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Home My WebLink About0153 INDIAN TRAIL l� 1 \ 3 r- n n ;5 w ' s w, r ' t. , • c a • a: • •,F , - F. is o • ,.. � r , _d .p, ... � eT . , .. v �E�7.� i a a,��a r p.•� A �a,. a • - S , t.� t 5tu, i a .n , L ji a •/YrRIVF�^a° .a ._..-wv�.•.'- non err', t...._,f' �. '. �-,. .,: y x -. .:.... Y.: e _ - .. .. - Cu- 9 J1 )oy E n _ .._ .. , -WA), 0�+�' 2TC�hC'S'u�Op}rP� 70 30w��Z5 nr ll t U 5.734 4 w. Town of Barnstable Building ' r. .3 ;�. .,; ? �.a k' �'�` � -- " Post This:Card SoTh"atkrt is.Uisible-From:the Street Approved Plans Must be Retained on Job and this Card Must be Kept = l r�axrwraa c ... s u y " -; w 6� Posted Until Final InspectionHas Been Made � w,s � � �� "a � �{ Permit a 39 Where a;Certificate'of Oecu anc is Re urged,such Bu�ld�� shall Not 6e Occu ied until*a Final Ins ectwn ,as been made p P Permit No. B-19-4003, Applicant Name: RYAN MALICIA Approvals Date Issued: 11/27/2019 Current Use: Structure Permit Type: Building Smoke Detector-Fire Alarm Dection Expiration Date: 05/27/2020 Foundation: System Map/Lot: 211-001-002 Zoning District: RD-1 Sheathing: Location: 153 INDIAN TRAIL,CENTERVILLE 'Contractor:Name:=_.,•RYAN MALICIA Framing: 1 Owner on Record: SILVERRYDER,KATHLEEN L Contractor Lrcense:� 55658 2 Address: 967 NORTH MAIN STREET Est. Project Cost: $0.00 Chimney : RANDOLPH, MA 02368 Permit Fee: $35.00 Description: updgrade current smoke detection system Add Heat deteector,add Insulation: Fee Paid $35.00 3 smoke detectors changed 4 smoke cot combos Final: Date 11/27/2019 Project Review Req: Approved by Martin comm fire Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzediby this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents fo11 r which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall-be in compliance with the local zoningsby laws,and codes. This permit shall be displayed in a location clearly visible from access street or road nd shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. p w a `r Electrical The Certificate of Occupancy will not be issued until all applicable signatures bykth-e wilding and A 'Owicials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:( l _ Service: 1.Foundation or Footing 2.SheathingInspection _ P Rough: - - 3.All Fireplaces must be inspected at the throat level before fi rest flue Iiningis installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final.: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: V1 - - IKE p� Application Number...... ....... ...... !!. . TOE Qf OARNSTA DARNS!'ASLE, « , MA88. Permit Fee;............2�.................Other Fee:....................... 1639. .� N111 MR 26 PH !: 12 TotalFee Paid.....................................................`.......... ...... TOWN OF BARNS Permit Approval by...eaD............on. 3 1 l .zwl BUILDING PERMIT a-H..........................Parcel........0.��.1..:..-�1.Q... .... APPLICATION Section 1 — Owner's Information and Project Location i Project Address `j l 6 Z-af l Village 0)1-c-- Owners Name_ 11'l f G4 Gf el 7a— '10 1� Owners Legal Address 4Vd�� L City. l State ' Zip Owners Cell# 8�77 ?;37` 00t i� E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty Fire Alarm Rebuild ❑ Deck Apartment © Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description lAri,lri(Ak el IAII ' -S�OAV 1;,c—A�eXRI A 4. Last undated: 11/15/2018 .y i Application Number... Section 5—Detail Cost of Proposed Construction Square Footage of Project _ Age of Structure; Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design a i Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage Smoke Detectors � y ❑ Plumbing ❑ Gas ❑ Fire Suppression i ❑El Heating System ❑ Masonry Chimney Add/relocate bedroom � Water Supply El Public ❑ Private i, Sewage Disposal - ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No _ I Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed , Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No s Last updated: 11/15/2018 Application Number........................................... 6 Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date ` Section 10—Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature �� Date 2,111 q Print Name Akk4lok Telephone NumberC� 77�, C��17 E-mail permit to. Last undated: 11/15/2018 Section 12-Department Sign-Offs ' Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval. i 9 Section 13—Owner's Authorization j I, , 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) j Signature of Owner date Print Name I J Last updated: 11/15/2018 3 �v The Commonwealth of Massachusetts Department of IndustridAccidenis Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibbr, Name(Businesslorganization& ividual): Address: 7 City/State/Zip: irt�� Phone M �� l Are you an employer?Check the appropriate box: Type of ro'ect r to 4. I am a general contractor and I p ( � . � I. I am a employer with ❑ g 6. ❑New construction employees(full and/or * have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees . These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' _ 9. ❑Building addition [NO Workers'comp.inc+r,an� Comp,insurance. 