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0177 LONG BEACH ROAD
F. ...r -r. , .:' -r._s�, g.. ..y',�.- r.. ._ ..•. r, -wµ; i� .- ¢. .v �,anp ,c* .,,�. � �h i •:iYiX''d - 'C.' t. `.,�.` j r,.r 1. j'= t' y t J'� i-' .4 s , a. y a F. , y Application number.. . .............a..�..J r*4 . ........ d e Date Issued.................. ...........��.��.. .�.... .............. . . sAMSTABNAM I.E. Building Inspectors Initials. Map/Parcel...Z25.—5.t..... ............... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION. PROPERTY TY WFORMATION Address of Project: /7 7 /-on� /&a c4 Rock ���✓�� NUMBER STREET VILLAGE Owner's Name: CkA r 1e-s '-?-,-\rdS e�Z Phone Number Email Address: �,t->;r J s-e�@ C&-.,c4 s �. n e -� Cell Phone Number 5 OF-7 71'- 6 3 2, Project cost$ Z q q 5 Check one Residential V Commercial OWNER'S AUTHORIZATION g g RgLLT7 N /.._. As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e �-f(Q�n� C'<r- �-� Date: TYPE OF WORK ❑ Siding [ V�indows(no header change)#--L_❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Gcl tcs�e�/nGi1a 9 Pn'lP/1 - ���Co�d► /t' L CONTRACTOR'S INFORMATION A 1L IO Contractor's name �t�un `7�n�►�so� - � ecn �e�J �r5�cn� 'nc�cn�S __ _ Home Improvement Contractors Registration(if applicable)# 17 3 2-K 5 (attach copy) Construction Supervisor's License# 09 5-7 O7 (attach copy) Email of Contractor �S� g � r �1,cv� Phone number �o 1 z 2 R - 19 00 ALL PROPERTIES THAT HAVE STRUCTURES OVER TS YEARS OLD OR IF THE SUBJECT PROPERTY/S IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. ~t APPLICATION NUMBER ........:............................... . .................... *For Tents OnIV* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent if food is being served at your event please obtain a Health Department approval betaveen the hours Of 8o00am-9e30 am or 3:30 pm-4:30pnL Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right sideL- HONEOW1 EWE LICENSE EXEITTION Homeowner's Name: Telephone Number Cell or Work number I understand any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with.780 CMR the Massachusetts State]wilding Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Date Signature ]PLICANT'S Date_ -� 5�' I£� Signature All permit applications are subject to a building official's approval prior to issuance Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Charles Birdsey Legal Name:Southern New England Windows,LLC 177 Long Beach Rd. RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02633 VIONOM NE IACEMEET 10 Reservoir Rd I Smithfield,.Rl 02917 - H:(774)722-2672 - Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)775-0325 . Buyer(s)Name: Charles Birdsey Contract Date. 06/07/18 Buyer(s)Street Address: 177 Long.Beach Rd.,Centerville, MA 02632 Primary Telephone Number: (774)722-2672 Secondary Telephone Number: (508)775-0325 Primary Email:bbirdsey@comcast.net. Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms;any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $28495 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $850 Balance Due: $1,645 Estimated Start: Estimated Completion: ; Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment. Credit Card We schedule installations based on the date of the signed contract and secondarily on Cash/Check the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: Taxes paid in Barnstable, Ma Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal . understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 06/11/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. . Legal Name:Southern New England Windows,LLC dba:Renew By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature " . Signature Gino Montesi Charles Birdsey Print Name of Sales Person~ Print Name Print Name UPDATED: 06/07/18 Page 2 /.11 'tfi-e of Consumer Affairs and Eusiness Regwiati®n 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Lorne Improvement Contractor Registration Registration: 173248 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD L+NCOLN. RI 02865 Update Address and return card.Mark reason for change. Address Renewal = Emplovment Lost Card =-0fiice of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: _- Office of Consumer Affairs and]Business Regulation Registration: 173245 Type: 10 park Plaza•Suite 5Il70 Expiration: 9j7 g/2018 Supplement Card Roston.MA 01-116 iUTHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON 1AN DENNISON ALBION RD a✓ J JCOLN, RI 02865 �-�dersecreiary Not valid without signature L'G. � r vii i:L �.'-: Rec; 5a io; .C G~iv G!'; CS-095707 S- RIANN D DENNISON LAND POND CIRCLE C"ARLTON MA 01507 ..i 0:: :JS 1071yi• ;20�r The Commonwealth of Massach.SeM Department of Industrial_Accidents 1 Con!ess Street,Suite 1 DD Bosion,MA 02114-2017 6 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Le 'b1- Name (Business/Organization/Individual): Address: ,G�Ll�lfl� City/State/Zip: 1u Phone#: Are you an emplover?Check the appiopriate box-- Type of project(required): 1'KI am a employer with Z�1temployees,(full and/or part-time).* 2.❑I am a sole proprietor or partnership and have no employees working for me in 7..❑New construction any capacity-[No workers'comp-:insurance required.] 1 8. D Remodeling 3.[]l am a homeowner doing ail work myself[No workers'comp.insurance required-1 t 9• ❑Demolition 4.F�I am a homeowner and will be hiring contractors to conduct all work on my property" I wiii 10 Building addition ensure that all contractors either have workers-compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have worker'comp-insurance.+ 13_� Roof repairs n 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14- ether 152,F 1(4),and we have no employees.[No workers'comp.insurance required-] re��4r�.rrP-► *Any applicant that checks box>vl must also fill out the section below showing their workers'compensation policy information_ 7 Homeowners who submit this affidavit indicating they are doing aU work and then hire outside contactors must submit a new afi-idavit indicating such. !Contractors tbat 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 emplovees. Below is the policy Ad job sire information. Insurance Company Name: I rf MQ/'S Policy 3�or Self-ins.Lic.it: W CA-31S�r7 2-9 _ Z Expiration Dare:_l 1 1 Job Site Address:17 7 L&-j c d c4 City/State/Zip: (P,r ✓,dl /�(,t} Attach a cop} of the workers'comp nsation policy declaration page(showing the policy number and eapira "on date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation ptkiishable by a fine up to$1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator"A copy of this statement may be forwarded to the Office of investigations ofthe DIA for insurance coverage verification. I do hereby certify under ih !ins and penalties of perjury that the information provided above rs true and correct Si ature: a D3`te: Phone#: AID l-ZZ g= Official use only. Do not write in this area,to be completed by city or sown ofciaL City or Town: Permit/License P Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityP own Clerk 4.Electrical Inspector S..Plumbing Inspector, b.Other Contact Person: Phone#� 4C RO O® CERTIMCAT P ATE(MMMDIYYYY E OF LIABILITY INSURANCE ' 12/29/2017 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). -RODUCER CoBiz Insurance, Inc.