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0168 LEWIS POND ROAD
����� ,� ;J eior�a Town ch"Buo ldfin Barnstable arnstable C tl ntilxa Final lns`,` a -tFi o`m h�as�een'm MBi11C1 1 g stPod UnosP639 WherC Permit Permit No. B-18-3386 Applicant Name: Craig Bishop Approvals Date Issued: 10/12/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/12/2019 Foundation: Location: 168 LEWIS POND ROAD,COTUIT . Map/Lot. 020-007 Zoning District: RF Sheathing: Owner on Record: ABRAMOVICH;JANE 'Contractor,Name: CAPE COD ENERGY SOLUTIONS Framing: 1 - Address: 12 CORDIS ST APT 3 LLC e 2 CHARLESTOWN, MA 02129 Contractor:License: 185543 Chimney: Description: -50 ft R-38 Fiberglass(Damming)-755 ft R-37 Cellulose(Attic)-1 Est Project Cost: $3-356.00 Temporary Access-76 vent chutes-10 hours air seal.m 226 ft R10 Permit Fee: Insulation: P ►Y . g.., $85.00 Rigid Board (Crawlspace) Fee Paid: $85.00 Final: , Project Review Req: �` Date:� 10/12/2018 Plumbing/Gas ky ;y;a� rt. ._ Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized=liy`th is permit is commenced within six months,afte'r issuance. Final Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents"-for which this permit has been granted. All construction;alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws�and codes. Electrical This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public rhspection for the entire duration of the work until the completion of the same. Service: v The Certificate of Occupancy will not be issued until all applicable signatures by.=the Suildmg and"Fire Officials are;;provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: ` 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage final: 6.Insulation 7.Final Inspection before Occupancy Health � • 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. Fire Department "Persons contracting With unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Assessor's office(1st Floor): Assessor's map and lot number Board of Health(3rd floor): e Sewage Permit number . . Engineering Department(3rd floor): // ✓�J Z seaa9TenLL House number ] �(oo ra 9• Definitive Plan Approved by.Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO O O TYPE OF CONSTRUCTION / 1/ i% 19 / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �rl.S n� Proposed Use ��(UCsL i4lYJJL� Zoning District f y / Fire District Name of Owner 0 © Address (�?� L v.re 5 Pd 4ca c 7V 17^«4 Name of Builder I AV Address ! Ci L-'e ��S ��� / \ Name of Architect Address Number of Rooms Foundation Exterior —^ Roofing e �t -e-A Floors Interior Heating Plumbing �o Fireplace Approximate Cost`�O 'T.,.9 0. Area Diagram of Lot and Building with Dimensions Fee c� 0 � i I I ® . ie4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 7q O C � r v�� 1 ` �. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License e> IL! 9 COOK, HENRY i x' 36537 REPLACE ROOF No Permit For l Singe Family. v Dwelling ` 168 Lewis Pond Road Location ` ' Cotuit > Owner Henry Cook t Type of Construction Frame _ Plot Lot , Permit Granted March 16, 19 94 m Date of Inspection 19 Date Completed 19 f COMMONWEALTH OF MASS A.CHUSE_ M —Eg—g-7 DFJ A.T::1` 'T OF I?�TDUSTRIA ACCIDFTITS ' 1 600 '\,7/6HFNGT0N ST=-- jarnes 130ST01\', M-ASSACHUSJ-717S 02111 �c--s.ss•�ne -WORKERS'COMPENSATION INSURANCE AFFIDAVIT 1, (1iccnscdpermiacc) with 2 principal place of business/residcnec2t (CitylSra(c/Zip) - do hereby eertifj; under the pains and penalties of perjury; that: 4s _4 j ) 1 am an cmplovcr providing the followingworkcrs' compcn sation.coverage for mycmployccs working on this job. Insurance Company Policy Numbcr j);�,am a sole proprictor,iand have no one working for mc_ j� 1 am 2 sole proprietor,gcncr-]eonaaaor or homeowner (tirde onc) :nd have hired the concraaors listed below• who have the following workc:-,'compc=don insurance politics: 1=me of Contractor Insurance CompanylPolicy N=bcr Nzmc of Contractor Insurance Company/Policy Numbcr 1,12mc of Contraaor Insurance Company/Policy Numbcr Q 1 2m a homeowner performing all the work myscl£ NOTE_ Plcuc be a,:rc t_tsatwbsac borcvwzcn wbo employ persoos tc do raaiatcosacc,coostnsaioa or rcpair..,Dck on a { d—cliin;of not more tbaa 6rcc units is wbi6 tSc boracorvbcr also residcs or on the grounds appurtcoant 11acto arc not Ecocrs]1y I conc,8crc J to be employers=&r tb<Varl<ri Corapca:at;on Act(GL C.152,sccz. 1(5)),aPP 1;ux;oo by a boracowacr for a license or Perna r-sy cvidcccc the lcgJ sure,cf"cr_:loycr undcr 6c Gorkcrs'Corapcosatioa Act. i caccrsc:nc tn_t a copy of tins u_t<mcrt-iu ix ior�vdcd to tic Dcpa::::cnt of Jndustri-I Acadcnu'Orcc o!l-scanc,c for.covcrz�c *-erifse.:t;on and that l:.ilurc to secure eorcr-;c z:rcSuircd undcr Section 25A of MGL 152 can ksd to dx impo:ir;on of-rriminA pcnAt;cs consisting of a fine of up to 51500.00 an&cr imprisonment of up to one year and 6Q pcnalucs in the lorm of:Stop Vork Order and a I fine of S 100.00 a day against rnc_ Signcd this d2yof , 39 h/ Lieens e/Permitzee Licensor/Permiuor COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY `—� F 9;vrc topoasaaaacurrent --- OF_ sSl3cbusett#State ftildin9 AI ,. I_ONE ASHBORTON PLACE � •- MASSACHUSETTS BOSTON,MA 02108CENSE __� - �.:�efrA+eaatorgvueatlon ... „� ;;i ti�•ese EXPIRATION DATE CONST R L.I SUPERVISOR CAUTION t FOR RESSTRICTIONS�96 EFFECTIVE DATE LIC-NO. HEFT, PUT ON RIIGHT THUMB NONE 06/30/1993 017111 PRINT IN APPROPRIATE ° BOX ON LICENSE. r ROGER B REI D o r PO B O X 145 z BLASTING OPERATORS m COTUIT MA 02635 m MUST INCLUDE PHOTO. }, PHOTO(BLASTING OPR ONLY) FEf00.00 0•0B NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER L - THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE ' .THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. "BONER � a �O%X/IX(YK[IJCQA�� ✓[�L(ldr/(LI�LL14P,�.(4 r HOME IMPROVEMENT CONTRACTOR Registration 180835 ' a Type _ INDIVIDUAL Expiration 06/08/94 I Roger B. Reid Carpentry Roger Reid 126 Lewis Pond Rd ADMINISTRATOR Cotuit MA 92635 i k ti .s w 4ot� � 4 r a i t. