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0035 PRINCESS PINE ROAD
i t 4-Al 777- -- -- - - - i Town of Barnstable Buildin i� r s z�y r"° �:u"""�, i�:..; ,� � .J � 4 �� � '"a '��` � ',. �v�` ,a" '�r;;s '»c�`?� z� .'�° �,;'fir „s5 "y'" ,. " Post..This Card So That rt is;V�s�ble From the Street„ A roved,Plans Must;be Retained,on Job and this Card Must::be Kept ; 74ASBAWMA& tUntil Final Inns ecfion Has BeenplVlatle pp r ..- ere�a Gertifi�cateof Occu anc "Is Re uiretl�such Bu�ld�n shall Not be Occu ied,until a F.mal Ins`action has been made Permit Permit NO. B-18-364 Applicant Name: Carl Rebello Approvals Date Issued: 02/26/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 08/26/2018 Foundation: Location: 35 PRINCESS PINE ROAD, HYANNIS Map/Lot: 269-090 Zoning District: RB Sheathing: Owner on Record: IGOE,SEAN D&SARA LEROYI C ntractor Name Carl J Rebello Framing: 1 $� Contractor Licenser CS-084358 Address: 35 PRINCESS PINE ROAD ; y' , 2 HYANNIS, MA 02601 . � Este PebjOct Cost: $4,444.00 Chimney : Description: Insulation,Air Sealing&Door Weatherstrippid ` Permit Free: $85.00 Insulation: Project Review Req: I I Fie Paid $85.00 Date 2/26/2018 Final: � �` k �� r fey Plumbing/Gas 15 Rough Plumbing: • � - a , Building Official Final Plumbing:. This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and str:,ktures shall be in compliance with the local zoning,by laws and codes. Final Gas: 4' iaz z� This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fo6',,p6bIi6J6sp&tion for the entire duration of the work until the completion of the same. Electricai `. � x� x The Certificate of Occupancy will not be issued until all applicable signatures,bythe Building and Fire Officials are providedo this permit.- Service: Minimum of Five Call Inspections Required for All Construction Work:; A 1.Foundation or Footing. , � � •, Rough: s.aa.....�� 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection LOw Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT EMAat.. $frN� Assessor's office(1st F.loor): � (j Assessor's map and'lot number �� �< 0 �Ft7C SYSTEM UST Be" %THE T . _.. LED 1N COMPLIANCE dQ� Board of Health(3rd floor): F �' '� o Sewage Permit number ��_ ® VWTH LE • y r• - Z DARISTMU i Engineering Department(3rd floor): a .eu'6 6' MENTAL CODE AND moo rb 9 House number '�' W&RECULATSONS Definitive Plan Approved by Planning Board• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only L TOWN ' OF BARNSTABLE i. BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION Z4,,o6,DmG1� ��- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc ding to the following information: Location V Proposed Use 79i QG/�S Zoning District - i Fire District S Name of Owner -:5:4 r»-c�— G170 m-o o S IJ 4 Address Name of Builder �SAr3'YC� Address Name of Architect Sib Address // Number of Rooms Z Foundation f/n 0 Exterior V�/ Roofing7V �{ Floors A -tl Interior dry Cv q LL. Heating Plumbing n Fireplace `7/.L+ Approximate Cost Area Diagram of Lot and Building with Dimensions Fee _ V 7 -- a -A OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ing the above/9 k I const►u Z / o4 ' /'U 1 Cons ruction Supervisor's License UF, JOHN ADD TO Noi 33668 Permit For DWELLING Single Family Dwelling *r Locatio(�Princess Pine Rd. Hyannis I� Jo hn Owner J LeBoeuf Type of Construction--- Wood Frame .F Plot Lot - l Permit Granted April 13 .19 go = Date of Inspection '19 Date Completed., -y 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.2,GC1 Parcel OctO �ppolicationl #f Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address P6,n cos ae— Village « r\ ; ,p Owner e_Ccdl C�01 Address �S Pr:t\c e_ 1 nepip Telephone a 3 G 7® 6:31 0 Permit Request � C�l 2Z LG 2�o w cJ+ l�tc le-S run fie.e` Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay rro Project Valuation cK —, Construction Type So Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes. LdNo On Old King's Nighway: -U Yes No; r'I l Basement Type: Q Full ❑ Crawl ❑Walkout ❑ Other r ' Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)l Number of Baths: Full: existing new Half: existing nevi` ; 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 ,So l n LLCAPPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number J� '�2�� Address 9' l ��GT l��[w License # r 1 2-17 5 r,xS /"I <��S jM A 0Z(04S � Home Improvement Contractor# 1755-79 Worker's Compensation # ii 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOcS't\Stgb� 1 : �c1 Q J SIGNATURE DATE 1J f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: i; FRAME A-1 iINSULATION.i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING t DATE CLOSED OUT - `i ASSOCIATION PLAN NO. f i The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations I Congress Street, Suite 100 Boston,-MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization'Name:Solar Rising Address: P.O. Box 2,623 C ity/State/Zip.:Mash pee Ma 02649 Phone #:508-744-6284 . Are you an employer? Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees (full and/ 5. ❑ Retail` or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑® I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales(incl. real estate, auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. .❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers"comp. insurance required]** 11:❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, Solar Installer with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. S I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: ` City/State/Zip:, Policy#or Self-ins.fLic. # Expiration Date: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby�1,tify, under the pains and penalties ofperjury that the information provided above is true andcorrect Si2nature: Date: 8/14/14 Phone#:508-744-6284 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. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone#: www.mass.gov/dia - t cap Office of Consumer.Affairs and Business Regulation 10 Park Plaza - Suite 5170 I Boston, Massachusetts 02116 rr Home Improvement Contractor Registration Registration: 175578 PF Type: LLC Expiration: 5/28/2016 Trtf 252367. r : #W 4 SOLAR RISING LLC. CHRISTOPHER PETERS:ONJi P.O. BOX 2623 MASHPEE, MA 02649 `,-Update Address and return card.Mark reason for change. . i Address' ', Renewal Employment �` Lost Card -,SCA 1 cs 20M-05111 &WO 1!?ca�t�rd�zcuettlat e t �GGc3:fte�luJefl3 P;C�-N Offiee of Consumer Affairs&Business Regulation License or registration.valid for individul use only UqME IMPROVEMENT CONTRACTOR before the'expiration date, Iffound return to: gistration. 175578 Type: Office of Consumer Affairs_and Business Regulation xpiration 5/28/2016 , LLC 10 Park Plaza-Suite'5170 F Boston,MA 02116 SOLAR RISING CHRISTOPHER PETERS OW' � 759 FALMOUTH RD ' MASHPEE MA 02649 Undersecretary Not valid without signature obi & taschlaesettn �fdf ;Otte s� el ' E3oatd o€�?ut#drn�Re� ��f �~<s.-a�r3�taftcnrcf s ,' ehse CS 1023'.5 dbklSTf HERC0ETFR.i 41 THATCHER fFOLWAX ROAD i' MARS.ONS M1f B MA'4176U." -. � y t xtt'ati ':. ^ 1aQir#1rlissia Ytet q 10/0N164, : COASTAL ENGINEERING COMPANY, INC. 260 Cranberry Highway, Orleans, MA 02653 n 508.255.6511 s Fax 508.255.6700 n c6astalengineeringcornpany.com August 25, 2014 Project No. C18180.00 Mr. Neal Holmgren Solar Rising PO Box 2623 Mashpee, MA 02649 - RE: Solar Roof Mount Installation 35 Princess Pine Road Hyannis, MA Dear Mr. Holmgren: At your request, we have reviewed the existing roof structure located at the referenced residential property relative to proposed solar panel installation. We understand that for the installation of the solar mounting;the Unirack Solarmount Rails will be anchored perpendicular to the rafters with L-foot supports with Ecofasten Green-Fasten flashing and ECO-CPOSQ Brackets located on the center of the rafters. The rails will be securely fastened to the rafters at 48' sp. max.with 5/16"x 3,1/2"lag bolts on every rafter. We have evaluated the adequacy and structural integrity of the existing roofing (one layer shingles): 2" x 6"rafters at 16"o.c, having a horizontal distance 13":200 pitch for mounting solar panels. Their installation will satisfy the structural roof-framing design-loading requirements of the Massachusetts building code-780 CMR Residential Code 8'h Edition. However,to provide additional stiffness,we recommend installing additional 2x4 braces in the attic at mid span at each rafter supporting the Unirack mounting rails. Therefore, based on calculations performed in accordance with the Massachusetts State Building Code- 780 CMR-81h Edition (IRC-09& MA Code Amendments),we find that the aforementioned photovoltaic. system and mounting assemblies will comply,with the applicable sections of the residential code and the loading requirements of roof mounted solar collectors. Very truly yours, COASTAL ENGINEERING CO., INC. ohn A. Bologna, P.E. President JABljak D:IDOCIC18100%181801Doc-Outl2014-08-25 SolarRocfMount Installation Repod.doc ®Providing solutions for the benefit of our clients and community , a. Solarx, LLC P.O. Box 2623, Mashpee MA 02649.508-744-6284. Fax 508-744-6283.www.SolarRising.net This agreement is made effective as of August 6th,2014 by Solar Rising LLC of Mashpee, Massachusetts (Here in after referred to as the service provider)and Sean Igoe of Hyannis Massachusetts(herein after referred to as the Owner).Whereas funds are made available from the Massachusetts Clean Energy Center(here in after referred to as Mass CEC)of$3,250 the parties agree as follows, in consideration of total system cost of$22,176($3.60/W x 6,160w). Solar Rising will acquire and retain the Mass CEC rebate reducing the total system cost of the system to$18,926 The service.provider agrees to: 1. Professionally evaluate the site for optimum system performance,structural integrity of the mounting area and compatibility of electrical system for interconnect. 2. Prepare,submit and complete all rebate applications. Facilitate all permitting and system interconnection,and acquire PE stamps as necessary. 