-' v 0-6-6 .1..Construction Supervisor's License ...... .... .,.... 7 CEDAR ACRES REALTY -RUST /9` - A=12'1-11-39 One No ..2$5.0.... Permit for .......................Story......... ........... .... ..Dwelling.......................... Location .....Lg:t.. .... ....19 West .Wind Circle.1................................. . .....................Q.rp.t.qj;y.i.11e..................................... Owner ........Q.e4,:IN..Acres Realty Trust ........................................ Type of Construction ....Frame............................ ................................................................................ Plot ............................ Lot ................................ Permit Granted - October 21........... �5 ........................... 19 Datg. of Inspection ....................................19 Date Completed ......................................19 log- �d � 1 o7 • TOWN OF BARNSTABLE Permit No. ___--28565___ 1 nun i Building Inspector - —------ Cash pull OCCUPANCY PERMIT Bond ___A______.__-___-. Issued to Cedar Acres Realtv Trust Address Lot #46, 191 West Wind Circle. Osterv-illP Wiring Inspector Inspection date Plumbing Inspector \ Inspection date Gas Inspector `\ Inspection date Engineering Department Inspection date Board of Health ` Inspection date 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. .Aww,.. ...� _ _.. Buildingflnspector ..i a. ... x•. i Y%e:. , �'�'; '�� �„r7-'r11Fr �..yr�y.. .;;.�ya1. ... a��.r'.'. '�..�:✓�i.i�.+,d�•r.,a'.... '.a�•�C`.��t 't"`.�' .. � a � r� w 'O•. TOWN OF BARNSTABLE BUILDING DEPARTMENT _ NsaaaT rua = TOWN OFFICE BUILDING i639- HYANNIS, MASS. 02601 MEMO TO: Town Clerk .�f FROM: Building Department DATE: 2 An Occupancy.)Permit has been issued for the building authorized by Building PerM;2�4:7 .. .. i issued to .... .............................._............. .. ...........�......... w.._.. . . " " Please release the performance bond., n •f I. ... SU �LOIN G TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT f JOB WEATH f, CARD- . acLc,bc : 11 ' 85 -a G DATE PERMIT NO. ��Ir3"ft �$:.lCilaaiiC `l. 19 APPLICANT ADDRESS IN0.) (STREET) (CONTR'S LICENSE) d� J1UilC1 .='t �fl T t PERMIT TO (_j' MBER OF STORY t;"`+1L I= / :ti='L�. ? DWELLIING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) iot "46 1J_ tiest 14I,:Jj clrc'tia (;,,=_Is�l�. ZONING (NO.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: .eTwzl'. ti :'64-9 2!, AREA OR VOLUMEE ; r4/' 3-J.UUL, PERMIT�, i4• --• ESTIMATED COST FEE (CUBIC/SQUARE FEET) 'OWNER - fy. ADDRESS BUILDING DEPT.:'~ BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE.RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. ELECTRICAL, PLUMBING AND MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT 'IS VISIBLE FROM STREET BUIL ING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 :3a-p:3a 2 4��k 1 3 i HEATING !NSPECTING APPROVAL ! Mo lEIFA P VALS (I 1 -- E ACRK S.AL_ NCT -RO-EEO UNT:L THE PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION iNSFECTIONS INDICATED ON THIS CARD NS=EC.CP AN A=PFcv0N -vE WORK IS NOT STARTED wITMIN SIX MONTHS OF DATE THE STAGE JF CONSTRUCTION. CAN BE ARRANGED FOR BY TELEPHONE PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION, 77 ((3 3 Asses;;;Dr's map and lot number ....... -2) -11-................................. THE Sewage Permit number ............... ..................... ay EAR39TABLE, iVVIRUST r MABEL 163 House number .................. ...C..... ................. C 0 t AN.IPLI TI-rI 1: 5 V 41Brh fi ODE AND TOWN , OF BARNSiTA t- Towai REGULATIONS BUILDING NSPECTOR J APPLICATION FOR PERMIT TO .................fe.. . . ... . ........................................................................ TYPE OF CONSTRUCTION ......... J W..0-0.1)......rt< - /4. ....................... ..................ze............ ..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... T.....4.1.......�/1���.'�......WI ..... ProposedUse ....... ..................................................................................................................... ZoningDistrict .......... .. .......................................Fire District .............................................................................. Name of Owner .......Z....YA1..K4.12*1=)... .7. Name of Builder ...y 1-9 45 . I.....—/.-/7/-.CO.##R101_4(d d r es s ....................:::�. .....X./ ... . .^/..W....: Nameof Architect ..................................................................Address ..................... ............................................................... Number of Rooms i....911�4-416--7..Foundation .....pov- e.e...cop/ .7-.15..... . Exterior ..... Roofing ......A-Y11.PAAT..... ....... 9 Floors ................... • 7 7.'S........................Interior ..........)1/4..y.....111t...#1e.— . ........................... 13 72..S...............................Heating ... ...Plumbing .......... Fireplace .................... .........................................Approximate. Cost ............. ,0 Definitive Plan Approved by Planning Board -------------------------------- Area ....1. Diagram of Lot and Building with Dimensions Fee ........11.51,940.................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 7 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 Name . .. .. . ........ Construction Supervisor's License ...... s 7 � �C",,a!R'ACRES REALTY TRUST ti C e T No°...28565.... Permit for .:.:One..S.inary............. ...........S ngle...Eamily...RWe.]J a ng................... Location Lot 46, 191 West Wind Circle ................................................................ Osterville ............................................................................... Owner .......Cedar..Araxes--"alty••Tr-ust•••••• Type of Construction Frame " Plot .:.......................... Lot ................................ ;! , Permit Granted ...Q9CQ.b.er..21 .............19 85 Date,'of Inspection ..............................:......19 :. Date Completed � ....19 /wefe-BY CERTIFY MA7 VIS LOT/J NOT GOCATEO /N f 'EiPAL F400P HAZARD ZONE ~.As -sho 'N ON THE FEDERAL ,/LOOP INSURANCE RATE Amp FOR THE row* OF F , COWMI/NITY PAM& NO. EFFEMYE A4TE R0BERT E. RAYMONA R.k.