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp ,V 1 Map Parcel J . Application Health Division 'Date Issued C3 Conservation Division Application'FAZ Planning,Dept. Permit Fee ?J Date Definitive Plan Approved by Planning Board + i Historic OKH _ Preservation/ Hyannis Project Street Address (ef3. Lowi3 Pvvi d R,04J Village Creii�' Owner C 00 tR Address Telephone 508 e q18 4 Z k,Z Soh s f cvc Cook :508,. 2 .7 I d Permit Request ® jnSfa 11 Z�( YoLPrq l4 n Z1D w Ptio�ouvf t`L My o 'fati't ✓too k Npled P wcn c Wg Cr V, apy %'4 troy dvI' wPres: �(i Ule� to a PV I y'000 �hvc���lr f�vY�? 5v let kd, h.v�w�cy = ��0 ff z, Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new- Zoning District, Flood Plain Groundwater Overlay Project Valuation .00 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 40 Historic House: ❑Yes )4 No On.Old King's Highway:_Gl Yes �No I � t_J Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Yp � Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.fi�_ Number of Baths: Full: existing new Half: existing negi j r, Number of Bedrooms: existing _new UD N Total Room Count (not including baths): existing new First Floor Room 'aount n -- m 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 I No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 5014V Ill/c i k is h G. Telephone Number Y06 3 TY o q qq Address Z VA �.s Pa� UPI T 1 License # 59133 S ,,,,,,f k h A Home Improvement Contractor q-1 4 7q d 2 L r9 Worker's Compensation # WCA�2 q 1 3S 6 - I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 6&q ,61 L TrqjAsfir 457 F - key o `Ils — - 6 SIGMA DATE 3 - 4 - 01 1 FOR OFFICIAL USE ONLY APPLICATION# y DATE ISSUED r = MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME " INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING L'7) t DATE CLOSEDOUT ASSOCIATION PLAN NO. f i.e Commonwealth of AftSSfCifte,SeitS Department of Industrial Accidents Office �i��T VI' egiCg�4b�•i17�✓� a lr (, 600 ll'ctshhigton street f T r ; Boston, MA 02111 a` =` wm,w.w. s.g,1v1dlit Workers' Compensation Insurance Affidavit: Builders/Coiita•actors/Electr>iciaiis/PliLnabea•s Applicant Information Please MIA' Legibly 1LaIT'_e GI � — Add-ress: 17 PLtrvoi) i° J � Ci /State/zip: 8y Phone.# 3 l q'ROI Are J:on a•n employer? Cheep the appropriate box: Tyj,e of project(required): �s. V am a general Onti'aCtor and I � 1,!� am a employer with C 6. El New construction f „ r Have Cured the slab-contractors employees (full' and or,part-tiirlc�. listed on the attached sheet. i 7. Remodeling I 1,� ! aln a Sole prcipl"IetOI'O!"partner- _ These sub-contractors have l � Demolition � shin and have no employees b I ij. employees and have workers.' , vvorlcing for me in any capacity. µ y. ❑ Blsilding addition '�� A,nl' P C, Il'11'� insurancecomp. •r.�S;:-..'�i.�P ! I [t o N, ker_, corn . � � �} �a . . a� r, ,' - - 5. 17 .Vve are a corporation and_itS I �•u Ele. rica; repaL., or add...ions , required.]i officers have exercised their 11.� Pl nnbing repass or additions j 3. i a►ni a homeowner doing all work. I� ; right of exemption leer Vif { � , � n_ r., �;,. 1 myself. [No workers-, Comp.. j i_ i2.1 Ro0i iep.aias f c. 152; §1(4), and we have no + insurance required.'i 1 I 13.Q. Other YAJi(° 1v employees. [No �-workers � - I�4�jby 1 e 'comri. insurance required.] Fv:y app,ic nt that checks box#1 Il.ust also fi l out the-section below shop,ing their o,corkers' compensation policy inf rmation_ :?onicoi'-hers who submit tfiis a ldai'it indicating they are doing all woIk and then dire outside contractors aliist submit a new at`E da'+it iindicating siiC�l. <Contra=tors t`:at Chccla this box must attached an addliional sheet showing t?C name of FC SL7b-contraCto- and state lvhet cr or not those etltitees have e?rploy ees. if the sub-con;actors have employees,they must provide their workers'corm,.policy number. p am afn etrployer thitt Is providing workers'comp ensngion insurance for ntv employees, Below is tine policij and;ob site inform,ation. Insurance Company blame: / 1 � � �1 � I�!�Lt dot Ott t Policy ii or.Cel f-LnS. c a D � � �3 tJ 8 _ �l) Expiration Date: f I ! r Iob Site Address: j e wr.5 Poo d City/stateizip: ifok yl , 02 633 7 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 iin tine form ofa 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 fo insurance coverage verification. I do here ertif € .ier tl pa is r fi pare tie ofperjury that tine information pros-;lerl above is true cr;arl correct 51Un tore: Date. Z () ' 2-004 Phone # 40 1 �U Q ficial use oitly. Do not write in this area, to be completer!b ,,city or town official. City or Town: Permit/License# !! Issuing Authority (circle one): i. 1. Board of Health 2. Building Department. 3. City,''Town Clerk 4. Electrical Inspector 5. Plunibing Inspector 6. Other Contact Person: Phone#: - Information sir .'lit°1 ,,dV,S cilai; C:r 152 I"e, li)Cc'S al I e i . .',i"= t0 id_' .:o1'nG'i'S C0.11pen3nt, illt e it ei?ll)lC}yee . ,'Lii SU�ilt to tills Stal,ltte, ill 8972�7�flyeG' iS defined as ...e1'tl': p'','"SOri i•'? Ilie SCr lcc Gi aliOule:'Llnd t ally COI?Tl'aCT Oh ll1rt. t , e-xpress oril-iptled, oral Or,',-ritten.' An employer is defined as "an individual partnership, association, corporation or other legal entity. or ally two or more Ot the foreaoing engaged in a joint enterprise, and ll?ClLiding the legal representatives of a deceased employer. of-the r Ceiver Or trLlstee Of an individual, partnership, associatlGil or other legal entity, employing enlplcn ees. l-lov ever the owner Ut a d�,Velling house having not more thali three apartments and viho i"esides therein, Or the Occupant Of The ' iSn, IOCSc o another r tii en .l0✓S )ettl.1 C GG a 't-la1Ce COnStrUC01 O'1Cpaili 'lC1 Su ' dell(?- 10tSe _ — f 04,on the gl'OUnds or building appUrtei1al'tt.tl"le.f"et i Shall not because Of such enriploynlent be deemed to be an iv9GL chapter 152, §25C(6) also stakes that"every state or local licensing a ency shaft withhold the issuance or i'vrewal of a license or permit to operate a business or to construct buildings in the commonwealth tor.aily applicant who has not produced acceptable evidence of compliance with the insurance coverage required.