3. Professionally prepare site,purchase and install a 6.16kW Pv system: 22 LG 280W solar panels(or comparable),racking for 'panels,Siemens/Enphase M250 micro inverters(or comparable),all wiring,conduit,and disconnects to comply with the National Electric Code of 2014,all applicable state and local building codes and laws,and Commonwealth Solar II rebate requirements. 4. Apply for building permit within 30 days of receiving initial deposit. S. Complete the installation within 60 days of receiving your Mass CEC approval letter. 6. Commissioning and verify that the system is working to specifications. Educate the owner about system operation and - maintenance. V 7. Warrant all equipment and workmanship for a period of 5 years from the date of completion,except for acts of god beyond the control of the service provider. The owner agrees to: 1. Make deposit payment of$6,308 upon signing of the contract. 2. Make a payment of$6,308 prior to start of installation. 3. Make payment balance of$6,310 within 30 days of final building permit inspection. 4. Provide required documentation for MassCEC and Allow MassCEC to inspect the installation site. 5. Removal of tree limbs to make the 80%requirement for the MassCEC Dispute Resolution Claims,disputes or other matters in question between parties to this agreement which arise prior to or during construction shall be resolved by arbitration in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association currently in affect unless the parties mutually agree otherwise The demand for arbitration shall be filed in writing with the other party to this agreement and with the American Arbitration Association.The award rendered shall be final,and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof.- d 11 Own signature-Sean Igoe Date L Contractor's signature-Christopher Peterson,CSL,Owner,'Solar Rising LLC Date Grid Tied Photovoltaic System DC Rating 6.16 kW Igoe, Sean Site Details: All Work To be in Compliance with: Solar Rising Shall install a 6.16 kW Grid-tied 2011 National Electrical Code (NEC) Photovoltaic system comprised of (22) LG280-S1C-B3 2009 International Residentail Code (IRC) Modules.with (22) Enphase Energy M250=60-2LL Micro- 2009 International Building Code (IBC) Inverters. The Modules will be flush mounted.to the 2012 International Fire Code (IFC) composition shingle roof and interconnected via line side MA,780 CMR 81h Edition tap. ASCE/ANSI 7-05 Minimum Design Loads for Buildings and other Structures. Equipment Specifications: Modulesn(22) LG Solar 275S1C-63 ,y Inverters: (22) Enphase Energy M250-60-2LL Racking: .Unirac Solar Mount Attachments: Eco-Fasten Green-Fasten flashing with 3 1/2 Stainless Steel Lag Bolts Roof Specifications: .a Roof 1: Roof 2: Composition Shingle Composition Shingle 2X8 Rafters @ 16" O.C. 2x6 Rafters @ 16" O.C. Pitch: 450 Azimuth: 180° Pitch: 190 Azimuth: 1800M1189-9 _ h w Site Specifications: Occupancy: 11 .� r � , r�'..,,,�•#'t,,„�,,„�...*- k ^,�r�, .mom .,.,,�''?*`E �_ Design Wind Speed: 110 MPH Mean Roof Height: 10ft Ground Snow Load: 35 PSFKIN v Solar Rising LLC Project: . Igoe Sean Solar Rising Building Permit Plans - Revision: 8/14/ 4 ar 508 744 6284 1 S0 PO Box2623 35 Princess-Pine Rd, Scale: None /2 i s i r-7 c, Mashpee, 'Ma 02649 Hyannis, Ma 02601 Drawn By: Chris Peterson 2x4 Braces Added to * Rafters Every 48" Where ROOF UniRack Attaches to Roof Roof 2 �- 5' /\ \ 13, 2x8 @ 16"o.c. „ 12 Pitch 153 2x6 @ 16" o.c. Solar Rising LLC Project: Sean I9 Oe Solar Rising Building Permit Plans Revis Solar 508-744-6284 35 Princess p i ne, rd. Revision: 8/14/14 s n PO Box 2623 None Mashpee, Ma 02649 Hyannis Ma 02601 Drawn By: Chris Peterson e Roof 1 Roof 2 22.75ft 17ft w M M N LO L----------—1 Quantity of attachments = 38 @ 48",O.C. Maximum UniRac Rail span = 48"O.C. -Maximum Allowable Cantilever = 20" . -Racking and Attachment: UniRac Solar Mount with Eco-Fasten Green-Flashing with'L-102 3" L Bracket and Aluminum Flashing with lag screw, Hex Head,-18-8 SS 5/16" x 3=1/2" Leangth. -UniRac Requires one Thermal Expansion Gap Every 40'. -Array Installed According to the UniRac Solar Mount Code-Compliant Installation Manual Solar Rising LLC Project: Sean Igoe Solar Rising Building Permit Plan SO ar 508-744-6284 35 Princess Pine rd Revision: 8/14/14 � PO Box 2623 Scale: None Mashpee, Ma 02649 H annis Ma 02601 1 Drawn By: Chris Peterson I Life's Good Mangy M451 .o W .1 LG Electronics,Inc. (Korea Exchange:06657.KS)is one of the globally leading companies and technology innovator for electronics,information IJ and communication products.The LG Electronics currently employs more than 91,000 people worldwide in 117 companies.In fiscal year 2011, a 48.97 billion USD of revenue was achieved. 