-S. GATE NOTE: NORTH ARROW NOT TO BE y 4/S6-P FOR W-44R tO n Opy Z co �. Op0 4i FX/STING OO Q S � -k q ~ � w/S P/,OT Pl.AN WA.S A40;r A IA,Pf Ma P#&41NG 4XATION PORN AN INSTRUMENT WfVEYANP /S FOR THE " USE OF THE BANK (2NLY. UNDER NO -�D.._T �o Gl� c�7T Gf�/.N�.CIA 17 CIRCUMSTANCES ATE OFFSETS TO.BE USED 4-OR FENCES, W.44kd, .HEDGES,. Erc. O/YNEO BY- ,'W 4e'U5 4'04 � Q,13'��`1H efgs��cyG .4*PRO)f EN&NEER/NG INC. :g ROBERT w 60 EAST F,4,LmDam H/omm Y . . ' RAYMOND E.IST Fi4it.MOUYH MA. 02536 No:21583 .p GI.GE� DATE% S.0* r. s�o� issEA��`� �„:�� 5� /of / q� 1P#f4WN,BY CHEC &rPJ ` A PP BY: PLAN Na N h 1 � a \ O n N O �c \ 4 \ Q tib \ •'L\ 9� \ m \ a w� _ LOT 46 m z m m \ 19978 t S.F. \ - A m A \ .od 4"' 7v #l9 I r `as �� �•? 'sue V 5 � TOWN OF BARNSTABLE ZONING BY-LAW DATED SEPT. 14. 1989 ZONE RC I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SETBACKS KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING FRONT - 20 SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE - 10' OF THE ZONING BY-LAW FOR THE R-C DISTRICT. REAR - 10' PROPERTY LINES SHOWN HEREON THE LOT SHOWN HEREON 1S IN FLOOD HAZARD ZONE C WERE COMPILED FROO AVAILABLE AS SHOWN ON MAP 250001 0015 C. DATED AUG. 19. 1985. PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY .ON THE'GROUND. THE DWELLING DEPICTED ON THIS PLOT PLAN PLAN WAS LOCATED ON THE GROUND I N BY .SURVEY- ON Aria. 9. i .96 AND BARNSTABI E. MASS. EXISTS AS SHOWN AS OF THE DATE OF LOCATION. SCALE: I'-40' APR. 10. 096 THIS PLAN /S FOR PLOT PLAN EAGLE SURVEYING A ENGINEERING.INC. PURPOSES ONLY AND- NOT FOR $23 Route 6A RECORDING. DEED DESCRIPTIONS. Yaraouthport. MA. 0267$ ESTABLISHING PROPERTY LINES (500) $62-8132 OR FOR CONSTRUCTION PURPOSES. (508) 02-5888 I THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. •0 20 40 80 PROJECT NO. 96-254 I i i e ,+ _ �•+''� ►. •fir �f"T .Ts� ,r • "O,t,_ r I r � I .44 10 L UA 'ILD • • , 1 , � . i THE AMERICANS=k AT + F,( � i .4 gimcwwl_� 8 x 16 Classic#6 Stylish and practical, our American Classic is the perfect solution to your utility shed or storage needs. This budget-fitting style has been the popular choice of customers throughout our 35 year history. But we're always improving and adding so, be sure to review these standard features currently available (below). This style available from 6' x 8' to 12' x 20'. STANDARD FEATURES AVAILABLE WITH ALL REEDS FERRY SMALL BUILDINGS: 1. 2 x 6 Pressure-Treated Floor Joists, 16" on Center 2. 5/8" Top-Quality Flooring V 3. 2 x 4, 16" on Center Framing CLASSIC 4. Tongue & Groove Siding UNE ROOF 5. Heavy-Duty Roof Trusses, 16" on Center 6. Roof Sheathed with 1/2" Exterior Grade Plywood 7. Aluminum Drip Edge 8. Asphalt Roof Shingles with 20 Year Limited Warranty 9. Aluminum Louvres with Screens 10. Three Light Window Hinged to Open 11. Window Box & Shutters 12. Solid Pine Doors Diagonally Braced with 2 x 4's . and three 6" Heavy Duty Zinc-Plated Black Hinges See Page 5 for 13. Black Bugle Head Screws Available Options, Custom Design, and PERMITS ARE THE CUSTOMERS RESPONSIBILITY WHERE REQUIRED Model Floor Plans. 2 THE COUNTRY SHED �` : 77 a' pW 8 x 10 Carriage#3 Fromthe charming slope and protective overhang of the carriage roof, to the quiet, traditional styling, you'll love your Reeds Ferry Country Carriage Shed. In addition to its obvious eye-appeal, this style features a full 7 foot front wall and is available in sizes ranging from 6 x 8 to 10 x 20. O 6 O O9 7 O CARRIAGE 4 10 ROOF 000 LINE � 11 o O 13 r l O 12 2 2 See Page 5 for Available Options, Custom Design, and Model Floor Plans. - 3 I Reeds Ferry Small Buildings, Inc., manufactures high quality custom-crafted wood utility building and pool cabanas. Established in 1960 by the late Hobart D. Carleton, the company boasts over 35 years experience. The company was originally located in Reeds Ferry, New Hampshire. In 1969, the company relocated to a new, modern facility in Hudson, New Hampshire and still operates in this location. i f � Today, the third generation of the Carleton family continues to own and operate the Recd7Feny;Sma11]Buil'dinge business. From day.one, Reeds Ferry Small .. Buildings, Inc. has strived to give its customers the best product for dollar spent. The best then, is still the best today. Some of the man uses for a Reeds Ferry Small Building Y rY g STORAGE SHED FOR: UTILITY SHED FOR: OTHER USES: • TRACTOR. • POOL CABANA • SMALL OFFICE • RIDING MOVER • POOLSIDE DRESSING ROOMS • STUDIO • SNOW BLOWER • LAWN & GARDEN • MINI STABLE • SKIMOBILE • HEAVY EQUIPMENT e WORKSHOP • MOTORCYCLE • FIREPLACE WOOD • ANIMAL SHELTER • BICYCLES • ROADSIDE STAND • REPAIR SHOP * GARDENING TOOLS • SPORTSMAN'S CAMP • B-B-Q EQUIPMENT • GUEST HOUSE • COLLECTABLES .• TOOLS & SUPPLIES . . .and, of course, your special needs! AUTHORIZED DEALER: EAGLE FENCE CO. D D OF FALMOUTH N c_ 570 E.Falmouth Hwy.(Rt.28) E.Falmouth,M-A 02536 3 Industrial Drive, Hudson, NH 03051 Phone(508)540-3161 For Dealer Nearest You: Call: (603) 883-1362 • Fax: (603) 882-9566 THE TRADITIONAL IN 12 Gambrel#4 Need more headroom, or storage space? New, this year, the Traditional Gambrel offers all the fine features that you've come to expect from a Reeds Ferry Small Building. But, here we've added the bonus of extra height and a more usable upper area. Easily accommodates our optional loft . . . add one on! This style available from 8' x8' to 12' x 20'. ROOF SHINGLE COLORS AVAILABLE WITH ANY REEDS FERRY SMALL BUILDING: •BLACK GAMBREL • WHITE ROOF "• LIGHT BROWN uNE • DARK BROWN • GRAY • SLATE ASK YOUR SALES REPRESENTATIVE See Next Page for TO SHOW YOU OUR CURRENT SAMPLES Available Options, Custom Design and Model Floor Plans. 