=, Additionally, MGL. chapter 1 5_, j25C(T) states,,;''neither the_con?nlonwealth no,-any of its political sLibdivisions shah eniei into ai.1\'COl:ttl'act for the perf0l'n?alicc OI public vvork until acceptable evidence Ofcompliance vYltl?.the inSUrance regialreii"te,ltS of ibis chapter have been Presented to the co litracting authork. ." Applicants please fi!`•, out the workers` cGmpensation afrida4 is CO mpletely;'by checking the poxes that aprl,:t:,your situation and+, IT necessary, supply sub-contractors)nanie(s), addresses,an' phone number(s) along with their Cer ifiCatc{S� Gf ins,Ui'a.i"tCe. Lii11i[ed Liability COmila111eS LLj or L i ili ited Liability Part n e rs h i p 5 (LLP,I W"itli il0 elillllOyees v^ihei'tlian iiiE rne.mbers or partners, are not required to Carr�v,orkers' compensation insurance. if ail LLC or LLRdoes have employees, a policy is required. Be advised that this affidavit may be subnl"itied to the Depal znient of Industrial Accidents for confiri-nation of inSUrance coverage. Ajso be sure to sign and date the affidavit. The affidavit should be.re+.,t_~1�ed to the eilj' or town that the application for the permit Gr license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation-policy,'- le e 1 P' P t 1 e n ll d 1 r � I r ie 1 • ' t 1 please call the i�epartm..n. a:r.h. number-listed beiG,u: ,Self-insured ..ompar,,s shG,�to enter tre.r self-insurance license numbff on the appropriate line. City or Town (O friciais Please I lPaffidavitP r 1 v ly. P i P at tit . ie..se be sire that the is complete and printed e�,ib' The Department has provided a space a�the bottom of the affidavit for you to fill out in the evelit the Office of lrivestigations has to contact you regarding the applicant. a_ r n', i ,t r r Please be sure to till 111 ilic peri7liutil.eilSe iUli1L'ci tuiiicli wltt t'ic i,i5c�, as a 1"eici'ZiICE iiUlTtber. tii aClultlOii, all applicant that must submit multiple permit/license applications in:any given year,need only submit one affidavit indicating.cur,'ent policy information(if necessary)and under"Job Site Address" the applicant should write"all locations iii (city or town'."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filed out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of investigations would like to thank.you in. advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address;telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street . Boston, MA 02111 Tel. 617-727-4900,ext 406 or 1-877-AASSAFE Fax 4 617-727-7749 Revised 4-24-07 vN vi�%vv.nlaSS.go�%!dIa Xr- BIKE 1p� Town of Barnstable • snxrtsrasi.E. - x Regulatory Services 1639. pTF� y n Thomas F.Geiler,Director 4 ; Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601,. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and.Sign This Section If Using A Builder -t i c as 0wner.of the subject property hereby authorize CJ e luY 3 o to act on my behalf, in all matters relative to work authorized bythis building pernzit application for a n L—>r W i-5 Po Ii J R o a (Address of Job) Wgn atUe o 1 0'4er. bate �i'! / \ lam' (�' +. M _ + •4 1' •• r , 'Print Name Q:\WPFILES\FORMS\building permit formsEXPRLSS.doC Revise020108 C , Vr Town of Barnstable Regulatory Services * Thomas F.Geiler,Director MRNSTABLE HA & 9�A 1 39. � Building Division TFb MAC a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 7. HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# • CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended t include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire o does not possess a license,provided that the owner acts as supervisor. DEFINI ON OF HOMEOWNER Person(s)who owns a parcel of land on which h she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or tacked structures accessory to such use and/or farm structures. A person who constructs more than one home ' a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Buildin fficial on a form acceptable to the Building Official, that he/she shall be responsible for all such work erformed der the building ermit. (Section t09.1.1) The undersigned"homeowner"ass es responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules an regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced es and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official • Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided&t if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application; that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fonn/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC ti ., x,. Rp e i a • Efi f C! 1EVtir +- L Arfd,�cS:S -lark '(`ARfeiYrtpF[b11j� .r '�i�y,S y ,,•_ �'R�'LFi94?iPvr-�C�[4°i3Lta; G� �S��ktGe��rE.�.n3:+�b � .• G(7flrSUL77'i id[:T. ttSH ROB 33iilIC3�h' Q? G3: Ago@aeri5f[�nr; 0� 34�din}`ef�"�irZbsetl'�rsee .1 A lkin,ki,tl*}'l6Dly t51lur'?f�9 of# pK," , eurSMcI, iiou ` �9agsa�fL� Sscile.�ulif�iaE;G�'��. A , s _ F *NC 43''ziiart C' 3unsd+� Rtr t �d> C� K{ t�tlt s,rci fi�i £�r,sr 3g ii►"d tine vidid rof tsi 9tult iat rt a sa+rt' etch impps3 #41ENT a� TRACTO6t i f ��►e�a pEr to 4 t;+r:i Bo I l u ks `a rs ilk ,;hb if04 P1���:_� �£�1� �'301 usetts fib Contra ,t r cais'fr tfoil. 1_112a09 T SOLAR ROBERT CHEW 1 Z`B'L R N l0E- 8RISTOI=, RI 028G9 i �F:s._ may• ...,w 9; rl�: cldr d rdlrts zAH;L}aek rtu-50tr ft?r-09u0u • � 'x,+�t�sFss ��" i�ai�r►°�(;_ � �it►3a�t'�vercat- � !` :�.5t.