4 LG is one of the world's largest manufacturers of MOO llit i, mobile phones,flat screen Ns,air conditioners, y washing machines and refrigerators.As a future- [Hill � u oriented company,LG enables others to use technology consisting of renewable energies. LG's high quality solar products are being manufactured in LG's leading production facility in South Korea. APPROVED PRODU ( D E C U� US axs �t O VV ---- ® I KM Bs EN 67275 Phw—lhotor�liaic Modules -.Sic`. �f _ LG's High Efficient Cell Technology ® D Convenient Installation 9 ® =_ Driven by LG's own N-type technology, LG's high- LG modules are carefully designed to benefit 5 efficiency modules will provide customers with installers by allowing quick and easy installations Lull ieehnetogy ; �enicrs high economic benefits. ;u�s_n .throughout the carrying,grounding,and connecting stages of modules. 16.6k9 Light and Robust 100%a EL Test Completed 9 P p With a weight of just 16.8 kg,LG modules are . All LG modules pass Electroluminescence proven to demonstrate outstanding durability t ! inspection.This EL inspection detects cracks and against external pressure up to 5400 Pa. other imperfections unseen by the naked eye. Reliable Warranties Positive Power Tolerance LG stands by its products with the strength of a LG provides rigorous quality testing to solar global corporation and sterling warranty policies. modules to+assure customers of the stated power L=near Warranty L� LG offers a 10 year product limited warranty and a. outputs of all modules,with a positive nominal pmat—P—, 25 year limited linear output warranty. tolerance,starting at 0% 7 r° .a, n J o erg; a if W +.: Q Mechanical Properties ® Electrical Properties(STC") Cells * " 6 z 10 _ 30O W 295 W 290 W 285 W 28O W ...................._....1............._.�._.-_.__..................... ..._ w Cell vendor ' LIS MPP voltage(Vmpp) 32.0 31.9 - 31.8 31.6 31.5 ....................._....._.._�. �__._... �__�. Cell type Monocrystalline �� MPP current(Impp) 9.42 9.30 9.19 9.09 8.97 Celldimensions 156 x 156 mm'/6 x 6 In'- ..............,............-..................,.............. ..-......-.......................................................... .............. .. ... ___��.______ Open circuit voltage(Voc) 39.5 393 39.2 39.0 38.9 #of busbar 3 - ...................._.............,--..........,..................... ............................................._............-......... .......... _ __�__._._:._....._............_...____.;. _.�__._: -- Short circuit current(isc) 10.0 9.91 9.80 9.68 9.56 Dimensions(L x W x H) 1640 x 1000 x 35 mm -.........:................._.._.._...........-...._.....--...................................--.................-..............................................,,, _.__.__.__........_...__ -..-,..__-.-_ 64.57 x 39.37 x 1.38 in Module efficiency(%) 18.3 18.0 177 17.4 171 Static'snow load 5400 Pa/113 psf Operating temperature('C) -40-+90 ................_....,......._....__.._..-.__..._....._.................................__._....._._........_.. _._._...._..r ...........................................................,............................................................................................................. Static wind load 2400 Pal 50 psf Maximum system voltage(V) 600(UL),1000(IEC) ._........ - ..._..... - ._...........---..._._-:..........._-__...._...__._._-_ .._ ____._. ................__...-".................-.................._........................................................"................................................ Weight yNV - 16 8'±0.5 kg/36.96±1.1 lb Maximum series fuse rating(A) 15 ............ .............................. ................................... ..............................._................................... Connector type,, MC4 connector IP 67 power tolerance(%) 0-+3 . _......_ _____ _..___�_,.__ _.. ___ __ Junction box IP 67 with 3 bypass diodes ........._......__..__...._._...._...___....-.__"_._...__._,..:__..._......"_.___._-..r�.._._..-.._..____.__.____, STC(Standard Test Condition):Irradiance 1000 W/mz,module temperature 2,r'C,AM 1.S ,Length of cables 2 x 1000 prim/2 x 39.37 In °")he nameplate power output is measured and determined by LC Electronics at its sole and absolute discretion. Glass _ - - - High transmission tempered glass_ 1 _. Frame. Anodized aluminum ® Electrical Properties(NOCT*) 1_ 0/Certifications and Warranty ' 30O W 295 W 290 W 285 W 28O W ..................................."........._............................................................,..................................... ....... Certifications IEC 61215,IEC 61730-1/-2,UL 1703, Maximum power(Pmpp) 220 216 213 210 206 _........._.. _.._.»- _ _.._..__ .................................................................................................................._......._....................................... ISO 9001,IEC 61701(In progress), MPP voltage(Vmpp) 29.3 29,2 29.1 28.9 28.8 ......._......_..........._.... .......... DLG-Fokus Test Ammonia Resistance' MPP current(Impp) 7.51 } 742 7.33 7.25 7.15 (In progress) _........-.._................. ..............:.............................................................................................................. _s.:..._......:'_.....,.