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0116 COMPASS CIRCLE
11(v �o� s5 Cir, !oa � 7 wowo Town of Barnstable O Re: Transfer of CSL License Dear Building Official: r We appreciate your willingness to continue working with Vivint Solar as we move to become a more operationally efficient andquality driven organization. As our landscape changes, so too has some of our organizational chart. In meeting these changes, we respectfully request to transfer the license of our former licensed construction supervisor David Precourt on the following permits as he no longer is working for nor representing Vivint Solar as of 4/8/2016. in replacement of Mr. Tobin construction license, we would like to continue operating in compliance within your jurisdiction under the following attached license. Mr. Emmanuel Mello III will be taking over the permits. 116 Compass Circle Hyannis B-16-631 Again, we certainly want to thank you in-advance for your support and Understanding. Please feel free to contact me directly if needed. Jeremy Sabin Director of HR Vivint So j� �F .Brendan Smith VP of Operations Vivint Solar. 10 Park Plaza Suite 5 170 Berton, Massachusefits 02116 Home Improvement Contractor-Registrationa Regi tRatim: 9T0849 Tg pe: Sd ent Cawd =WT SOLAR. DEVELOPER LL.... E.MMA.NUEL ME€LO LEHI, UT 84043 i iUrpithte Addres's and aretltticre ewd..iMark reason fbr-cii=tge.. .Addirtis;s [JI Renewa C,Employment G.Lost Ckd �r/'i7G �nrv.7[rY�•,•ri t�rnt�ftJ'+.n-����(,Jdit�K,.r lf�. - �Ef is e of Caasmer Aftirs&9usiness"Repdation = &eeerua tua vgg a£ ua walid f6r i WO- we crib. E N PROVEM E:AT CONTRACTOR ire.thv eap arms gate. If 6boad trey uva tram Offfee o6 Coatsumer A ffar'rs and Business: egwa2ie:t+ r l pgistna3iare: 6762848 Type:,; 16 Fark t'taza Suite 5170 Expriaatton f,: 0tg. SupplementCzrd,. gbstoo,MA @2t16 VIV NT SOLAR DEVELOPER ULC. EMMANUEL MELLCi.. 33D I N T4 kANKSGIi/NG WAY SUi �.:a. � — _ / � �/f� "�✓�/�t L€F , UT 84043 Undersetretany _ �-1 N:r°valid*ithout signature 7L 12 Thompson Rd Webster MA 01570 as a s�r wrwv.RRPEPA.com 508 826 5757 MaSSdChUSettS -Department OB I�tPbilC Safety Certificate of Attendance and Completion JIM t� ���� Refresher Renovator.per40 CFR part745.22 SOard Of Building i:t?^y eiati^vrS and Standards Lead-safe Renovator-su ervisor ^-- -"-- - —' - P %.tltt%Li utaauu ounct riNot ., .. Emmanuel Ni lello III License: CS-065607 4 80 Kende99e Rd. t r; ,7l� Jefferson iA 01522 EMMANUEL T ' Course&Exam mate:04/1715. P®]l3ox 326 ti� V Expiration_date:04/17/20- Jefferson MA 0IM2 �',�'' •. Certificate R R-18867 i5-00228 � f / 7 Trainer Date." - � ,,,> iv/„J Expiration Commissioner 05103/2017 Cx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street o Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly 1 Name (Business/Organization/Individual): V, it "_nG°'FQ'✓"t 4 rr t. 1 f Address: 301 hJ - 1. her q v. S'o a City/State/Zip: L14 T Sl Y v 4 3 Phone#: '?U l - Z Are you an employer?Check the appropriate box: Type of project(required): t 1. l am a employer with 4. ❑.1 am a general contractor and 1 6: ❑New construction employees(full and/or part-time).* have hired the sub-contractors i t 7. ❑ Remodeling 2.❑` [ am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition I 1� working for me inany capacity. workers' comp. insurance. 4. ❑ Building addition [No workers' comp. insurance 5_ ❑'We area corporation and its i 10.❑Electrical repairs or additions required.] officers have exercised their (I 3.❑ l am a homeowner doipg all work right of exemption_per MGL 1 L[J Plumbing repairs or additions_ myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs t insurance required.)t employees.[No workers' 13.0Other + comp. insurance required:)' i 'Any applicant that checks box#1 must also f tit ou4 the sc: tion below showing their workers'compen.Gltion{olicy i0onr ion. t Homeowners who Submit this affidavit iaJic rng they are doing all work and lheri hire outside conlrac,tom ruust subm'4 a new aid-avit indicating such, tCor tr.retr m that chikk this box mu_;t attached an additional sheet shoving the,Warne o&:the subs-contractors and their workers'comp.policy infomral on. i I ant,an ernpiayer that is prq yi#tcg workers'conrpensat an;insura,!rce for,my e,rt�toyees. Bekq v,,is the policy anQ job site information. Insurance Company Name: � e.t r`��, �er-r G,tv� •�-'�-*SUi✓� +�r� � _ _ Policy#or Self-ins. Lic.#: V�/ `�l��f U' / !' Expiration Date: I d t " Z O1 4 . r Job Site Address: City/State/Zip: MAA '. Attach a copy of the workers'compensation policy declaration page(showing the policy number nd expiration date). i 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone#: 2- Official use only. Do not write in this area, to be completed by city or town official, t 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#: '4COR CERTIFICATE OF LIABILITY INSURANCE °ATEMM°°""'"' 01/27r20 16 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 MARSH USA INC. NAME: _-- 122517TH STREET,SUITE 1300 a/CONIJ Ext: a/c No DENVER,CO 80202-5534 ADDRESS:Attn:Denver.CeaRequest@marsh.com Fax:212-948-4381 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Axis Specialty Europe INSURED Vivint Solar,Inc: INSURER B:Zurich American Insurance Company 16535 _ Vivint Solar Developer LLC INSURER C:American Zurich Insurance Company 40142 Vivint Solar Provider LLC INSURER D:N/A NIA 3301 North Thanksgiving Way,Suite 500 Lehi,UT 84043 INSURER E: INSURER F:. COVERAGES CERTIFICATE NUMBER: SEA-002920068-04 REVISION NUMBER:2 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. ILTR TYPE OF INSURANCE ADD S BR POLICY NUMBER MM/DDIYY lY MN°IILDD E'tP LIMITS A X COMMERCIAL GENERAL LIABILITY 3776500116EN 01/29/2016 01/29/2017 EACH OCCURRENCE $ 25,000,000 CLAIMS-MADE OCCUR PREA SES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL R ADV INJURY $ 1,000,0W GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 25,000,000 X POLICY❑JECOT LOC PRODUCTS-COMPlOPAGG $ 25,000,000 OTHER: _ r $ B AUTOMOBILE LIABILITY BAP509601501 11101/2015 11/01/2016 COMBINED SINGLE LIMIT Ea accident $ 1.000,000 Ix ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIREDAUTOS X NON-OWNED PROPERTYDAMAGE AUTOS Per accident $ Comp/Coll Ded $ - tow UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE . - AGGREGATE $ DED RETENTIONS - - $ C WORKERS COMPENSATION WC509601301 11/01/2015 11/01/2016 X PER OTH- AND EMPLOYERS*LIABILITY STATUTE I iER ANY PROPRIETORIPARTNERIEXECUTIVE YIN ,CA,CT,HI,MD,NJ,NY,NV,NM, E.L.EACH ACCIDENT. $ 1,000,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) _ OR,PA;UT E.L. OF DESCRIPTION OF OPERATIONS below DISEASE-EA EMPLOYE $ 1,000,000 B byes,describe WC509601401(MA) 11/01/2015 11/01/2016 E.L.DISEASE-POLICY LIMIT $ 1,000,0W t DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION Town Barnstable ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis,MA 62601AON ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Kathleen M.Parsloe ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF:ARNSTABLE BUILDING PERMIT APPLICATION Map ly/w Parcel D Application # lG(J Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis B U Project Street Address Aea" e ma" A 'LiNG n Village T Rf. ,, AT Owneri4? ( Address �a ed-fe Telephone cOg F Permit Reques Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout 0 Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number C 77w G��S Address License# cm Home Improvement Contractor# /76RW Emailg&aAp� Worker's Compensation # At/d 0-6; ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE y DATE FOR OFFICIAL USE ONLY APPLICATION # ; DATE ISSUED f MAP/ PARCEL NO. ADDRESS '� VILLAGE GYWNER I t DATE OF INSPECTION: FOUNDATION r FRAME INSULATION FIREPLACE T ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT t; ASSOCIATION PLAN NO. n :Illy r all I t i•I i t l � I�� it tl tOfice of11Consumer Affairs '��Businessi egulation ! :IiI til ll ilji i ' ,i I '{ ' It i II I11111';1II411i{ II' !:I::II 211 Jl+lltl) II'RIj10 Park Pl a Surt� 10'�, i } il';!I) It 'i 11., lliIf i iit I lill t „I J; q ' i ;1 a I "Boston lVl each' 0�]l� 11:►� u!(�r•il I.Ita`•.� i;,,illijil I' 1(Ii,IrLIIIi�III,(� r' 'f `1ilHomelImp ode a i�,t ont a� u'Rekistrat]OR i, . , t _1 { rI' Illti' I! III ! t'ijl, Ir ! � trtclr, , I {.:• ii + , ti.¢ lrr I!�I I I iI(11llji t a •,.i ill I'"li I! ' .1 I i,,liflilllMt�lll`I�`', i a' '9.t° II` I i ift�pistratlanal(170848 t ;tl I,t! tly, 1 1 e t: i it ' 'i � i t` a lr Y�,r1 1 i 5 i I I I nl l'T ,Su Pigment Cw3rd }. 7 I,' , .� " I.�{ ! E1�rraUon' 11 512018 VIVINTtS61 RiDEVELOPER LILQ'-i i r t '' •" i(LI y' ti t tF!'.DAVID PRECOURT''.,;i ` 1( 33 I L f �i�1)tI�i!'1 1'I dI iul)III(`!i!1 I I1 I 1I:4 iIt I r1 I411 — LEHI, UT 84043 f tl ' { ,+�Ii;(�,I!Ili i I ! ��ilj� la�� I` �� �— i'll►iI II'1;'!'i'N I r ` r S :r is rrrl��i I� .I i�I] �wlr r 1;1 III �.�1 tt��, 't' 'I I� �I ,�rrnl I „�qt I,.r•'-r !