-CO [NAME: 1401 Lawrence St, Ste. 1200 303-988-OWDenver CO 80202 FAiir No303-988-0804 COMaiI cobizinsurance.com INSURERIRI AFFORDING COVERAGE NAIC/ NSURED ESLERCO-01 INSURER A:Acadia insurance Compariv 31325 Southern New England Windows, LLC. iNsuRER a:Firemens Insurance Com an of WA,D.C. 21784 Jba Renewal by Andersen of Southern New England iNsuRER c:Homeland Insurance Company of New York 10 Reservior Rd 344$2 Smithfield RI 02917 INSURER D: INSURER E: INSURER F: ,OVERAGES CERTIFICATE NUMBER:1252851165 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. ISR T RR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP \ POLICY NUMBER MM/DD MM/DD LIMITSA X COMMERCIAL GENERALUABILITY CPA3158728 1112018 1/1=19 EACH OCCURRENCE S 1.000,DOD CLPJMS-MADE X OCCUR DAMAG T -RENTED PREMISES Me occurrence $30D,000 MED EXP(Any one person) S 10,000 PERSONAL B ADV INJURY $1•D00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.00D X POLICY ECT LOC _ PRODUCTS-COMP/OP AGG $2.0DD.DOD OTHER: $ A AUTOMOBILE LIABILITYN CPA3158728 1/12016 1/1201& COMBINED SINGLE LIMB X Ea a.dent $1 ODD OOG AALL OWNED NY AUTO i SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS-OWNED AUTOS i PROPERTY DAMAGE $ Per arc dent I A X LA OCCUR,LB X OCCUR. CPA315872E 111201E 1171201E EACH OCCURRENCE 51D.ODD.000 EXCESS LJAB CLAIMS-MADE DED I X.1 RETENTIONS AGGREGATE $10.ODO.DOD E WORICERRSLOMPENSATION WCA3158729-20 n PER S AND EMPLOYERS LIABILITY V12018 1/1201_ X ANY PROPRIETORIPARTNERIDO=CLMVE YIN _ STATUTE FRH" OFFICER/MEMBER'EXCLUDED? ❑ N/A EL EACH ACCIDENT $1.000,D00 (Mandatary in NH) N yes desenU under E.L.DISEASE-EA EMPLOYEE S 1,000,0131) DESCRIPTION OF OPERATIONS be]ox F-L DISEASE-POLICY LIMIT 51,000.00D C Pollution liability 7930073340000 Gaims-Made Policy 1/1/2018 1/10MG Each O=urrence $1.000.0m Retroactive Date 06)2012013 a $1.00 0000D iESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) :ERTIFiCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE .EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. iCORD 25:(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable Permit# Expires 6 atotjlks from issue date ' Regulatory Services Fee snruvAM a T 9$Ai t6 9. a`0� Richard V.Scafi,Director OD Building Division Tom Perry,CBO,Building Commissioner n` 1� 200 Main Street,Hyannis,MA 02601 OCT 0 4 www.town.bamstable.ma.us 2017 Office: 508-862-4038 TOWAI TOF N 08-790-6230 EXPRESS PERIMIT APPLICATION - RESIDEI�T�'IAL BLE Not valid without Red X-Press Iutprvnt Map/parcel Number .2—0 S_ Ulzg _ --.-._ T�-- Property- .. Address- / '7� Pc C� �D� et'�r� e residential Value of Work 7 5 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t`tea 17�t d S e ? ch ndr7,,,1 2?/t / /I r,501( Telephone Number� -G��-�. 7 2�Contractor's Name ' Home Improvement Contractor License#(if applicable) / '3 S— Email: Construction Supervisor's License 4(if applicable) -7 07 co/workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ hm the Homeowner [!I have Worker's Compensation Insurance Insurance Company Name S f ,_n`5 In siird.'1 r.ea �C) Workman's Comp.Policy# W C A 1 5 a 7 2 9 — 2.0 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) e-side Replacement Windows/doors/sliders.U-Value 2. (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property wner must sign Property Owner.Letter of Permission. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Locai'dMicrosoft\Windows\Temporary Internet Files\Content.0udook\2P101 DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms Andersen. dba:Renewal By Andersen of Southern New England Barbara Birdsey Legal Name:Southern New England Windows,LLC 177 Long Beach Rd: RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Centerville,MA 02,632. 10 Reservoir Rd I Smithfield,RI 02917 WINDOW RE LACEMEpT � � H:(774)722-26,7Z�' Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:.(508)775-0325 Buyer(s)Name: Barbara Birdsey Contract Date: 09/22/17 Buyer(s)Street Address: 177.Long.Beach Rd., Centerville; MA 02632 Primary Telephone:Number: (774)722=2672 Secondary Telephone Number: (508)775-0325' Primary Email: bbirdsey@eomeast.net Secondary Email: i. Buyer(s).hereby.jointly and severally agrees to purchase the products and/or services of Southern.New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement. Document and Payment.Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed:to b the parties and incor orated herein by reference;(collectively,this"Agreement").'',. . y p Buyer(s)hereby:agrees to sign a completion certificate:after Contractor has completed.all work under this Agreement. 'Total Job Amount: $5,751: By signing this Agreement,you acknowledge that the Balance Due;.and.the Amount Financed must:be made by personal check,bank check,credit card,or cash Deposit Received: $1,916 Balance Due: $3,835 Estimated Start: Estimated Completion:. ; Amount.Financed: $0 7 to 9 weeks 7 to 9 weeks Method of Payment: Credit Card : We schedule'installations based on the date of the signed contract and secondarily on the date in which:we complete the technical measurements.The installation date that" we:are providing at this time is only an estimate.We will communicate an official date and time a later date.Rain and extreme,weather are the most common causes for delay,' Notes: Taxes.paid in Barnstable; Ma . .. •h there.