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Home My WebLink About0042 MARSH LANE �� ,� _ i I �'� � �' _ •_- .._ I i �� t ��. � � w-� �� I `, C'x TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map JPq Parcel Ivy Application # `7 S Health Division Date Issued H-7 16 Conservation Division Application Fee i Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board d Historic - OKH 0 _ Preservation / Hyannis - �` Project Street Address � A E_ h Village an 15 Owner I-1 C-t.4- 0 Address e Telephone O S a> k C Co a Permit Request A&)\_ ,'(S c -f, `vim ff^^ ) � � I l Crx-Y�� L ' � � � i () k32• L Q (� O-C) O 1�"Gy�Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ''Total new Zoning District Flood Plain Groundwater Overlay L Project Valuation *, ~,AOD Construction Type Lot Size Grandfathered: ❑Yes AAo If yes, attach supporting documentation. Dwelling Type: Single Family ,;_ Two Family ❑ Multi-Family (# units) Age of Existing Structure 9 to Historic House: ❑Yes 2(-No On Old King's Highway: ❑Yes )kNo 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 s- 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 AJ B- Central Air: ❑Yes ❑ No Fireplaces: Existing ALA New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new sizPo-ol: ❑ existing ❑ new siz Barn: Dexisting ..❑ news}size_ Attached garage: ❑ existing ❑ new siz�r��l Shed: ❑ existing ❑ new siz Other: �3 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 4-No If yes, site plan review# '- Current Use ��G�ee-� e,, Proposed Use w� - - - APPLICANT INFORMATION-- (BUILDER OR HOMEOWNER) Name (i drA+- 0 ► ��Sevl Telephone Number 62't qD Address G r License # Cs- I 0 f S L J V►v1� C"b b Home Improvement Contractor# Email (2 e_1AS'\-r-AV\ k,Li z CU", Worker's Compensation # ALL CON RUCTION DEBRIS RESULTING ROM THIS PROJECT WILL BETAKEN TO CI �►�`�� - 1 -a SIG NATURE DATE_lq&, �� to 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 h j n DATE CLOSED OUT ASSOCIATION PLAN NO. 11ova of flume 469,44t4os $Ad sttrntarcts *¢oesp C6408616` JASON.PATRY 3.21 SnWART DRI . A VE Abington MA 02�S1 :,..., 02/08/2016. -- OMte of Counmer Afbin&0osiae S RegallUoa "HOME IMPROVEMENT CONTRACTOR + Rogtstretlon: 168P2 Typo7�7 Ertpira8on: 3WO17 SuppSemeal C " SOLAR CITY CORPORATION JASON PATRY 24 ST MARTIN STREET BL0 2UNI IiAko0ROUGH;MA 01752 U mkrmretery X/ J � T(s Lfinzoes(Negulation Office of Consumer Affairs d 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home'Improvement.Contractor Registration. Registration: . 168572 Type: Supplement Card . SOLAR CITY CORPORATION # Expiration: 3/8/2017 CHERYL GRUENSTERN - - --- -- 24 ST MARTIN STREET BLD 2UNIT 11 MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. SCA i t, 20-1;;a1!?. i Address' `.. Renewal i ; Employment �_`? Lost Card o,,. �ltr' f�rr.Nr.IY'JijJ"tY/l�fJ g/'_f(�i_..�Ys 1rU.�.•�%. : ,.. -. - . ' rrt- mce of Consumer Affairs&Business Regulation License or registration valid for individul use only � � t"t -i H2OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' v-N, Office of Consumer Affairs and Business Regulation T` " Registration: 168572 Type: 10 Park Plaza-Suite 5170 Expiration: 3/8/2017 Supplement Card Boston,MA 02116 SOLAR CITY CORPORATION . CHERYL GRUENSTERN v 3055 CLEARVIEW WAY - � C7 SAN MATEO,CA 94402 Undersecretary -Not valid without signature The-CommonweaXth of Mas=ckjaefts Department o,f Ihdustrial Aceldens 1 Congress Street,Suite 100 Boston,MA 02114 2017 www mas&gov/dia Workers'Compensation Insurance AfI'idsvnt:Builders/ConfraeEorslEleetriclaas/PEumhers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apg[ie ant Information Please Print Legt'biy Natrte(BusinmelOr'gunbmrmitftndividuat): '"MCity Corporation Address: S055 Clearview Way , City/State/Zip: San AI!<-tteo,CA 94462 Phone#: (888)765-2489 Are you an caplaW.Check the r p"date box: Type of project(required): 1.01 am a empla)v with 15AMO c"loycas(roll anafor paa4irae).* .7. ❑New construction 2.[]1 am a sale proprietor or partnership and have no auployexs tvodd-ing for arc in 8. ❑Remodeling any capacity.[No workm'comp.i uarmcc regu'teod.] 3.�1 arnalmmeostncretaitrgall wok myscIC jNuvsorkers'rnttrp,insuranoerequin:d.i t S• 0 Demolition 4.[]l am a huc onowaer and will be hiths rxmtroaWrs to conduct all work on my properly. 1 will 10[]Building addition ensam that all cmdtactods oitltcr have workers.'compensation insurance or are sole I I.❑Etech ieat mpairs or additions proprictorg With no CnIF oye:e¢. 12.Q Plumbing repairs or additions 501 am a generaal•cantdactor and l have hired She sutYcontractom lhsaed on the attached sled. 13.❑Roof repairs These gab-conuactors have employees and leave potters'comp.ursumaoo. G.O We are a corporation and it3 officers have cxcraised their right of e:xaarplioa per MOI,c. 14.0Other solar panels 152,§1(4h and we have noemployces,[No wort ors'eon,iusarauce"quited.l *Any appliml that cheeks box/if mast also till out the v. xtiou below showing.their workers'compensaaitut policy information. r 1 Eomeownets ivho submit Ibis allldsvii indicating titcy arc doing all work and then hire outside.contractors must sabmita nrw ailidavit indicating sucit tConvacton that check this box num attached an additional sheet showing the mate of tie sub-contractors and state whdler or not those eaddes frays craployM. 1f the%V b-mrttdtctots have corpdoyacs,lhay mast provide their workers'cramp.policy ounter. 1 ant an employe that is providing workers'Corltperlsgtion lnsrrreirnce jinn my employees. Rdow is the pe6y uad job site irrjormatiwt: Insurance Company Name:American Zurich Insurance Company Policy#or Self ins.l ic.#: WC0182015-00 Expiration Date. 9/.1/2015 Jab Site Ae1dr 9s: 42 Marsh Lane dress: yannis,MA 02601 Attach s copy of the workers'compensation.policy deelamdon page(skowing the pocky number and expiration date). Failure to socu re coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 anchor one:year imprisonment,as well as civil penalties in the feria of STOP WORK ORDER and a fine of up to S250.00 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 iFereby eerie wetter the pains and penefties of perjury theft the Pirjormadon propided above is true vird correct. ason.Patr D March 24 2016 PP one QTk&1 use only. Do not write in lies et wo,fe be compieted by city or rave gp'07daL City or Town: Peryuit/License Issuing Apthority(cirte one): 1.hoard of HeaiHn L Building Department 3.City/Town Cleric 4.Electrical Inspector I Plumbing Inspector 6.Utber i Contact Person: Pihone#: AC RL7� � � - DATtrIMMmemmry CERTIFICATE OF LIABILITY INSURANCE 0807 015 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 pmioy(les)must he endorsed. If SUBROGATION 15 WANED,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 Hau of such endo►sement(s). CONTACT MARSH ISK&INSURANCE SERVICES 346 CALFORNR STREET,SUITE 1300 rocNE :r x►a 1i NnY CALIFORNIA LICENSE NO.0437153 E4AAIL SANFRA ICISCO,CA 941D4 Atim Shannon Scott 415-743-8334 IN91/RER S AFFOftwNO COVERABE _ NAlcw _998301-STND-GMVUE-15-16 — INSURER A:Ztlrt h AffWdCan lnsUrdnce CDmpany _ 116535 INSURED INSURER B NIA NIA SandrCity Corporation 3065 OwMew Way INSURER c:NIA tF 1A -- San Mateo,CA 54402' American Zunc—h l.n_sea..nc Company a-nYINSURER 0142 INSURER S INSURER F: COVERAGES CERTIFICATE NUMBER: SEA•00271383B-08. REVISION NUMBER:4 THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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. 11.19'.__ !AODLTSU81i .. ....................... .:....... .... --06LICYEFF POLIGYEXP — = : TYPE OF INSURANCE I ¢ ICY NU FA fMMw1YYYYI IMMID-11—ffmiLIMIT'S A X commFRCIAL GENERAL LIABILITY GLOO182016-00 09)0112015 10910112016 EACH OCCURRENCE $ 3,000,000 _ DAMAGE RENTED ._..... ........_ .... F. .IL. ICLAIMS41ADE nOCCUR - - _ rREN�SE$.SEB.R£.P.4!�!C?,}.. S .__ 3DDD.0 . X ISIR 1250,000 1 MEDEXP(AnY9ns.personl... §. 5,000 . ....._._..,.. ..-. . .. __.... _._..: PERSONAL&ADVINJURY S 3,Wa00,000 GEN'L AGGREGATE LIMIT APPLIES PER. 4 - - ,; _GENERAL AGGREGATE $ 61000,000 xq POLICY f ] LOC PRODUCTS-COMPIOP AGG S 6,000.000 PRO- OTHER. S A AUrowomi.EuARILITY IBAP0162017.00 09)O12015 09101120% COMBINED SINGLE LIMIT 5 S,0 O= ALL OWNED SCHEDULED I E BODILY INJURY(Per a son) S - x_. AUTOS X AUTOS l BODILY INJURY(Per ecadent) S X X �'O'�� 1 j PROPERLY DAMAGE S . HIRED AUTOS AUTON S COMPICOLL DED 5 $5,000 UMBRELLA LfAO OCCUR _- ! EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE i y AGGREGATE ..: S._ ..._.. ... ......._ O- i RETENTIONS D WORKERS COMPENSATION jWC0182014-D0(A(M 09ID1015 109101R016 XIPER :-ER AND TA UTE_ -ER A Y 1 N WC0182015-DO MA 09f0112015 09101120A pNYPROPRIETOR7PAR7NERlEXECUTIUE ( � - E.l_EACHACCIDENT- &�. 1,DDD,600 O"MERRAEMBEREXCLUDED9, 1T1Aj ' —.__. _.....- ............. (Mandatory In N►) WC DEDUCTIBLE$500,OD0 E L.DISEASE EA EMPLOYE S 1,000,000 If(yyeeaa desaihe under l — _.... i,DtiD,Dao 'DESCRIPTIONO OPE1tA710NShelaw E.L.DISEASE-POLIGYlJMI7 S: t DESCRUKION OF OPERATIONS!LOCATIONS/VEHICLES IACORD f0f,Additional Remarks Schedule,may he at6uhod If mace space I&requiredl Evidence of insurance. CERTIFICATE HOLDER _ CANCELLATION SdarUy Corpmatron SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE 3055CtmNedWay THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN San Mateo,CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. + AUTHORIZED REPRESENTATIVE of brash Risk&Insurance Services I Charles lMaratolejo 01980-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Version*54.7-TBD ;SolarCot G'p a c. March 3, 2016I' RE: CERTIFICATION LETTERAWS Project/Job#0262736 Fl+m Project Address: Cook Residence979 42 Marsh Ln HYANNIS, MA 02601 c ,� ii$Tr'' � ,r•�.a AHJ Barnstable SC Office Cape Cod 4r /� Design Criteria: -Applicable Codes= MA Res.Code, 8th Edition,ASCE 7-05,and 2005 NDS - Risk Category = II -Wind Speed = 110 mph, Exposure Category C -Ground Snow Load = 30 psf - MPI: Roof DL= 11.5 psf, Roof LL/SL= 20.1 psf(Non-PV Areas), Roof LL/SL= 10.8 psf(PV Areas) 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 SolarCity. 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. Sincerely, Marcus Hann, P.E. Professional Engineer Digitally signed by Marcus Hann T: 888.765.2489 Date:2016.03.03 17:39:59-05'00' , email: mhann@solarcity.com 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AZ ROC 24,1771,CA CSl B 6R8104,CO EC R041.CT HIG 063277fl.CG i itC 71 i014R6,DC H15 71101488,Hl CT29i 70.MAA HIC 168872.MD tAH1C 128948,NJ MM06180600• OR CC8 IPP493.PA 077343,TX TDLR 270M WA 9Cl SOLARC'91907 0 2013 Saa,O.ty.Ah❑Ohts resermd. Version#54.7-TBD �o� SolarC�t y HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES Landscape Hardware-Landscape Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever . Configuration Uplift DCR MP1 64" 24" 39" NA Staggered 77.3% Portrait Hardware;-Portrait Modules'Standoff Specifications Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR MP1 48" 17" 65" NA Staggered 96.4% Structure Mounting Plane Framing Qualification Results Type Spacing Pitch Member Evaluation Results MPl Stick Frame @ 16 in.O.C. 390 Member Impact Check OK Refer to the submitted drawings for details of information collected during a site survey. All member analysis and/or evaluation is based on framing information gathered on site.The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC. w 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AZ ROC 243771,CA CSLS 8F38104.00 EC 8Q•11,CT H1C 0=778,0O HIC 71101466,DC F11S 711a1588,HI CT-29770,MA HIC 188572,MD MHIC 128�)48,NJ 13M.'618Gtioo, OF OCS 180498,PA 077343,"rx TDL.P.27oo6,wA GCL:SOLAAC491aal.0 2013 Sola,0ty..All rights reserved.. 1 TRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK- MP1 Member Properties Summary MPi Horizontal Member Spans Rafter Pro erties Overhang 0.66 ft Actual W 1.50" Roof System Properties San 1 9.73`ft Actual D 7.25" Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof San 3 A 10.88 in.A2 Re-Roof No Span 4 S. 13.14 in.A3 Plywood Sheathing E :-No. .,Span S .. _ I°u'a.x 47.63 in.A4 Board Sheathing Solid-Sheathing Total Rake Span 13.37 ft TL Defl'n Limit 120< Vaulted CeilingNo' PV,1 Start 150 ft Wood Species SPF Ceiling Finish 1/2"Gypsum Board PV 1 End 12.50 ft Wood Grade #2 Rafter Slope 390 , PV 2 Start - Fb 875 psi Rafter Spacing 16"O.C. PV 2 End F,, 135 psi Top Lat Bracing Full PV 3 Start E 1400000 psi Bot Lat Bracing At Supports PV 3 End Emi„ 510000 psi Member Loading mary Roof Pitch 10 12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 11.5 psf x 1.29 14.8 psf 14.8 psf PV Dead Load PV-DL 3.0 psf z 1.29 3.9 psf Roof Live Load RLL 20.0 psf' x 0.73 14.5 psf Live/Snow Load ` .:,_ LL SLl'2. 