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0182 TROUT BROOK ROAD
Town of Barnstable �P aAa 200 Main Street, Hyam is MA 02601 508-862-4038 s �. ' Application for ]Building Permit 4 Application No: TB-17-1957 Date Recieved: ' 6/21/2017 Job Location: 182 TROUT BROOK ROAD,COTUIT Permit For: Building-Insulation-Residential Contractor's Name: Craig Bishop State Lic. No: CS-109777 Address: Sandwich, MA, 02563 Applicant Phone: (774)205-2001 (Home)Owner's Name: PETERSON,LISA$TR Phone; (508)728-1301 (Home)Owner's Address: 182 TROUT BROOK ROAD, COTUIT,MA 02635 Work Description: Weatherization&air sealing Total Value Of Work To Be Performed: $3,987.00 cn a _ ca e-- Structure Size: #0.00 0.00 0.001 rn Width Depth Total Area P I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. ; I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have-` been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. fi Signed: Craig Bishop 6/21/2017- (774)205-2001 Applicant Date _ Telephone No. Estimated Construction Costs/Permit Fees } Total Project Cost; $3,987.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 Total Permit Fee Paid: i $0.00 Y f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma U d Parcel C>•, Y Application I Health Division atilt Date Issued �.lNG D Conservation Division EpT Application Fee Planning Dept.' SEP 01 - Permit'Fee Date Definitive Plan Approved by Planning Na f U Historic.- OKH _ Preservation / Hyannis �STggLF - Project Street Address K oa d• Village C64-(A',Owner L ,Sca P���r �Ow Address ( �a ray,-i' 6�o�dt K6,J Telephone S Q 7,2 2 001 01 Permit Request �v� �� �(s-Ko� O� 13 �, a��we.+-t o �1�� a� rear od 1u:►W�NX V a L1s�� - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a1 � � Construction Type So Lot Size Grandfathered: ❑Yes ' ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure j 7 7S Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) II Name e--A !ol ��---�, Telephone Number Address ." �11 coo License# C) W C1 a cA h^a d a S"34_ Home Improvement Contractor# Email I n $�t6rr� 5 zv���, ��- ' Worker's Compensation # �® J'�1� ??OSO- - Ic� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE r /b FOR OFFICIAL USE ONLY APPLICATION # _`DATE ISSUED k MAP/ PARCEL NO. ADDRESS VILLAGE t OWNER DATE OF INSPECTION: ;. FOUNDATION " FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING .y DATE CLOSED OUT ' ASSOCIATION PLAN NO. F Grid Tied Photovoltaic System DC Rating 12.255kW Lisa Peterson 182 Trout Brook Road Cotuit Ma 02635 Site Details: All Work To be in Compliance with: Solar Rising shall install a 12.255 kW grid-tied 2014 National Electrical Code (NEC) Photovoltaic system comprised of(43) LG 285 N1C-A3 2009 International Residentail Code (IRC) Modules with (43) Enphase Energy M250-60-2LL Micro- 2009 International Building Code (IBC) Inverters. The Modules will be flush mounted to the Asphalt 2012 International Fire Code (IFC) roof. MA 780 CMR 8t" Edition ASCE/ANSI 7-05 Minimum Design Loads for Buildings and other Structures. Equipment Specifications: Modules: (43) LG Solar 285N1 C-A3 Inverters: (43) Enphase Energy M250-60-2LL N w Racking: Unirac Solar Mount * Attachments: EcoFasten Flashing with 4" Stainless Steel Lag Bolts Roof Specifications: Roof Structure +r` Asphalt 2X12 Rafters 16" O/C Pitch: 350 Azimuth: 2600 Site Specifications: Occupancy: ll Design Wind Speed: 110 MPH Mean Roof Height: 22ft Ground-Snow Load: 35-PSF-- Solar Rising LLC - Project: Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 182 Trout Brook Road Revision: 8/26/16 � g 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 Cotult, Ma 02635 Drawn By: Neal Holmgren I 1 I _ _ f -Quantity of attachments = 80 @ 48" O.C. -Maximum UniRac Rail span = 48"O.C. -Maximum Allowable Cantilever= 16" -Racking and Attachment: UniRac Solar Mount with -lag screw, Hex Head, 18-8 SS 5/16" x 4" Length -Array Installed According to the UniRac Solar Mount Code-Compliant Installation Manual. Solar Rising LLC Project. Lisa Peterson Solar Rising Building Pennit Plan Solar rout Brook Road 508-744-6284 182 Trout Rd Revision: 8/26/16 2 S i 9 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 COtu It, Ma 02635 Drawn By: Neal Holmgren 16 Species Spaute't�tnB-FeC i�.a� Size 2X12 Grade too, 2 Member Trope ttafters(saaa Load) }y Deflection Limit 7180 7 sct-tice cundiiians2�� Nm . _ V F-tui., zpasam -., _._ ...,,.. .. incised lumber' NO l y ' FT. SoOt�Load(psf) 13S f head 4oad(p#1). k0 � i�� The MEminium Horizontal.Span.is 20 ft. 2 in. Nvitlf a ini.niinum bearhig length of 0.95 in. required al each end of the member.. 2x 1 0 l'r®pe_ fY valaae - , Size 1202 j '[Modufm 4f Elaeuch ( ]460000 psi Bending Strength(F'b) �1tY5719psi i Be mg.Strength(P� +E?5 psi _ F!_ Shcaa Strength fFtt a fss.2Spss . Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 182 Trout Brook Road Revision: 8/26/16 2 s 9 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 COtult, Ma 02635 Drawn By: Neal Holmgren ' }. GreenFasten"GFt—Product Gulde Cut Sheets:GFt-L 8 P E `.. `Y �A 14, ,i m e fixer r` SECTION A-A 1 { Camm ttM — --- A71-A533A4] _torte SW pon ofkMnwble Energy 6EadaCM Star:All ttnttnt yaecred�mdMw�+tpht.All right resme1.10;17/13 3.1 Solar Modules to be flush mounted to existing roof structure and set above shingles 4" Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plans Sola)� Mashpee,508-744-6284 182 Trout Brook Road Revision: 8/26/16 759 Falmouth Rd Unlit 8 Scale: None Ma 02649 Cotuit, Ma 02635 A Grid Tied Photovoltaic System DC Rating 12.255kW Lisa Peterson 182 Trout Brook Road Cotuit, Ma 02635 Site Details: All Work To be in Compliance with: Solar Rising shall install a 12.255 kW grid-tied 2014 National Electrical Code (NEC) Photovoltaic system comprised of(43) LG 285 N1C-A3 2009 International Residentail Code (IRC) Modules with (43) Enphase Energy M250-60-2LL Micro- 2009 International Building Code (IBC) Inverters. The Modules will be flush mounted to the Asphalt 2012 International Fire Code (IFC) roof. MA 780 CMR 8` Edition ASCE/ANSI 7-05 Minimum Design Loads for Buildings and other Structures. Equipment Specifications: Modules: (43) LG Solar 285N1 C-A3 Inverters: (43) Enphase Energy M250-60-2LL Racking: Unirac Solar Mount Attachments: EcoFasten Flashing with 4" Stainless Steel Lag Bolts Roof Specifications: Roof Structure Asphalt 2X12 Rafters 16" O/C .. Pitch: 35' Azimuth: 260' Site Specifications: Occupancy: II Design Wind Speed: 110 MPH Mean Roof Height: 22ft Ground Snow Load: 35 PSF Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 182 Trout Brook Rd Revision: 8/26/16 759 Falmouth Rd Unit 8 Scale: None � � S � " �� rou roo Road Mash pee, Ma 02649 p Cotult, Ma 02635 Drawn By: Neal Holmgren - r 1' ;r i G C I ffr -Quantity of attachments = 80 @ 48" O.C. -Maximum UniRac Rail span = 48"O.C. -Maximum Allowable Cantilever= 16" -Racking and Attachment- UniRac Solar Mount with -lag screw, Hex Head, 18-8 SS 5/16" x 4" Length -Array Installed According to the UniRac Solar Mount Code-Compliant Installation Manual. Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plan Solar rout Brook Road 508-744-6284 182 Trout Rd Revision: 8/26/16 S i i � 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 COtUit, Ma 02635 Drawn By: Neal Holmgren Species Sp--=-tine FPas q Sipe Z%!2 trade No, a Member Tigre ttafters(Srnota toad) Deflection Limit, L�r180 %.v1 Spaefng(in)If 16 Wet scr%icc.conditions' Exterior Exposure N; '" ^7 " I tnci ed lumber No + Snow Load(psf) 35 Dead Emad(psf to The M-aximum 1 orizontal Span:.is; 20 ft. 2 in. with a m4iiinum bearitia length of 0.95;in, required at each end of the member. 2x 1 piropearty ltte l�Spccnrs ?Spa�cc-pemc-C°it Grade No,! Size 12--12 i Modulus ofElasddty(E} 1140000opsi jBen&oM Sueasgth(Fb) i 1257 t9 psi 1', B,miug Strength(,Fq z5 p51. . She 3r Strength TO �g135 2S psi A, --- - - Solar Rising LLC Project. Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 . 182 Trout Brook Road Revision: 8/26/16 s i 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 COtU It, Ma 02635 Drawn By: Neal Holmgren r. + T Greeffasten"GH—Product Guide Cut Sheets:GF1-L A " 4 ji. ra — _— Y 1 5 $ a: SECTION A-A �t Bn.859-33.17 Com-W to de 5i po of 0.en ble Eremy OE¢Easm 5O&AA contea pm.dimd^ M,{ phl All rgh— ei 10MA3 37 Solar Modules to be flush mounted to existing roof structure and set above shingles 4" Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 182 Trout Brook Road Revision: 8/26/16 2 759 Falmouth Rd Unit 8 Scale: None S Mashpee, Ma 02649 Cotult, Ma 02635 - The Commonwealth of Massachusetts Department of Industrial Accidents 1 Con;ress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED 1,k ITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leaihly Name(Business/OrganizatiurAndividual): Solar Rising LLC Address: 759 Falmouth Road Unit 8 City/State/Zip: Mashpee MA 02649 Phone 9 508 744 6284 Are you an employer?Check the appropriate box: Type of project required)' 4 1 I am a employer with employees(full and/or part-time)• 7 ❑ New construction 2❑l am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity [No workers'comp insurance required J 9 El Demolition 3❑I am a homeowner doing all work myself[Nu workers'comp.insurance required,J' 4❑1 am a homeowner and will be hiring contractors to conduct all work on my property I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑ Electrical repairs or additions proprietors with no employees 12 ❑Plumbing repairs or additions 5 711 am a general contractor and I have hired the sub-contractors listed on the attached sheet. [j []Roof repairs These sub-contractors have employees and have workers'cump insurance 6❑We are a corporation and its officers have exercised their right of exemption per MGI,c 14 [a Other Solar 152,§1(4),and we have no employees.[No workers'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 /ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information- Insurance Company Name. Travelers Indemnity Company Policy#or Self-ins. Lic.