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Home My WebLink About0066 WOODLAND AVENUE �CoWood 4vll . 4AV,:F�- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map-, cA� Parcel , Application # 4 7 Health Division Date Issued 7/4 Conservation Division Application Fee Planning Dept. Permit Fe V -0& Date Definitive Plan Approved by Planning Board Historic - OKH Mo _ Preservation/ Hyannis /VD Project Street Address (a G h C_ Village v1 vs Owner %n-e_ Address v(x�lc,.inch (� Telephone a nk 14 6-J-6 a I Permit Request P e, t • r - nn lF C-L �� ►n t h' `R � w�c4n 1�w,r„� cam.. s �• a V�/ g ��ne.15 Square feet: 1 st floor: existing '— proposed 2nd floor: existing — proposed Total new Zoning District RP) Flood Plain Groundwater Overlay Project Valuation UJr 0�2 Construction Type R3 Lot Size Grandfathered: ❑Yes ;'No If yes, attach supporting documentation. Dwelling Type: Single Family XQ Two Family ❑ Multi-Family (# units) Age of Existing Structure 5S y cs- Historic House: ❑Yes H No On Old King's Highway: ❑Yes a No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 1�1� 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 NfA— New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new sizoApool: ❑ existing ❑ new size A(A—Barn:.0:existing ❑ new size/V�_ Attached garage: ❑existing ❑ new siz4M�5hed: ❑ existing ❑ new size // Others Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ANo If yes, site plan review# r Current Use� Proposed Use k 15 h - , APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ~J• c;8 a • 3q'1 Address 1Ua.. G-ewt License # C-5 5 � C^V\Vn lla-L (.0 Home Improvement Contractor# 72, Email rUe.+)5ie r- S ki- C Worker's Compensation # ALL CO STRUCTION DEBRIS RESULTIN FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE _g 6 c�b is FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ti `f. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .. DocuSign Envelope ID:CB67EE5C-9B7B-438B-9917-25652D862CB5 SolarCity I PPA AMENDMENT Customer Name and Address Installation Location Date Pauline Peters 66 Woodland Ave 7/6/2015 66 Woodland Ave HYANNIS,MA.02601 HYANNIS,MA 02601 Congratulations! Your system design is complete and you are on your way to clean, more affordable energy. Based on the information in your System design,there are some amendments we need to make to your Power Purchase Agreement(the"PPA").The amendments are as follows: • We estimate that your System's first year annual production will be 1,696 kWh and we estimate that your average first year monthly payments will be$22.15.Over the next 20 years We estimate that your System will produce 32,359 kWh.We also confirm that your electricity rate will be$0.1567 per kWh,fixed for the next 20 years(i.e.electricity rate$0.1567 and tax rate $0.0000). By signing below,you are agreeing to amend your PPA and you are agreeing to all of the new terms above. If you have any questions or concerns please contact your Sales Representative. Customer's Name:Pauline Peters Power,Purchase Agreement Amendment pooCskF-a ey Signature: f AaA�AIAd' P�T�,Y� E.. SolarCity Date: 746/701 s approved Customer's Name: Signature: Signature: Lyndon Rive, CEO Date: Date: 6/30/2015 f • 1. I 3055 Clearview Way,San Mateo,CA 94402 888,765.2489 solarcity.com Power Purchase Agreement Amendment,version 2.0.1,June 25,2015 Contractor License MA HIC 168572/EL-1136MR OR Document generated on 6/30/2015 909377 L•516 M1 OWNER AUTHORIZATION Job M: Location: J .z flzn� 1 !' as Owner of the subject property hereby authorise SohrQ:ity CoM—HIC 168572/_MA Ue 1136 i to act on my behalf,in all matters relative to work,authorized by this building permit application and signed contract. Signature of Owner: late: •7.�:�I.pi:�•�.S I�..B'wwq* J�ri{► hwe�.�tiwr�i •!M• ♦•f.�4 rb�} Ms . � •.�'�!e *�:w•r..�v !?Mw1{�lrll�.\iVilr Maaaachusette Oepsafflant*;Public Satefy Boafd of Ouiid►ng Rayulation!A„d Stanftardb, 4conoq,CS-1088'1rJ: . JASON PATRY 921 SUWART DR1V s ! I Abington MA 02351 iwftrai�l�i��e. 02100/2019 �» Office of Consumer Affairs&audness Regulation ; - HOME IMPROVEMENT CONTRACTOR r f Registration: 16W72 Typeti A t Expiration: 31=17 Supplement 4 SOLAR CITY CORPORATION - I JASON PATRY 24 ST MARTIN STREET BLD 2UNI bAkBOROUGM,MA 01752 Wnderaeercbry s , r y \ r— f e yor?lye��r r nrrl<c 1�'err c �<?%! c;��rxc% tccseltl Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement..Contractor Registration Registration: 168572 Type: Supplement Card r' �,�� , _�, Expiration: 3/8/2017 SOLAR CITY CORPORATION CHERYL GRUENSTERN ._. 24 ST MARTIN STREET BLD 2UNIT 11 # - - - - --- --- - MARLBOROUGH, MA 01752 Update Address and return card.Mark reason for change. SCh, G a"—=Vi: )� 1. J Address ;•' Renewal Employment F_�? Lost Card '�,�r lrile l!((a/r.r•r•<//l•I '!(tGiditr7rr.;rjft ffice of Consumer Affairs&Business Regulation License or registration valid for individuI use only HOME IMPROVEMENT CONTRACTOR before the czpiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 168572 Type: 10 Park Plaza-Suite 5170 Expiration: 3/8/2017 Supplement Card Boston,MA 02116 SOLAR CITY CORPORATION CHERYL GRUENSTERN 3055 CLEARVIEW WAY ' f" SAN MATED,CA 94402 �.— Undersecretary rNot valid without signature t , The Commoni'wealth ofMassachusetts Department of IndhoWd AecWna Office of.Tweebgafions. 1 Congress Sbw4 Srute IM �i= '• - -� Boston,MM 02114-2017 www mamgov/dia Workers'Compensation Insuranee Affidavit:suiilaers/Coittrsctors/Electriidans/Ptnlnbers Agplicant Information Phase Print Le�ly Name(Busiaess/orgaatiodlaaiw�duat}: SalarCity Corporation Address: 3055 Clearview Derive City/State/Zip: San Mateo CA 94402 Phone#: 8W765-2489 Are you an employer?Cbeck the appropriate bom A Type of ro ect a 1.Q 1 am a employer with JU,000 4. I am a general c oniracwr and I e t lion to eas full and/or * have hired lbe sub-eonEractOrs b. []New construction �P Y � part-bare). 2.❑ I am a sole proprietor or partner- listed on the aftcMd sheet. 7. ❑Remodeling ship and have no employees These sub-conhacbors have 8.'[]Demolition working for me in any capacity. ) employm and have workers' [No workers'comp.insurance camp-ia�an�.' 4 ❑Building addition . 1 5. E] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself♦(No workers'comp. right of exemption per MGL 12Q Roof repairs insurance required.]t ,° c.152,§1(4),and we have no employees.[No worimrs' III Odwr solar panels comp.iasurmwe required.] 'Any app6exstt dw chi box#1 mutt elm fill out flu:=Cbn below showing then woean'compensation policy informatic a t Uomwwntns who submit this affidavit Micating they are doing all work and dm fire oxalate omnmms tanst submit a new affidavit indicating sash. ems that check this box must attacked an additional sheet showing the mm a of due aab-emmactots and slaw whether or not those etaides have auployees. if the sub-wnm3etots have amployees.they must faavme their wo kM,cootR ply MM*ff• I am an employer that is praviding workers'compsnsation inarance for my employeex ,below is the paliry,and fob sue Wormatiem Insurance Company Name: Liberty Mutual Insurance COMP4 Y Policy#or Self-ins.I.ic. WA766D06.6265024 Expiration Date: 9/1/2035 Job Site Address: C.tty/State/Zip: 66 Woodland Avenue Hyannis,MA 02601 Attach a copy of dw workers'compensaden policy declaration page(dwwl3 the policy member and explradm date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. [do hereby ceraTy under the nit bead allies o that tlae h1formado provided above is true and correct S' a , _ ate July 8, 2015 Phone A; �%8.314.1581 ' O.gWd use only. Do Trot wr to in this area,to be completed by e*y at,town ooWaL City or Town Permit/License# Issuing Authority(tdrde one), ' 1.Board of Health L Bafiding.Departineat 3.City/Town Clerk 4.Electricai bwpeator 5.Plumbing Inspector b.OWer Com."et Person: Phone 4- CERTIFICATE OF LIABILITY INSURANCE THM CER1 FMIE IS OWED AS A UATM OF DWO811 MOH ONLY An 00Wt 9 ND RIt M jjpON Va CmtTv=1m MOLDER.Ti88 MTfF=1t DOE$WT AFARdRIWMY OR NMTMMY ANiW.FJLMD OR ALTER THE COWMAGE ARtORDW BY THE POUCH NELJDW TM CERT11FICATI=OF braURAMM 40M NDT OOf48TlY'a11'E A CONTRACT BETVWW TIC tMUG 01189Fd4M AI/TH6rjM REPRESMTATNE OR PRODUCER AND 7MCERTMGATE HOLDER IA UKWANI. R the owtWouto hoMm Jr.an ARIL 1N$URM fe POUR("Met be mutt aed If GL TKW IS WAWM su um-tar tha tem and owwwom of tits QOUCy,Qa"a poll my rsi"f re im 4ad61iment. A itftxefQ as Wo awUlaNa dam Pat Confer datos to ow aeffft o odder ft Itse ofaueA tea} 315G1{PBASf1i�7,SU1f618� Es CAUR'TWLEM ENQ 048iO - SAN MMEW0.CA 29101 _COVERPAE HAM SEOit-�T4f5HWMW A.LAeAyfAutual F#eUWe�m9 Cgt Pq R1t1t9im hh(69d)Do 9fOG F 4M 9ff3�J�rrll 18H11F8iRC:WA NIA Sacs tlUto,CA Z2 �. .. esseAenra: MumP.. - OWERAWS CERT MATE NUffOM N 14 THIS IS TO CERTFY THAT THE POUCIE3 OF 1NBURANW LWM BaJOW HAVE BE W 16SUFD TO THE MOM NAMW A80UE FOR 711E POtiCY PI.am A= 113TtlNifiiSiMMM MY REQUIRIMMM,TUN OR CWDMON OF ANY COWIMOT OR OTHER OOCLUDU VWH RESPECT TO YIhIICJI INS CERWXATE MAY BE JSWW OR MY PERTAIN,1tW►NSMNC.'E AFF01 WIm BY TKE POLICIES DE8CRII u mam IS 5U80ECT TO ALL we Tm118S. . EXCI MNS AND CONINTf0t1S OF SUCH PODS.UMS SH0VW MAY HAVE RM RMUCED BY PAID CWMS. YMOFB� -aim alffim 1JerrS A 6f' MALUAMM cMPOCCURRIBICE g }pOD,000 X Cal0A6RC1A�GQ�fAItlALVLITY } low PPJt8t3iVAt.sAawera:usr i i�il►� f.88$kAIA iF i 2.9W.00D GHt1.4RGR -M-M .WrAPPISMPM iftoossCr9. AM 14 2=01 X P..r"X-1LOC 4 A A1l'fpIJDMUASIJJf4 ild0lf 1 75 4,W0,9DQ AW AM [iOpILY IHJfAH(flrPenwiq AUi06 AVroe - 90eIlY 8tttlRY�OtsOgdgpO i x HIRWA NDS x mrr� s t x �` 17E1t i it fl00JS1.900 eta u uA8 em oocw ET E s 99cm Lim d r BAFJitdYBCCUY frY Tf 09fB W4 W11A}15 PAWWAVEGMA H/A EL&sfJi i AWADDff D I+ya�oa.IwtwHnJ ;1NCOt�iJOE18lE$350000' ' EL08MM-FAEMPLOM 3 . 1.U�Upt1 eaP_'S Rtl+ftp' emew i- tiLtA -pOIICyUWff t�0 ^ t As�laa�at'arrarAmHsr�.Oc+�naaefvaFa.�qa.a,Awsmmt,Armu� sd�am�e,um�.