30.0 sf x 0.67't,j x 0.36 20.1 psf', 10.8 psf Total Load(Governing LC TL 34.9 psf 29.5 psf Notes: 1. ps=Cs*pf; Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Cj(Ct)(IS)pg; Ce=0.9,Ct=1.1,I,=1.0 " Member Design Summa (per NDS Governing Load Comb CD CL + CL - CIF Cr D+ S 1.15 1.00 10.49 1.2 1.15 Member Anal sis Results Summary, Governing Analysis Pre-PV Demand _PVDemandj Net Im act Result Gravity Loading Check 499 psi 418 psi 0.84 Pass [C.ALCUI:ATION_OFDESIGN WIND LOADS=MP1 �'�1 ' Mounting Plane Information Roofing MaterialComp Roof - PV System.Type- - _ � _ °_ '` SolarCity SleekMount " __ Spanning Vents No Standoff Attachment Hardware - Comp Mount Type C Roof Slope 390 Rafter_Spacing.. _16 O.C. FramingType Direction P _ Y-Y Rafters PurlinSpacng. . - - -_ XX.Purins,OnlY. Tile Reveal Tile Roofs Only NA Tile Attachment S stem Tile Roofs Only_, Y_ __�...a_._. __ Standin seam/Trap seam/Trap S acin q SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 � __—.. _ _ __.._ - --. — _-__ — Wind Design,Method, ,� •_ _ Partially/Fully_Enclosed Method �� Basic Wind Speed V 110 mph Fig. 6-1 Exposure CategorY___w_ " C Section 6.5.6.3 Roof Style Y,-.. Gable Roof Fig.6-11B/C/D-14A/B Mean Roof Hei ht o, Wind Pressure Calculation Coefficients Wind Pressure Exposure-. KZ 0.95 . Table 6-3 Topographic Factor K �� 1.00 Section 6.5.7 Wind Directionali Factor Kd 0.85 Table 6-4 Importance Factor - I 1:0 _ z Table 6-1 Velocity Pressure qh qh=0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15. 24.9 psf Wind Pressure Ext. Pressure Coefficient U GC -0.95 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GC Down 0.88 Fig.6-11B/C/D-14A/B Design Wind Pressure p p =qh(GC) Equation 6-22 Wind Pressure U -23.7 psf Wind Pressure Down 21.8 psf ALLOWABLE STANDOFF SPACINGS___ X-Direction Y-Direction Max Allowable Standoff Spacing —Landscape _ 64" _- _ 39" Max Allowable Cantilever- _ —_Landscapes � 24'` NA_ Standoff Confi uration Landscape Staggered Max,Standoff TributaryArea --_ _ Trib -- - 17sf., . PV Assembly Dead Load W-PV 3.0 psf Net Wmd,Uplift at..Standoff ,. T actual_ :r ,; - - 387 Ibs . - - ° Uplift Capacity of Standoff T-allow 500 Ibs Standoff Demand Ca ba city = DCR. 7!7o_,.:N 77.3% F " '. X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" ____ _ 65" Max Allowable.Cantilever __ _Portreit�. r- 17" --NA�L_ Standoff Confi uration Portrait Staggered Max Standoff Tributary,Area .. Trib �� µ22 sf PV Assembly Dead Load WPV - 3.0 psf Net Wind�Uplift _t_Standoff T actual Uplift Capacity of Standoff T-allow 500 Ibs St doff Demand Ca aci :DCR I _ %TNMAU .. �»»J{{{[+++J��,u�}`p`(A�{}'�/'1�.gf'..'p\Ny7 job MD: �.(flZ-lam 2 J4 a D r,C.r CC)o k(- as Omer offis subjw pa®pery bghdt 6n dR EMMUns,ralaSTO to wo&w&vsked by Was bala ng pmmd2 a ffic u®m wd s*gmed fir `a- 3—Z-( y ' siv : Daft. G ofomm t:G 3 C+�1S "'--. .r •F•.. ='ti:'.�.3«u St7�r+r:v-::�.�i�.u� M•-\rw •f4Ctti1.�-•�� '�4�i:'�wf•Y}'��. '1 Zw«i•w:•':iti'.wc •�.�•�'.� ' r:�i:�t�i r�.".�hi h�ii'r�'�•if.��.'�Ml��:- i S::•'. i .�'i^i�•i��f: '-ti.• • .n• + ' �•: Epgineering Dept.(3rd floor) Map 1`� Parcel D E, ermit# r� House# ZZ _fA6-Date Issued _ �'�02 —R'_ Board of Health(3rd floor)(8:15 -9.30/1:00-4:30) Fee o .1b(rA ' Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) THE ID , Ian Approved by Planning Board 19 - ' � BARNSTARLE. TOWN OF BARNSTABLE Building Permit Application reet Address- e -C)L( - LeTS --12 13� J 4 Village % 1J Owner PIS. COOK- . dress q z M Ies k L Ii Telephone Permit Request I-E)67 it" 4 F_C,4-B 01-- 4� dew- First Floor square feet Second Floor �J� square feet Construction Type oyD a-t8 Estimated Project Cost $ 0019 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family `� Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes Wo On Old King's Highway ❑Yes 5Wo Basement Type: 01"Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use �C C. Builder Information Name. �d1q �' RC' Telephone Numbers Address License# e s, o5z5/ 17 VIA • M ILLS rh A Home Improvement Contractor# l 7E�,Z Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO El C C. SIGNATURE DATE BUILDING PERMIT DENIED F THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE rJ OWNER r .h DATE OF INSPECTION: ! r _ FOUNDATION FRAME J INSULATION ¢ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ' FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonli'ctrltlt of.4fassachuscIA ' Dc�part»rent of Industrial • z `1_ .� � !� Oflic�allayestfgatlons �•��ji;ii __�;:+` h00 !1'ashiag;tna Street `, �•. j �u�:c.•` Bt)wt) .Man. 03111 Workers' Compensation Insurance Affidavit _ - �PPIIC ITIt rnitirmatitin• P1cise PRINT ieblily a earl n• 1327 ,. hnn• 5 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity r I am an empiover providing workers compensation.for my employees working on this job. a t � cnmvani, n• nte- •tddrecc• city nhnnc 1!• incnr�ncc cn Holley# 7 I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed beiow who nz the following workers' compensation polices: cmmn•tnt• n•ttne, adtiresc• cin nhnnc 0, incurnnrr rn Holley t! _ _ cnm nn%• natnt^ addrecc rin~ nhnnc it• nniic�•>3 incor•tncc co -Attach additional sheet if neces_saty ,_,;;,�;�,_� '<-".'�::L'• „=�' ' ""�—' �_.,._:_. ^ ..... .; ...�..-.^:awe: ...�.a.��. Failure insecure coverage as required under Section:SA of NIGL 152 can lead to the imposition of criminal penalties of a lineup to S1.500.00 andiu; unc cars' imprisonment as well as civil penalties in the fo of a STOP NVORK ORDER and a fine of S100.00 a dad•against me. 1 understand that cope Of this.statemen r t ma% be forwarded to the Once In stigations of the DIA for coverage verification. 1 do herehr cerrift•tattle th• s a e • 'art•drat the information provided above is true ut d co ect. Signature Date, Print name �/ l�P Phone 0 f �f w — ' official use only do not write in this area to fie completed b� cin or town official City or tmwn: permitilicense d R1luiiding Department C ❑Licensing Board t C] ►_ check if imtncdiatc response is required ❑Seicetmcn s Ufficc ❑ticaith Department ` k phone 0- contact person: r—tUther aniurrrraaacin gnu ltin�rr uciacanti - - Massachusetts General Laws chapter 152 section 25 requires all emplovcrs to provide workers' compensation for their employees. ..A:s quoted from the "law". an etnpt(�rec is defined as every person in the service of another under any contract of hiri;_express or implied. oral or written. An emph rer is defined as an individual. partnership, association. corporation or other legal entity. or anv two or more . the forcgoina cnuaucd 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 house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or oil tlt: :_rcunds or building appurtenant thereto shall not because of such employment be deemed to be an employer. v1GL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or -en01:a1 of a license or permit to operate a business or to construct buildings in the commonwealth for any ipplicant who has not produced acceptable evidence of compliance with the insurance coverage required. %dditionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for tite �erformanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha :een presented to the contracting authority. .pplicants !ease fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and ipph•in�_ company names. address and phone numbers as all affidavits may be submitted to the Department of :dustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The -tidovit should be returned to the citN' or town that tite application for tite permit or license is being requested. :)t the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required obtain a workers' compensation, policy. please call the Department at the number listed below. try or Towns :ase be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fall out in the event the Office of Investigations has to contact you regarding the applicant. Pleas sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless other arrangements have been made. e Office of Ittvesti=atiotts would like to thank you in advance for you cooperation and should you have an questions. :ase do not hesitate to aive us a call. - e Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents r r Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (6I7) 727-7749 phone ;r: (6I7) 727-4900 ext. 406, 409 or 375 I /ie 'C�ar�ii�w�zruea.�t a�../�avoaclucoeC�i I - , Restricted To: _G - - DEPARMENT 4F PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE �. 00 - None : .5 6 7.6 9 Nu©beT Expires: 1G'- 1 & 2 Fim ly a,a r Pelt+ trpa Ta` "1G F2ilure to possess a current edition of the { £ Massachusetts State Buiilding Code { S d OROURKE 'cause.ter revocation of this license. (kPST^P+S MI,'S, MA 02618 • k .. «{fit b2� y,a1V s, e dti`' �.-,�' Sf�, w '• .^` 4�:� i tl '}!"I �, HOME'I MPROVEMEN.T;,CONTRACTOR c T �'-�Regtstr.ation.',� 100032 :' ,i ' ExplTatlon .} ,� 'ROURKE-BUILDING CO r:' ° z ..:-A nomas J O'Rourke ADMINISTRATOR Q�ox 602/261o.veL n x� , arstons Mills MA 02648 ' ` � Ve W The Town of Barnstable Department of Health Safety and Environmental Services BuiIding Division 367 Main Street,Hyannis MA 02601 Office_: 508-790-6227 Ralph Crossen Fax:. 508-790-6230 BuiIding Commi: For office use only Permit no.�_ Date _ AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: �� Est. Cost l> Address of Work: Owner's Name Date of Permit Application: l I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. BuiIding not owner-occupied Owner pulling own permit • Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I here y ap ly for a permit as the agent of t �V 1D-0:3Z- Date Contractor Name Registration No. CAPE COD INSULATION [j7 111IA OA71A33 OUTTIEAM L 37 SPRAY$ULATIOFOAM SCOILIN010 IAli3 OU11147 INf Ul A110N CIIlIN07 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 sg /Date: 2/r�' � t-n I Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, iic. perfornie completed the insulation and weatherization work at the property listed below. CWapeml Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village OR/,44 �QOK- 7 A1.4. r,11 /t a4x AlY.a,1n1r Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) FPqr0,e,4je01 Sincerely VryHE ssi r, President Ins ation, Inc. f I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- y I Parcel I y� Application '1 0 Health Division Date Issued P Conservation Division Application Fee Planning Dept. Permit Fee�'�•V V Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Streel Address YL DUl L� Village Owner �N(M�O r e Address Telephone Per it Request 4 ' h w riv 1(1 / 6v Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater O erlay Project Valuation J ° V 1' Construction Typem Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supo &ta'u entation. . ®�, ' IA Dwelling Type: Single Family Two Family ❑ Multi-Family (# Age of Existing Structure Historic House: ❑Yes ❑ No On Old Fng'9,% hway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) . Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ 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 o If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name , Telephone Number ! (•� Address �� License# Db Home Improvement Contractor# F Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PR JEC WILL BE TAKEN TO 4 SIGNATURE 6ADATE �r ` FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION F FRAME 4 INSULATION � s FIREPLACE '. ELECTRICAL: ROUGH FINAL mr i PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL t i FINAL BUILDING DATE-CLOSED OUT ASSOCIATION PLAN NO. w Ulassach�usetts:Department o.f Public"Safety rBoard of Building Regulatrons;and,Standards ^�^.�,e^a License• Cs-100988 y ,tru,ction •SLIpel\iisci`r: - A I l: ' v N HENRY E CASSIDY, 8 SHED ROW rTe r`s ��\� y a• # WEST YARMOU`<H.t>��1i 5 Expf:ration; �n` k 4. missioner Commissioner. 