__....-......_,...._..__.._..,...._....,.._..... .._.:._..._._. .,. ..__ Open circuit voltage(Voc) .36.5 36.3 36.2 36.0 35.9 Product warranty 10 years Output warranty.ofPmax + � Short dreuitcurrent(Isc) 8.08 7.98 789 Z80 7.70 Linearwarranty' . .ffi..............re c.tio.........._........-. .. ...........................<.. ...-..,,......-....._...................-....... (measuremenrTolerance. t:3%) '. Efficiency reduction ') <4.5 '1)1st year 97 h 2)After 2nd year 0.7%annual dogradation,3)80.2%for 25 years 1• (fmm 1000 W/ms to 200 W/mT) NOCT(N-in'al Operating Celt Tcrnperature):Irradiance 800 W/m�,ambienl temperature 20 Qtemperature Coefficients wind speed I ml. NOCT 45±2'C loro,4o 10/0.40 ............. _......... ......._...... --...__....__.._....._.._.. Pmpp -0.42%/K ® Dimensions (mm/in) Voc. .. --...._............._.......__ °0.31 6CK r Ise O Characteristic Curves - 1000r9.37 Zen''° zz/o.ei ss•4.o tx.�.) tsaeaa-tee) long side frame Shudslde frame - Grain htles(4aa) , Q 10 1000w -4.WTS(Y-) 96o/37w . C 9 Rein Aatea(Ma) (Oizranae behaean movmlep h 4 - v F s - Soow 4en.e9 °I 9 _ u. 7 ) � Jun.n'on bea . 6 600W - G.oueairy 6aezltzea) (.) l.) 5 e-jasolz A-) � - 400 W Haunting htlezlee,l 8 200 W 100039.37_..y, 2 .. able terrarh o 1 _ _ 5 10 15 20 25 30 35 40oliage(V) pis/o.os ( 140 r _- .4 .E Detail x o - £ ri i! a0J0.16 x 12o _ E - - - -::_.__...._._..__._. ... _ o ° g gs � a loo {sc y a d " 0 80 Voc is De+>;ly 944137.17 0a/o.m Pmax 60 . 1 --- - - - - - ---------- <. � anti z , 0 � w o n G o �_ 3snae -40 -25 O _ 25 \50 75 9oTerrlpe-ture I'Q ,•The distance between the cotter of the mounting/grounding holes /A North America Solar Business Team Product specifications ate subject to change without notice. 4 a - LG Electronics U.S.A.Inc "LG Life's Good'is a registreted trademark of LG Corp V 1000 Sylvan Ave,Englewood Cliffs, All other trademarks am the property of their respective owners. a�� NJ 07632 ,[ Copyright©2013 LG Electronics.All rights reserved. Ls i efs Good Contact,.Igsolar@Ige.rnm a _- www.l solarusa.com 03/01/2013 A F7tt::tGt;Gi6�lQbiPlitiY U IN I I"K'4A C SolarMount Mid Clamp Part No.302101C,302101D;302103C,302104D, 30210513,3021061) ! Mid clamp material: One of the following extruded aluminum 'derrafe Bolt alloys:6005-T5;6105-T5,6061-T6 Fla'ri a Nuts / • Ultimate tensile:38ksi,Yield:35 ksi Clamp Finish: Clear or Dark Anodized • Mid clamp weight: 0.050 Ibs(23g) Allowable and design loads are valid when components are f , s assembled according to authorized UNIRAC documents #A Values represent the allowable and design load capacity of a single " mid clamp assembly when used with'a SolarMount series beam to retain a module in the direction indicated Assemble mid clamp with one Unirac%"-20 T-bolt and one%"-20 9 " ASTM F594 serrated flange nut } Use anti-seize and tighten to 10 ft-Ibs of torque Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third- party test results from an IAS accredited laboratory Applied Load Average Allowable Safety Design Resistance i•ao osru�cc Direction Ultimate Load Factor, Load Factor, WMIVI MOOLUM Ibs(N) Ibs(N) FS Ibs(N) (1) a ., Tension,Y+ 2020(8987) 891 (3963) 2.27 1348(5994) 0.667 -- - ---= Transverse,Z± 520(2313) 229(1017) 2.27 346(1539) 0.665 Y Sliding,X± 1194(5312) 490(2179) 2.44 741 (3295) 0.620 �x Dimensions specified in inches unless noted SolarMount`End Clamp Part No.302001C,302002C,302002D,302003C, 302003D,302004C,302004D,302005C,302005D, 302006C,302006D,302007D,302008C,302008D, 302009C,302009D,302010C,302011C,302012C End clamp material: One of the following extruded aluminum _ alloys:6005-T5,6105-T5,6061-T6 130� Ultimate tensile: 38ksi,Yield: 35 ksi "` - Finish: Clear or Dark Anodized End clamp weight:varies based on height: --0.058 Ibs(26g) Clamp Allowable and design loads are valid when components are Seriated. � assembled according to authorized UNIRAC documents Flange Nut Values represent the allowable and design load capacity of a single r end clamp assembly when used with a SolarMount series beam to M retain a module in the direction indicated A Assemble with one Unirac Y<"-20 T bolt and one'/°-20 ASTM F594 serrated flange nut Bea ;vY Use anti-seize and tighten to 10 ft-Ibs of torque ,✓' Resistance factors and safety factors are determined according to part 1.section 9 of the 2005 Aluminum Design Manual and third- Y party test results from an IAS accredited laboratory Modules must be installed at least 1.5 in from either end of a beam .x is Applied Load Average Allowable Safety Design Resistance Direction Ultimate Load Factor, Loads Factor, Ibs(N) Ibs(N) FS Ibs(N) (1) VA3ES tiv,tn Tension,Y+ 1321 (5876) 529(2352) 2.50 800(3557) 0.605 monw; # o Transverse,Z± 63(279) 14(61) 4.58 21 (92) 0.330 Sliding,X± 142(630) 52(231) 2.72 79(349) 0.555 Dimensions specified=in incViesunl&ss noted "UNIRAC :;NII-li GRQtIP Cl)FAPFlFSI' 0 V'k 0 SolarMount Beam Connection Hardware SolarMount L-Foot Part No.304000C, 