4 z Fq veryReeds Ferry Small Building is hand-built by New Hampshire craftsmen who take pride in ir trade. All Reeds Ferry Small Buildings are pre-fabricated for easy access to your property and on-location assembly. Buildings are delivered unstained, ready for your personal touch. Roof shingles are available in a wide variety of colors. What's Your Pleasure? Would you like to add a window, move a door, or. . . create your own "custom design"? Just select from the 3 basic styles,use one of the 6 Model Floor Plans below and choose from the list of available options. For example: The American Classic, Model 4, 8' x 16' with an additional window on gable end and an access ramp. Consult the price list for sizes and further details. MODEL FLOOR PLANS All three basic styles are available in any of these models. MODEL 1 MODEL 2 MODEL 3 Classic 6 x 8 - 12 x 20 Classic 6 x 8 - 12 x 20 Classic 8 x 10 - 12 x 20 Carriage 6 x 8 - 10 x 20 Carriage 6 x 8 - 10 x 20 Carriage 8 x 10 - 10 x 20 Gambrel 8 x 8 - 12 x 20 Gambrel 8 x 8 - 12 x 20 Gambrel 8 x 10 - 12 x 20 1 window, 3' door 5' door 1 window,5' door MODEL 4 MODEL 5 MODEL 6 Classic 8 x 12 - 12 x 20 Classic 8 x 16 - 12 x 20 Classic 8:x16 - 12 x 20 Carriage 8 x 12 - 10 x 20 Carriage 8 x 16 - 10 x 20 Carriage 8 - 10 x 20Gambrel 8 x 12 - 12 x 20 Gambrel 8 x 16 - 12 x 20 Gambrel 8 - 12 x 20 2 windows, 5' door 2 windows, 3' door, 5' door 1 window, 3' door, 5' door Options Available-on All Buildings • Pine Partitions • Dutch Doors 3' only • 2 x 8 Pressure Treated • Additional Window (s) • Additional Wall Height' Floor Joists • Additional Door (s) 3' or 5' • Custom Hole in Floor for Pool Filter • Pressure Treated • Custom Windows • Ramps Plywood Flooring • Arch Doors 3' or 5' • Cupola • Loft • Black Wrought Iron Hinges • Window Screens 5 ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE 1. THIS SYSTEM IS GRID—INTERTIED VIA A AC ALTERNATING CURRENT _ UL—LISTED POWER—CONDITIONING INVERTER. BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. CONIC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING DC DIRECT CURRENT LABORATORY SHALL LIST ALL EQUIPMENT IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. (E) EXISTING 4. WHERE ALL TERMINALS OF THE DISCONNECTING EMT ELECTRICAL METALLIC TUBING MEANS MAY BE ENERGIZED IN THE OPEN POSITION, FSB FIRE SET—BACK A SIGN WILL BE PROVIDED WARNING OF THE GALV GALVANIZED HAZARDS PER ART. 690.17. GEC GROUNDING ELECTRODE CONDUCTOR 5. EACH UNGROUNDED CONDUCTOR OF THE GND GROUND MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY HDG HOT DIPPED GALVANIZED PHASE AND SYSTEM PER ART. 210.5. I CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL Imp CURRENT AT MAX POWER COMPLY WITH ART. 250.97, 250.92(B). Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR kW - KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC LBW LOAD BEARING WALL DISCONNECTING MEANS PER ART. 690.31(E). MIN MINIMUM 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN (N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY NEUT NEUTRAL UL LISTING. NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE OC ON CENTER UL—LISTED LOCATION PROVIDED BY THE PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING POI POINT OF INTERCONNECTION HARDWARE. PV PHOTOVOLTAIC 10. MODULE FRAMES, RAIL, AND POSTS SHALL BE SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS. S STAINLESS STEEL STC STANDARD TESTING CONDITIONS TYP TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY V VOLT Vmp VOLTAGE AT MAX POWER VICINITY MAP INDEX Voc VOLTAGE AT OPEN CIRCUIT W WATT 3R NEMA 3R, RAINTIGHT k PV2 SITE EPLAN EET PV3 STRUCTURAL VIEWS PV4 UPLIFT CALCULATIONS PV5 THREE LINE DIAGRAM LICENSE GENERAL NOTES Pv6 STRUCTURAL VIEWS — MP1 GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION t Cutsheets Attached ELEC 1136 MR OF THE MA STATE BUILDING CODE. 2. ' ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2014 NATIONAL ELECTRIC CODE INCLUDING MASSACHUSETTS AMENDMENTS. MODULE GROUNDING METHOD: ZEP SOLAR i AHJ: Barnstable � REV BY DATE COMMENTS REV A NAME DATE COMMENTS UTILITY: NSTAR Electric (Commonwealth Electric) CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER J B-0 2 6 2 412 00 OWNER DE ON: DESIGN. ` CONTAINED SHALL NOT BE USED FOR THE �.`�i BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MourinNG srs1EM: WULFING, ROBERT WULFING RESIDENCE • Faisal Mosed SolarCity.NOR MALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 191 WESTWIND CIR 11.44 KW PV ARRAY ►r PART IZ OTHERS EXCEPT IN THE RECIPIENT'S MODULES: OSTERVILLE MA 02655 ORGANIZATION, ECCEPT IN CONNECTION WITH , THE SALE AND USE OF THE RESPECTIVE (44) TRINA SOLAR # TSM-260PDO5.18 24 St Martin Drive,Building 2,Unit 11 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV: DATE Marlborough,MA 01752 PERMISSION OF SMENT, TY INC. INVERTER. T: (650)636-1028 F: (650)638-1029 SOLAREDGE SE1000OA—USOo0SNR2 (508) 681-8594 COVER SHEET PV 1 12/17/2015 (888�sa-aTY(765-2469) ,rw..slaaltYao„ Y PITCH: 32 ARRAY PITCH:32 MP1 AZIMUTH: 137 ARRAY AZIMUTH: 137 MATERIAL: Comp Shingle STORY: 2 Stories PITCH: 32 ARRAY PITCH:32 MP2 AZIMUTH:317 ARRAY AZIMUTH: 317 MATERIAL: Comp Shingle STORY: 2 Stories B LEGEND (E) UTILITY METER & WARNING LABEL e e e e EV Iry INVERTER W/ INTEGRATED DC DISCO & WARNING LABELS Inv DC DISCONNECT & WARNING LABELS ---- ©AC AC AC DISCONNECT & WARNING LABELS i - © DC JUNCTION/COMBINER BOX & LABELS i D O Q DISTRIBUTION PANEL & LABELS A Lc LOAD CENTER &.WARNING LABELS � �►t OF O DEDICATED PV SYSTEM METER WU MA. O STANDOFF LOCATIONS $ 9o.DWj;L — CONDUIT RUN ON EXTERIOR CONDUIT RUN ON INTERIOR @� GATE/FENCE Cr+tnt � HEAT PRODUCING VENTS ARE RED Digitally signed r , by William A. It %I INTERIOR EQUIPMENT IS DASHED Eldredge Jr. _ o Date:2015.12.17 SITE PLAN 19:47:46-05'00' STAMPED & SIGNED Scale: 1/8" = 1' FOR STRUCTURAL ONLY 0 1' 8' 16' s F J B-0 2 6 2 412 00 PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: \\ SO�a�C�t CONTAINED SHALL NOT BE USED FOR THE WULFING, ROBERT WULFING RESIDENCE Faisal Mased =:t, ' BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: w s8 NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 191 WESTWIND CIR 11.44 KW PV ARRAY ��� PART TO OTHERS OUTSIDE THE RECIPIENT'S Co m OSTERVILLE MA 02655 ORGANIZATION. EXCEPT IN