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0566 PHINNEY'S LANE
r e 2 0 i 1 NO. 152 1/3 BGR ESSELTE _ 1 o°ia O 0 0 0 Town of BarnstableBuilding Post4TT'is Card So�That rt i a ' ' "�' " h'e Street A ; 'roved=Plans Must e`Retained on Job.antl this Card;Must be.Ke t` s Visible From t BnXtraa rerst V P � = • M" Posted Until%Final;InspectionHas:Been Made ,°` £'. ,X • Where a Certificate of.'Occu�anc : Re 'ti red such.Buildm�'shall Not be..0"ecu ietl,<until,a.F nal:lns ection,ha been matle Permit Permit NO. B-19-374 Applicant Name: MCCORMACK, LISA A& RICHARD J Approvals Date Issued: 02/05/2019 Current Use: Structure Permit Type: Building-Stove Expiration Date: 08/05/2019 Foundation: Location: 566 PHINNEY'S LANE,CENTERVILLE Map/Lot 250-017 Zoning District: RD-1 Sheathing: r ,�.... ,7 :max Owner on Record: MCCORMACK, LISA A&RICHARD J ! �ContractorjName :.� Framing: 1 Address: 566 PHINNEY'S LN { Contracto 'Ucense ,. 2 CENTERVILLE, MA 02632 k Est Protect Cost: $0.00 Chimney: Description: Intrepid vermont casting) x Permit Fee: $35.00 p p g) � � Insulation: Fuel Type:wood _ Fee Paid $35.00 Manufacturing#2115 2/5/2019 Final: Date , _ Project Review Req• 4, Plumbing/Gas F Rough Plumbing: Building Official ' = - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed*th s permit is commenced within six njonths�afterkissuance. All work authorized by this permit shall conform to the approved applica'tin and theapproved construction documentsfo�rwhich this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresishall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access s eet1orroad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. fir : Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ' Service: 1.Foundation or Footing g 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue'lini g is`insta'Il'ed ` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Priorto Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application number.... TOWN OF RARNSTAI Fee .......... . ......................................... - b�ilg�5 ............................................................ 1Dl9 FER _5 AN $ 53 Building Inspectors Initials...:......'`.:`. ,. Date Issued............... ...................................... NVISION Map/Parcel........ ...:��/.....0................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: J�G��o d�'A i h n e ys Z,4p e CC A- v i I NUMBER STREET VILLAGE Owner's Name: Rk c-�A r M 'C Ca r m a c(L Phone Number 77 S'©F!5� Email Address: m L c a r wia��, r ? CVWIca,T,At�Cell Phone Number Project cost$ Ca a d Check one Residential ✓ Commercial OWNER'S AUTHORIZATION , As owner of the above property I hereby authorize to make application for almilding permit in accordance with 780 CMR Owner Si ature: ��i�/ Date: � l TYPE OF WORK © Siding 0 Windows (no header change)# F-1 Insulation/Weatherization 0 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 CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy)` Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYIS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* r N Date Tent(s)will be erected Removed on r ' E 'number of tents total r Does the tent have sides?Yes No (If yes-please attach-floor plan with exits marked) V' Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required., If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# ®2 J I Model/I.D. Fuel Type l)a of Testing Lab R.r Ge`ss e r 113s o e. i n c Offsets from combustibles: front le" back /9 left side /f ' right side /6 ' HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: "������ C r►^�a �- Telephone Number 5V�--77 S= O 95' Cell or Work number 2 3 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town stable. Signature G� / Date APPLICAN'T'S SIGNATURE Signature All permit applications are subject to a building official's approval prior to issuance. The Commonwealth'of Massachusetts Department of IndustrialAccidents c — — Office of Investigations ' 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 2i F r- ILL C6r*to ck Address: �6(0 ehlrine f� City/State/Zip: G,��ryc lIe_ lhk Phone#: 5Dr 95--6/q,�j Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 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• Demolition . workingfor me in an capacity. employees and have workers' Y P ty $ 9. ❑Building addition [No workers'comp.insurance - comp.insurance. required.] 5. 0 We are a corporation and its 10.❑Electrical repairs'or additions 3.[Elam a homeowner doing all work, officers have exercised their 11.❑Plumbing repairs or additions ' myself [No workers' comp. w right of exemption per MGL 12.E Roof repairs insurance required.]t c. 152, §l(4),and we have no ` 11 `� / employees. [No workers' 13.®Other S 4v u tvvUc !a S 1 nv a 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 anew 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 isproviding 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 criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well_as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification ' I do hereby certify u he pains and penal ties of erj. ry that the information provided above is true and correct signafore: L / / SDate: S Phone#: ����" Official use only. Do not write in this area,to be completed by city or town afficiaL 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 4_ Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation far their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express o ' plied, oral or written." An employ is defined as"an individual,partnership,association,corporation or other le entity,or any two or more of the forego' engaged in a joint enterprise,and including the legal representatives of. deceased employer,or the receiver or a of an individual,partnership,association or other legal entity,empl ing employees. However the owner of a dwel g house having not more than three apartments and who resides th ein,or the occupant of the dwelling house o other who employs persons to do maintenance,construction or epair work on such dwelling house or on the grounds o uilding appurtenant thereto shall not because of such emplo ent be deemed to be an employer." MGL chapter 152, §25 also states that"every state or local licensing agen shall withhold the issuance or renewal of a license or rmit to operate a business or to construct baildin in the commonwealth for any applicant who has.not pr duced-acceptable evidence of compliance with t e insurance coverage required." Additionally,MGL chapter 52,§25C(7)states"Neither the commonwealth or any of its political subdivisions shall enter into any contract for the erformance of public work until acceptable deuce of compliance with the insurance requirements of this chapter ha a been presented to the contracting autho ' Applicants Please fill out the workers' comp. on affidavit completely,by the g the boxes that apply to-your situation and,if necessary,supply sub-contractors)n E e(s),address(es)and phone n ber(s)along with their certificates)of insurance. Limited Liability Companie (LLC)or Limited Liability artnerships(LLP)with no employees other than the members or partners,are not required to workers'compensa' n insurance. If an LLC or LLP does have employees,a policy is required. Be advise that this affidavit may e submitted to the Department of Industrial Accidents for confirmation of insurance co e. Also be sure o sign and date the affidavit. The affidavit should be returned to the city-or town-that the applic 'on for the permit r license is being requested,not the Department of • 1. 