� ! l i ! I� i t t'�i:t: I l 1 UPdat {>ddre�s pod rourn�mrd Mark reason forA--r chachange ,, ,ir'r I 4• II.. !1 !.' Pat I t t II t i I I _ ! I ( � Irt ( r r I,'(` ' III Addres Rearwal I Etn t ent (.ostCard � &CAl Q 2?11-05'tl �� / Ill• ii- ,tll ,' /^i J�I# -+ F ��11 (�`, I r�ll 1I 'III II 1l�II Il11 ii �il l 'i1' _ ,i 10 j` r'�!II'1 tct ortoarvmv At6lrr&Busiatrs RtRatatioo )I i I , l 1 reease,o f reglst>jadon valid�orilndl�•idnl use only! ' It•I C.. 1".11I { al I I l D EIMPROVEINENTt;OjiTRACTOR t i s 41t ii.:jbWretheexplFatwndate!ifroundreturn!to ' _ ORceoronsumrri(affalrivsndl�ussnc+vRtgulauon - eglstration:.1708d8 I!I ' t Itiii3l i,�t 7YPe lull ll Ip Fa�k FlrcSu!t�il?01(i i;l�!�r i 11 = ,-Ex"oa ;115+2018,, Suppiemem hard IBoston tNlA 021 bl '(I' !1, ) _ ' I 'rt' 1i4 .1! 1 Iq 11 tl. cit( + i Iii I,11; ViVINT SOLAR DEVELOPERLLC t, ;� i) Lit ,it '; DAVID PRECOl1FtT I ! ! 3301 N THANKSGIVING WAY SUl .c' �, ' I'+' _ LEFIT&Il?43 t i i 7i {i 1'i r!t I-li ' t ,t ! I I UadMttrehl I tII i t ! Slot Jnlyd;RphOutagna14 d�Il. �.{Ll.t .ttlli'li`fl, ll: ,1I..�III �iIII�rII,i.'.II,I,.n'.Ill ,tllt'I.1�1.,'iGtlt ,i Massachusetts Department of Public Safety sy Board of Building Regulations and Standards License: CS-013119 ' Construction Supervisor DAVID A PRECOURT 97 FREEMAN STr NORTON MA 02766 16. Expiration, Commissioner 08/07/2017 RO �#b I The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 tom, www mass gov/dia N1•orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Vivint Solar INC i Address:-3301 N Thankstaivings Way Suite 500 City/State/Zip: Lehi LIT 84043 Phone#: 801 6246459 k f Are you an employer?Check the appropriate box: Type of project(required): f 1.®1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑[am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling iii any capacity.[No workers'comp.insurance required.] I 3.❑[am a homeowner doing all work myself.[No workers comp.insurance required.]+ 9. ❑Demolition I 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. l will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.r-I We are a corporation and its officers have exercised their right of exemption per MGL c. .®Other 14 SOLAR 152.§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box ill must also 611 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 or 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 t information. Insurance Company Name: Zurich American Insurance Policy#or Self-ins.Lic.#: WC509601401 Expiration Date: 11/1/16 ! Job Site Address: 116 Compass Circle Hyannis Ma 0201 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain and enalties of perju tthe information provided above is true and correct 1 Sin_ atur�/' ;`� ��~`''�' Date: 3/15/16 Phone#: t 508-776-6235 f t 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#: AcoRo® CERTIFICATE OF LIABILITY INSURANCE DATE YYYY) �- o1/2712016r2o1s 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 MARSH USA INC. NAME` __-- 122517TH STREET,SUITE 1300 acNri Ext: A/c No): DENVER,CO 80202-5534 ADD IL Altn.Denver.Ce�Request@marsh.com Fax:212-948A381 INSURERS AFFORDING COVERAGE NAIC M INSURER A:Axis Specialty Europe INSURED INSURER B:Zurich American Insurance Company Y 16535 Vivint Solar,Inc: ---- Vivint Solar Developer LLC INSURER C:American Zurich Insurance Company 40142 Vivint Solar Provider LLC INSURER D:N/A NIA 3301 North Thanksgiving Way,Suite 500 Lehi,UT 84043 INSURER E: INSURER F* �A COVERAGES CERTIFICATE NUMBER: SEA-002920068-04 REVISION NUMBER:2 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY) (MMIDDJNYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY 3776500116EN 01129/2016 01/29/2017 EACH OCCURRENCE $ 25,000,000 D MAGE TO RENTED CLAIMS-MADE LXj OCCUR PREMISES-Ea occurrence $ 1,000,000 _- MED EXP(Any one person) $ 10,000 PERSONAL&AOV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 25,000,000 X POLICY 0 PRO- ❑LOC PRO- JECT PRODUCTS-COMP/OP AGG $ 25,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAP509601501 11101/2015 11/01/2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) _ Ix ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDPer accidentAUTOS AUTOS ( ) $ BODILY INJURY HIREDAUTOS X NON-OWNED - PROPERTY DAMAGE AUTOS Per accident Comp/Coll Ded $ 1,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ C WORKERS COMPENSATION WC509601301 11/01/2015 11/01/2016 OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE- ER ANY PROPRIETOR/PARTNER/EXECUTIVE AZ,CA,CT,HI,MD,NJ,NY,NV,NM, OFFICER/MEMBER EXCLUO NIA A E.L.EACH ACCIDENT $ 1,000,000 EDT (Mandatory in NH) OR,PA,UT E.L.DISEASE-E4 EMPLOYEd$ 1,000,000 B If yes,describe under WC509601401 MA 11/01l2015 11/0112016 DESCRIPTION OF OPERATIONS below ( - E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule;may be attached if more space Is required) CERTIFICATE HOLDER - CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis,MA 02601.4002 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , of Marsh USA Inc. Kathleen M.ParsloeLruljt-JQy¢(oeL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD vivh o sciCi RESIDENTIAL SOLAR POWER PURCHASE AGREEMENT `.` Customer Name and Contact Information: Transaction Date 2016-03-03 v Name(s) Ana Locks Sevice No. 4850321 Marcos Locks Installation Location Address 116 Compass Circle Approximate Start and Completion Date 116 Compass Circle Hyannis MA 02601 2016-08-30 Hyannis MA 02601 Home Phone 5088159601 Cell Phone 5088159601 E-Mail marcoas-locks@hotmail.com Our Promises + We will design,install,maintain,repair, + We will not place a lien on Your Property. monitor,and insure the System at no additional cost to You. + You are free to cancel any time prior to Our commencement of installation work at Your + We warranty all of Our work for the Property. initial 20-year term. + The Energy Price includes a$5 monthly + Your Energy Price will not increase by discount for paying by automatic debit from more than 2.9%per year. Your bank account. + We will fix or pay for any damage We + You will not be responsible for any property may cause to Your Property or belongings. tax assessed on the System. Your Commitment • Pay for the Energy produced by the System. • Maintain a broadband internet connection. • Keep Your roof in good condition throughout • Continue service with Your Utility for any the Term. energy used above and beyond the System's production. • Respond to Our sales and support teams when scheduling and completing paperwork. At the End of Your Initial Term • You can renew the Agreement for a • You can request that We remove the subsequent term; System at no additional cost. • You can purchase the System;or If You Move • We guarantee You can transfer the Agreement • You can relocate the System to Your to the new owner,regardless of credit rating; new home;or . You can prepay the Agreement; • After the sixth anniversary,You can purchase the System. WE MAY HAVE PRESCREENED YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT IMPACT YOUR CREDIT SCORE. YOU CAN CHOOSE TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM US AND OTHER COMPANIES BY CALLING TOLL-FREE 888.567.8688. SEE PRESCREEN &OPT-OUT NOTICE BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS. The Notice of Cancellation may be sent to this address support@vivintsolar.com I vivintsolar.com 3301 Thanksgiving Way, Suite 500 Lehi, UT 84043 Phone 877.404.4129 1 Fax 801.765.5758 Copyright O 2011-2015 Vivint Solar Developer,LLC All Rights Reserved PPA(11/2018,v3.2)I'Page 1. NOTICE TO CUSTOMERS A. LIST OF DOCUMENTS TO BE INCORPORATED INTO Agreement, signed by both You and Us, before any THE CONTRACT: work may be started. a. Residential Solar Power Purchase Agreement, G. CUSTOMER'S RIGHT TO CANCEL. YOU MAYCANCEL b. Exhibit A—Notice of Cancellation, THIS CONTRACT AT ANY TIME BEFORE THE LATER OF: c. Exhibit B—State Notices and Disclosures, (1) MIDNIGHT OF THE THIRD (3RD) BUSINESS DAY d. Exhibit C—Certificates of Insurance, and AFTER THE TRANSACTION DATE, OR (II)THE START OF e. Customer Packet. INSTALLATION OF THE SYSTEM OR ANY OTHER These documents are expressly incorporated into this, INSTALLATION WORK WE PERFORM ON 'YOUR Agreement and apply to the relationship between You PROPERTY. IF YOU WISH TO CANCEL THIS CONTRACT, and Us. YOU MUST EITHER: (1) SEND A SIGNED AND DATED B. WE HAVE NOT GUARANTEED, PROMISED OR ,WRITTEN NOTICE OF CANCELLATION BY,REGISTERED OTHERWISE REPRESENTED ANY REDUCTION IN OR CERTIFIED MAIL, RETURN RECEIPT REQUESTED; OR ELECTRICITY COSTS IN RELATION TO THE SYSTEM THAT (2) PERSONALLY DELIVER A SIGNED AND DATED WILL BE INSTALLED ON YOUR PROPERTY. WRITTEN NOTICE OF CANCELLATION TO: VIVINT C. IT IS NOT LEGAL FOR US TO ENTER YOUR PREMISES SOLAR DEVELOPER, LLC, 3301 N THANKSGIVING WAY, UNLAWFULLY OR COMMIT ANY BREACH OF THE SUITE 500, LEHI, UT 84043, ATTN: PROCESSING PEACE TO REMOVE GOODS INSTALLED UNDER THIS DEPARTMENT. IF YOU CANCEL THIS CONTRACT AGREEMENT. WITHIN SUCH PERIOD, YOU ARE ENTITLED TO A FULL D. DO NOT SIGN THIS AGREEMENT BEFORE YOU REFUND OF YOUR MONEY. REFUNDS MUST BE MADE HAVE READ ALL OF ITS PAGES. You acknowledge that WITHIN 30 DAYS OF OUR RECEIPT OF THE You have read and received a legible