•r never Buyer(s)agrees and understands that this Agreement,constitutes:the entire understandings between the parties and that t e e are o bal understandings changing or modifying any.of the:terms of thisAgreement.No alterations to or deviations from this Agreement will be . valid without.the signed,:writcen consent of both the Buyers)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1).has;read this' Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices.of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement NOTICE.TO BUYER: Do not sign this contract if blank.'You are entitled to a copy of the contract at the time you sign. YOUJ E.BUYER,.MAY.CANCEL.THIS TRANSACTION AT ANYTIME NOT LATER THAN MIDNIGHT • OF 09/26/2017 OR THE THIRD BUSINESS.DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER:SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT., Legal Name:Southern New England VfWindows,LLC. , - dtia;IRe 'v By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature'. Signature ".. Gino Montesi Barbara Birdsey PrintName of Sales Person' Print Name: Print Name.. Page.2 10 UPDA'TED:'09/22/1 Z . �,iassachusetts.Department of Public .,af at,r 3oard of Building Regulations and Standards _icense: CS-095707 6 BRIAN D DENNISON 7 LAMBS POND CIRCLE' CHARLTON MA 01507.= ; „M C Pir3tion: Commissioner 00812018 4_ �a)L':SL7ner AFfaL' S'widP.usi.es = eQL'ia�G i a P!aza- Saute 5 17 1) . Boston,Nlassachu-sects;,2"__' Tact=�e rcvement c-ractor ?�SCTatlOP_ =- - Registration: 173245 -` - - Type: Supplement Card Expiration: 9I1 912018 SOUTHERN NEW ENGLAND WINDOWS=L'L _ BRIAN DENNISON ---------p'-------- 25 A' BION RD ___------ LINCOLN,RI 928,5 - � [udnm'-ddrvss and rcl�rn aeti:Nart::ctioo inr::iu�oCe• . . Address _ 3exewal _.Zmployment _ost Card ._- tLcc ni conwmer.%ffairs 3wiu Ks 2�ni2d0n I R gistmriuo ialid inr individual ssc nni;•qe€ate the -Xpiratiim dates if found return to: -. EIOME IMPROVEMENT CONTRACTOR Oifcc;jf Caosltmer A:Tnir^:and 3stinm,3e6m?atina Registratlon:.IM45. Type: t0 Park P1:rm-Soim 51.0 � Expiraticm*.,y19 Is Supplement Card Smtun.NLA 32116 SOU?HERN NE`N ENGLAND`NINDOWS L LC. - RENE4VAL BY ANDERSON BRIAN 0ENNISON - UNCOLN.RI 02365 - '-Underse cowry Nnt ra titre atnre . e • The Commonwealth,of Massachusetts Department of Industrial Accidents 0 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. A licant Information ` Please Print Le 'bl Name (Business/Organization/Individual): L !, 0W s Address: City/State/Zip: LNdJP 02f4r Phone Are you an employer?Check the appropriate box: Type of project(required): 1,K1 am a employer with Zo f,employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.7I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 E]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have re the sub-contractors ttachdhet ors listed on the attached se . ❑ h hired b 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.�ther 0 t/1 o W 152,b 1(4),and we have no employees.[No workers'comp.insurance required.] T Cc (-ell-7e•7 f S *Any applicant that checks box i�1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must 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: ire MQ $ Itis. l_f7 Policy#or Self-ins.Lic.#:MCA 3 IE 7 z q " Z Expiration Date: ! O Job Site Address: L-Of7 CA 1U City/state/Zip: Ile Attach a copy of the workers' compensa 'on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thaz nalties ofperjury that the information provided above is true and correct. Si ature: Date: 1 Q` `7 11 Phone#: 4D 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#: ESLERCO-01 SANDERSO ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYI� 06/07/2017 I 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 have ADDITIONAL INSURED provisions or 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 C NTACT CoBiz Insurance,Inc.-CO PHONE 303 988-0446 Fa,No: 303 988-0804 1401 Lawrence St,Ste.1200 A/C,No,Ext:( ) ( ) Denver,CO 80202 ADDRESS:COMaii@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED jNSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:LibertySurplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D Lincoln,R102865 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR POLICY EFF POLICY EXP ILTRR TYPE OF INSURANCE INSD VWD POLICY NUMBER M DD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑ RENTED 300,000 X OCCUR CPA3158728 01/01/2017 0110112018 DAMAGE TO PREMISES ES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JPE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. EBL AGGREGATE $ 2,000,0 EOM�BIINdEDtSINGLELIMIT $ 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO CPA3158728 01101/2017 01/01/2018 BODILY INJURY Perperson) $ O OS ONLY SCHEDULED BODILY INJURY Per accident $ AAUTOS HIRED NON-OWNED Per PER tlenDAMAGE $ AUTOS ONLY AUT ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LULB CLAIMS-MADE CPA3158728 01/01/2017 0110112018 AGGREGATE $ DED I X RETENTION$ 0 Aggregate $ 1,000,000 B WORKERS COMPENSATION X PER OTH- - AND EMPLOYERS'LIABILITY Y/N CA3158729-20 0110112017 01/01/2018 STA ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACHR ACCIDENT $ R 1,000,000 A pFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Worker's Compensatio WCA3158730-20 01/01/2017 01/01/2018 1,000,000 C Pollution Liability TIEDE654299117 01/0112017 0110112018 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY 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 ACORD 25(2016103)Informational ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V o� y Town of Barnstable 'Permitr 2�( (0�5 + �p� K pirem 6 monthsfrom issue dale Regulatory Services ees �,8 pF, �' 7 KAM B y ' �$ a634, g� Richard V.Scali,Interim Director 3l01� � /0 Building Division �Q 01,70 Tom Perry,CB®,Building Commissioner Y 4#;d 200 Main Street,Hyannis,MA 02601 %v ww.town.barnstable.ma.us - ssad, e Office: 508-862-4038 Fax: 890-6230 EXPRESS PlERME APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number .2-6 5 / 0 LR `- r,; Prope 'Ile— rty'�Address / 7 7 /�.o n s /�rPa c� �y�i = ,. •• �E✓i��f rJ� Residential Value of Work SQ6 gq 3 " Minimum fee of S35.00 for work under$6000.00 w Owner's Name&Address C� t "CA 17 7 Aw� /'�ewcJ, Ref PIA 02-6 :3 2- Contractor's Name r{ &Le,L,);OC6.5 J j�� ,�,,, i �� Telephone Number(401)X 2 k--q fit'Z)3 Home Improvement Contractor License_(if applicable)_/�_q_5- Email: Construction Supervisor's License 4(if applicable) 0 ci.1E;7 n Of Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I°am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Arftn Gut :1 nSu<aY1ce • r�Gnv Workman's Comp.Policy 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) ❑ Pe-side Q Replacement Windows/doors/sliders.U-Value aximum 35)0 ofwindows�_ T of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ``Note: PropertyVOwner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q.-NW FILESTORi'Obuilding permit formsO(PRESS.doe Revised 061313 I . o Ul Ucem Itswis R3 R RENEWAL BY ANDERSEN rLim fearrl2.3 art ,�«0674345 o,e eouaarar q t.�o,47 26 Albion Road Lincoln,RI02865 lssdfirm 41237 Piioue 866.56.2235•,Fax 401633.6602 reaer.l me Soudkrra New Ensisad Windows,LLC d/b/a Resswal by Andaaxa of Soothers Now Esigland "1rn I►t Q , D CU8TO WlrTDOW AND.DOOR REMODELING AGREEIIl�NT ��� I &WO)N>aw. - �.