5. E] We are a corporation and its 10,E Electrical repairs or additions required.] officers have exercise their ❑Plumbing 1 L repairs or.additions 3.El I am a homeowner doing all work d '� ePa myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs � �t C. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tr—ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. - I am an employer that is providing workers'compensation insurance for»ry employees. Below is the olicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: WL16_gV `Z j.qq q0'_�(/� 1 / i Expiration Date: Job Site Address: `�/ 1n)1 � % city/State/Zip6kn✓> 'i '0 J G Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ' of up to$250.00 a day against the violator. Be'advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenah es of perjury that the information provided above is.true and correct. signature: .i'-'�"'- Date: // at I�� Phone#• Oj,j wkd use only. Do not write in this areg to be completed by city,or town oflicial City or Town Permit/License# A ` Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M • 1 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 k 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 into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or UP 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 lime. 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 future permits or licenses. A new-affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike 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 1n&%-tr al Accidents Owe of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 MASSAM Revised 4-24-07 Fax#617-727-7749 www.mam.gov/dia - f 4 � { SUE DETECTORS REVIEWED V).., - L LIZ-_a BARNSTABLE BUILDING DEPT. DATE - FIRE DEPARTM -- BOTH SIGNATURES ARE REQUIRED FOR PERMITTING f / - n /{ , s fiw � i ± t �,;%} 00 "'P t j 1 - Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization I, UVI �Nl , as Owner of thee property subject r� operiy hereby authorize Ryan Malicia to act on my behalf, in-all matters relative to work authorized by this buildingermrt a lication for: pp AM (Address of job) AM EST Signature of Owner date Y4z Lriq Print Name J T oM nnAnwA. t l n enni e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map cV 11 Parcel C9 - 60 i C►® 2� . Application # 06 5 rJ e Health Division Date Issued Conservation Division Application Fee �IPlanning Dept. Permit Fee Date Definitive Plan "Approved by Planning Board Historic - OKH Iv C� _ Preservation/ Hyannis v Project Street Address Village__ Owner c.T�l�Gh �-• lr� C_ Address 15 3 �� nd��h 1�� Telephone LaODO Permit Request \ 5L)k4_,_ XVAe-15, On 41- 014 PIA e T S c c �1 h' i'C�mncc I�,i� `�� lc��c�,.I 5u��.u�. K�►.I I P��ls Square feet: 1 st floor: existing proposed — 2nd floor: existing — proposed Total new "— Zoning District ��' \ Flood Plain Groundwater Overlay Project Valuation,'JDD� Construction Type Lot Size Grandfathered: ❑Yes A No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family (# units) Age of Existing Structure 0r) %I 5• Historic House: ❑Yes 6No On Old King's Highway: ❑Yes .�9 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other If 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 ,r Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other _ ' Central Air: ❑Yes ❑ No Fireplaces: Existinga New Existing wood/coal stove:. 0 Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size Barn: ❑.existing ❑new izm— Attached garage: ❑ existing ❑ new size)A-S-hed: ❑ existing ❑ new sizdY VOther: `?4 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ _ Commercial ❑Yes ONo Ifyes, site plan review# Current Use r_�1G��JI �-� Proposed Use °-` APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r1A pp?A- U^ [-r..sm Telephone Number Address Aa -c� 5'I�✓� �\c� License# C'S ID8(� (S Home lmprovement 'Contractor# J Email 0-4 Worker's Compensation # wCb Io�b 1S Z>� ALL C04TRUCTION DEBRIS�RvESUL NG OM THIS PROJECT WILL BE TAKEN TO (2, dlc�yr�PSl [� n�S SIGNATURE DATE JW� S,A �S i FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. L k ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION l FRAME t t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH _ ` FINAL FINAL BUILDING 09 ZJ'Z31/r DATE CLOSED OUT ASSOCIATION PLAN NO. V_ t+Ch�srrtlt (*Uonn m 01 Oau Sol"* fitlatfJ of 8cs tof AleO+�st+eMEt+'sn0 Sl~dt- mor"In 1 te"j* CS-108815 JASON PATRY La 821 STEWART DRIVE Abington MA 023'Sl •.." Oflke of Couomer Athirn&Baalum Wgadatloo ?HOME @IPROVEIIENT CONTRACTOR RegistMMOnt 108572 '! A Expimtton: 311mi1 Supoemaid SOLAR CITY OORPORATION R . JASON PATRY 24 ST MARTIN STREET 8LD 2UNI k4kLBOROUGK MAA1752 UoQeaseeetibry' ! J ; Tire Cotltmiswealth of Massackjodo Depwtnwent of 1wadustridAccident I Congress Street,Sake]0(1 Boston,AM 02114.2017 www mampv1dki Ararkers'Compensation Insurance Aflifts'#:BuilderslCentradardEfectriciaas/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aanllcsot InfarmatioM Flue Print L��y Name(P1uyineworgunitlmnitwuVidual) -%LarCity Corporation Address: 3055 Ciewview Way City/State/Zip; Bart Mateo,CA 94402 phone.#� (888)765=2489 Are you ao employer?Cheek the apprope6te box Type of project(required): 1,01 am a employer whit 12,500 otVlayecs(full aed►or' rt t;oa)x. 7. [:]New cottstrttction I ton a sole proprietor or Partnership and hwe no.m*ym tval:t-.for mc.m: 8. Restttxiol'mg any aapaoky.Fitt workers'comp.insurance requllted.[ 9. 3.[J1 am a Isnmeovrnerdnipg'ell work mysdr.[Novrorkers'c",instttmmaquired.l r El Demolition 4,1:]t om a Ironwowner and will be hirhrgrec cwttorb to conduct all work on my Property. 'Will 10 0 Building addition onsurc that all r rrnirmun oithor have worWs.'boa ittst mee orate sole I l.(]Electrical repalm or additions propr[etors vrhh no argdoyes 12.E]Plumbing repairs or additions SO I am a g md.contractor and l have binsd the soli-coaftwtom listed rot the attached sheet. These stdruaeon am have cmpl%=and have vvwkas'comp.inamme i I3.�It0of repairs G.Q We are a curpormion and ire offtxrs haveesemised their right of exemption per MGl C. .14.0Othetr solar pane 15Z§1(41 and we have no emtployees,[Na workers'catrtp.insurance requitcAl *Any gVlicwt that checks box 111 must tdso till out the section blow showing their workers'compaawion policy iftfwwdoa. °I iorneowrtm rho submit this affidavit indiaft they are daft all work raid then hire outside.contractors mast summit a trew offrdavh inditift steak tCootmours that cheek this box taunt attached an a+klitionat shoat showing the name of alto sub-vontraclws and state wltetber or not those entities Lave. trrertoyws. if the tarb-mntraators have empkwees,they mmt provide their witAcrs'comp.policy r enter. . !act:ate employer that is pmwang werkm,compensduen immmee for my enVoyem Balmy fs the pa(icy and jell site irtfortrratio►r. Insurance Company Name:Arnerlean Zurloh Insurance Company Policy#or Self irm Lie.#: WC01821DWOO Expiration Qatc: 9/1/2016 . . 153 Indian Trail Centerville,MA 02632 Job Site Address: City/$tatw7ip: Attach a copy of the workers' compensation pow declaration page(showing the policy ammber and expientfott date). Fall lure to secure coverage as required under MOL c.152,§23A is a criminal vioWlan punishable by a fine up to$1,500.00 and/or one-year imprisonment,ea well his civil penalties.in tho form ofa S`OP WORK ORDER and a tine of up.to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA#'or insurance coverage verification. I do hereby card eerier the petters eml ptcnaltles of perJury their the liifmwodon provided above is true and correct. asnn Pa - October 5,2015 Phone O ietal usuonly. Do not write in this area,ro be compleW by clay or tower officiaL City or Town: Permit/Liceme# Inning Apthority(circle one): 1.Board of Health 2.Building Department 3 Cityfrown Clark 4.l leettrlcal inspector.S.Plumbing Inspect" 6.Other Contact Peen. fltave#: Sisal AC RDA _• . . . .DATB(MM/DDnrYY1� CERTIFICATE OF LIABILITY INSURANCE 0 117 015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOFFS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND. OR ALTER THE COVERAGE..AFFORDED BY THE POLICIES BELOW. TWS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemont. A Statement on this certificate does not confer rights to the certificate hotdaT In Rau of such endorsement(s'). PRODUCER - _.. . . -CONTACT - MARSH RISK&INSURANCE SERVICES 346 CALIFORNIA STREET,SUITE 1300 ESL-E�dk ..._ ._.. . . .. ... . .. 1l+��t42}• CALIFORNIA LICENSE NO.0437153 ARRRE :.......... ............_._...__.. ——. . . SAN FRANCISCO,CA 94104 Attn:5harumn Stott415 743 8334 ...: ......... _; .....::::1N9UtiER[S}.AFFORDRlO 00 RA�iE-:. , . NaO#. . 908301-S1ND GA4YUE-151fi iNsut A:ZOridlAmerican lastnance CamPanY ... 