�'�'d _ 3 a INVERTER SPECIFICATIONS PVl 3000 I PVl 4000 Pvt 5000 ( Pvt 5300 �INDUSTRYLEADING FEATURES Input CContinuous Power @240 VAC 3050Ud 4100W 5150W 5575W -_ @208 VAC 284OW 3580VV 452OW 484OW •Highest efficiency tranformer Recommended Max.PV @240 VAC 360OW 490OW 6200W 670OW isolated inverters in the Array Power,STC Rating @208 VAC 340OW 4300W 5400W 5800VV MPPT Voltage Range 20OV-550 VDC 200V-550 VDC 20OV-550 VDC 200V-550 VDC industry, 96% CEC, full line! Maximum Input Voltage 600 VDC 600 VDC 600 VDC i 600 VDC Strike Voltage 235 VDC 235 VDC 235 VDC 235 VDC Maximum Input Current 16 A I 20 A 25 A 25 A •Fuly integrated with DC Maximum Short Circuit Current 24 A 24 A 30 A 30 A disconnect, 3 or 4 fuse 'Fused Inputs 3 4 4 4 combiner and detachable DC Output wiring box. Continuous Power @240 VAC 290OW 390OW 4900VV I 5300W 208 VAC 2700W i 3400W 430OW 4600W i Voltage Range @240 VAC 212-264 VAC 212-264 VAC 212-264 VAC 212-264 VAC *Widest DC voltage range, 208 VAC 184-228 VAC 184-228 VAC 184-228 VAC 184-228 VAC 200-600 VDC. Frequency 60Rz 60Hz 60Hz 60117- Ran e:59.3-60.51-1z Range:59.3-60.5Hz Rangy 59.3-60.51-Iz I Range:59.3-60.5Hz 'Continuous Current f 3 A 16.3 A - 20.7 A 22.1 A -Easy installation with low Output Current Protection Required 20 A 25 A 30 A 30 A Max.Backfeed Current 0 A l 0 A 0 A , 0 A weight (47-60 lb)with quick- Power Factor Utility,>99% i Utility.>99% Utility.>99% Utility,>99%HD ----- <3% _� <3% , <3% <3%— mount bracket feature, and Efficiency Peak @240 VAC 96.7 96.7 96.7 96.6 universal.240/208 VAC @208 VAC 96.4 ; 96.5 96.4 96.3 operation. EC Efficiency @240 VAC 96.0 96.0 96.0 96.0 @208 VAC 95.5 '' 95.5 96.0 95-5 -High reliability, 10 year General warranty and certification to Enclosure Rainproof,NEMA 3R latest UL 174•I/IEEE1547. Housing Material Painted aluminum Ambient Temperature Range -25°C to+55`C Doling Convection Convection and fan assist *Free PC Software and both Weight 47 lb(21.4 kg) 1 48 lb(21.8 kg) 58.5lb(26.6 kg) I 60lb(27.4 kg) , RS232&485 communication Size(L x W x H) 29.75 in x 17.75 in x 6.75 in 29-75 in x 17.75 in x 8,27 in (741 mm x 454mm x 175mm) (741 mm x 454mm x 210mm) ports Wire Sizes 12 to 6 AWG input and output connections andards UL1741AEEE1547,IEEE1547.1,ANS162.41.2.FCC part 15 B Warranty 10 years standard •Solectria or Fat Spaniel- Inverter-Direct Internet, and/or Fused PV Combiner 600 VDC , Detachable revenue-grade monitoring 4 fuses Disconnect Wiring Box options available.Also compatible with Energy Recommerce, Draker,and ` - others. *Optional integrated panel _ assemblies with kWh meter and/or AC disconnect. M. _: - - - - _ SOLECTRIA - - :WWC1i9WABLES Lawrence, Massachusetts _ - USA o , r Ph:�978.683.9700 (MA} -- Ph: 562.608.8913 (CM -u - - - Faz: 978.683.9702 GFDI Fuse RS232/485 interfaces inverters@solren.com " DC Connections. AC Connection WWW.Solren.com e.r M Us .;: RAN I L QUALITY HARDWARE FOR THE PV INDUSTRY r , The POWER RAIL"'PV module lllounti p,-C�ng - - module mount designed for paralkd4o4vW arrays. The POWER = RAIL7°'extrusion is 6M TS shwWral aluminum. The lief-Clamps and End-Clamps are Type 304 aftinless SISSL Sbndar�d Mounting Feet Bra SM402 ahmminum. All hardware is •steel. -71 r - ¢. e ' S y 4 iPower Rail-End View_-- Standard�i Foot a jr Power-Post with (Mo&ft 3Z afto OVS&V UffkM) Power Rail Bracket i � x x .'4as w 9 a - s x R. b am_04a lr � . WIF E 9 Power Rail End Clamp Power Rail Instep in Dress Poww Rail Kid-Clamp The Power Railm system is designed and warranted to withstand 125mph wind toads in an Exposure C sett when Wiled parallel to the roof and in accordance wo our design gumeum_ The mum q=betaam suppoft is W and the greeftd ails canblum Is �32'. For ft%Hd=in areas WM mmem wN q=ft up to 90rnph in im lure C SAng and snow loads not grew than 302Wsq ft a spars beween supporls of gir and a maximum cantilever of 3(r is allowable i THE NEW VALUE FRONTIER KHMERa KD MODULES SPECIFICATIONS gktx uk .° y;. T.. +y1K3� 14rt' w7 d rf i Kyocera is leading the solar industry with - the development of the most efficient and cost effective systems available. Our new and improved, larger modules feature higher output per module and maintain the three-bus bar circuitry along _ with our d.Blue solar cell technology. KD21OGX-Lf KD205GX-LP KD180GX-LP KD135GX-LP •Locking Connector Specification 21OW 205W 180W 135W 1 •Utilizes a larger,more powerful r solar cell(156mm) +5%/-5% +5%/-5% +5%/-5% +5%/-5% •Upgrades KC200GT,KC175GT and KC130GT T 600V 600V 600V 600V 26.6V 26.6V 23.6V 17.7V i 7.90A 7.71A 7.63A 7.63A Output.Cable-MC Connector 33.2V 33.2V 29.5V 22.1V Positive connector Q> 8.58A 8.36A 8.35A 8.37A ftq 15A 15A 15A - 15A i 59.1" 59.1" 52.8" 59.1" Negative connector a r 39.0" 39.0" 39.0" 26.3" p Q, 1.4" 1.4" 1.4" 1.4" �•' 40.7lbs 40.7lbs 36.3lbs 28.6lbs 20 Years 20 Years 20 Years 20 Years Locking Plug-in Locking Plug-in Locking Plug-in Locking Plug-in Connectors Connectors Connectors Connectors t - KYOCERA SOLAR,INC. c 800-223-9580 toll-free NEC 2008 Compliant 800-523-2329 fax UL 1703 Listed www.kyocerasolar.com Kyocera reserves the right to modify these specifications without notice. All specification at 25T.cell temperature,1.5 AM and 1000W/m'. t 0 2008 Kyocera Solar,Inc.All rights reserved. 0806 35'-6" chimney— B" tall o 0 -` 12t-499Qo 0 5,-4„ N pipe — 1 8 tall d- r= 0 N r7 22,-9 1 /4„ 26'-7 1 /2' Perpendicular View 180 magnetic 24 Kyocera KD 210w modules 5.04kW' — DPW mounting C� . Y 9 38 degrees SOUTH Cook, HenryolarWri hts' Scale: 3/18- = r-o- _Al Y ® Serving the Northeast Date: 10/2sios Ivldsh ee, MA Earth Frien ly Energy'" Revised: f 35'-6" 2'-0" IV 2 chimney - 6/ tall =ao I I 1.2'—4" 5'_40f `v I pipe — Y 8 tall 'q_ 0 N ' d- p 22 —9 1 4„ r7 26'-7 1 /20$ Perpendicular View 180 magnetic 24 Kyocera KD 210w modules 5.04k W — DPW mounting 38 Y g degrees SOUTH a Al Cook, Henry SolarWrightsm a Serving the Northeast Date: 10/29i08 0� Mash pee, MA ® Earth Friendly Energy Revised: ACORD CERTIFICATE OF LIABILITY INSURANCE 1/21 0 PRODUCER (860)928-7771 FAX: (860)928-7144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. Gerardi Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 Pomfret St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Putnam CT 06260 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Acadia Insurance Co 31325 Alteris Renewables Inc INSURER B: 17 Burnside Street INSURER C: INSURER D: Bristol RI 02809 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN 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. AG REGATE LIMIT SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR SR TYPE OF INSURANCE POLICY NUMBER POLICY (MWDDIYY) DATE MWDD POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES RENTED $ 100,000 A CLAIMS MADE ❑X OCCUR CPP0241356 2/1/2009 2/1/2010 MEDEXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY JECT LOC . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Ea accident) A ALL OWNED AUTOS CAP0241357 (CT & RI) 2/1/2009 2/1/2010 BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS MAA0249941 (HA Auto) 2/1/2009 2/1/2010 BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ A DEDUCTIBLE CUA0241359 2/1/2009 2/1/2010 $ RETENTION $ A WORKERS COMPENSATION AND WC STATU- TER LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? WCA0241358 2/1/2009 2/1/2010 E.L.DISEASE-EA EMPLOYEE,$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT Is 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Alteris Renewables Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 17 Burnside St 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Bristol, RI 02809 _ FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Matthew Desaulnier ACORD 25(2001108) ©ACORD CORPORATION 1988 IWcnIC—no,no., Gano,rd9 eb 06 09 02:57p p.1 HARNs FABLE alteris20R FE 3 p M 3 v RENEWABLES �G Alteris Renewables Inc. a�rst SolarWorks / SolarWrights Company Credit Sheet www.attedsinc.com Business: Alteris Renewable Inc. (SolarWorks / SolarWrights), is the leading renewable energy company that designs, installs and services renewable energy equipment throughout the Northeast. The company installs Solar Photovoltaic, thermal and wind turbines on a residential and commercial level Both companies were recently (September and October 2008, respectively) purchased by a common investor Riverside Partners (60%). Combined, SolarWorks and Solar Wrights will leverage more than 30 years of renewable energy expertise and a seasoned staff of 110 employees to provide a full spectrum of sales, service and support to residential and commercial customers in the Northeast. With over 2,000 combined installations, the new entity has the experience and logistical capabilities to deliver quality solar electric, solar thermal and wind installations from large commercial projects to smaller residential customers. Corporate Headquarters 523 Danbury Road Wilton, CT 06897 Tel: (203) 762-8921 Web: www,alterisinc.com Corporate Finance and Accounting (Billing): 17 Burnside Street/Bristol, Rhode Island 02809 P: (401) 396-9901 /F: (401) 633-6714 • Tax ID#26-3503699- (A Delaware Corp) C-Corp, ` • Duns#829-329-216 Alteris Renewables Inc. Duns#610-593-597 SolarWrights. Duns#360-852-354 SolarWorks • SolarWrights since 2003 as a Corporation 0 SolarWorks since 1980 as a Corporation Feb 06 09 02:57p p.2 I References: SunPower-3939 N. First Street, San Jose, CA 95134 Phone 877-786-0123 Fax 408-877-1808 (Terms net 45) Fronius USA, LLC —10421 Citation Drive, Suite 1100, Brighton, MI 48116 Phone 810-220-4414 Fax 810-220-4424 Kyocera Solar—7812 East Acoma Drive, Scottsdale,AZ 85260 Phone 480-948-8003 Fax 480-483-6432 (Terms net 60) UniRac - 1411 Broadway Blvd NE Albuquerque, NM 87102 f Phone 505-242-6411 Fax 505-242-6412 I Contacts: i Accounts Payable: Christopher Bourgeault- (401)396-9901 ext 302 cbourgeault@solarwrights.com i Officers: President Ron French 203 762-8921 President of Residential Sales Robert Chew 401-396-9901 CFO Paul Raducha 401-396-9901 COO Tim Seaman 203-210-5087 VP of Development Mark Nelson 401-641-9289 k Offices: ` • Corporate Finance and Accounting Office: 17 Burnside Street Bristol, Rhode Island 20809 -401- ? 396-9901 • Corporate Operations Office 523 Danbury Road Wilton, CT 06897 203-762-8921 • We 12 office thru out New England and in Saratoga Springs New York I Banking: Silicon Valley Bank 2221 Washington St Suite 200 Newton, MA 02462 Phone (617) 630-4158 Fax(617) 969-5478 fax Email; drodricuez(&svb.com Line of Credit of $5,000,000 i i Q ACORD CERTIFICATE OF LIABILITY INSURANCE 2i16 Zoo PRODUCER (860)928-7771. FAX: (860)928-7144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION: ONLY AND CONFERS NO RIGHTS UPON THE CERTI;�T Gerardi Insurance Services Inc �,,, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEIDOR 16 Pomfret St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . C Putnam CT 06260 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.Acadia Insurance Co 31325 Alteris Renewables Inc INSURERB: aka Solarwrights Inc & Solar Works Inc INSURERC: 17 Burnside Street INSURER D: Bristol RI 02809 INSURER E: ' RAGES 7}. v 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. AGGREGATEIM D BY PAID CLAIMS. INSR ADIYL POLICY PDT EXPIRATION TYPE OF INSURANCE POLICY NUMBER DAT (MMIDIMMMDDI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY pR E ocowencel $ 100,000 A CLAIMS MADE FiE OCCUR CPP0241356 2/1/2009 2/1/2010 MEDEXP A one rsan $ 5,000 v INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER p 0 MP p $ 2,000,000 X POLICY JECT PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB X ANYAUTO (Ea accident) $ 1,000,000 A ALL OWNED AUTOS CAP0241357 (CT & RI) 2/1/2009 2/1/2010 BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS MAA0249941 (MA Auto) 2/1/2009 2/1/2010 BODILY INJURY NON-0WNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN FAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE_ $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ A DEDUCTIBLE CUA0241359 2/1/2009 2/1/2010 $ RETENTION TH- A WORKERS COMPENSATION AND TORY WC ST MIT ER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E-L.EACH ACCIDENT $ 500,000 OFFICERiMEMBEREXCLUDED? WCA0241358 2/1/2009 2/1/2010 E.L.DISEASE-EA EMPLOYEE$ 500,0001 fl yes,describe under '— SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMB 500,600 OTHER DESCRIPTION OF OPERATIONSILOCATK)NSMEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTTSPECIAL PROVISIONS + CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Alteris Renewables Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL AKA Solarwrights & Solar Works Inc 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 17 Burnside St FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE. Bristol, RI 02809 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Matthew Desaulnier ACORD 25(2001108) ®ACORD CORPORATION 1988' INS025 p106.0ea Page I of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE ii3o%2o0 " PRODUCER (860)928-7771 FAX: (860)928-7144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gerardi Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 Pomfret St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Putnam CT 06260 INSURERS AFFORDING COVERAGE NAIC# INSURED wsURERA:Acadia Insurance 31325 Solarwrights Inc INSURER B: 17 Burnside Street INSURERC: INSURER D: Bristol RI 02809 INSURER E: OVERAGES 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. LIMITSWN MAY HAVE BEE 4 REDUCED IM . INSR D TYPE OF INSURANCE POLICY NUMBER DATE MMRXV EFFECTIVE POLITE MMIDD EXPIRATION LIMITS. GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PG DAMAISE a.R ENTE D � $ 100,000 A CLAIMS MADE aOCCUR CPP0241356 2/1/2009 2/1/2010 MEDEXP(Any oneperson) $ 5,000 PE SONALB ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS PAGG $ 2,000,000 FXI POLICYF--JjPE'cT a LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB X ANY AUTO (Ea accident) $ 1',000,000 A ALL OWNED AUTOS CAP0241357 (CT 6 RI Auto) 2/1/2009 2/1/2010 BODILY INJURY SCHEDULED AUTOS (Per parson) $ HIREDAUTOS MAA0249941 (OIA Auto) 2/1/2009 2/1/2010 BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EA A $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY $ 5,000,000 OCCUR CLAIMS MADE AGGREGATE $ A DEDUCTIBLE CUA0241359 2/1/2009 2/1/2010 $ RETENTION TH- A WORKERS COMPENSATION AND WDRYC LIMITS I 0IR EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERMIEMBEREXCLUDED? WCA0241358 2/1/2009 2/1/2010 E.L.DISEASE-EA EMPLOYEE$ 500,000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONsILOCATK)NW4EMCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Solarwrights Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 17 Burnside St 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Bristol, RI 02809 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUREK ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE M Desaulnier CIC CPCU ACORD 26(2001108) ©ACORD CORPORATION 1988 INS026(ol o8).o8a Page I or 2 Assessor's map and lot number ...................... ... ............ SEPTIC SYSTEM MUST SE °`T►+e ` -ASTALLED IN COMPLIANCE Sewage Permit .number .......: ........oV�1 WITH TITLE 5 >; 11AUSTAXIS, 3 House number . l ..'....: ...................................:...... : ENVIRONMENTAL CODE AND900 "639 TOWN REGULATIONS TOWN OF BARNSTABLE BUILDINGgNSPECTOR C 2G" Sal �. P 6'rrr APPLICATION FOR PERMIT TO .116^f:..�....�...� ..........�.....��"/�..3'�+4.+,tot�...............7.f�D.'�l.�P TYPE OF CONSTRUCTION ...&00.11dllZ.k.414....PW- r[!.-F0, kll�!!',G'7l d... %/�'......................................... ............ ... ...............................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to/tthe follow�i►ng information: Location ...��Z �e W is Q..I d �0. 4 C o7gU ................ . ........�............................................ .............................. Proposed Use v ..S CC/ �YS �.�...aYnPIZ.,I;%Ol/5.............................................................................. Zoning District .......... � . '`-...Fire District r / ......1.......y..................n:.................... ............. Q.......................................................... p. �............................. �.+ ........... Name of Owner l.� Y �' ° /�Yy.A.:l..:.( OO ..........Address �5{.�-1. .� .... �r.vl. . Name of Builder ,- , .Y.;���!!...51.(./! ...!5r ..............Addres's Nameof Architect ........... ...................................................Address .................................................................................... Number of Rooms ........Q/7..e.............................................Foundation /D...N!all5. ..4!P;......e./..k!..9 Exterior .......7. Roofing ,-keF .... .............. ........ . .. . ...Roo Floors ..........................Interior .................................................................................... ........ /3'I.y..—...................................... Heating ..!`A5/ Y!c .........................Plumbing N Fireplace ..................................................................................Approximate. Cost ..... .(�. ."..".....:................. Definitive Plan Approved by Planning Board ________________________________19_______. Area ..,.. ......................�......... Diagram of Lot and Building with Dimensions Fee ........./ `�� .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bornstab regarding the above construction. Name ................................. .. :r ....... ........................... Construction Supervisor's License ..... OOK, HENRY E. & MARY M. A 3 No .. ..7..6.... Permit for ADDITION............... Single Family .9 Dwellin ...................................................... ...................... Location .......168...............Lewis......P.. ..o.nd........ .R.o.ad.................... Cotuit ............................................................................... Owner ........ Y. M. Cook ......................... Type of Construction ..Fram.e.............................. ..................... ........................................................... Plot ............................ Lot ... ................. .......... December 5, 85 Permit Granted ....................................19 Date.of Inspection ,........... .................19 Date Completed ......... al P Wet 1s - oFn+� Town of Barnstable *Permit# l7 Expires 6 mo hs from issue date O P ( Regulatory Services Fee • uctxsrnsRE. • J p` 16 2015 Richard V.Scali,Director N OF BARNSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number O 20-/oQ � Not Valid without Red X-Press Imprint Q � CA Property Address ( Gz ( t_-- �91 S T clo lb )� ©'Residential Value of Work$ ���•� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �TM�C`-tJ R C30 LL Contractor's Name Telephone Number �03 Z7+-1 JG(=O Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ED�V®rknian's Compensation Insurance Check one: ❑ I Wn a sole proprietor RI-am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ 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) 9'Ve-side ❑ Replacement Windows/doors/sliders.U-Value (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 ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,.Conservation,etc. ***Note: Property Owne must sign Property Owner Letter of Permission. A copy oft a ome Impro emen on ctors License&Construction Supervisors License is required. SIGNATURE: C:\Users\DecollikWppData\Local\Micros \Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services ofTMe Richard V.Scali,Director Building Division RAWS'^ELK ` Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: � Z f(`� 2d I�j p �j�.�T, JOB LOCATION: �O� L�^Z.]C rj 1 a.J� V-� T y num-7beerr� �sttrtre�`ett '7 //� village "HOMEOWNER": 6 t c V&� COOK- 6— Z`4-1 166 name ^� n home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as su ervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. TheAundeiomeo her" erti that he/she understands the Town of Barnstable Building Department minimum inspection prouir n d t e/she will comply with said procedures and requirements. Signat#eofHomeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\Decollik\AppData\Local\Microso8\Windows\Temporary Internet Files\Content.Outlook\2PI01DHR\EXPRESS.doc Revised 040215 Ile Commomvealth of Massachusetts Depm hnewt of Industb'ial Acciden& - Office of Investigations 600 Washington Street Boston,MA 021II iPmv mass gov1dra ` Workers' Compensation.Insurance Affidavit-BmldersiContractors/EIect imnsd%mbers Applicant Inform:atiun —- p Please Print I.et=IblY Nat=(Busiaento Address: . 43 SR-ew5Ta�.2 Ci /state t� I"l/} OZlo Phone: Are you an employer?Check the appropriate box: T f 3'l?e o pro]ect(required),' rspurred): , 1.❑ I am a employes m ith 4. ❑I am a general contractor and I ❑New cotrsfrucEion employees(full andfor part-fiime).* due hired the sub-contractors 6. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling T ship and have no employees. These mb-contractors have g. ❑,Demolition ' working for me in any capacity- employees and hate workers' LNo 'oomp "insutance .. comp_snsuranmi 9. ❑Building addition 14.❑Electrical repairs or actions5. We area oration and it's officers have exercised their 3. am a homeowner doing all work11_❑Plumbingrepairs or additions ' myself[No work s'comp- right of exemption per MGL inc c.152, 1/ and we have insurance fet�,ifed,�� � L� no employees.[No workers' 13-00ther2Lfh 14>1 N6 comp-insurance required- "Any appKca�that checks box ftl east alai fM out the section below sbaving their wadseie compeasafwn policy infbrmstiao- I Homeowners who submit this affidavit iadicatmg they axe doing all Waal and then lairs ou de cantractars mast submit a new affidavit indicating sack Cent actors that eh-lr this bast-=atumbed as additional sheet shoving the name of the and state whether or not fhnse enftk s base emplayees.Ifthe sub-contactors haveeanployee_%d3eym tscpmuidetheir workeoV comp.porky number. I a m an emplvper tlratisprowzdhW workers'compensation insurance for my empLayem Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie-4 Expiration Date: Job Site Address: bEwls Wbo � City/state/zip rot /-W !3 Zp� 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 a l52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and.rar one-pear imprisonment,as well as chril penalties.in the fozm of a STOP WORK ORDER and a Ene of up to$250.D0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of .. Investigations of the DIA E5 i#urance-coven I do hereby certify under s and fp that fit e information pratRded above is bue and correct Sitmsture. Bate Phone Of rcial use only: Do not wrke in this area,to be completed by city or town official. City or Town: PermitUcense# Issuing Authority(tdrde one): 1.Board of Health 2.Building Department 3.ptylrown perk d.Electrical Inspector S.Plumbing Inspector ` 6.Other. Contact Person: Phone#: Information and lastruefions m Massachusetts General Laws chapter 152 requnes all employers to provide workers'compensation for their employees. Pursnantto this st 3tute,an OnPIvyee is defined as."_.every person in the service of another under any contact of hire, express or implied,oral or An e npjayer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,andmchidmg the legal representatives of a deceased employer,or the receiver or trustee of E.individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of tine - dwPTTmg house of anofher who employs persons to do make,constuc i on or repair work on such dwaRiag house or on the grounds or braiding appMt=zrt 1heret o shall notbecanse of such employment be deemed to be an employer." MGL chapter 152 §25C(6)also sites that"every state or local Hcen m agency shall withhold the issuance or renewal of a license or permit to operate'a-bnskess or to consiruct bnrldIIrgs in the commonwealth for airy applicant who has not produced acceptable evidence of.cumpl mce With tim incvrance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neifizer file commumwealth nor any of its political subdivisions shall ente into any coatrart for the pmfmmance ofpublic work until acceptable evidence of compliance with the msurar,ce r . requirements of this rhapt!X have been presented to the contracting auffioaty." Applicants Please fill out the workers'compensation affidavit completely,by checking tire boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(m)and