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HomeMy WebLinkAbout0004 GUY LANE U io kint! 'own of BarnstableId ' 4 ost- hrslCa,d T.It::ri,rs, rsrktXeEr. rtr.t d.Stteet:..A rovedWansMvrsibeReta�nedcs�rlats,and,this,Car .,Mus #.elCe t iC. t. . kr �� ,.. s� PIS F,, , � �,� ., . P ,� s, ., .� ..,, .,.- � ems.. w,. , .... , s a.. #` f c.M.. 4,11f k. ,finejn .. ... f.. .. i. ..a. , .,:,. >z ,...sv postedUntil Final Ins echo .Has Been. ade. ,�. },- � � ,�. ,r {..kY..y. s ,a a.. .& ., ., .. ,...✓ ,.. Y . .,, ,. �e s here.a..Ce>tilt.Eat ofi�pcc, n rs Re urted such. urldrn ,shallzNat.be,.Occu ied.un#rya Finaislns ectronGh p _ :1iR ` .., ,a` 7,77:= . ;� + _. -�.,,n >,..,: �. .,'•,a3 .,, g., .I:'z 'fir_ ,' s{. a:f .,. _ ,. k ,..,x ,r,.�. &«. .....». ,�a..-..». .. - ., -., A I�cant Name. Crai Bisho Permit_No. . B-17 3325 pP' g P Approvals bate Issued. 10/13/2017 Curren,t;Use Structure ` 04/13/2018xpiration Foundation:Permit:TyPa .Building In sulaion-`Residential Date: Location::.4:GUY.LANE HYANNIS Ma /Lot 71 004 006 Zonin 1 p g District: RC-1 Sheathing: . Owner on Record: POLLOCK,JESSICA M,GALLAGHER, MIRIAM , � Contractor'Name Craig P Bishop Framing: 1 �, Yak F k ...... 9 �: - Contractor License: CS-109777 Address:. 4 GUY LANE 2 HYANNIS,MA 02601 <"Est' Pro ect Cost: $3,138.00 Chimney: Description: Weatherization&Air Sealing hermit Fee: $85.00 Insulation: Project Review Req: Fee Paid S85.00 . Final: Date 10/13/2017 � � �. - x Plumbing/Gas RoughPl umbing: in : � fN� � ,Building Official <; 4 - Final Plumbing: . :This permit shall,be deemed abandoned and invalid unless the work authorrze by this permit is commenced within six months fte ar Jssuance. Rough Gas: All work authorized by this permit shall conform to the approved application and iL approved construction documents for which this permit has been granted. . .I, Final Gas: All construction,alterations and changes of use of any building and structures shall be m compliance with the local zonmgby caws and codes. This permit shall be displayed in a location clearly:visible._fromaccess street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. n Electrical rnK s` v .. Service The Certificate of Occupancy will not be.issued until:a&applicable signatures by the Bwldmg and.Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work �` P qz Rough: 1.Foundation or Footing t 2.Sheathing Inspection Final _ - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Whereapplicable;separate permits are required for Electrical,Plumbing and Mechanical Installations. _ :. .. : W,-orkshall_nQt:proceed until the Inspector has approved the various stages of.construction , - k Fm of Person :co tlactln .`. Ith:unre r to.re:dr:contractoks,do.not;h ve access o tF a uaran 'fund" as set forth`in:MGL;c.142A Fire;Department - J is n gw g$ t .g tY ,. Building plans are to be available on site Final ., ;AII Permit"Cards are the property of the APPLICANT=ISSUED RECIPIENT £M�LIr S i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION'S � I Map L� Parcel Oyi Application # Health Division Date Issued Conservation Division �0J 41(10 Application Fee Planning Dept. Permit Fee j'si J Date Definitive Plan Approved by Planning Board 4i„ Historic - OKH _ Preservation/ Hyannisr4-, Project Street Address Village 5 Owner 0 is Address o0 Telephone ---7 Permit Request ,:76 07-6 11 10 6" `k) Square feet: 1 st floor: �existing proposed 2nd floor: existing proposed Total new / Zoning District , �1- Flood Plain Groundwater Overlay Project Valuation COO, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Typ Two Family ❑ Multi-Family(# units) Age of Existing Structure IV Historic House: ❑Yes 04IN/0 On Old King's Highway: ❑Yes O'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) PA 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 u'r Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other � Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No 0hetached 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) c� P/ Name Telephone Number ������� Address I I 1���l 'ev License# 1ptu rl Home Improvement Contractor# Email 0", 61k-coyn Worker's Compensation # WGV-Zg I(--gI ALL CONSTRUCTION DEBR S RESULTING FROM THIS PROJECT WILL BE TAKEN TO J 5 SIGNATURE DATE O 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. ` ���n (�'CZ1�2�/124�Zi!11E��t/�'1� Q�.• ��,/,�'(�C�:�Sft:C�'L�LI�Pl F Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home ImprovementContractor Registration �*� • Type: SupplementCard , " / Registration: 168572 SOLAR CITY CORPORATION .P ._-�� ^1 1 ',� Expiration: 03/07/2019 24 ST MARTIN STREET BLD 2UNrr 11 MARLBOROUGH,MA 01752 _ �ai sip -,�r..oryf 1. r Update Address and return card. Mark reason for change. SCA 1 0 20M-05.11 ❑ Address ❑ Renewal ❑Employmtent ❑Lost Card �-i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found retum to: u RaatstratPon Expiration Office of Consumer Affairs and Business Regulation 168572 03/07/2019 10 Park Plaza-Suite 5170 SOLAR CITY CORPORATION Boston, 6 DANIEL ARVI 3055 CLEARVIEW WAY SAN MATEO,CA OW2 Undersecretar Not valid.Without signature a Massachusetts Department of Public'Safety