`' Cam offteeffmw Mrya(/�SrlaetMdrtsr.Q4'Sn».adZ�,Cad�fRQ; r 6t41IAddrep;. mrTelraAone Mb �L .Tt4yha,e tV-f. .. , ,�r�� . Buytr(s)hereby jointly and sewrally agrees to purchase the products and/or services of Southern New Englan8 Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agteement.and'on the•auached spcciRcation sheet(.)(collectively,this"Agreemene j. a Historic, o condo. ❑HOAT Total)ob Ainoam lsNmttld StardnS D,,.. Method of Payment p Check O Cash XFlranced Deposk'RecelveO(33%). CreditCards sire accepted for deposit easy-mardrirum 1/3 of rile Balance at Start of job(33%)a', y rmted u� cost Paw ( see Credit Lard Rrymmt form.)By slgtblg this AV-mere..you&&gNkdge that the Balance at$tart ofjob and the Balance on Subst ndal' y Balance an Mstantlsl_Campletion of Job cannot be made by critic Comptedah.ef)ob(33l6) Card and must be made by Wwral.dheck.bank check or cash: ` "W(e).agrees aid vas illuit-this Agreement con titittet the entire understanding.between thepareies,snd that? theret an no verbal andetsttm8inga chwogingpiny of the terms of this Agreement.-Buyer(a)aclraowledges that Bnyes(s): (I)lass dead ib3 Agreenacet,aadeertiade the trims of this Agreement,aid his received a completed,signed,'dnd dated' copy of dl;is Agreement,indading the two,auache4 Notiee"s of Cancellation;on the dace Stet written above and(2)was orally informed of Payees right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF TIME AM ANY BUNK SPACES:. (Rhode lfmsd Shce+O»ly)Notice to Bnyert(1)on not tli®o this Agreement if arty of tte ipaeesatended for the agreed ter for to the extent of then available'infoemadoa was ledit blank.(2)Yon are entitled to a copy of this'Agreement at the time you tan IL(9)Yon.mayataay tine payoff'the full unpaid balance doe hinder this Agreenseny and in so doing you may be entitled to receive a partial rebuts of the 8nauce`and insnniee ckarges.(4)The seller has no: right to tenlawMi enter your pier rises or eom malt ahaybrestch of the police to.eepossess goods .. Agreement.(S)Yon'asaycaricel this Agreement, pnrchued Hader this- d it lawsnot been signmd.at the main uffiee or a brunch office of the seller,provided you notify the seller at his or her snsin. ot$ee or branch office phowe in die Agreement by reltlsteredar certified snail,twhick shag be posted rot Ltec than sssdddgkt. of Vie.turd caleadai day>afsee"toe day oa which tki.bayee signs the Agee nenti esClnding Snnday and iany holiday on which regalac mM&Uvrsies.ore not made:See the aetompanying,iofii*of ia=W idea form for,an e,planatjqi of buyer's,eigkts. Buyers)received th Wosumer education materials pttrvidcd by the khode Island Contractors Registration Board (Btj slmaultJ Renewal o ern England, Bayer!W""'(y,�Q s e-{ Buyer(.) By , l�rlature of Si tune' Signature t o u G else-. ,. Pent Nart raf o Manager Pont Name Pant IVarne; YOU, TM Pt7ER(S),;_*T CANCEL THIS TRANSACTION AT,:MY TEM.PRIOR TO MIDMGHT.OF THE THM, BUSINS$8•DAY AFTER THB DATE OF THIS TRANSACTION.SBS.Tl ATT ACHED NOTICE OF CANCELLATION FOANU FON AN EXP!I WATION OF THIS RIGHT LATION )( `.NOTICE Of CANCELLATION 1 Dame,of:Transacdon .You rosy cancel i OaW of Transaction You•may cancel thk transaction,whh o pa salty or obfrgallon,within ! this:tat"tdon,without any penalty or obligation,wittin, three btnkhess days from the above datre.if you imniml,any.. three business dap from the:above date.If you cancel;arty Propgrtytraded n,tiny paymenes.msde by you under the l property bided in,any payments made by you antler the, Coneraet,cw,Sale,and arty negotable'lnstru7nen-t execute I Contract or,Sale,and any negotiable instrument executed by you will be retiurnd within then burners dalis following I by you,will be returned within ten business days following receipt ti).the:Seller of your cancellation no*Oi itb tasty I receipt 1 tlhe Seller of your cancellation notate,and atiy. security Interest arising out of the OW"acdon will be security nteM_ arising out of die trsrisas4don-will be. cathceledaf you,cancel you trust make,.aiisble'to the Seller: I canceled.if you tartcekyou must make airmfible.to the%Ikr at your.rtestdance,in subbssttaannttiially as good condition as when I at your r esidenee,in.st+bs4ntially as good condition as when, recehied:;atry goods.dalhrered to:you under this Contract or; I rece_ved,my goods delivered to you under this Contactor: Sate;or peas tnaA;it you whlh,comply with the tnstruedota Cif. I Sate•or lion may,if you wish,wrnpyr with tiie;Instrucdons of the Seller regaedirsg the return shipment of eke goods at the. ' the eiler regarding the return shipment of the goods at the SelkrRs`' end uiak N you do tnaake rite atvallable Seller% nee and Ask If you do make die available eta nods ape ids do Clan Seller aid eM Soler,does.trot pits fry;up ItriWn to fM Seger and din Seller don not pits Jietn up widt(n: ,.ttials d Hie dttr e[tsaHullat3ah,jloia ntq,ritehh or, I twenty dtllrr of tea data of nnalbttiotlti,you maW real a or e off the goodii%,ft t any further obegadon If you I dispose of the goods,wittout arty,further obligaton.If u' fw to ma's the:goods available o-the Seller,or if you egret;; I fail to make the goods available to the Selter,or if you uigre tin eettun the foods to the Seller and fail,to do so,then you l to return the goods to.rite Seller and fail to do so,then you remain fleble,for.per/orn»rtee of all obSgsuions under rite I ierriatn IhMe for performance-of all obligadem under the Conlsact'T cancel this trerdset3on,mail'or delhier;a signtid ContracLTo cancel this tninucdon,mail or deliver a signed and dsted coy.of thk.varlcellatiott nodce or,say otfser• I orb dated copy of this idinceliaton notice:,or any other written..TER s N MIDNIGHT OFn� n of i N�nodtxi,or send a telegram to Renewal byAndersen of Southern New E d at ton _ o RI 02865, I Soilthem New En end.at 26Albion Road,Lincoln,R10286li, ';GNOT LA T (( ))LATER T MIDNIGHT Of ER CANCELTHISTRANSACTION. l iNARYCANCELTHISTRANSACTION. sw r%squft" Pro""a" Qw fat-%$* as. pr4K'Nar" nag ftA Cope,Whlts Boyer Copy:Yellow Buyer Cope kink Southern New England Windows d.b.a Renewal by Andersen of SNE ` Massachusetts-Department of Public Safety Board of Building Regulations and Standards co11 tructinn superl'isor .5 License: CS-095707 BRIAN D DENNISON . 7 LAMBS POND GIR. �} Charlton MA 01507 , Expiration Commissioner 09/08/2016 •r: ��� �>z»>�n�,o�zwe�c�f Q���Cz��ac�ur�eiir/.Y +� Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement.Contractor Registration - Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND W RbiNiS LL Expiration: 9/1912018 DENNISON BRIAN _...._ : ...