1..,,.Vr;�yo-—A rarnrirP�fn nhi-ain a—Or1C_ers' -i�u la!Accidents. JilOtild you have,aiiy tiuc uvu3 rc ar=g e u... a -— -I—.- -- compensation policy,please call the Department the numb. ' ted below. Self-insured companies should enter their self-insurance license number on the appropriate 1 e. City or Town Officials Please be sure that the affidavit is complete and printed ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office o Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which ° be used as a reference number. In addition, an applicant that must submit multiple permit/license,applications in y 'ven year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site ess' the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for a permi or licenses. A new affidavit must be filled out each eps.or p not related to any business or commercial venture year.Where a home owner or citizen is obtaining a c (i.e.a dog license or permit to bum leaves etc.)sai person is NOT r ed to complete this affidavit. The Office of Investigations would like to thank u in advance for yo cooperation and should you have any questions, please do not hesitate to give us a call. t The Department's address,telephone and fax n ber: The C onwealth ofMassaah fts D ent of Tndnatclal Aodden 4 ce a.-Investigations 600 Washington Weet Boston,MA�21 I1 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617427-7749 Revised 4-24-07 ViWV-M=,g0V/dia FtHE> Regulatory Services Richard V. Scali;Director = Building Division uxxsTnsr,E, : � . .16 `��' Tom Perry,Building Commissioner prEn rat s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#• HOME OCCUPATION REGISTRATION Date: Name: \C_�PnJ_ l L c p"(�/I G� �� Phone# Address: �� /!I M h e S Village: ce_VAe� .Name of Business:• /9• Type of Business-' Home m,4 ar-J+ .UJ p Y' Map/Lot v D IlV I1V'r: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation, within single family dwellings,subject to the provisions of Section4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual.alteration to the premises which would suggest anytbing other than a residential use,no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: , • The activity is carried on by the permanent resident-of a single family residential dwelling unit,located within that dwelling unit • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such'use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is Ao exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot'containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the'Customary Home Occupation is listed or advertised as a business,-the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,hav d a �wiith he/above re tric' ns for my home occupation I am registering. Applicant: Date: 69�v/,/61 Homeoc.doc Rev.103113 i YOU WISH TO OPEN A BUSINESS? For Your Information: . Business certificates(cost$40.00 for 4 years). A business.certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st Fi., 36.7 Main St., Hyannis, MA 02601,(Town Hall) and get the Business Certificate that is required bylaw. DATE: l Fill'in please: - a} APPLICANT'S YOUR NAME S: 1�. har� M e CO,- W BUSINESS YOUR HOME ADDRESS: 5-l�ln �tii nn� s. �tne a ,PxE y = 3-03-(vu-&j93 Ce`.terv.ilt, rrtyt c��G,3� a . s TELEPHONE # Home Telephone Number s7�S- ASS- G1193 NAME OF CORPORATION: ' y NAME OF NEW BUSINESS D.Ae TYPE OF BUSINESS Home Yard Work IS THIS A HOME OCCUPATION? 3C YES ADDRESS OF BUSINESS E66 him �� �c MAP/PARCEL NUMBER o�J O .C� l (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need: You MUST GO TO ROD Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.- 1. BUILDING CO ISSIO ER'S nFI MUST COMPLY WITH HOME OCCUPATION This individ al ha a mfo d f y erm re uire s that pe ain to this type of busWLES AND REGULATIONS: FAILURE TO COMPLY MAY RESULT IN PINES. Au hprized at ` l� �M N . ` ' a 2. BOARD OF HEAL Ql This individual has been informed of the permit requirements that pertain to this type of business. ` Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) ' This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: ` - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION LQ Map 060Parcel �! ' ; ()r B��.RNSTABLEApplication ! .Health Division Date Issued f� pin a r'J. Conservation Division Application Flee Planning;Dept. 'Permit FeeS 153 Date Definitive Plan Approved by Planning Board ;t ' Historic - OKH _ Preservation/ Hyannis = ti Project Street Address FJ�� (2 Phl n n Q 'I S' LA Village Le n del L) Owner 9 ej Address L0 Telephone Permit Request 3 A I. SO kW �gC_ t��m_ THIS I s Or- A aA re,Ni n wNltebtu i AD+ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Nlf+- Groundwater Overlay fs'� Project Valuation �c� Construction Type hj P ,�yll Lot Size, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure �v,1fi 19 30 Historic House: ❑Yes �,No On Old King's Highway: ❑Yes Po Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Pik 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: ;6 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 anU -e_ 16411A Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Jason SAnokS Telephone Number 501_f_01 J7-3 9 la1 Address 'a31 Si- License # 016A1 3 �o nnx S. I b X(a 3 !j� Home Improvement Contractor# Worker's Compensation # 90 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �Z. ��. J , \ FOR OFFICIAL USE ONLY .4 APPLICATION# t .DATE ISSUED. MAP/PARCEL NO. f ADDRESS VILLAGE t OWNER i ? 5 DATE OF INSPECTION: } FOUNDATION: ° FRAME INSULATION fi` r FIREPLACE ELECTRICAL: ROUGH FINAL v PLUMBING: ROUGH FINAL "GAS: r;F: ROUGH 1(wKIY FINAL : r # - ;',FINAL BUILDING' ` ' ji DATE CLOSED OUT ASSOCIATION PLAN NO. 10. ENTIRE AGREEMENT, SEVERABILITY,AND MODIFICATION This Agreement represents and contains the entire agreement between the parties. Prior discussions, verbal representations or written memoranda of any kind by Contractor or Owner that are not contained or referenced in this Contract are not a part of this Contract:In the event that any provision of this Contract is at any time held by a Court to be invalid or unenforceable,,the parties agree that all other provisions of this Contract will remain in full force and effect:Any future modification of this Contract must be made in writing and executed by Owner and Contractor in order to be valid and binding upon the parties. The parties have read and understood, and agree to, all the terms and conditions contained in this Agreement. .. D to Jas96 4toots for F2 0l r Inc, Contractor .Date Richard McCormack to isa McCormack Photovoltaic Contract Page 9 of 9 E2 Solar Inc.,Contractor Richard&Usa McCormack,Owners 4/16/15 FGENERAL NOTES: PANELS ARE ATTACH ED TO EXT,G ROOF z 0 STRUCTURE WITH X 4 SST GRK LAGS 48 g OC. TYP. Y - Q V 2. ALL RAIL AND M OUNTNG S a W ARE RATED FOR 110 z MPH WIND LATERAL LOADS. ? 