11/11I2015. rlr,r Offide'of Consumer:Affatrs.and Business,Regulation . 10 Par1c Plaza '`Suite 5170. Bostan mWachuseM'02116 ` Home Improv-ement'Cor��tlactor Regist'ration : Registration, 153567. Type; -Private Corporation "fl^ , r Explratlon: 12/15/2016 Tru 259788. CA REC0D'INS`U•l' R,TION INC w +. ► I HENRY CASSIDY ( ' ' 18"REARDON CIRCLE / I " 8 YARMOUTH,MAQ2664 `Update Address'and return card, Mark reason for chaligc, t Address 0 R'enewal D-Employment �� Lost C'ni _ SCA I .i 20M•OSII I °V/i2 (p001Y4t209ZdUaCIGL�P��CGJO�FO�G6JC�d ' e ...... .. _ Office of Consumer Affairs&'f3uslness Regulatlon License or reglstratlon valid for Indivldul use only` ITOME IMPROVEMENT CONTRACTOR. before the sxplyaflon dAte, If found return to, eglstratlon: 153567 Type: Office of�C'Qnsumer Affairs and Business Regula6lon j xplrallon :, 1�I15�2Q;p6 Private Corporallori 10 Park Plaza Suite$170 Boston,MA 021`16 CAPE COD INSUlA1'It7N HENRY CASSIDY : I REARDO,N CIRCLE;',,.' i SO. YARMOUTH,MA 02664 Undetsec-etar y N walld wi tit sign e - l he coMmoinvealth of Massachusetts Department=of Industrial Accidents 'j Office of Investigations 6.00 Washington Street ' Boston, MA 02111 >> www,mass,gov/dia Workers' Compensation.Insura'nee Affidavit: Builders/ContractorslElectricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual); (�f l Address; City/State/Zip; �, �t��4� t�; L�b ll' Phone #; Are you an employer? Check th appropriate box;` l. ,1 am a employer with 4, [] 1 am a general contractor and 1 Type of project (required): employees(full and/or part-time).* have hired the sub-contract 6. New construction p ) ors 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. [] Remodeling ship and have no employees These sub-contractors have ❑ working for me in any capacity, employees and have workers'. 8. Demolition [No workers' comp, insurance comp, insurance,$ 9• ❑ Building-addition required,) 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3,❑ 1 am a homeowner doing all work officers have exercised their l l.[] Plumbing repairs or additions myself, [No workers' comp, right'of exemption per MGL insurance required.) t c. 152, §l(4), and we. have no 12,❑ Roof repairs employees, [No workers' 1'3, Other COMP,,insurance required,] *Any applicant that checks box HI 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 attaphed an additional sheet showing the name of the sub-contractors and state;whether or not those entities have employees. If the subcontractors have employees,they must provide their workers' comp, policy number. I am an employer that is providing workers compensatio 4nfo.rmation, n insurance for my employees, _Below is the policy and job site Insurance Company Name; Policy 9 or Self-ins, Lic, #; g �el�' N Expiration Date:_I � ! �� Job Site Address: f1twiveA City/State/Zip ; Cj Attach a copy of the workers' compensation policy declaration page (showing the,policynu er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 candead to the imposition of criminal penalties of a Fine up to $1,500,00 and/or one-year i)rtprisonment, 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 insura coverage verification, I do-hereby certify d the pat an penalties of perjury thatthe information provided above is rue and correct, S i nature; 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, plum Inspector, 6. Other Contact Person; nr, ,.,A �• CAPECOD-27 BDELAWRENCE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 6/30/2015 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(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(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency, Inc, HAJ E a AX N01 (g77)816.2156 434 Rte 134 E-MAIL South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:ATLANTIC CHARTER INSURANCE GROUP . Cape Cod Insulation,Inc, INSURERC: 18 Reardon Circle INSURER D South Yarmouth,MA 02664 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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 B POLICY NUMBER MM/ODY� MM/DD�YY LIMITS' A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000, CLAIMS-MADE FKIOCCUR CBP8263063 04101/2015 0410112016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES RER: GENERAL AGGREGATE $PRO- 2,000,000 X POLICY 0 ECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS LIAB CLAIMS-MADE AGGREGATE $ OED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WCE00431901 _ - 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Insulation,Inc 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ® arn. m, TO c e s �.�b�� utt�+di�g 3Di�siun Tom�e�rrynildig Comrm�rssiq�ner 'Office SD�8�62�F03'8 ` Fax. so�'T90-6230: • ��►' ex�� :t is . i .all:matters rely veto wrs 'auflxou ed bytes ;pe Vpluatiion`for • d�e5s _ .g.P 1peaces ana,ilt= �nsp ctions amp e 'Pat M. of 1'►p}ilicatt Date-' gFoRmgto f Town of Barnstable Regulatory Services BARNsrABMMASS ' Thomas F. Geiler,Director lE1639. Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 July 10, 2007 Mr. Briar Cook 42 Marsh Lane Hyannis Ma. 02601 Dear Mr. Cook, Enclosed please find a copy of an affidavit. You need to use this format. Please make sure add all the language highlighted in yellow. Call me with any questions. Regards, Linda Edson IME l "o Town of Barnstable BAMSTnaLE. + MASS. Regulatory Services �Ar i639• a,� Thomas F. Geiler,Director FD MA'S Building Division Thomas Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 September 20, 2007 Mr. Briar Cook 42 Marsh Lane Hyannis, MA 01601 Illegal Apartment: 42 Marsh Lane Hyannis, MA 02601 Map: 324 Parcel: 106 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish,to take. incer da Edson Amnesty Apartment Investigator E Building Department gforms:zoning3 b L �OF1HE ram, Town of Barnstable Regulatory Services k + BARNSTABLE, v MASS. Thomas F. Geiler,Director �AIEoMA�"�� Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 AMNESTY APARTMENT ELIGIBILITY VERIFICATION Re: th A.,P4 Ll Date d d After reviewing the street file of the above named property, I verify, to the best of my knowledge, that the apartment was in existence before January 1, 2000. This property is now eligible to apply for the Amnesty Program. Tom Perry Building Commissioner I AFFIDAVIT I W. Briar Cook,upon oath state as follows: I reside at 42 Marsh Lane, Hyannis,MA 02601 from 1997 to the present. The home was built for my father in 1939 and the family has occupied it since then. My wife and I purchased the home from my sister in 1997 in order to help take care of my mother. From 1997 until 2001 my wife and I occupied the second story of the house and my mother occupied the lower floor of the house. My mother passed away in 2002. The upper story has three rooms(one room is broken up into a living area with a small kitchen area and there are two bedrooms)plus a bathroom and a loft. There is a large deck off of the living area. The property is located at the end of a dead end street(although the local maps show that Marsh Lane goes from Gosnold Street through to Snows Creek) . We have room to park 6 cars within the property(though we do not have the need to do that). The property has town water and sewer and has 2.3 acres of land. The house next door is owned by my sister and is a good distance away. There are no children and no pets. The upper story has been inspected and approved by the health department. Signed under the pains and penalties of perjury this 29 th day of September 2007. ------ �-� --- --1�L`_ `f -------- Wi ss ,1 e�y,�j , Cc,�l( W. Briar Cook Briar& Shirley Cook 42 Marsh Lane Hyannis,MA 02601 508-790-5942 Dear Linda, In reference to your letter to us dated 20 September,2007 we would like to apply to the Amnesty Program. The enclosed Affadavit is written per your instructions. Please note that the house is 2500 square feet so overcrowding is not an issue since we have no children or pets residing at the house. Thanks for any consideration you can give us. Sincerely, Briar Cook NONE IMPROVEMENT CONTRKTOR Ro0istrotios 101014 _ Tpps PRIVATE CORPORATION E:Plntlos 06/24/9s CAPE CO NONE IMPROVEMENT SPE b rt A. Wsushlis ir,00uoh Rae MWWMATM Nrsssis NA 02601 - a r d ` � . i TAk f�w�wmoxu�alQ� ��. /1.,.,,..�,,,.✓i� OF.PARTNENT OF PU81IC SAFETY z'. CONSTRUCTION SUPERVISOR LICENSE N*er: Expires: Birthdate: "x I CS 111351 07/23/1999 17113/1941 Restricted To: 11 ROS(RT A NACIAUGHIIN 25 HARVARD ST S YAPNOIltH. NA 17661 l I , o GRANITE STATE INSURANCE COMPANY 13102 71109 SEND ConRasroNDv#"1-34-60 AMERICAN MUNATMAL CO. P.O.BOX 409 PAUMPANY, NJ 07034.0409 HOME IMPROVEMENT SPECIALISTS OF CAPE COD I NC PHONE: 1-800-645-2259 25 I YANOUGH ROAD Member 100171panies of HYANN I S MA 02601-0000 AmericarfTntemational Group EXECljr VE OFFICES: L0/ 70 PINE STREET, NEW VORK.N.Y. 10270 WORKERS COMPENSATION AND RROGERS .b GRAY INSURANCE AGENCY EMPLOYERS LIABILITY POLICY 0 BOX 1601 INFORMATION PAGE 434 ROUTE 134 SOUTH DENNIS MA o2660 INSURED IS CORPORATION fOTHER WORKPLACES NOT SHOWN ASOVE PREVMS��'NUMBER NEW POLICY PERIOD 12:01 AM.standard time at the Insmailing address A. Workers Com FROM 07/02/97 To 07/02/98 Penution Insuranq: Part One of the policy appliesto the Workers Comstates listed here: Pensation Law of thMAEmployers Liability Insuranq: Part Two of the 1The limits of our liabil under po icy applies to the work In each state listed In item 3.A. liability Pan Two are: Bodily Injury by Accident S 100 000 .aet:h accident Bodily Injury by Disease 8 S00 000 + Bodily Injury by Disease • 100 000� �Iky limit C. Other States Insurance: Part Three of the each employee SEE ENDORSEMENT WC 20 03 06A Policy applies to the states, If any, listed here: mm a The Premium for this policy will be determined by our Manuals of Rules, ClassHications, R , All information required below, Is subject to verification and change by audit. ates and Rating Plans, Classifications Estimated Total Rafe yet Estimated Code Number Remunvatl t1""TIP" .�fralnitMt The Town of Barnstable BARMAIM s 9 MASS. Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW ' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions, with other requirements. Type of Work: A:ut�to,r,-1 Est.Cost / I®o 0 Address of Work:- Owner's Name "V. tOt� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that:' OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c- 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. —6-g erz�. a �•v Date Contractor Napfie Registration No. OR Owner's Name � � � �� n� J Phrcel Detail Page 1 of 3 HE- _, .• . se p� y BARNSTAIIr F MO Logged In As: Parcel Detail Thursday, Septemb• Parcel Lookup Parcel info Parcel ID 324-106 I Developer Lot LOT14, Location 42 MARSH LANE I Pri Frontage 320 Sec Road Sec Frontage Village(HYANNIS T I Fire District I HYANNIS Sewer Acct 13329 I Road Index 0985 Interactive Map - Owner Info___ owner COOK, W BRIAR & SHIRLEY A I Co-owner Streetl 42 MARSH LN I Street2 �— City I HYANNIS I State MA j zip 02601 Country LS — - Land Info Acres�2.37 Use Single Fam MDL-01 I zoning RB Nghbd 0110 Topography Level I Road Paved Utilities JAII Public A Location Lake/Pond View Construction Info Building 1 of 1 Year 1939 —_-I Roof[Gable/Hip I Ext Wood Shingle I Built Struct. Wall Effect 2833 ^�Y+" Roof Asph/F GIs/Cmp I AC Central �I Area Cover Type Style Colonial--____:] wall[Drywall Rooms Be 4 Bedrooms Model Residential Int ---� - -- Bath r Floor! Rooms I2 Full Grade Average Plus Heat ` Total I Hot Water (6�Rooms g Type Rooms http://issgl2/intranet/propdata/PareelDetail.aspx?ID=26921 9/20/2007 Parcel Detail Page 2 of 3 8M[3'64] 8 6ko t �_ A'g WOK FG, OAS 19' 1R>1 :t2 1a K '26 24. Stories 12 Stories Heat Gas Found- Typical GAR FUS i5 `io A5 Fuel ation a� $ B i �4 05 26 Permit History_ Issue Date Purpose Permit# Amount Insp Date Comm 3/10/1998 New Addition 29329 $27,000 6/1/1999 12:00:00 AM 2/20/1998 Remodel &Addn 29028 $41,000 6/1/1999 12:00:00 AM - Visit History Date Who Purpose 3/28/2002 12:00:00 AM Paul Talbot Meas/Listed 6/3/1998 12:00:00 AM Lloyd Kurtz Meas/Listed Sales History Line Sale Date Owner Book/Page Sale P 1 1/23/1998 COOK, W BRIAR&SHIRLEY A C147280 2 4/15/1991 CHAMBERS, JAN R C123071 3 CHAMBERS, ROGER A C72624 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2007 $291,100 $4,100 $0 $317,100 2 2006 $260,200 $4,100 $0 $230,700 3 2005 $228,200 $4,000 $0 $206,100 4 2004 $185,900 $4,000 $0 $206,100 5 2003 $160,800 $4,000 $0 $150,100 6 2002 $157,400 $4,300 $0 $150,100 ; 7 2001 $157,400 $4,400 $0 $150,100 8 2000 $107,200 $4,000 $0 $71,900 9 1999 $88,500 $4,000 $0 $71,900 10 11998 $88,500 $4,000 $0 $94,300 11 1997 $84,600 $0 $0 $59,000 ; 12 1996 $84,600 $0 $0 $59,000 13 1995 $84,600 $0 $0 $59,000 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26921 9/20/2007 a F-arcel Detail Page 3 of 3 14 1994 $81,900 $0 $0 $109,500 15 1.993 $81,900 $0 $0 $110,200 16 1992 $93,400 $0 $0 $121,600 17 1991 $106,000 $0 $0 $175,100 18 1990 $106,000 $0 $0 $175,100 19 1989 $106,000 $0 $0 $175,100 20 1988 $81,300 $0 $0 $63,000 21 1987 $81,300 $0 $0 $63,000 22 1986 $81,300 $0 $0 $63,000 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26921 9/20/2007 % qvk Is THEro�°°� TOWN OF BARNSTABLE BAHHSTABM i "°9 BUILDING INSPECTOR °�E0 MAI a APPLICATION FOR PERMIT TO ..........J.... �. ....