#r U13-513677050-15 Expiration Date: 11/02/16 Job Site Address 19a I'k,+b`A)ti Y J City/State/Zip coke f Attach a copy of the workers'compensation 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. l do hereby ce ' under the pains and penalties of perjury that the information provided above is true and correct Si nature. Date 11/02/15 Phone 9 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License 4 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 4: a Office of Consumer Affairs nd Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImprovemM.t Contractor Registration Registration: 175578 Type: Supplement Card 17 �"-^: 1:__-_ -; Expiration: 5/28/2018 SOLAR RISING LLC. NEAL HOLMGREN 759 FALMOUTH RD UNIT 8 MASHPEE, MA 02649 Update Address and return card.Mark reason for change. SCA 1 0 20M-05m ❑ Address ❑ Renewal ❑ Employment Lost Card `-� ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only (� OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - — Office of Consumer Affairs and Business Regulation - , Registration: 175578 Type: 10 Park Plaza-Suite 5170 Expiration: 5/28/2018 Supplement Card Boston,MA 02116 SOLAR RISING LLC. NEAL HOLMGREN 759 FALMOUTH RD UNIT 8 K��:r z-s •5 ---- MASHPEE,MA 02649 Undersecretary Not valid without signature ®S Massachusetts Department of Public Safety p Board of Building Regulations and Standards License: CS-088921 Construction Supervisor NEAL F HOLMGREN 75 SPRING HILL RD ; EAST SANDWICH M i ,0 1(--I Expiration: Commissioner 09/18/2017 LG Life's Good Mono ,x-, N eON LG300NIC-A3 •0 LG Ekctrcrsio5 Inc Korea Exchange:06657.KSP SOON is one ofthe globallyearing companies and tectsndogy ininnovatorfor electronic;nfuarmatton and communication products.LG Ekctronia ar*endyempioys more than 911300 people worldvade in 117 companies,to fiscal year 2011 a tuirnouer oaf48,47 billion LISrD has been achiewd ��■■ LG is one of the vvo dds larwst manJacturers of mobile phones,flat screen TVs;air conditioners, ■ washing machines arsd refro"tim As a futum- oriented company,LG relies on the tectsnobgy of renewable energies and is expanok-rg it The entire range of high quaky sw`ar pnoducis are being manufactured in L.G•s leadling produchon site Korea. INN ovE c(Dus C E r AZLE Iry�• LG s High Efficient Cell Technology Reliable Wwranties Driven by LG's own k-Type techrsobgy,LLY high- L•_stands by its products with the strength of a efficiencymaduleswwNpivedecuslomerswithhigh global;rxporatianandsterfingwarrarstyRolicies. economic benefas. Together with a 10 year product warranty a 2s year linear performance warranty is offered. 100%EL Test Complewd Ptasitive Power Tolerance =3 All LG modules are+.ested at aanwsstages of the LG pr,vdt;rigorous quality tasting to solar modules »s production by Electrolu manescence inspection.The to assure customers of the stated payer outptz EL inspection detects cracks unseen by the raked of all modules wrth a Wrhye nominal tolerance eye v surtJn3 a!D%. Light and Robust p p Convenient Insulation iYrth a weight of lust 16,8 kg,LG modules are Ls,modules are c ardu ily designed to help installers proven to demonstrate outstanding durability benefit rrom quick and easy insulations few owghout ar?airtstexternal e-sureu w54MPa. Tarr grounding,and es of Pr-- P� f►u9.9r rsdng, stag m duies. ti x r am k X, ✓ ,a^'fi'-.a 2.; a '�� " •s R "�, ;s;;; r,"�,�Ftxk�''�r'.neutrxr 4„5•, y � ��� �`�.•'�_ ra n, MKhWik2 FkopenieS 01 9ectOcatftpeifi3ffCj cabs a be Boy 30DW M1't tow 2R&W natcdm 1� ........... ---------•-----------•- ------•--------------• Pd�r„>en aw�VmmaQVdp 3w 2- zm zM E1:t Mmux�¢taq,,,n PEPPwha btr,p}►1ti'1 33t1 312 312 31.6 dimnnsians: 15+Tix l�G mn[' --•--•... ...........•.......... ......... .... ................ 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UNIRAC40=01ts SOTa/C:10,91eb0136aE1e0;MM1C,NZ1SG- End Caaul meaarfaf:one oft,_,,rfowhg.eru+Wed 8h7rNauirn Assemble adR one."ASTM F.583 b�.One W-20 ASTM F694 Urrim:8lbSTS 810ST5,eld: 5 - ' serraed Rage nui,and ono YNtat washor Uttlmam totrsfto 361d.Ymltl 35 kid • U�eanleetreeMt)atceniotORbsofbt+ya � ff&dsh:Cl&x rOa*Arredzod ',�a f t+bsls44tg,felon arW safety,fades am datarrttNed aomidbg m �� l End ctlrlgo we1gM:vaatn based an nelgM:-0.058 Ds(26g). pan 1 SedHn9 O,tare 200M)tmWIm Design Manual aM dre7- Saaabd'. bid Qbrxgr- Alienable anasseWlad aCOOMIng to l Qes nloads aWand�d itl�mdtdimmtrae party Isar r6sufbl loran an VAS aw6dited lab omuiy • Moduiaadgommtbefttyv4Vefedbyfhebnam y'FIge th Wws;Topmsent Me allowable and design badcapa&yd a sbgN and damp assenbiy when used wkh a SN,,MW,,Sar3aS beam for . • NOTE ON WASIWA-War washoron bot head sWde of aasamb(y: - mialna module In One direcllon indmled . 00 NOT Instant washer uMer WniM.Rangb nu Assembfa u.4h one unime%*-20 T-boR and am W-20ASTMF594 ` •.-v...••. ^-•.»•� Apyt.a L Alb aaC Average wsbh Settlr e Deatgn -ResIsta— 1 s' `,. 6 saaatad 1�11g3 nt! _- use antW-seize aM Wien to to(1ib,of sofque ob—d— U18ma1e Load Feetw. Load Fadm,. ��. f�shtarrcefadore and sltdy fadarsare detemYngd aoWdrg to .�•.•.•_..•.• IDa 00 Ibs pO FS tea ill) m . - part 1 mdiml9 d dta 2oo5mumiauslg n Oen Manual atd dill . Y ibnovn y 1566 fwe7) BBB(3052) 228• 1038(4615) 0.8% y pony tell meats from an1AS ecaadited taixtaldry Tmm ne.X1 112E(SO19) 329(1463) 3.43 497(2213) 0,441 ! Madues meal be hnSldbd at I&sl 1.56n.f um 0WWhat 6M of beam. rrrx r� 4-�» w swkvvzr' 66(292) 27(119) 2.44 ,41(181) aeu) '!•max _ rs Applied Load Ax ARbwabla Safe" Ds mftecls Dloo 8ta Lad Factor Le tatce Fader, oerarse„ioedtedbl�mwteer'Wed ...