copy of this CANCELLATION NOTICE. SEE THE ATTACHED NOTICE Agreement, that We have signed the Agreement, and OF CANCELLATION FOR AN EXPLANATION OF THIS that You have read and received a legible copy of every RIGHT. DO NOT SIGN BELOW UNLESS WE HAVE GIVEN document that We have signed during the. YOU THE "NOTICE OF CANCELLATION." WE ARE' negotiation. PROHIBITED FROM HAVING AN INDEPENDENT E. YOU RISK THE LOSS OF ANY PAYMENTS MADE TO COURIER SERVICE OR OTHER THIRD PARTY PICK UP A SALES REPRESENTATIVE. . - YOUR PAYMENTATYOUR RESIDENCE BEFORE THE END F. DO NOT SIGN THIS AGREEMENT IF , THIS OF THE CANCELLATION PERIOD. AGREEMENT CONTAINS ANY BLANK SPACES. You are H. You have the right to require Us to have a entitled to a completely filled in copy, of this performance and payment bond.. BY CHECKING THIS BOX, YOU AGREE TO RECEIVE ELECTRONIC RECORDS AS FURTHER DESCRIBED IN SECTION 7(m),AND AGREE THIS CHECKBOX CONSTITUTES YOUR ELECTRONIC SIGNATURE. BY CHECKING THIS BOX,YOU AGREE AND OPT-IN TO RECEIVING TEXT MESSAGES AS FURTHER DESCRIBED IN SECTION 7(n),AND AGREE THIS CHECKBOX CONSTITUTES YOUR ELECTRONIC SIGNATURE. BY CHECKING THIS BOX,YOU AGREE TO ARBITRATION AND WAIVE THE RIGHTTO AJURY TRIAL AS DESCRIBED IN SECTION 6(e),AND AGREE THIS CHECKBOX CONSTITUTES YOUR ELECTRONIC SIGNATURE. VIVINT SOLAR DEVELOPER, LLC CUSTOMER(S): Signature: Signature: Printed Name: Mathew Ferland Printed Name: Ana Locks Salesperson No. a1rn16000007gi2WAAA (� Signature: Printed Name: , Marcos Locks Copyright.Q 2011-2015 Vivint Solar Developer, LLC. All Rights Reserved. PPA;1.2/2015,v3.2) I Page 17 V u V o l 1 a r 3301 North Thanksgiving Way, Suite 500 S O ` v Structural Group Lehi, UT 84043 P: (801) 234-7050 Scott E. Wyssling, PE Senior Manager of Engineering scott.wyssling@vivintsolar.com March 05, 2016 Mr. Dan Rock, Project Manager Vivint Solar 3301-North Thanksgiving Way, Suite 500 Lehi, UT 84043 Re: Structural Engineering Services Locks Residence 116 Compass Circle, Hyannis MA S-4850321 3.64 kW Dear Mr. Rock: Pursuant to your request, we have reviewed the following information regarding solar panel installation on the roof of the above referenced home: 1. Site Visit/Verification Form prepared by a Vivint Solar representative identifying specific site information including size and spacing of members for the existing roof structure. 2. Design drawings of the proposed system including a site plan, roof plan and connection details for the solar panels. This information was prepared by the Design Group and will be utilized for approval and construction of the proposed system. 3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the solar system. 4. Photographs of the interior and exterior of the roof system identifying existing structural members and their conditions. Based on the above information we have evaluated the structural capacity of the existing roof system to support the additional loads imposed by the solar panels and have the following comments related to our review and evaluation: Description of Residence: The existing residence is typical wood framing construction with the roof system consisting of the following: • Roof Section 1: Roof section is composed of 2x6 dimensional lumber at 16" on center and a single layer of roofing. The attic space is unfinished and photos indicate that there was free access to visually inspect the size and condition of the roof members. All wood material utilized for the roof system is assumed to be Spruce-Pine-Fir #2 or better with standard construction components. The existing roofing material consists of composite shingle. Our review of the photos of the exterior roof does not indicate any signs of settlement or misalignment caused by overstressed underlying members. Stability Evaluation: A. Wind Uplift Loading 1. Calculations for uplift are based on ASCE/SEI 7-10 Minimum Design Loads for Buildings and other Structures, a wind speed of 110 mph based on Exposure Category B and 30 degree roof slopes on the dwelling areas. Ground snow load is 30 PSF for Exposure B, Zone 2 per(ASCE/SEI 7-10). 2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the dwelling. vowan e solar Page 2of2 B. Loading Criteria 10 PSF = Dead Load (roofing/framing) 30 PSF = Live Load (ground snow load) 3 PSF = Dead Load (solar panels/mounting hardware) Total Dead Load= 13 PSF ` The above values are within acceptable limits of recognized industry standards for similar structures and in accordance with the 2009 International Residential Code with Massachusetts Amendments. Analysis performed on the existing roof structure utilizing the above loading criteria indicates that the existing members will support the additional panel loading without damage, if installed correctly. C. Roof Structure Capacity 1. The photographs provided of the attic space and roof rafters show that the framing is in good condition with no visible signs of damage caused by prior overstressing. D. Solar Panel Anchorage 1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar Installation Manual", which can be found on the Ecolibrium Solar website (ecolibriumsolar.com). If during solar panel installation, the roof framing members appear unstable or deflect non-uniformly, our office should be notified before proceeding with the installation. 2. The solar panels are 1 '/2' thick and mounted 4 %2' off the roof for a total height off the existing roof of 6". At no time will the panels be mounted higher than 6"above the existing plane of the roof. 3. Maximum allowable pullout per lag screw is 205 Ibs/inch of penetration as identified in the Nation Design Standards (NDS) of timber construction specifications for Spruce-Pine-Fir assumed. Based on our evaluation, the pullout value, utilizing a penetration depth of 2 '/2", is less than the maximum allowable per connection and therefore is adequate. 4. Roof Section 1: Considering the roof slopes, the size, spacing, condition of the roof, the panel supports shall be placed at and attached no greater than every fourth roof member as panels are installed perpendicular across members and no greater than the panel length when installed parallel to the members (portrait). No panel supports spacing shall be greater than four (4) spaces or 64"o/c,whichever is less. 5. Panel support connections shall be staggered to distribute load to adjacent members. Based on the above evaluation, with appropriate panel anchors being utilized the roof system will adequately support the additional loading imposed by the solar panels. This evaluation is in conformance with the 2009 International Residential Code with Massachusetts Amendments, current industry standards and practice, and the information supplied to us at the time of this report. Should you have any questions regarding the above or if you require further information do not hesitate to contact me. V truly yours, -,N OF r sc SLIN � VIL Scott E. Wyssling, P No z, 507 MA License No. 5 7 A�o��Fc/sTEPe FSS/ONAIL ENV fi WEVUH e solar 0'OF 1"PVC CONDUIT FROM JUNCTION BOX TO ELEC PANEL o U C o PV INTERCONNECTION POINT, N INVERTER,ANSI METER LOCATION, JUNCTION BOX ATTACHED TO LOCKABLE DISCONNECT SWITCH, ARRAY USING ECO HARDWARE TO W 1 v c w &UTILITY METER LOCATION KEEP JUNCTION BOX OFF ROOF m I -- ---- d Q ETz w cin— �().Z r z , cn a: 0 1 0 Q U N , ceo , J m 75 I ❑ ' cn I ° ° I C (14)JKM260P-60 MODULE ❑ ) c I I N N IU I CR I I 0 - VI Ul fr U Q ,^ 1 1 Zia v, > :3 a i.L I I Z 3 cr � � r w w z m J J V z E 1 N 'n Q Z Z p SHEET O . NAME: PV SYSTEM SIZE: w z 3.640 kW DC a r SHEET NUMBER: PV SYSTEM SITE PLAN o SCALE: 3/32"= 1'-0" > d TIE INTO METER# - (� 2298738 o 0 v Q)L. yo� ---------- N m (D V� A/--Z c F- �Z U) D 0 U a Roof Section 1 O Roof Azimuth:284 J ~ Roof Tilt:30 PV STRING#1. 