2 g� 3. EXISTING ROOF FRAMINGS CONSIST OF 2 X12 a RAFTERS 16 OC M z-JJ 4.PLANS ARE DRAWN FOR SOLAR INSTALLATION ONLY. ALL DETAILS ARE NOT SHOWN. o %O w = V co Gi Z IL o:Lot) (26) SUNPOWER 327 WATT TITLE: AC PHOTOVOLTAIC MODULES DETAILS WF' W C 2p0 N a� Zz N m Z �Zpp W If1 17' SPAN u RAFT 16* c RAFTER 16" OC 4/12 PITCH � o ® sm 03 YJd `9 Date: 10.21.2015 Sheet: L Al 1/201 Maximum Span Calculator for Wood Joists and Rafters jr� Home Education Membership I News ( FAQs I About Us Members: Login Register I" R RDI WfW Tube AMERICAN WOOD COUNCIL 2p�S CODES&STANDARDS I ENVIRONMENTAL REGULATION I GREEN BUILDING Search PUBLIC POLICY Publications I Calculators&Software I Building Codes I Fire I Span Tables I Decks I Weights and Measurement Codes & Standards > Calculators & Software > Maximum Span Calculator for Wood Joists and Rafters Spedies Spruce-Pine-Fir Size 2x12 Grade No. 2 Member Type Rafters (Snow Load) Deflection Limit L/36o Spacing(in) 16 - Wet service conditions? • Exterior Exposure No Incised lumber? No Snow Load(psi) 30 Dead Load(psf) 15 • Calculate Maximum Horizontal Span Go to Span Options Calculator for Wood Joists & Rafters s LIMITS OF USE HELP I RESTART F a Span Calculator for Wood Joists and Rafters available • for the Whone. ON Span Calculator for Wood ` • ' • Joists and Rafters also available for the Android OS. The Maximum Horizontal Span is: 20 ft. 2 in. with o minimum �caorinrt lanrrtl•. of n OG in, htfpJM".awc.org/codes-standards/calculators-software/spancalc 1/2 10/21/2T1 Maximum Span Calculator for Wood Joists and Rafters W1L11 a 111111111111111 UVaLnxr'1w1r'L11 Vl V.IJ AH. re uired at each end of the member. Property Value Species Spruce-Pine-Fir Grade 11No.2 Size 2x12 Modulus of Elasticity(E) 1400000 psi Bending Strength(Fb) 1157.19 psi Bearing Strength(F�p) 425 psi' Shear Strength(F") 155.25 psi While every effort has been made to insure the accuracy of the information presented,and special effort has been made to assure that the information reflects the state-of-the-art,neither the American Wood Council nor its members assume any responsibility for any particular design prepared from this Online Span Calculator.Those using this Online Span Calculator assume all liability from,its use. Comments?info@awc.org. M J AMERICAN WOOD COUNCIL 222 Catoctin Circle SE, Suite -Phone- -Email- 201 General:202-463-2766 Technical: info@awc.org Leesburg,VA 20175 General Fax:202-463-2791 Publications:publications@awc.org Publications:800-890-7732 Education: education@awc.org -Public Policy Office- Publications Fax:412-741- Fire:fire@awc.org 1101 K Street NW, Suite 700 0609 Washington, DC 20005 ©Copyright 2015 American Wood Council.All Rights Reserved. http:/ANww.awc.orgleodes-standards/calculators-saftware/spancalc 2/2 i solar Photovoltaic Installations E2 SOLAR INC 831 Main St. Dennis, MA 02638 - 0:508.694.7889 F:508 694 7886 CS License#CS090293 Home Improvement Contractor's Lic. # 160360 e2SolarPV(cD_gmail.com Contract for Photovoltaics OWNER'S NAME: Richard and Lisa McCormack PROJECT ADDRESS: 566 Phinney's Ln Centerville, MA, 02632 1. PARTIES: This contract (hereinafter referred to as "Contract") is made and entered into on this 16t of April, 2015 by and between Richard and Lisa McCormack (hereinafter referred to as "Owner"); and E2 SOLAR INC. (hereinafter referred to as "E2Solar" or"Contractor"). WHEREAS, Owner seeks to have one (1) 8.28 DC KW grid tied solar photovoltaic (PV) system, hereinafter called "the system" professionally designed and installed at the above-named project address. WHEREAS, Contractor agrees to install the systems in accordance with all local code requirements and in accordance with current National Electric Code. WHEREAS, Contractor agrees to install the systems in a professional and courteous manner, leaving the job site secure and clean at all times. THEREFORE, In consideration of the mutual promises contained herein, Contractor agrees to perform the following work: '2. GENERAL SCOPE OF WORK DESCRIPTION 2.1.) System Specifications: The 8,502 Watt DC PV system will consist of twenty-six (26) Sun Power E-20 327 Watt high efficiency AC photovoltaic modules mounted to the south facing roof areas. The photovoltaic modules will be mounted to the roof using Unirac mounting system. All roof penetrations will either meet or exceed the local building requirements. Each module will have an integrated Microinverter factory designed and premounted on the panels. Production will be monitored with a SunPower Monitoring System. The AC disconnect will be located on the exterior of the house, near the service entrance, with all appropriate signage posted as required by the utility. This system will connect to the electrical grid via the grid tied inverter. The System will not include a battery backup system, meaning the System will not supply power in the event of a power outage. Y S U N F E R' • and • AR �. II 20% EFFICIENCY SunPalver E20 pan Is arv':tFie highest E ffielen�y panels on ,e mark tl et today SERIES t ° prci'aidilig mare pock er.in the sctmc'arrlaunti of Spctc TR-ANSFORMERLESS INVERTER COMPATf$lllTY arfll�rchcll5l`c Inticrt r GCrnpatlblllt( Vnsures that customers can e"[DO Ir.the htgh sJ cfficlCncyT panels v,�lth th hi Iasi It IV rlers _i-naximizing sysl rn autput PQSITIVE;POWER TOLERANCE Positive tolerance ensures cu, brners �} s receive th[a rated p(Y:ver ca high r far every pcinel:, REtIABIE AND ROBUST DESIGN THE'WORLD'S STANDARD FOR SOLAR'" Sun.Po� ea.-'S unique lv`ictrr-GnT"' well SunPowerT"` E20 Solar. Panels provide today's highest efficiency and t chrnolayy and advanced module performance. Powered by SunPower MaxeonTA" cell technology, the E20 r design ensure industr,rl cidina r-,J_I dity series provides panel conversion efficiencies of up to 20.4%. The E20's low voltage temperature coefficient, anti-reflective glass and exceptional low-light performance attributes provide outstanding energy delivery per peak power watt. SUNPOWER'S HIGH EFFICIENCY ADVANTAGE - 20% 15% _R' 10% } ��nl► 5% yam_ THIN FILM CONVENTIONAL 1M - SERIES SERIES SERIES MAXEON CELL: TECHNOLOGY c� Patented all 6ackcontact solar cell ', m, C E PV CYCLE MCS Pr �ding the'�ndustry s;hrgh st =a o , \p S U N POWE • • • R PANELS MODELS: SPR-333NE-WHT-D, SPR-327NE-WHT-D - _ ~ELECTRICAL DATA ` � I-V CURUE t Measured of SloMdord Tesl�Condrficns(STC1 Irradiome�1000W/mz AM 1 5 and cell Nominal Power(+5/A%) Pnom 333 W 327 W� I 7 Cell Efficienry� r) 22.9% 22.5°k l 6 ,_1000 W/m2 Panel Efficiency 0 20.4% 20 1 °/ 5 Rated Voltage Vmpp 54.7 V 54.7 V Rated Current Impp oW/m 6.09 A 5.98 A v 3 —50 ' --- — -- - - ---- ---- 2 Y -----—-- — i Open-Circuit Voltage Voc 65.3 V 64.9 V Short-Circuit Current Isc 6.46 A 6.46 A 200 W/mz _.— .. -.W. _........ _ Maximum System Voltage IEC lot V — 0 10 20 30 40. 50 60 70 I Temperature Coefficients Power(P) -0.38%/K ( Voltage M I !I Voltage(Voc) -176.6 mV/K Current/voltage characteristics with dependence on irradiance and module temperature. Current(Isc) 3.5 mA/K NOCT — 45°C+/-2^C TESTED OPERATING ;CONDITIONS Series Fuse Rating 20 A S Temperature -40°C to+85°C Limiting Reverse Current(3 strings) IR 16.2 A 550 k m2 5400 Pa front e. .sno Max load g/ 1 ). I g Nl i Grounding Positive grounding not required w/specified mounting configurations i — 245 kg/mz(2400 Pa)front and back(e.g.wind) ;. ELECTRICAL DATA 11-- 1 Impact Resistance Hail:25 mm at 23 m/s Meawred at Nomirwl OperaM1ng Cell Temperow.(NOCT)UrodiorKe 800W/m�20°C wind 1 m/s - Nominal Power Pnom 247 W 243 W Rated Voltage Vmpp 50.4V 50.4V 1 WARRANTIES AND CERTIFICATIONS I Rated Current Impp 4.91 A 4.82 A 1 Warranties 25-year limited power warranty I Open-Circuit Voltage Voc 61.2 V 60.8 V 10-year limited product warranty } Short-Circuit Voltage I .22 A 5.22 A ; Certifications IEC 61215 Ed.2,IEC 61730(SCII) sc 5 I y MECHANICAL DATA ! Cells 96 SunPower Maxeon'cells 3 Output Cables 1000 mm cables/MultiContact(MC4)connectors Front Glass High-transmission tempered glass with anti{effective(AR)coating Frame Anodised aluminium alloy type 6063(block) I Junction Box IP-65 rated with 3 bypass diodes 1 32 x 155 x 128 mm Weight 18.6 kg f� - DIMENSIONS w 2X 11.0[.431 I MM (A)-MOUNTING HOLES (B)-GROUNDING HOLES 2X577[22.701 180[7.071 �,JI (IN) 12X06.6[.26] 1OX04.2[.17] 30[1-18] 322[12.691 4X 230.8(9.09 I I I l IBI i I i i B91H o i I o END I i N o � N 3 4• j I L1559[61.391 46[1.811 I �— (A) 915[36.021 1200(47.241 1 - 12[.47] 1535[60.451 •4t FLANGE NUT .a.