304000D ` • L-Foot material:One of the following extruded aluminum alloys:6005- T5,6105-T5,6061-T6 -' Ultimate tensile: 38ksi,Yield:35 ksi s +" •- Finish:Clear or Dark Anodized °. L-Foot weight:varies based on height:-0.215 Ibs(98g) Allowable and design loads are valid when components are assembled with SolarMount series beams according to authorized ' Bea ,f - F Bolt" UNIRAC documents �.. L=Foot For the beam to L-Foot connection: •Assemble with one ASTM F593 W-16 hex head screw and one errated ASTM F594'/e"serrated flange nut Flange Nu •Use anti-seize and tighten to 30 ft-Ibs of torque Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third-party test Y results from an IAS accredited laboratory NOTE: Loads are given for the L-Foot to beam connection only; be sure to check load limits for standoff,lag screw,or other attachment method Applied Load Average Safety Design Resistance c rrYFan.. I ' Direction Ultimate Allowable Load Factor, Load Factor, Ibs(N) Ibs(N) FS Ibs(N) 0 i t"_ Sliding,Z± 1766(7856) 755(3356) 2.34 1141 (5077) 0.646 Tension,Y+ 1859(8269) 707(3144) 2.63 1069(4755) 0.575 Dimensions specified in inches unless noted Compression,Y- 3258(14492) 1325(5893) 2.46 2004(8913) 0.615 Traverse,X± 486(2162) 213(949) 2.28 323(1436) 0.664 l r Y Y i i v s"UNIRAC.13 e A MI:T!GROUP IONAPANY ' SolarMount Beams Part No. 310132C, 310132C-B, 310168C, 310168C-B, 316168D 310208C, 310208C-B, 310240C,310240C-B, 310240D, 410144M,410168M,410204M,410240M Properties Units SolarMount SolarMount HD Beam Height in 2.5 3.0 Approximate Weight(per linear ft) plf 0.811 1.271 Total Cross Sectional Area in' 0.676 1.059 Section.Modulus(X-Axis) in 0.353 0.898 Section Modulus(Y Axis) in' 0.113 0.221 Moment of Inertia(X-Axis) in 0.464 1.450 Moment of Inertia(Y Axis) in 0.044 0.267 Radius-of Gyration (X-Axis) in 0.289 1.170 Radius of Gyration (Y Axis) in 0.254 0.502 s - z & s - .' -1 a. SLOT FOR T-BOLT OR SLOT FOR T-BOLT OR 1.728 1/4" HEX HEAD SCREW 1/4"HEX HEAD SCREW 2X SLOT FOR SLOT FOR BOTTOM CLIP 2.500 BOTTOM CLIP T 3.000 1.316 SLOT FOR L2 3/8" HEX BOLT SLOT FOR 1.385 3�" HEX BOLT .387 .750 1.207 y y, 1.875 A ►X ►X SolarMount Beam SolarMount HD Beam Dimensions specified in inches unless noted I James A.Maras,Jr RE 10 High Mountain Road Ringwood,NJ 07456 E-mail.jamlght@verizonnet October A 2011 Unhe.Inc. 1411 Broadway Blvd.NE Albuquerque,NM 87102 To Building Department or Others: RE. Engineer's Notice of Evaluation foz UniRac SolarMountTM Universal PV Module Mounting:System for application to One and Two Family Dwellings in Massachusetts Dear Sir; I have reviewed Unirac SolarMountTM"Code-Compliant Installation Manual 227",and certify that the information'and results are accurate:To determine the design jevel.forces, the appropriate wind speed shall be determined as prescribed by local jurisdiction requirements and applied in accordance to the Eighth Ed.of the 780 CMR Massachusetts State Building Code(flue and Two Family Dwelling)& Massachusetts Ammendments (2011)requirements where the Massachusetts Amendments contains repbace e Table R301.2 for wind speeds and ground snow..'_ The 780 CMR requires that wind loading be determine.(.based upon International Building Code-2009 or International Residential Code-2009-and ASCE 7-05.Unirac's Manual+22,7 utilizes ASCE 7-05 for which Unirac Table 2 is based upon,`and that is dependent upon conditions of spatial form,height and other structure parameters that are specified-in the code provisions for determining the,`applied wind loading pressures imposed onto the Unirae SolarMouriMl rails supporting solar panels.The SolarMountTM railing and�anchorage requirements;for the installation are,properly,represented in the Installation Manual 22-T For other conditions,the..determination of wind pressures-should.be determined by the aforementioned International Building Code=2009 and ASCE 7-05 procedures. The International Building.Code requires that wind loading be determined based upon ASCE 7-05 Simplified Method 1 or.ASCE 7=05 using Method 2 that which is dependent upon conditions of spatial form,height and other structure parameters that are specified in the code provisions for.determining:the applied wind loading pressures imposed onto. the UnitasSolarMountTM rails supporting-so ar panels. S i 4 1 James A Mane;3r.P.E. Page 2 of 2 The design veficatiox is based on I ASCEM5:- A.SCE Standard a "Steel Construction lvtanuai,"I Ith Ed.,American Institute of Steel . Const etion,Chicago,IL;2005!; ".