14 MODULES LUMBING VENT(S) O OOF VENT(S) N 00 9 �J OMP.SHINGLE rn N v O N h W O CHIMNEY-------__ g o v N & U Q r W = Z m a 2 Z Z w w Z Y W Z co U Z z z < SHEET NAME: V- Z OQ O � • � a SHEET NUMBER: PV SYSTEM ROOF PLAN o r. N SCALE: 1/8"= V-0" a W O CLAMP C o MOUNTING SEALING �N PV3.0 DETAIL WASHER N Nam LOWER N E z SUPPORT LL cs`-Z m cq m 0 U U Q PV MODULES,TYP. MOUNT OF COMP SHINGLE ROOF, FLASHING —� PARALLEL TO ROOF PLANE / 5/16"0 x 4 1/2" MINIMUM STAINLESS PV ARRAY TYP. ELEVATION STEEL LAG SCREW NOT TO SCALE TORQUE=13±2 ft-Ibs CLAMP ATTACHMENT NOT TO SCALE a N 00 a 9 � CANTELEVER L/4 OR LESS 0= O COUPLING L=PERMITTED CLAMP ECO SPACING SEE CODE COMPLIANT COMPATIBLE LETTER FOR MAX ALLOWABLE ry MODULE CLAMP SPACING. o � N O PERMITTED COUPLING n g CLAMP CLAMPo ? o COUPLING SPACING PHOTOVOLTAIC MODULE `� w a z m Q zz z w .. w (r m > J z m J J V z mmt7 m cnJ Q L=PORTRAITA L H H SHEET CLAMP SPACING NAME: ECO Z J COMPATIBLE 5 Q L=LANDSCAPE MODULE PV SYSTEM MOUNTING DETAIL O w CLAMP SPACING 2 p MODULES IN PORTRAIT/LANDSCAPE NOT TO SCALE SHEET NUMBER: NOT TO SCALE cM a O Conduit and Conductor Schedule DC Safety Switch Notes: . Solar PV System AC Point of Connection Tag Description Wire Gauge #of Conductors Conduit Type Conduit Size AC output current Rated for max operating condition of inverter Accoding to Nec 19.79 Amps 1 Solar Edge Cable 10 AWG 2(V+,V-) N/A-Free Air N/A-Free Air 6s0.8(B)(1) NEC 690.35 compliant ungrounded Nominal AC Volta a zao volts 1 Bare Copper Ground(EGC/GEC) 6 AWG 1 N/A-Free Air N/A-Free Air opens all unded conductors g Cl) o 2 THWN-2 10 AWG 2(V+,V-) PVC 1" * p THIS PANEL FED BY MULTIPLE SOURCES 0 c (UTILITY AND SOLAR) 2 THWN-2-Ground 8 AWG 1 PVC 1" 3 Notes: SE380OA-US-U Inverter Specs: 3 THWN-2 10AWG 3(1-1-1,1-1-2,1-N) PVC 1" -0_eN 3 THWN-2-Ground 8 AWG 1 PVC 1" Wire size and breaker calculations dependent upon CEC Efficiency 98% W 22<m Inverter Continuous Maximum Output. (1)°ate AC Operating Voltage 240 V Example:SE38000A-US-U Max Output=16A<20A. c�Z Therefore a 20A solar breaker will be needed for each Continuous Max Output 16A L).Z SE380OA-US-U inverter. Wire Gauge should also be DC Maximum Input Current 13 A �`�=o determined with 16A Max for each inverter. U a ALL CONDUCTORS Solar Edge Optimizer Specs: P300 DC Input Power 30OW J SHALL BE COPPER DC Max Input Voltage 8-48V DC Max Input Current 12.5A Design Conditions: DC Max Output Current 15A ASHRAE 2013 Max String Rating 5250W Highest Monthly 2%DEl Design Temp 35.6°C. Module Specs: ` � 14 PV MODULES PER INVERTER=3640 WATTS STC Lowest Min.Mean Extreme DB -17°C JKM260P- VOC Temp coefficient V/C 60 e'-� 1 STRING OF 14 PV MODULES p coe Short Circuit Current(Isc) 9.00A System Specs: Open Circuit Voltage(Voc) 37.8V Operating Current(Imp) 8.47A Max DC Voltage 500V Operating Voltage(Vmp) 30.7V JUNCTION g a •� O 0 13 4 WITH IRREVERER SIBLE Nominal DC Operating Voltage 350V Max Series Fuse Rating 15A GROUND SPLICE Max.DC Current per String 15A STC Rating(Pmax) 260W •0 � - - - - Nominal AC Current 16A Power Tolerance -0/+3% J *CONFORMS TO ANSI C12.1-2008 - - - _m- - EXISTING L1 L2 N I SUPPLY-SIDE ENTRANCE `< t SOLAREDGE SOLAR TAP CONDUCTORS m P300 OPTIMIZERS SOLAREDGE NEC 705.12(A) M RATED: 100A SE38DQA-US-R g m o 0 INVERTER` p ^ K A V < Z Wm Q SOLAREDGE Square D ND221NRB > • ti DC SAFETY 30A240V FUSED NENIA3 100A Z lii ❑ M� SWITCH OR EQUIVALENT _ K W W N m M20A Z p EXISTING SHEET NAME:� 240V/100A AC UU -- - -- -----------------— - LOAD-CENTER z_ 'f wsl'LE WITH 1-20A FUSED J Q L LOCKABLE M 3 KNIFE'AC — DISCONNECT o DISCONNECT SHEET NUMBER: O W r Ln (n o� 03 to D 0 01 10 n cc 00 Z r z m Nm m M r ;1 � o Z m O n m3 Cn 0 3O T° D Z 00) Op v m rn 2 m 7C7� r O n Y_ O O O N 0 00 �Z �o -n Z Z m rn ro z x N M m O z C -I 09 =O O— Oy 3Z Cr N C � A v A 3 wp O Nc v C Z X m x3 N cm z O 6, ND00 'a !n n O JAL cNm z A O _ 0 0-10 pz o Z C7 s OZ r _ CO r m m m .� v A 0 z0 rn m A mC , m m o 90 N Z N O m m �O C s t c_ zz x3 OC M3 O m O C . ;0 m m m z .. N z O z cn INSTALLER:VIVINT SOLAR o o DESIGN m INSTALLERNUMBER: 877.404.4129 � Locks Residence PV 4.0 -4 MA LICENSE:MAHIC 17088VaVouofarj 116 CompassLOGIC m Hyannis, 04601 DRAWN BY:DN AR 4850321 Last Modified:3/4/2016 UTILITY ACCOUNT NUMBER: 1440 077 0021 .Y 0'OF 1"PVC CONDUIT FROM JUNCTION BOX TO ELEC PANEL 0 . C o 0 PV INTERCONNECTION POINT, � a INVERTER,ANSI METER LOCATION, JUNCTION BOX ATTACHED TO �o LOCKABLE DISCONNECT SWITCH, ARRAY USING ECO HARDWARE TO ) U o w &UTILITY METER LOCATION KEEP JUNCTION BOX OFF ROOF �V/1����y¢0 I -- ---- I V/a6� n/E!_z �j.1- _�6 Z CDN O Ov U^ Co I I o N J Q a (14)JKM260P-60 MODULE ❑ ) c I I cc=3cu m N 09 00 a� N E-1 9 I I J U L_ e 5 � � � � Z °w° a V — > Z III I I Z m of W N W W Z m J J V �QQjy E I I Z Z O I I SHEET O NAME: V PV SYSTEM SIZE: i W Z L 3.640 kW DC - I U r- - - - - - - - - -�J SHEET NUMBER: PV SYSTEM SITE PLAN SCALE: 3/32"= V-0" a .J N TIE INTO METER# 2298738 0 C o Ev o Nam LL�j CZ �Z Cn D U a Roof Section 1 J Roof Azimuth:284 - ~ Roof Tilt:30 PV STRING#1. - 14 MODULES LUMBING VENT(S) - 'W sY O ROOF VENT(S) N o� M N OO o 9 � J OMP.SHINGLE rn N O N � O CHIMNEY--------__ g v 0 • U U 6 Z m 4 Q Z 6i .. Lu Lu > w w Z m J J w Z < J > a SHEET NAME: ILL Z of EL SHEET NUMBER: PV SYSTEM ROOF PLAN N SCALE: 1/8"= 1'-0" > d • t t ^^\\ N W O O U CLAMP c c MOUNTING (D SEALING � N U PV3.0 DETAIL WASHER N yQm LOWER E�z SUPPORT o c z m Nwio U Q PV MODULES,TYP. MOUNT OF COMP SHINGLE ROOF, FLASHING J PARALLEL TO ROOF PLANE 5/16"0 x 4 1/2" PV ARRAY TYP. ELEVATION MINIMUM TEEL LAGTSCREW lie% NOT TO SCALE TORQUE=13±2 ft-Ibs CLAMP ATTACHMENT c NOT TO SCALE N 0= 9 � CANTELEVER U4 OR LESS O= O COUPLING L=PERMITTED CLAMP ECO SPACING SEE CODE COMPLIANT COMPATIBLE LETTER FOR MAX ALLOWABLE N MODULE CLAMP SPACING. a � N PERMITTED COUPLING . 2 ir CLAMP CLAMP. g COUPLING SPACING PHOTOVOLTAIC MODULE N wo it a z m a 2 Q Z .. Lu ErU)m > J J Z Co z 111 H U_U) J Q z z g ❑ L=PORTRAIT SHEET CLAMP SPACING NAME: c ECO Z J COMPATIBLE 5 Q L=LANDSCAPE MODULE PV SYSTEM MOUNTING DETAIL ° w CLAMP SPACING 2 p MODULES IN PORTRAIT/LANDSCAPE NOT TO SCALE 1 SHEET NUMBER: NOT TO SCALE CD CM O Conduit and Conductor Schedule DC Safety Switch Notes: Solar PV System AC Point of Connection Tag Description Wire Gauge #of Conductors Conduit Type Conduit Size AC Output Current Rated for max operating condition of inverter Accoding to Nec 19.79 Amps 1 Solar Edge Cable 10 AWG 2(V+,V-) N/A-Free Air N/A-Free Air 690.e(B)(1) NEC 690.35 compliant Nominal AC Volta a zao Volts 1 Bare Copper Ground(EGC/GEC) 6 AWG 1 N/A-Free Air N/A-Free Air s g , 2 THWN-2 10 AWG 2(V+,V-) PVC 1„ `opens all ungrounded conductors THIS PANEL FED BY MULTIPLE SOURCES n U . (UTILITY AND SOLAR) C 2 THWN-2-Ground 8 AWG 1 PVC 1" c Notes: SE380OA-US-U Inverters Specs: ���� 3 THWN-2 10 AWG 3(1-L1,1-L2,1-N) PVC 1" p e o7 3 THWN-2-Ground 8 AWG 1 PVC 1" Wire size and breaker calculations dependent upon CEC Efficiency 98% (1)-<m Inverter Continuous Maximum Output. �n2 2 Example:SE38000A-US-U Max Output=16A<20A. AC Operating Voltage 240 V E y Z Therefore a 20A solar breaker will be needed for each Continuous Max Output 16 A SE380OA-US-U inverter. Wire Gauge should also be DC Maximum Input Current 13 A fA�=o determined with 16A Max for each inverter. U ALL CONDUCTORS Solar Edge Optimizer Specs: P300 DC Input Power 30OW J SHALL BE COPPER DC Max Input Voltage 8-48V DC Max Input Current 12.5A Design Conditions: DC Max Output Current 15A ASHRAE 2013 Max String Rating 5250W Highest Monthly 2%DEI Design Temp 35.6°C. Module Specs: 14 PV MODULES PER INVERTER=3640 WATTS STC Lowest Min.Mean Extreme DE; -17'C JKM260P-60 1 STRING OF 14 PV MODULES VOC Temp coefficient V/°C 0 Short Circuit Current(Isc) 9.00A System Specs: Open Circuit voltage(voc) 37.8v tri Operating Current(Imp) 8.47A Max DC Voltage 500V Operating Voltage(Vmp) 30.7V JUNCTION BOX •O v jEWITH IRREVERSIBLE Nominal DC Operating Voltage 350V Max Series Fuse Rating 15A GROUND SPLICE Max.DC Current per String 15A STC Rating(Pmax) 260WNominal AC Current 16A Power Tolerance -0/+3%CONFORMS TO ANSI C12.1-2008 - L1 L2 N EXISTING N SUPPLY-SIDE ENTRANCE SOLAREDGE SOLAR TAP CONDUCTORS $ P300 OPTIMIZERS SOLAREDGE NEC 705.12(A) M RATED: 100A - SE3800A-US-R o? o 0 INVERTER' p � D: N K V < Z M < SOLAREDGE Square D OD221NRB > Z Z ti OC SAFETY 30A240V FUSED NEMA3 e > Z M4 SWITCH - OR EOUIVALENT 100A K �, N w w Z M � w 2 U_ Q Ln Z W < < 20A Z Z M p EXISTING' SHEET NAME: 240V/100A AC w '-----------------— - -----------------— c LOAD-CENTER Z 2 VISIBLE WITH 1-20A FUSED J LOCKABLE f7 3 'KNIFE A/C — DISCONNECT o DISCONNECT SHEET NUMBER: 0 Lij A (n D C n 0 00 71 c 00 0 N m M m w (n r ;u W 0 z m I0m 9 wO R0 T D Z 0m cm +n f� �m m r 0 O m 2 O rn0 f1z O (n Dom = mp ITI m 0 z C 1 �3 _0 3Z OC� N C � A wp 0 y 0 C C Zr xm m 0K Cm N Lo� Z 0 O (n�m cram Z A C x 0 01 C Z + A o . Ff, 4 oz J ; Cm mh mm g DA { z 0 m" T cn m 0-4 �0 nz N O W m r C 3 w Z z x� OC X 3 m --m 0 C X m m m z z O z m INSTALLER:VIVINT SOLAR O O C m D= ������ Locks Residence DESIGN >Km INSTALLER NUMBER:1.877.404.4129 PV 4.0 m MA LICENSE:MAHIC 170848 Q g 116 Compass Circle LOGIC Hyannis,MA 02601 DRAWN BY:DN AR 4850321 Last Modified:3/4/2016 UTILITY ACCOUNT NUMBER:1440 077 0021 EcolibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 4850321 Street Address Line 1: Street Address Line 2: City: State: Zip: Country: System Info Module Manufacturer: Jinko Solar Module Model: JKM260P-60 Module Quantity: 14 Array Size (DC watts): 3640.