�.. END CLAMP OP MOUNTfNG FLANGE NUT CLAMP `- MID CLAMP . T-80LT CLAP T-BOLT SOLAR MOUND RAIL T-BOLT UGC-t _ CLIP, r RAIL - 00 000 U , InstallabonDetAd DD o2009 �G soiarmount wit TOP Mounmv-cam � , UmU Grounds Chi - UURASSY-0005 � ��j�---f"j2m AV - SOLARMOUNT Bears Connection Hardware SOLARIV OUNT L-Foot Part No:304000C, 304000D L-Foot material:One of the following extruded aluminum alloys:6005- T5,6105-T5,6061-T6 Ultimate tensile:38ksi,Yield:35 ksi • Finish:Clear or Dark Anodized • L-Foot weight:0.215 Ibs(98g) Allowable-and design loads are valid when components are Bea assembled with SOLARMOUNT series beams according to authorized f t---'Bolt UNIRAC documents L-Foot For the beam to L-Foot connection: Assemble with one ASTM F593%7-16 hex head screw and one errate ASTM F594'/"serr6ted flange nut Flange N •Use anti-seize and tighten to 30 ft-Ibs of torque • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third-party test Y results from an IAS accredited laboratory NOTE: Loads are given for the L-Foot to beam connection only;be sure to check load limits for standoff,lag screw,or other attachment method I ; 3.01 Applied Load Average Safety Design Resistance 3%SLOT FM I Direction Ultimate Allowable Load Factor, Load Factor, '.b HARDWARE t Ibs(N) Ibs(N) FS lbs(N) m 2.01 Sliding,Z± 1766(7856) 755(3356) 2.34 1141 (5077) 0.646 Tension,Y+ 1859(8269) 707(3144) 2.63 1069(4755) 0.575 Dimensions specified in inches unless noted Compression,Y- 3258(14492) 1325(5893) 2.46 2004(8913) 0.615 Traverse,X± 486(2162) 213(949) 2.28 323(1436) 0.664 SunFrame Unirac Code-Compliant Installation Manual isgUNIRAC Table 9.Downforce Point Load Calculation Total Design Load(downforce)(max of case I,2 or 3) P psf Step I Module length perpendicular to rails B x ft Rail Span L x ft Step 4 Downforce Point Load ' R Ibs ' Step 6:Determine the Uplift Point Load,R(lbs),at each connection based on rail span: You must also consider the Uplift Point Load,R(Ibs),to determine the required lag bolt attachment to the roof (building)structure. Table 10.Uplift Point Load Calculation Total Design-Load(uplift) P psf Step I Module length perpendicular to rails B x ft Rail Span L x ft Step 4 Uplift Point Load R Ibs Table 11.Lag pull-out(withdrawal) capacities (Ibs) in typical roof lumber(ASD) Use Table 11 to select a lag bolt size and embedment depth to Lag screw specifications satisfy.your Uplift Point Load Specific S/s_sha(i;* Force,R(lbs),requirements. gravity per inch thread depth It is the installer's responsibility Douglas Fir,Larch O.SO 266 97, to verify that the substructure and attachment method is strong Douglas Fir,South 0.46 235 enough to support the maximum Engelman Spruce,Lodgepole Pine point loads calculated according to (MSR I6SO f &higher) 0.46 235 Step 5 and Step 6. Hem,Fir,Redwood(close grain) 0.43 212 Hem,Fir(North) 0.46 235 Southern Pine 0.55 307 Thread depth Spruce,Pine,Fir 0.42 205 Spruce,Pine,Fir (E of 2 million psi and higher grades of MSR and MEL) 0.50 266 Sources:Amencon Wood Council,NDS 2005,Table 11.2A,11.3.2A. Notes:(1)Thread must be embedded in the side groin of a ra ter or other structural member integral with the building structure. (2)Lag bobs must be located in the middle third of the structural member. (3)These values are not valid for wet service. (4)This table does not include shear capacities. If necessary,contact a local engineer to specify lag bolt size with regard to shear forces. (5)Install lag bobs with head and washer flush to surface(no gap).Do not over-torque. (6)Withdrawal design values for lag screw connections shah be multiplied by applicable adjustment factors if necessary.See Table 10.3.1 in the American Wood Council NDS for Wood Construction. *Use Pat washers with lag screws. 13 ll •; C +f Cut Sheets.Gf1 812 i GreenFasten GF1 — Product Guide f,i•t I ., S i .� I i - i t - ! pli ill r • � � i. I I ` 1 it r • , ail ''� �•, ` T - C/l ' 16_ i 5J64 •..J.. - ' ...DETAIL A ' ._.__ SCALE: 2:l s` Finish Options BILK=Matte Black MLL Mill Finish 3.2 877-859-3947 EcoFaslen SolarDAli content protected under copyright.All riglits reserved,7/24/2014 EcoFasten Solar products are protected by the following U.S.Patents:8,151,522 82 8,153,700 B2 8,181,398 82 8,1GG,713 82 8,146,299 B2 8.209;914 B2 8,245,454,132 8,272,174 62 8,225,557 82 The Commonwealth of Massachusetts Department.of Industrial Accidents I Congress Stree4 Suite 100 Boston,MA 02114-2017 www.mass.govhUa Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEILVITTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Orsat»zation/Individual): Address: City/State/Zip: (V\a DA 0 / Phone#: Se`6`6 ILI- 11'g1, ` Are you an employer?Check the appropriate box: Type Of project(required): 1.f ' am a employer with_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.] 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]'t 9. ❑Demolition Q. 4.�I am a homeowner and will be hiring 10 Building addition.contractors to conduct all work on my property. I will . ensure that all contractors either have workers'compensation insurance or are sole I L Q Electrical repair_s or additions proprietors with no employees.. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. _ ROOF repairs. These sub-contractors have employees and have workers'comp.insurance.; 6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. V 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: ' Q', ' ,✓1 Policy#or Self-ins.Lic.#: _ 1A�[� ?j Expiration Date: Job Site Address:_540(D Ph! e J q, City/State/Zip: teAk efo`A±,M A .()i 6-3.4 Attach a copy of the`workers'coin ensa 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 thepains andpenalties ofpedury that the informadonprovided above is true and correct Si ature: Date: Phone#: "fir 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#: • DATE(MMIDDIYYYY) AcoRV CERTIFICATE OF LIABILITY INSURANCE 10/26/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Christine Davies DOWLING &O'NEIL INSURANCE AGENCY PHCNN 508)775-1620 FAX No: E-MAIL cdavieS doins.com ADDRDR Ess: @ 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B: E 2 SOLAR INC INSURERC: INSURER D: 831 MAIN STREET INSURERE: DENNIS MA 02638 INSURER F: COVERAGES CERTIFICATE NUMBER: 7834 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DDfYYYYI (MMfDO1YYYYI LIMITS t COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea ocwrrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO-- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NIA NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLJAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED7 NIA NIA NIA R2WC633340 07/19/2015 07/19/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If moos space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdtworkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Richard McCormack ACCORDANCE WITH THE POLICY PROVISIONS. 566 Phinney's Lane AUTHORREDREPRESENTATIVE Centerville MA 02632 Daniel M.Crc y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS..090293 JASON D STOOTy-` 120 CHASE ST HYANNI(S Mn 03601 � W ..r�l Expiration Commissioner 04/28/2016 _.> Q' .. �f1c Trr+,irrrrc+rrrrv.rr���el f'-Alir.;rrmlrr.;r//.; Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR . = egistration: 160360 -Type: ' pirabon 7/16120.16 DBA E2 SOLAR JASON STOOTS .. 