(A�(l�ulnmum Design Manual",The Afurwnum Association, Washington D.C.. 2005 TV 'I'Me Properties and Static:Load Testing of Unrac.extruded rails and related'components obtainad fr6m Ihr Walter Gerstle;PE,Department of Civil Engineering:;University.of New Mexico,Albuquerque,NM. �. Use Unirac So1'arM:ount is evaluated for use.in Iocatons`whee wind pressure requirements do not'exeeed:50 bsf or snow load condition s do not exceed 50 psf Rround snow toads. Eor I lo",ngin ex�.ess of either of the above=stated.conditions,Unirac,-Inc. should be contacted for.suitability of installation $:y this.Letter,i certify that the'Unirac SolarMount 'assembly;when installed inaccordance withthe Installation Mahual,227.Witt meet the requirements of the building C. adopted 1 y Massachusetts.Ot ers:should evaluate the structure to:*Mch the Onirac SolarMount`m system is to be connected on a case-�by-case basis,per Part I- Insti lle"r's Responsibilities.of the lnstallation.Manual,to ensure its adequacy to accept attachments and to support all applied loadings pei the building code. .. Eiease call me if you have any.quesciorns or concerns. , Siacerei'y, 7ame�A.Marx,:Jr., , t P.�nfessonal.Engtneer` , 'vlA License Dumber 3b365 a. 14 l CC rams.r d,t3nin 7 AT, 1A k GreenFasten'GF1 — Product Guide Cut Sheets:GF1- L all a . 50CP. r u ggs i ac Nt ___ _____ _ _______ ______ _____ __ __ ___ _ ______ __ \J Syr A A t - AW Down Vol ASTMISM r �.t too '� {, tins., x SECTION A-A M' i B770590947 Committed to the Support of Renewable Energy O Ecol asten Solar"All content protected under copyright.All rights reserved.10/17/13 3.1 rr � < .-,«i,#a.,...,.-yt.,rah_�,�asra.r�aH'rf.�}as+er-k.,x.,arx,.. '+ —.+—.•.�: �-VM.�.-••-.'e�•,.,�mm.�*r{. — r "H"''""'[' L��;' kd"F3�u..�„*=i".,�•,rA��,.e•..��y�. Assessor's office(1st Floor): ^ - Assessor's map and lot number Board of Health(3rd floor): " Sewage Permit number. •` Z DlHd9.T"LL i Engineering Department(3rd floor): rrua House number Definitive Plan Approved by Planning Board 19 �o M�Ys• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILD.IHG INSPECTOR 17YZO _ APPLICATION FOR PERMIT TOjl7b- '{ TYPE OF CONSTRUCTION /� /- - 19 TO THE INSPECTOR OF BUILDINGS: i 4 The undersigned hereby applies for a permit according to the following information: Location f/�", f r�S" � r- �4) 11 I4) Proposed Use Aim Zoning District Fire District n n I S Name of Owner <"A ryn-r-- Address ► Name of Builder S Am -Address ► � Name of Architect S-A Address i Number of Rooms Foundation ��G Exterior �J 4,y�ia'�h - Roofing L. Floors Interior _ Heating 4 ,A _� '""� Plumbing ti d 0(E-_ C/ Fireplace /A/-ram^ �'` } Approximate Cost d / Area �d Diagram of Lot and Building with Dimensions Fee r . . r 5 � r OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS 1 hereby agree.to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. . Name Construction Supervisor's License 01061 �,eBOEUF, JOHN 1 A=269--090 ADD TO No 33668 Permit For DWELL-LNG Sin le . family dwelling Location Princess Pine Rd. Hyannis Owner John LeBoeuf Type of Construction Wood Frame . Plot Lot Permit Granted April 1.3 19 90 Date of Inspection 1.9 Date Completed 19 q r PERNifT COMPLETED 1/1/ 1(,. E A ZE 'y° ERMIT Town of Barnstable *Permit# 657�s� S C D 13 Z007 Expires 6 months from issue date Regulatory Services Fee TOWN OF BARNSTABLE Thomas F.Geiler,Director Dkp Building Division Tom Perry,CBO, Building Commissioner- 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 5087.862-4038 Fax: 508-790=6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Numbe Property Address 35 E S £ O (Residential Value of Work �,_Va. 00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address f o1nE y` Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to t ❑Re-roof not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town"department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must.sign Property Owner Letter of Permission. A copy of ome Improvement Contractors License is required. SIGNATURE: Q:Forma:expmtrg _0 Revise061306 Ail- r' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. Address: City/State/Zip: ,S 40J Phone.#: O� �7� CSGd Are you an employer? Check the appropriate box: -Type of project(required):. 1.❑ I am a employer with 4. [] I am a general contractor and I employees(full and/orpart;time). * have hired the stib-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9 n Building addition [No workers' comp.insurance comp.insurance.# required.] 5. n We are a corporation and its 10.❑Electrical repairs or additions 3 I am ahomeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[] Other comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance far my employees Below isthe'policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),, Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the CIA for insurance coverage verification. I do hereby c fy:ender the p=andpenaldes of perjury that the information provided above is true and correct: Signature: Date: Phone#: Official use only. Do not write in this area,Yo be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable. ° Regulatory Services i SABNSTABLE, � MASS. $ Thomas F.Geller,Director �AlF1 ►19. A,0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable,ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner M t Complete and Sign T 's Section If Using A ilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to rk authorized bythis 6 ' g permit application for: . (Address of Job) Sig tore of Owner Date Print Name QFORM S:OWNERPERMIS SION p Engine ring Dept. (3rd floor) Map C�6 J Parcel d Permit#". 