�G.odd. ..............:.............................................. TYPEOF CONSTRUCTION .................... 1 :.:............................................................................................... ........................192 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... l'� :.... ��1� ........1�7�'/�d3�01�i,S... :�t�..............:........:... ProposedUse .... .�� 0: �:... .. ......... ................ . ........................................................................... Zoning District ........ ..�.................................................Fire District .,1��.�YOV��............................, Name of Owner ......(1,0.,Y.......................Address ... !`'C .. ¢?! ............................... Name of Builder .,ll.YGr/�yPI.J... c�Ql ..............Address ..sJ .. rr.. /. OY�. r............. Name of Architect ...........5 ? ....................................Address .........S/-::).P- ...................................................... Number of Rooms ......� ..... .........Foundation ..../32.C!lrl ''.......:.................................'........ Exlerior .,RA1 IAIA' .....................................Roofing .... �r %/1 .. ................................................... Floors C �G .......5 . G .� .t...........................Interior .....4,Ll 'e . pa-D. Heating ......... ................. ...Plumbing ,1..�� ................. Fireplace ........................................Approximate Cost moo• Definitive Plan Approved by Planning Board -----------__________________19 Diagram of Lot and Building with Dimensions -Re SUBJECT TO APPROVAL OF BOARD OF HEALTH d SEPTIC SYSYEM MUST BE INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOWN z4-da I hereby agree to conform to all the Rules and 'Regulations of the Town of Barnstable regarding the above construction. Name .. � '..................... Cook, William i �-5893.... Permit for add to single No .......:.... .... family dwel ................ .... .... ...................................... t Locatidnv` .............. Ma.rsh..La.ne ...................... .... ...... .... .... 8Y3T37,S........................................... Owner ............k"IUM..C?C)9............................. Type of Construction ............frma.................. F t ................................................................................ Plot ......................... . Lot ................................ Permit Granted' ......February 13 73 1 ...................... ...............19 Date of Inspection .�rJ'r.s.7 ... ..��..........19 c Date Completed PERMIT REFUSED ................................... ......................... 19 6 je ...................................... ..................................... j ................................................................................ 4 C Approved ................................................. 19 ............................................................................... ............................................................................... i I '� ti°d�'�wi�o�o'�s's eun r ca. � � ', ::�,.I: .:, ,.,. , F. �1 f. •Ig \�` i'� v ,y J' i.�'. ';\'. � 1 +��1 ,.1/. r:. � �� l: �, .,: � � :.; �:I:. �' � 1 � mac\ `,j �� I 4� � A% 4;. } �11 t, , �: _ f �I • H !�C^1 ,,� ,; �, r;kr �. sr � � ,�� .: y�. � '.. � ! 'I;, • ._ l ;} ' 4" ��. ' { J. Y�. "1 ' L I �. _ � � ' ;� ' ' F �� .. i r I i v � I- t'a, � d 1 46 .1:'•- ,�'.- � � �N_= a �� » r � � I . r. ,., : _ _. . _ 1�� .. . R: ��' i - .1' 7 rk�„'i. -'� - �' ',, I Pl.i_ • e 7k. , a F i:2-o' — a. To Y x h � d "_ 'I' -- -- — — M I 'r g "�y I i i 4°?w`Bi�'dd j � "� n��, y 3� �:v_cie c• �;�r�z�c*�.r GLaLJ plmpr*venten* h L.0 9 Ci(gj .U.r— :a: .+2ei�nL.__._:SS��'rs._,•'a.i�:`,+� a �-0 L i �„ -E.. f 'ti -� •�,T S T- Y` w ,r._ .. .. _. _ ...._a,b,_:�.._.aa+s:. _'��a. ..,.�.s..wrS�a::..frassw,. �_*...:>s`i�i'�'.�.ccyr�-��s.�.. -e�,s• r :. _ e'0.C. li ' Ijil! 1 �� _ i . ml Improvement specialists w eooaeoa •nveoiso n oq•m.�r ' w : IMPAMNENT CONTRACTOR i R"Istntioo 10101/ Type - PRIVATE CORPORATION ExPirltiol 06/24/9e CAPE COD NNE IMPROVEMENT SPE ' rt A..NocL&v#hliM r V e If►000u0h RodADMNSTPAOR - k . } .. Nymalls NA 02601 H K jJ �R6 l!'0414Il1R�ltl/JC(ZLC/7 [�. IIIJ.II/I'I/CHILI DEPARTMENT Of PUBLIC SAFETY CONSTRUCTION SUPERVISOR lTCENSE Number: EBDires: Rir[hdete: CS 011350 07/2311999 B]r:"11941 Restricted To: 10 . ROBERT A NACIAUGHIIN 25 HARVARD ST �. YAPNOUTli, MA 0?964 3 - P y fi 0 r-' N Q j � -. b N,, AMC 4-1 F 0 1• S 1� / a i� 1 37ojG - o W ; i It k � * at r N co y �, Y LA. pn O 0 ; � v� u1 + .. 0 + r f�- 0 _ J x O rA V 6N �_ Z.0 n � j •+ ' fit. ;_ � T s to " W y 3 �'+j .tit ri. .'A .. '- .� r _1_,;•4 r 04 -77 -.*?er: • i i ,# VA -!Fflt, fl 1 i VA i la NT - I� s Y ' j� f �� b�mzna» 6R"�' A � aK« a .,�.. ;»:.ri..: ,:.r.-:.ct .,�.c�.ti'.;�.n•,4i�n::iad? r+.rRaw.:.rwtfl.Ss', iv,`+�§iF+ eTe�F.�.s-,tbY'�4.%:1EY,.e`3xsG+,�✓��las":-r- `•5 s #;� GRANITE STATE INSURANCE COMPANY 13102 71109 31C SEND CORRP.91mDEi 1-34-60 AMERICAN INTERNATIONAL CO. P.O.BOX 409 PARSIPPANY, N1 07034-0409 HOME IMPROVEMENT SPECIALISTS OF CAPE COD I Nt PHONE: t-too.a4s'ias9 25 I YANOUGH ROAD on Member COrMnies of HYANN I S MA 02601-DODO AmericWntemational Group LDi/ 70 PINE MEET, NEW VORK.N.Y. 10270 WORKERS COMPENSATION AND OGERS b GRAY INSURANCE AGENCY EMPLOYERS LIABILITY POLICY ROG BOX 16031 INFORMATION PAGE 4OUTH I S ROUTE 4 INSUREDta CORPORATION MA 02660 OTHER WORKPLACES NOT SHOWN ABOVE1EviouS POLICY NUMBER NEW ITEM 2 POLICY PERIOD 12:01 A.M.standard lima at the Insured-s mailing address MIN 3 A. Worker Com FROM 07/02/97 To 07/02/98 Pensation Insuranp: Part One o/ the policy applies to the Worker Com states listed here: Pensation Law of the MA 0. Employers Uablllty Insurance•. Part T WO The limits of our.11abllity under Part Two n he policy applies to the work In each state listed In Item 3,A, Bodily Injury by Accident : 100,000 each Bodily Injury by Disease 8 900,000 accident I Bodily Injury by Disease a 100 000 Policy limit f C. Other States Ins,►encr Part ThrN Of Me each employ" SEE ENDORSEMENT WC 20 03 06A policy applies to the :rates, It any, listed hen: tTdr The Prwnium for this All Information r policy will be determined by our Manuals of Rules, Classifications, R squired below Is subject to verification and change by audit. Notes and Rating Plans, Classifications Estimstad Told Rag pK Ceti Cods III I, or Remunarall matnd1100 MCURAppomftj Table J5.2-Ib(condoned) Ptucripdve Package for Oae and Two-Family Resddentw BoUdinga Heated with Fad Fula MAXIMUM MINIMUM Glazing Glazing Ceiling wall Floor gases Slab Heating/Cooling �'(%) U-value= It-value' It value' R value° Wall Paimeta Wpmmt ElLciatcy' package R vedue° R value' 5701 to 6500 Heating Degree Days' Q 12% 0.40 38 13 19 1 10 6 Normal R 12% 0.52 30 19 19 10 6 Nomad S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Nolan! V 15•/0 0.44 38 13 25 N/A N/A 8S AFUE W IS% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 25 N/A N/A Normal Y 18'/e 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 IO 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE hec4eS co� Lq 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-980303a 780 CMR Appendix J Footnotes to Table J5.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft'of decorative glass may be excluded from a building design with 300 ft'of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. " If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 The Commonn-calth of:'Itassachuselts w , ' •Mil `---=j•�- Departrrrent of Indusrrial Accidents ONCEfi/InyOW9,7llons • •tom i i w , � J •,�j=.;l . j:=+ 600 !l u.0u voil Strut �'f: ��`'a• �. Bt►vall.A1aas. 02111 .1 Workers' Compensation Insurance Affidavit . apjtlirint informatitin• _ PlcF! PRINT lebUP— name: e�G n COO rift. PP(6,,V AJ l 5 1 ///1 4 nhnnc# I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capaciry ,. • �w. ..w.. -..�r�—•�.�....__r..�•�.-r.s...�+w..cs�•�ww+11�'.��'q`- �.�..ww..�•�..��.....waw_....w•�..,w.,..�..__... .. am an employer providing workers' compensation form} empi veer working on this job. ennt cant• name: ✓ei'9 hJ 6 N address* CD3 —i— 0,•V V ltnl city 91A 01/JIV 1 s nhnnc ts• /�� t� C 7 insttr:trtcc co. nnlict•# [I I am a sole proprietor. ;enerai contractor, or homeowner(circle n»e) and have hired the contractors listed beiow who hay the following workers compensation polices: comnant• n•inc- •tdrlresc• city- nhnnc a• _ inciir•tnrc rn nniirr id_ _ .�..__ •°�.. Vw•._... _ _�.a�.r — r — -1^.w:l'.• __'.T}•.. ___ ter` ` _�_� cmmninv name: addresc: (•ift'• nhnnc 0: insur•tncc cc), nnlict•# _ Attach additional sheet if necessary .. ,_ --'% ^�:: — ^�� - "'� ""� :� ;c% '="+ M%•�%+^- F:tiiure to sreurr cot crat a:tsequ rired under Section 3A of;11GL 152 can ic::u :u the imposition of cnminal penalties of a tine up to S1.500.00 andiur unc t cars•imprisonment as well as civil penalties in the form of a STOP'1'OR1:ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement mac be funrartied to the Office of 1nvestic2tions of:he 011 fur cover2rc verification. 1 do lrerehv ccrrift•urtrlcr Nre air arrd/tertalti of perjun•that the i.won. anon provided above is true uitd correct. Si__na.0 _ Oatc / O Print name �� ✓ Phone>* w - ofDcial use only do not write in this area to be completed by city or town official sin or town: permit/license tt rlBuilding Department ` ❑Licensing 1luard t Selectmen s Orrice a check if immediate response is required ❑ -. ❑ttcalth Department phone contact person: =: rlQther Information and Instructions Massachusetts General Laws chapter 15'_ section 25 requires all employers to provide workers cclmpcnsation for empio1 ccs. As quoted }�om the "fa++" an enrptnree is defined as eve nother under a r}►person in the service of an+• contract of hire. express or implied. oral or written. An eiy ph rer is defined as an individual. partnership, association. corporation or other legal entit}•. or any two or me the foregoing cnt_►a�_ed in a.joint enterprise. and including the legal representatives of a deceased ctnp10.er. or the recciver or trustee of an individual . partnership. association or other legal entity, employing employees. However o++'ncr of a dwelling, house havin-a not more than three apartments and who resides therein. or the occupant of the d++cllittg house of another cmplo-,s persons to do maintenance, construction or repair work on such dwelling ?i or on the :_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio" MGL chapter 152 section 25 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 commmu-calth for sny applicant who Iias not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contractinc authority. Applicants Please fill in the .vorkcrs* compensation affidavit completely, by checking the box that applies to your situation anc sup11 1%•in_ company names. address and phone numbers as all affidavits may be submitted to the Derar mcnt of Industrial accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit• The atfdavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are require to obtain a «•orkcrs' compensation policy. please call the Department at the number listed below. City or towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant. P1 be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returner the Department by mail or FAX unless other arrangements have been made. The Office of Ittvestiaations would like to thank %ou in advance foryou cooperation and should you have any questic plen-se do not hesitate to give us a call. The Department's address. telephone and fax number: `M The Commonwealth Of Massachusetts Department of Industrial Accidents .. Office of Investigations 600 Washington Street - Boston,Ma. 02111 fax #: (617) 727-7749 _ 1_ �,-N i,7 ionn -..