831 MAIN-ST DENNIS,MA 02638 Undersecretary j JASON'STOOTS President_ inc j Photovoltaic Installations 831 Main Street(Rte 6A) Dennis MA 02638 � » '``-- cell:508.237.3892 office:508.694.7889 vuw.e2sola fax:508.694.7886 w rcapecod.com. jason®e2solarcepecod.com h . •dul use only --• • Y t for I ° yicense or registration valid f found`return to* iration date Business Regulation before the exp (fairs and B . Office of consumer Suite 5170 lO Park Pl p , I Boston,TAX2116. I .. li \� tur J-- vali withoutsignae , T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION C Map Parcel_��d ®I p is r, Health Division � V"" D e Issued IJ J . t Conservation Division Application Fee Planning Dept. PeX Permit Fee 1 Date Definitive Plan Approved by Planning Board Q„ap 4 Historic a OKH _ Preservation/Hyannis = Project Street Address 5 0(o Ain n n e y S + t XAV1 c Village Cen Aer v, 11 e Owner415oa �"R%Aarj. MCCorm.aC_k Address�szato Phinrley0 4,ne CelAerv,lie Telephone 11 s o` Sa 8'-.7 7S-O 9 9,57 &"$S 61 93 Permit Request l e m l I rb y% of d _+ol ch.e� SM& le ear Gt car'ct. - arvno s.fk Lan •-L� eo h s f ru')�a" of og Car a40L C_krk ar a a 1e_ Square feet: 1 st floor: existing 3 Oproposed 5�76 2nd floor: existing O proposed ® Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiorf"30,00a Construction Type Wavd _ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure �— Historic House: ❑Yes )d No On Old King's Highway: ❑Yes X,No Basement Type: ❑ Full ❑ Crawl ❑Walkout ) Other r z X oi, ;:..1/ re-mg,� cL4 craw Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 6 z X70 Number of Baths: Full: existing new Half: existing new J► Number of Bedrooms: existing _new Total Room Count (not including baths): existing to new First Floor Room Count Heat Type and Fuel: X Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes g No Fireplaces: Existing New Existing wood/coal stove: XYes ❑ No Detached garage: f existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: Coexisting `0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:CrI 1 ^� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# \ 4 �. Current Use Gar cL$g- ( Jc J�XGl el Proposed Use _rtXrc&4 'e- -LcAi it APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L6� 1►�CCOri, GwG� Telephone Numbed' Address 5&& 641 m n eyS L License# V�� ��, m �-'� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO )�,imw SIGNATURE ��� DATE ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. f" ADDRESS VILLAGE, OWNER DATE OF INSPECTION: FOUNDATION FRAME 5 E1 �3Lf�il r� INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING IL ` DATE CLOSEDmOUT 4 ASSOCIATION PLAN NO. The•Cornmonwealth of.Massachiisetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street c� Boston, MA 02111 www.niass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber Applicant Information ' nQ Please.Print Legibl Name (Business/Organization/lndividual): �iSq �Gle I Io C(or vna Jc Address: & . Pl7in 4e 5LS �a�e City/State/Zip: �•�`te�y�1 h M fr OZG 3 a Phone M S-V$ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. X 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. ElRemodeling ship and have no employees These sub-contractors have g; X Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ 5. ❑ We are a corporation and its required.] 10.❑ Electrical repairs or addil 3.X I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs.or addil myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance re uired. t c..152, §1(4) and we have no q employees. [No workers' 13,0Other comp. insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. 1 am an employer that is providing workers'compensation insurance for illy employees. Below is the policy.and jab sit6 information. Insurance Company Name: Policy#or Self--ins.Lie.#: Expiration Dater Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dat Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties o:. 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 Be advised that a copy of this statement may be forwarded to the.Office of of up to$250.00 a day against the violator. Investigations of the DIA for insurance coverage verification. r do hereby certify tinder thepains and penalties of perjury that the information provided above is true and correct. fDate: Signaturem Phone.#: SP (�� 'd-1-19.J Official use only. Do not write in this area, to be completed by city ar lown official City or Town: . Permit/License;# Issuing Authority(circle one): 1, Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plum bing.Inspector 6. Other information and Instructx®lis as chusetts General Laws chapter 152 requires all employers to provide.workers' compensation for their employees. Purrssu�an tto this statute, an employee is defined as ".,.every person in the,.service of another under any contract of hire, express'or�im lied .oral or written." p An employer 's defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the forego in engaged in a joint enterprise, and including the legal representatives o deceased employer, or the receiver or trust of an individual, partnership, association or other legal entity, em oying employees. However the owner of a dwellin house having not more than three apartments and who reside. herein, or the occupant of the dwelling house of'a. Cher who employs persons to do maintenance, constnicti or repair work on such dwelling house or on the grounds or'tb ' ding appurtenant thereto shall not because of such e ployment be deemed,to be an employer." MGL chapter 152, §25Q, states that"every state or local licensi g agency shall withhold the issuance or renewal of a license or pe operate a business or to construe buildings in the commonwealth for any applicant who has not prod c d acceptable evidence of complia e with the insurance coverage required." Additionally, MGL chapter 152, 5C(7) states "Neither the co onwealth nor any of its political subdivisions shall enter into any contract for the perfb ance of public work until. ceptable evidence of compliance with the insurance requirements of this chapter have be resented to the contra ing authority." Applicants Please fill out the workers' compensation a d it com etely, by checking the boxes that apply to your situation and, if contractors names a e e and hone numbers) along with their certificate(s) of necessa , supply sub O O, ( P r7' PP insurance. Limited Liability Companies (LLC) o Li ited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry work s' mpensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that is a da it may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage Also e re to sign and date the affidavit.. The affidavit should be retumed to the city or town that the applicatian for the pe or license is being requested,not the Department of Industrial Accidents. 