__-..- 26 ALBION RD _— LINCOLN,RI 02865 - Update Address and return card.Mark reason for change. scA t O 2ora-05n1 1j Address L Renewal ('I Employment ff�)Lost Card Cu0snmer:117airs&Rusin",Reeuhtion Lieense or registration valid for individul use only ME IMPROVEMENT CONTRACTOR beforethe expiration date If found return to: a rg Office of Consumer Affairs and Business Regulation Registration: 173245 Type 10 Park Plaza-Suite 5170 Explration: 911SQ016 Supplement,ard Boston,lfA02116 SOUTHERN NEW ENGLAND WINDOWS LLC. - RENEWAL BY ANDERSON DENNISON BRIAN r 26 ALBION RD lI LINCOLN.R102865 podrrsrcretary Not valid without signature Y The Commonwealth of Massachusetts Department of IndustrialAccidents LL Office of Investigations u ' a I Congress Street, Suite 100 Boston,MA 02114-2017 y° www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone #:401-228-9800 Are you an employer? Check the appropriate box: Type of project(required): 1�1: YP P J ( 9 ) 1.0 I A a employer with 20+ 4. ❑ I am a general contractor and I t employees (full and/or part-time).*.__ have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.: corporation an required.] 5. We are a coid 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 12.❑ of repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other�/���� �acernee comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must 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:ARGONAUT INS. CO. Policy#or Self-ins. Lic. #:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: " 177 .Con S flea oh PRoac/ City/State/Zip: a fe!✓i l�e A 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--qfVGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil.penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the.Office of Investigations of the DIA forXnsurance coverage verification. I do hereby certi under the ' s and penalties of perjury that the information provided above is true and correct Si ature: c Date: — l Phone#: 4012289800 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#: SOUTNEW-01 SHETTYSHT DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8119/2015 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 CONTACT NAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE I-AX (888)467-2378 c/o 26 CenturyBlvd A/c No Ext:(g77)945-7378 Arc No E-MAIL P.O.BOX 305191 ADDRESS'certificates@Wlllis.com Nashville,TN 37230,5191 INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 8 Southern New England Windows LLC INSURER c:Argonaut Insurance Company. 19801 DB/A Renewal by Andersen 26 Albion Road INSURER D Lincoln,RI 02865 INSURER E: e ^ INSURERF: 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,'6R CONDITION OF ANY CONTRACTOR 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 ANQ-CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDIYYYY MMIDDNYYY A X COMMERCIAL GENERAL LIABILITY .. EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR S 2029459 08/10/2015 08/10/2016, PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 _ PERSONAL&ADV INJURY $ 1,000,000 MOTHER: 'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY TJET �LOC PRODUCTS-COMP/OPAGG $ 3,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000,000 Ea accident) r A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X N NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident $ X UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER � B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 0000068028 08/21/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 JOFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C orkers Compensation WC928058352394 08/21/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 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 Evidence of Insurance 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The-ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 36-0 l a Map Parcel Application # Health Division Date Issued a t Conservation Division Application Fee Planning Dept. Permit Fee !J Date Definitive Plan Approved by Planning Board - Z 1�113 J Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner t rb Address PO RO 1526 44XSQuJ f:L Telephone 77 L/ 2'g Permit Request �� w.�,L.,..� �.�.,�� f — I•It s 4-4 166 j c\JA9 i A�.�,(� i-t 5 a I n,-r h •tee C of 'd'5 kw 5TS#�✓n Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0.4 ;L Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attaq upportin q doc-Rnentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi Family (# units) b �: 4 Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highwq' : ❑L s ❑No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ' Basement Finished Area(sq.ft.) Basement Unfinished Area (sq�ft) ffi "°= U B7 Number of Baths: Full: existingnew Half: existing h w g Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION h (BUILDER OR HOMEOWNER) ;Name 3{ "r4�_))It XhC Telephone Number 4A` Address License # c ld� Home Improvement Contractor# 1 o3 71 J Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� l� L FOR OFFICIAL USE ONLY APPLICATION# �. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 4 DATE OF INSPECTION: i;. FOUNDATION .- FRAME `+ INSULATION FIREPLACE N ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING oN o S oL#'t2 IpA-1•fELA X�%J IEO 2Ji-ghs DATE CLOSED OUT ASSOCIATION PLAN NO r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington,street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): fklz J eAMdaeT Address: /6 31 &AtW 5,4— 1 7 CitylState/Zip: 6TfiQ(�l LLB Al Oxa Phone#: (G�J� �l T/ A u an employer?Check the appropriate box: Type of project(required): 1.Are a employer withtJ-&L 77tVe 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, D Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LEI 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 afridavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employces. 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:� n /1�S�tU.lGig/1/e� (;GIC), Policy#or Self-ins.Lic.