•...T-,.•......-.' E .. _ _ Fibs 00 ho04) FS Us.(NJ 0 _" -.-,. -�.wo.. fill -......- ---•-•- Ta'V- 1321{SM) St9 f2352) y,50 SOOR557)- _.ate TransN a,Z2. 63(271)) 14(81) 458 21(9211 0.330 : *- slmbg,xt 142(630) -52(2311 272 79049)1 0.555 Technical Dat. d-UNIRAC • :'UNIRAC Solarrl aunt Beams Aei!acs*Is�1ar, Pus:W.3101=,310132C8,31010C,310MC8 3101040 MONK 310208C•e.3102404-31024OC-8,310240% SolarMount Beam Connection Hardware 410144AL410MA0.410204M,41024M SDIarMDunt LFoot Part No.304MM 3040M - Vropedbo 'units Sdarmount Solarmount HD. • Lfoot maelrbt One Offhe following Wdaided ak nium alloys:6005. - T5.8105 T4 ON146 Baron Heig)d in 2.5 3.0 Ui6mate tenoita 38krA Yeakt 35 k3i A Ftnlan:Mar a Dark Pnodimd LFaol weight:vales based an hegM:-0215 ffa(98g). ADQecmllato Weight(par linearfi). ptl O.Bt1 ]17s Atldrabb and din laeds ma valid char conpor"dsae Total Cram SectionlArea in, 0.WG �7.059 - III Bea -S rmbladpdh SobAkurd eerias beams a dttg b.aW.Azod 809 L"RACdocmenls L.Feot 'FM M bwm to L.Foot Ccnnaction: Sabtdn fdodllus(X-Axis) W 0.353 IIS98 •Assara/a vviM oneAS U F593 W-161m bead sc ewerd ora Irpod ASTM F594 Weenaled fbre3e rsd Sec&an LlocUus(Y-A49) ie 41113� 0,221 �Fler9a. •WO and-saba andtolan to 30 Rbs Of blpue • Remus fakm and seW faibQa are de to.aad aom16ag to pad - . 1 section B Of#Ia 2tlp$Abniafrn Dssgn Lfawal end Itk4jurty test 7Aomer(dilerta('X�11iis) ire O.a64 f.4Jr0 Y re;tdls lom an IAS eocleditad labaratby { :. - _ = llornaet of Inertia'(Y-A.ids) in 0.044 0.287 c� NOTE:"Loada al•.giwn fro the L•Fout to baara conrodbn only;be X - a fo dwck toW finite for eta 1 m rlAlft,ag res.oro7har f dkazO ) anadilnerd-method R (11Sttati0n(%.Aria in 0:289 4.170.. >. ApDtbdtnad.- +m'eroga ., '..Safety Design ltealatence - Radial of C3yTation.(Y ):. Fro 0.25!' O::A2 h Olfaction IRt(mate Albwabla Load- Factor,. Load Factor. .. ri,• JDs W) lbo 00 FS the(it) m - x„ SIISM7t 1768(7856) 755(3356) 234. 1141(5077) 0548 TensSon,Y+ 1850(8280) 707(3144) 2E3 IM(4755) 0575 dme+mns.paeenddhtrWtesWea aoeei Ceavession..Y- 3258(14492) 1325(58M) 2A8 200t(8913) 0515 y Traverte,Xr 435(21.8Y) 213(9491 228 323(id)W l)a8i.. _�a 7„-a• „$ _ SLOT MR.T•&7LT OR L728—+� JIDt:.HE1D StCREW SiDT FqR T BOLTOR 1/s'l&7i 1FAD SCRFJV M(SOTFOP. � 'SLOT FOR —T BDTTDM.CUP 25t�: +sorm dip low. 1.3% T� FOA O � -SIOTBpLT -�� ! ' 1�•flit BUT IILIL,3H7 .Sclarubiad Beam Sdaftowd HDHeam z otnensm VedWlftkd*s ram need . 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S�$��i7TtM'�i Y �•sT. _ - TPflpikHTFfl'6 LE� `If Y1R'di, 'Ll���S3�??S; 4E, 13 �1't 7�� � any IV i MINOR E.�EGFAa� s 1 DtVitikaC_ G�R�Gt'tJ!uldElil4 s9 iDlw�)`�e`EMFL a5 E[i 1, B+ taAi9 - .i . �. ��asCFk3 A�dR# lG�fiT{1>tBEASQ�'�r,'r�m �d!iJSl�it;4€ rmr���od c,�r;9p Ct, TFIaSktl3bAa _ �a€1wstssIP4 '"a, 'N�k?Rt7klSIR:S4�aFAttAEifFd` FTI�i1Zt:�yNel4aitPGF61f�Tf�13Ci.t4ikC cum"Yawv vSP?°fitlIM idto"NUe 3P SiBC 1 '.Fi !ale ' gi R A l f1 F7 APt1 �I RCF1 ATD h4thL� CAN,MATDi7RF: � 8449ti,�.d4!'�YI'G�'p .{�L11(E�0� 9L'pBfl��iC1�9iD�4dhF10E�L� 4 E A HIdIYT fkl1019 i flN'u@'4d11e PRHFs1:4YfER1 p Tom Petersen Architects Planners Construction.Official August 30,2016 Building Department for project at: 182 Trout Brook Road Cotuit, M.A.02635 Re: Solar Panel Installation Peterson Residence 182 Trout Brook Road Cotuit, MA 02635 Dear Sirs, I've reviewed the proposed solar panel installation at this location to evaluate the existing roof structure and.the connection of the panels to the roof. Criteria: Applicable codes: 8"' Edition Residential Code(2009 International Residential Code with Massachusetts Amendments) 2001 Wood;;F,ra.me Construction-Manual Design roof load: 35 psf live load, 10 psf dead load,45 psf total load Design wind load: 1 l 0 mph,35 psf, Exposure Category `B`' My findings are as follows. l. The new solar panels will imply an additional dead load of 3.psf. The existing roof structure (2.x l2 roof rafters @ 16"o.c., with 2xl2 ridge,span=+/--16'-2") is sufficient to bear this additional load. 2: The solar panels are attached to the roof with the SolarMount-I rack system by UNIRAC. The rack system,roof connections and connection spacing are rated for 110 mph. This project requires the larger Solar Mount I.-2.5 beam(2.5" high)and spacing of flange foot connection to roof at 48"o.c. maximum. Flange footing connections to the rail are not.required to be staggered. The Flange foot connections to the roof are 5/16"diameter x 4"long lag bolts. 1 therefore certify that this installation complies with the applicable codes and design loads mentioned above and is acceptable for approval. Please let me know if you.have any questions on this information. Thanks! i er Iy y S e y fours, `horn Petersen Cc: Neal.Holmgren, Solar Rising LLC 6 Country Lane• Howell,New Jersey 07731 •Telephone 732-730-1763,Fax 732-730-1783 slser+e�5ptusr•�a-F'x �- 160 5ist T�f3 v O rode NO.I Nfatnb*t-f�lw gaftHx(SMW Load) v tlefleetFan 4iatN .tJltYa� `" - S)tu(ntAt t) 116 eW-xu-t art _ ►�(I t>1} leritrt '3 !'P i posm ` I )tit csrd ttitYtt9+C! .$nIDK t.WAd 111E K Deatd L"d(pit) 10:w v The Mixtaltttn 110tt.onta.l SnUI i"'. 