�w+��..8 cvm�ors. . CERMCATE HOLDER 'CANCELIA 1 BNDIAWIAfiYGE'7}R:g9t1YBP�M'Nr 3t� BRF+ORE 5�11 h6aEo.CA 1W EXPIUVI OII GATE TF>1�F. t MIX WAL W IlFltf� fill kCCOROl1111EEMA11tT1pW�Y� • IYfstNSt®7fA'nye arms"*+ma<s eeospaca earta�s 01vW2M0 ACM COmRA'IIOM. An fan raswwtL ACORN 28(M40" The ACM mmnu and logo eta+ e�maflat of At _ S �} Version#46.4 4"AsolarClt Y HOFI{ June 30, 2015 go�� N 4'yG Project/Job#0261356 g RE: CERTIFICATION LETTER I L Project: Peters Residence 66 Woodland Ave S NAL Hyannis, MA 02601 06/30/2015 To Whom It May Concern, A jobsite survey of the existing framing system was performed by a site survey team from SolarCity. Structural review was based on site observations and the design criteria listed below: 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 - MP2:'Roof DL= 11 psf, Roof LL/SL= 21 psf(Non-PV Areas), Roof LL/SL= 21 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 On the above referenced project,the components of the structural roof framing impacted by the installation of the PV assembly have been reviewed. After this review it has been determined that the existing structure is adequate to withstand the applicable roof dead load, PV assembly load,and live/snow loads indicated in the design criteria above. I certify that the structural roof framing and the new attachments that directly support the gravity loading and wind uplift loading from PV modules have been reviewed and determined to meet or exceed structural strength requirements of the MA Res. Code,8th Edition. Please contact me with any questions or concerns regarding this project. Digitally signedby Nick Gordon Date:2015.06.30 12:26:09-07'00' 3055 Clearview Way `San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.corn AZ ROO 243771,CA CSI.8 388104,C0 GO 8041,;CT.HI0 C632778,.DC Hid 71 i01488,DC HIS 7110i488,lit.CT-29770,MA HIC 168679 MD MH1C 128948,NJ'IW1406180800, OR GCB 180498,PA 077343.TX TDt.R 2,7008f WA GCL—SOLARC'91007-0 2013 SoterOliy,,A I rights rewmed. 06.30.2015 Version#46.4 SOfaCCit PV System Structural °V, Design Software PROJECT INFORMATION &TABLE OF CONTENTS Project Name. "' Peters Residence _ AHJ _ Barnstable_ Job Number: 0261356 Building Code: MA Res Code,8th Edition. - - ----_ Customer Name: Peters Pauline Based On: °_77 7 me 2009./_IBC 2009 Address: 66 Woodland Ave ASCE Code: ASCE 7-05 —City_ _ City/State: .: ��Myannis,_ � MARisk Category II_ Zip Code 02601 Upgrades Req d. No Latitude_/rLongitude: �41650592 -70.309644 �$tamp_Reg'd? �Yes�___:_ --- — _. SC Office: Cape:Cod PV Designer: Joon Choi Certification Letter 1 Project Information,Table Of Contents, &Vicinity Map 2 Structure Analysis (Loading Summary and Member Check) 3 Hardware Design (PV System Assembly) 4 Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.18757 < 0.4g and Seismic Design Category(SDQ = B < D 1 2-MILE VICINITY MAP i A i 66 Woodland Ave, Hyannis, MA 02601 Latitude:41.650592,Longitude:-70.309644,Exposure Category:C STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK-MP2 Member Properties Summary MP2 Horizontal Member Spans Rafter Pro erties Overhang 0.24 ft Actual W 1.50" Roof System Properties San 1 ;;` 11.917ft°`t Actual D „ fi: , 7.25", - Number of Spans(w/o Overhang) 1 San 2 Nominal Yes Roofing Material Comp Roof., San 3 ; x A 10.88 in.A2 Re-Roof No Span 4 SX 13.14 in.A3 Plywood SheathingYes San 5 ' r . .L: j _ ; 47.63 in.^4 Board SheathingNone Total Span 12.15 ft y TL Defl'n Limit 180 Vaulted Ceiling 8 Yes ` ;PV 1,Start r 1.33 ft v f.^ Wood'Species ; SPF .. Ceiling Finish 1/2"Gypsum Board PV 1 End 11.42 ft Wood Grade #2 Rafter Slope 150 PV 2 Start'. ; , Fb , 875 psi Rafter Spacing 16"O.C. PV 2 End F„ 135 psi Top Lat Bracing Full ; PV 3 Start. - k ` `E 1400000 psi Bot Lat Bracing Full PV 3 End Emin 510000 psi Member Loading mary Roof Pitch 3 12 Initial Pitch Adjust Non-PV Areas PV Areas Roof Dead Load DL 11.0 psf x 1.04 11.4 psf 11.4 psf PV Dead Load PV-DL, 3.0 psf,,a = - : x 1.04 W '° k ` ` ; 3.1 psf Roof Live Load RLL 20.0 psf x 1.00 20.0 psf Live/Snow Load LL SLl'Z 30.0' sf N, `. ;„z 0.7, z 0.7" ;z 21.0 psf 21.0 sf Total Load(Governing LC TL 32.4 psf 35.5 psf Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 7-2] 2. pf=0.7(Ce)(CO(IS)py; Ce=0,9,Ct=1.1,IS=1.0 Member Design Summary(per NDS Governing Load Comb CD CL + CL CF Cr D+S 1.15 1.00 1.00 1 1.2 1.15 Member Anal sis Results Summary Maximum Max Demand @ Location Capacity DCR Load Combo Shear Stress 35 psi 0.2 ft. 155 psi 0.22 D+S Bending(+)Stress _ -764 psi 6.2 ft. g 1389; si 1, 0.55 A D+ S ,Bending - Stress -1 psi 0.2 ft. -1389 psi 0.00 D+S. Total Load Deflection 0.34 in. L 431 . w_ . .6.2 ft. 0.82 in. J, 180 .° n 0.42 7-1 D+S' CALCULATION OF:DESIGN WIND LOADSMP2 Mounting Plane Information Roofing Material Comp Roof PV System Type ° .r SolarCity Sleek _ountT"" ----j N,. n $ _. Spanning Vents No Standoff Attachment Hardware v b h Comp-Mount Type C ., Roof Sloe 150 Rafter Spacing 16"O.C. Framing Type Direction Y-Y Rafters Purlin,SpAcing, lins Olily Tile Reveal Tile Roofs Only NA Tile Attachment System Tile Roofs Only NA - - Standing Seam/Trap Seam/Trap Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method; - _ Partially/Fully Enclosed Method Basic Wind Speed V 110 mph Fig. 6-1 - .� Exposure Category " C _Section 6 5.6.3_ Roof Style Gable Roof Fig 6-11B/C/D-14A/B Mean'Roof Hei ht -4 7h 25ft '£ Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ 0.95 Table 6-3 To g phi c Factor _ ;,` '.. .,, Krt .. 1.00 ' ` Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor. _ w. _ _ I 1.0 ". Table 671 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 -0.87 Fig.6-11B/C/D-14A/B Ext. Pressure Coefficient Down GC�oown` ° x w 0.45 > . Fig.6-11B/C/D-14A/B Design Wind Pressure p p= qh(GC) Equation 6-22 Wind Pressure U 21.8psf Wind Pressure Down 11.2 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable,Cantileve_r = 3 x r Landscape; 24 NA_ Standoff Configuration �Landsca a Staggered Max Standoff Tributary Area Trib _ Ate';: ,17 sf, PV Assembly Dead Load W-PV 3 0 psf Net Windypllft a_t Stan_doff�'T a� T actual Uplift Capacity of Standoff fallow 500 Ibs Standoff Demand Ca aci DCR ' " m° 70.1% i' X-Direction Y-Direction Max Allowable Standoff Spacing Portrait' 48" 66" Max Allowable.Cantilev ___er __,,� _. .n Portrait Standoff Confi uration Portrait Staggered Max Standoff�Tributary,„Area ___ __Trib_ ,. ` " 22 sf " PV Assembly Dead Load W-PV 3.0 psf Net Wind Uplift at Standoff' T-actual , �_. -439 Ibs m Uplift Capacity of Standoff T-allow 500 Ibs r-- Standoff Demand city DCR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel._ Co Application # 0,),ji S O Health Division Date Issued 3-3 Conservation Division Application Fee Planning Dept. Permit Fee Y 3rJ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street AddressM1 V. 1A] -A V� Village Owner Pad ) l ) P Q V-5 Address (Q � l�✓��c��('��Q�ku Tell phone S J Pe�mit Request uL' I (f/0,5 V a . �S Square feet: 1 st floor: existing g proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ro�ect Valuation"" TQ -.- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ 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 CentralAir: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detacried 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 ❑ A y Commercial ❑Yes ❑ No If yes, site-plan review# Current Use Proposed Use APPLICANT INFORMATION (B ILDER OR HOMEOWNER) ` Name n 1. Telephone Number ZQ Address License# Rrpo Home Improvement Contractor# i( mail enod Co Worker's Compensation # P J`' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / r � 1 IN SIGATURE DATE FOR OFFICIAL USE ONLY APPLICATION# -' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r - The Cominanivealth ofmassachuseft Dqwrtment of Industrial Accidents QKweofInvestigadons . 600 Washington Stmet Boston,.M54,02111 wrvtuntamgov1 dira Workers' Compensation Insurance,Affidavit:BuiTders/Contract®rMectriciansIPlu nbers ApOwant Information Please Print Leaib * Name m=,aewo,3an zsfl=bdarridm,): Address_ city/state/zip: u � 09--3) Phow, �� Are au employer?Check the appropriate bog: Type of pal (required): L am a employer with 4. ❑ l am a general cAnbactar and I employees(full and/or pact-time)- s have:hired the sub-con�ct�ors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodel ship and have no employees These sub-contractors have g. ❑Demolition woddng for me in an employees and have.woadeers'' y� d3` 9. ❑Building addition [No worims'comp.insurance comp_msutance- retlutred] 5. ❑ We are a corporation and its 10_❑Electrical repairs.or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑ of insurancereRpirs o c. 152,§1(4�and we have:no fl employees.[No.wor 13.L1L1{Jtlaez Y�j(�`Ql'tl� comp.insurance reguiretl,J •Any appH=Spat chedrs boa##1 mmsfaLw fill our the section below showing&&des"aompensatian palicg infoasaatiam_ Homeowners who submit this of ulavit iDffcatmg they are dokg all wale aid dm here outidi•co4uaetsars nmst s&mil a new affidait indicating sail- tCantucmrs that gibed this bus mast attached an addi d mA sheet showing the name of die sab-conamcmrs.and scam whedw or not those enfities bm employees. If the sob-ca3mctors Bmee employees,they mi-st provide flteir workers'-mp.policy nmmben lain an empZa w that is provM&g workers'concpensntion inmrance for my,enzptolem Bekw is the peficy wa job site informatiocb q Insurance:Company Name:' L Policy#or Self ins.Lie.#:-�—? � I ®a1� Expiration Date: Job Site Addr : fPD i l �, v t. iyt$ p: JAI CEO Attach a copy of the workers'compensation policy declaration page(showing the policy rm4 er and exphmfion 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-Sear impaisonmenk as well as cavil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against:the violator. Be advised that A copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification- I do hereby certi rdreder the pains and s a that the information d rebore is Lire nand correct 14 Sa fuse: �. Date_ 73 Q,faeiel case only. Do not write in this area,to be completed by city car tri M offie$dt City or Town: P'ermitUcense 9 Issuing Authority(circle one): I.Board of Health 2.Building Depar�ent 3.City//:own Clerk '4L Electrical Inspector,5.Plumbing Inspector 6.Other Contact Person: Phone#: '`�C�® CERTIFICATE OF LIABILITY INSURANCE- F °ATEjNf�°°"""' �� f 3/5/2015 THIS CERTIFICATE IS ISSUED-AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT:. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BRYDEN&SULLIVAN OF DENNIS INC. -NAME:CONTACT PO BOX 1497 PHONE FAX SOUTH DENNIS, MA 02660 E-MAIL AIC Noll: ADDRESS: j INSURE S AFFORDING COVERAGE NAICA INSURER A: LM Insurance Corporation a 33600 INSURED SHAYNE DEWITT INSURERB: DBA ALL CAPE ENERGY INSURERC: PO BOX 1492 INSURER 0: BREWSTER MA 02631 INsuRERE: INSURER F COVERAGES CERTIFICATE NUMBER: 23710547 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. p INSR ADDL SUBR POLICY EFF' POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDO MMIDDNYYY -LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FlOCCUR DAME RD� PREMISES Meoccurrence $ MED EXP(Any are person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO POLICY❑JECT LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ' ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS AUTOSULED BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPER DAMAGE S - AUTOS Per accdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31S-378516-024 9/13/2014 9/13/2015 STATUTE ERH AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? �Y N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SHAYNE DEWITT. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE LM Insurance Corporation d ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23110547 Lucy Garfield 3/5/2015 9:33e46 AN (EST) Page 1 of 1 �IMassachusetts -Department of Public Safes�"r Board of Building Regulations and.Standard Construction Supervisor Spec%alty Lice nse'�CSSLA03842 SganvE.nEwrrT `. 161 VominbhS Brewster MA 0201" Exp�ratioft Comrnissionee 02/2312016 ; /4�V(%�Cl15lICl1CL5C� Office of Consumer Affairs.&;Busioess'Regulation ! TOME IMP.ROVEMENT-CQNTRACTQR ��2 sgistration 166888' TYPe Exp�ration� -T/19%2016. DBA ALL CAPE ENERGY' SHAXNE DEWITT `x` 161 COMMONS WAY }gyp ; BREWSTER,MA"63361 Undersecretary f H Y . � 1 � Corporation 1 Cape Cod HOME OWNER WEATHERIZATI N WORK PERMIT&FUEL RELEASE; PLEASE FILL OUT AND 9GN THISFORM IFYOU ARE THE APPLICANT HOMEOWNER. I' r hereby consent to and agree that weetherization work may be dome by the Weetherization, Program of Housing Assistance Corporation (hereinafter referred as a Aa—M%")on the property located at* Theweatherization work donewill bebased on programmatic priorities and availability of funding and It may Indudeall or someof thefollowing measures: r��rl Weather-stripping& caulking of windows and doors, insulation of attics, sidewalls& baserrvntA attic and other ventilation measures and possibly replacement of badly deteriorated windows in consideration of the weetherization work to be done at my home l agresto the following- 1. 1 give permission-to the"Agency" Its agents and employees to travel onto or across said property with such equipment and materials as maybe necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect thefud or utility bill for the weatherized unit on an ongoing basisfor no morethan five(b)yearsafter theweetherization work is completed. I have read the provisions of thi eement as lis#ed d freely give my consent. Home Owner: (9gnature) u Data ( f A { Agent: (signature) Data HAC approved Weeltharization Company:-- f �... live-- learn work grow r r` Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee : .�►niver,►s�. M"9'1639. Thomas F.Geiler,Director �� Fp MIS Building ��— Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (D9 T Property Address (DU L000A 6_ nn' t\ye. L-F OL h t1 L S esidential Value of Work �. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address LOG Lit" Ave— d jjaa ,�s Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Home.Improvement Contractor License#(if applicable) 103757 Construction Supervisor's License#(if applicable) 0—S (j X]Workman's Compensation Insurance Check one: J lJ 1' 1) ❑ I am a sole proprietor ❑ I am the Homeowner , OWN OF BARNSTABLE X I have Worker's Compensation Insurance Insurance Company NameAssnciatp(l Industries of MA Workman's Comp. Policy#AWC 7004943012011 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors CReplacement Windows/doors/sliders. U-Value a oaOQ� (maximum .35)#of windows:_ "Where required: Issuance of this pernnit does not exempt compliance with other tovtm department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the om Improvement Contractors License&Construction Supervisors License is ire SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\W'indows\Temporary Internet Hies\Content.Outlook\DDV87AAZ\EXPRESS.doc. Revised 072110 The Commonwealth of Massachusetts a Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass govldia . . . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) Sprinkl&Home Improvement Address: 199 Barnstable Road City/State/Zip:Hyannis;. MA 02601 Phone#• 5.08 .775=1778 Are you an employer?Check the appropriate boX: Type of project(required): 1. X.I am an employer with 9 4:❑.I am a general contractor.and I .6..0.New construction employees(full and/or part:time).* have hired the sub-contractors ? p Remodeling 2. ❑ :I.am a sole proprietor or partner-, listed on the.attached sheet: ship.and have no employees These sub=contractors have 8. ❑ Demolition working for the in any capacity. . employees and.have workers' . 9. 0 Building addition [No workers'comp:insurance comp.insurance. $ required] 5.0 Wee a coprationndits. 10. ❑`.Electcal rpars or additions 3. ❑ I am a homeowner.doing all work officers have exercised their 11. ❑ Plumbing.repairs or additions y [N p right of exemprion perm MGL . g eP myself o workers com : . . . . insurance required]t c. 152, § 1(4),and we have no. 12.'p Roof repairs employees. [no workers' 13; ther comp:insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees..Below is the policy and job site information. Insurance Company Name:ASSOCiated Indu§tries of MA. Policy#or Self-ins.Lic..#: AW tC 7004943012011 Expiration Date: 01-01:=20.12 Job Site Address: D Gt�l1 �P City/State/Zip`. vr.�A c S, . .05L(0 0 T 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 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 $250M a day against violator.Be advised that a.copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby.certify n in nd penalties:of perjury that the.information provided above is,true and correct: . Signature: Date: Print Name: Brad.Sprinkle Phone#. .508 775=1778 Exit 10 Official use only Do not write in this area to be completed by city or town official Cityor T wn� o Permit/license#i Issuing Authority:(circle one)* 1.Board of Heath I:Building Department. 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6:Other Contact person; Phone#: d- 1 Town of Barnstable Regulatory Services ; Thomas F.Geller,Director Building Division Thomas Perry,CBO Bnllding Commissioner 200 Main Stout, Hyannis,MA 02601 wwwA8wnbarnsftbI&maui r Offime: 509-8624038 Fax: 50&790.6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject 1 property hereby authorize Sprinkle Home Improvement to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Paul(,/U- PeArs Print Name If Property Owner Is applying for permit,please complete the Homeowners License Exemption Form on the reverse dde. _ Q ry internal FilesVContentOutloolc�DDV87AAZ�RBSSAN Ravised 07n110 T ` �i.n..i�iiu�t'll• _ I)i }'rai'Ltllinl : �' },tt},lip �.:;c�. // V !s •J C�/6llGII(.(lL.(1C�.GI,/i' It..:_ I •.(.C`t( • Bn,uel :1 Buildin'_ Itr_ulat,„tt. 'Ind Officeof`�onsumerAt`ftairs&IB ►nes gulat►on Construction Superv,sor -icen5 HOME IMPROVEMENT CONTRACTOR „s S 6643 `,� Registration: 103757 Type: i t Expiration: 7/9/2012 Private Corporatic SO&KLE HOME IMPROVEMENT,INC. BRAD K SPRINKLE 190 LOTHROPS LANE Brad Sprinkle W BARNSTABLE, MA 02668 199 Barnstable Rd. �_. Hyannis,MA 02601 Undersecretary t x tr r a t u,�,: 10/8/2011 T:= 5478 Restricted to: 00 License or registration valid for individul use only 00- Unrestricted before the expiration date. 1f found return to: I-12 Family Homes Office of Consumer Affairs and Business Regulation ► 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS Not valid without sign lure CERTIFICATE OF LIABILITY INSURANCE DATE11 4/2 10Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Bryden & Sullivan Ins Agency PHONE FAX Inc. (A/C. No. Eat): (A/C. No): E-MAIL 88 Falmouth Road ADDRESS: PRODUCER Hyannis, MA 02601 CUSTOMER ID®. INSUREDS) AFFORDING COVERAGE NAIL 8 INSURED INSURER A: A.I.M. Mutual Insurance Co Sprinkle Home Improvement Inc INSURER B: 199 Barnstable Road INSURER c: Hyannis, MA 02601 INSURER D: INSURER E: INSVAER 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. POLICY EFF POLICY EXP Ltrr TYPE OF INSURANCE POLICY NUMBER (NNIDD/YYYY) (w/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURANCE 9 ❑COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea.occurrence) CLAIMS MADE ❑OCCUR ❑ MED EXP (Any one person) $ PERSONAL S ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: ❑POLICY ❑PROJECT ❑LOC PRODUCTS -COMP/OP AGO $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ANY AUTO (ea accident) $ ❑ALL OWNED AUTOS BODILY INJURY (per pare..) $ ' ❑SCHEDULED AUTOS BODILY INJVRY(per accident) $ ❑HIRED AUTOS PROPERTY DAMAGE (per accident) $ ❑NON-OWNED AUTOS UMBRELLA L.A. OCCUR EACH OCCURRENCE $ []EXCESS LIAB ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE 9 ❑RETENTION $ g WORKERS COMPENSATION ® xc erarv- oxx- AND EMPIAYEES LIABILITY ronY Llxxrs ER THE PROPRIETOR/PARTNERS/ EXECUTIVE OFFICERS ARE E.L. EACH AcclDeNx g 500,000 A ® incl ❑ eXcl 7004943012011 01/01/2011 01/01/2012 E.L. DISEASE -POLICY LIMIT $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 COMMENTS / DESCRIPTION OF OPERATIONS OR LOCATIONS: CERTIFICATE HOLDER CANCELLATION ESSEX GAS COMP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 1 BEACON STREET POLICY PROVISIONS.BOSTON, MA 02108 AUTHORIZED REPRESENTATIVE' //]] a, Town of Barnstable *Permit# Expires 6month,, romrsarl$F a e Regulatory Services ee%a snaxsrnsLE, t ° Thomas F.Geiler'Director1639. Building Division Tom Perry,CBO, Building Commissioneri� 206 Main Street,Hyannis,MA 02601 ON 4www.town.bamstable.ma.us Office: 508-862-4038 \ Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C9 0 41 (> Property Address E`L kp C> 18 I Ct Ci r t S Residential Value of Work K 500.