phone,number(s)along with their cm ihcate(s)of n,srn-as,ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not r6quimd to cant'workers' compensation insurance If an LLC or LLP does have employees,apolicyisregnired. Be advised that this affidavit maybe su_bmitti--dto the DepartmentofIndustrial Accidents for confirmation of insurmce coverage. Also be sure to sign and date-ire affidavit. The affidavit should ,3 be rvt mmed to the-city or town that the.application for fire permit or license is being requested,not the Department of Industrial Accidents.,ts., %ould you.have any gnestions regarding the law or ifyou are r-,q=ed to obtam a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-ice license number on the appropriate line. City or Town Offitcials f - Please be sure that the affidavit is complete and prod legibly- '1he Department has provided a space at the bottom of the affidavit for you in fill out in the event the,Office of investigations has to contact You regarding the applicant Pleas e b e sure to Ell in the permit/licemse n=ubeu which will be used as a reference number. In addition,an applicant that must submit multiple pennitll c;=se appli-cations in any given year,need only submit one affidavit indicating crn-ent policy in.6rn.ation(if necessary)and under"lob Site Address"the applicant should write"all locations in (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or tows maybe provided to the ' applicant as prooft o t a valid affidavit is on file for formic permi s or licenses_ A new_affidavit must be filled oft each year.-Where a home.ownes.or,citizen is obtaining a license or pennitnot.related to any business or commercial ve niru e (Le. a dog license or pemdt to btun leaves etc.)said person is NOT regnied to complete this affidavit The Office of Investig?dions would hke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephoue and fax M=bm-. 1�e Cain f of I�assachn tt ;; .... .. Department of 1udutzial AAcbZents duce of jtveyu,�tio ,~ Ba ton,MA tl 11 Tf,-L 4 617 727-49QO Qxt 4€16 cr 1-V7-hLkSSAFE Fax 9 617` 27-7749 Revised 424-Q7 maz_gavIdia , Assessor's map and lot number ' QUO%TH E TOE Sewage Permit number ............................... ... ............... } Z BARNSTABLE, i House number .......)_�..a( 1-..................I......... so NAea Oo,i639•TOWN OF - BARNSTABLE .����- i9 BUILDIW,G INSPECTOR j,rlP �j. APPLICATION FOR PERMIT TO .,�".):':.,..f."./....�-..�..�':r�...�`�...........�?°......� j,,. ........................�?...�:✓.'...� TYPE OF CONSTRUCTION ... /,,:,.1*.f.1.?.f44.7 ....... . ll ..rit°x , pe.,l r.11...................... ov...... ,.................... ............19......... TO THE INSPECTOR OF BUILDINGS: a TIle undersigned hereby applies for a permit according to thefollowing information: SYn. Lo ation . .�� ! .. a .F ..... .! ....1..1 r?' ........C,.....��...1 ....................................... ................................... Proposed Use ... �'' �' '"'?��?�' ,. . .. (?Y �ni.'A!,�Ae�s<.`.......................................... .................................. W Zoning District ........ ti ...............................................................Fire District .......... .� .................................� ........... .. Name of Owner1k Y ��:..f�>/��Ky.��'..`..8"�!� ..........Address�#� �}�!'�p��.�../..t'�,�.r,.;!:..��.�' ���.. l: /,.�:�1�... Name of Builder !....Zy,..............Address/...-/"�`/`�:t`/:./Po yfl, Name of Architect Address .........................................................:.......................... Number of Rooms ....... ..e.............................................Foundation A� W.1..c//=; ..'. .,, :f! r✓ ................................. Exterior r . ...................................................................Roofing ......t?'. =. ..,.....................................,........................ Floors ..............,.. .... .............................. ...'.......................'Interior;' ..........::..........,............................................................. Heating f .. r .................................... Plumbing ....... c - Fireplace �...'................................................... ...................Approximate Cost ./...`/..r�... .................................�..... .,. ..... .... Definitive Plan Approved by Planning Board ________________________________19-------- . Area .....,.............!.......... I. ....... 0 4 , Diagram of Lot and Building with Dimensions Fee - ............................................. SUBJECT'TO AP R�VAL OF- BOARD OF HEALTH f ,�F 4 . tf `: �yy.�� 77YfjJf OCCUPANCY PERMITS REQUIRE FORNEW DWELLINGS I hereby agree to conform to djII the Rules and Regulations of the Town of Barnstabne regarding the above construction. w ' �.. Name :............ Construction Supervisor's License ......... j COOK, HENRY E. & MARY M. A=20-7 No ..28736.... Permit for .,ADDITION ................ Single Family Dwelling ............................................................................... i Location 168 Lewis Pond Road ................................................................ Cotuit ............................................................................... Owner Hanry E. & Mary M. Cook .... ......... ... Type of Construction ..Frame ..................... ................................................................................ Plot .................... .. .... Lot .............................. Permit Granted ....December 5, 85 ~ .......I...........................19 Date of Inspection ......................19 x Date Completed ................:.....................19 v 74 PC-"a,I r �: . .. ' /J� •//mil � - ii Ba L o T- /O Q _� y a t ' U i I � j 04 Ef ' O � �W151 L OA ............ ............................................ i mow , 1 �J A--,r n' CK IT e . R. C. e rit , SOUTH CK :► JiGI jr'RLJr.M - L i '. � ,4 �Y� I �¢l-A•� / '_ Gam/ �v✓��� /V�1 -.i w«... . ....r.. ..... ... .ter . ..-.o.. ...e. ,..,._ { t