20 ft. 2 in. uith a rtl41i.n►Uttt bearing length of 0.95 in. requiml at each end o 'site attet AVL 2x 10 4�stAAC X4 'M0&.ft&o libtaat}•(E) it4MV0f`u lsnwtu*Sttcalthifi) IIS3i§pi! i kS"Sarno(F,t `tss31s�,r ��RED ARcy • o ►i- No. 31621 z HOWELL, o NJ ti�y�gC TH OF M P�SPG� Solar Rising LLC Project: Lisa Peterson Solar Rising Building Permit Plans Solar 508-744-6284 182 Trout Brook Road Revision: 8/26/16 r {� 759 Falmouth Rd Unit 8 Scale: None Mashpee, Ma 02649 Cotuit, Ma 02635 Drawn By: Neal Holmgren IKE PERMIT Town of Barnstable *Permit# CO� ti Expires 6 m onths from issue date III - 2008 Regulatory Services e ` Thomas F. Geiler,Director 1639• .� � � Building Division tFD � Y/ Tom Perry,CBO, Building Commissioner 200 Main Streei,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number • Property Address �� fie a TAmle- /1()6 t ®I u( 7 IM-4 g2673 J 06Residential Value of Work '7; Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address k64 lea-1 u7r3,n k'oA) ; ( 'gTztd i aq Contractor's Name 1k,44 'C'7t-ton e Telephone Number Home Improvement Contractor License#(if applicable) lU/e4- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �I am the Homeowner ; I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not.stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le bl Name(Businesslorjmizario&gndividua): �/S/� / �r�S Q Addre55: -z 'd �°�T✓1'a�G( • �✓C�CI�/` � . lty/State/Zlp: - w /� 7— W f-Phone.#: 5��✓ lW`! 36j Are you an employer? Check the appropriate bow Type of pioject(required): 1.0 I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in employees and have workers' �Y capacity. in�rrranGe,$ 9. ❑Btr'lAmg addition [No workers comb.insuiance comp required_] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.MI am a homeowner doing all work officers have exercised their 1 LEI Plumbing repairs or additions myself:[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance require&]t e. 152, §1(4),and we have no employees. [No workers' 13.❑Other . camp•bsuranw required.] . *Any applicant that checks box#1 must also M out the section below showing their workers'coxnpmsation policy inforrcatiaaL t Homeowoas who submt this affidavit indicating Icy are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContwtors that check this box natst attached an additional sheet showing the name of the sub•conhactan and state whether or not Most entities have canployers. If the sub-conhwtors have employers,they must provide their wrnia:cs'comp.policy nwober. I an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ir[f0 anon. XSit�eA ny Nam: ns.Lie.#: Expiration Date: City/state/zip.- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sectn:e coverage as required under Section 25A of MGL c. 152 can lead to the imposition of eri=hial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statcmei t may be forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify under paias•andpenalties ofpeduiy that the information provided above is true and correct Si e: Dane: Phone#- ��— qo-F-13d 1 Official use only. Do not write in this area,tb be completed by city or town ofj=tciat City or Town: PermitlLicense# 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#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides'therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter mto any contract for the performance of public work until acceptable evidence of compliznce with the fimirame requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)_along with their cmtificate(s)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Bp advised that this affidavit may be submitted to the Department of Industrial Accidents for confiimtation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-fimn-ed companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitllicense applications in any given year,need only submit ono affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the aff davit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to brim leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would Wx 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 C6mtmonwmM of Massachusetts Department of Industri.sl Accidents ofce of Investigations 600 Wuhington Street Boston,MA,02111 Tel. #617-727-4900 ext 406 or 1-S77-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia Town of Barnstable roc SHE r � Regulatory Services t3ntuJsrwsc>✓ Thomas F.Geiler,Director 99, E Building Division j°TEu �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.toym.barns table.ma.us Office:'508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print (CURRENT ATE: OB LOCATION: l of �f . C�(J r'U_ ` number street village HOMEOWNER": �b' l�0 '�J�� name home phone# work phone# MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum ins ection procedures and requirements and that he/she will comply with said procedures and requireme Si re, f 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 perfomring work for which a building permit is required shall be exempt from the provisions of this section(Section 1ou'.1-Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie 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 