3 -3 7 73(el. House# - Date Issued Aard Health(3rd floor)(8:15 -9:3 1:00-4:30) Fee. -V Conservation ice(4th fl 8:30-9:30/1:00 r 2:00) - :- Planning Dept. School Admin. Bldg.) �fNE►�;-` Definit' a Plan Approved by anning Board s 19 +� 1 _ RNSTABLE MASS _TOWN OF'BARNSTABLE• ' 'E°t639. ' Building Permit Application , Project Street Address -IS 6—r) IL , Village Owner ,� / C j�0E- L1� Address `S1017� ..Telephone :Permit Request /fif_ci,� /50,6 rFirst Floor / square feet Second Floor 9 square feet Construction Type &ci v d _b Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered 12 Yes ❑No Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure� 7 Historic House ❑Yes R No. On Old King's Highway ❑Yes �No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing oL New Half: Existing New No. of Bedrooms: Existing -,,T New Total Room Count(not including baths): Existing 6 New First Floor Room Count Heat Type and Fuel: )W Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes JJNo Fireplaces: Existing ;�, New Existing wood/coal stove ❑Yes 4No Garage: ❑Detached(size) .2 V X 30 Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ,�rShed(size) /O .,)' / 0 ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name yio G/t! ZZ rll. Telephone Number -2 ) U 6 Address �_ rn c .,fS !i ra s License# D/0 ZI 11 �/�,�h dyf /�,�ff Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /O ING PE T DENIED FORTH OLLOWI G REASON(S) .`m — 2 q K FOR OFFICIAL USE ONLY _ PERMIT NO. DATE-ISSUED MAP/PARCEL NO. ADDRESS VILLAGE _ P OWNER f DATE OF INSPECTION: , FOUNDATION FRAME INSULATION _ FIREPLACE _ •. - , `. , ' r ' ••r _ _• h t x . ELECTRICAL: ^ ROUGH ' ' r FINAL e t PLUMBING: ROUGH FINAL GAS: . ROUGH FINAL . FINAL BUILDING + " DATE CLOSED OUT i ASSOCIATION PLAN NO. _ - ,�.• ', all t °F THE I'd The Town of Barnstable • ,�arrsr� • . 9 " Department of Health Safety and Environmental Services ' Building Division 367 Main Street,Hyannis MA 02601 - Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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. ,/ ype of Work: Estimated Cost DU Z--'A- ddress of Work: /Owner's Name: Date of Application:/P I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 C]Buildi g not owner-occupied er 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: Date Contractor Name Registration No. � d- �-- C� � 1 �� OR C Date Owner's Name q:forms:Affidav z -.-=_- The Commonwealth of Massachusetts = •_ Department of Industrial Accidents Office 811.085ftations . 600 Washington Street +� Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name: ^�i0�.� /s o r 11-111,0cation: 3-T &,PXJ4 e ELL - 17,0 `-- /'�_;tv I7 n/f 4toe ohone# am a hom owner performing all work myself. ❑ I am a sole proprietor and have no one working in any ca acity Xxxxx ❑ I am an employer providing workers' compensation for my employees working on this,job. company name: address: city phone*. insurance co. DO&# - ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have , the following workers' compensation polices: company name: address: city uhone#. insurance co oltcv# r company name address: city' phone#. insurance co.. - olicv# i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cent un the pains d penalt' perjury that the information provided above is Ira.-and correct /0 �— 9 �gttature _ Pit Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# � ❑Building Department ❑Licensing Board ❑checkff immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P)A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the,legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who iesides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlestigauens 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 � A 1 #g s -ec i a I i� I i DIME , The Town of.Barnstable Department of Health, Safety and Environmental Services trautvsret,t.E. Building Division s" ,0�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration $ a -7 _ Date: ' Name: f' C (� Phone !#: v Address: C/ �1 Yi�' Fop�- �f CJ Village: , .l Type of Business: ( i 449/4< Map/Lot: C)" INTENT. It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,.subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within,that dwelling unit. • Such Inc occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residenual volumes. • The use does not involve the production of oilensive noise.%ibration,smoke,dust or other particular matter,odors,electrical disturbance,heat.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardotu materials,or P2--nmable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing die Customary Home Occupation. • No sign shall be displayed indicating the Customan• Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. n• Home Occupation who is not a permanent resident of the • No person shall be employed in the Customa dwelling unit. 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