116636 INSURED INSu Ii N1A NIA SdarGty Corporation 3065 Clewhow Way tNSuRER C:NIA - _ Sm Malso,CA 94402 -_.._._- _... wsuftER D:American Zura lnstirari a C&wrry �40142 INSURER F.- COVERAGES CERTIFICATE NUMBER: SEA OD27t 3648 : REVISION NUMBEiL4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNTHSTANDING 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 SUBJtCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i i,— WAX du-TYPE OF INSURANCE POLICY NU`._.,... .... ..POLICY EFF POLICY EXP _. .LIMOS....._.._ _. ......,.....,. IMMIDONMI A X. CONWERCIAI GENERALLIASILITY GLODI82016-00 091D112015 009016 g 3000000 DAMAGE TO __...... TED F •1•—�CLAIMS41ADE nCCCUR PREAILSEP.I{ 3.00D.0W • X SIR$250,000 I bIED ExP(Nry .P? �1.. S PERSONAL&ADd INJIiRY S 5,000 3 M0 ODO GEN'L AGGREGATE LIMIT APPUES PER - GE.NER.ALAGGREGATE S 6 000,000 ff X POLICYC t:. LOC PRODUCTS-COMPIOPAGG 3. _ 6.000.040 . OTHER. . . . A AuroMoau.ELuumiTY 'BAP0182017.00 09A112015 0910112016 c EINEDSINGLEUMIT• S 5,000.W0 Ix . B�DpY 1NURY(Per person) g ALL ANYAUTO AUTOS ED H AS SLEDSODILY INJURY(Per accident) SHIRED AUTOS AUrOSNIt£D I I PROPERTY DAMAGE S CO APICOLL DED. s $5,000 UM6 113"LIARHCLAIMs� OCOUR i EACH OCCURRENCE _ 5 EXCESS LU1e . . r' : � . . . . .. :. , . . AGGREGATE S DEB i R ONS D WORKERS CWFENSATION jWC011 14-00(AO51 0901R015 10910112016 X PER oTH• AND EMPLOVERS'LIAB9.rTY -' T _Iffi -_- ___ A Y r N --WC0182015.00 MA 09101 015 409101I2016 ER ANY PROPRtErOMPARTNERO(ECUTIVE K1A { .I E.L EACH ACCIDENT S 1,OOO,fl00 OFFICER7MEM9ER EXCLUDED? —'- " (Mandatory In NR) i G DEDUCTIBLE S500,000 E L DISEASE.EA EMPLOY S 1,000,000 iIt dasaibeunder 1j 1,000,000 D SCR r 0 TIONS eMw I E.L DISEASE e i nESCRNTION OF OPERATIONS I LOCATIONS 1 Va4CLES(ACORD tat,Additional Remarks Schedule,may be atrachod It more space Is required) Evidence of tnslaance. CERTIFICATE HOLDER CANCELLATION SdaF(Ayy Corporation 8E CANCELLED BEFORE..SHOULD ANY OF THE ABOVE DESCRWO POLICIES 3055 Clearview Way THE EXPIRATION. DATE THEREOF, NOTICE .WILL BE DELIVERED: IN San Mateo.CA 990.02 ACCORDANCE MATH.THE POLICY PROVISIONS— AUTHORIZED - AUTHORIZED REPRESENTATIvs of Marsh Risk&Insurance Services I Chades Marmolejo 01980-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Version#49.3 G1 `\\! a...r: I lY a: . 6 . arClt ® 30E�o October 1, 2015 Project/Job#0262022 RE: CERTIFICATION LETTER Project: Silverryder Residence 153 Indian Trail 'Centerville, MA 02632 To Whom It May Concern, A jobsite survey of the existing framing system was performed by a site survey team from SolarCity. Structural,review was based on site observations and the design criteria listed below: Design Criteria: -Applicable Codes= MA Res. Code, 8th Edition,ASCE 7-05,and 2005 NDS - Risk Category = II -Wind Speed = 110 mph, Exposure Category C -Ground Snow Load = 30 psf - MP1: Roof DL= 10.5 psf, Roof LL/SL= 21 psf(Non-PV Areas), Roof LL/SL= 21 psf(PV Areas) Note: Per IBC 1613.1;. Seismic check is not required because Ss=0.19069 < 0.4g and Seismic Design Category(SDC) = B < D On the above referenced project,the components of the structural roof framing impacted by the installation of the PV assembly have been reviewed. After this review it has been determined that the existing structure is adequate to withstand the applicable roof dead load, PV assembly load,and live/snow loads indicated in the design criteria above. i certify that the structural roof framing and the new attachments that directly support the gravity loading and wind uplift loading from PV modules have been reviewed and determined to meet or exceed structural strength requirements of the MA Res. Code, 8th Edition. Please contact me with any questions or concerns regarding this project. t F. 2� p K. t�+ Digitally signed by Humphrey g IUKI Kariuki V s UCTURAL DN:dc=local,dc=So larCity, RNo.51E9E3 L3 Sincerely, Humphre�ou=5olarCi ,At ou=Beltsville,cn=Humphrey G/ST Kriuki, Humphrey Kariuki, P.E. Y Kariuki F(email=hkariuki@solarcity.com /Q(1-AL Professional Engineer Date: 015.10.0607:1159 T: 443.451.3515 (� email: hkariuki@solarcity.com 3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com AZ 1400 243771.CA CSIB m164,C0 EC 8041,OT HIC 0632778,DC HIC 71101486.DC HIS 71101488.HI CT-29770,MANIC 168572'RED MHIC 128948,NJ 13VH06160600, OR CCB'180498.PA OTTZ43,TX TDLR 27006,WA GCI.;SOI.ARQ'21807..0 26J3,S41erCity..AB rights re"rv®d. - i r 10.01.2015 PV System Structural Version#49.3 Design Software PROJECT INFORMATION &TABLE OF CONTENTS Project Name: - .SilverryderResidence _ - �' - _AHJ Barnstable Job Number: 0262022 Building Code: MA Res. Code,8th Edition Customer Name: -. $i erryder,_Kathleen - Based On: IRC 2009%IBC 2009 Address: 153 