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: SolarEdge Technologies Inverter Model: v.SE3800A-US (240V) Project Design Variables Module Weight: 41.88778 Ibs Module Length: 64.960665 in Module Width: 39.0551392 in Basic Wind Speed: 100.0 mph Ground Snow Load: 40.0 psf Seismic: 1.5 Exposure Category: B Importance Factor: I Exposure on Roof: Partially Exposed Topographic Factor: 1.0 - — Wind Directionality Factor: 0.85 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load - Upward: 820 Ibf Lag Bolt Design Load - Lateral: 288 Ibf EcoX Design Load - Downward: 918 Ibf EcoX Design Load- Upward: 720 Ibf EcoX Design Load - Downslope: 460 Ibf EcoX Design Load- Lateral: 252 Ibf Module Design Moment—Upward: 3655 in-lb Module Design Moment—Downward: 3655 in-lb Effective Wind Area: 20 ft2 Min Nominal.Framing Depth: 2.5 in Min Top Chord Specific Gravity: 0.42 EcolibriumSolar Plane Calculations (ASCE 7-10): West Roof 3 Roof Shape: Edge and Corner Dimension: 4.542695821841497 ft Roof Type: Composition Shingle Stagger Attachments: Yes Average Roof Height: 20.0 ft Include Snow Guards: No Least Horizontal Dimension: 45.426958218415 ft Include North Row Extensions: No Roof Slope: 30.0 deg Truss Spacing: 16.0 in Snow Load Calculations Description Interior Edge Corner Unit Flat Roof Snow Load 26.9 26.9 26.9 psf Slope Factor 0.73 0.73 0.73 Roof Snow Load 19.6 19.6 19.6 psf Wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf Net Design Wind Pressure Downforce 19.4 19.4 19.4 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf Design Wind Pressure Downforce 19.4 19.4 19.4 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.4 2.4 2.4 psf Snow Load 19.6 19.6 19.6 psf Downslope: Load Combination 3 9.7 9.7 9.7 psf Down: Load Combination 3 16.8 16.8 16.8 psf Down: Load Combination 5 13.7 13.7 13.7 psf Down: Load Combination 6a 21.8 21.8 21.8 psf Up: Load Combination 7 -11.2 -13.3 -13.3 psf Down Max 21.8 21.8 21.8 psf Spacing Results(Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 70.3 70.3 70.3 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 64.0 64.0 64.0 in Max Cantilever from.Attachment to Perimeter of PV Array 23.4 23.4 23.4 in Spacing Results(Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 54.5 54.5 54.5 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 18.2 18.2 18.2 in. EcolibriumSolar Layout 44 1 s N 7 u I Y b Y C pCp 6 g Y' fl r— t { z x c k Skirt o Coupling o End Coupling 0 Clamp 0 End Clamp Note: If the total width of a continuous array exceeds 35 ft, break array to allow for thermal expansion and contraction. See Installation Guide for details. 0 North Row Extension Warning: PV Modules may need to be shifted with respect to roof trusses to comply with Bonding Jumper maximum allowable overhang. EcolibriumSolar Roof Weights In Conformance with Solar ABC's Expedited Permit Process Module Quantity: 14 Weight of Modules: 586 Ibs Weight of Mounting System: 46 Ibs Total Plane Weight: 632 Ibs Total Plane Array Area: 247 ft2 Distributed Weight: 2.56 psf Number of Attachments: 23 Weight per Attachment Point: 27 Ibs y EcolibriumSolar G Bill Of Materials Part Name Quantity ES10195 EcoX Base, Comp Shingle 23 ES10197 EcoX Flashing, Comp Shingle 23 ES10144 EcoX Junction Box Bracket 1 (Optional) ES10132 EcoX Power Accessory Bracket 14 ES10184 PV Cable Clip 70 ES10103 EcoX Clamp Assembly 15 ES10136 EcoX End Clamp Assembly 8 ES10201 EcoX Bonding Jumper 2 ES10121 EcoX Coupling Assembly 11 ES10146 EcoX End Coupling 7 Town of Barnstable *Permit# Zb 1 bsI tips Expires om's date Regulatory Servic Fee ' snaxsrASIZ = e MAC' • Richard V.Scali,Director i639. Building Division J A� � Tom Perry,CBO,Building Conn �/s�'jo�nler��Y o 2015- 200 Main Street,Hyannis,MA 02b0I OF RAR www.town.barnstable-ma.us sTA8CF Office: 508-862-4038 Fax:-508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ilk Co Vtq ioss uolry .Z Residential Value of Work$ 5- a 00r 00 _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address k ,40 L tq � WL -S Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: { ❑ I am a sole proprietor lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# - Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ,-, �j lV ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to '2 4, 4 li e 4o �G Q 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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. S � SIGNATURE: QAWPFILESTORMS\building permit formsEXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services of TOisti Richard V.-Scali,Director - °� Building Division RUMS'As1 ` Tom Per Building Commissioner MASS. v ss. $, Perry, g 1639. .0 200 Main Street,-Hyannis,MA 02601 ' AEG MA't a www.town.barnstable.ma.us 4� ,'`Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION_ DATE: © 0 V — (— �! Please Print. JOB LOCATION: ��1p ���] number , n streetn Q village •'HOMEOWNER": /W A A t 0 d..C/CI S ��/0 PIS— P name home phone# r work phone# CURRENT MAILING ADDRESS: L l �� )� ��j OCE c1 town . state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. . DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one. home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildinj, ep rmit (Section 109.1.1) The undersigned"homeowner"assume s'responsibility for compliance with.the State Building Code and other applicable cdes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proce d requirements and that he/she will comply with said procedures and requirements. r Si e o Homeowner ' Approval of Building Official t Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. ` HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is,required shall be exempt _ from the provisions of this section(Section 109.1:1A Licensing of construction Supervisors); provided that tithe homeowner' engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often, results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board`cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is' ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 r n .i ��TFIE 1p� r r BAM&rABM Town of Barnstable Regulatory Services g rY Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner t ' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ti Office: 508-8624038 Fax: 508-796-6230 i � n Property Owner Must , Complete and Sign This Section If Using A Builder I L ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work aX* bythis building permit application for: r (Address o ob) e of Owne Date �6 �S rint Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit fomvsTYPRESS.doc Revised 040215 27te CommomtwwM of Massachusetts Dep Trent of 1ndkstrid Acddeztts QKwe of Inmfigafions - 600 Washrington Street ic Boston,MA 92111 "*Mmasxgov1dea Yorkers' Compensation Insurance Affidavit:.BersJC.�antractarslElertricianslFlumbers Applicant Infuriation Please Print IcedMY Name �:�/lr� A&h-ess: 4 S Citylstahe/zi,- Phone Are you an employer?dkeek the appropriate box: T f ' 1.El am a with 4. ❑ I am a general contractor and I 7PPe o project(required): ernpl or part-&w-* have hired the sub-contactors 6. ❑New 2.❑ I am sole proprietor or partner- listed on the attached sheet. T- ❑' Remodeling ship and have no employees These'sub-contractors haze g_ ❑.Demolition worming for me in any opacity_ emplo7es and have wtnkers' 9_ El Buddingadditicm [No workers'camp-iumnance' comp-nizu ante X required] 5. ❑ We are a corporation and its 10-❑Electrical repaim at additions 3.® I am a homeawnu doing all wodc officers halve exercised their I LD Plumbing repairs or additions v\ myself o y�l�' - right of exemption per MGL sst vequiaed]T c-152, §I(4),and we have no 12.❑Roofrepaus employees-[No workers' 13.0 Other comp-+taus ce required] +Aaay apphcsaa2 dust checks boa C nansi also fill act the se€tim belaw showing their wo*ers=men policy iaf mufi m t FBooaew 11C- who submit this.affidavit huhcathig they ate doing 0 we&and thin hue eutd&cos mmmis mast submit a new afdaw indicating such ICoaa�ac�s that check this boat mast attadbed am addid— sheet sbndng the name of the sub-�and state whether tr nat those eadaies base employees. IfthesIIbtoatnutotsbaseemp1ayees.,dwymtstpmvidet9baeir waders'comp.policy number. I am an emplo}?er tliat is pmuTing workers'comper'sadoir insurance for nay employees. $ek'►v is the poficy and job site inyorrrratian. j I==xe Compatry Name: Policy#or Self ins.Uc-#: Expiration Date: Job Site A,ddrew:_`( i C'/�( U �e - =rw�_ s , ( tgfStateJ7sp: Aftach a copy of the workers'compeusaflon polio declaratiem page(showing the policy ntam er and.expimflon date). . Failure to secure coverage as required under Sectiau 25A o€MGL c. 152 on lead to the imposition of criminal penalties of a . fine up to$1,500-00 andfor 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 Euv�arded to�Office of Investigations of the DIA for insurance coverage vetitcation- I do hereby caarhfy wider the pains a i t d penalties ofpetyary,thatAe info rm ado n prmided above is bui and correct -:I?ate: Phone#: Official use only..Do not write in this area,to be carnpleted by city or town official, City or Town: Permitffikense# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/rown Clem 4.Electrical Inspector,5.Plumbing Inspector 6.other Contact Person:. Phone#• -- - 6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �y Map Parcel Applicatiorq�10(ii ls Health Division Date Issued S_ Z 6-l S- �= Conservation Division Application Fee 06T LT� - Planning Dept. Permit Fee -SS5. 0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address //4/, Village ,A YM4si/f lj OwnerzV," Ceo Address S � �- Telephone JW ��D ,� z ./ Permit Request ✓�? ��,l�Y� /2�� y, ,9��� �, ����-� lam/ 22Wo gwi �v6 J e.