#: AC..6-3 �c� 1 D 2Y 6 6/9- O& 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$1,500.00 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 Inveshizations of IA for insurance covers a verification I do hereby rtify u er th ai s an penalties of p ry that the information provided above is true and correct Si tore: Date: d1 z l z Phone#• `>C') �ZA 9 //-71 Official use only. Do not write in this area,to be completed by city or town offwiaL 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#: 3/16/201.3 8:05:09 AM .PST (GMT-8) FROM: 100005-TO: 15084204555 Page: 2 of 2 A � ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER DOWLING &O'NEIL INSURANCE AGENCY INC CONTACT NAME: 973 IYANNOUGH RD PHONE A/c o FAX A/C No): PO BOX 1990 HYANN IS, MA 02601 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC,ft INS URER A INSURED INSURER B: PAUL J CAZEAULT &SONS ROOFING INC 1031 MAIN STREET INSURERC: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: 17327850 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBIN�Dn SINGLE LIMIT (Ea aca aq $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS $ HIRED AUTOS NON OWNED PROPER N DAMAGE AUTOS Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC5-31 S-386670-013 8/10/2013 8/10/2014 WC STATU- OETI y/N J TORY LIMITS - AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. 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 - Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD C R7 NO.: 17'�2JB50 CLIENT CQOE: 1619182 Anne Chandl r 8/16/2 p13 8:03:3,3 AM Page 1 of,1 TFh>s certiY>cate cancels and supersedes A L previously issue certificates. aul J Cazeault& Sons,Inc w-vw.cazeault.com 1031 Main Street_ p office@cazeault.co.m Osterville,MA 02655 ® Phone(508)428-1177 Fax(508)420-4555 Pr®po;sal BILL TO � , Mr&Mrs Charles Birdsey DATE Proposal No. Post Office Box 586 Hobe Sound, FL 33475 9/11/2013 E10102 Estimated by: Mike Customer E Mail cc)l.07_ 5� Description of work to be performed Total At 117 Long Beach.Road,Centerville;MA - Remove existing shinule roof. Re-nail any loose boarding. Install .032 aluminum heave drip edge. Install WeatherWatch or Stormguard ice and water shield on bottom edge, in valleys,and around penetrations. Install GAF Deck Armour premium roof deck protection. Install.GAF Timberline HD lifetime architectural style shingles. All shingles to be storm nailed. Vent pipes to receive new flashing. Cut open and install Cobra ridge vent. All roofing related.rubbish to be removed from premise. Paul J Cazeault&Sons to obtain buildi:ng/roofing permit. Provide GAF System Plus Warranty that covers both labor and material. COST 19,250.00 Furnish and install Dow Powerhouse Shingle 2850 watt solar system Three(3)arrays as indicated on.Dow layout design COST 22,812.00 , 1/3 due with signed contract; 1/3 due when job is half done;1/3:due upon completion TOM $12,062.00 Customer Signature The above prices,specifications,and conditions are satisfactory and hereby accepted.You are authorized to do the work as ecified'Pa mentto be made as' P P Y Date.of Acceptance outlined above. In addition to the above,if Customer fails to make payment set forth above,then Customer agrees to pay Paul}Cazeault&Sons Inc,all reasonable costs and fee: (including but not limited to Attomey's fees)incurred in collecting payment from Customer.— Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-026325 VN PAUL J CAZEAUyr r. 1031 MAIN ST OSTERVILLE NfA 022655� 'VI Expiration Commissioner 10/20/2015 Office of Consumer Affairs and Buslness Regulation 10 Park Plaza - Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 '- Type: Private Corporation Expiration: 7/9/2014 •Tr# 228652 PAUL J. CAZEAULT & SONS, INClwi - � Paul Cazeault Fx =y 1031 MAIN ST = OSTERVILLE, MA-02658 , ��'=`^. • : Update Address and return card.Mark reason for change. ,Address ❑ Renewal ❑ Employment ❑ Lost Card PS-CA1 is 50M-04/04-G101216 Office of Consumer Affairs&Business Regulation. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: _ °1.03714 . Type: Office of Consumer Affairs and Business Regulation Expiration: 7/9/20.14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 PA J.CAZEAULM;&SONS.;;ING, . Paul Cazeault '.�y .. oj Y 1031.MAIN ST <,• ,' g ���a_ OSTERVILLE,MA 02656 el'�-L� Undersecretary Not valid withou'\ature n � DOW Solar Project ID: System Data N _ STC system rating-DC Watts: 2850 n 1493_P D Est.1 st year production-AC kWh: 3182 <3> 177 Long Beach Rd. Total Sq.Ft.Roof Area/Solar Array Area: 3181 /387.3 E Centerville,MA 02632 Percent of Annual Electrical Offset-AC kWh: TBD F C'U S ok � Chimney W � Project Overview J Roofing Project Manager: Russell Cazeault(508)428-1177 Array 2 0 Authorized Roofing Dealer: Cazeault Solar&Roofing Dow Solar Field Operations Specialist: Adam Sollner(908)797-9313 04. Electric Utility: NSTAR _ NOTES: N, _ 1. Drawings are per NEC2011.Project design must be evaluated against local governing codes. w o 2. Installation shall be consistent with Dow Solar installation specifications and the National Electric Code. t d 3. Estimated first year production reflects shading impact.Shading analysis based on estimations.It is assumed any trees shading the R ae solar array(s)will be removed. o 4. Facility electrical one-line diagram must be stamped by a Massachusetts Electrical Professional Engineer. � 3 Main Billing Meter L L hco t v AC Disconnect egg 0 Primary PV Disconnects 1 Located Inside Below Inverter N Ci-a zmmo Array 3 m .. 3 ESTIMATED 1ST YEAR PRODUCTION(kWh)<3> 375 364 Array 1 3531 c c 350 331 Chimney 8 s a 325 310 0£' 303 `i €S 300 295 SOLAR ARRAY LAYOUT a 275 � d 250 -_ 245 1 REF:DO SOLAR SCALE: NTS o n € Y N o — e 225 200 192 _ v E 175 154 154 Annual 3182 .0 150 140 Jan 154 p Feb 192 O. 125 - >r Mar 295 Array Inverter String Solar True 100 * A r 331 # # # Pitch Azimuth North Shingles DC Watts Sq.Ft. 75 J" May 310 Azimuth Jun So 364 Jul ass 1 1 6:12 17°E 163° 115 1437.5 191.7 25 sa 303 2 1 2A 11:12 73°W 253° 81 1012.5 138.4 c Oct zas Jan Feb Mar Apr May Jun Jul Aug 26 11:12 73°W 253" 32 400.0 57.3 y g Sep Oct Nov DecDac Nov 1ao � Month Dec 154 Totals 228 2850.0 387.3 r - Array Layout - Plane 1 . Strings 1A, 1 B INSTALL ARRAY THIS SURFACE VOc String C@ Rows. Biscuits Shingles S . N B El STC IA 282.1 1-11 Ill 80 91 153.5 S W Q 113 80.6 1-5 5 21 26 45.3 60 O Totals• 1161 101 1 117 198.8. DO NOT USE NAIL GUNS O 'sr.ii' �r-5. Z o 91 SHINGLE R6 13 RH FINISHER R6 26 SHINGLE. 11 ROOF KEY PLAN 80 BISCUIT R4 STRING 1A R4 21 B CUIT REF:DOW SOLAR scams: NTS W o 1 LH FINISHER ' STRING 1121 �1 DCV � 11 � "; � 6�`: 001M Co DCV DCV U) DCV � _ Dcv - r 9 � i o DCV = �" 8 START LAYOUT HERE t210 DCV R8 2X RH ROW TO ROW M 0 DCVO" . _7 ,�" _ 10 RH STARTER $U'DCV m m o DCV _ 2X LH ROW TO ROW R7 DCV 5X LH ROW TO ROW R7 START LAYOUT HERE t2 R8 5X RH ROW TO ROW R60F VENT LH STARTER R9 , o SKYLIGHT s ARRAY LAYOUT C/) M 11) REF:DOW SOLAR S.A.:'NTS s w Array Layout - Plane 2: String 2 INSTALL ARRAY Lr) THIS SURFACE VOC String @ Rows Biscuits Shingles. Sq, STC Ft. o e (U 2 319.3 1-9 9 94 103 171.0 E m W Q Totals 9 94 103 171.0 S (n O 00 DO NOT USE NAIL GUNS - Q ROOF KEY PLAN ^' 13 REF.DOW SOLAR scatE:NTS 0 STRING 2 R6 403 SHINGLE R4 94 BISCUIT �- co can LH FINISHER R11 � • � ROOF VENT " 4X LH ROW TO ROW R7 W DCV _ N DCV `o m ~z m CO DCV DCV DCV 8 � DCV — _ DCV m ' c> Ta ,DCV § o START LAYOUT HERE t2 R8 4X RH ROW TO ROW 10 RH STARTER g � s ARRAY LAYOT ` 12 REF:Dow SOLAR U.A. NTS °C o � Solar Shingle Data Sheet � C . - 11-Ci2G0 � • .. 