Indian Trail ASCE Code: ASCE 7-05 City/State: -Centerv_iIIMA _Risk Categoryry_: Zip Code 02632 Upgrades Req'd? No -Latitude/-Lon itUde_ 41664855 70.350004 _Stamp Req'd? SC Office: Cape Cod PV Designer: Jao Wen Certification Letter 1 Project Information,Table Of Contents, &Vicinity Map 2 Structure Analysis (Loading:Summary and Member Check) 3 Hardware Design (PV System Assembly) 4 Note: Per IBC 1613.1; Seismic check is not required because Ss= 0.19069 < 0.4g and Seismic Design Category(SDQ = B < D 1/2-MILE VICINITY MAP of DigitalGlobe. MassGIS, Commonwealth of Massachusetts EOEA, USDA Farm Service Agency A 153 Indian Trail, Centerville, MA 02632 Latitude:41.664855,Longitude:-70.350004,Exposure Category:C STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK- MP1 Member Properties Summary " Horizontal Member Spans Rafter Pro erties MP1 Overhang 0.75 ft Actual W 1.50" Roof System Properties San 1` : '12.77,ft p Actual D .ter, .. &%7.25" Number of Spans(w/o Overhan 1 San 2 Nominal Yes Roofing Material ` Comp Roof Span, .:., s , a A -t .x 10.88 in.^2 Re-Roof No San 4 SX 13.14 in.A3 Plywood Sheathin Yes .: San 5:> I 47.63 in.^4 �.. .r Board Sheathing None Total Rake Span 14.58 ft TL Defl'n Limit 120 Vaulted Ceiling No: i PV 1 Start.; x. i2.42;ft?" -, _ ,Wood Species-a. ;, - SPF..- Ceiling Finish 1/2"Gypsum Board PV 1 End 12.42 ft Wood Grade #2 Rafter Slope �. 220 PV 2 Start jk :gk,Ab � x=, 1" .Fb, o e� •q875 psi .AAr Rafter Spacing 16"O.C. PV 2 End R, 135 psi Top Lat Bracing _ Fulls, .: . r;PV 3 Start - sE o - *1400000 psi Bot Lat Bracing At Supports PV 3 End Emi„ 510000 psi Member Loading mary Roof Pitch 5 12 Initial Pitch Ad'ust Non-PV Areas PV Areas Roof Dead Load DL 10.5 psf x 1.08 11.3 psf 11.3 psf PV Dead Load -PV-DLr- f "10 psf f `' 11 x`°1.08 _ r m' 3:2 psf Roof Live Load RLL 20.0 psf x 0.95 19.0 psf Live Snow Load ° LL -SL12 s 30.0 O§f r z 0.7 a' x 0:7 h "_' 21.0 f , .21.0 psf,,,,. Total Load(Governing LC TL 32.3 psf 35.6 sf Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure,7-2] 2. pf=0.7(Q(Ct)(I,)pg; Ce=0.9,Ct=1.1,I,=1.0 r Member Design Summa (per NDS Governing Load Comb CD CL + CL - CF Cr D+ S 1.15 1.00 1 0.44 1 1.2 1.15 Member Anal sis Results Summary Maximum Max Demand @ Location Capacity DCR Load Combo Shear Stress 39 psi 0.8 ft. 155 psi 0.25 D+S Bending + Stress '872 psi " '7:2 ft. w1 1389 sk,. .w 10-,_d.:, .A,0.63, >, .,: sD,+ S �E, ,Bending - Stress -13 psi 0.8 ft. -616 psi 0.02 D+S Total`Load Deflection �- " "0:49:in: 339' 7.'1 ft. 4- ji 0.35. .t A: . fD,+S CALCULATION OF DESIGN WIND LOADS-'MP1 -_ Mounting Plane Information Roofing Material Comp Roof PV y terg Type 00 _ : 7 tYi '� SolarCi SleekMountT"^ Spanning Vents No Standoff Attachment Hardware "-' �,'i? 7,7 07 7 y 4N 1;. "m,� Como Mount Tvoe C, P, 4, Roof Slope 220 f.Rafter Spacing R fit: t 5F 16 ,,. . -- ,,, ? "O.0 wrr Framing Type Direction Y-Y Rafters Purlin Spacing "' =X_X Rurlins Only b ec NA,.,u� Tile Reveal Tile Roofs Only NA Tile Attachment,System . " IL Y Tile Roofs Only tin NA t ,� a, ,k - _ Standin Seam/Trap Seam/Trap Spacing SM Seam On NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method k -. _ -7�'( _ Partially/FullyEnclosed Method Basic Wind Speed V 110 mph Fig. 6-1 Exposure Category A: .rAb ,,.s, k,. _ ,:L R ..x4 C Section 6.5.6.3 Roof Style Gable Roof Fig.6-11B/C/D-14A/B Mean Roof HeightIs. e <<" k.. h .KK .� - x: -v _. ..u_.0 25 fta ,, a Section 6.2 r , Wind Pressure Calculation Coefficients Wind Pressure Exposure KZ_ 0.95 Table 6-3 Topographic:Factor t: :, K 1.00 Secto 65J_ Wind Directionality Factor Kd 0.85 Table 6-4 Importance Factor,, _ _. .,I - 1.0 _ Table 6-1 Velocity Pressure qh qh = 0.00256(Kz)(Kzt)(Kd)(V^2)(I)24.9sf Equation 6-15 Wind Pressure Ext. Pressure Coefficient U GC u -0.88 Fig.6-11B/C/D-14A/B Ext.°Pressure Coefficient Down GC [)OW x 0.45" ': Fig.6-11B/C/D-14A/B Design Wind Pressure p p=qh(GC ) Equation 6-22 Wind Pressure U -21.8 psf Wind Pressure Down 11.2 psf ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing Landscape 64" 39" Max Allowable Cantilever ._,,,,,_.'� landscape 24"k NA Standoff Configuration Landscape Staggered Max Standoff Tribute Area Tri6 r 17 sf' = "' PV Assembly Dead Load W-PV 3.0 psf Net d'Uplift at Standoff T-actual 349_Ibs M7 U_plift Capacity of Standoff T-allow 500 Ibs Standoff Demand Ca acity` I' 'DCR � o �- X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 48" 65" Max Allowable Cantilever _ �-. Portrait ' Standoff Configuration Portrait Staggered Maz.Standoff-TributaryArea % ; +s,+ Trib :®. 22 sf PV Assembly Dead Load W-PV 3.0 psf Net WindlUplift at Standoff. -actual ti :a :,, :436 Ibs Uplift Capacity of Standoff T-allow 500 Ibs StandoffBemand Ca aci : ze Lea.. >,x ,DCR . . . -_ . 