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` 0.)1 P f C5. GG W 006 I ct,r 11-v e Contractor's Name �o S L u g Telephone Number 5 v 8 400 2 5t S D Home Improvement Contractor License#(if applicable) i 5 `� �7 Q�' `: B,G-13 . Construction Supervisor's License#(if applicable) q f,,'7 3 A Q -1'7 a6i a. ❑Workman's Compensation Insurance Che k one: 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 accompany each permit. Permit Request(check box) [9/Re-roof(hurricane nailed)(stripping old shingles) All construction debris-will be taken.to G42,joSSG Q `bjpAsq,t° ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is quire . SIGNATURE:. CAUsers\decollikWpp ocal\Microsoft\Windows\Temporary Internet Files\Content.Ouilook\DDV87AAZ\EXPRFSS.doe Revised 072110 r, 4 - The Conrnionwealth of Massachusetts Depprtrrtnrent of Indrrsoial Accidents _= 091ce of Investigations - 600 Washurgion Street Boston,AL4 02111 iw mi:nras.+bgovldiia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electaic ans/Plumbers Applicant Information Please Print Legibly Name(Bvsmes Organ(ization&&vidml): ZTo5(, . 6 e,, 3 vx� (got,Iry �-�a i �n Address: d \ n V4 V i e w `'U e- - City/State/Zip: m k e V'Sl1q 0461 5 phi one# 106 y 6t -) ci 5 C� Are you an employer?Check the appropriate box: T of project r �- I am a general contractor and I 3'P1e p ] (required): I.❑ I am a employer with ❑ 6- ❑New construction employees(full and/or part-tame). s have hired the sub-contractors 2:R"I am a sole proprietor or partner- listed on -c attached sheet. 7- ❑Remodeling ship and have no employees Thy contractors have g- ❑Demolition w forme in a capacity.ci employees and have wormers' working T 9- ❑Building addition [No workers' con -insurance'comp-insurance p requfired.] 5- ❑ We are a corporation and its 10.ElElectrical repairs oIr additions 3-❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[NO wcrken'c=V- tight of exemption perMGL 12-Raoioofrepairs insurance rewired-]t c- 152,§1(4),and we have no employees-[No workers' HE-Other comp-msurance required.] •Any applic that checks bus#1 omx also fill out the sec6aon below showing then mere'compensation policy infaano@rm. Someaw ers who submit this of ulavit iadmatmg they are dom.-all war&mud dunbore auM&usattactors io=submit a new affidavit iadicatiog sack. sCoatractors that check this box must attached an additional sheet showing the name of fe sub-emmusadots and state whether or not those entitles have employees. If the subtontracmrs have employees,they must provide their warkers'c mp.policy number. lam an employer that is provddfng workers'conrpansation insurance for nfy eddTlo�we& Below is thepoticy and job site information. Insurance Company blame: Policy#or Self-ins-Lie.#: 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 up to$1,500-OD 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-DO 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 rfy A+ r the pains andpen f pedury that the information provided abom is tnw and correct Si Date: 7 Phone#: P i� Official use only. Do not mite in this area,to be completed by city or town official City or Torun: PerdnitffAkense Issuing Authority(circle-one): 1.Board of Health 2.Building Department 3.City,7own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: t f � BA6NSTABLE, 1` , Town of Barnstable DMArp , Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, PQ.[:V Y Q e +e f 5 ,as Owner of the subject property hereby authorize 105 k'U6 Gov o 1^X� to act on my behalf, in all matters relative to work authorized by.this.building permit application for: (Address of Job) r Si re of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. 1 C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 MC Registration Lookup Page ,1 of 1 YThe Official Website of the Office of Consumer Affairs 8 Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home > Consumer> Home Improvement Contracting> 1 _...... ---. - _._..... ........ Home Improvement Contractor Registration Lookup The list is current as of Wednesday, April 27, 2011. You can search/fitter the registration list by any of the criteria below. . RELATED LINKS Search by Registration Number V5427P Home Improvement Contractor Registration.t-tome Page Search Registration Number Search by Registrant Name Search by City Zip Code - Search Registrants Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. Search Results REGISTRANT NAME RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS INDIVIDUAL NUMBER DATE JOSH GOVONI 144 NOISY HOLE RD 2/26/2013 Current i CONSTRUCTIO GO OS 154279 . MASHPEE MA 02649 ©2011 C mo ealth of Massachusetts -' Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 96732 h Restricted to: 00 JOSHUA G.OVONI ti 2 POND VIEW AVE. hF MASHPEE, MA 02649 t- r Expiration: 6/17/2012 Commissioner Tr#: 27287 http://db.state.ma.us/homeimprovement/licenseelist.asp 4/27/2011 f f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 — Application # Dd 0 I ) co Health Division Date Issued -31 ci C Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation / Hyannis r-P-roject-Street_Address �� Oz5� Village cOwner� " A�� Address!��Gl/� / �i� i- C�lr-1 /I/3� cTelCpp-hone=�� 701 ePermit Request Ze �D ,?(� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5,y- Construction Type ; Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes No Basement Type: A Full ❑ Crawl - ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: // existing —new Total Room Count (not including baths): existing (0/ new First Floor Room Count Heat Type and Fuel: ❑ Gas 29 Oil ❑ Electric ❑ Other Central Air: ❑Yes S No Fireplaces: Existing/New Existing wood/coal stove: ❑Yes A No Detached garage: Vexisting ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ ;Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Fti.y7 C) Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -._ C'�,- Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - - ` APPLICANT INFORMATION 'J L (BUILDER OR HOMEOW�_ `NER) 'zName--. l k" .. Telephone_-Number cAddr-ess-lr4g� 4d. License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �SIGNATURf DATE if FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 5.. DATE OF INSPECTION: "* FOUNDATION FRAME `r INSULATION 'ft FIREPLACE ELECTRICAL: ROUGH FINAL J PLUMBING: ROUGH FINAL ;1. GAS: ROUGH FINAL _ 4 FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts. 1 , Department of Industrial Accidents �Y t. Office of Investigations ;r 600 Washington Street Boston, A"111 c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Le ibl W3[TIe (Business/Qrganization/Individual): Azvz Ir ddress:-�ol� C=Gi T/-&fie/Z-i-p=: f�/did/ /o,4 OZ/,O/ Phone #: QG 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. F1 Building addition [No workers' comp, insurance 5. E We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself. [No workers' comp. c.,152, §I(4), and we have no 12.0-Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins. Lic.M 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 up to$1,560.00 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 maybe forwarded to the Office.of Investigations of the DIA for insurance coverage verification. I do hereby cert'y under the pains�anlddjalties of perjury that the information provided above is true and correct Q ` ature:� - Date: 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): L"Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector.' 6.Other t Contact Person: Phone#: ofiK�E try Town of Barnstable ti� o Regulatory Services &kMS,,BL.F. : Thomas F: Geller,Director ,0� Building Division PJFo µay" Tom Perry,Building Commissioner 200 Mairi•Street, Hyannis,MA 02601 Www.town.b arnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMMOWNER LICENSE-EXEMPTION Please Print CJOB IAGA-TION:l!L D /C.Y n bar street village 2 name home,phone e##// work phone# CUTE EXT MAILING ADDRESS: city/town state zip code , The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A. person who cons"cts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes, bylaws,riles and regulations. _ r The undersigned"homeowner"certifies that,be/she understands the Town of Barnstable Building Department mirdTmum inspection procedures and requirements and that he/she will comply with said procedures and r ments.e. j . - Signature-of-H-ornro. Approval of Building Official Note: 'Three-family:dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. i HOMEOWNER'S,EXEMPTION The Code states that "Any homeowner performing work for which a building pcmvt is required shall be exempt from the provisions of this scction,(Scetion I D9.1.1 --Licensing of construction Supervisors);provided that if the homcowncr engages a person(s)for hire to do such work,that such Homcowncr shall act as supervisor." lvtany homeowners who use this exemption am unaw?r-e that they are assurning the responsibilities of esupervisor(see Appendix Q, Rulcs&Regulations for Licensing Construction Supen ison,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the.permit application; that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a.fonn currently used by several towns. You.may care t amend and adopt such a fom/ccrtification for use in your community, Q:forms:homecxcmpt ; Town of Barnstable ` Regulatory Services F F F ♦ ' F BARNSTABL.E. F v ►idAE& $ Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Dfce: 508-862-4038 $ t' Fax: 508-790-6230 Property Owner Must 0 Complete and Sign This Se on If Using A Builder I, as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work autho ' d by building permit application for: (Address f Jo 1 Signature of Owner Date o Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:Fo RMS:o wrrERP ERM rsS)ox N � J UJ - V W/ Q LtJ I ml ----__ 3 1•4' v N LLJ Q 0 Ln o° EXISTING ILI N Q Lf DWELLING ----, Q PROPOSED Q ; DECK Lu O lu 1 OI � � o EXISTING � ----- GARAGE V N I �. I ' L i m it O BUILDING LOCATION PLAN (61 04' FOR G2 WOODLAND AVE., HYANNIS, MA PREPARED FOR PAU LI N E L. PETERS. SCALE: DATE: DRAWN BY: STEVEN G I " = 20' 1 1 -03-2008 TMW MB JOB NUMBER: PEV15ION: 5HEET NUMBER: 357 1 f j - - 08-05G CPP- I 1�1 WELLER * ASSOCIATES G45 FALMOUTH RD., SUITE 4C — P.O. BOX 417 CENTERVILLE, MA 02632 2 WINDY WAY,#232 NANTUCKET. MA 02554 1 k TEL.: (508) 775-0735 — FAX: (508) 775-0754 EMAIL: tri5weller@comca5t.net REGISTERED LAND 5URVEYOR5 ter Traverse PC �fa�t � i Ily OWNER, Pauline L. Peters 66 Woodland Ave. (alk/a 62 Woodland Ave,) Hyannis, NA 0260E PROPERTY LOCATIOM . 