3 �� � DOW POWERHOUSE`" Sola• Shingles: 'technical aC iCa t - , � LU • WPrkS�ilkB•$tkJ OC`Pr Shif i F,$Ut h3l1 r2ft MECHANICAL SPECIFICATIONS �+ � C � 7Ar'eCSGSWp©WEFHOUSE`"SG�r51'�fnr�te TOP VIEW \• _ r SN6t �1 is dLs.jtie�d tc+lttsta((M{ke�r!,f, " A ,fie fn � �� tk5e,additlonaLbeY+eflt,of6enAratf0,9•tleatr,, P°°'mmr edr•e) rG.,6,rN„r...,;,,lanwnia9�+� '�" �� l .� fx, oth2f Psp118![shtngjLd roof 6UtproVhlos a'—• ' \ I Pront cl�,v renaJaabte'er2eTpYtor homes. - - c ^. - ti Reso,Neig6t. iOYref 1 �I -- //��;��{/��y( �y ((yy Jt _- '. twc+Asan,e,niAm mv.a.:2l ircAoil P(!)W"'.i?HO V EE•, cc LU I _ �• :,;� ' t u,a .=Iwt=.w•PIPv�uL u,t•e a.51 m:.Pq. pro.wr 23% v SAFETY CURAWLITV DOW POWERHOUSE" Solar Shingle System delivers: 23 can Ul]a6,.12p1;tp9),)90.e0a•na 51a �'» � u • • •:;, i CEC:CIa A 9 en c • .: >. 0 1 m :`' •. " . ro 2006.]OD9..tl1t IDG eVC — v ��J11•-,�i`•y-•.qa•.v yam ':= •S.`'"`� 1 •'"a..Yr .r.{+�.+ � r•. .. — R . y'•+ t"�`.i W.`+Cjtia`.t] ..y YlralRMl+rnnc• ... � ��y gar.y,� c�,. ��'1••,�y3 «„�y�Axt^�'x';r �:g��+ :��, In asecmnn wu:I rreesatDD,. ISOMETRIC VIEW PROFILE ["'•/ 'cam a+G1vv r M nm vm i"A mpn '�"t'3i G�✓:�t�Tu+<r...u..: -+) .T'li k�37`5s.,�y 7�"�7'� 7 Par a.mroePPov uma9os.a.ltt) iYf..t[2S t,:o wit + TMa E`h o S m N 'T�=r ':z , 2a m Aid wraine•trnwn nrrtY _ �~L m m c mv9,v�Arw>o An,n Wrvrnnl;As _ m ar 8r twvrn nw•rl uf.xvtarw'vrxrlY N N C .• safety and performance certifications o o ELECTRICAL SPECIFICATIONS •UL r�3 F•a2 R7t:Pr,ora»E.wc'-e..ailiecS Ra.In. •efG _ Lw e E M tarn rUsrn e c 'Ul ,'f.r!fA•31tl+9GL`•TMiaAYa h•�Fnw T4Kf eppfl Cucut YaP 9e tvaG) 2.8V 2.Ov 4.0, 3.Iv :12V " o Na.hnun Pa•e,VPYtap•IVn+PP) IAv 1.9V 1tv 2.2Y 3aV .. a U$v • • •• • • • • • rveamnf OPa u,OCd TbKavaN•PQIW)62•C UYC 6M 6YC 62•C IX !� .. •:Cx.. 'xtiy ar��Dxtrnlww.c:wl t*,sra3++� �HA •srsur,3rt,rrr�r,rrzs H�•^I nrscc=nx@G.uiCiu'dd : .•• g��` A � reem.L51'AI 0,Lp i•Q9 - rPw am n9 tDA ,oa itsA too IPn . :2Ut'h;:'iDtit1,87f�::,II+T•}'+fYT orh:-R'e5c!,xntwtCattw ...... •SWM3rn hm n CIMC f*r Y1H`G•/TC�!=AC•;1+ E er A3vwt 55W"<FdrlJrir'a16..4N1•dd3 vn,n Tamr�9.a:w•soAnc�=ro •Daefuc-D+Dwc-a.awz•Davuc.48,,c .«r.., .. .,•.},r PUWERHOUSE F.s'•`�SOLAR • ® tM*tsiTtturf•txs\iArrr�,r5f1I't+GtO�xJrel[iKVy •B,ti�estdry drs�tnr.'�ta WiFnw�w - _ awPewAa,- A�em rnwtdesw n r'C:,cgt:+prc(ci'I�a atliwswt4 "��. k:'O-;oat e[r`arrtprcca rid.vny.. sa 0•+SA IjnVSJ•reM Otr+,2091w tq ltow Nt 564 C.;,.- ! 1W7F 485ktlrA SOL9 ��•`++ OPG mo_ „Mi xe�We y�P.r.« a+. :M wv.sn aPhn� 1a . - - 41P.wH.+r.++�Y! �4 ^n' Pp «.KYn�}I+»ry w.\44. t .mte.V Pw y`.m.na ro-ary,v.ri•u�.u. _ � s - POWERHOUSE ter., m�a r """'Ywnprk��«.r. A,.aea �..�Ar.»A•e. .l,x..,..r..>,•• ! DS:' ry•r,su✓.i laev•wN -0 ae• I as Al Manh •tiP.,IX iyrrti aH'MI4 IaBH'i r«VNb�uilvl i, fv,tW cPn!w«C. e512' �.V. --C�SOLAR v,o--Gaw, 4•-0tta•I+.rd wr:mMA w.mcv mhmnar w,mv-..w¢ ,C 1nrAma ras i& tiGtit+cm Crc ,.4+ACA�1 Derr•1 W . MFA-.,(t6s�il jaly„±•'hRIP.l af40a 6up 181VMA 1LIEG C101 iill �.�44;.TeAMIVN Ji+I.[SGSOr ymKy1•an ryltlyp;G eA6C:'n11FG%vE•IILW N :..- :. .- _ a w<aewom•ua..cen. Iwfemrva t,nr,m.�aN�.rdt�,ra+nr,»�•�o,,,n,r,G.lw.,,wn+rn;.oA.e:a�lnenw ell•-v.e tPrP,d.r - - 0 z � - .. can,w•6::Y•DDaaea2o cc ' - � � One-Line Electrical & Bill Of Materials <Notes>: 1. The back fed AC breaker from the inverter must be located opposite the incoming utility feeders N w on the load center. The AC breaker shag be of the suitable type for back feed per NEC . N 2. Negative DC conductor wire to be gray or white. Positive conductor wire to be black,red;or GRID-TIE INVERTER-AC WATTS 3500 051 blue. MFR.: Dow 3. TBS,SA,FEP,FEPB,MI,RHH,RHW-2,THHN-2,THHW,THW-2,THWN-2,USE-2,XHH, MODEL: 362589 XHHW,XHHW-2,or ZW-2 may be used where THHN is designated. 150.550 VDC T012D240VAC 14 W Q 4. Utility required AC Disconnect.This disconnect requires grounding.The installation of a ground 'NEGATIVE GROUND' J bar is required. <8> Q 5. 2011 NEC 69O.31(E)allows type MC Cable in lieu of FMC,RMC,or EMT. If FMC or MC cable (0 is used,guard strips must be installed per 2011 NEC 69O.31(E)(2). E2 AC ES methods shall not be installed within 25 cm 10 in. 1 specifies that wiring 6. 2011 NEC 690.31E p ( ) 0 0 of roof decking or sheathing except where directly below the roof surface covered by PV modules and associated equipment Circuits shall be run perpendicular to the roof penetration point to support a minimum of 25 cm.(10 in.)below roof decking. cc d 7. 2011 NEC 69O.47(C)(3)and NEC table 250.122. A a. Please see sheet E4 for equipment labeling requirements ° W o 2-12 AWG CU THHN<2,3> 4-12 AWG CUTHHN<2,3> 4-12 AWG CU THHN<2,3>-- BIII Of Materials - Roofing Materials Et 1-12 AWG CUGND E8 E9 1-12 AWG CUGND E8 E9 1-12AWGCUGND !1 12'FMC- MT-RMC<5,B> 12'FMC- MT-RMC<5,6> 12'FMC MT-RMC<5,6> FP Item Q Vendor/Part No. Descri lion _ � - . 3 Rt 2 Contractor S lied VersaShield 100'x 47 Roe o R2 2 Contractor SuDDfled Rin Shank Nails 3B'x 1 12 9001Box >_ R3 3 Contractor Supplied Ice and Water Shield 18'x75'Roo ft3 R4 4 11000822 DPS Connector Biscuit 50-PACK STRING STR NG STRIN O R5 3 362021 DPS Roof Grommet 2 1B 1A (A e R6 220 376943 DPS 13.000 Shine R7 11 376994 Row to Row LH System Trim Pc R8 11 376944 Row to Row RH System Trim Pc BMIRECTIONAL MAIN LOAD C) R9 t 376999 Starter LH System Trim PC UTILITY CENTER Rt D 2 376998 Starter RH S stem Trim Pc R11 t 376996 Finisher LH Trim Pc w/rhru Roof METER 12O28> R12 1 11033699 DPS Finisher LH Wfrtw Roof 50 FL <8> U) r R13 1 11033700 DPS Finisher RH Wfrhru Roof 50 FL E4 2-12 AWG CUNMB PV SYSTEM UTILITY rz m m o r t•12 AWG CU NMB NEU DISCONNECT SWITCH" 1.12 AWG CU GND LOCUS WP,:SQUARE D' 3 LGATEtot MODEL:DU221RB(30A 14))INTE F 2OA2P v INTERFACE <4,8> o` z o Bill of Materials - Electrical Materials 1 13 Item Qtv Vendor/Part No. Descri lion Et oA2P 1 362583 DPS Tlmt Roof Kit < f2 E2 1 1362589 DPS 2-String 3.5KW Inverter E8 E7 E E3 1 11008126 DPS Performance Monitor-Gen and Cons I m y E4 1 362577 DPS NEC Label Set !t_ U E5 1 362578 DPS Custom Inverter Label I-- o E € . Ell 1 362580 DPS AC Disconnect 30A 2-10 AWG CU NMB z o E7 1 11049158 DPS Ground Bar-Thomas 8 Betts Model:IBT3C8 Bt A EB 2 11045953 DPS Tlw Roof Kit Vaulted Ceiling 1.10 AWG CU NMB NEU � e E9 2 11034565 DPS Vaulted Low Profile Conduit K t UTILITY GRID 1-10 AWG CUGND <7> 12O240V INPUT SINGLE PHASE N m ELECTRICAL SCHEMATIC g 2 �F:DOW SOLAR SCAIF:'NTS Three-Line Electrical Schematic w <NOteS>: GRID-TIE INVERTER-AC WATTS 3500 1. The back led AC breaker from the inverter must be located opposite the incoming utility feeders MFR.:Dow on the load center.The AC breaker shall be,of the suitable type for back feed per NEC MODEL:362589 705.12(D). 