87.1% TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �-(� Parcel U D 0 �-- Application # ! 5 Health Division Date Issued �- Conservation Division _ Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village 0- Owner A I e � St�J_1 �9 ' Address l5 3 Tn��Qn ��ra� 0. g (8c� Telephone 50 9 3164 �� (Cr� K� -I V �`�/ �� Permit Request a-as- Qr- T--e_V0.L'r G At S'm aLe "vL.._c_"_k c1r4?4S I r �e��►, w��c . a--�- gar-a..Q-p- • t (\. . t n &,L l4, -to r) rock- CL 41— TV% un-e rjD Lr) Ses j p C•t n.a AL t n 'aft-D (ek i r ercis ,� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed .::;. Total— 'newt-Zoning District Flood Plain Groundwater Overlay -? Project Valuation 3 O 4 O o CZ) Construction Type w a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docCerrrnentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure t q 8'q Historic House: ❑Yes 19 No On Old King's Highway: ❑Yes X1 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 ,�?S new Number of Bedrooms: 3 existing Onew Total Room Count (not including baths): existing _ (2 new First Floor Room Count Heat Type and Fuel: ❑ Gas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes PrNo Fireplaces: Existing I New Existing wood/coal stove: 6 Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: V 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) �.e►� Telephone Name � F Number 50 g- 60017 Address l�-�• �x «� License # �r\MA-4--n ��ci Home Improvement Contractor# CP-►ti'�'er�� 1� d 3 L Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE,_ DATE _r FOR OFFICIAL USE ONLY APPLICATION# DqE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE', OWNER DATE OF INSPECTION: _ 4 FOUNDATION FRAME D I4ILho9 r t , c INSULATION Dh I /09 FIREPLACE ,> ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Iti IS) DATE CLOSED OUT ASSOCIATION PLAN NO. r f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I' 600 Washington Street Fj Boston, MA 02111 x ,,yy www.mass.gov/dia Worker' Co usation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Le ibl Name (Busin`ess/Organization/Individual): Address: c �1'i r City/State/Zip: ✓�Jl /l-� A 0.2,CSZPhone#: \-'5" Are you an employer? Check the appropriate box:� Type of project(required): 1.El am a employer with 4� I am a general contractor and I f � 6. ❑New construction employees(full and/or part-time).* V" 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 workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition_ i [No workers' comp. insurance comp. insurance.) required.]e u 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their Plumbing repairs or additions 11. 3. I am a homeowner doing all work ❑ g p El myself. [No workers' comp. right of exemption per MGL 12.❑.Roof repairs insurance required.].t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 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. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a'fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify underCt/hepains and penalties ofperjury that the information provided above is trite and correctt Si nature: J� Date: }� Phone#• &lo 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, 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 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 certificate(s)of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no.employees other than the, members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 'Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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 future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia f 0 ENER �' CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE, AND TWO-FAMILY DETACHED RESIDENTIAL.CONSTRUCTION (780 CMR 61.00), Applicant Name: Site Address: CJ�� ,L/7G �✓Q L Prim Town: Applicant Phone: PP � (e () Applicant Signature Date of Application: GF(D 1� dZ3 Q � r NEW CONSTRUCTION: choose ONE of the folIDWin two•o tions 790 CNIR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MA)QMUM Ceiling or Slab QOption l: Basement Fenestration exposed Wall Floor Perimeter Wall AFUE HSPF 5E U-factor floors R Value R-Value R-Value R Value R-Value and De th National Appliance Energy 35 R-38 R-19 R=19 R-10 R-10� Consmallan Art(NAECA) 4 ft. 1997 as asncndcd,minimums eater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ _Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be- accessed at http--//www.cnf,-rgyrodes.gov/rrschf--ck/ A,DDX' )01 S--OR AX..T�RATZONS.TO EXISTING 33M"*IlrIGS r0 VER5 FEARS