� x -� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed'- Total newer y XJ Zoning District Flood Plain Groundwater Overlay - , - 4 Project Valuation Z ldgg., O Construction Type. D� r 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 A No On Old King's Highway: ❑Yes,4 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � � /,/i�ly�f! oR/ Telephone Number J',3(F ��S'�/Zj 4L Address/ /2W)r" //w Oj/! License # P 74I Home Improvement Contractor# Email Worker's Compensation #�/��40.��,r�`��®/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE zi DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of$arnsta te. Regulatory Services w.nv SS Ri�Lxrd V:Scab,Director b 039. 10 Building Division Tom Perry,Building Conunissioner 200 Main Stieet,.4ywun s,''IMA 02601 wimtown;ba rnstabl a-ma_u s a office: 50s-862-4035 n Fax: 508-790-6z30 Property:Cvnier Must rtx g Act-ai --Sigp:' l s-fir-titre_ If Usinc A,Builder T, 'M(t V_C 's as Ch'ler of.clue si blecb. propff cl.� hereby aurhoriZe G 6 y1 to act on my behalf, in all rMttcrs rdative to work authorized by.this.b,e&i g pernit applic titiutz for (,Mdress of job) "Pool fences and ahLaw are the ,espoasibilit17.6f the'zIppkani.Pools are nog.to be filled orutilized before fence IS,,ImtLed and all l?ia4 ` Inspections.are: performed and ac:Ce-peed. Sigrature.of OAmer, Sim attire of Aplil,icalit < t — � - Pruit..'Vaine Punt Natre; . Date H MAY= s2'0 20i5 Q;FfJiU�1S>Ol'r1F,.hPr.PJ.iISSIQ�'P(iUl.S : � \ 1 he Commonwealth of iVassach usetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' R www.mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contractors/EIectricians/Plumbe1 AppUcant Information _ Please Print I,efrii�l ' �.,.. Name usiness/ s (B Otganizatiou/Individtaal): (i' X. - 1 Address: �� GtV _- City/State/Zi : aVLd�( ���� Phone - ,. Y ` Are you an employer? Cheek he appropriate boz: 1. I am a employer with �� 4• ❑,,1 am a general contractor and I - Type of project (required): 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 [No workers' comp. insurance comp, insurances 9• El Building addition required:] 5..0 We are a corporation and its 10.0 Electrical repairs or adc t o 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or addi. oi; . myself. [No workers' comp: right of exemption per MGL 12 Roof repairs insurance required.] t c. 152; §1(4), and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13. Other j� general contractor..(refer to#4) -�— comp. insurance required.] 'Any applicant that chocks box#1 must,also fill out the section below showingtheir workers'co - -- ......_.... mpcnsatio0olicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outsidecontracton must submit a new affidavit indicatine suci. 'Contractors that check this boz must attached an additional sheet showing the name of the sub•conhactors and state whether or not those endtirs hav- employees. If the sub-contractors have employees,they must provide their workers'co Policy number. '3 mP•P Y am an employer that is providing workers compensation'insurance for my employees. Below' is the policy and job �rrt information. ''Insurance Company Name: Policy#or Self-ins. Lic,#: � 0� 6l -t=— Expiration Date:_-__ Job Site Address: VI ���� �� f�jo j city/state/Zip: �l��G--�- Attach a copy of the workers' compensation policy,declaratio❑ 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 or 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 an(l a f)c of up to$250:00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certi nA the pains and penalties o P p f perjury that the information provided above is true and correct. Si a Date: L - Phon 11 #: Official use only. Do not write in this area, to be cam leted b i - y city P _or (own official ;I City or Town: Permit/Liceuse Issuing Authority(circle one):, - ----I. Board of Health 2: Build.ing,Department 3. City/Town Clerk Q. Electrical Inspector 5: Plumbing Inspect 6. Other Contact Person: Phoae From:Rogers&Gray Insure Fax: To:,+1 5 08 7 7 857 35 Fay:-+'15087785735� `, Page 2 of 2 :03/30/2015 10:04 AN1 CAPECOD-27 BDELAWIR NCE ,acorrc�s CERTIFICATE OF LIABILITY INSURANCE- DATE(1 ``'/D06''' - 3/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT SUPON THE CERTIFICATE HOLDER. TI its CERTIFICATE DOES NOT AFFIRMATIVELY OR'NEGATIVELY AMEND, EXTEND.OR ALTER THE COVERAGE AFFORDED.BY THE POL:ICIE f[, I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING-INSURER(S),AUTHORIz-ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, Subjeci to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to tl,e l certificate holder in Ileu of such endorsement(s). PRODUCER - "" CONTACT - -- -- NAME:- Rogers&Gray Insurance Agency,Inc. _ PHONE, FAX 434 Rte 134 (A/C,No,ExtL A/c No): (877)816-2.156 South Dennis, MA02660 EMAIL -- ADDRESS: INSURER($)AFFORDING COVERAGE __ I•Ir-..IG : INSURER A Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY �39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Ins. Co. j 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 - - INSURER E I INSURER - --.j 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 PERIGr) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO1/ HICi i'!=.1:3 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL I HE TE RiviS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAINIS. INSR - P L C EFF PO C EXP ---' "--"-`"---' LTR TYPE OF INSURANCE POLICY NUMBER --- f✓IMIDDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE�- $ .1,0)OOOO, CLAIMS-MADE a OCCUR CBP8263063 .04/0112015 04/01/2016 "PREMISES Ea ocahrence s, 100,0001'" MEDEXP(Any one person).. -- 5,000. . PERSONAL&ADV.INJURY $ 1,000,000, GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE'" 2,000 X POLICY a PECT LOC PRODUCTS-COMP/OP'AGG $ 2,000 00Q OTHER: —=- _- ;t AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT $ T 1011-00(?- - Ea accident B ANY AUTO TBD .04/01/2015 04/01/2016 E30CILY INJURY(Per person) $ ALL OVNVED X SCHEDULED — -- AUTOS AUTOS BODILY INJURY(Pei accident) $ t NON-OWNED PROPERTY DAMAGE q X HIRED AUTOS X AUTOS Per accident ---- X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000 00/'; C EXCESS LIAB CLAIMS-MADE EXCl000663.5000 04101/2015,"0410112016 ;AGGREGATE DED I X I RETENTION$ 10,000 Aggregate 1,000 UDn WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER' D ANY PROPRIETORIPARTNERIEXECUTIVE WCE00431900 06/30/2014 06/30/2015 E.L.EACH ACCIDENT - $ 1,000 0D('i OFFICER/MEMBER EXCLUDED? �N NIA' (Mend story In It yes.describe undnc er E.L.DISEASE-EA PLOY 1,000,000 - •,.� EM EE , ._ . DESCRIPTIONOF OPERATIONS below _ - E.L DISEASE-POLICY LIMIT _ 1'000, )00i r:. ------ ---- --� DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided undertA General Liability acid Auto Liability when required by'vrritten contract oragreement With the Certificate Ncrlclol i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED B FORE Cape Cod Insulation, Inc. THE EXPIRATION DATE THEREOF,. NOTICE WILL BE DELIVERL-D lii 18 Reardon Circle ACCORDANCE 1MTH THE POLICY PROVISIONS.• . k, South Yarmouth, MA 02664 ----------- AUTHORIZED REPRESENTATIVE — - ©1-988-2014 ACORD CORPORATION. All rights re'.:e f veil ACORD 25(2014101) The ACORD name and logo are registered marks'of ACORD Office of Consumer Affairs and Business Regulation '` 10 Park Plaza Suite 5170 `s ` Boston., Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration.: 12/15/2016 TO.-i59 I�8 CAPE COD INSULATION, INC HENRY CASSIDY 18 R EA R D O N CIRCLE _._-- ------ _ SO. YA R M O U T H, MA 02664 ---- --- -=--- -- Update Address and return card, Mhrl<'rcason for cilmi (� Address Renewal ❑ Employment f ^;"1,o i Cm(I •SCA 1 :i 20M-05111 e (J,2 9)l.M2CUCC!•�C�O�C-���(�ClJJClC�!l;iCCXJ, . - 4\ Office of Consumer Affairs& Business Regultitiori License Or registration valid for individul use only before the ex nation ante, ff found return to: (T1G==" HOME IMPROVEMENT CONTRACTOR ' I. • �. - - i Office of Consuincr Affairs an(! Business Regulation ! j egistration: 153567 Type: 10 C� Park Plaza-Suite 5170 xpiration: 12/15/201.6 Private Corporation ;> Boston,MA 021 16 , CAPE COD INSULATION, INC HENRY CASSIDY j 18 REARDON CIRCLE SO. YARMOUTH„MA 02664 Undersecretary N ,valid wi ut sign " e Massirc;husetta, Dbparfinent of �'uulic Safely- •80ard'of Buildliig Re ulatlons and'Sin g a ndarcls Construction Silper�islii Llcense, CS"-100.988., HENRY B CASSD?Y f ..dji.�4r!!vLslH 8 SFED ROW .WEST Y ARM 0Vj` J,�-� .�✓%1� Ex1)ir,) 0n Commissioner 11'/1112015 a •-,'I per- Town of Barnstable r j 'ME'a Regulatory Services 1 -�` Richard V. Scali,Interim Director - C sAxivsr�ar.E, s Y�..', MIMS. Building Division V0 N OF 'Af ,, 1659._ Tom Perry,Building Commissioner ��8R� . T 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us .0` PR Office: 508-862-4038 Fax: 508-790-6230 DI f_`T0 N --- PERNHT# FEE: $ 3 S } SHED REGISTRATION' - RESIDENTIAL ONLY 200 square feet or less . Location of shed(address) . lage „ Property owner's name Telephone number., 5 cz>t Size of Shed I Map/Parcel# afore Date } Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway ` Conservation Commission(signature is required) c,J a."