6e Woodland Ave. Plot 269/Lot 66 0,27 Acres (11,761.2 Square Feet) DATE, October 6, 2009 o Proposed i Pressure-Treated Deck S-6' cJ c G lJ N b 6' Stldew- � Existing 1-Famity Residence (94' x 321 N62 (a/k/a #66) Woodland-Ave, SCALEi N.T.S. NOTES, I.- Ail pressure-treated wood construction and galvanized hardware. 2. Location and quantity of steps to be determined an site cbased on existing grade). NATER1ALSi 1. 12' diameter cement plerc, 41 deep) 2. 2 x 9 joists, 16' on center) 3. 5/4' x 6' floor decking; 4. 4 x 4 posts, T on center (maxlnun) and post basesi 5. 36' Nigh rallfngs with balusters 5' apart (maxhum spacing)) 6. Galvanized nalpls, 6' lag screxs/nuts and joist hangers. 7. Number of stops to be determined on-site f10' run, S' rise maximun). Z abBd 9LSL166909 dL9:£0 800Z'L0 ,LOO Town of Barnstable *Permit# 0 0�5 v ti Expires 6 nronths front issued to Regulatory Services Fee • BARNSTABLE, ' MASS* Thomas F. Geiler,Director AIE�MP't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint acog p(� Map/parcel Number. Property Address Residential Value of Work ` ' 1 C` Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 0 TO i)A IV Y 1 5- Contractor's Name J �—C}`1? -/c- Telephone Number ai �Y Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) / c - ❑Workman's Compensation Insurance Check one: - ,� I am a sole proprietor , ❑ I am the Homeowner _` ft SwjS PEW�&� � ❑ I have Worker's Compensation Insurance Insurance Company Name 6��a1��'�STABL�. (%t- Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany e1 6 permit. Permit Request(check box) 10 Re-roof(stripping old ohm fesj'F�dl construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License.&Construction Supervisors License is required. SIGNATURE:', ...,;611 t ,✓tJ 1 Q:\WPFILES\FORMS\buiJng permit forms\EXPRESS.doc Revised 090809 " `� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 1500 Washington Street F , Boston, MA 02111 wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1 (� Address: q 3 City/State/Zip: '` -' , f�- . � , Phone #: ��'."' d•—� 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 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.JaI am a sole proprietor or partner- listed on the attached sheet.` 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition Workingfor me in an capacity. employees and have workers' Y P Y• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.) required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the 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 ciiminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided bove is trite and correct.. Si ature: /. Date: 1, 3/0 Phone#:( C'�l Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also 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,MGL chapter 152, §25C(7)states"Neither the conunonwealth 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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Si'e Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia G, �'THEr� - Town-of Barnstable Regulatory Services BARv ' '$ Thomas F. Geiler,Director Eto) 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 Prop '�'e, Owner Must Complete and Sign This Section If Using A Builder , , as Owner of the subject property. hereby authorize ' U 1 w F?}5T7e4 _ to act on my behalf, in all matters relative to work authorized by this building permit application for. �� %/ems//� • `� a-2�� (Address of Job) Signature of Date Print Name - If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q;FORMS:OWNERPERMISSION ` c �y Town of Barnstable Regulatory Services • Thomas F. Geiler,Director lARNSrABLE, "`ASI& i639• Building Division 9� �� g �lfo 1u'�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: I — !�L r, JOB LOCATION: nu r street a� vilIlaggeB "HOMEOWNER": / "elf name ,home pho e# work phone#1 CURRENT MAILING ADDRESS: 1plB _� cityltown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mini um inspection procedu es and requirements and that be/she will comply with said procedures and requments. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.) -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPF.ILES\FOPMS\homcexempt.DOC i w °- Board of Bulldmg'RegWatioand Standards Construction 3upervlsor LlCense Lic�e se CS 19854 Expiration /17/2010 Tr# 22022 i '3` � es ri tIQTl O� d µ JAM ES P FOSTER; `J 1 IE 43 JOHN PARKER�13D. E-.FALMOUTH,MA 02536 Commissioner 1 i } ✓fi /lid St�anda & �,.. Board of Building Regulations and Standards r HOME,IMPROVEMENTOONTRACTOR : iz? Registr ob 104951 f v Explration 7/16/2010 Tr# 271874 T rivate Corporation . - ,`' FOSTER& JIM x E '—James`Foster t I z>. '43 JOHN PARKER��D Administrator E.Falmouth,MA 02536 # p. i lir ',I License or registration valid for individul use only #` =1 before the expiration date. If found return to: t Board of.Building Regulations and Standards #` One Ashburton Place Rm 1101 Boston,Ma.01108 1- ' f Not valid wit out signature Aaoaxoo/o mop and lot number -- J� /� --' —..--'/=^' Permitnumber ......................................................... mum ~ House number ...- .....--... .....---------'----. . t639- . � �-��T7�T �-�� vl�T�� r0� � ��l� �7 ` TOWN ��-� ��|� �� - ' | ' BUILDING � N� 0 N �� 0 �� INSPECTOR �� ' �� NN00-NNN �� N ��0.N� 0NN �� ~ � �� - . --~- APPLUCATUO14 FOR PERMIT TO .............. -.-...---.-----.---_-..^- TYPE OF CONSTRUCTION -.. �----------- ___,_._____.________. /^~.~ .�y ) --. :«':-��.�....../x..e.. TO THE INSPECTOR OF 8Vm}|NGS The 6e i e6 ho,eby, |i for o permit according to the following information: Location -. c --------- ��.. . ----.-.^...-----.-.-_-.. `'~r~~~~ Use --------~^^^'—^'^''[----------------'---^^--------^---'-~------' Zoning District -..�---- ---------..Rre District ----. ----------------..- . / - Name of Owner ...............\ ..��k-�^.....................Address ................ --------------«--_____. | . �- .+ ' ~ -- +Nome of Boi|dar( � —7\�X.c...-------'A6Jrex ----,--.. ------------. ` . Nome of Architect ---------------...------.Add -.--. . - .. ------_____.. [ . Number of Rooms ---'_—.--------------'-Foundohon -' ��\/�� .--~-------_ ' - Eme,ior --.�--` �.'-----------------'Roofing ---' A -----._---_-,._ . . Floors ---.��.`�!��-------------.`-.Interior ..............'...[....<.................------_______.. ~�_ Heating ------ ..............................................................Rum6i -----.-----.------__________. ` �`�� ~_- Rrep|oce .--------------------------.Approximohe Cost ---.��C0/�--.----_,___,_ � Definitive Plan Approved by Planning Board l9--------. Area ....��`7 � . ................ h Dimensions of Lot and Building v Fee ............ ._. ~_,_-~_�_/ ______ � SUBJECT TO APPROVAL OF BOARD OF HEALTH all 04? ` / . / / /� ^ ` ' . | _ | ' � ' . ' ' ` � | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above � construction. . Nome ( -._.,=�°=�.......~`=,..-.�=--..-.-.-... � � . a A=269-66 , PETE tS , FRED AA�.7mA�itionNo . .. eror .... ....................... , Garage to Sin le....FamilY...Dwellin g....................................... ..... Location A6 ... oodland Avenue .......................................... H annis Owner ...Fred Peters ..................................................... Type of Construction ...Fdz ame .............................................. ............................... Plot ............................ Lot\ ...................... Permit Granted . April.. 15.i...............19 80 Date of Inspection ............ ....................19 i Date Completed 19 y (PERMIT REFUSED "00�v . ..... - .............. / I ....:..:... ..... .. . ..... ......... ....... ............................................................................... ............................................................................... i s Approved ................................................ 19 i ...................... ..................................................... i i ..................... ......................................................... i i V Assessor's map and lot number �p..��..-.... ..�o..........� PyOf THE t0� ' O ..A-Sevage Permit number ........................:............................... Z BAMTADLE, i r MABa 'f House number ....15�. ........................................... 9 00 1639, 'Fp YFY a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 9 TYPE OF CONSTRUCTION .................................................. ........ ... `/.......19�.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......( .9. .... .......... .....r-` ............................. ..... ....................................................... ProposedUse .................................... .......... ............................................................................................................................ DZoning District .........Fire District ................:.. Nameof Owner ..r"r-.t4...........\.......).`�r .....................Address .................................................................................... Name of Builderl.rW...!!�.. 1..� i ...................Address .Name of Architect ..................................................................Address .............................. ..................................................... Number of Rooms ............ .. Foundation .......0 ........... .................................................... .. Exterior ................ .'-'1./..I.....................................................Roofing ............. ........ . .... f! !............................................. t Floors Interior ............... �� .......................................... Heating ...................................................................................Plumbing .................... ........................................................ Fireplace ..................................................................................Approximate Cost .......... ...:................................... Definitive Plan Approved by Planning Board -----------____---------------19________. Area 1..10.�1 Z..... .................. Diagram of Lot and Building with Dimensions Fee L J,. SUBJECT TO APPROVAL OF BOARD OF HEALTH N c� J No r07 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ........ ........................... �y �k1 . . . No32T—.. Permit for ..Audditioo'---- / . � —'Gaza��.'tl�..Si�g][e...Family...[xellibg i Location 62 . ' aod..j��____._ Hyannis __________________________. Fred Peters Owner ---------------------- Frame Typeof Co .......................................... ` --------------------------. `Mot ............................ Lot ................................ ~ v . ' IN — � Permit Granted �z�ril I�� ' lg 80 --'`'�==-- ��--' \_' Dote of Inspection ��. 19 ~� Date Completed - ` ^ . ' . PERMIT REFUSED - \ ! -----,-------------':—.. �]� ----------------_--------- —.----.---~_---~-----------. ------------------~--'—.---. ( ~ 'n _---------__.------__._----.. Approved ---------------- lA ' �� -------`---.---------...--.—, ' ~ � � ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE 1. THIS SYSTEM IS GRID—INTERTIED VIA A AC ALTERNATING CURRENT UL-LISTED POWER—CONDITIONING INVERTER. BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS:t. CONC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING. DC DIRECT CURRENT LABORATORY SHALL LIST ALL EQUIPMENT`IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. t (E) EXISTING 4. WHERE ALL TERMINALS OF-THE-DISCONNECTING EMT ELECTRICAL METALLIC TUBING MEANS MAY BE ENERGIZED IN THE OPEN POSITION, ¢. j 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 Imp CURRENT AT MAX' POWER COMPLY WITH ART. 250.97, 250.92(B). i Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT., ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS ORA ' kW KILOWATT _' ENCLOSURES TO THE FIRST,ACCESSIBLE DC LBW LOAD BEARING WALL 'DISCONNECTING MEANS PER ART. 690,31(E).7 MIN. MINIMUM Y 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN . (N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY NEUT NEUTRAL _ - UL LISTING. NTS NOT--TO SCALE 9.. MODULE FRAMES SHALL4BE GROUNDED AT THE ". . . . OC ON CENTER UL-LISTED LOCATION PROVIDED BY THE _ } PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING P01 POINT OF. INTERCONNECTION t, HARDWARE < PV PHOTOVOLTAIC .;, 10. MODULE FRAMES,'RAIL, AND :POSTS SHALL BE SCH SCHEDULE BONDED_WI111 EQUIPMENT'GROUND CONDUCTORS. . S STAINLESS'STEEL STC STANDARD TESTING CONDITIONS ' TYP TYPICAL - UPS UNINTERRUPTIBLE POWER SUPPLY , V VOLT Vmp VOLTAGE AT MAX- POWER Voc VOLTAGE AT OPEN CIRCUIT VICINITY MAP INDEX , - � � . _. W WATT 3R • NEMA 3R,`RAINTIGHT PV2 SIOTE VER P ANEET " PV3 :'STRUCTURAL, VIEWS " PV4 THREE. LINE DIAGRAM x' s : LICENSE :; }.. GENERAL NOTES eet Cutsh s Attached 1. ALL WORK TO BE DONE TO THE .8TH, EDITION GEN #168572 -. rtELEC 1136 MR OR THE MA STATE BUILDING CODE. 2. ALL ELECTRICAL WORK SHALL.COMPLY WITH THE 2014 NATIONAL ELECTRIC CODE INCLUDING 4'. MASSACHUSETTS AMENDMENTS..- _ MODULE GROUNDING METHOD: ZEP SOLAR AHJ: Barnstable " REV ,BY ;DATE COMMENTS r A- NAME- DATE � COMMENTS .. f M UTILITY: NSTAR Electric .(Commonwealth Electric) - CONFIDENTIAL— THE INFORMATION HEREIN [NV MBER: J B-026 1 356 00 PREMISE OWNER'- DESCRIPTION: DESIGN: . CONTAINED SHALL NOT BE USED FOR THE PETERS., PAULINE PETERS RESIDENCE Joon Choi SOIarCIt BENEFIT OF ANYONE EXCEPT SOLARCITY INC., NG SYSTEM: NOR SHALL IT BE DISCLOSED IN WHOLE OR INp Mount Type C 66 .WOODLAND AVE - 2.08 .KW PV ARRAY �i„ y PART IZ OTHERS OUTSIDE THE RECIPIENTS S — HYA N N I S, q 1 t. T ORGANIZATION, EXCEPT IN CONNECTION WITH MA. .0260 I ITMK OWNER. ,THE SALE AND USE OF THE RESPECTIVE Hanwho Q Cells # Q.PRO G4/SC 260 = 7�t1�MM * 2 Su artin Drive Building 2,Unit 11 "�O 01752 LARCITY EQUIPMENT, WITHOUT THE WRITTEN R: /t11AIfV' RAGE NAME: SHEET: . REV: DATE T: (650)M636-1028h F:A(650)638-1029 PERMISSION of soLARCITY INC. AREDGE SE3000A—USOOOSNR2 5087753026` ' COVER.'SI-IFFY PV 1 6/30/2015 (8BB)_SOL_CITY(765-2489) www.solarcity.com PITCH: 15 ARRAY PITCH:15 c MP2 AZIMUTH:86 ARRAY AZIMUTH:86 MATERIAL:Comp Shingle STORY: 2 Stories B Vt OF 2 o N G . v IV�L LEGEND E�G`�� Front Of House a NAL 06/30/2015 O (E) UTILITY METER & WARNING. LABEL Digitally signed by Nick Gordon k inv INVERTER W/ INTEGRATED DC DISCO Date:2015.06.30,12:26:19 & WARNING LABELS 07'00' DC DC DISCONNECT & WARNING LABELS ---- © AC DISCONNECT & WARNING LABELS p 1I ❑ DC JUNCTION/COMBINER BOX & LABELS M Inv 0 DISTRIBUTION PANEL & LABELS o LG LOAD CENTER & WARNING LABELS 0 (E) DRIVEWAY O M DEDICATED PV SYSTEM METER D Q STANDOFF LOCATIONS CD CONDUIT RUN ON EXTERIOR --- CONDUIT RUN ON INTERIOR GATE/FENCE Q HEAT PRODUCING VENTS ARE RED INTERIOR EQUIPMENT IS DASHED L_�J SITE PLAN N" Scale: 1/8" = 1' W E 0 1' 8' 16' S J B-0261356 00 PREMISE OWNER. DESCRIPTION: DESIGN. CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: �.,,S��a�C�ty. co"TruNEo SHALL NOT BE USED FOR THE PETERS, PAULINE PETERS RESIDENCE _ Joon Choi BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 66 WOODLAND AVE 2.08 KW PV ARRAY ��11 PART TO OTHERS OUTSIDE THE RECIPIENTS MGDUL¢ 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) Hanwha Q-Cells # Q.PRO G4/SC 260 SHE: REV: DATE Marlborough,MA 01752 L PAGE NAME SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN T: (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. INVERTER- 5087753026 SITE PLAN PV 2 6/30/2015 (888)—SOL—CITY(765-2489) www.solarcity.com SOLAREDGE SE3000A-USOOOSNR2 r, S j PV MODULE 5/16 BOLT WITH LOCK INSTALLATION ORDER & FENDER WASHERS LOCATE RAFTER, MARK HOLE ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT 4" ZEP ARRAY SKIRT (6) HOLE.' s (4) . PI (2) SEAL PILOT POLYUITH RETHANE�SEALE LANT. 12 ZEP COMP MOUNT C ZEP FLASHING C (3)' (3) INSERT FLASHING. (E) LBW (E) COMP, SHINGLE (4) PLACE MOUNT. SIDE VIEW OF M P2 NTs (,) Q (E) ROOF DECKING (2) INSTALL LAG BOLT WITH V 5/16" DIA STAINLESS (5) (5) SEALING WASHER. MP2 X=SPACING X-CANTILEVER Y-SPACING Y=CANTILEVER NOTES STEEL LAG BOLT LOWEST MODULE . SUBSEQUENT.MODULES , INSTALL LEVELING FOOT WITH WITH SEALING WASHER (6) BOLT WASHERS. LANDSCAPE . 6411 2411 STAGGERED . (2-1/2" EMBED, MIN) PORTRAIT 48" „ _19�� ROOF AZI 86 P. . (E) RAFTER RAFTER 2X8 @ 16 OC ITCH 15 STORIES: 2 S 1 ST~I V DOrr ARRAY AZI 86 PITCH 15 s Scale: f 1/2" = V Comp Shingle H OF �{ N IVIL S NAB EN 6/30/2015 CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: PREMISE OWNER: DESCRIPTION: DESIGN: JB-0261356 00 CONTAINED SHALL NOTCE USED FOR THE PETERS, PAULINE PETERS RESIDENCE ;loon Choi ,;SOIa�C�t BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: NOR MALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type c 66 WOODLAND AVE . 2.08 .KW PV ARRAY y. PART TO OTHERS OUTSIDE THE RECIPIENT'S MODULES: H YAN N IS M A 02601 . ORGANIZATION, EXCEPT T CONNECTION WITH 24.SL'Martin Drive, Building 2, Unit 11 THE SALE AND USE T, THE RESPECTIVE (8) Hanwha Q—Cells # Q.PRO G4/$C 260 PAGE NAME SHEET: REV: DATE: Marlborough, MA 01752 PSOLARCITYERMISSION EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)811111 F: (650)638-1029 PERMISSION OF SOLARCITY INC. SOLAREDGE SE3000A—USOOOSNR2 5087753026 STRUCTURAL VIEWS PV 3 6/30/2015 (688)-soL-aTY�,65-2489) www.scIarcitycom iI GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) #8 GEC TO TWO (N) GROUND Panel Number:G303OB1150 Inv 1: DC Ungrounded INV 1 —(1)SOLAREDGE# SE3000A—USOOOSNR2 LABEL: A (8)Hanwha Q—Cells #Q.PRO G4/SC 260 GEN #168572 RODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number:2296780 Inverter; 390OW, 24OV/208V, 97.57/977.; w/Unifed Disco and ZB,RGM,AFCI PV Module; 260 , 236.7W PTC, 40mm, Blk Frame, H4, ZEP, 1000V ELEC 1136 MR Overhead Service Entrance INV 2 Voc: 37.77 Vpmax: 30.46 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 2 SOLAREDGE SE3000A—USOOOSNR2 (E) LOADS 27v Li 4� L2 2OA/2~ N JDC� P ____ GND EGC/ DC- A ----------- GEC ---TN DC- MP2: lx8 B GND M_ EGC- ---------------- ------- I N jI - o EGCLEC tc T-1 TO 120/240V `. SINGLE PHASE UTILITY SERVICE I I. I PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Voc* = MAX VOC AT MIN TEMP POI (1)SIEMENS 11022Q PV BACKFEED BREAKER A (I)CUTLER—HAMMER �DG221UR8 /fj� P V (8)SOLAREDGE #P —2NA4AZS DIC Breaker, 20A 2P, 2 Spaces Disconnect; 30A, 24OVac, Non—Fusible, NEMA 311 /-� PowerBox optimizer, 30OW, H4, DC to DC, ZEP —(2)Ground Rod; 5/8' x 8', Copper —0)CUTLER—{HAMMER R DG03ON8 Ground eutral Kit; 30A, General Duty(DG) (1)AWG6, Solid Bare Copp —(11 Ground Rod; 5/8" x 8% Copper 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, O THWN-2, Black 2)AWG #10, PV Wire, 60OV, Black Voc* —500 VDC Isc —15 ADC O Ise(1)AWG #10, THWN-2, Red W (1)AWG#6, Solid Bare Copper EGC Vmp —350 VDC Imp=5.87 ADC (1)AWG #10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=12.5 AAC . . . . . . .. (1)Cond4it Kit;.3/4".PVC, Sch..40 . . . . . . .70 AWG#8,.TH.WN72,.Green . . ECC/GEC-(1)Conduit.Kit;.3/4".PVC..Sch, 40. . .. J B-0 2 613 5 6 0 0 PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: �\,!s ■ CONTAINED SHALL NOT BE USED FOR THE PETERS, PAULINE PETERS RESIDENCE Joon Choi �;, So�arCity. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: !'i3 m NOR SHALL IT BE DISCLOSED IN WHOLE OR IN CompMount Type C 66 WOODLAND AVE 2.08 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS MODULE H YA N N I S MA 02601 ORGANIZATION, EXCEPT IN CONNECTION WITH ' 24 St Martin Drive,Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (8) Hanwha Q—Cells # Q.PRO G4/SC 260 SHEET: REV; DATE: Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME T: (650)638-1028 F.