OLD* *X3uildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following f6rmula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Fomnula: (100 x b_ a) SF 100 x - _ % of glazing (b) Glazing area equals SF b a e If glazing js<40%.use the chart below. If glazing is> 40 % rpcee,'d to"SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM hCNDVfUM Ceiling and Slab Perimete Fenestration Wall Floor Basement Wall R_Value U-factor Exposed floors R-Value R-value R-Value ' R Value and Depth .39 R-37 a R-13 • R-19 R-10 R-10, 4 fee a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). ' SUNROOM An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form found in Appendix 120.P The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street c Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): d^1^.j _57 Gi^W.Jy- /i3 N 6: A)-V COVIrrdcPbvJ Address: City/State/Zip:C.rp/A0a7{ AA 07-531 Phone #: �`7� �3�j Fg D Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.X I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp, insurance.$ y 10.❑ Electrical repairs or additions y required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11:❑ Plumbing repairs or additions myself o . right of exemption per MGL y [N workers' comp. 12.❑ Roof repairs insurance required.] t c. 152,§1(4), and we have no q ] 13.❑ Other employees. [No workers' , comp. insurance required.] "Any applicant that chdcks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. ` 1 am an employer that is providing workers'compensation insurance for my employees. Below rs the policy and job site-- information. f Insurance Company Name: Policy#,or Self-ins.Lie.#- Expiration Date: Job Site Address: City/State/Zip: < Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of MGL c.`152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 statementmay be forwarded to the Office of Investigations of the DIA for insurance coverage'verification. I do hereby certify ender the pains and penalties of perjury that the information provided above is true and correct, Signature: // Date: Z/ Phone#: Z/ Official use only. Do not write in this area, to be completed by city dr town official City or Town: Permit/License# Issuing Authority(circle one): I:Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions ` t. 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, 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 into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance: Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job 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 future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia I � ! -aae7 rac on/ ee, / A 1 � /dtOSal�z-. <6nl eei A mot jl CATIeChle f fJ,to t�-30 4-rAP-?- ACeCj I►,,"��' Qr �ej�/gc�s�eeT,g ac/< o v ee:�;,� Gr- �►I � �iep�,gCe ��r��r'io�l fin/ CG�•'�' �?� k-30 A iJ c( �l'p�4c�T At/.4Gre- /ace ,5�7-40CX Aa/cf -4poi-- t �re4 : - ��a,4ir /lMA AMA Q,�.Jlomr }3} 11f 4,Vd owe ^JAc/ s-t'y�, &e /cC ra' o.�- &.11 raved DoOrc 44 - INS - t 1 1 over ` Re,%�salp're, ce,/1:4 r� ��o • �/A�T _�A CZW 1NlU1 TON -' S�Pe1" ROUG ✓Tire Qiard�o� c✓ j`t �p" Altle,60/0 rc! AAJ,� c aaT A457'r / Na' AAJV .I%c✓P. c✓A!/ s' -,pi" TO �� (eJV� C,✓PAr' M� 1 G�, �C i,l?✓� Trim �gi� lJ1�o /��,2c� eAlOA)l i / G.1 i-1'4 Ade c3 i I • 1" , Town of Barnstable ��oftl�r�y� • Regulatory Services Thomas F. Geiler,Director 1659. . ,� Building Division Tom Perry,Building Commissioner 200 Mairi-Street,_Hyannis, MA 026.01 www.town.barnstable.ma.us Office: 509-962-4038 Fax: 509-790-6230 HOTF_O�kNER LICF-NSE EXEMPTION .C� Please Print DATE: /_ JOB LOCATION: I53 Zr' a r,,,i it a-t •/ number/I / /street vil lage „HOMEOWNER": �(;L7�j�.i.en 'SIIIW Q�f ,er c` yX36'S�-�D 62 7-1 name m Q hoe phone# " work.pbone# CURRENT"MAILING ADDRESS: O. O• 1)C) DC24 3�s _ cityhown state rip 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 Persons)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 DU 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 undcrsigncd"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeownef"certifies that he/she,understands the Town of Barnstable Building Department minimurn inspection procedures and requirements and that be/sbc'.will comply with said procedures and . rcq rir nts. 5tgna ' of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to cornply with the State Building Code Section 127.0 Construction Control. HOhIEOWNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building parnrit is required shall be exempt from the provisions of this srcbon_(Seetion 1 D9.1.1 -Uccnsing of construction Supervisors);provided that if the bDMCOWnEr engages a parson(s)for hire to do such wort,that such Homenwncr shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awarrness oflrn results in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it xould with a liccnscd Supervisor. The homeowner acting as Supervisor is uhimatcly responstblc. To ensure that the homeowner is fully aw=of hisAcr rasponstbilities,many communities mquire,as part of the pa-mit application, that the homeowner certify,that hdshe understands the responstbilitics of a Superrisor. On the last page of this issue is a.form curr ntly used by several towns. 