�+w od�► Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE - COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOM PANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 1 F Y Tt+.Y T41AT THVS FQQ:NDAT0N 1 lE}Cn l�k �I�t 7"M LOT AS 5HOWN AND �O.h(F{�lZ1 .. TQ fH iC ^1N.'OF �42N$fl°1/3cF zc,ld�uc fi ,fl Tfdt�' h:C ARDYVG SUB�ACK9 Rt7fi� Ti. L 'L9ly'ES 'ANU:'-- .OT.tiAEG.. 48 , m a. . .. -70 3; z¢ • i b D fv . a ib. W IA a 41 o t m - u - sessor's map and lot n ber ...... ..... .f:�"...4^y,gl.J� `f F G 7� (3p"� SEPTIC SYSTEMMUST' BEINSTALLED ,INCOMRLIANCE Sewage Permit number ..................................................."' WITH ARTICLE II STATE OWN ' SANITARY CODE AND T QyoF?NEtO�y h, TOWN OF 'BARNS 1' T ` E i BARNSTADL$ 2639 BUILDI`H �EpYAYAre G , INSPECTOR APPLICATION FOR PERMIT TO. ................ ... ........ TYPE OF CONSTRUCTION ........ .. . .... . ... ...... ................................................... ...... ..... . ...... 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby a plies for a permit according to the following information: Location .......... ., ...... .yl 3� ..... .1 `'. � ,.1..:.. .4 ,f p �� ....... .A j r. Proposed Use .......... ........ . ......................................................... Zoning District ........................................................................Fire District Name of Owner .... �....:(, !*;z7,,;?,/ . � ddress ........ q... ... r... Name of Builder lr12 . ......� ..ate.. . ...... . . ....� ddress ......... .......... ............... ......... .......... Name of Architect ................. ..................................Address ..:.........:t—=-::..........::............................................ Number of Rooms ....... �........................... on Exterior ...... ': .... r.. . �r Roofing .....: .... ... Floors ......... ......................... .........Interior .........j Heating . i .............P.lumbing .................... ......... 1 Fireplace p ................... :...........,................... .........Approximate Cost ............... 4".:.0ne-0.......:................. I Definitive Plan Approved by Planning Board _______________________________19_____,__, Area MTV Diagram of Lot and Building with Dimensions Fee !.......... ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH ��° p I hereby agree to conform to all the Rules and Regulations of the Tow of Barnstable regarding the above construction. ''QQ Name sd)., ... .. :. �1..... .... •;i . ' N(.Y,.20661 one ^ single family dwelling Theo Construction Co. OERMIT REFUSED . . ~ . . . . . . ` { . . . ] ' - ' . . . . ^ _ . .~.~... ~ . ' lA | ' ---,....—..—�.---.—.. ' . ` . —..-----..,..'....—''~.. � . ' 2a i zi�o0 L-6T /aA Q 6 N K f ¢s- 0 CA 4• � zPLAN S140WIN6� K NORI AI i 9 GROSSMAN 'n SCALE ) '1c30' AUO 11, JD78 ` ►s�E .�,.. ��� .�. N©.►El��4 N �k'c7 SSoVli4A1 9E' L.S. ,c� ►v,,, Assessor's map and lot number ...................................:........ Sewage Permit number .......................................................... 1 0`TNET�'`+ TOWN OF BARNSTABLE • 33MUST"LL "6 9 . BUILDING INSPECTOR a APPLICATIONFOR PERMIT TO ........................... f....... .................................................................... TYPEOF CONSTRUCTION ......... .................. ................................ ................................................... ........... ... C .......19... .'.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ! ....'........ .................... .... ......... ............................... Proposed Use ................... .:....r . !... ' �:: ............................................................................................................... ..... ..... ... Zoning District .................................................../...............Fire District Name of Owner ................................ ;:..aAddress .. �.y.�..' .�.' .................... .................... ...... ............................... ..... Name of Builder ......: .......................................f...ffr?.A.....Address 7, .. r. r Nameof Architect ............................-r..................................Address ............... ...:.:............................................................ Number of Rooms .......... ...............................Foundation !`r . , "� .' ,�� ... ....... r Exterior � sty/ Roofing .......:� I'....... ... .....j.r'/� .., Floors Interior i ... ................... ..... ............... .................................. ......................... I d f - Heating . '::?.........'............lr... ..............Plumbing ....................�. ................................................... Fireplace ...................!.q`"1.......................................................Approximate Cost .....................'�!........ !.::U......................... - r , Definitive Plan Approved by Planning Board ________________________________19--------. Area ................ .�!.. !.................... Diagram of Lot and Building with Dimensions Fee p�� ... �'�~c !`� ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH - 1 I � I A%�� ' I hereby agree to conform to all the Rules and Regulations of-the Town of Barnstable regarding the above construction. - Name ...................................................``�-' Theo Construction (ao• A=310-404 ' No .......9§6 lPermit for ........on .A; 12 ....... rI. single famil .dwelling................ 14 Location ..........116...Com8as.s..C.,r Q.:LirQj.Q.............. ........................HY.a.nnis................... Owner .............................heo Con, trup..:kq ... .0......... Type of Construction ........ZrAWe........................ .................................................... ................. Plot ............................ Lot ...... . ............. Il Permit Granted ......October...............:� 7g ................19 Date of Inspection ....... ...................19 Date Complete....................................19 PERMIT REFUSED ............................ ............................... 19 ...... ..d........... ... . : ........................... ^ -- � . � .. Approved'................................................ 19 .......................................................................... .............................................................................. i i �'`„�• ` TOWN OF BARNSTABLE Permit No. ----20661 I ns : Building Inspector cash $580.00 ,5 iM9 ;Cedar Acres Rea: ry OCCUPANCY PERMIT Bond .. 2:;VuSt, "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Theo COrlstructlali CO. Address rrea.t Pond Dr. , South Y=nouth l nt #1RA 1116 rmnas.,q Cixcl.P. llvarms Wiring Inspector f l Inspection date J l C<- Plumbing mspec Inspection date h f Gas Inspector Inspection date Engineering Department / Inspection date,- THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. j�....Building Inspector __-A Town-of Barnstable *Fermi acb Expires 6 m hs romL yT °� Regulatory Services Fee • BMMSTAat.e. • � MASS. Richard V.Scali,Director 039. prEQ MA't A Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-_790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - I L Not Valid without Red X-Press Imprint Map/parcel Number� � (� Property Address ,@ ®--Residential Value of Work$ 4 P'00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner AUG 1 ❑ I have Worker's Compensation Insurance T Insurance Company Name - 1® �ncn�� /� Workman's Comp.Policy# `ABLE 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 Q ,Replacement Windows/doors/sliders.U-Value W Igmaximum.35)#of windows 0 #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 Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is fired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 k� ��tt�s�zapts€-�rilt�`i e�'�rrssr�e�t� • 600 ffisw1dri<g#QnStreet Bastan,.MA 02111 rvtt�to�.rrirrssgasa�il'ic� ' orkea-s' Compensatian. nsuranceAffidavit SuEildearsfCaahactors/FJectricianslP umbers Apit.E .ut Lafarmation ,y(� Please Prnat Leeibly Name(B��ay naafioa/h>dividrzaq_ A 0 Ci S tateJZjP= dy W i phone 6D91. .�-� Are you an employ ?Check the appropriate b= Type of r 4_ I am a e�al coutr�ctor and I �"o'�ect E e�au��.: L El I am a employer with $ 6- ❑New o=gtr.rcfiioa e=loyees{full andlorpart-#ime}* Uve-hired the sub acfors. 2_El I am a sole propaetor or partner- ship on the attached sheet 7- ❑Remodeliag ship and haze no employees These sub-coatrackors have 8_ ❑Demolition wo&ing for me in any capacitlr empin5�ees and have workers' p_ ❑Euild7i g addition [No,work=' comp_insurance comp_Insurance, A:��l 5-❑ We an:-,a corporation and its 10-0 Electrical repairs or additions 3_[ ,Pma hometnfiner doing all woxk' ofEcers have exercised their 11_0 Plumbing repairs or additions S£ [No w orlan'comp- right of eammption per MGL 12_.0 Roof repaz<s a lmxannce req-airell F e_1.52,§1(4} and wehHveno e-ployees-[No workers' l _.