writh 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 fomr/certification for use in your community. I S,l d °F�KEfati Town of Barnstable Regulatory Services to Thomas F.Geiler,Director 039. A,Fo ,,a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner ' Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. I-FRMIi tniti:i,i hLU I'1 TOXIN DF BARN',I ABLE BUILDING DEPARTMEN( 200 HAIN SIREEf HYANNIS, MA 02601 r UA1E: 05/02/06 # ]IMF: 07:35 ------ _ __ --TO(AI S _. PERMIT $ PAID 25.U0 AMT TENDEKO: 25.0o AMT APPLIED: 4. CHANGE: 00 APPLICATION NUMBER: 1006013E PAYMENT ME1H: CASH PAYMENT REF: 659 NOTES RECEIPT DATE No. " RECEIVED FROM ADDRESS $ FOR ACCOUNT HOW PAID AMT.OF CASH ACCOUNT AMT. CHECK PAID BALANCE MONEY BY DUE ORDER 2,2001 REDI_FORMx 81_808 ------------------ - -- ,. ..a �:. �� '�, a 1 �" i i J� 1 J) I Town of BarnstablePermit: c2eo6D 13,g:9 'THE r, Regulatory Services ate: Thomas F.Geiler,Director 4 Building Division ee:� po 9�p i6 ►�e� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT M1.Owner: _(�/SG� l Phone: a g J so s4 Install at:-/SZ fr_Q4�_QQA, A� village: (>l� Map/Parcel: 008 O 01 .Date: b D (v 1 f Stove A. New sed B. Type: adi /Circulating C. Manufacturer: Lab.No. D. Model No.: Chimney A. 0/Existing ,(If existing,please note date of last cleaning B. Flue Size s! C. Are other-appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: -�q B. Sub Floor Construction. e~-6 Installer Name: ® ''— Address: aS Phone: " $' Location of Installation: G lcY.�l APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector r r O .r. 74, m� jo Lis- ip air JS`^,/t � ` � r �i� •, '• ; ► ,~, 01 It f l � J - 17L r # } 4} e0f Iwo N .r • iL .�-� _ � �! -- spa .•_---'� ,'r, lr.-__•... �i � "y .!t t i ti� �r�fP - trig g ( .•z*I �. � .�•,,:„�,v'�: � + o } b..,-_r.—�- ►.,.•�----�^-= � , .,.. �fir, s s t N..a _J r lG-.- . 4 omit 00 am . _ a 11 •: t i m Now . ..... .. ... T,' i r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 "' ?� Sq6 Map e,�o $ Parcel t 2 k :, ' =t,;t# i_te Permit# - Health Division q__12? 'AlfVk Date Issued 30 ®S Conservation Division Fee 4Q,SO Tax Collector 8 ,-,3/g 5�: J _ m_ Q 07 Treasurer Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address I$ 2 '-P B Poic- V$ ' Village co-n- Owner LDS A P S o Address OP- Telephone Permit Request of S Y-k-Ct_ ��'✓ Square feet: 1st floor: existing- proposed 2nd floor: existing proposed Total new ValuationY Zoning District Flood Plain Groundwater Overlay 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 LINO On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other 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:0 existing ❑new size ' Shed:❑existing Cl 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 Goat?-" CFRYS:5�5 Telephone Number 2r%f Y"Z Address P 4, Ro X 81 License# GtN-U*Zi� , ,l t pt 0 26 3 - Home Improvement Contractor# f y 6 2- Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � c-+,►S. '��- S , S DATE SIGNATUR s w FOR OFFICIAL USE ONLY e n PERMIT NO. DATE ISSUED MAP/PARCEL NO. + r + ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ; GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. „s The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations a 600 Washington Street r y� Boston,MA 02111 ' M www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business�Orpnization/Individual): `� � S©C A �o a1 R- Address: D . �- e• Q a X $q. City/State/Zip:- C-o*0T-'V - o4 A ' ' 0 2-6-5 5 � Phone 4:' Sa 8-1.-2r`d P ?'t�f � Are you an employer? Check the appropriate box:. 1. Type of project(required). 1. I am a employer with 4. El am a general contractor and I 6 : ew construction employees(full and/or part-time).* have hired the sub-contractors - I am a sole proprietor or partner- listed on the attached sheet. t 7 emodehng ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. ( workers' comp.insurance. 9. Buildingaddition [No workers' comp. insurance 5. ❑ We are a corporation and its ❑ officers have ex 10.❑ Electrical repairs or.additions required-] erased their . . 3.❑ I am a homeowner doing all work right of exemption per MGL 11-❑ Plumbing repairs or additions myself:[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: '• t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' P" PocY_li information. c� I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Dater 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 maybe forwarded to,the Office of . Investigations of the DIA for insurance coverage verification. I do hereb c fy unde the Mns and penalties of perjury that the information provided above is true and correct: Signatur t Date: o r Phone#: S P 4 t� 2 B " VA c{ Z Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined a�'p �duat.p�elbiP,,�sociation,carporation'or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. Howev,,er:te owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work-on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any ce of compliance with the insurance coverage required." applicant who has not produced acceptable eviden Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain,a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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 town may be provided to the applicant as proof that a valid affidavit is on file for:fixture permits.or licenses..Anew affidavit.must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum 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 02.111. Tel.