Board of Building Regulations and_Standards ' License: CS401687 Construction.Supervisor �. DANIEL D FONZI i 390 ANDOVER STREET' , WILMINGTON MA 01887 = •-�- 1 ^^ Expiration: Commissioner 09/13/2019 I (6 671?e 201milmol1't1j w,11XYl> CJl C �GGC'�J:1C�'CyJiGI/J� �l A Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration t rr r r Type: Supplement Card Registration: 168572 SOLAR CITY CORPORATION It V '3' i T�- - -� Expiration: 03/07/2019 24 ST MARTIN STREET BLD 2UNIT 11 rE . MARLBOROUGH,MA 01752 r, �-- Update Address and return card. Mark reason for change. SCA 1 is 20M105)11 - r �J�r,�crnrrrr+rrn..trl/�r�.:���rJ3rrc�n::c/% Office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only 1 TYPE:Suoolement Card before the expiration date. If found return to: RRigistration Expiration Office of Consumer Affairs a s ess Regulation o 1168572 03/07/2019 10 Park Plaza-Suit 170 SOLAR CITY CORPORATION Boston,MA 021 r NATHAN TISSOT 3055 CLEARVIEW WAY ithout signature SAN MATED,CA 94402 N v Undersecretary I • II r The Commonwealth of Massachusetts Department of Industrial Accidents d 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 Please Print Legibly Name (Business/Organization/Individual):SolarCity Corp Address:3055 Clearview Way City/State/Zip:San Mateo CA 94402 Phone#:888-765-2489 Are you an employer?Check the appropriate box: Type of project(required): I. ✓ I am a employer with 12,000 employees(full and/or part-time).* ❑ 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. 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.: p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E✓ Other solar panels 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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:American Zurich Insurance Company Policy#or Self-ins.Lie.#:WCO182015-.01 Expiration Date:9/1/2017 Job Site Address:4 Guy Ln City/State/Zip:Hyannis MA 02601 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 p of this statement may be forwarded to the Office of Investigations of the DIA for,insurance coverage verificati I do hereby er ' u de pa' s and penalties of perjury that the information provided bo a is true and correct. Si nature: Date: v Phone#:508-640-538 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#: ATE .PLC ROB CERTIFICATE OF LIABILITY INSURANCE D19M16 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. 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(t3 .PRODUCER CONTACT MARSH RISK&INSURANCE SERMCES 'PHt°�a -- .._. .—....—. _..__._._._TTF ....._......_......_.._._..._.........__ 345 CALIFORNIA STREET,SUITE 1300 �gI',Ne x11• 1(ALO.N CALIFORNIA LICENSE NO.0437153 E-MAIL RDRESSL.— .. .:.._ ......._........ . .............._.._._.—.. 5AN FRANC15CO,CA 84104 i Attn:Shannon Soot(415.743.8334 .............. ...............INSURER(Bi AFFORDING COVERADE,_... ._.._.^_... NAIL N 996301-STND•GAWUE•16.17 INSURER A:Zurich American Insurance Company 16635 INSURED . —................ ........---.._..--- ----- 'INS INSUR NIA NIA ER — � ............ ...,,....._.... .,---- NIA 3055ClearviewW _._._.. ..._....,......... .. .... .. . ........ .....:_._ SolarC' Corporation San Mateo,CA 944402 INSURER D..Amgiran Zurbh Insurance Company 40142 ..........................—.__.._.._....-- —._...................._........_......,............................ INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-DD3003278.03 REVISION NUMBER:6 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. T _.LTRTYPE OF INSURANCE g WVDOL NUMBERMhULooY Ei F YM MOLtCY EXP LIMIT'S A X COMMERCIAL GENERAL LIABILITY �LOOi82O16.01 0810112016 ID910112017 EACH OCCURRENCE S 1,000,OOD 1 DAMAGE TO RENT-3E--- ...I CLAIMS-MADE [.X..J OCCUR i PRE�i11SE5EaaccurrencoL„i 9,DQD�Dt)D X SIR.*$250.00D MED EXP(Any ono porso 5:....._.. 5,000 ----- PERSONALaADVINJURY S 1,000,00a rGEN4.AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE_. 11 . 2.000,000 F..... PRO• �_._..__..._......... ....... .... .......... _._ X POLICY L...J PRO- JECT LOC PRODUCTS.-COMPIQP.AGG 5........... .. .. 2,O00,000 r ... e OTHER: I S A jAUTOMOBII.ELIABILITY tAP0182017-01 090112016 0910t12017 a ieenq..............__. $ 1,000,000 X OM51NED.5INGLE LIMIT ANY AUTO BODILY INJURY(Per person) S ALL OWNED }SCHEDULED .._ ..----................_. .._. X AUTOS X 'AUTOS EODRY INJURY IPoracoldcident) S NON•.OVVNED PROPEI?TYgAMAG�' S X HlREOAUTO5 X,(AUTOS .@LA�i �.....-- --.........—..... $ UMBRELLA UAS OCCLREACH OCCURRENCE $ EXCE33LIAB AGGREGATE $ ED RETENTI N S S D. WORKERS compENsATIoN C0182014-DI(AOS) 9 2016 09 11-2017 X PER UTH- AND EMPLOYERS'LIABILITY STATUTE ER . D ANY PROPRIETOWPARTNERtEXECUTIVE YIN WC0182015.01JMA) 09012016 09,10112017 E.L.EACH ACCIDENT S 1•DQD:000 A OFFICERIMEMBEREXCLUDED? EINIA EWS0182018-01 CA• I0910112016 0910112017 — __ (Mandatory In NH) I E.L.DISEASE-EA ELOYEd S 1,000,006 N yyes describe under Vmlu apply excess Dr$500K SIR-CA 1,000,000 DEBGIRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddiUonat kemarrra Schedule,maybe attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SolarCilyCorporaloo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3055CtearviewWay THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Mateo,CA 94402 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE of March Risk&insurance Services StephanieGuatumi _eftp;� ..Q 4w14;11w• ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are,registered marks of ACORD 41;�,`,6olarCity. OWNER AUTHORIZATION Job#: 7 61 11-114, Property Address. 