'Should you have any que ti.ons regarding Ne law or if you are required to obtain a workers' compensation policy, please call the Departme. t/at the number lis d below. Self-insured companies should enter their self-insurance license number on the appropri, line. City or Town Officials ' Please be sure that the affidavit is comp11 and printed legibly. The Depa t ent has provided a space at the,bottom of the affidavit for you to fill out in the , len't the Office of Investigations ha to contact you regarding the applicant. Please be sure to fill in the permit/licens6 n mber which will be used as a re enc,number. In addition,an applicant that must submit multiple permit/licepse applications in any given year, need o y submit one affidavit indicating current policy information(if necessary)and'under"Job Site Address" the applicant sho ld write"all locations in (city or town)."A copy of the affidavit that,has been officially stamped or marked by the 'ty or town may be provided to the applicant as proof that a valid a�davi'Us on file for future permits or licenses. A n w affidavit must be filled.out each license or permit not related to an business or commercial venture year. Where a home owner or citizeriJA obtaining a (i.e. a dog license or permit to buns leaves etc.) said person is NOT required.to comple this affidavit, The Office of Investigations would ike to thank you in advance for your cooperation and ould 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 4724-07 www.mass,gov/dia ENERGY CONSEIRVAT-ION APILZCATION FORD FOR ENERGY EFFICICIENCY FOR OME_ AND TWO-FA MY DETACHED'' RDSIDENTIAL CONS`z'RUCC'rzIOQN (78o Cn-.6x:oo) APplieant.Name: �t5'� €' �t CrO� ► t CIOr WtaG� Site Address: ,7�0�o U idl►)e S L print Town. Gay l l/t l�e. Applicant Phone: SV -7?S=O995, bV8 6es-6193 Applicant Signature: �;%: �� Date of Application: NEW CONSTRUCTION: choose ONE of the-following two-o tioas 780 CM R.TABLk 6107.1 PRESCRIPTIVE ENVELOPE COMTDNENT ERIA FOR NEW ONE- AND TWO-FAMILY B DINGS MA�QM(JM M� Ceiling Slab ❑ Option 1: Basement Fenestration expos d W 1 oor wall Perimeter UE HSPF U-factor floor R-Val R-Va a R-Value R Dr, R=Valu and De National Appliance R- ConscrYal(°h Act(N.1 35 R-3 8 -19 R-19 R-10. 1987 as mcndcd,m11 cater as iLpp11cftb1n Dote: This form is notrc ired ifyo choose of the two Wr ' ns ofREScheckas fisted below. ❑ Optibn 2: REScheck ersion 4. .2 rvariant soflw e analysis must be completed 780 CMR. RESche'ck-Web 'c can Abe accessed http-://www.t-,nnrgycc)dn.Gov/reschect AbDZ-T�Q IS'OS ' T` ' X 0 Eb[S zS O DXNGS.O E12'5 YEAR13 OLD* *X3uildings under 5 years old must use n#1 or#2 in Now C struction section above. ,Complete the following formula to determine the % of glazing: (a) Gross Wal 1& Ceiling Area equals Formula: (100 x b a) ' S 100 x — _ % of glazing G a . (b) G1 in area c uals .. SF If 'lazin X :40%.use the chart belo If glazing is > 40 % rpceed to "S�UNROOM section ' 780 CMR TABLE 61Q1.3 PRESC RTIVE ENVE OFE COWONENT CRITER7AADDITZONS TOEXISTING. OW.-RISE RESIDENTXAL DT MDINGS . _ MA�C[M:[JM h9TIIMUM . Ceiling and Slab Per Fenestratio Exposed floors 'wall Floor Basement Wall Slab, U-facto R-Value R-Value R-va]uc R-Value and D, R-37 a R-13 • R-19 R-10 R-10, a.. R-30 ceiling insuI on may be used in place of R-37 if the insulation achieves the full R-Value over the entire ceiling area i•e, not com ressed over exterior Walls, and includingan access o enin s . SUNROOM—An addition or alteration to an existing building/dwelling unit where the to ❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of addition.. Note: Owner to fill out Conswnerb ormafion Form found in A endix 120.P I Towia. of Barnstable of s r F q Regula..tory Services ' Thomas F. Geilcr, Director Building Division t6sq .'.a Tom Perry,Building Comrrtissioner+: 200 Maid•Stmee _HYannis,lvfA 02601 ps-ww.t o w n.b arns tab l e.m a.us Fax. 508 - 90-6230 _. 7 office: 508-862-4038 HOl•,EEOWWER LICENSE EXEMPTION Plcasc Print —DATE: JOB LOCA77oN: J!o(o Q i n n e Xa n e number _ street , v llagc -"HOM130WNER": O n dI YS - wor1C_ one# name �fJ home phone ff � CCJRREI�I MAfLING ADDRESS: Y ltI Vp . lane sta(r bp 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 notpossess a license pzovidcd that the owner acts as ' ,. suPcryisoz. DEFIhMON OF I3O E0'SVh`E12 Persons) who owns a parcel of land on which he/shc resides or intends to reside, on which there is, or is intended to, bc, a onc.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 homcovaicr. Such "homeowper shall submit to the Btu7ding Official on a form acccptablo to the Building Official, that hr,she shall be responsible for all such work performed under the building permit. (Section 109.1.1) s responsibility for compliance with the State Building Codc and other The undersigned"homeowner"assume applicable codes, bylaws,rules and regulations. The vndcrsigncd"homeowner"certifies that_ ta he/shc undersnds the Town of Barnsiabl.c Building Dcpart ncrit rr7;n;mllnl inspection procedures and requiremcnts,and that he/sbc will comply with said procedures and rcquizcm nfs. /. ignaEtm of mcowncr Approval of Building Official . Notc:sThrce-fam�y dwellings containing 35,000 cubic feet or larger will be required to comply with the {${c Building Code Scctioa 127.0 Construction Control. Ii011�1:EOwNER'S EXEMPTION .'I1rc Code stales thak "Any homeowner performin%work for which a building perrrdt is required shall be cxcrnpl from the provisions of this scction_(Scetian 1b9,1.1-Licrnsing of r 4tiction Supervisors);provided that if the homcowna engages a pQson(s)for biro to do such work Ihat such Homcowtict sha])act as svpcm,sor." Man homeowners who use this rxemption arc unaware that they aim usurping the r css bftcn i6csrc-u ofa supervisory(blcmAsPPa�rbcul�ly - Y svlts in scno ,p css often rc .P= This 1 ack of awarcn 1Zulcs&R.cgulations for Licensing Consbvction SupaYisora,Scctton 2:1 Th , _Lj)cs he hdmcowncr hires unliFrnscd PcT=pns• In this case,our Board cannot proceed against the unlicensed person es it ti ould with a ltecnscd whr-n Supervisor.. The homeowner acting es supervisor is u)timatr)y responsible. hS h fully zwarz of hiv( q rc.ponnbilities,many communities rcquirc,m part of the 7o ensure that pamit application, omeowner is that hdshe understands the rrspanstbilibes of a Supervisor. On the)ast.pagc of this issue is A.form currcnily used by that [he homco4rncr ctat L several towns. you may ears t amend and adopt such e forrrrlcertificalion for use in your Community. �THEr� Tawn 0f BarastaWe Regulatory Services � f ` uxr+rrAst� Thomas F_ Geiler, Director k(1 R4 �o Building Division Toni Perry, Building Commissioner 200 Main Strcet, Hyannis, MA 02601 1VWW.town.barnstab1e.m2.us Office: 508-862-4038 Paz: 508 " , Property OvrherMust Compk*to ante Sign This Section zfUsing .A.Buxlder as Owner of the subject.propert.y hereby authorize to act on iny6ehalf, m all,matters relative to work authorized by tbds building permit application for: (Address of job) Signature of,O Iner Date Print Name If ProTDertY Owner is,applying fog pertn.it please complete the Homeowners License Exemption Form on 'the reverse side. CV '' ` Q A`,� N Ot W a LOT AREA .= 224GO.5 5.F. Agb BUILDING LOCATION PLAN FO R 566 PHINNEY51ANE CENTERVILLE;. MA tN OF PREPARED`FOR ` LISA * ,,RlCHARD' MCCORMACK .: F o U BA SCALE: DATE: DRAWN.BY: 1 =. 40 02- 13-2009 TMW JOB NUMBER. PEV15ION: SHEET,NUMBER: A'QoFEss�� ` 09-002 CPP- lqN I SURN� WELLER * ASSOCIATES 1645 ;FALMOUTti RD:, 5UITE 4C P.O.^B0X 417 2' .CENTERVILLE, MA 0263 . 2 WINDY WAY, #232 NANTUCKET, MA,02554' TEL,: (50(5)775 0735 FAX::(506) 775-0754 EMAIL. tni weIIcr@C0MCP5t net. , -- RE015TERED;IAND 5URVEYORS Traverse PC � o Lu �^ 1 2.2' Lf) r ; N w U7 Q r LOT AREA = 22460.5 5.F. Ion SzoE ItowT (see L•a+s.+a BUILDING LOCATION PLAN FOR 566 PHINNEY'5 LANE CENTERVILLE, MA H OF PREPARED FOR N L15A RICHARD MCCORMACK o 723J59 BA SCALE: DATE: DRAWN DY: " I " = 40' 02- 1 3-2009 TMW AROFESS`ONPv ' J05 NUMBER: - REVISION: SHEET NUMBER: 09-002 CPP- I lgNp SURv� WELLER * A550CIATE5 I G45 I'ALMOUTH RD., 5UITE 4C — P.O. BOX 4 17 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 TEL.: (506) 775-0735 --- FAX: (505) 775-0754 EMAIL: trl5Weller@COMCa5t.net REGI5TERED LAND SURVEYORS Traverse PC d p. i f ST�dc-vsprc fom/�oN<�1s 72, 4,-177/ �i sS. Srxi r3u/<oi.