+ mr. d(lU nr 174 THE r� The Town of Barnstable KAM.eatvsr�etE. : �0 'Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissio; For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work 4dt+(Opu Est.Cost Address of Work: r t Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A „SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 0/ Date Contractor Name Registration No. OR Date Owner's Name LOT 14 9 BRIAR GOOK00 % far Lo%, LOT AREA bti 20,844 5F 0.47 AGRES do 40. PLAN OF LAND IN BARNSTABLE, MASSACHUSETTS AS PREPARED FOR SHIRLEY & BRIAR COOK T0: SHIRLEY & BRIAR COOK PLAN REFERENCE— L.C.P. 17595 PLAN SCALE— 1" = 40, I CERTIFY THAT THE LOCATION OF THE EXIST. DATE DRAWN— 2i27i98 DWELLING SHOWN ON THIS PLAN CONFORMS NOTES— THE DWELLING SHOW TO THE LOCAL ZONING LAWS. OR IS EXEMPT ON ThdS PLAN FALLS ON FROM VIOLATION ENFORCEMENT,ACTION c-ZONES B 1$ C DETERMINED RIDER M.G.L. CHAPTER: 40A SECTION 7. BY SCALE-AS`DEPICTED ON A-—MAP` OF.COMMUNITY r (N REGARDS T NSIONAL 1, ) PAI0 2500Dt 0006D ' P�Ss9°ti DATED 5/5 1985 BY FIA. FEB. 27,1998 �, FT . DATE PROFESSIONAL W9QPY FILE 1516-03 . 014 F.B.: The Conrnromirealtlr of:1las.vac•IJutictty '' ! !il 1. Dc ptrrtrtuirt of lndrtstrial.4ccitlerrts officeathWOSti OMBS harp 11I:. •';�� - .. •�:=; u111%tr�tUlr Street .,; -' Bosrorr.,9lirss:' 021I1 Workers' Compensation Insurance Affidavit atiniirint%inftirmatirin- —' Plcnse PRINT led'ilv Mime, f[ [r%(/� ( t�'(J /< loc•ttian Ma a25 0 1 am a hoKeowner performing all work-,myself 0 1 am a sole proprietor and have no.one working in any capacity am an employer,providing workers' compensation form} employees working on this j�ob. cnnl ,awt name, 6 it !/ �✓� , �f /� �7 M/1-1 I ,l S. nhnnc# in,mrancc cn. dirt•# 7 I am a sole proprietor. general contractor. or homeowner(circle otte) and have hired the contractors listed below who have the following workers compensation polices: cmmaan,• narncr nddr"s�- city- nhone#• incurnnrr rn nnlirt•# • •'.:.�+.'r..�- .... _ _t.. __ _ ra-��:�"tom rT••r•r.._,,.yl" ._�«._ �� . �.•..�._.—.. �. innlnln\' n:11111•' - ' mldresv -Its- -- --- nhnnc#• ncurance co policy# attach additto_nal sheet if necessary• •=.. — •; --_- . /i't:aiy. �~.':`r'r.• �„� .^_ ��'� aiiurc to secure coverage as require)under Section 25A of NIGL 151 can lead to the imposition of eriminai penalties of alline up to S1S00.00 andiur ne%cars' imprisonment:1.WC11.13 civil penalties in the form of a STOP WORK ORDER and a Grte ofSI00.00 a dad•against me. I understand that a 3M of this statement may be forwarded to the Met:of Investigations of the DIA for coverage verification. do herehr cerriji•raider the Yellafties perjure that file information pror ided above is tear and correct. nature Datc �- 7 rinr name ?"O�eeF aIA Phone rift - otiiciai use only do not write in this area to be completed by city or town o[rcial `• city or town: permit/license# r'ttluilding Department C3Ucensing Board Q check if immediate response is required Oseleetmen's Office 011ealth Department contact persnn: phone#: nUther_e Information and Instructions a Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for employces. As quoted from the "la++ an emplgree is defined as every person in the service of another under an: contract of hire, express or implied. on. or writtett. An emph rer is defined as an individual. partnership, association. corporation or other legal entit}', or ally two or the foreaoin;; en aged 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. Howevc owner of a dwelling hcnise ttavin` not more than three apartments and who resides therein, or the occupant of the dwell in`, house of another who employs persons to do maintenance , construction or repair work on such dwelkin,_: or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emp: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance o renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Addition i+ commonwealth nor any of its political subdivisions shall enter into any contract for the Additional iv. ncttl�er the can performance of public work until acceptable evidence of compliance with the insurance requirements of this chap: been presented to the contracting authority. 777 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation a: supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. rite affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are reeu: to obtain a x+•orkers' compensation policy. please call the Department at the number listed below. - City or 10++n5 Please be sure that tite affidavit is complete and printed legibly. The Department has provided a space at the bottor. the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. I be sure to fill in f the permit/license number which will be used as a reference number. The affidavits may be return the Department by mail or FAX unless other arrangements have been made. rite Office of Investi=ations would like to thank you in advance for you cooperation and should you have any quest please do not hesitate to give us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 375 Phone n: (617) 727-4900 ext. 406. 409 or.3 Engineer4Vg Depi.(3rd floor) Map ' Parcel 60 Permit# 9Q T House# Date Issued Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30 f 2 Fee 7. / D Consirvation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) APFLiC A SEWER RON THE D ti Plan Approved by Planning Board 19 ENGE I MOB TO ABLE, ASS. 039• TOWN OF BARNSTABLE Building Permit Application Project Street Address �-� �� lz n k- /,�.,AV Village 1A CA Id R Owner a Coo 1� Address �G.Y✓i. P._ Telephone �'Z Permit Request tAetAU z First Floor �� X�j� square feet Second Floor square feet Construction Type /4R-h1c-1G 3 Estimated Project Cost $ cry Zoning.District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 4tVeaec Historic House ❑Yes �No On Old King's Highway ❑Yes aio Basement Type: ❑Full Xcrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New ' +S— * Total Room Count(not including baths): Existing New _�First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes o Fireplaces: Existing c';t, New '' Existing wood/coal stove ❑Yes ,01�o Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address G1N �— , License# Home Improvement Contractor# Obl al 7 Worker's Compensation#WZ/°� ,3J-1 ,3 31 O I� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONS UCTION DEBRIS RES LTING FROM THIS PROJECT WILL BE TAKEN TO n� A /�r " [ �� / s4kz7I I 4 SIGNATURZAf,:�z / DATE -�'— BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUEDx� MAP/PARCEL NO. ADDRESS -- VILLAGE OWNER w DATE OF INSPECTION: r FOUNDATION a FRAME INSULATION 2 !� FIREPLACE r ELECTRICAL: ROUGH FINAL _ r PLUMBING: ROUGH FINAL' GAS: FINAL '• s FINAL BUILDING;;r;�!9 t 53 i J DATE CLOSED OI s .pro+ i 14 ASSOCIATION PLN 1t[RO. 1 ' Engineering Dept. (3rd floor) Map 3077 Paicel 40'4 " P" ermit# ' pv/ o2_" House#. Date Issued '- ' /0 ' 1 Board of Health(3rd floor)(8:15 -9:30/1:00 Fee Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) Yna.c`� 1 as�• - Planning Dept.(1st floor/School Admin. Bldg.) ' �{114E►p;_ Definitive P App ved by Planning Board 19 A SEWER ' CO CAA IT FROM THE , TOWN OF{BARNSTABLE EN ION PBIORTO Building Permit Application oject S Address 42 'otQt bo Village CA C411/N k Owner �i2 f Address Lod (Q�� ,Telephone Permit Request F` 09 CarZ- Fe- First Floor ✓JD square feet Second Floor square feet Construction Type rJc.ia a Gc PYL Estimated Project Cost $ 2?o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes �No On Old King's Hi hway ❑Yes �io Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �[A.� 4�sT c.l& Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New � r No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) XAttached(size) /v x" / XJO ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ;dNo If yes, site plan review# Current Use SrA) c Proposed Use SGtiv! P H0vongV-- ✓ege&� CIA LP s�f Builder Information Name U �r,C LI ti Telephone Number Address �. �o�a•llJ�v�l'!1 �C� License# Q&— t�t 11 e V Al c S Home Improvement Contractor# Worker's Compensation# \/ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. L CONSTRU ION DEBRIS R ULTING FROM THIS PROJECT WILL BE TAKEN TO 82 p r SIGNATURE DATE J� BIRLDING PERMIT DEN�IED--F OLLOWING REASON(S) r FOR OFFICIAL USEIONLY _ PERMIT NO. DATE ISSUED MAP/PARCEL NO. - + �1+ + � - - +`c r. - •� I - 1 � Imo ADDRESS VILLAGE �� .r '. k� _ � ' • � .- .� � _ ' OWNER DATE OF INSPECTION: ► M 1 - - a FOUNDATION FRAME INSULATION �i r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ,+ ROUGH FINAL r ' FINAL BU LDING DATE CLOSED OUT, d'Sti t 1 ASSOCIATION PLANS s r �, CU ; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map 3 2.4 Parcel 106 Permit# Health Division` !,ZW�/ `��` Date Issueo, lit I / 9 �Conservation Division 1 l - �O ?� Fee Tax Collectol- '" '"° —Treasurer 0 / {,,PRLICANT MUST OBTAIN A SEWER tONNECTION PERMIT FROM THE Planning Dept. ENGINEERING DIVISION PIUOR TO r W' TRVcTION r- Date Definitive Plan Approved by Planning Board J' v Historic.'OKH Preservation/Hyannis Project Street Address 12 M II R s H L A R D r Village Ny9�![mt Owner t3RI Ca9 -i� st-tkRLFY CW X Address Ya7 oLnti tsk' Lhl Ke t1YBPtws Telephone ' L5 0 8) 7 Rio s, m Permit Request -ro rain-,T Tg4T- ca. ®8� 0,r%C . A&C V, C onf1erTL[4 TWD e 6 F -Tile- k nut 0 .t Square feet:•1st floor:existing proposed 2nd floor: existing proposed Total new stimated Project Cos Zoning District Flood Plain Groundwater Overlay Construction Type c onk F7«me_ Lot Size 2 . 3 cL.c r es Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) s�dgcT�c r+ Age of Existing Structure dohs i7mmars Historic House: ❑Yes Flo On Old King's Highway: ❑Yes T(No Basement Type: 0 Full Id Crawl ❑Walkout • ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: 04 Gas ❑Oil ❑ Electric ❑Other Central Air: W Yes ❑No Fireplaces: Existing 3 New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:W existing ❑new size Shed:N existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# '>ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR )DTE _ !! r!2 -9 9 ��. FOR OFFICIAL USE ONLY PERMIT NO. g 3- v 1� DATE ISSUED MAP/PARCEL NO. !' ADDRESS VILLAGE OWNER f `7 DATE OF INSPECTIO R' U FOUNDATION '° ~ 1 FRAME INSULATION !FIREPLACE ELECTRICAL: ROUGH FINAL ,~ PLUMBING: ROUGH FINAL t GAS: ROUGH R FINAL , FINAL BUILDING DATE CLOSED OUT ' ` ASSOCIATION PLAN NO. - " 2910 lo.q ScreujeJI inTc �nou-se zx12 �' ,2X10 on IL" 10 N , f4 I PtLi._T_O.�STs To ze 3 i l o 18. ��i H61At ERS 8Y Za1ST C" d lu 43 cn w t= ! _ Epee o.r-exlsTle�q.RaoC - w -- *--kx4 e— IM(B .UG14 ENPVG 4Xlo _TOP_. ...,DECK STAIRS jRA1L1K RT ScA�R :IN 30" o F PAjLVrA S ON s COMCRE,TE (2) 2X12S2X12 To ZF- SUPPORTED "BY -RIOOF .T_wte-E IN41 _.. Iz1 zX12 TE 1$' q" LENGTH R.J( las-on i6" r _ zz6 the zx.ys vw111 only suPpsri s Ex l 3'C.I.N (.2) 2X8 Roo.FGUTTF-IR � plywoa� plus TooFtn9 _ 10' 7" s The 2x101 u.11tt 6e, ToPPec� wlTk s/y x decl<,n� rE— Ll R G S D OR To SIDE. OF 140t)S E r GROOKO LEYCL `«5rCon,CRZTE WITVi STEEL:ON 16" ¢ SiDE VIEW .. SZFIRS >�oY Shown NOTE: ALL WOOD TO 8E. PRESSuRf— Ti ZATEZ I3RIATJ COOK PROPOSED RAlta COVER 42 MARSH LANE 14YANjWS, MA ARM DECK _ 790 S9Li2 N F 4` p h i �' ' •_ � y LOT 1 4 BRIAR -GOOK J 2 • w y / `LOT AREA b� 20,844" 5F �. �` •� 3 , N y 20 f • 40.00: LAN .. PLAN OF LAND IN BARNSTABLE, MASSAMUSETTS AS PREPARED FOR , SHIRLEY BRIAR COOK, K PLAN REFERENCE= TO: SHIRLEY &c BRIAR COOK L.C.P. 17595 PLAN SCALE— I" = 40' DATE DRAWN— 2i2V98 1 CERTIFY THAT THE LOCATION OF THE EXIST. . NOTES—JHE DWELLING SHOW DWELLING SHOWN ON THIS PLAN CONFORMS ON THIS PLAN FALLS ON TO THE LOCAL ZONING LAWS. OR IS EXEMPT ZONES B k C DETERMINED ti 'FROM a VIOLATION ENFORCEMENT,ACTION BY 'SCALE=AS DEPICTED K. ". UNDER M.G.L. CHAPTER 40A SECTION 7. w ON A .MAP OF COMMUNITY, V REGARDS T NSI BACKS) PANELO 250001 0006D �N OF ss'c DATED 5/15/1985 BY FIA. FEB. 27,1998 DATE -' RROFES'S� EYOR FILE: 15 -03' � ti F.B.: 014 ".. o� The Commonwealth of Massachusetts Department of Industrial Accidents OB/ce of/aYest/gat/oas 600 Washington Street s; Boston,Mass. 02111 workers' Compensation Insurance Affidavit name: C O®K location 42, M R,P,5f-t LAX — city 14 Y ft htN IS M R 15-©e 7 90 5-9,(Z ® I am a homeowner performing all work myself. ❑ I am a sole etor and have no one worlds m any ca ici %% ////%/IIIIAyVIIZ////%%/G//%////�/% EN,//%% ////% //G%%///%/%%%%%/////%////////1121�//////%////////////�- ----/%%%%%//// rl I am an em 1 roviding workers'compensation for my employees working on this job.: :.::::::::: ::::::::::::::::: :: : :. .. . :;.::: :::::::............:::::: :::.:::.::.;;::..:;.:::.:::::..:. :::.;::;:::<;.:;:<::.:;.:;::......:..:.::.;:::.:: com anv name:. ;::.....; .. :. a mare hues :::... ::.;.... :. ::..,: .. .: ;:::::...... ...::.::.;:::. : :::. .....:::......::..:... A Q tV" insurance co.:: ::..:..:.::...::.,::..;... oiicv ------------- ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com anv mate:. ... ad ales :.:....:.: :::::•: ........ v. .:::.:............................. :.:. :....nhon city .................................................................................................. . iasurance*cm. ;.;:.;;:.,.....::::..:::::::.:.:.:::: :: ::.... . oil ..:.:.....:. ... .... ..... address. :::.. ....::::::. ... ..................... ... :..........::::.:: . :::::.:::::.:..: ;:- 0000 city' :. :...,. phone di:: :::::.:::::.. :. .:,,.:.:.,.,..:.... t'v XX Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crhnin d penalties of a One up to$1,500.00 and/or one year'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a Hue of S100.00 s day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verincatton I do hereby certify under the pains and penalties of p that the information provided above is trru and correct t Signature - Date /> '.iz -99 _ Print name i3 g f i✓1 g i1n o K Phone# Hid ��o 90 .59 tf oal use only do not write in this area to be completed by city or town oHidsd city or town: pern0flicense# QBuUing Department -❑Licensing Board Q checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; fi❑ r. 0evind 9195 PIA) ESTIMATED PROJECT COST WORKSHEET . a Value LIVING SPACE square feet X $55/sq. foot GARAGE (UNFINISHED) square feet X $25/sq. foot PORCH square feet X $20/sq. foot e , DECK 8? square feetX $15/sq. foot= . _ 3 OTHER R At r[ e®v tT_-R urcflC-R DF.e K l B� 7 square feet X $??/sq. foot= .5 6( Total Estimated Project Cost g990915b 3 Main SftTetFFY—a=isMAUlbuh Office: 508-862-4039 Ralph Crossen 'Fax: 508-790-6230 Building Commissic HOMEOWNER LICENSE EXEMPTION Please Print JOB LOCATION: 42 K A IR S Vl 9..RK 1✓ Iry r,n t 5 number Sir= village "HOMEOWNER". 13 R i A aZ r 60 K 9 0 513 S A J1q E name home phone 0 work phone s CURRENT MAMING ADDRESS: a-m cilynoMm rip code The current exemption for was extended to include i led dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, that the owner acts as snn� 'tor DEFINEL OFHOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached strucum accessory to inch use and/or farm stmcmres. A person who comtru=more thaw one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official on a form acceptable to the Building Official,the he/she shail be=nnsible for nit such work rerfamed under the hnildingy germit. (Section 109.1.1) The umdersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,byiaws;rules and regulations. The undersigned"homeowner"certifies that he/she undmmtaads the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requrremeam. S1tt�, Building 0)$tdai Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to compiv with the State Building Code Section 127.0 Conduction Control. HOMEOWNER'S E71F1UIF ION The Code states that: -Any homeowner performing work for wwc h a banding permit is requited shall be exempt from the provisions of this section(Section 109.1.1-Ucensing of conwnetion Supervisors);provided that if the homeowner engages a person(s)for hits to do such work that such Homeowner shall act as super visor:" of a . Many homeowners who use this cxeatption are mzwaie that they ate asassuming the responsi responsibilities supervisor(see Appendix Q.Rules&Regulations for L.lcensing Construction Supervisors.Seedw Zls) This lack of awareness often results in serious problems.pnticuiady when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the unlicensed person as itwould with a licensed Supervisor. The homeowner acing as Supervisor is ultimately responsible. To enswe that the homeowner is fully aware of hisaw responsibilitim mum'communitiesrequire.as Pan 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 curdy used by several towns. you may care to amend and adopt such a formtecrtifncation for use in your community. Q:F0Rh1S.E.MAPTN f MAM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cressen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPR OVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. . Type of Work: a rigM CQ v c c)ee-K Loy Estimated Cost cx%s-t %n9 cooCs Address of Work: 42 M cLr s E. t-avt-e, 1(va n n tiS Owner's Name: -O R 1 A R C-QQK Date of Application: 11 d 1 Z-J 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied ®Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME EUROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY i hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. O / 2,- Date Owner ame q:forms:Affidav i - , I LOT I' 47__'_ 9 DRIAR GOOK 0 / 6°`tip � /,�q .�` - ` fib ` _� , • . / LOT AREA / 201644 5F v b 0.47 'AGRES \ 0 9' 40.00 ' ��RShT L�N� Am X +1!Y ..t itt f I PLAN OF LAND IN BARNSTABLE, MASSAhCHUSE'T-T AS PREPARED FOR n SHIRLEY & BRIAR COOK, TO: SHIRLEY & BRIAR COOK PLAN REFERENCE— _ _ L.C.P 17595 PLAN SCALE- ';r 40' DATE DRAWN >2�tti98 ' I CERTIFY THAT THE LOCATION OF THE EXIST: J NOTES TI—�rDWELLING SHOW Ni i >itr DWELLING SHOWN ON THIS PLAN CONFORMS q ON THIS PLAN FALLS ONE; y _�° TO THE LOCAL ZONING LAWS, OR IS EXEMPT ZONES B &c C DETERMINED FROM' VIOLATION ENFORCEMENT ACTION £' N` UNDER M.G.L. CHAPTER 40A SECTION.7• BY SCALE kASr DEPICTED , ;�, ON�A;MAP rvOF COMMUNITY;. .; (IN REGARDS TO DIME BACKS) °:PANELf 250001 :0006D PAuL sgcy DATED1985°BY FIA # p E. FEB. 11.1998 # DATE PROFES RVEYOR FILE: 1516 t00 014: 4.: yi C:TF# BARNSTA BLE REGISTRY OF DEEDS 1, JAN R. COOK! formerly JAN R. CI IAMBLIV . now of 208 John Joseph Road, Harwich, Massachusetts 02645 for consideration of$175.000.00 grant to W. BRIAR COOK and SHIRLEY A. COOK. husband and wife as tenants by the entirety, of 42 Marsh Lane, I Iyannis, Massachusetts 026t01 with QUITCLAIM COVENANTS the land with the buildings thereon in Barnstable. that part called Hyannis, Barnstable County Massachusetts, bounded and described as follows: PARCELI BeingFL`OT 14 on Subdivision Plan 17595-1, tiled in the Land Registry Office fit Boston, a copy of which-is duly Tiled in the Barnstable County Registry District. PARCEL II Bein OTT24!on Subdivision Plan 17595-L, tiled in the Land Registry Oflict:.- ABostor►, a copy of whi�Lch isydul'y tiled in the Barnstable County Registry District. PARCEL III Being VOT 651on Subdivision Plan 17595-11, (tied in the Land Registry Officc at Boston. a copy of which is duly tiled in the Barnstable County Registry District. Together with and subject to easements, rights of wa:.. road taking, wetlands restrictions and betterment assessment of record, in so far as the same are now in force and applicable. There is reserved by the Grantor as appurtenant to he, remaining land being shown as Lot 12 on Land Court Plan 17595-1, and Lot 62 as shown on Land Court Plan 17595-P the following easements: 1. A view easement over so much of the herein described premises as is shown on a attached hereto and made a part hereof. Said casement being reserved for the purposes of providing a full, open, uninterrupted and unobstructed view between the remaining la.,,t of ttic Grantor and the marsh. And to that end, no structure of any kind shall be built or placed ul.on the easement area and the Grantor shall have the right to remove underbrush, trim trees and rerrio•,e UNT a DOHERTY dead trees from said area. ORNEYS AT LAW 63 MAIN STREET SOUTH HARWICH - ASSACHUSETTS w 02661 2. An easement for foot travel over the above described premises between the remaining land of the Grantor described herein and the water of the marsh over the land described in the view easement. This access easement shall terminate wlicn said Lot 12 and Lot 62 (referenced above) are no longer owned by the grantor, Jan R. Gook, or her daughter, Kenna R. Chambers. or her son, Pieter B. Cook. PROPERTY ADDRESS: 42 Marsh Lane, Hyannis, Massachusetts. For my title, reference is made to Certificate of Title No. 123071, recorded in the Barnstable Registry District in Land Registration Book 1008, Page 71. The undersigned releases the Homestead rights for herself and her family created by her declaration recorded in the Barnstable Registry District as Doc.No. Executed as a sealed instrument this d/srday of January, 1998. R. COOK y COMMON WEALTl4 01- tvIASSACHUSETTS Barnstable, ss. January c2 f'. l g,)8 Then personally appeared the above-named JAN R. COOK and acknowledged the foregoing instrument to be her free act and deed, before me. Notary Public My commission expires: �' y i tuefid-cook i A..,. i �t Nas 6`�,• � _ 1Q N \` 0 00 ay�� I N bbhb 1a' 1 �s� LO T 24 � _ 1 n� •p0 � ,� . o eL tel s�" Ioh• 101• iU y 3 d Iv G A • 1 \ ELOT 14 � A a s bati0' 0 \ LOT 61 ;J LOT 62 "o AO' ,5 A4 9 �•1 ' 9 4 . 40.00 LOT 12 N651 O•I O'W PAU E R ABBREVIATIONS ELECTRICAL NOTES., JURISDICTION NOTES A AMPERE 1. THIS SYSTEM IS GRID—INTERTIED VIA A GA AC ALTERNATING CURRENT UL—LISTED POWER—CONDITIONING INVERTER. BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. - CONIC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING DC DIRECT CURRENT LABORATORY SHALL LIST ALL EQUIPMENT IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. (E) EXISTING 4. • WHERE ALL TERMINALS OF THE DISCONNECTING EMT ELECTRICAL METALLIC TUBING MEANS MAY BE ENERGIZED IN THE OPEN POSITION, FSB FIRE SET—BACK A SIGN WILL BE PROVIDED WARNING OF THE GALV GALVANIZED HAZARDS PER ART. 690.17. GEC GROUNDING ELECTRODE CONDUCTOR 5. EACH UNGROUNDED CONDUCTOR OF THE GND GROUND MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY { HDG HOT DIPPED GALVANIZED PHASE AND SYSTEM PER ART. 210.5. CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL t• Imp CURRENT AT MAX POWER COMPLY WITH ART. 250.97, 250.92(B). } Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR = kW, KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC, LBW LOAD BEARING WALL DISCONNECTING MEANS PER ART. 690.31(E). _ MIN MINIMUM 8. ALL WIRES. SHALL BE PROVIDED WITH STRAIN O NEW h RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED-BY # NEUT NEUTRAL ' - UL LISTING. ` c NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE { , OC "ON CENTER UL=LISTED LOCATION PROVIDED BY THE } PL PROPERTY LINE r' MANUFACTURER.USING UL LISTED GROUNDING ' P01 POINT OF INTERCONNECTION : HARDWARE. } PV PHOTOVOLTAIC 10, MODULE.FRAMES, RAIL, AND POSTS SHALL BE- SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS. S • STAINLESS STEEL STC STANDARD TESTING CONDITIONS TYP TYPICAL _ . UPS UNINTERRUPTIBLE POWER SUPPLY 4 ` V VOLT Vmp VOLTAGE AT MAX POWER VICINITY MAP - INDEX i Voc VOLTAGE AT OPEN CIRCUIT W WATT y. 3R NEMA 3R, RAINTIGHT' i z PV1 COVER SHEET PV2 SITE'PLAN • , PV3 STRUCTURAL VIEWS w PV4 THREE LINE DIAGRAM LICENSE GENERAL NOTES n._ Cutsheets Attached GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION !� ELEC 1136 MR OF THE MA STATE BUILDING CODE.- 2. • ALL ELECTRICAL WORK-SHALL COMPLY WITH THE 2014 NATIONAL ELECTRIC,CODE INCLUDING - MASSACHUSETTS AMENDMENTS. " MODULE GROUNDING METHOD: ZEP SOLAR ram .. •fir . - _- REV, BY DATE COMMENTS ' AHJ: Barnstable � - ,� -, ' • „ REV A NAME DATE COMMENTS UTILITY: NSTAR Electric (Commonwealth Electric) PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER `JB-0262736. 