4 I J Cy C as Owner of the subject . property hereby authorize SOLARCITY CORPORATION to act on my behalf, in all matters relative to work authorized by this building permit application. ig ture of/ow ner: Da : SOLARCITY.COM - DocuSign Envelope ID:4017548F-3851-4428-8177-4BA677D7D905 SolarCity Solarlease Customer Information Installation Location Date jessica pollock 4 Guy Lane 8/1/2017 4 Guy Lane Barnstable,MA 02601 ' Barnstable,MA 02601 7749947132 Here are the key terms of your Solarlease Agreement 4~ ~Y ) 4 } U0 50361- 0 �9`0% 2 Gyrs I Amount due at contract First year month) gayment Annual Escalator Agreement Term signing (Est.Price per kWhEST_ r:$0.1450) An A� Jr� JInitial her Initial here Initial here � The SolarCity Promise DS •We provide a money-back energy performance guarantee. �� •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. us •We restore your roof at the end of the Agreement. 9� •We warrant,insure and repair the System. .........................................................................................................................................................................................................................................:........Initial her •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 pricing in this Agreement is valid for 30 days after 7/31/2017. Your SolarCity Lease Agreement Details Your Choices at the End of the Initial Your Prepayment Choices During } Amount due at contract signing I{ Term: the Term: $0 •SolarCity will remove the System at no • If you move,you may prepay the Est amount due at installation cost to you. remaining payments(if any)at a $0 •You can upgrade to a new System with discount. — - the latest solar technology under a new Est.amount due at building inspection contract. F $o You may renew your Agreement for up to Est.first year production ten(10)years in two(2)five(5)year 7,064 kWh j increments. - _ _.__ -._.,_ ___ __ •Otherwise,the Agreement will automatically renew for an additional one (1)year term at 10%less than the then- current average rate charges by your local utility. . J 3055 Clearview Way,San Mateo,CA 94402 .1 888.765.2489 solarcity.com 2820450 SolarLease Agreement,version 8.6.0,July 11,2017 SAPC/SEFACompliant 7� SolarCity Corporation DBA Tesla Energy Contractor License MA HIC 168572/EL-1136MR 7 Document generated on 7/31/2017 Copyright 2008-2015 SolarCity Corporation,All Rights Reserved �■ DocuSign Envelope ID:4017548F-3851-4428-8177-4BA677D7D905 24. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS LEASE AT ANY TIME PRIOR TO By signing below,I agree that SolarCity can contact me for MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE telemarketing and informational purposes via call or text using YOU SIGN THIS LEASE.SEE EXHIBIT 1,THE ATTACHED automated technology and/or pre-recorded messages using NOTICE OF CANCELLATION FORM,FOR AN EXPLANATION the phone number(s)I provided that are listed on the first page OF THIS RIGHT. of this contract. I understand that consent is not a condition of 25. ADDITIONAL RIGHTS TO CANCEL purchase._You may opt-out of this authorization at any time by IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL calling us at:888-765-2489 or.sending us written notice and THIS LEASE UNDER SECTIONS 7 AND 24,YOU MAY ALSO mailing it to:SolarCity Corporation,Attention: Phone CANCEL THIS LEASE(A)AT NO COST AT ANY TIME PRIOR Authorization Opt-Out,3055 Clearview Way,San Mateo,CA TO MIDNIGHT OF THE TENTH BUSINESS DAY AFTER THE 94402. DATE YOU SIGN THIS AGREEMENT AND(B)AT ANY TIME PRIOR TO COMMENCEMENT OF CONSTRUCTION ON I have read this Lease(INCLUDING THE AGREEMENT TO YOUR HOME. ARBITRATE)and the Exhibits in their entirety and I acknowledge that I have received a complete copy of this 26. Pricing Lease. The pricing in this Lease is valid for 30 days after 7/31/2017. If you don't sign this Lease and return it to us Customer's Name:jessica pollock on or prior.to 30 days after 7/31/2017,SolarCity reserves Doeusignedby: the right to reject this Lease unless you agree to our then Signature: f �LSSIGA"�bG `� current pricing. L� 25o,3„1`noo 5460... Date: 8/1/2017 Customer's Name: Signature: Date: SolarLease Agreement SolarCity approved Signature: Cal Lankton VP,Energy Sales and Operations f Date: 7/31/2017 ❑■ N0 SolarLease Agreement,version 8.6.0,July 11,2017 2820450 ❑ ■ r 1 �r1 Version#69.4-TBD SN OF A August 6,2017 9 Y NG NG G RE: CERTIFICATION LETTER ZI'W Project/Job#0263718' V CML Project Address: Pollock Residence _ NO.S2791 4 Guy Ln Barnstable,MA 02601 C/STEa� AHJ Barnstable Town/City SC Office Cape Cod Digitally signed by Henry Zhu Henry n ry Z h u°ma'n=H2n"Zhu, Design Criteria: a;-US,@sdarciCityC,00mflon E(r} DatAATe 20 U5 8.06 11 30 43-07'0 ation- Date:2017.08.00 