CONNECTION WITH 24 St. Martin Drive,Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) TRINA SOLAR # TSM-260PDO5.18 PAGE NAME SHEET: REV: DATE Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T. (650)638-1028 F: (650)638-1029 PERMISSION of SOLARCITY INC. SOLAREDGE SE1000OA-USOOOSNR2 (508) 681-8594 SITE PLAN PV 2 12/17/2015 (888)-SOL-CITY(765-2489) wawsolaroity.00rn 0 S1 S1 4" 0 12,-10„ 0 12,-10" 70, - (E) LBW (E) LBW A SIDE VIEW OF MP1 NTS B SIDE VIEW OF MP2- NTS MPl X-SPACING X-CANTILEVER Y-SPACING I Y-CANTILEVER NOTES MP2 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES LANDSCAPE 64" 24" STAGGERED LANDSCAPE 64" 24" STAGGERED PORTRAIT 48" 17" PORTRAIT 48" 17" RAFTER 2X8 @ 16"OC ROOF AZI 137 PITCH 32 STORIES: 2 RAFTER 2X8 @ 16"OC ROOF AZI 317 PITCH 32 STORIES: 2 ARRAY AZI 137 PITCH 32 ARRAY AZI 317 PITCH 32 C.I. 2X8 @16"OC Comp Shingle C.I. 2X8 @16"OC Comp Shingle -PV MODULE 5/16" BOLT WITH LOCK INSTALLATION ORDER & FENDER WASHERS LOCATE RAFTER, MARK HOLE ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT ZEP ARRAY SKIRT (6) HOLE. (4) (2) SEAL PILOT HOLE WITH POLYURETHANE SEALANT. ZEP COMP MOUNT C ZEP FLASHING C (3) (3) INSERT FLASHING. �yto� (E) COMP. SHINGLE (1) (4) PLACE MOUNT. aDRWM�;L (E) ROOF DECKING u 22) INSTALL LAG BOLT WITH $ 5/16" DIA STAINLESS (5) (5) SEALING WASHER. - STEEL LAG BOLT LOWEST MODULE SUBSEQUENT MODULES �'NSTALLVELING FOOT WITH WITH SEALING WASHER & WASHERS. r/ (2-1/2" EMBED, MIN) (E) RAFTER STANDOFF • FOR STRUC URA ONLY CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: J B-0 2 6 2 412 00 PREMIX OWNER DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE BENEFIT OF ANYONE EXCEPT SOLARGTY INC., MOUNnNG SYSTEM: WULFING, ROBERT WULFING RESIDENCE Faisal Mased °SolarCity.NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 191 WESTWIND CIR 11.44 KW PV ARRAY '�ip PART TO OTHERS OUTSIDE THE CONNECTION MODULES: OSTERVILLE MA 02655 ORGANIZATION, EXCEPT IN CONNECTION WITH � •` 24 St Martin Drive, Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) TRINA. SOLAR # TSM-260PD05.18 ��: �y DATE: Marlborough.Drive, Ma ins, SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME T: (650)636-1028 F: (617 638-1029 PERMISSION of saLARaTY INC. SOLAREDGE SE1000OA-USOOOSNR2 (508) 681-8594 STRUCTURAL VIEWS PV 3 12/17/2015 (888)-SOL-CITY(765-2489) www.Sdarclty.com UPLIFT CALCULATIONS SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS. J B-0 2 6 2 412 00 PREMISE OWNER: DESCRIPTION. DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: �\\t� CONTAINED SHALL NOT BE USED FOR THE WULFING, ROBERT WULFING RESIDENCE Faisal Mased BENENOR FIT OF ANYONE EXCEPT IT ,SO�afC�t�/ BE DISCLOSED OLARRCIT MOUNTING SYSTEM:OR IN 191 WESTWIND CIR '►i� • Comp Mount Type C 11.44 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS Moou OSTERVILLE MA 02655 ORGANIZATION, EXCEPT IN CONNECTION WITH 24 St. Moron Drive,Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) TRINA SOLAR # TSM-260PD05.18 I SHEET: REV. DATE. Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: T: (650)638-1028 F: (650)638-1029 ` PERMISSION OF SOIARCITY INC. INVERTER. 508 68178594 PV 4 12 17 2015 (888}SOL—CITY(765-2489) www.edarcity.com SOLAREDGE SE10000A—USOOOSNR2 � UPLIFT CALCULATIONS � GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) #8 GEC TO TWO (N) GROUND Panel Number:G2020MB1100 Inv 1: DC Ungrounded INV 1 -(1)SOLAREDGE E1000OA-USOOOSNR LABEL: A -04)TRINA SOLAR ## TSM-260PDO5.18 GEN #168572 RODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:2236091 Tie-In: Supply Side Connection Inverter; 10 OW, 240V, 97.5%d•w/�Unifed Disco andZB,RGM,AFCI PV Module; 26OW, 236.9W PTC, 40MM, Black Frame, H4, ZEP, 1000V ELEC 1136 MR Underground Service Entrance INV 2 Voc: 38.2 Vpmox: 30.6 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER �E 100A MAIN SERVICE PANEL E� 10OA/2P MAIN CIRCUIT BREAKER SolarCity (E) WIRING CUTLER-HAMMER CUTLER-HAMMER II1V21t2C 1 5 A 1 Disconnect 100A/2P 7 g 60A Disconnect 6 SOLAR00A-U 00 DC+ p 1 + MP 2: 1x1 SE10000A-USOOOSNR2 Da - EGC C zaov ------- ------------ -- �----- - 3 -- ---------- w A L1 r--- 2 - - B L2 DC+ N DC_ I 4 Dc MP 1: 1x10 _ D __-__--____-_-___________ EGG T + MP 2: 1x16(E) LOADS D D �� I N jDC, EGC--- --------- EGC ------ -- N I (I)Conduit Kit; 3/4'EMT I o EGCIGEC_ z � � I I I I I _ GECT-1 TO 120/240V SINGLE PHASE I I UTILITY SERVICE I I I I I I I I I I ' I I PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Voc* = MAX VOC AT MIN TEMP p�I (2)Groygd Ro# (1)CUTLER-HAMMER #DG222NR8 /� A (1)Solaty#4 STRING JUNCTION 80X D� 5 8 x 8, per v Disconnect; 60A, 240Vac, Fusible, NEMA 3R /-, 2x2 STRMGS, UNFUSED, GROUNDED -(2)ILSCO IPC.,ng -(1)CUTLER-HAMMER 9 DG100N8 PV (44)SOLAREDGE�300-2NA4AZS Insulation Piercing Connector, Main 4/0-4, Tap 6-14 Ground/Neutral Kit; 60-100A, General Duty(DG) Power9ox ptimizer, 30OW, H4, DC to DC, ZEP S SUPPLY SIDE CONNECTION. DISCONNECTING MEANS SHALL BE SUITABLE -(1)CUTLER-HAMMER a s R FuuseEKit#DS16FK AS SERVICE EQUIPMENT AND SHALL BE RATED PER NEC. -(2)FERRAZ SHAWMUT TR60R PV BACKFEED OCP nd (1)AWG #s. Solid Bare Copper Fuse; 60A. 25OV, Gass RK5 -(1)Ground Rod; 5/8' x 8',Copper C (1)CUTLER-HAMMER #DG222URB (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL Disconnect; 60A, 24OVac, Non-Fusible, NEMA 3R (1)cur rNeuMER i D o00-1OOA General Duty(Dc) ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE 7 1 AWG �, THWN-2, Black gT' 1 AWG#6, THWN-2, Black 1)AWG#B, THWN-2, Black Voc* =500 VDC Isc =30 ADC 2 AWG 0, PV Wire, 60OV, Black Voc* =500 VDC Isc =15 ADC O (1)AWG/6, THWN-2, Red ©L^�L(1)AWG#6, THWN-2, Red ® (i)AWG#B. THWN-2, Red Vmp =350 VDC Imp=19.06 ADC O L`] (1)AWG#6, Solid Bare Copper EGC Vmp =350 VDC Imp=13.2 ADC (1)AWG�, THWN-2, White NEUTRAL Vmp'=240 VAC Imp=42 AAC (1)AWG#10, THWN-2, White NEUTRAL VMP =240 VAC IMP=42 AAC .. . . , , . (1)AWG#10, THHN/THWN-2,,Green. EGC. , , , , . . . . . . . . . . . . . . . .. .. .. . . ... . . . . .. . . . . . . . . . .... . . . . . . . . . . .-(1)AWG#6,,Solid Bare.Copper. GEC, , . (1)Conduit.Kit;.3/4',EMT. . ... . . . . . . . . . . . .