%G Baal 7 a-j • �, ` CO.,.cvl� /� �E ��Y./ ��0,�/ /yii.✓..'Co�n�s0'EsSi� 57�'�G/7� —' Z- 8 �� �tsP/f�-f/Paoj• Shr6z6s ra in.9-,zw+ 6�.sn...G //s��cc+x,4ro# G�P�aIF PL�/ti!/ao0° SlIew7m i 3Y11 r�8 LVL C-4AR&O wOK 4+ vex¢ i �Z CT., 6,?AOL- pC1we-PO . !re m�rtN Su�Sn.�G ' ///�\ /� / y � �o i.v ./.SUCH psi //s- ` ta.vc�pETE cm�G•a.V A3ov-- - ay v_=�-�•--_ " i �o iN fO.n�R CTG�iO �/Y�fR crJ.Y6r,� Sso • ZN�o" CA -3 ST�PciCT7/�i4� ✓Yo7L�5 /• ' CaNCR�-r-C 7U. BE'/r/N/�u� ' .�ooD fir/ ' ' 2. A.✓ci,4i•e 8o ice'. •S.�R�i..:G �1b � /n/ I r` /��co.-ed/3i.G�_ w�l;•y/ iri�sr 'Sirs-ice d�i<o%.,G Goa�E 7"f Gina,✓. , ': ! I � ' 29 a•. ! ol ol i as�CN� �•c,�c�t 5 P y; I � O � i - i i Fod.�loyno../ /�u9.✓ ' .. i i '. �, t - ,. � � _ ti ' I � _ ` .. � � \ - - . ,� - ,E/xisr�,..0 . _ •. � � t � � � ,f � #�v.` ..�,F.. i...r�.y p:''... r4yt, - r�� III/_-���I � -. ,,, r^Q,�. - ate''' I - -�6 3- ;'s - '{, REo c'l-,oRR Si�i.v6GES _ _ � pia m�qr�./ G-•risr�.w . �a�ya,..o� . ';> � - . ,�: ., ,. 2Y�0" Sc�c E //y c� -p �� �,' ALL CON�iplIG7JGi✓ rn 19G i/✓ mecca�o�t../c� f%PO.dOsEo G.rtR^}GE : I.��Tr� irl�SS. .. s�� I�u/�-oi..�G God 7'ar��iT.�a�✓. /n�ny �-h-�,STy/✓Gr, { SG6 �/fiN.NEYS L/�N6 CE.✓r�p✓�<cE , M.q 026 32 ♦ ♦♦ � ..' r: : / : - .. - - A FK'onT AGE✓p Tion� r r. j�. { Town of BarnstablePermit: ofTME' ti Regulatory Services a `� Thomas F.Geiler,Director •219• U 5 HAM 1 Building Division ee:a, dv 9 16 3�a��� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: \ a^ Cr r (� G r C 0'� V r tM c9-t Phone: Install at:•566 f t vi n p ys 10o-e Village: ar Map/Parcel: ZV om Date: /Obz�/,,r— Stove A. New se B. Type: Radiant Circulating C. Manufacturer: New C&We- Lab. No. D. Model No.: Chimney �011 A(�O/Existing (If existing,please note date of last cleaning �;� B. Flue Size C. Are other appliances attached to Flue? hl o f D. Pre-fab Type and Manufacturer__ �-� E. Masonry: Lined/Unlined Hearth A. Materials: joje- B. Sub Floor Construction: / o car Installe 1 Name: i cLra^ MCC VM Vt c-k Address: )66 Am He, 44 Phone: -7�S= _5 Location of Installation: zo APPROVED BY: �4 .2 L <' Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove I '+ er - { �eR rr• p `� CE � � 7 )�yk.. My �- -�.�,nrs�.,.,�fi` B S ti✓ aka� 4 •,fit tiY �F4 r>x SZ� +r , t++r..4`Fltz ! ak0. Usf!., wn w v r t r :!. '� r .f S Rfi✓x> § ' " ' .t x- 1l < na ",, ''y" ov 'r i'M x '��-'y°x.s t. ,.,=•4. ns '4 i i' `�`�` %ra tfi x'.vpns t e ,�ss ! t; -.Y '�, 'r,'�,+a. ,✓'�'.�",�s�Cl"a'� �ytYt��.F,:�P' �.,5.�`: �'tF��a��`„,'�$+ imU�✓'�M ^.'�t � � ^m ,. � i :• .s t Sys: TWN J l ' i • C' nr! bA k d# v a 11, • „h ro k ^ • ms MIT o n wo a ' " %mot III ffi �r w a Q j f 317 y a � � �y A �r. '� e " � y j -. iL $ P ,' "' i "k a, `� �, � �"k,� mee",;��^N'�t�m ii k� m. �+��'u'" �� k�� �,.a.�,h;. w, - d •` - � .-s � T� "' -�,�9y .m z ii a th 14 IL7 IZR � u a M a r y� , s� � s n V1� W yy 2�YP' Z a� � ^,�typ /� 4`9Y �� ..L.. l � i� ,� w r w t e `'` •�. .ice y w"It ,t y° ,J.h .� `kY,� "^ah�., y' ws '' x .,s.,�sn" "'�' 'z set 41, It It- t4' Pit '4P F 3+ TIJ;4 53r Jf't 44, k ,4,7 A' JI � 7c- 7- , 11 —11; 41", ' 4--'wo 4-14 aatt, On A 'A V'- 4 oP A, ik- 4 I,�';, f 7 zff- k"p'p, q4' 'f 1 *14 lie f I A 41 '96 77 au a 4 q-1 14,4 JP till", Ali 4�A it j M, ilt 44 th Ailic Al a Al TF�pk # A 1 as PRNI CONCRETE-O RR��,' w � %?H1 #� .air o- xx r 10/26/20'05 ., T WR V, 0 A C . w i' Addin .. m ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'Parcel C� I > Permit# Health Division ' i e � 6f��1�1�(,� 1�0 a Date Issued 1 2 -� 3 -'`b 3 j 24 1•� Conservation Division � t ® l;r .I r�Application Fee Ll Taz Collector � n �— 0 L '— ��`� r�3 Permit Fee Treasurer "P'PLICANT MUST OBTAIN A SEV 11 Planning Dept. ONNECTION PERMIT FROM THE "MINEERING DIVISION PRIOR TO bate Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 516 PA i n n _ s q►i e Village ccvt+f.f v 1 _ Owner CI Ard 't� I �COV a�cL C k Address '� �i✓l e !_ �� rvt�J e Telephone J a1 7 75- ©9 5— _ Permit Request 4dd� �o n ?�iree M � r`Fh O•.Iy Nb ham- Square feet: 1st floor: existing /DyoZ proposed 2nd floor: existing ,?rX proposed _� Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /O,®o® 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 3l0 On Old King's Highway: ❑Yes 2<0 Basement Type: ❑Full 56 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing j new Half: existing j new Number of Bedrooms: existing new Total Room Count(not including baths): existing ) new J First Floor Room Count Heat Type and Fuel: Ud"G as ❑Oil ❑ Electric ❑Other Central Air: Cl Yes V< Fireplaces: Existing New Existing wood/coal stove: ❑Yes YN0 Detached garage:'5existing ❑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 BUILDER INFORMATION Name Telephone Number ��� 22 f , Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE DATE &2 3 —d.� FOR OFFICIAL USE ONLY PERMIT NO. ^ DATE�,SSUED - r MAP"/PARCEL-NO. , f ADDRESS VILLAGE t A J 7 OWNER { f DATE OF INSPECTION: FOUNDATION 50 0 Z01®K FRAME INSULATION G "7 2- D S FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r a FINAL BUILDING 9 r U i DATE CLOSED OUT. x i - ASSOCIATION PLAN NO. 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I do hereby certify a anu and penalties of perj that the informadian provided above is true and totted E� Date 10-3 3, Signature � c Phone# �-,/ �7��G � L==--- Print name r' official use only - K do not write in this area to be completed by city or town official perndttlicense# CIBua ing Depattnent city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑Health Department phone#; Other contact person: ❑ I (rAmd 9/95 PJA) r Information and Instructions Massachusetts General La s chapter 152 section 25 requires all employers to pro 'de workers' compensation for their employees. As quoted from a "law", an employee is defined as every person in service of another under any contract of hire, express or implied, or. r written. ' er is defined as an in di ual, partnership, association, corporation or er legal entity, or any two or more of An employ the foregoing engaged in a joint ente rise, and including the legal representativ of a deceased employer, or the receiver or trustee of an individual,partnership, ociation or other legal entity, emplo ' employees. However the owner of a dwelling house having not more than thr apartments and who resides there' or the occupant of the dwelling house of another who employs persons to do maint ce, construction or repair,wo on such dwelling house or on the grounds or building appurtenant thereto shall not becau a of such employment be d ed to be an employer. MGL chapter 152 section 25 also states that e ry state or local licens. g agency shall withhold the issuance or renewal of a license or permit to operate a business or construct.buildin in the commonwealth for any applicant who has not produced acceptable evidence of compliance 'th the insuran coverage required. Additionally,neither the commonwealth nor any of its political subdivisions enter into y contract for the performance of public work until acceptable evidence of compliance with the insurance r ements f this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation afftdavit completely, y ecking the box that applies to your situation.and supplying company names, address and phone numbers al with certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for co lion f insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the its'or to t the application for the permit or license is being requested.,not the Department of Industrial Accid Should ygu ve any questions regarding the"law"or if you are 1equired to obtain a workers' compensation policy,pl a call the Dep eat at the number listed below. City or Towns d 1 'bl . The D artznent has ovided a space at the bottom of the Please be sure that the affidavit is complete an p � Y ep affidavit for you to fill out in the event the Office of estigations has to contact you reg ding the applicant. Please be sure to fill in the pernnt/license number which will a used as a reference number. The davits maybe returned to the Department by mail or FAX unless other arrang eats have been made. The Office of Investigations would like to thank yo in advance for you cooperation and should you ve any questions. Please do not hesitate to give us a call. 1/000/0 The DepartmeIIt's address,telephone and fax n ber: The ommonwealth Of Massachusetts D partment of Industrial Accidents Once of fnvestlgatloos 600'Washington Street Boston,Ma, 02111 fax#: (617) 727-7749 phone#: (617) 727=4900 ext. 406, 409 or 375 To" of Barnstable Regulatory Services L 33AM rAsr�, _ Thomas F.Geiler,Director - Mnss. 6 .19.