11:30:93-07'00' -Applicable Codes=MA Res.Code,8th Edition,ASCE 7-05,and 2005 NDS ` Risk Category=II Wind Speed=110 mph,Exposure Category C,Partially/Fully Enclosed Method -Ground Snow Load=30 psf -MP1:2x8 @ 16"OC,Roof DL=11 psf,Roof LUSL=16.8 psf(Non-PV),Roof LUSL=9.21 psf(PV) Note: Per IBC 1613.1; Seismic check is not required because Ss=0.18757<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 Tesla. Structural evaluation was based on site observations and the design criteria listed above. Based on this evaluation,I 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 referenced codes for loading. The PV assembly hardware specifications are contained in the plans/docs submitted for approval. Tesla,Inc. T S 5 L R 3055 Clearview Way.San Mateo,CH 94402 1 p 650 638 1028 f 650 638 1029 1. Version#69.4-TBD `•.HARDWARE DESIGN'AND'STRUCTURAL"ANALYSISRESULTS SUMMARY TABLES Landscape_ ". Hardware'-Landscape.Modules',Standoff S ecifications . Hardware'.1 X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR. MP1 64" 24" 39 NA Staggered 63.1% "Portrait ;Hardware-:Portrait Modules'Standoff Specifications i Hardware,;�. X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1 48" 20" 65" NA Staggered 78.9% i Mountin Plane Framing "- w °` Qualification Results 'Structure Type" Spacing Pitch Member Evaluation Results MP1 Finished Attic 16"O.C. 44° Member Impact Check OK e o i collected / evaluation is based on framing information gathered Refer to the submitted drawin s for details f information toll ted during a site survey. member analysis and/or valuat n 9 9 Y Y 9 on site.The ebsting gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC. Tesla,Inc. L Fi 3055 Way,Sac.Mateo, ,A 94402 p 6K 638 1028 f 650 638 1029 r ,STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK - MP1 Member Properties Summary M P1 Horizontal Member Spans Rafter Properties Overhang 0.82 ft Actual W 1.50" Roof System Properties Span 1 11.86 ft Actual D 7.25" Number of Spans w/o Overhang) 1 Span 2 Nominal Yes Roofing Material Comp Roof Span 3 A(in"2) 10.88 Re-Roof No San 4 Sx(in.A3 . 13.14 Plywood Sheathing Yes San 5 Ix(in A4 ' 47.63 Board Sheathing None Total Rake Span 17.63 ft TL DefPn Limit 120 Vaulted Ceiling Yes PV 1 Start 2.25 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 11.92 ft Wood Grade #2 Rafter Sloe 44— PV 2 Start Fb(psi)`' 875 Rafter Spacing 16"O.C. PV 2 End Fv(psi) 135 To Lat BracingFull` - 'PV 3 Start : �� "° "T E si 1,400,000 Bot Lat Bracing Full PV 3 End E-min(psi) 510,000 Member Loading Summary Roof Pitch 12112 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 11.0 psf x 1.39 15.3 psf 15.3 psf PV Dead Load gf a *PV-DL '1� ?<3.0 psf % ` x 1:39 {i� 4`2 psf Roof Live Load RLL 20.0 psf x 0.63 12.5 psf Live/Snow Load -ILL/SL'z 30.0 psf x_0.56,q1'x 0.31 16'8 psf��° - 9.2 psf `' Total Load(Governing LC) TL 32.1 psf 28.7 sf�:d Notes: 1. ps=Cs'pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-21 2. pf=0.7(CJ(Ct)(Is)p9; CQ 0.9,Ct=1.1,IS 1.0 Member Analysis Results Summary Governing Analysis Pre-PV Load s Post-PV Net`Impact Result Gravity Loading Check 32.1 1 28.7 -11% Pass EZEP HARDWARE_DESIGN_CALCULATIONS_MP�1 Mounting Plane Information Roofing Material -_ Comp Roof Roof Slope 44' Raf� t S',acin 71 k z.a ,r, Framing Type/Direction Y-Y Rafters PV System Type " _ 4 SolarCityy SleekMountTm A Zep System Type ZS Comp_ Standoff AttachmentHardware .; ,hu _ :.. Comp,Mount+SRV Spanning Vents No Wind Design Criteria Design Code IBC 2009 ASC_E 7-05 Wind Design Method Partially/Fully Enclosed'Method Basic Wind Speed V 110 mph Fig. 6-1 Exposure Category ' � � C� � �� Section 6.55.6.3 ,We—an Roof Hei ht ,. h b M Roof f Style � Gale Roof Fig.6-116/C/D-14A/B 15'ft r ' '"-'Section 6.2'r-' Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.85 Table 6-3 Topographic__Factor {*. a K� _ w ) 1".00 �' Section 6.5.__ Wind Directionality Factor Kd 0.85 Table 6-4 .Importance Factor 1 0 Table 6-1 Velocity Pressure qh qh=0.00256(Kz)(Kzt)(Kd)(VA 2)(1) Equation 6-15 22.4 psf Wind Pressure Ext. Pressure Coefficient U GCp(Up) -0.95 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GCp(Down) 0.88 Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh (GCp) Equation 6-22 Wind Pressure Up RUM -21.3 psf Wind Pressure bown down 19.6 psf �LLOINABLE'STANDOFF SPACINGS _ r X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Can_tilev_er Landscape 24" NA Standoff Confi uration Landscape Staggered Max Standoff Tributary Area a` Trib_ #' 17 sf PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at_Standoff T-actual 7 3461bs' Uplift Capacity of Standoff T-allow 548 Ibs v "m'^ Stand Demand/Ca acit - W DCR ItVia, - ° j X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever Portrait 20" NA Standoff Configuration Portrait Staggered Max Standoff TributarY Area• Trib 101 " 22 sf ' PV Assembly Dead Load W-PV 3.0 psf Net Wind U hft`at Standoff_'_ T-actual 432 Ibs --- p =-- ---- _ Uplift Capacity of Standoff T-allow 548 Ibs Sta d bemand/Ca acit . `7- - T ,�- Town of Barnstable *Perm4 ©Exp �s(� Re ulato Services Fee_Mont ro issu e - g rY • anxxsrnstL v rtnea Richard V.Scali,Director s639. 