-(1)AWG#8,•1HWN-2,,Green . . EGC/GEC.-(1)Conduit.Kit;.3/4',EMT, , , , , . ,,, , , (1 AWG#10, THWN-2, Black Voc* =500 VDC Isc =15 ADC (2)AWG#10, PV Wire, 60OV, Black Voc* 500 VDC Isc =15 ADC O (1)AWG 110, THWN-2, Red Vmp 350 VDC Imp=13.2 ADC O 1)AWG#6, Solid Bare Copper EGC Vmp 350 VDC Imp=7.33 ADC (1)AWG#10, THHN/THWN-2,,Green EGC ( - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . (2)AWG#10, PV Wire, 60OV, Block Voc* =500 VDC Isc =15 ADC O (1)AWG#6, Solid Bare Copper EGC Vmp =350 VDC Imp=11.73 ADC . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . .. . . . . .. . . . . . . . . . . .. . . . . . . . . . . CONFIDENTIAL- THE INFORMATION HEREIN JOB NUMBER J B-0 2 6 2 412 0 0 PREInSE OWNER DESCRIPTION: DESIM \\,CONTAINED SHALL NOT BE USED FOR THE WULFING, ROBERT WULFING RESIDENCE Faisal Mosed SolarCity. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSIEIJ: ��: NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 191 WESTWIND CIR 11.44 KW PV ARRAY h� ° PART TO OTHERS OUTSIDE THE RECIPIENT'S NODDIES OSTERVILLE MA 02655 ORGANIZATION, EXCEPT IN CONNECTION WITH , 24 St.Martin Drive,Building$Unit 11 THE SALE AND USE OF THE RESPECTIVE (44) TRINA SOLAR # TSM-260PDO5.18 SHE; RM. DATE: Marlborough,MA 01752 • SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER PAGE NAME T. (650)638 1028 F: (650)636-1029 PERMISSION OF SOLARCITY INC SOLAREDGE SE1000OA-USOOOSNR2 (508) 681-8594 THREE LINE DIAGRAM PV 5 12/17/2015 (888)-SOL-CITY(765-2489) www.solarcity.com Location:Label .•- Label PHOTOVOLTAIC POWER SOURCE WARNING • WARNING ' Per Code: Per Code: Per Code: NEC 690.31.G.3 NEC �ELECTRIC SHOCK HAZARD ELECTRIC SHOCK HAZARD DO NOT TOUCH TERMINALS NEC •THE DC CONDUCTORS OF THIS Label • • TERMINALS ON BOTH LINE AND PHOTOVOLTAIC SYSTEM ARE TO BE USED WHEN LOAD SIDES MAY BE ENERGIZED UNGROUNDED ANDINVERTERIS PHOTOVOLTAIC DC D Code: •_ IN THE OPEN POSITION A�IAY BE ENERGIZED UNGROUNDED NEC DISCONNECTPer .•0 LabelLabel Location: • • PHOTOVOLTAIC POINT OF • MAXIMUM POWER-_ INTERCONNECTION Code: A D WARNING: ELECTRIC SHOCK POINT CURRENT(Imp) Per • - HAZARD. DO NOT TOUCH NEC '• NEC 690.54 MAXIMUM POWER- VNEC 690.53 BOTH THE LINE AND LOAD SIDE NIAXIMURA SYSTEA1_V NIAY BE ENERGIZED IN THE OPEN Label Location: VOLTAGE(Voc) POSITION. FOR SERVICE SHORT-CIRCUIT A DE-ENERGIZE BOTH SOURCE CURRENT(Isc) AND AAAIN BREAKER. PV POWER SOURCE MAXIMUM AC A OPERATING CURRENT NIAXINIUM AC OPERATING VOLTAGE V WARNING ' Per ..- NEC ELECTRIC SHOCK HAZARD 6 9 0 IF A GROUND FAULT IS INDICATED NORMALLY GROUNDEDLabel L• • CONDUCTORS MAY BE CAUTION • UNGROUNDED AND ENERGIZED DUAL P01NER SOURCEPer Code: SECOND SOURCE IS NEC 690.64.13.4 PHOTOVOLTAIC SYSTEM Label • • WARNING ' Per Code: Label Location: ELECTRICAL SHOCK HAZARD DO NOT TOUCH TERMINALS CAUTION ' • TERMINALS ON BOTH LINE ANDPer Code: NEC LOAD SIDES Iv1AY BE ENERGIZED PHOTOVOLTAIC SYSTENi •, • 4.13.4 IN THE OPEN POSITION CIRCUIT IS BACKFED DC VOLTAGE IS ALWAYS PRESENT WHEN SOLAR MODULES ARE EXPOSED TO SUNLIGHT Label • • WARNING '• Per ..- INVERTER OUTPUT Label • - • CONNECTION NEC 690.64.13.7 PHOTOVOLTAIC AC • DO NOT RELOCATEDisconnect DISCONNECT - Code: THISODEVCERRENTConduit NEC ••014.C.2 (CB): Combiner :• Distribution Disconnect Interior • • Label • • Iv1AXIMUM AC A • Load Center OPERATING CUP.P,ENTPer Code: AC VNEC •• •I): Point of • • OPERATING VOLTAGE San Mateo,CA 94402 • r� r • ,• I ' ?f 1� J ' t Next-Level PV Mounting Technology Q,SOIarGty ZepSolar Next-Level PV Mounting Technology SSolarCity I ZepSolar Components Zep System y for composition shingle roofs Leveling Foot :�_ Up-roof �0101dzep Interlock (Vey$ldQ'"01`'a) Part No.850-1172 LevaIr+g FOO1 : ETL listed to UL 467 T Zep CompaftW P/Module ._--• Zep Groove - Root Attachment Array Skirt Ire Comp Mount F Part No.850-1382 Listed to UL 2582 Mounting Block Listed to UL 2703 _ `eMPgr' ', Description • / PV mounting solution for composition shingle roofs now" i^AO� Works with all Zep Compatible Modules ° P Auto bonding UL-listed hardware creates structural and electrical bond • Zep System has a UL 1703 Class"A"Fire Rating when installed using modules from any manufacturer certified as'Type 1"or"Type 2" Interlock Ground Zep V2 DC Wire Clip �L usrEo Specifications Part No.850-1388 Part No.850-1511 Part No.85(M448 Listed to UL 2703 Listed to UL 467 and UL 2703 Listed to UL 1565 • Designed for pitched roofs • Installs in portrait and landscape orientations • Zep System supports module wind uplift and snow load pressures to 50 psf per UL 1703 • Wind tunnel report to ASCE 7-05 and 7-10 standards • Zep System grounding products are UL listed to UL 2703 and UL 467 • Zep System bonding products are UL listed to UL 2703 • Engineered for spans up to 72"and cantilevers up to 24" • Zep wire management products listed to UL 1565 for wire positioning devices • Attachment method UL listed to UL 2582 for Wind Driven Rain Array Skirt,Grip, End Caps Part Nos.850-0113,850-1421, 850-1460,850-1467 zepsolar.com zepsolar.com Listed to UL 1565 This document does not create any express warranty by Zep Solar or about its products or services.Zep Solar's sole warranty is contained in the written product warranty for This document does not Create any express warranty by Zep Solar or about its products or services.Zep Solar's sole warranty is contained in the written product warranty for each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely each producL The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely responsible for verifying the suitability of ZepSolar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. responsible for verifying the suitability of ZepSolar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. Document#800-1890-001 Rev A Date last exported: November 13,2015 2:23 PM Document#800-1890-001 Rev A Date last exported: November 13,2015 2:23 PM io solar=oo solar=oo SolarEdge Power Optimizer NModule Add On for North America C= P300 / P350 / P400 SolarEdge Power Optimizer p P300 P350 P400 Module Add-On For North America (for 60-cell (fomodulesr Z-cell V (fomodulesr 6-cell V modP300 / P350 / P400 Paz (INPUT Rated Input DC Power"' 300 350 400 W Absolute Maximum Input Voltage(Voc at lowest ...... ..... 