150.550 VDC TO 120/246VAC 1 I Negative DC conductor wire to be gray or white.Positive conductor wire to be black,red,or ,blue. NEGATIVE GROUND' 3. TBS,SA,FEP,FEPB,MI,RHH,RHW-2,THHN-2,THHW,THW-2,THWN-2,USE-2,XHH, <B> XHHW,XHHW-2,or ZW-2 may be used where THHN is designated.• W cr Q 4. Utility required AC Disconnect This disconnect requires grounding.The installation of a ground AC J bar is required. DC O 5. 2011 NEC 690.31(E)allows type MC Cable in lieu of FMC,RMC,or EMT. If FMC or MC cable (p is used,guard strips must be installed per 2011 NEC 690.31(E)(2). O ° 6. 2011 NEC 690.31(E)(1)specifies that wiring methods shall not be installed within 25 cm(10 in.) of roof decking or sheathing except where directly below the.roof surface covered by PV modules and associated equipment Circuits shall be run perpendicular to the roof penetration point to support a minimum of 25 cm.(10 in.)below roof decking. I6 --ois�c 7. 2011 NEC 690.47(C)(3)and NEC table 250.122. 8. Please see sheet E4 for equipment labeling requirements:< o0o W o 2-12 AWG CU'THHN<2,3> 4-12 AWG CU THHN<2,3> 4-12 AWG CU THHN<2,3> 1-12 AWG CU GND 1-12 AWG CU GND 1-12 AWG CU GND �} 1/2'FMC-FMT-RMC<5,6> 70— 1/2"FMC-EMT-RMC<5,6> 1/2'FMC- MT-RMC<5,6> P, PD o � g TRING STRING STRING V 2 - 18 - _ - to • _ _ _ Q - BI-DIRECTIONAL MAIN LOAD UTILITY CENTER METER 120/240VAC to 2 m <8> M~zmm� 2-12 AWG CU NMB 3 r 1-12AWG CU NMB NEU PV SYSTEM UTILITY d d 1-12AWG CU GND DISCONNECT SWITCH o`'v�"i o i LOCUS MFR.SQUARE D G W 8 LGATE101 MODEL DU221RB(30A 1 4,) INTERNET E 20A/2P NTERFACE <4,8> g 2 tt 20A/2P 1 0$ < N> E 2-10 AWG CU NMB f. 1-10 AWG CU NMB NEU UTILITY GRID 1-10 AWG CU GND c 7 120/240V s INPUT SINGLE >- is § r : PHASE w ELECTRICAL SCHEMATIC 3 REF:DOW SOLAR scALE: NTS m G System Monitoring Low Voltage Instrumentation Diagram _ LU .<NOTES> 1.Ethernet Wire is not required to be in conduit,however it should be hidden in wells where possible or enclosed in liquid-tight flexible conduit lo prevent incidental contact (�l 2.CT instrumentation wires between electrical service and LGate should be enclosed in liquid-fight flexible conduit L6 V 3.Power conductors for LGate should be hidden behind walls or protected from incidental contact with liquid-tight flexible conduit 4.The ICT(Inverter CT)goes around L1 and the green dot needs to face the source(inverter). T5688 Pin Placement<7> UJ Cc 5•The white labels on the Has(consumption CTs)need to face toward the utility. _•• r n J 0.High voltage power(L11L2 from the 20A 2-pole breaker)should be run In a separate raceway than the low-voltage,Instrumentation wire per the L-Gate MFR Installation guide. �/J Q .7.Exploded view pin out for CAT5E Ethernet cable. _ e-B=n �. 5•WhileBAre - _— 4-Mue p e.. �• ILL . - - 3-Wh ianu en i e CU // \ LOAD CENTER 2r Termination Switch Location \ _ � 000000 JQD I O I Emerson 1 / Ethernet N co Inverter \ �/ 1 1 m m o Termination Switch / O ���� \ j E� . oulw ON / ( ' -ear LJ 1 / HCT1 T2 1 CAT 5e Wale 101E 6 Ll L2 o o M —= Max Length 30V \ _ <t> m Main Panel o c o o i • m LFi Grand Poet E in - - ( - a e� �L L RETAMERPARTOF - L21 L2. \ / THE PLUGOABLE - 12 AWGta✓8 8 UNAL BLOCKS Max Le�Bi 3W L1 Llcanmuster L7 TO $I°9 NO CONNECTION I L2 L2 CAT 5e A( Max LN91h 3W t BLACK - • - Internal WHTE I B _ WHrrE .} LU SYSTEM MONITORING SCHEMATIC Q 0 4 REF:DOWSOLAR SCALE: NTS. PV System Labels Local code may require additional labeling with specific locations. N L U <Notes>: 1.NEC 690.56,705.10 / 2.NEC 690.64 refers to 705.12(D) - 3.NEC 690.5(c),690.53,690.54 - U 4.2011 NEC 690.31(E)(3)MC and Conduit must be labeled Photovoltaic Power Source at 10' _ intervals I ' 5.Required by Local Energy Company, - - ' - `�--' Q 6.Red with White Font Slicker LABEL DATA p i Invener 1 cn Imp 6 O lu 6 7 .�. Vmp 274 J_ {� o VoC 433 G RAC 20 W a M MOM 6 p i oI—� L • E4 DPS NEC LABEL SET E5 UPS INVERTER LABEL N REF:c 1,2,4> FA:1 T REF:a 3,5> EA:1 Q .: M m m - - _ m $i • y o 'S • E c n its imair - E E4 DP NEC LABEL SET ® REF.c 5.6> EA:1 - - - 113 > S LU IN � z - o Shading Analysis - With Solmetric SunEye.Measurements Included Optimal Estimated Estimated <Notes>: Solmetric SunEye tool measurements have been taken at the indicated locatlons and are Array Strings Percentag Structural Shading Objects e Annual Impact of Unshaded Shaded 1. i,��, into Me shading analysis. of Shade Yield Orientation Annual Annual e U (kWh) Yield(kWh) Yield(kWh) W Cr o Impact of shade caused by the S ^ Q 1 to 1.5/o adjacent chimney and roof. vJ Impact of shade caused by the , W 2 1 B 0.60% adjacent vent and roof. 3502 9.31% 3176 309b O o Impact of shade caused by the 0 3 2 4.2/o adjacent roof,chimney,and vent. LL SKY - o 1 Array 1 0 ° U) $ � a � s Skylight m o 2 m`od SKY v - d d 2 Chimney d.S S Vent SKY r 1 2 EAR c o$�s Chimney. E Array,2 Array Vent. LEGEND • I I I�.I I I I � g s SHADING ANALYSIS NOT SHADED, SHADED N 5 R .. z REF:DOW SOLAR scnL>: NTS - w o m � 4Y Underlayment Layout Plane 1. 0-4 Local codes may require additional S THIS SURFACE undedayment. INSTALL UNDERURFACE et - <Notes>: B e 1.Minimum VersaSAield undedaymentmust extend S'pasl Bray wgme on ag dries. 2.Grommet placement is always 5'horizontally from neared edge of sWn*area oullim. - S F W Q n r J VJ Q 00. of 39'•6'REF.DIM. ROOF KEY PLAN P•3' 21'-11' 1'8' 17-5' -I 7-3' REF:DOW SOLAR scALE: NTS L o 22'-9' 14V-3* I R1 UNDERLAYMENT<1> V <2>GROMMET RS RS GROMMET cED 2> Axxx o R1 UNDERLAYMENT<1> -- -- I N 5b m^� PLACE CHALK LINES HERE 6 i Q I. 'XIT - N ca c 1 - - 2 z m m o PLACE CHALK LINES HERE __ °P °p " a P m 3 d ROOF VENT zv SKYLIGHT ao E 9'(TYP) �' 10'8'. 3'•10' 1'-11-0 11' L 3 10' 1'9' 3 10' B T 7 3' M1 Y 6 UNDERLAYMENT LAYOUT REF:DOW SOLAR scaLE: NTS m F Underlayment Layout — Plane 2 INSTALL UNDERLAYMENT .{,Fy M Local codes may require additional underlayment. THIS SURFACE <Notes>: 1.IAINmum VersaSNeld undarla mient must extend 8'pest grey w9he on all sides - - - 2,Grommet placement is always 5'hodmnt*Ir mnearest edge of shinge was oullm. W* il\ - _ C3 E W Q S0 . 7 9 ROOF KEY PLAN 11 REF:DOW SOLAR SCALP: NTS LU 0 2W-V REF.DIM ,=2' I 23'-10' 4'-W RS GROMMET<2>. ROOF VENT Q N M m c 1 .. Mm' rz'Mm� 1 1 m 3 8r c d J. o m 1 R1 'UNDERLAYMENT-0> r ( E do Ts 3 c PLACE CHALK LINES HERE 1 $ E m V-4' 1= UJ .UNDERLAYMENTLAYOUT t 8 REF.DOW SOLAR SCALE: NTS m