❑O.f3rer comp_insurance reg6red:I day aag rsf fat c?j--cJs box rl vmst also fill oiA the section below shy idea tsa 3ras�roaxpe�s o�gpii�fruf�m t HomeawnE-s who submit this RTadxvA it mr Tdn�E tney are tlomg zIl Trovc and then hue outside contracr=nmsY sabwit a new aLdsrit mdirmlm snrR tCbntmrmrs fist rh eck this box must sttached a'A additiona those owafies hxwe EmpkUErs_ Hth°sub-cDatactom have empIoyee-%they must pM Ade thr_r workers'comp pokey n=brr_ am arz tr7tL°3'"r tisat is pre»de tE orkers'c-ozrtpRrurtiv�t arrsttrarcce jar ml enrplayeRs IleLotr is Ste paLic}and job azfe inforffza Za2;L s_ Insurance CompanfName: PGR 4-cr Self ioA-Iic-:k FxpirationDzte: Job Sites A-d.&r=: CifylSfateEZip- . AttacIt a copy of the-workers'compensation policy declaration page(showing the policy ntrraber and cipn-ation date). Failure fu secure covt:rage as required under Sectiosa 25 A of MGL c- 152 can lead to the imposition ofcrimiaA pMalfies of a fine up to$1,500.0a andlor me-year impn as well as civil peualfies in Ihe fona of a STOP WORK ORDIlZand a fine of up.to 5250.0+0 a.day against the violator_ Be advised thst:a copy of this statement maybe forwarded to the Office of Investigations of fie DIET;for i surance coverage� zification Ido kgreby crrfi rarrlgr }tsPons ondlpenaLess of'p,nywy 6atthe informat&npratided above is b-U0 and carrect Sianatm s Bate- V U t Phone 9: Off FcrttL rue anly. llrr trot write in M&area, o bs compteted by city ar town ofic&L City or Town: Fern dtf icerse# Lssu"4's t' n hariq(tlrcle oue): . . 1.Board of$e2dth 2.Ruff frog Department I GitylTiow a Clerk 4.Electrical fnsgec#or fi.Plumbing Empector 6.G her Costrct Person: none#: 6 Informafion and Instrucfions Massachusetts CTreneral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this sta-tote, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees_ However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also stat-s th2t"every state or local Licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings'ia the commonyV alth for arl.y applicant who has not produced acceptable evidence of complian.ce vying the insurance-coverage requir e.d.- Additionally, MGL chapter 152, §25C(7)states"Neither the con,monweal h nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable t-,ideuice of compliance v idi the irs�ance requirements of this chapter have been presented to the contracting au horitY_" Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to yrur situation and, if necessary,supply sub-contractor(s)name(s), address(es) and phone mnr_ber(s)along with their certiiicatc(s) of insurance. Limited Liability Companies(`LLC) or Limited Liability Pai-tDe.zslius(I-LP)VvZuno tunployt-es other ban u7e members or partners, are not re.t2�_ed to carry workers' compensation if an LLC or LLP does have employees, a policy is required_ De advised that this affidavit may be s;b;.nitted to the Depaut--nent or Industrial Accidents for confirmation of insnance coverage. Also be sure to sign and date the affidavit Ilia affidavit should be retume-d to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents- Should you rave a1y ques%io-s regarding the law or if you are requ;l-ed to ob:Hh!a workers' compensation policy,please ca12 r:he Department at the number lis`Ltd below. Sell insured companies so.ould enter. daei.r self-insurance license number on u_e appropriate lore. City or Town Officials Please be sure that the affidavit is csmp.lete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to nll out m i e event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pem license number which will be used as a reference number. In addition-an applcant that must submit multiple pej-LD-iillicense applications m any given year;need only submit one ar�davit indicating current policy information(ifnecessaly) and under"Job Site Address"the applicant should v.-rate,"all Iocatio-ns is (city or town)."A copy of the a#fi, davit 1hathas beam officially stamped or marked by be city or town may be provided to-tale applicant as proof that a valid affid_vit is on file for future permits or Lcenses. A new affidavit m,.i<st be filled out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn Ieaves etc.)said person is NOT required to complete this affida:dt The Office of lavestigations would like to thank you in advance for our cooperation and should you have an uesaons, Y Y Y Yq please do not hesitate to give as a c731. i The Department's address,telephone and fax number: Tb Cum=iwn-alth of Ma.ssachv s�tt Diapaitmeat Qf Iadustaal Accldrnts Q�flCe oI�i'4FeS�I�tk(}A5 600 Washington St —t &ostou,NIA 02171 Tti,9 617 727-49-00 W 406 or I-9771 N—LkSSA E Revised 4-24-07 Fax 0 617-727-T It91 Town of Barnstable ` Regulatory Services • r., `�-- �oF rOtyy Richard V.ScaIi,Director Building Division Tom Perry,Building Commissioner MASS. 9� 1639. ��� 200 Main Street, Hyannis,MA 02601 ATED MA'I a • www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION l t Please Print DATE: JOB LOCATION: cv J S • number ��J � sheet. QvillaQg'e "HOMEOWNER": � j tiU O I TO1/N name home phone# Q work phone# CURRENT 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. r The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection Pr oceaurerapLd equirements and that he/she will comply with said procedures and requirements. �.� yE Sign m of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control: HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." , Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. QAWPFILES\FORMS\building permit fomis\EXPRESSAC)c Revised 061313 � ETti Town of Barnstable Regulatory Services EMMSTARiE� Richard V.Scali,Director ��EDMAIA`0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barns le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property er Must Complete and ign This Section If Us in A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized this building permit application for. D (Address f Job) ' ''Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized t efore fence is installed and all final inspections are performed and accepted. Ignature of Owner Si e of Applicant Pnnt Name Print Name Date QTORMS:O WNERPERMIS SIONPOOLS Town of Barnstable Regulatory Services Thomas F.Gefier,Director { Building Division . EAEUMA=, � MASS g Tom Perry,BnUding Commissioner ib39. kt® rFD 200 Main Street, Hyannis,MA 02601 www1own.itarnstable.m&us Office: 509-862-4038 Fax: 509-790-6230 Approved: ^- Fee: Jg e 6-D Permit#: c-"130 (c,,253 HOME OCCUPATION REGISTRATION Date: ®7 Name: f^I two J (,�, L( S Phone#: Address:/b .P t14,(JC (g Village: Name of Business: Type of Business: C©wl rkiW- r t,-L- Mapq-ot: ' ® I IIJ'I'EN'I': It is the intent of this section to allow the residents of the Town of Barnstable to operate a Home occupation widen single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,pro`nded that the actiirity shall not be discernible from outside the dwelling7 there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundmater pollution. Y After registration Nrith the Building Inspector,a customary home occupation shall be permitted as of right subject to the follovring conditions: • The actiirity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling vAhich are not customary in residential buildings,and there is no outside e`ridence of such use. • No traffic vtrill be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosh e materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not iArithia the required front yard.. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one - pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. , • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business, the street address shall not be included, • No person shall be employed m die Customary Home Occupation irlho is not a permanent resident of the 1 dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. � Applicant on"-1 0111,r�(�K/(�— Date: '(/ ( - )'o Homeoc.doc Rev,01/3/08 i r Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you Est do by M.G.L. - it does not give you permission to operate.] You must first obtain the necessary Signatures on this forrn at 200 Main St., Hyannis. Re the completed form to the Town Clerk's'Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is quired by law: DATE: 02 � Fill in please: la1l �s � ti'ti APPLICANT'S YOUR NAME/�:C D �Z TKO 't� i-�jr ` a BUSINESS YOUR,HOME ADDRESS: Oto G TELEPHONE # Home Telephone Number AME u' GORPORATIONn USINESS J;. ::+ : EW BUSINE OME,OCCUPATION , '• or � ;, . Assess . (� � �: •: _.._ ®DRESS OF BUSINESS '' I '' ' then starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of arnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St: - (corner of Yarmouth ',d. & Main.Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. BUILDING COMMISSIONER'S OFFICE ? OVA- P. This individual has been in ed of a ermit requirements that pertain to this type of business. MUSTC MP ME C-(i1 (��r!✓�J�/'C� At Si nature** COMPLY WITH WQ OCCUPATION �l`1�Q aOMMENTS: m RU ry . BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* I'3 COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: fY . .