{"�°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax:- 508-79076230 Permit no._ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERTSUT APPLICATION MGL c. 142Arequires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which.are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. /n Type.of Work: Iq 1 20✓! Estimated Cost Address of Work: AlnnexJ JIM n e Owner's Name: KR1 C-►tom^( , Y ► 'C l d r wt a C k Date of Application: I hereby certify that: Registration is not required for the following reason(s): C]Work excluded by law []Job Under$1,000 []Building not owner-occupied jd�nier pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE OR GUARANTY FUMED UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM . SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name RegistrationNo. 1-0-3-0-3 n,+e Owner's Name f ' RESIDENTIAL BUILDING PERMIT ML-FIEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALLFE-WORKSHEET — i NEW LVYING square feet x$96/sq.foot= --plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EIfLSTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$96/sq.foot= .. ITS . STAND ALONE PERM US x$30.00 Open Porch _ - (number) _ x$30.00= Deck (number) Fireplace/Chimney umb x$25.00= (n ) Inground Swimming Pool $60.00 ' Above Ground Swimming Pool $25.00 RelocatiowMov ug $150.00 e 3 (plus above if applicable) Permit Fee I f The Town of Barnstable _ { Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWKER LICENSE EXEIYiPTION Please Print DATE: /0-3 JOB LOCATION: number street Village .'HOMEOWNER, , C T•'IM a -723-® 3 So a 7S-1300 name home phone# ` work phone# CURRENT MAMWO ADDRESS: 3.21 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. DEFINTI'ION 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]Rerformed 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 minimum inspection procedures and requirements and that he/she will comply with said proce s re uirements. Signature of Ho owner w Approval of Building Official Note. Three-family dwellings containing 35,000 cubic feet or larger will be required to comply withthe State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION e 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 109.1.1=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. Tn—„ iirp that the hnmenwner is fully aware of his/her responsibilities,many communities require',as part of the permit _ TMETp��� The Town of Barnstable swnTARLL Department of Health Safety and Environmental.Services Building Division 367 Main Street,Hyannis,MA 02601 ice: 508-862-4038 508-790-6230 PLAN REVIEW Owner: ��� �c 1r 1M et C Map/Parcel: ti U O 1 `7 1 Project Address:\�(9 G— k l MI 1 eW S ►n Builder: 0(.vh(2 v-- The following items were noted on"reviewing: Reviewed by: Q:2&0'0--4 A Date: )2-,3 U 3 i I ! I I � I I : I I ! I � t - I i , z I I i c , 76ir� Est N I � I I I I • i i i � :i i. ece i ! I. 1 a I I i i I ' I � : I I I i I I ' i I i { i : I , : I I .. I ' : I i I I _ I I I I I 1 I I 'a7 0 I N I : i 1 I I , : , I I , � 2 I 1: i I I I I f : I r I I fc i i i ( i i I I 1 � � I I .. . . ! dr I I I i I I i I i_ i I- , I I I i i I i i I I I I 7 Ir_6 1, . � ! 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I I , 2 ZulU�T , : I _ f ; I I I I I i : i I o tu lz 112 : ; I • s I : : I , I I ' I I ' • i; I , : 1 : L x : I ,r� I I ' I , : I f a CS-- I .vim r � fJ Vr 2a" o I 3 -\ A. "'� ASS. LOT 2g•0=_�.�►_ fig' 4568 lqp Z• ASS:, LOT 17 ASS. LOB' 18--1 (LOT 2) NOT. • PRE—EX?S'?'IM NONCONMRMM m .zo" "IJW4 " Tb� MOR'I`OAGE INSPECTION o`' FOOD zONK V REGIS"1'RY ME&MY-4_Z'Q".aN_____. ___w___ DEED REP _2,0 .LAB7 ---------BUYER: A.- D — _—_ PLAN RED'; _ S "T I HEREBY CEItTI�°Y TO _THAT THE B[II�DINTG tl T YANKEI; SURVEY SHOWN ON WO PI AN IS LOCAM ON nW GROUND AS � CONSULTANTS SHOW AND THAT ITS POSITION 'DOES CONFORM (c VITE I TO THE ZONING I.AW-SETBACK REQUUMENTS OF THEA` INDUST 3YY ROAD TOWN OF E Irf DOES .. LYE WITHIN THE SPECIAI, I;'LO D�HAZARD � "i'ONS i am. uk 02648 • AREA AS SIYOi ON Z` ILIJ-D. MAP DATED TEL 4 QY3-O055 F 20=5553- 1�v a .0 m .. on+areti e9r »hva nr,. eassns t YtUSR1T _ - , z , 1 ,.�� ;�+.j\� d 4--�� II•w L..•.,� - "� Y��i �r .1��tC...- .W`:' �� �•� ... ;/`� }L-+"'i�*E -, ,_ ..�..r, .. - i N L e e N 5TIF-.W,MOP .- / f v '�..'- � . � -----.. �`�a?�1.�' �-;�!, .�t,��'�;. C�``k• .Cam `� ___._._»__. _..__ ___..__.._ S a ? __. -- i ,,, ! y# /�� ,✓'fit '. !{! : , ! , LA TIt 1 vVy wt,-0t> ` 1 IN Cl 7D t P 1 _ .: LAI I j 11 1s I �t r 4 j t ' k S14�E DETECTOtB REVIEWED ° ' ' �T;',.. _. v j a, � �3 � IN�►k- t. . Ltfv, ' � , T LE BUILDING DEPT. DATE Bug — C V, FIRE DEPARTMENT DATE 1 BOTH SIGNATURES ARE REQUIRED FOR PERMITTING IVI El s ! i f Y 1 ; Y Y i 5%pe- K�pllu, U164>11, r: Jat�Phi` �6. l — __ .-..__ cw 1—_ N I } i t C Fa-tX:- _P�..,� Y � `�:6 # f t TT ... _ cry-lG. P X1 46� l -s-r To rApt. C,AIPWIr 5`p11 CwNfT, A New Garage Addition for: 7\Dick ��� 0. S � �r t�f,�4 A 4 ) 15 Y' f 4 �✓�C ! ���� 5SCALE• A �} AT�..� APPROVED BY: DRAWN BYr }1= 7{lc� �oDATE REVISED and Lisa McCormack Ra. 47a� . ri L-AKRO ASSOCIATES ARCHITECTS �r "�� &P� 566 Phinney's Lane, Centerville Massachusetts 02632 27 Eastview Terrace, Marstons Mills, MA 02648 � c� � 1 DRAW"NG NUMBER Tel. and Fax: 508-419-1217 I � �° p IQ Hull c l - G1 i P �'/ TrU°1�7 M r� -- _ fi r.._.> 54 / 1l � - �.�.M Civ� ��i����i. lA111�157�iJJ. !t@ � 1 4•� ( Y p<%v r-ULL, T1-i f CMG 1 N w r Vi/ U.ice. r• , A G I Iz PL O ---- --- f z Pl 1 l r l tr �L�,��, TD � sH�T rN C ---- <_ � 3 � w� 3c � F�� C�vE� � � i �rl �z�.fit► I ,�" �. ,� - �-, �: �• i �� `Tel M e i1L-Z. • l Lb-5 VJ/ X& W.IW tA .:� R 5�INc NouSE vim Mks r atit cc> �, M►► , , r - — _._ - -for Cr FIOA. VP �J�T�')t,. 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N Z i w, r -_ Cy e� �.: f�Ti ____ __._ _ _—_.._ C TT k' z 4 n 414, . 1SYT _ f .. _ q LJ I 4 �� - 1 - -- ---- l- �C T P - __ Z. s` i i V. 3 WWII- pty f . ,...._.,_ -`t`�---'•-'----"..,...,...�.�. _____. ..._. - ._. __...._.. _...._....__.. -�::...::=.;�c� .. �. mas.�v-: sc. - ,asp ,. � f • tl'� 4✓ i — ( � � i L �. � fir, : � . A�Z;rr�� I f*l�v� cc�,��• S-rr:�.�....��. zo — _ 4— __ 1- ;Vp. 1 2 A New Garage Addition for. F,A Sys r 'J SCACX4 M N&TF j� APPROVED BY: DRAWN BY LisaC armaC DCand __ _. �MO. 4702 DAM; (��lf� Zs%1� REVISED AKRO ASSOCIATES ARCHITECTS � gOU7Nw° �, c� fraW S: r 566 Phinney's Lane, Centerville, Massachusetts 02632 27 Eastview Terrace, Marstons Mills, MA 02648 �0 �� DRAW"�G t.uMBER Tel. and Fax: 508-419-1217