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 of Valid without Red X-Press Imprint Map/parcel Number Property Address (rat iz L// Residential Value of Work$_f IV,2 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /V-V Contractor's Name - h, �� Telephone Number 1/? -7 Z 6 C,`Z Home Improvement Contractor License#(if applicable) Email:= (5 9 (,tom hCA /Cf� Construction Supervisor's License#(if applicable) �'� 0 C) ❑Workman's Compensation Insurance0 Check one: ❑ I am a sole proprietor qq ❑ I am the Homeowner 9 4� I have Worker's Compensation Insurance ToW G015 Insurance Company Name L, /' 3 I % 3 /D l S ARNSTAB zJ ` c Workman's Comp.Policy# bty,4L�,GIi `c Copy of Insurance Compliance Certificate mat 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 Replacement Window oo /sliders.U-Value (maximum.32)#of windo s #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. ***NotAildingpe rty Owner must sign Property Owner Letter of Permission. y of t e ome Improvement Contractors License&Construction Supervisors License is red. i SIGNATURE:Q:\WPFII- \FORMorms\E)(PRESS.doc Revised 040215 l TTie ComrHorriveakh of Massachusetts Depart went o•f Industrial Accidents - - fI,/`nr ofInvestigadons 600 Washingion Street y Boston,CIA 0211I wiviv.niasmgovfdia Workers' Compensation Insurance Affidavit:BE ilder-JContractarslEIectriciansiP"lumbers Applicant Infbirmatian Please Print Le:Qibly Name(Busmes�l�rganizatianllndivi3nal}_ 1 L Z h l_ Address: < ,f1 . ✓ a City/sta-&Zip r Phone-41,,_ Are you an employer?Checlee appropriate box: Type of project(required)c' 1.p I am a employer with 4. I am a general contractor and I 6. ❑New construction.construction.employees(full arld(or part-time)-* have lured.the sub-contractors 2.❑ I am a sole propiietofr orpartner- listed on the attached sheet 7- ❑Remodeling slip and have no employees. These sub-contractors have 8. Demolition w o far me in an capacity- employees and bare workers' orktnb y9. Building addition INa Worifless'camp.inswmce comp.imuranci—1 required-] 5. ❑ We area corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or'additions m)%el£ [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required-]'s c.152,§1(4)�and we have no employees.[No workers' 13.0 Other comp.insurance required.] 'A¢y apptica that cbedabox AEl mast also fill out the sectionbelowshowing thee¢wo&ex'compensationpolicyinformation- Homeowners who submit this af5da%$[indicca mg they are doing all wa3[sad then hire outside contactors must suhuit a new off davit indx=mL-.such- rCoatactors Yhat rhea this boa must attsched as addimand sheet showing the name of the sub-camtactm and state whether or not those entities have employees.IftheSubtontsstneshace eoaployee%theymustpiuvide their workers'coup.policy number. I am our entpLg-er that is pronzdirrg it,orkers'courrpensaliruu iumira.uce for my*employ,e¢,s $eloty is the policy arrd jobs Sao inf orraation. Insurance Company Name: � • v Policy 44 ar Self-ins.Lic.is Jp/ (—_ 04L Expiratioa Date: Job Site.Address: LIV. City/StataZip: / a. Attach a copy of the worker 'compensationpolicy declaration page(showing the policy number.and expiration date). Failure to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a fine up to S1,50D:00 and for one-year imprisonment,as well as cisal penalties.im 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 verificaticm. I do hereby cerh r render the pains andpsnahfies 4,j`perjuiy that the infbrmati�orrprmztledabm�is true and correct Signature: Bate: Phone#: Offi iai use army. Do not ayrite in this area,to be coanpleted by city rartonrn offidat City or Town: PertmtUcense# Issuing Authority(circle one): 1.Board of Mal& 2.Building Department 3.(itytTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and lnstrnctions Massachusetts Geheaal Laws chapter 152 requires all employers to provide woikers'compensation for their employees. p to this saii,te,an.ewTIoyez is defined as."_.every person i a the service of another under any contact of hire, express or implied,oral or wriiirz_". An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged is a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trastee of an iadividag partn=hip,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 - dwel�house of mother who employs persons to do maintenance,constracti-on or repair work ou such dwelling house or on the grounds or budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(t7 also states that"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 in the comm o rwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage regnired." , Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor auy of its political subdivisions shall enter into any contract for the perfoumanco ofpublic work-until acceptable evidence of compliance with the i as rran ce._ requzir-enients of this chapter have been presented to the contracting authozity_" Applicants Please fill out the wodcers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)nane(s), address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability"Partnerships(LLP)with no employees other than the members or partners,ai a not required to catty woikers' compensation insurance. If an LLC or LLP does have employees,a policy is regna'ed. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or tnwn that the application for the permit or license is being requested,not the Department of hidulstrialAccidmts. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sore that the affidavit is complete and pried legibly. The Department has provided a space at the bottom of fire affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sine to fill in the pelmitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple p ennit/licens a applications m any given year,need only submit one affidavit indicating current policy inlf6rmation Cif necessary)axed under"job Site Address"the applicant should write"all loca Eon s i a (city or town)_"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for furore permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to.any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations wound like to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give ns a call. The Department's address,telephone and fax number. Tlhe f aMMM tth of Massachus-p-tts Department of hi&mtdal Accidents Office Of).Ve9dolio.= . ��-�ashin�tant T(lL 4 617-727-49OG"cxt 4-06 or 1-9977-MA.SSF Fax 9 617-727-774- Revised 4-24-07 W w x-masg-gavIdia ,per v/ie�omvrrzareFrsea�o��ccaacr.�cureCla \ Office of:66umer Affairs*Business;Regulation ME IMPROVEMENT CONTRACTOR e istration 9 165936 Type:. xpiration 4/9/2016 Private Corporatio: � Egg'CAPE A:ISLAND CONSTRUCTI:ONt,CO.INC. -� JOSHUA"KOURl " 55 ELM'AUE. HYANNIS,MA.0260.1 Undersecretary 3c s:. Massachusetts -Department of Public Safety Board of Building Regulations and Standards .. Construction Supervisor License: CS-074660 JOSHUA X KOUR PO BOX 210 M MIMI CENTERVELLE VIA "LA Expiration Commissioner 02/12/2017 License or registration yalidlor individul:use only before!tt etexp►rat►omdate. If found,retu`rnto: Office of Co:nsumer;Affairs•an&4usiness:Aegulation 10!Park Plazaf-Suite:5170 Boston,lV"A 02116 v �d,' l o signature Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. !, i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS licensing information visit: www.Mass.Gov/DPS 5/8/2015 10:58:25 AM PST (GMT-8) FROM: 100005-TO: 15087756688 Page: 4 of 18 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 5/8/2015 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 endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME: 44 BARNSTABLE ROAD PHONE FAx PO BOX 250 c il' A>c N°: HYANNIS, MA02601 E-MAIL INSURERS AFFORDING COVERAGE - NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURERS: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURER C: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24610723 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. POLICY EXP TR TYPE OF INSURANCE IANSD DQL WVD POLICY NUMBER MM117DY EFFMM/DDrn YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR A R I rr e $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY DPRO ❑LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY _ MBINED SING E LI IT $ e accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR I CLAIMS-MADE AGGREGATE $ DED I J RETENTION $ A WORKERS COMPENSATION WC5-31 S-377540-015 5/7/2015 5/7/2016 / STATUTE ERH AND EMPLOYERS'LIABILITY ' ANY PROPRIETOR/PARTNERIEXECUTIVE Y� N/A E.L.EACH ACCIDENT $ 1 OOOOO OFFICER/MEMBER EXCLUDED. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!.LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 24610723 Anne Chandler 5/8/2015 1:54:54 PM (EDT) Page 1 of 1 LVVV oFWETatt Town of Barnstable *Permit# : Regulator Eree 6 nondisfo,,,i ,r y Services Fee • LAfiNSTABLE, y MASS. i639. ��� Thomas F. Geiler, Director lf0 Building Division Torn Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Off-ice: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax.- 508 790 6230 N01 Valid wilhoul Red X-Press Jmprinl `vlap/parcel Number Al/ 61 �o��G Prop `�pe�erty Address !� _X J esidential Value of Work j,�X aC Minimum fee of S35.00 for work under S6000.00 Owner's Name & Address �^ r .,niracror's Name � Telephone Number --T 3-1-3q--7 I ,:Olne Improvermnt Contractor License#(if applicable) %.(T onstruction Supervisor's License #(if applicable) —� _`w'orkrnari's Compensation Insurance Check one: X-PRESS PERMIT'�1 am a sole proprietor �C'II ❑ lam the Homeowner �l have Worker's Compensation Insurance JUL 11 2013 !surance Company Name an foc s-yz .;rkman's Comp. Policy tf ' .ARN vpy of Insurance Compliance Certificate must accompany each permit. niii Request (check box) ❑ Re root(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of root) ❑ Re-side Replacement Windows/doors/sliders. U-Value 3C� # of doors (maximum .44) # of windows tG( 1ti'hcrc requued. Issuance of this perrnit does not exempt compliance with other town depanmcm regulations,i.e.Historic,Co-nservation,etc. "':Vote: Property owner must sign Property Owner Letter of Permission. A copy Of'the Horne Improvement Contractors License & Construction Supervisors License is r wired. mCa5T IJeT ;O'URE: Jo�fi�� w LES1F0 MIS'ibui ing permit(grins\EXPRESS.doe The Commonwealth of Massachusetts l 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 Le ibl Name (Business/Organization/Individual): Address: EU �-'(tAolice- lk%_� City/State/Zip:Cp&renj(ir VIA 6gt(.3 )-- Phone #: 9--a -`c._5�7:;Q� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.