#617-727-4900 ext 406 or I-K7-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia r 4p�pUTHE roq, Town of Barnstable Regulatory Services MMSTyi►iss` 'g Thomas F.Geiler,Director 1639.• �0 ArEp a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us • w Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: t)�ArQ� �$►S`t-Ar-t� a tJ Estimated Cost ,8 0 o Address of Work: 19 2 9"OY—" Owner's Name: UPS Date of Application: I?f 1,q0� I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied S ❑Owner pulling own permit k i Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED ER PENALTIE OF PERJURY I hereby apply for a permit as the agent f th owner: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav oFE r Town of Barnstable Regulatory Services •, r snRxsrcAa . r Thomas F. Geiler,Director A,£o 01 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabli.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 9 I, fS/T �/ -��'" ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) l ignature of Owner ate he r'ks'�AJ Print Name E f Q:FORM&OWNERPERMISSION 1 t 1 f Uf TT f ! y 1 4 ! I f { y j , t i ice(__+_ f ! j i I _ f y 4-_ t : 1 K 1 1 1 l L t !- Lj- - . r J(!Nte Board of Buil ing Regulati ns and Standar s One Ashburton Place Room 1301 Boston. Mass usetts 02108 Home Improvemen o actor Registration Registration: 146276 Type: Individual z Expiration: 4/8/2007 CONRAD GEYSER CONRAD GEYSER P.O. BOX 89 ®_ COTUIT, MA 02635 < 5.4 a Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card Al 0 5OM-04/04-G101216 �/e �orrvawrcu�ea/,� a��aoacfivaeG.a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrat146276 Board of Building Regulations and Standards Ex`: 2007 One Ashburton Place Rm 1301 n�Idual Boston,Ma.02108 )NRAD GEYSER )NRAD GEYSER, '` OLD SHORE RD )TUIT,MA 02635 Administrator Not valid without signature ti f G�� 7-7 .�_ Assessor's map and lot. number ...!.1..1:�.�.....� .�:.57.�.:. �� a SE'TmC rY'STEM MUST BE TAL 1-0 I N COMPLIANCE lj. �... r, Sewage, Permit number :', WITH 1 AI 'i'C E 11 STATE a SAz i r;"Y CODE AND TOWN �; �P�of:THETo�o TOWN . O F 'BARN TIA��B LE ' Z Bj$B9TSIILE, i ry "AS` 47 BU,LLDIHG. INSPECTOR aMPy4 J, '/ `' � APPLICATION FOR. PERMIT-TO .:...... .................................. ........ ........rZ .........7-0 ..............:....... TYPE OF CONSTRUCTION .?.......... � .. ... .............. ,` w. '„ ' 1:12-'L6 .19 .17 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for bb permit according to the following information: Location ........k.0 .1./J.0.............J..keay..�.... ..4�J.P.. -A........!.��Lc................ U U k............................................ ProposedUse ........................... ............................................................................................................................................. ZoningDistrict ................................................. ................. .Fire District ................................ .......................................... Name of OwnerQ.U1I.hl..t.. jS�19... Te�sa>v Address .................. ..p � ..................` 1 ... Name of Builder Q.44.�J./4�.....�....... ..U.. .d. .........Address 1 ` i"41fi.Af.....Lot.. .........W.Y. A. Nameof Architect ..................................................................Address .................................................................................... - n Number of Rooms .......... .1....................................................Foundation ....... ......� ce!e�tt............... Exterior ..�' .A. .. D .► ..... .Shl ?. .'. , .......................Roofing .............1. S. ...!I�. ..................... .................. Interior ..... . !.......................... :........I......... ................................................. .................... .. Heating ... !. L l.�'—..:.. . ...........................:...............Plumbing .......a...� ..v 5............................................. r Fireplace .......0 g N.�.........................................................Approximate Cost .................. ..e.......................'�� Definitive Plan Approved by Planning Board ---------------------------------19---------. Area ... ...................... Diagram of Lot and, Building with Dimensions Fee ... s` - SUBJECT TO APPROVAL OF BOARD OF.HEALTH I hereby agree to'conform to all the, Rules and Regulations of the Town of Barnstable regarding the above construction. fi Name . ............................................................. Peterson, Edwin & Lisa, 19167 1 1/2 story No .........I........ Permit-for .................................... single family dwelling .....................� .............................................. Trout Brook Lane Location. ......................... .................................... C6tuit ............................................................................... Owner Edwin & Lisa Peters6n ............ Type of Construction ........frame ,.. .................................. ................................................................................ Plot ............................ Lot .........#io' ...................... Mai 3 Permit Granted ........... ............19 77 -7 Date of Inspection 4112172................19 Date Completed ...........*..,...19 PERMIT REFUSED .................................................................. 19 ............................................................................... .................................................................... ............ ................ .......................................... ................... .................................. Approved .................... .......... 19.................... ............................................................................... ............................................................................... Assessor's map and lot number ...!. .................................~ ��" /- ��' 7 7 � 7 /ll J] y •'� Sewage Permit number ......................fT:,.. 4Y y �QyOF?HET��o yT TOWN OF BARNSTABLE Z MARNSTAkE, i 9 MUM' � Op 1639• I 0 131.11.1.1) ING INSPECTOR -:� s .,'�.......................,................................ - .......................` ��• APPLICATION FOR, PERMIT TO ...........,. �� �.../... ..... TYPE OF CONSTRUCTION :.........\ f t/. ... ... C ........ : - l l 11 C).:... + ............../1,�(<�L....... ... .......19..7..: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locationtlf Irl .jsjT f.'} ,�nK Foal ) ..0 ...................................... ...................................... ............................................................../.r.... ProposedUse .............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..............# r 111 1...'........ ! .... r `�t ;,v 1......Address .......LFF.'`�.............k......�.....�irt?G.ety Name of Builder ........::. ..:..::. :. ..........Address ��.l:�.t�t,/AIA�.....t.4.100 ...................... i:Y`IUv Nameof Architect ..................................................................Address .................................................................................... Number of Rooms A ` 0 11C-CI q .....................................................Foundation c r Exterior .............. 5.+.r /.. . .......................... ............. , r t ,.°......` :..``............:.......:.'...?.`:........................Roofing .................... ?..L....... Floors ..!..l... :........lil U d .Interior + ..I...... . .. 1 Heating ry. �� l / ................... ........ + +. Plumbing •_ Fireplace ........ 2.1:'.�:...:..................:......................................Approximate Cost ................................................. ................... .,� Definitive Plan Approvedty Planning Board --------------------------------19N-------- -Area ...7q4•A?•.I•••••••••••••••••••••• Diagram of Lot and Building with Dimensions Fee j� . ....................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH N r,I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..- .......................................................................... Peterson, Edwin Lisa 1=8-12 dwelling TINNXXMNZR Trout Brook barie, Location Cotuit � '—^------^^-----~----------- . . Edwin & L1eo Peterson [hwnor ----------------'—r---- . , frame ` Type of Construction -- ................................... ' . -.—.--~-----------.--------- #lQ Pb» .--------- Lot ---..�------.. ' � . . � � 77 ren"x Granted . _ . . uo,e of Inspection um/e Complete � . . ' . " E MIT REFUSED - . . ---.. — . - � . ......... % ~ --..�...�....- .�.—... ' .............. . .--,—.,~.----. . � � ^� � —~---�..^.�"�v,..�.—. ---------..- � Approved ................................................. lV � ' ' . -------.--------.—.-------.—.- ^ . � � ����������������...............,...,,...,',_ ' � � � | | � . ! r 1 , qrl >o qua Dix Eck l:,i r .. Jj •, :[q /1 i 1' 0 x ,may / '4 \4 �. �.� r5��•i. 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BEING LOT 1 As sHowN r r .0� fC E c o oe� E D /N - ./-HG .L7 ol?-,e 1�'g.a s ,r= 57-gBLE cOU1,17 /eE`G /sr-,ey Ooc' DEEDs T/ C : 7TA N k 7.o B E f/ I- AI NI y // EJM' OF /O' FRO/�// Fo.ov� q ° o� � °r/ O A/ •f� Ai U L E fH C H /� / T•S ti LOW JR, p �: Er9'CH / /V,G P.:/ TS TO elE .A „ UoI O F /f©' "f fe. o• I_ O sw€av� iq/ll D 2 O Fz Q:M F: O U.N D A T/OA/.' r Y. T 7f-!'E' FOUNDATl0iV ; oN T'N1S PLAN /S Loc,-g-TEQ oN 7"H E G. O-(J N D ,4 5 S H o to,,/ B9 eEo. c 7 '+ b /�-1•Et'1.:3"5;4 © ;. TiYE' •'T�Dl.// / o 13` ° y'}"1f4�. L.I •'F./'C.rFr* r(, 'Y, lF�.i&'+. y, ��• ,.�' t �e:.e.,. s v �s { t '..fir t•. ,r .. .. ,,f >,;s S #r�� •S Y` +rr'�. " r v/,! Y r•� -zF � f•D�7 �"'� .� - '.' . R Ef-r ,L:,9:N D' U'f� VE y 41; ; , �..- .. .. •�, - - - tl,,._t er.: ,ls s-•.�f �� c - ...t `•t,`. .qr2.: i7,J :.,� '..{ _ .A.. � �1�,l. }• ..:fi'..Y' "C'_'k•�4 ya rL. '1 5, •F �..}' :�T .; .;pr• � 4 r/�.,. .. •,n H. A.. ., -;. .. ..:. .;.. � Y.. [ �. 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