- (650)638-1029 SOLAREDGE SE3000A—USOOOSNR2 PERMISSION OF SOLARCITY INC. INVERTER: 5087753026 THREE LINE DIAGRAM PV 4 6/30/201 (888)-SOL-CITY(765-2489) www.solarcitym.caL Label Location: Label Location: „ Label Location: r o o e •e a (C)(CB) a (� (AC)(POI) 1 (DC)(INV) '= Per Code: _ •_ Per Code: - o _ Per Code: NEC 690.31.G.3 •o 0 0 ° NEC 690.17.E o o e o- •o NEC 690.35(F) • Label Location: - o :o . - e e e TO BE.USED WHEN. ■ O O O p (' (DC)(INV) °•° o-• --o o • -o e e • INVERTER IS D O Per Code: UNGROUNDED r NEC 690.14.C.2 " , Label Location: Label Location: - o 0 0 .° (POI), -o (DC)(INV) o o Per Code: -e '- Per Code: NEC 690.17.4; NEC 690:54 •-e .o e e NEC 690.53 w � :o o o•o s ML #' Label Location: e- ►CeS � o (DC)(INV) Per Code: NEC 690.5(C) s Label Location: o o- O (POI) o •e - e Per Code: NEC 690.64.B.4 e o o - ? ` LL Label Location: (DC)(CB) 5 • ° ,_ Per Code: Label Location: MN 00 0 0 - NEC ne 690.17(4) ' l�JllV (D)(POI) o eo • ' •o - - • e ` - o 0 0 • E .64.B . • Mw P C 690 N .4 . . R e l0am. Label Location: o � (POI) Per Code: Label Location: o - o o- NEC 690.64.B.7 ■ O O O G (AC)(POI) eo o - o (AC):AC Disconnect D O Per Code: °� _ _ � . - : .�s (C): Conduit NEC 690.14.C.2 (CB): Combiner Box Y f (D): Distribution Panel.. (DC):DC Disconnect Label Location: (ICV Interior Run Conduit f � (IN ): Inverter With Integrated DC Disconnect U11119"' p (AC)(POI) (LC): Load Center • -- Per Code: (M): Utility Meter • lr)` NEC 690.54 #' (POI): Point of Interconnection ' CONFIDENTIAL— THE INFORMATION HEREIN CONTAINED SHALL NOT BE USED FOR ��•�•��j 3055 gearview Way THE BENEFIT OF ANYONE EXCEPT SOLARCITY INC., NOR SHALL IT BE DISCLOSED �— ■ San Mateo,CA 94402 MOL E OLE OR IN PART TO OTHERS OUTSIDE THE RECIPIENT'S ORGANIZATION, Label Set �� T:(650)638-1028 F:(650)638-1029 EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE Ov S��al'��t (888)-SOL-aTy(765-2489)www.solarcity.com SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PERMISSION OF SOLARCITY INC. o =N ® Next-Level PV Mounting Technology ''SOIafClt Z Solar Next-Level PV Mounting Technology SolarCity I ZepSolar 9 gY y l P Zep System Components for composition shingle roofs =�C-M.—ry t. a F z�p c R..f A +1 A..�ystarf Description F j e PV mounting solution for composition shingle roofs q cdMPl*Sl Works with all Zep Compatible Modules • Zep System UL 1703 Class A Fire Rating for Type 1 and Type 2 modules Auto bonding UL-listed hardware creates structual and electrical bond V� Comp Mount Interlock Leveling Foot LISTED Part No.850 1345 Part No.850-1388 Part No.850-1397 _ Listed to UL 2582, Listed to UL 2703 Listed to UL 2703 Specifications Mounting Block to UL 2703 ®R Designed for pitched roofs An 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 ETL listed to UL 467 • Zep System bonding products are UL listed to UL 2703 1) 1 . • Engineered for spans up to 72"and cantilevers up to 24" • Zep wire management products listed to UL 1565 for wire positioning devices Ground Zep Array Skirt,Grip,End Caps DC Wire Clip • Attachment method UL listed to UL 2582 for Wind Driven Rain Part No.850-1172 Part Nos.500-0113, Part No.850-1448 Listed to UL 2703 and 850-1421,850-1460, Listed UL 1565 ETL listed to UL 467 850-1467 zepsolar.com zepsolar.com Listed to UL 2703 This document does not create any express warranty by Zep Solar or about its products or services.Zep Solar's sole warranty is contained in the written product warranty for This document does not create any express warranty by Zep Solar or about its products or services.Zep Solar's sole warranty is contained in the written product warranty for each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely each 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 Zep Solar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. responsible for verifying the suitability of Zep Solar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. 12 22 14 ZS for Comp Shingle Cutsheet Rev 02.pdf Page: 1 of 2 12 22 14 ZS for Comp Shingle Cutsheet Rev 02.pdf Page: 2 of 2 so I a r ' 0 0 - solar=oolEdSolarge Power Optimizer ^l7 Module Add-On for North America C== P300 / P350 /'P400 SolarEdge Power OptimizerP30 g ,. Module Add-On For North America GG-c P350 P40D (for 60-[ell PV (for 72-cell PV (for 96<ell PV ' modules) modules)- 'modules) •-'INPUT - P300 / P350 / P400 LS "` Rated Inpu[DC Power•'I 300 350 400 W '` '.. •.it Absolute Maximum Input Voltage(Voc at lowest temperature) 48 60 80 :: Vdc - - ............................ .. . ......... ......... ....... ........... ..... .... MPPT Operating Range ...........8.... ..............8 60 .......8:80.... Vdc Maximum Short Circuit Curren...... .,..... ..., 10 ...Adc - . - - Maximum DC Inpu[Current 12 5 All .... ... Maximum Effiuenty 995 % ...... .. ........................ ......... .. .. ............................ - r„ '* ... . Weighted Effic ency .................... .... .. ......... ........ ..... ... ... ..-... %...... ' Overvoltage Category I OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO OPERATING INVERTER) - Maximum Output Current.. ...... .... .... ............ ....... ..... .. Adc - - Maximum Output Voltage 60 Vdc ° ' o _ - I OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM INVERTER OR INVERTER OFF) .,-` .• ;> Output Voltage per Power Optimizer 1 - Vdc r - (:J"� •P g ND M^ y r FCC PartlS Class 8 IEC61000-6 2 IEC61000 63 4 - _ ARD COMPLIANCE % EMC Safety......................... .. .. .. JIEC62109-1(class II safetYh.UL1741.... .. ...... - ... RoHS - ............Yes.. .. .: - I INSTALLATION SPECIFICATIONS + - z•. Maximum Allowed System Voltage 1000 Vdc Drmensluns(WxL x H) 141 x212 x 40.5/S.55 x 834x L.S.9 mm/m ' Weight(including cables) 950/2.1 gr/lb.. ......... .. MC4/Amphenol/Tyco.......... ..,.. ...... .. ........ .. .. :.. .. .... ... ..... ......... ...... ... ... ...... Output Wire Type/Connector Double Insulated;Amphenol bOutput Wire Length ................. ... 0.95/3.0- ..L.-.... ..1.2/3.9.. ...rrr/@.. Operating Temperature,Range - - 40-+85/-40-+185 'C/-F Protect) Rating IP65/NEMA4 -. ........ ......... ..... ...... .......................... ....... ........ .._.... .................. ... Relative Humidi 0 S00 % - �a �nn.v.a sre aowe.onnemme e.moau.or ec ro sxco.e.em.madaowen ' - - J - l PV'SYST A EDGE -THREE PHASE THREE PHASE SYSTEM DESIGN USING SOLAR 1 .. - :,,. •. _ SINGLE PHASE 1 - - t:- JINVERTER - 208V '480V - PV power optimization at the module-level Minimum String Length(Poweroptimi:ers) "!........ 8 - 10 18 .- ` - - - Maximum String Length(Power Optimizers)' -25 .25-...... SU... - _ Up to 25%more energy. - .......... ....... .............. ..... ... ...... .... ...... .. .... ...... .. Superior efficiency(99.5%) Maximum Power per String........ ... ..... - -..... ..-. 6000. ..... .--. ..... - Mitigates all types of module mismatch losses,from manufacturing tolerance to partial shading - �s Parallel Strings of Different Lengths or Orientations. Yes ..- ' 5250 12750 W -, — Flexible system design for maximum space utilization - - - — Fast installation with a single bolt .".tm .; ',•f:, - Next generation maintenance with module-level monitoring - - Module-level voltage shutdown for installer and firefighter safety USA - GERMANY ITALY - FRANCE ' JAPAN - CHINA ISRAEL - AUSTRALIA WWW.Solaredge.uS . _ .. � re,�m,., cm n[k&� � �mmlQ•tQ�um.•<•aq^ .ne � Single Phase Inverters for North America f # �2 Solar o o V o I a r 0 * 0 SE3000A-US/SE3800A US/SE5000A US/SE6000A US/ Xo .-,. t � SE7600A-US/SE1000OA-US/SE1140OA-US SE3000A-LIS SE380OA-US SE5000A-us SE6000A-US SE760OA-US SE10000A-US SE1140OA-US - 3 'OUTPUT i SolarEdge Single Phase Inverters " � 4 Rfr 99BD@2DBV . � �' P` Nominal Power Output 3000 3800 ....5000... 6000 7600 11400 VA q ...................................... .. .. .. .. 30000 @240V i t 10800 208V ;„-r,t�p�..T�S'- Max.AC Power Output 3300 4150 .5400 @ 208V 6000 8350 @ 12000 VA For North America "7 ss ; � 5450 @240V. .............. ............ 10950 @240V. ................ ........... ............ .............................. ................ ............... ....... .. .. .. . '�• ,� -i AC Output Voltage Min:Nom:Max.-ASIR _ � 183-208-229 Vac ,,,,,,,,,, .... SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ ...Outp.t Vol.........-No .......... ................ ............... ................. ................ ................ .................. ...... •�# • AC Output Voltage Min:Nom.Max.' SE7600A-US/SEt0000A-US/SE11400A-US �r ' zll-zao 264vac ry ..... ... ... .... ... ... ..... ... .. ......... ...... ... ... .... ........... ................ .. ... ......................... ................ ',„q. �" +a'`� AC Frequency Min. .-Max.* ............ ....•,.•_.. 59.3 60 60.5(with.Hl_country setting.57-60 60.5) ....__...., ..Hz..... _ ...24 @ 20SV . .. ...... .. ... .. ...48 Max.Continuous Output Current ...... .....12.5......I......16......I.....21 @.240V..L.....ZS.......L.....32.......L..42 @ 240V...L.....47.5....... ... A GFDI "'e'er° `"z,`e ^,. .% .r ...Utility Monitoring,Islanding...... ............................. ..... ....... ...... ......... ........ ......... Protection,CountryConfigurable Yes ..... ..... ..1.. ..... .. . A � '-'•T'jXo Threshold rJ• 2 'iFi r e °INPUT'^ C t '� - Recommended Max.DC Power'* - (STC)............................. .. .. ................. ...... ..... . ...... .. ................. .................. ...... •,� •" `: tr I ;,.�,r �' �„ •:r':."� Transformer-less;Ungrounded 75Ye .......... ........... ...... ................. ........................ .. ............ . ...... ................ ... ........ ... ...... .... 3750 4750 6250 9500 12400 14250 W ..Max.Input Voltage ... .. ................................... . .. ...5 0... .. ..... ........................................ ...Vdc... Nom DC Input Voltage 325@208V/350@240V •Vdc ............ ......... ....... .... ........... . ... ...... ...... ..... ............ .. .............. ....... ................. 16.5 @ 208V ...33 @ 208V... Max.Input Current*** .. ... ....�.�...... ......�.3. .. 15.5 @.240V.I......18 ... ....23.......I.30.5 @ 240V.. . ....34.�..... Adc .` .r.`• s-x= �` Input Short 30.... ...... . .. 45.... ...Adc -....... .. .. I.. Max. r ........................... ........ ..................................... ................ ......... 1 ........... ........... ...... ................... l ,x..-a>ti ns'+-)7:.s `d}k, -' ' "• �C ''s, "`'�r .' Reverse-Polanty Protection ... ................ ...... ..................... Yes .. .................................. ......... _ kuSensitivity r' `'.• r s ;.k .a, a ,':; A ...m Inverter Efficiency ....... .......7... ...98.2... ....98.3.... 00 98.3 ............. ....98.... ......98..... ......98..... ...%..... Mrxi .on.... ............ ......... 6............ ......... ..... ..... .. .........( .x Maximu .. ...... ...... .. r „ v . : a. s. f f r < ;,:. _ ., : CEC Weighted Efficiency 97.5 98 7 5 @ 208V 97.5 97.5 •7.@ 240 .• g7.5 % .-• • ,-, ra s .,.,, ,o 99S @ 240V ..... :@ 240V n '•Night"e Power Consumption.:.. ................ ......... ..<2 5... ..... ....... .. .. .. <4.... ...W. rt. >ADDITIONAL FEATURES - - -� _.. /. •- Supported Communication Interfaces RS485 RS232 Ethernet ZlgBee.(optional) ............................................. Revenue Grade Data ANSI C12.1 .- .. •Optional Tv, �. .. . ., ; - STANDARD COMPLIANCE, _ - - l .- .,.' Tr,.�._._. r '^• ' "` ` 99B,UL1998,CSA 222 Grid Connection Standards..... .. L161EEE1547.. U L1741 U e, ....................... .. ... .......... .................... ... ........ .... t. ........ .......... FCC part15 class 8 - 24-6 AWG ...3/4„minimum/8-3 AWG INSTALLATIONoutput conduit SPECIFICATIONS /AWG range 3/4 minimum/ t .. ............... . ........ ............................ .................................................. ......... Emissions DC input conduit size/N of strings/ - _,^ i • _ •- ."` - 3/4"minimum/1-2 strings/24 6 AWG 3/4"minimum/1-2 strings/14 6 AWG rangAWG........... ..... .. .. ..... ................ ... ... ..... ... ................. ......... ........................................ .. Dimensionswit AC/DC 30.5x12.5x7/ 0.5x12.5x7.5 30.5x12.Sx10.5/775x315x260 .m "" *,•. „•:' ,,�;, „ Switch(HxWxD) A 775 x 315 x 172 `3775 x 315 x 191/ mm : rt- - s=..,.,.._.x,::,.;.. _..:«e:'� .� ,....; ..�:�.. .• _: , ;, C/D.. .eri ...... ...... ....... ....... ................. .. ..... .................. ...... . ...... .. ..... ..... ..... .. . ..... ..... .. Weight with AC/DC Safety Switch . .. ..51.2/23.2.. ..54.7/,24:7......... ......... 88.4/40.1 .......... lb/kg../.. .. . Cooling Natural Convection Fans(userreplaceable) - ......... .... .................. ....... . The best choice for SolarEdge enabled systems Noise ......- <2s.... ..................:........ .... .... <.50............. .. .dBA... Min.-Max.Operating Temperature -13 to+140/-25 to+60(CAN version—• -40 to+60) -F/•C - - Integrated arc fault protection(Type 1)for NEC 2011 690.11 compliance Range .. - Protection Rating .. ........ ... .............. ......... ................NEMA 3R............................................. ...... ......... Superior effi'ciency'(98%) contact .............:....................:................... ' � 'For other regional settings please contact SolarEdge support. Small,lightweight and easy to install on provided bracket Limited to 125%for locations where the yearly average high temperature isabove 77•F/25'C and to 135%for locations where it is below 77•F/25•C. For detailed information,refer to htto'//www=-olaredne us/files/ndfs/-i v rter do oversizinji auide.odf .- Built-In module-level monitoring - - __ •�'Ahgher current source may be used;the Inverter will limit is input current to the values stated. •••CAN P/Ns are eligible for the Ontario FIT and mlcmFIT(micmFIT exc.SE11400A US-CAN). — Internet connection through Ethernet or Wireless } —;Outdoor and indoor installation h I — Fixed voltage inverter,DC/AC conversion only Pre-assembled AC/DC Safety Switch for faster installation Optional—revenue grade data,ANSI C12.1 SUIISF E[ ID ' t USA GERMANY ITALY FRANCE-JAPAN-CHINA-AUSTRALIA-THE NETHERLANDS-ISRAEL WWW.SOI21E!CIgE'.US " " ""> ,'�'" ;:a n , n • S " �:; �t i 1 ' Format 65.7 in x 39.4 in x 1.57 in(including frame) _ (1670 mm x 1000 mm x 40 mm) -.•M -W- .M- s, ^ 1T14S-� I Weigh .. 44.09 lb(20.0 kg) y - } From Cover 0.13in(3.2 mm)thermally pre-stressed glass with anti-reflection technology ^- .R � ! Back Cover Composite film ' -,,,,,,r.►•""` -"`� Frame Black anodized ZEP compatible frame - ��, Cell � 6 x 10 polycrystalline solar cells � -�- Jundiortbox Protection class IP67,with bypass diodes y` Cable 4 mm'Solar cable (+)a47 24 in(1200 mm),(-)2:47 24 in(1200 mm) ' L .,,,..� "y �,-_..ram _ r-^^•zw.,...r+.n-.. ...._•---^.--.�.-- _.--_....-.. s-. onwn°^"H"� Conner or mphenol,Helios H4(IP68) a I PERFORMANCE AT STANDARD TEST CONDITIONS(STC:1000 WAna,_25•C AM 1.5G SPECTRUM)' _ 'POWER CLASS(+5W/-OW) - -- - '[W] 255 -._260 265 Nominal Power ,.- P•n _ IWl 255 T 260 --'t- _265 - Short Circuit Curren I,, [A] - • �-9.07 - .-,.. 9.15 - •9.23. - • • L t • - - .-.._R 37.54� 37.77 38.01 Open Circuit Voltage - V. [Vl _ .. .. i,•, Current at P,•, - .1•,r [A] 8.45 13%53 - r. 8.62 [VI • �_,._.._ _ I V - 30.18 30.46 30.75 The new Q.PRO-G4/SC is the reliable evergreen for all applications,with a Efficiency(Nominal Power) r1 r°/] a15.3 2:15.6 a15.9 TM PERFORMANCE AT NORMAL OPERATING CELL TEMPERATURE(NOCT:800 W/ma,45m3C.AM.1.5G SPECTRUM) a black Zep Compatible frame design for Improved aesthetics, opti- �.-L--- --- - mized material usage and increased safety.The 4th solar module genera- POWER class i+sw/-Dw)t_- Iw]_ 255 _Zso. Z6s - tion from Q CELLS has been optimised across the board: improved output Nominal Power P (WI '_ x 188.3 1920 .- 17.44 p p p - Short Circuit Current _.. I�- [Al' ` �` 7 31 __... 7.38 -� - 7.44 _ y g operating reliability ability,quicker installation and a '- _ r _ w �Open Circuit Voltage V, IV] 34 95 .� 35.16 -- - - - 35.38 _yield, higher eratin reliabie and dui _ more Intelligent design. _ ^� Current at P" -I•p [A] 6.61 6:68 6 75 . . Voltage at P,•°..._..,..r... VN :[V]'•- - - 28.48 28.75 - -29.01 - 'Measurement tolerances STC:s3/(P o;m 10/(Iu;VIm -V )+ Measurement tolerances NOCT:x 5%(P o;m 10%(I,V�,I^p0 V_D) --_ - INNOVATIVE ALL-WEATHER TECHNOLOGY PROFIT-INCREASING GLASS TECHNOLOGY G cELis'PERFORNIANCE WARRANTY u�m PERFORMANCE AT LOW IRRADIANCE ' ' •Maximum yields with excellent low-light Reduction of light reflection by50%,.' _ --' -- At)east97k.otnominalpowerduring > and temperature behaviour. plus long-term corrosion resistance due l"• first year.Thereafter max.0.6i degra- - -,h ��a --- cation per Year. •Certified fully resistant to level 5 salt fog to high-quality (�R At least 92 i of nominal power after f ` --- r f {% •Sol-Gel roller coating processing. }E At lent 83 r of nominal power after , .e._ 25.years. - - ENDURING HIGH PERFORMANCE t e Long-term Yield Security due to Anti. EXTENDED WARRANTIES • • �° ^ +' wlarrdant terms ofata within theQ CELLS saasurement tolerances. lee es IRRao t( warranties , • Full wa anties in accordance with the PID Technology',Hot-Spot Protect, •Investment security due to 12'-year'A., g ,syho w ry. _ IANCE IW ' �'. and Traceable Quality Tra.QTM. ` product warranty and 25-year Linear o The typical ange in module efficiency at an irradiance of 200 W/m'in relation °w , rraRs •Long-term stability due to VDE Quality, performance warranty2 _ ran' n of your-respec'e count ' (both at 25°C G spectrum)is 2%(relative). o Q. -� � _ TEMPERATURE COEFFICIENTS(AT t000W/WI',25`C,AM 1.SG SPECTRUM) Tested-the strictest test program. --, _ . - �'.` °-• . - Temperature Coefficient of of Va �[�/IQ/K1 -0.30 - . - -- •, _ ... � Q CELLS ��' Temperature CoeNmient of Ix �a [�/K] � +0 04 Temper 9 _ ___ '-TOP-BRAND,PV - TemPeramre Coettmieet of P•„ V [%/K] -0.41 NOCT - w [°F] _-... 113 m.5.4(45 i 3°C) sir SAFE ELECTRONICS _ •Protection against short circuits and - 2®'IS Maximum System Voltage V_ IV] 1000(IEC)/1000(UL) Safety Class thermally induced power losses due to, - 'ciTVPE e e breathable junction box and welded' MaxtmumsedesFos.Rating'• [aocl zo ` Fire V _ � _ I =Wmg �T`T�'�[Ibs/fl'] �, 50(2400 Pa) Permitted module temperature � -40°Fup to+185°F W cables. - - - ] n continuous duty - „p to+85°C) e ��'[Ibs/ftal� •� M50(2400Pa) on installation manual - e Phntnn ` up .. .. ..i ,. OUality Testea QCEUS a ! 1 1 1 1 1 L _ -� ,.me.N JJtl Basl R IYcryshlhn 555 . . . , . ,« 1 . r a°q°v± sala ale 2013 UL 1703;VDE Quality Tested;CE-compliant; ' Number of Modules per Pallet IEC ^ gb 26 ° _ - a .�.•.,_. nPRDE�''s IEC 61215(Ed.2);IEC 61730(Ed.1)application class A - -"` i "`""-• •" "' '•-'T' -"� 3 - _ Number of Palletspe_r 53'Container - 32 THE IDEAL SOLUTION FOR: ID.40032687 „,A>� -- �. _. _._ A4 (. Number of Pallets per 40•Container 26 Rooftop arrays on - _ �; pMPAT - OVE C 'C' ��U - Pallet Dimensions(e x W x H 1 -� 68.7 m x 45.0 in x 46.0 in - residential buildings. _ - QG 7d� - { c w, Us �aJOe" - (1745 x 1145 x 1170 mm) - ® comas` Pa I .. _. 1226 b 69 kg) • � - / . - �.-.. - I el Weight _.,..-...._(5 .. _ .. • . - ,• w NOTE:Installation instructions must be followed.See the installation and operating manual or contact our technical service department for further information on.approved installation and use of - - ' APT test conditions:Cells at-1000V against grounded,with conductive metal foil covered module surface, CpMPp,'(� this product.warranty void if non-ZEPtertified hardware is attached to groove m module frame. 25°C,168h __ ' y r - Hanwha 0 CELLS USA Corp. See data sheet on rear for further information. - - - - ..300Spectrum Center Drive,Suite 1250,Irvine,CA.92618,USA ITEL+1 949 748 59 96 1 EMAIL gtells-usa®gcells.coml WEB www.gcells.us Engineered in Germany (.5 CELLS �. Engineered in Germany �=-•O CECCS g _ , C 1 - _