® I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] of 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other�IP►�cj comp. insurance required.) li *Any applicant that checks box#I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. v Insurance Company Name: '�55erf AXt V_C4 tek-S � Policy #or Self-ins. Lic. #: tie- ocog)i0C)I 2=n� Expiration Date: 1_ Ikl Job Site Address: -o---- City/State/Zip: a a(d'Ji 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 S 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 her y certify der the pains and penalties of perjury that the information provided above is true and correct Si atur 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. rnntnrt Pprcnn• Phone#: Y Massachusetts Department of Public Safety Board of Building Regulations and Standards l� f nrn�ru»uurrtll�r ', u�,u,�,�*tea ( "n.IrucUnn tiulrcnr.m Office of Consumer Affairs&Business Regulation License CS-014007 as HOME IMPROVEMENT CONTRACTOR Y Reglstratlolf --`1011d Type: xpirationn: 6/2512014 Individual JOHN P DUNN E`�_,v r" / BOX 924180 MARIE JO HN P. DUNN Centerville MA 02632 John Dunn 80 MARIE ANN TERR. 05/25/2014 CENTERVILLE,MA 02632 Undersecretary i. >nunrssrUner I Unrestricted- Buildings of any use group which contain less than 35.000 cubic feet (991 rn`)of License or registration valid for individul use only enclosed space. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS N valid without signature 4. , f VEro ti Town of Barnstable o Regulatory Services qQ $ Thomas F. Geiler,Director D�E06 �\� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Off-ice: 508-862-403 8 Fax: 508-790-6230 Property OwierMust Complete and Sign This Section If Using A Builder I, , as Owner of the subject.property hereby authorize to act on m behalf, Y atfu - Y in all matters relative to work authorized by this building permit application for. (Address o Job) 1� Signature f Oler 6ate Print Name IfPropedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. _1 e16ar12�a � %v Asstsskr's office (lst floor): Z71 /� 6 o*THE o Assessor's map and lot number ( t board of Heelth (3rd floor): Sewage Permit number ... ....... ............�.,......• •'•Z �f-941�7 ' Z 33AHd9TABLE. i Engineering Department (3rd floor): / +oo NAM 9. A House number ........................... .. ......�.��...!�.......... �oNp Definitive Plan Approved by Planning Board ---------g -g.__._______19_ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only z TOWN OF BARNSTABLE BUILDING ANSPECTOR APPLICATION'FOR PERMIT TO .....S..�NS%RUeT ...................... TYPE OF CONSTRUCTION 5��F.. ........ .........r& ��..... ............................. ..... .................................... • is - � GG ......-•--•-.•..................................19..`. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for //a permit/according to the following information: ar Location h/� Wy..!/n/.��............................ ProposedUse ............................................. ..;.............1 ..............:..........:.................... Zoning District ............................................Fire District Name of Owner .�1�.�L.,^/8/Z3C�..........�...a(�..............Address .-.L..... ....����..�... Erv'C�d1C LC................ Name of, Builder �ji0./�-t� .......Address .... ,1.1 Name of Architect ............ ...................................:.............Address ....... Number of Rooms _..........:.....................:. Foundation (�UILCO d0A/C./CF'TE .......................... ...................... .......................................... Exte for ............. ...... ...Roofing f e >9 /z�E � SNC5"T�'0C-k_ Floors ............ ..... ........ ...... .............................. Interior .................................................................................... - cieatin /�.....:...: ,/ �S N g .....�-�4 .... 1.............................................Plumbing .........�....f•,�......... Fireplace ...........:..... ........................:.......................................Approximate Cost .................`I5•• ,..................... . ........ Area / . � S. Diagram of Lot and Building with Dimensions �/ — Fee ............................................. UN x �� ACE 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. '�'� W � - Name .... G ....... ...................... Construction Supervisor's License (.Do�S' ,GREENBRIER CORP. t �. L 4 • ,3 3121. 1 1 S for '. No ................. Permit for .......z........ . .Y............ Sin le FamilyDwelling N ............... ........ _ Location .....Lot.................r....4...GuY...Lane........... ¢ :'.............Hyannis........................................ ! Greenbrier Cor M - Owner ..........................................P. ". ................... Type of Construction' ....Frame _ ..................... ........ _ Plot ............................ Lot ................................ r Permit Granted . August 3:,.... .......19 89 Date of Inspection ....................................19 ` Date Completed .................. .................19 • a r J S A • t Fof ,+.',a,.;.a-... ':r..,:�r,e-+,w.La�.::!' :,.M^ .cr.".""r'G'}...'."'. 9`.f�'i'i" `...i.r.S'a::s+hrT7jl?'a.wr+f��Vrr. aAic`„'y4.:.c.;rt.d'R'v^'C'Z'T �ny�v,r.aay.+ ,U,p•q•�'5.' ^'„ Assessor's, office (1st floor): , v THE Assessor's map. and lot number ............................................ �oF rot♦ Bgrd of RealtH (3rd floor): Sewage Permit numberSa ....•..•...........•... O..... BlBd9TADLE. i Engineering Department (3rd floor): —) ^ ,a,rasa 1639- House number ........................... . ' ................ . �oo�O ypY a\ei, Q Definitive Plan Approved by Planning Board __________��____`_d_______------19_ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....!:.(4N..S%/�Ue% ...........!)W L fA%6/ .............. ............................................................................. TYPE OF CONSTRUCTION .........,....�J(r..`. AMID. i WOOD �lZ/J/W� .................................. ......... .....19......__ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i. GT /u .v F �+ l S Location �......_°!-*... i............ ................ .....�`'N�1............................................................................. Proposed Use 5J V�f "� !"``-1L ... .......................... .............. ............................................................................................................. ,r ZoningDistrict ...............�..`...... ............................................Fire District .............................................................................. Name of Owner 6,°.F �v�3KIl`h [ 61'1... V �' ...... .... ,✓d N1c�V1t LC Address ...:................ ......................................... Name of Builder ..5.4 r .....yj��«` .............. .............................................Address ... ...................................................................... Nameof Architect ..................................................................Address .........r.............................................:.. ........................ Number of Rooms ..................................................................Foundation ...1?0(../k'0) C On/CXrryTF [� ...................................................................... E X i E r I O r t�/n`S � /✓S'J�'�r� C���/� /Pa L � .................................../................................................Roofing ...................j................................................................ Floors C /9 le19 J V�rvl� C Interior ....... .14re- r/-'.o.C.i�................................................ o ................rA...............i.................................. Heating "=}.......A.......... (....... ..Q.s.........................Plumbing .........�.... � r . ................. .\J d ...Approximate Cost .................`..5. U'd Fireplace ............................................................................... o...........e................................ Area .......................................... Diagram of Lot and Building with Dimensions Fee (/N 1,V.I5{JC)9 �,+ . St/�ftiS 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. Name .....�........................ ................................. Construction Supervisor's License .uUi 3�7 GREENBRIER CORP. A=271-004-006 a?7/ No' ..33121.. Permit for ..1.z...Story............. Single Family Dwelling..,,,,,, Location .Lot #6 4 Gu Lane Hyannis . ................................................ Owner ...... reenbrier. Corp..................... Type of Construction ..Frame ................................ ............................................................................... Plot ............................ Lot ................................ Permit Gran`ed .., August 3, 19 89 Date of Inspection ............19 ........................ Date Completed ......................................19 h� � I � l Y• s Ii li itit II � II II � I � II I ®�® 0 it ® CD ® I I I Ii I MI[lVl _t— I II � I � I II � � II S I d �v i P II P ILL, Ell s rt I I r -i �--- - -7 I ' Il yN , I � MR i f I � II � I II I I iD II � i i i I � • I � I I a II I I N .. it 1 — ,1�-� N r, 4. i `t o 12 00 cr Ilk � COYY� -. \ 0 i I c � , �OT 161 e74 ' sF i o N 32 h m �U sz s-y �;zy o00 1 THIS PLAN IS NEITHER INTENDED 10. T �"C '�"fc DATE DEl10N By FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT (P MORTGAGE LOAN PURPOSES. - ,y i_+' it wsrs}84f i MASS. C. Y PAUL A. ,{ WALE I 440 JOB Na 1396' 1 CERTIFY THAT THE FOUNDATION LEVY SHOWN ON THIS PLAN IS LOCHNo, 10517 ON THE GRO0QAS INDICA D ��1ST��k ;Z IVY, 111mm & Tim e39 113 K DATE REGI TE/ ED LAND SURVEYO eav vm um mm. s oxea� t 7 T � I i 7 / T- O ` s To w 5 r r INMAL ISSUELOT t NO, DATE DESCRIPTION BY OF SCALE: _ 4 0+ - JOB N0. t 3 9� �>aUt A. i. LEVY, ELDREDGE & WAGIM ASSOC 4 Mlhm WOM a cmm FWM Lm SUMI S -- --------------- —__-- --- _ -- — ____-_ _ — _ 889 WEST FAIN STREET CENTER�II,LE Rk 02632