80 .... Vdc.._. MPPT Operating Range........................................................8:48.....................8.:60 ........8:.80......... ...Vdc..... Maximum Short Circuit Current(Isc) 10 Adc 'nano^' Maximum DC Input Current..................................................................................12:5............................:.......... ...Adc..... 1� .......................... Maximum Efficiency ..............................99:5 ...%...... I -.. Weighted Efficiency ...............98.e.................................... ............. Overvoltage Category II I,OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) Maximum Output Current 15 Adc //�� Maximum Output Voltage _ 60 Vdc a A f r , S.OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) i _ � Safety Output Voltage per Power Optimizer 1 Vdc A ,r ISTANDARD COMPLIANCE EMC FCC PartlS Class B:lEC61000-6,2.IEC61000;6,3 Safety IEC62109 1(cla55II safety)UL1741 RoHS yes 1INSTALLATION SPECIFICATIONS ........................................ . .. I 'fir"' Maximum Allowed System Voltage 1000 Vdc Dimensions,(W x L.x.H)... ....................................... .................141.x 212x40.5/5.55 x.8.34x1.59................. mm/In.. Weight(includin8 cables) 950/2.1 gr/Ib Input Connector MC4/Amphenal/Tyco + Out ut Wire Type/Connector.... .... . . . .. . .........................Double lnsulated;Am henol....................... ........... .. /3.0 . I........................................................ ...n1.�..... .................................................................. OpeatinQ Temperature Range....................................................................: •C/•F ............................ ............. e ..Protection RatinB............... .................................IP65/NEMA4 Relative Humidity 0-100 % wn.ma srt oo�.a me�mam�.Momaed w ro.sx oo.<,�oxnMe.ro.ea. 4fPV SYSTEM DESIGN USING A SOLAREDGE THREE PHASE THREE PHASE (INVERTER SINGLE PHASE 208V 490V PV power optimization at the module-level Minimum String Length(Power Optimizers) 8 10 18 ........................................................................................................................................................................ Up to 25%more energy Maximum String Length(Power Optimizers) 25 25 SO ....................................................................................................................... Maximum Power per String 5250 6000 12750 W —Superior efficiency(99.5%) ............Strings of i ...........�.................................................................................................................................... Pam11el5trin s of Different Len hs or Orientations Yes — Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading """"""""""""""""""""""......"""""""""'"""""""""""""""""""""""""""""..... """"""""'""""""' — Flexible system design for maximum space utilization — Fast installation with a single bolt — Next generation maintenance with module-level monitoring — Module-level voltage shutdown for installer and firefighter safety n USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA WWW.SO)aredge.u5 ^_ qp, m ...o: finu a r� u •tnslts U.7•i 4".-..;V ° THE mamount MODULE TSM-PD05.18 Mono Multi Solutions DIMENSIONS OF PV MODULE ELECTRICAL DATA @ STC unit:mm Peak Power Watts-PMex(Wp) 245 250 i 255 260 • 941 Power Output Tolerance-PMax(%) 0-+3 i THE Trin-amountMaximum PowerVoltaget-1 (V) 29.9 8.27 8.37 30.6 8.50 eox `Maximum Power Current-IMw(A) 8.20 8.27 8.37 8.50 - xuuvurt c Open Circuit Voltage-Voc IV) 37.8 38.0 38.1 38.2 .ev rx wsrasaxc xar 1 Short Circuit Current-Isc(A) 8.75 8.79 8.88 9.00 ) MODULE Module Efficiency qm(%) .Air 15. 15.6 15.9 STC:Irradiance 1000 W/m'.Cell temperature 25°C Air Mass AM1.5 according to EN 60904-3. Typical efficiency reduction of 4.5%at 200 W/m'occording to EN 60704•1. 0 0 to e ELECTRICAL DATA @ NOCT Maximum Power-PMax(Wp) 182 186 190 193 6 CELL Maximum Power Voltage-VMv(V) 27.6 28.0 28.1 28.3 I MULTICRYSTALLINE MODULE Maximum Power Current-IMrr(A) 6.59 6.65 6.74 6.84 A A `Open Circuit Voltage(V)-V-(V) 35.1 35.2 35.3 35.4 WITH TRINAMOUNT FRAME Short Circuit Current(AJ-Isc(A) 7.07 7.10 7.17 zv NOCT:Irradiance at 800 W/m',Ambient Temperature 20-C.Wind Speed I m/s. 245-26OW PD05.18 812 180 Back View POWER OUTPUT RANGE MECHANICAL DATA -1-1-I Solar cells Multicrysfalline 156 x 156 mm(6 inches) Fast and simple to install through drop in mounting solution I Cell orientation 60 cells(6 x 10) { 15.9 Module dimensions 1650 x 992 x 40 mm(64.95 x 39.05 x 1.57 inches) Q v `Weight 21.3 kg(47.0lbs) MAXIMUM EFFICIENCY Glass 3.2 mm(0.13 inches),High Transmission,AR Coated Tempered Glass A-A Backsheet White ® Good aesthetics for residential applications Frame Black Anodized Aluminium Alloy with Trinamount Groove 1-V CURVES OF PV MODULE(245W) J-Box IP 65 or IP 67 rated 0~ ■i 31 Cables Photovoltaic Technology cable 4.0 mM'(0.006 inches'), IO.m 1200 mm(47.2 inches) - POWEROUTPUTGUARANTEE 9m CFire Rating Type am 800W/m' Highly reliable due to stringent quality control 6m • Over 30 in-house tests(UV,TC,HF,and many more) d 5m As a leading global manufacturer •' • In-house testing goes well beyond certification requirements u am TEMPERATURE RATINGS MAXIMUM RATINGS of next generation photovoltaic 3m 200w/m' Cell Operational Temperature u-40-+85°C products,we believe close 2.