00 BRIAR COOK Briar. Cook RESIDENCE Rafael Castro Veramendl• lh ity CONTAINED SHALL NOT E USED FOR THE SO�ar'C BENEFlT OF ANYONE EXCEPT SOLARCITY INC., Mourinec SYSTEM: 42 MARSH' LN NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 2.04 KW PV ARRAY PART IZ OTHERS OUTSIDE THE RECIPIENTS MODULES H I ANNIJ MA 02601 ` ORGANIZATION, EXCEPT IN CONNECTION WITH � � 24 St: Martin Drive,Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (8) TRINA SOLAR # TSM-255PDO5.18 9 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN p PAGE NAME: SHEET: REV: DATE Marlborough,MA 01752 PERMISSION OF SOLARCITY INC. INVERTER: 5087763385 ' PV 3 3 2D16 T: (650)638-1028 F. (650)638-1029 4w SOLAREDGE SE3000A—USOOOSNR2 ;� -COVER SHEET V (888)—SOL—CITY(765-2489) nn.solarcity.com PITCH: 39 ARRAY PITCH:39 MP1 AZIMUTH: 160 ARRAY AZIMUTH: 160 MATERIAL: Comp Shingle STORY: 2 Stories .Inv AC 0 - • M D LEGEND (E) UTILITY METER & WARNING LABEL Inv k r INVERTER W/ INTEGRATED DC DISCO &`WARNING LABELS © DC DISCONNECT &.WARNING LABELS Front Of House © AC DISCONNECT & WARNING LABELS e X A DC JUNCTION COMBINER BOX & LABELS MP1 tif. D PAN DISTRIBUTIONEL & LABELS WAY ED FOR E DRIVE STAMPED �c �6�(V cn � � LOAD CENTER & WARNING LABELS Lc S RUCT6 # LLY O DEDICATED PV SYSTEM METER _ OF CONDUIT STANDOFF LOCATIONS iA CONDUIT RUN ON EXTERIOR --- CONDUIT RUN ON INTERIOR A. GATE/FENCE ARCoU Q HEAT PRODUCING VENTS ARE RED KAN r—� INTERIOR EQUIPMENT IS DASHED Digitally signed by MarcusHann ° ' SITE PLAN N Date: 2016.03.03 17:43:13 =05'00' _7_�C, scale: 1/8" = V w F 0 11 81 16 ` S J B-0262736 00 PREMISE OWNER DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER SolarCity.CONTAINED SHALL NOT BE USED FOR THE BRIAR COOK Briar Cook RESIDENCE Rafael Castro Veramendi .BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �' NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 42 MARSH LN 2.04 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES H YA N N I S, M A 026 01 ti THE SALE AND USE OF ORGANIZATION, EXCEPT IN CONNECTION THE RESPECTIVE WITH 8 TRINA SOLAR TSM-255PDO5.18 24 sL Marlborough,M MAd01752 Unit 11 SHEET: REV: DATE: SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: PAGE NAME T: (650)638-1028 F. (650)638-1029 PERMISSION OF SOLARCTY INC. SOLAREDGE sE3000A—us000sNR2 5087763385 SITE PLAN PV 2 3/3/2016 (886)-SOL-CITY(765-2489) �.solo«ny.com s <4<. PV MODULE < 5/16" BOLT WITH INSTALLATION ORDER. FENDER WASHERS LOCATE RAFTER, MARK HOLE ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT S1 - ZEP ARRAY SKIRT (6) HOLE. (4) (2) SEAL PILOT HOLE WITH - POLYURETHANE SEALANT. ZEP COMP MOUNT C 4t. ZEP FLASHING C (3) '-9° _. (E) COMP. SHINGLE ,z - _ 1 (4) ' PLACE MOUNT. (E) LBW O. • ,z (E) ROOF DECKING U (2) (5) INSTALL LAG BOLT WITH SIDE VIEW OF MP1 NTS ' - 5/16 DIA STAINLESS , (5) SEALING WASHER. A STEEL LAG BOLT LOWEST MODULE SUBSEQUENT MODULES INSTALL LEVELING FOOT WITH MPI X SPACING X CANTILEVER Y SPACING Y CANTILEVER NOTES WITH SEALING WASHER j (6) BOLT & WASHERS LANDSCAPE 64 24 {2-1/2 EMBED, MIN) " " '. + ." STAGGERED '. PORTRAIT. 48" : 17" (E) r ' 1 1 ' R RAFTER nI ROOF AZI 160 PITCH 39 ♦ 1 V D - RAFTER 2x8 @ 1611 OC STORIES, 2 J � STA OFF ARRAY AZI,160 'PITCH 39 Ca e: 1 t '. C.J. ' 2x8 @16"OC - Comp Shingle' STAnIIPEA.&`SIGNED' FOB a STRp'IlZTQ!RAL0N,LY , ``fifC3$"`L`�1� CONFIDENTIAL- THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE JB—O262736 OO BRIAR COOK /� Rafael Castro Veramendi *4RM, ' BENEFIT OF ANYONE EXCEPT SOLARCIIY INC., MOUNTING SYSTEM: Briar Cook RESIDENCE SolarC�ty NOR SHALL IT BE DISCLOSEDIN WHOLE OR IN Comp Mount -Type C 42 MARSH LN 2.04 KW PV ARRAY '►�% 4� PART TO OTHERS OUTSIDE THE RECIPIENTS MODULES H YAN N I S M A 02601 ORGANIZATION, EXCEPT IN CONNECTION WITH ! 24 St. Martin Drive,Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (8) TRINA SOLAR #'TSM-255PD05.18 Pace NAMe SHEET: REV. DATE Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: ` ' Q - T: (650)638-1028 f: (650)638-1029 PERMISSION OF SOLARCFlY INC. _ 50$7763385 PV - 3 3 3 2016 �. SOLAREDGE SE3000A-US000SNR2 STRUCTURAL VIEWS / / (888}soL-CITY(765-2489) www.edaraity.com GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE ( ) ( ) INV i —(1)SOLAREDGE SE3000A—USOOOSNR2 —(8)TRINA SOLAR TSM-255PDO5.18 GEN 168572 BOND N 8 GEC TO TWO N GROUND Panel Number:HOMC30UC Inv 1: DC Ungrounded ## # ELEC�136 MR RODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:2302791 Inverter; 3d'OOW, 240V/208V, 97.57./97%q w/Unifed Disco and ZB,RGM,AFCI PV Module; 255W, 232.2W PTC, 40MM, Black Frame, H4, ZEP, 1000V Overhead Service Entrance INV 2 Voc: 38.1 Vpmax: 30.5 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER �E 150A MAIN SERVICE PANEL E; 150A/2P MAIN CIRCUIT BREAKER Inverter 1 (E) WIRING CUTLER—HAMMER 150A/2P Disconnect 3 SOLAREDGE SE3000A—USOOOSNR2 (E) LOADS g L1 iaov SolarCity �— L2 N 2 A 1 20A/2P ---- GND --———————— _ EGCI DC, DG - A —--———————————————————————— GEC ---TN DC- DC- MP1: lx8 E'3 13) I - . ---,---- EGC ————— tJ B GND -- EC—'C--------------------------- -- -------------- I , N. V 0 rl� _ GEC - -TO 120/240V SINGLE PHASE UTILITY SERVICE I I PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Y Voc* = MAX VOC AT MIN TEMP POI (1)SQUARE D#HQM220 PV BACKFEED BREAKER 6 (1)CUTLER—HAMMER DG221UR6 /fj�. Q (1)SZarCity 4 STRING JUNCTION BOX D Breaker, A 2P, 2 Spaces ' Disconnect; 30A, 240Vac, Non—Fusible, NEMA 3R A ^ x2 STR�. UNFUSED, GROUNDED C (2)Gro qd Roo 0)CUTLER— AMMER�DG03ONB = 5/8 x 8, Copper Ground�Neutral it; 30A, General Duty(DG) PV (8)SOLAREDGEP3oo-2NA4AZS PowerBox ptimizer, 300W, H4, DC to DC, ZEP n� (1)AWG g6, Solid Bare Copper a —(1)Ground Rod, 5/8' x 8'. Copper (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE � 1 AWG#10, THWN-2, Black (1)AWG #10, THWN-2, Block Voc* =500 VDC Isc =15 ADC 2 AWG#10, PV Wire, 60OV, Black Voc* =500 VDC Isc =15 ADC O (I)AWG#10, THWN-2, Red O � "(1)AWG#10, THWN-2, Red Vmp =350 VDC Imp=5.75 ADC O � (1)AWG#6, Solid Bare Copper EGC Vmp =350 VDC Imp=5.75 ADC ��—(1)AWG#10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=12.5 AAC (1)AWG/10, TIiHN/TIiWN-2,.Green. EGC•—(1)Conduit.Kit;,3/47,EMT, , , . . . , . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . _-(1)AWG#8,.TH.WN72,.Green , , EGC/GEC-(I Conduit.Kit;.3/47.EMT. . J B-0 2 6 2 7 3 6 0 0 PREMISE OWNER DESCRIPTION: DESIGN CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: CONTAINED SHALL NOT BE USED FOR THE BRIAR COOK Briar Cook RESIDENCE Rafael Castro Veramendi SolarCity BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: NOR MALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 42 MARSH LN 2.04 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENT'S MooDtE� H YA N N I S M A 026 01 ORGANIZATION, EXCEPT IN CONNECTION WITH r 24 St. Martin DrI w,Building 2,Unit 11 w THE SALE AND USE OF THE RESPECTIVE (8) TRINA SOLAR # TSM-255PDO5.18 PACE NAME SHEET: REV: DATE: Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. SOLAREDGE SE3000A—USOOOSNR2 5087763385 THREE LINE DIAGRAM PV 4 3/3/2016 (888)-SOL-CITY(765-2489) www.Warcitycom y •• go o •e e Label Location: Label"Location: Label Location: a (C)(CB) (AC)(POI) o �(� (DC) (INV) Per Code: Me o -■ Per Code: Per Code: NEC 690.31.G.3 NEC690.17.E o- o NEC 690.35(F) Label Location: :o ■ - o 0 0 TO BE USED.WHEN (DC)(INV) : ° e ■ -o ■ ■ • p INVERTER IS Per Code: wit @M UNGROUNDED - D O - NEC 690.14.C.2 Label Location:, Label Location: o 0 0 •e (dp (POI) flyl YAW rkyj Mimi_ •o (DC) (INV) man_ Per Code: _ __�_ Per Code: o NEC 690.17.4;NEC 690.54 •° ` • r•- ■ ■o 0 0 -e o •° NEC 690.53 • ■(p o- IN IMMINAININJIM Label Location: o (DC) (INV) - _ Per Code: • -o ■ ® ■ o NEC 690.5(C) . o- -o . ■ Label Location: Qp o ■ o- O (POI) " ■ •e ° -Per Code: o ■ o - NEC 690.64.B.4 T. - o 0 0 Label Location: (DC)(CB) s ° flam _ Per Code: Label Location:11*00192M . ■o rA 0 0 - NEC 690.17(4) l_. "J U'UL�JII�J (D) (POI) o :o k Per Code: J ® -o o • o -o In:•o ■ NEC690.64.B.4 ■ o 0 0■ •o ■ o Label Location: , %QQQM0w (POI) Per Code: Label Location: o 0 o NEC 690.64.B.7 . .. (AC)(POI) ■o o - e (AC): AC Disconnect D O� Per Code: ludoLwy MR9011190r (C): Conduit NEC 690.14.C.2 (CB): Combiner Box (D): Distribution Panel (DC): DC Disconnect Label Location: (IC): Interior Run Conduit (INV): Inverter With Integrated DC Disconnect �A (AC)(POI) - •" - '' - (LC): Load Center •' Per Code: � (M): Utility Meter NEC 690.54 (POI): Point of Interconnection 4 CONFIDENTIAL— THE INFORMATION HEREIN CONTAINED SHALL NOT BE USED FOR I ��.tp 41 3055 Clearview Way THE BENEFIT OF ANYONE EXCEPT SOLARCITY INC., NOR SHALL IT BE DISCLOSED I� I San Mateo,CA 94402 IN WHOLE OR IN PART TO OTHERS OUTSIDE THE RECIPIENT'S ORGANIZATION, Label Set I�'I„`�O T:(650)638-1028 F:(650)638-1029 EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE ►l (888)-SOL-CITY(765-2489)www.solarcity.com 1� SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PERMISSION OF SOLARCITY INC. o e ^SolarCity ZepSolar Next-Level PV Mounting Technology '''^SolarCity I ZepSolar Next-Level PV Mounting Technology Components Zep System for composition shingle roofs .Up-roof ' Leveling Foot . . , Ground Zep Intettock trey sde shown). - Le nslmg Foot Part No.850-1172 " _" ETL listed to UL 467 1 f " . Zep Compatlblc Zep Groove 1a Root Attachment - Array skirt i _ _ Comp Mount �..-.. Part No.850-1382 Listed to UL 2582 Mounting Block Listed to UL 2703 e`er Description • PV mounting solution for composition shingle roofs u Works with all Zep Compatible Modules °oMPptw Auto bonding UL-listed hardware creates structural and electrical bond Zep System has a UL 1703 Class"A"Fire Rating when installed using modules from • any manufacturer certified as"Type 1"or"Type 2" Interlock Ground Zep V2 DC Wire Clip LISTED • Specifications t Part No.850-1388 Part No.850-1511 Part No.850-1448 Listed to UL 2703 Listed to.UL 467 and UL 2703 Listed to UL 1565 • Designed for pitched roofs - Installs in portrait and landscape orientations • Zep System supports module wind uplift and snow load pressures to 50 psf per UL 1703 • Wind tunnel report to ASCE 7-05 and 7-10 standards • Zep System grounding products are UL listed to UL 2703 and UL 467 • Zep System bonding products are UL listed to UL 2703 1 • Engineered for spans up to 72"and cantilevers up to 24" • Zep wire management products listed to UL 1565 for wire positioning devices 4 • Attachment method UL listed to UL 2582 for Wind Driven Rain t ~ { Array Skirt,Grip, End Caps Part Nos.850-0113,850-1421, 850-1460,850-1467 zepsolar.com zepsolar.com Listed to UL 1565 r This document does not create any express warranty by Zep Solar or about its products or services.Zep Solar's sole warranty is contained in the written product warranty for This document does not create any express warranty by Zep Solar or about its products or services.Zap Solar's sole warranty is contained in the written product warranty for each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely _ responsible for verifying the suitability of ZepSolars products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. - responsible for verifying the suitability,of ZepSolar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. Document#800-1890-001 Rev A Date last exported: November 13,2015 2:23 PM - Document#800-1890-001 Rev A - Date last exported: November 13,2015 2:23 PM S®IarEd a Power 0 tieteia r 00 � =oo g P e solar solar Module Add-On for North America - o P300 / P350/ P400' SolarEdge Power Optimizer g -P300 P350 " "Go - • Module Add-On For North America O - (for60-cell PV r- ':(fo�72:cell FV' (for 96aell PVI modules) modules) modules) P300 / P350 / P400 ' ° JINPUT m ,,, Rated Input DC Pawert'� 300 350 400 W . ........ ................ _ .. ' '•- - Absolute Maximum Input Voltage(Voc at lowest temperature) 48 60 - 80, Vdc... y. f• MPPT Operating Range ......8.:48.... .. .. .....8..fio... 8 80 ..... Vdc.._ Short Circuit Current(Isc) - 10 Adc .p - ... .. ........................... ...... .............. ..... .......... ...... • _ _ a' • - Mawmum DC InputCurrenC 12.5 Adc - r Maximum Efficiency..... _ - 99.5 ............... ... �..................... ... ......... ........ .. ........ Weighted Effiuency ..........98.8.... .... ..... ..%...... ..Overvoltage Category .:'..... .......... ........................ .............ii...... .... ...... 4 , - - - :OUTPUT DURING.OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) + z .. .. , Mawmum Output Current ........... ....................... ......... ......... .... 15 ............... .... Maximum Output Voltage 60 -.,C Vdc • S:OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) - r� Safety Output Voltage per Power Optimizer - _ - 1 Vdc - - STANDARD COMPLIANCE- f z -. fMC FCC Part15 Class B,IEC61000 6 2,IEC61000 6 3, _ " Safety _ IEC62109 1(class II safety),UL1741 .. ... .. ....... .... .... .. ..... ......... .... ......... ... .... ... .. ROHS � Yes i • - -- I INSTALLATION SPECIFICATIONS, �' "' ` - y ' e "" r •• - - Maximum Allowed System Voltage 1000 - Vdc ....................................... .......:.............................................................. ...... .... .............. ............................... ... ....141x212x40.5/5.55 z834 xY 59. .. .. .. ... ....... Weight(including cables) ..........950/2.1 .. gr.lb s - „- - - Input Connector ` ....MC4/Amphenol/.Tyco • '` �' Output Wire Type/Connector Double Insulated Amphenol f _ .............................. ... ...... .......................... .. - Output Wire Length...................... ...... .........................0:95/3:.........I................................. 9.... ......... nt ..... - - :`is ,'- '� Operating Temperature Range 40-+85/-40-+185 `C/'F ......... ............ ... ... ........ I..................... - .. _ _ Protection Rating IP65/,NEMA4..............................:. - - > ............................................ ...... ..... . ,. ♦ - ,. r Relative Humidity 0 100 %...... , .�- ....... ... _ mead sre p.waf.ruh.momd.Mad.],If.oeaxc Irro],nice WI—d. J PV SYSTEM DESIGN USING.A SOLAREDGE THREE PHASE" THREE PHASE �a SINGLE PHASE INVERTER 208V 480V 4 - PV power optimization at the module-level � � �� '." - � � �,, ♦ ..Minimum String Length(Power Optimizers) ....... ... ....... 8 .. ..�..... 10 ....... ... 16 ..... ......... v- ........................... ...................... Up to 25%more energy Maximum String Length(Power.Optimizers) 25. 25 „50 - - .. .......................................................... t - - Maximum Power per String'' 5250 6000 12750 - W- - - Superior efficiency(99.5%) ............................................................. ........ ..................... .............. r. ,'.Parallel Strings of Different Lengths or Orientations Yes - Mitigatesalltypesofmodulemismatchlosses,from manufacturing tolerance to partial shading _ -,+. '••-"" "".""'•' •••"""'•"'•'...."""'-..•.••.. - Flexible system design for maximum space utilization (� .. - - .` „_, ♦ - - Fast installation with a single bolt — Next generation maintenance with module-level monitoring 4 . Module-level voltage shutdown for installer and firefighter safety { - - USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL -.AUSTRALIA WWW.SOlaredge.u5 THE Trinamount MODULE TSM-PD05.18 Mono Multi Solutions DIMENSIONS OF PV MODULE ELECTRICAL DATA @ STC it un :mm - ' ' Peak Power watts-Prnnx(Wp) % 245 � 250 ) 255 260 941 Power Output Tolerrance-P (%) 0-+3 THE URR-E. MoUht ou� Maximum Power Voltaget-Imp(V) 8.20 8.27 8.37 8.50 iu"rno" o 30.6 Maximum Power Current-IMPP(A) 8:20 8.27 6.37 8.50 I • c Open Circuit Voltage-Voc(V) 37.8 1 38.0 38.1 38.2 21 °g9='z i Short Circuit Current-Isc(A) 8.75 8.79 8.88 9.00 ' - - MODULE D 1_ ) g Module Efficiency M(Ce r 15.0 i 15.3 04-3 I 15.9 SIC:Irradiance 1000 W/ ',Cell Temperature 2S°C.Air Mass AM1.5 according to EN 609D4-3. 1 Typical efficiency reduction of 4.5%at 200 W/m'according to EN 60904-1.. o ELECTRICAL DATA @ NOCT ' ® CELL �� Maximum Power-Pmnx(Wp) � 1 182 I 186 190 � 193 Maximum Power Voltage-VemP(V) 27.6 28.0 28.1 28.3 i Maximum Power Current-I.PP(A) I~ 6.59 I 6.65 6.74 ( '6.84 MULTICRYSTALLINE MODULE `�°""°""°'"°"°" A A ) ,z-°Par"Wore - _ {Open-Circuit Voltage(V)-Voc(V) 35.1 ' 35.2 35.3 35.4 WITH TRINAMOUNT FRAME ^ . - �- Short Circuit Current(A)-Isc(A) ! 7.07 7.10 7.17 7.27 NOCT:Irradiance at 800 W/m',Ambient Temperature 20°C,Wind Speed I m/s. - - 245-26O V V �t. • PD05.18 Ste t8o Bock View POWER OUTPUT RANGE MECHANICAL DATA . ,,--'•^•.�.., J1L� Solar cells ?Multicrystalline 156•156 mm(6 inches) 1 Fast and simple to install through drop in mounting solution P g P g t Cell orientation so cells(6 x lo) € i • rf Module dimensions )1650 x 992 x 40 mm(64.95 x 39.05 x 1.57 inches) O � ---_,.- Weight 21.3 kg(47.0 Ibs) ` MAXIMUM EFFICIENCY Glass - 3.2 mm(0.13 inches),High Transmission,AR Coated Tempered Glass A-A IBacksheet White j f /r, Good aesthetics for residential applications Frame Black Anodized Aluminium Alloy with Trinamount Groove t ! l 1-V CURVES OF PV MODULE(245W) 4 IP 65 or IP 67 rated - w./y f J-Box ®~ '�/O -�- - r Cables I Photovoltaic Technology cable 4.0 mm'(0.006 inches'), ., to W - ,. 1 1200 mm(47.2 inches) POWER OUTPUT GUARANTEE Fire Rating Type Bm Highly reliable due to stringent quality control <<6m • Over 30 in-house tests(UV,TC,HF,and many more) sm m e -- AS a leading global manufacturer - .� >a.OD 49ow/ TEMPERATURE RATINGS MAXIMUM RATINGS • In-house testing goes well beyond certification requirements a of next generation photovoltaic _ am 20Dw/m' Nominal Operating Cell Operational Temperature 40-+85°C products,we believe close Temperature(NOCT) 140 maximum System 1000V DC(IEC) ( S cooperation with Our partners - - D.mU- f Temperature Coefficient of P- -0.41%/°C j Voltage 1000V DC(UL) is critical to success. With local o.m lo.m 20.m 30.m bo.m 1 1 d . J presence around the globe,Trina is - voltage(v) Temperature Coefficient of Voc f-0.32%/°C `Max.Series Fuse Rating - -`15A 4 service exceptional se le to provide ezce o _ °c able p p �Temperature Coefficient of Isc ,0.05%/ t to each customer in each market f' r Certified to withstand challenging environmental -- - - - --- and supplement our innovative, conditions reliable products with the backing \ • 2400 Pa wind load `,.. a of Trina as a strong,bankable WARRANTY - $400 Pa SHOW load g partner. We are committed 10 year Product Workmanship Warranty to building strategic,mutually beneficial Collaboration with 25 year Linear Power Warranty - installers,developers,distributors (Please refer to product warranty for details) and other partners as the backbone of our shared success to CERTIFICATION driving-Smart Energy Together. LINEAR PERFORMANCE WARRANTY (VL us SA' PACKAGING CONFIGURATION a' 10 Year Product Warranty•25 Year linear Power Warranty O av� Modules per box:26 pieces w Trina Solar Limited - - f - E www.trinasolar.com per 40_container.728 pieces ^ 31ooz AdJ F ditional vpll EomePUAm i �onr.NnpSol S ljhepj n c walla CAUTION:READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. GOMVAT� Q o u ; C O 2014 Trina Solar Limited.All rights reserved.Specifications included in this datosheet are subject to �i• ?T uPon�solar O BDB _ ____ on-asolar change without notice. Smart Energy Together rears r D Is zo 25 Smart Energy Together p°eg9n�e I3 Trina standard O Indumy_tandard - solar ' Single Phase Inveters for North America SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US VoIaQ SE760OA-US/SE10000A-US/SE1140OA-US .yT xi r+ sm,.r rOUTPUT : SE3000A-US SE3800A US SE5000A US : SE6000A US .0 SE7600A US SE10000A. S SE1140OA-US SolarEdge Single Phase Inverters IQC Nominal AC Power Output 3000 3800 5000 •6000. 7600. 100 0�240y. 11400 VA VV ��_--�� - 540 10800 @.208V 0 @ 208V - {_ Max.AC Power Output - 3300 - 4150 6000 8350 12000 VA For North America ............... .......E......... . ........ . ..............5450.Q240y.. ..... ... . ........ ......io9sq.@2agy ........ .. . ........... AC Output Voltage Min-Nom:Max.I1i . > 183-208-229 Vac . - - .... ......... ........ ......... SE3000A-US/'SE380OA-US/SE5000A-US/SE6000A-US/ .......... .Volt.. .-No .Max.... .......... :..... 'y � AC Output Voltage Mln-Nom-Max!'I SE760OA-US/SE10000A-US/SE11400A-US 211-24o-264Vac . ......................: .... ...... ..................... AC Frequency Min.:Nom-Max.(') :_. ;593:60 60:5(with country setting 57 60 60.5) Hz - _ 208V 48 @ 208V L40 .21 2.... I................I.............':..L.42 @.240V. I,.:...... - - •• - Max.continuous Output Current 12 5 16 25 32 47 5 A G DI Threshold ? - v ................... .....Y ..... ......... ...... .......:; .... ...... ....... Utility Monitoring,Islanding Protection,Country.Configurable Thresholds Yes, - Yes 1INPUT s M' ttt - e�-. Maximum DC Power 4050 -.5100 6750 9100. '10250 13500 t 15350.. W ,avert .. ..... Transformer-less,Ungrounded Yes -'r 12L ..................... � Max.Input Voltage - S00 ... - ,- ...................... .......1..... . L 3 o YdefCalttY 'I Nom.DC Input Voltage 325 @ 208V/350 @ 240V .Vdc .. .Fr ,.. .......... ............. ........ .... ... ... ........ ..... a "'• +at�eNa�':�A Max.Input Currenthl - 9.5' 13 16.5 @ 208V .18 23 33 @ 208V 34.5 Adc �•t ............................................ ................I..�.:..........L.15:5.(p1.240y.a:... ... ...:.I........ .......I'..30-.5. 240V..I............................. - .. Max Input Short Circuit Current -45 - Adc ,........... Reverse-Polarity Protection Yes ..............rote....... - Ground-Fault lsolation.Detectione 600ka Sensitivity - Maximum Inverter Efficiency 97 7 98.2 98 3 98 3 - 98 98 98 �' o , - ....... .........."..) .::.I,998 P•240V..I. .. .........L....... .. ..975 @2240V. (....................::...... 1 - CEC Weighted Efficient 97 5 98 97 5 97 5 97 5 R v ..... .. ..... g Y Nighttl me Power Consumption. <2.5 <4 - W ¢ P _ ADDITIONAL FEATURES j Supported Communication Interfaces RS485,RS232,Ethernet,ZigBee(optional) Revenue Grade Data,ANSIC121 - __..... optional(3) ,. ... .. ..._ ................................ ... .. . ... Rapid Shutdown-NEC 201 l t STANDARD COMPLIANCE69 d. 0.12 .Functionality enabled when SolarEdge rapid shutdown kit is installed(4) 1`"." r" S a'""�"•r�y '+�a - Safety UL1741 UL36998 UL1998 CSA 22.2 .:............. ...... :..... .. .. ... Grid Connection Standards.. ..... r ... IEEE1547 ... ....r- ..... . -. .................. ........ -_ Emissions f FCC part15 class B:. ' •-' � f i INSTALLATION SPECIFICATIONS > ` P a .p J )noutput conduit size/AWG range 3/4 minimum/16 6 AWG - 3/4 minimum/8-3 AWG " DC Input conduit sae/#of strings/ - -. 3/4 minimum/1-2 strings/ s 3/4 minimum/1-2 strings/16 6 AWG AWG rang?...... ...... .:...... ......... ........ ....... ......... ... ....14-6 AWG..: ... .. _ Dimensions with Safety Switch 30.5 x 12.5 x 10.5/ in/ 305x 125x72 775x315x 184 1y / i 'S,,:, ..•" �$ y', I - ..(HxWxD)....:...:......:...... ................................................................................... 775 x 315 x 260• min.... :Weight with Safety$witch.. ••:..... ....512/232:.............. 547/247.•. •• - 88.4/40.1 lb/.kg.,, ` 3 t ..... ... - 4 ...Natural - ..... ..... . .,.., .. . . �,..•�..�s�.. . .,.. ... • -.- •" ..' - - convection .. Cooling ,.'+ .. Natural Convection" and internal- Fans(user replaceable) fan(user The best choice for SolarEdge enabled systems _ replaceable). . Noise . . <25 <SO ...dBA... Integrated arc fault protection(Type 1)for NEC 2011 690.11 compliance Min:Max.operating Temperature 13'to+140/-25 to+60(-40 to+60 version available(sl) 'F/•C Superior efficiency(98%) Range............ ......... ........................................................... ........... Protection Rating NEMA 3R Small,lightweight and easy to install on provided bracket I hlForotherregionalsettingspleasecontact5olarEdg support. IA A higher current source maybe used;the inverter will i mit its input current to the values stated. - Built-In module-level monitoring - pl Revenue grade inverterP/N:SE—A-U5000NNR2(for 760OW'nverter.5E7600AUs002NNR2). • • - , ) I°I Rapid shutdown kit P/N:SES000-RSD-51. .Internet Connection through Ethernet Or Wireless - Isl-00 version P/N:SExxxxA-USOOONNU4(for 760OW Inverter:5E7600A-US002NNU4y. y _ - Outdoor and indoor installation a : a" Fixed voltage inverter,DC/AC conversion only - Pre-assembled Safety Switch for faster installation - Optional-revenue grade data,ANSI C12.1 rrt�^` sunsae 0. r USA-GERMANY-ITALY-FRANCE-JAPAN-CHINA-AUSTRALIA-THENETHERLANDS-ISRAEL WWW.SOIaredge.US o �, • JtS4 t