� Temperature Nominal Operating rating(NOC 44°C(±2°C) 1 cooperation with our partners i !Maximum system I000V DCfEC) is critical to success. With local O.m Temperature Coefficient of PMNc -0.41%/°C Voltage IOOOV DC(UL) O.m 10.00 ZD_m 30.m 40.m - - presence around the globe,Trina Is Temperature Coefficient of Voc -0.32%/°C Max Series Fuse Rating 15A able to provide exceptional service Temperature Coefficient of Isc o.05%/°C to each customer in each market ® Certified to withstand challenging environmental �_, and supplement our innovative, conditions reliable products with the backing 2400 Pa wind load of Trino as a strong,bankable 5400 Pa snow load WARRANTY partner. We are committed - 10 year Product Workmanship Warranty to building strategic,mutually 1 25 year Linear Power Warranty beneficial collaboration with ._ installers,developers,distributors (Please refer to product Warranty for details) <r and other partners as the fr backbone of our shared success in CERTIFICATION driving smart Energy Together. LINEAR PERFORMANCE WARRANTY 17-371 PACKAGING CONFIGURATION 10 Year Product Warranty•25 Year Linear Power Warranty `, $per Modules per box:26 pieces z Trine Solar Limited ccom m1 A 1LModules er 40'container:728 pieces www.trinasola 00% i41 p --- AddlfiogglVoluefro COMPIII WI 0 90% rll TUii� ICAUTION:READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT, 07// o 02014 Trino Solar Limited.All rights reserved.Specifications included in this datosheet are subject to ,'yTr�nasolar 0 80% Tr�nasolarchange without notice.SmartEnergyTogether rears s ID Is zo zs Smart Energy Together ■Trinasgndard ,❑ Industrystandard THE Trinamount MODULE TSM-PD05.18 Mono Multi Solutions i DIMENSIONS OF PV MODULE ELECTRICAL DATA STC unlf:mm Peak Power watts-Pwa(Wp) t 250 T 255 260 265 941 t Power Output Tolerance-Pwcx(%J 0-+3 30.5 THE rinamount Maximum Power Voltage-VMl ( 8.27 8.37 1 8.50 8.61 NNCTxIN O ll °o. 1 Maximum Power Current-IM°r(A) 8.27 8.37 8.50 8.61 - o Open Circuit Voltage-Voc(VI ' 38.0 38.1 I 38.2 38.3 ' rxxs Short Circuit Current-Isc(A) 8.79 8.88 9.00 9.10 1 • nuswc MODULE 'Module Efficiency gm(%) 15. 1 16.2 STC:Irradiance 1000 W/m',Cell Temperature 25°C.Ai Air r Mass AM1.5 accorr ding to EN 60904-34-3. Typical efficiency reduction of 4.5%at 200 W/m2 according to EN 60904-1. o ' v e e 0 ELECTRICAL DATA®NOCT /� Maximum Power-PN (Wp) i 186 190 1 193 i 197 60 lELL !Maximum Power Voltage-VMr(VI 28.0 28.1 28.3 28.4 ' V Maximum Power Current-IMry(A) 6.65 I 6.74 1 6.84 6.93 MULTICRYSTALLINE MODULE �a.��ou� �o� ' 1 P005.18 ,2sxwxnose A �Open Circuit Voltage(V)-Voc IV) 35.2 r 35.3 35.4 35.5 i WITH TRINAMOUNT FRAME short Circuit Current(A)-Isc(A) 1 7.10 7.17 1 7.27 _7.35 NOCT:Irradionce at 800 w/m'.Ambient Temperature 20°C.Wind Speed I m/s. 250-265W 812 18D Back view MECHANICAL DATA POWER OUTPUT RANGE }}solar cells MDlticrystalline 156 x 156 mm(6 inches) +1` Fast and simple to install through drop in mounting solution 11 Cell orientation 60 cells(6 x 10)Module dimensions )1650 x 992 x 40 mm(64.95 x 39.05 x 1.57 inches) r 16.27o o Weight 19.6 kg(43.12 lbs) .Glass 13.2 min(0.13 inches).High Transmission.AR Coated Tempered Glass " MAXIMUM EFFICIENCY i Backsheet White A•A ® Frame t Black Anodized Aluminium Alloy Good aesthetics for residential applications `J-Box IP 65 or IP 67 rated Cables Photovoltaic Technology cable 4.0 mm2(0.006 inches'), (. 0 ill+3 {1200 mm(47.2 inches) - O POSITIVE POWER TOLERANCE 1-V CURVES OF PV MODULE(260W) (Connector t H4 Amphenol ,o.� 111 111 r,.00 samw m' Fire Type UL 1703 Type 2 for Solar City Highly reliable due to stringent quality control 8.w i • Over 30 in-house tests(UV,TIC,HE and many more) 7.W As a leading global manufacturer '+��J • In-house testing goes well beyond certification requirements 8'0D TEMPERATURE RATINGS MAXIMUM RATINGS of next generation photovoltaic PID resistant 5'W i `�- i- ' r Nominal Operatin Cell_ Operational Temperature, 40-+85°C _ products,we believe close °'0° Temperature(NOCT) 44°C(+2°C) r f cooperation with our partners soo i I Maximum System 1000V DC(IEC) is critical to success. With local 2.0 Temperature Coefficient of P.,,�x -0.41%/°C I Voltage 1000V DC(UL) presence around the globe,Trina is 1•0° 'Temperature Coefficient of Vac -0.32%/°C Max Series Fuse Rating 15A able to provide exceptional service m.o e 20 „ .� rem erature Coefficient of Isc o.o5%/°C to each customer in each market Certified to withstand challenging environmental P and supplement our innovative, i conditions V"n.M reliable products with the backing • 2400 Po wind load of Trina as a strong,bankable • 5400 Po snow load WARRANTY partner. We are committed I 10 year Product Workmanship Warranty to building strategic,mutually CERTIFICATION beneficial collaboration with 25 year Linear Power Warranty installers,developers,distributors c VL a SP' JPleose rarer to product warranty for details) and other partners as the Imm a es backbone of our shared success in ( '�'" r rw PACKAGING CONFIGURATION I driving Smart Energy Together. LINEAR PERFORMANCE WARRANTY IL PACKAGING� ® 1 F 10 Year Product Warranty•25 Year Linear Power Warranty ` Modules per box:26 pieces Z Trino Solar limited www.trinasolor.com f m l00% Addlilongl value l Modules per 40'container:728 pieces J y 1 ( -- afro f o 90% r11 Tflrla falar,t Ilrlegr Warrant), alla CAUTION:READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. 77 Trinasolar _ �ty Trinasolar (it,2015 Trino Solar Limited.All rights reserved.Specifications Included in this datasheet are subject to ti�o�B7W ()80% change without notice. Smart Energy Together 1� rears s to Is zo 2s Smart Energy Together �soMv.S i I Y- Trinastandard Industry standard _ _____� solar a r=ee Single Phase Inverters for North America soIar SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE760OA-US/SE1000OA-US/SE1140OA-US SE3000A-US SE3800A-US I SES000A-US I SE6000A-US I SE760OA-US I SE1000OA-US I SE11400A-US :OUTPUT SolarEdge Single Phase Inverters • Nominal AC Power Output 3000 3800 5000 6000 7600 99 9980 @ 208V 00,�p1240V 11400 VA 5400 @ 208V 10800 @ 208V Max.AC Power Output 3300 4150 6000 8350 12000 VA For North America ..... ......... ...... 545D,@?4oy.. �0950.@?4oV .. AC Output Voltage Mln:Nom.Max!'I ✓ ✓ 183-208-229 Vac SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ ...Outp.... ......Min.-No .Ma .... ................ ................................................ ............................................................... AC Output Voltage Min:Nom:Maz!'I SE760OA-US/SE1000OA-US/SE1140OA-US 211.-.24.0. .-.264Va0.. ....... .. . . . ........................ ................ ................................................ .................................. ............................. AC Frequency Min:Nom:Max.0) 59.3-60-60.5(with HI country setting 57-60-60.5) Hz 24@208V 48@208V - - - Max.Continuous Output Current 12.5 16 25 32 47.5 A ...................................... ........21,(a1240V ..................42,�1a,240V GFDI Threshold ............i..... ... ......................A..... ......................... ..................................................................................................................................... - Utility Monitoring,Islanding Protection,Country Configurable Thresholds Yes Yes IINPUT F•�werfe� t, Maximum DC Power(STC) 4050 5100 6750 8100 10250 13500 15350 W ........................................... ................ ................................................ ........ Transformer-less,Ungrounded Yes Max.Input Voltage 500 Vdc Yeats ........................................... ........................................................................................................................ .... ... Watta��i Nom.DC Input Volta a 325 @ 208V/350 @ 240V Vdc ........................ .................. ................ .. ........... - I �,!e���eh��• Max.Input Current1�l 9.5 13 15.5 @ 208V 18 23 33 @ 208V 34.5 Adc ........................................... ................I...............I.ls:s.�p 240V..I................I................I..30S @ 240V..I............................. Short Circuit Current 45 Adc ............................................................................................ .... ee i Reverse-Polarity Protection Yes - ............................R ............ ........................................................ ................................................................. Ground-Fault Isolation Detection 600ko Sensitivity _— ........................................... ................ ................................................ .................................. ............................. ..P��ximum Inverter 97 EC Weighted Efficiency encY.......... .....97.5......I..... 98 .....I.97. @.2 0V..I.....97.5.....I..... 5.........97 @ 208V...I......975...........%..... 97,5 @.240V.- Nighttime Power Consumption <2.5 <4 W ADDITIONAL FEATURES Supported Communication Interfaces R5485,RS232,Ethernet,ZigBee(optional) ........................................... ..................................................................................................................................... M. Revenue Grade Data,ANSI C12.1 Optional(') ....X.n................................... ..................................................... .............................................................. Rapid Shutdown—NEC 2014 690.12 Functionality enabled when SolarEdge rapid shutdown kit is installed(4) -- - !STANDARD COMPLIANCE .l. - Safety ...............UL1741,UL3699B.UL3998:CSA 22:2.--.-.-.--.-...-...-......-..- ........onne Connection tand................. ......................... ...................... ' - Grid Connection Standards IEEE1547 ........................................... ..................................................................................................................................... la — --- ;t Emissions FCC part15 class B INSTALLATION SPECIFICATIONS 1 AC output conduit size/AWG range .........................3/4"minimum/16.6 AWG 3/4"minimum/83 AWG ` 1i DC input conduit size/#of strings/ 3/4"minimum/1 2 strings/16-6 AWG 3/4 minimum/1 2 strings/ AWGrang@..................... .... .... ...........,.................................. ...14,6 AWG Dimensions with Safety Switch 30.5 x 12.5 x 10.5/ in/ „(HzWxD), 30.5 x 12.5 x 7.2/775 x 315 x 184 775 x 315 x 260 min I ...... ............................... .................................... ........................................................................................... ° Wei ht with Safet Switch 51.2/23.2..........I............:......547./24.7.- ._--.,-...-.......--..-.-.-.88:4/40.1.............,Ib/-kg,.. ......g.............Y..................... ............... ...... Natural - - -- convection Cooling Natural Convection and internal Fans(user replaceable) fan(user The best choice for SolarEdge enabled systems ........................................... ................................................................... .replaceable).......... ............................. ......... ........................................... ................................................................... Noise <25 <50 dBA ................................................................. - Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance Min.-Max.Operating Temperature -13 to+140/-25 to+60(-40 to+60 version availablels)) 'F/'C — Superior efficiency(98%) Range,.................................. ..................................................................................................................................... Protection Rating NEMA 3R ........................................... ..................................................................................................................................... — Small,lightweight and easy to install on provided bracket For other regional settings please contact SolarEdge support. us higher wrrent source may be used;the inverter will limit its input Current to the values stated. — Built-in module-level monitoring wRevenue grade lrwerter P/N:SEmoW-USo00NNR2(for 76DDW Iiwerter.SE7600A-US002NNR7). (4)Rapid shutdown kit P/N:SE1000-1450-51. — Internet connection through Ethernet or Wireless 01-40version P/N:SE—A-US0001,11,11.04 Ifor 76WW Inverter.SE7600A-U5002NN1.14). — Outdoor and indoor installation — Fixed voltage inverter,DC/AC conversion only — Pre-assembled Safety Switch for faster installation — Optional—revenue grade data,ANSI C32.1 surlsvE RoHS USA-GERMANY-ITALY-FRANCE-JAPAN-CHINA-AUSTRALIA-THE NETHERLANDS-ISRAEL www.sol a redge.us s s BY •