'You may taro t an=d and adopt such a form/catifieation for use in your community. Q:forms:homccxcmpi 'THEr Tawn of Barnstable t Regulatory Services Was- Thomas F_Geiler, Director FDa Building Division Toni Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6: Property Owxier Must Complete and Sign This Section If Using A.Builder r , 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 ofJob) Signature of Owner Date Print Name 1 'n for permit pleas e complete the If Property Owner is app yr g p p p Homeowners License Exemption Form on the reverse side. a` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel 1-o T Z r3 Permit# Heahh Division, 6 37 I b Sl Date Issued .. !�� ?:to c� Conservation Division o E � j j + Application Fee Tax Collector Permit Fee Treasurer L110 1 D VIl 71,--SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village Owner Address Telephone Permit Request c o ye.,- Square feet: 1st floor: existing proposed 2nd floor existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Er Two Family ❑ Multi-Family(#units) // Age of Existing Structure l%7o Historic House: ❑Yes l�0 On Old King's Highway: ❑ 3�Yes o Basement Type: u 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:O/existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# ,. � . ... � Current Use Proposed Use� BUILDER INFORMATION r>( Name Telephone Number Address License# G5 a 7;2 6-7 3 �'._J�T�rylL-C-e '� o Home Improvement Contractor# _13,54{'7d Worker's Compensation# 7{A-G66 0'r-46 55��T� �9a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4r A -Ir— A 4-5 7-e SIGNATURE DATE ?—1 FOR OFFICIAL USE ONLY ..tip._ PERMIT NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS, VILLAGE OWNER DATE OF.INSPECTION: FOUNDATION FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH_- m FINAL PLUMBING: ROUGH: C? FINAL S . GAS: ROUGHZ) fZ R„ oz FINAL FINAL BUILDING S: fT; c'i cr � GC7 i d tMco 5 DATE CLOSED OUT �? S • ASSOCIATION PLAN,NO. �v The Commonwealth of Massachusetts { — — .Department of Industrial Accidents' - 600•Washington Street Boston,Mass. 02111'. Workers'. Coin ensation.Insurance Affidavit-General Businesses •- ' y s •f ;ro�sSna.• •T'�ar-'a4`'3,r•"•��,.:. ...• 'd • ,•:ice '� ,�; ;ieiV� N ame address; Cl 72-�e j�r - • state• zi :C� wor site locaiio>j full address I am•a sole proprietor and have no one $usiness Type. El Retail[]Restaurant!Bai�Eatin'g Establishment working in any capacity. [ Office❑ Sares(including.Rea1 Estate,Autos etc.)' ❑I am an em toyer with ern Io ees (full& art tim�: ❑ ether I am &oyer providingNYPrkers comp JyN +�' '•r„ •t - r.1:Y:ri•• '•:1:i•:r: ,j:.?.' :tt;:`:.,:' .� '.� "2I1 S18IT36' -{. ;;�:;;.ry; ., ,} ,•�.c j,��,:{•- r • ,; ':�':•• - t '•,i -;�:: ti': :,'1 w 'L "•t.'i:•' •• t•;:a:•'•':)�.• i•}:G'f��'di,Ti. •'{.:. ,7._ '.:i >: i„.'It r�' .. eddr•e'ss r .: r •• `, .t:.:.., '..,�.::• .i •; .. ;r ', ..{::n1•:'it ,l::r.. — f'•::' %t�'.ZJ:':,ter• '�•{. : :+ ..J.� ..'�t.••'• 'r' ii�t'•.��;j;��r 'i:•. ... ' �.� •'��.� � hope.#:��.�:•';� :.: •. ••+ ,',: •tr ,J. ,`'4 , ,`•+•r• y ;..J�'••.i�• fC' 'r .i •t�6� ''!',t:.'t{• 'i ' : •' ' �� ',^ �.j'; ,.. '.1 3't•'k: is'.ti'Ia:N'.t:�:,, ,. t O�C. •# : e..a ' •NaDCe.CO: :.r:•.I: •4y:.y,r.,• r:?::y'• .. ....' t ... •.n•.•;•,>� r ;...+,::. .,:.:-.-.: • // ' 0 I am a sole proprietor and hove hired the independent contractors listed below who have the following workers' compensation polices: ti :• ' .'t.' ' ,{• 't,,1. -.,:'3+1�31•' , ••y.• r:,•�., ,t.' ' '•+, �`.'• `•+ _~r•.rt3 y;, >,J•�y, '•':r.•:.;:t.i-•� •, aD 'IIam'C 4• ..:a 3:. , - S i• .i.y:•.t�r.'„ �� .c;- ^�'^ "„ice .tl' ^yN.:,,, rry: c.:n :'�.;..ti 't'•�" s'•t.• '.• —<i4r7 t,- ' V. •ini;'•Jii. ?r'1: !,: '3.' ,tr '� ',�:� ',h• :� v �.� .l � •(� •,•_ '�•�`. :�% � .jv::� .t,t•;�..•• �I '�,• .•a' • ,;:,. 'L. �.,�;•*t..J.••t '!. .�i. .aJ;r :.r• �'�: ,`i.�ro.r::l.y,�• .i .L• Y: : •:tip• r 7�•'•:.��•r'+•' t�,�: h•• r' • •:•' �t. -•!:1 : - .�. .'e 'rt, r.i �w;, . .i":r;i.r:',�'^ 7:�t; �t". , ••.,;' 'r~';5p .', .{•i•,'t `�• ,• ,r• •`,t •Y 1/:'.4.:'• •' =F,:4 r'r� t• :::• _t:' �o b :#'• ,f,J .,L•1•:•.:,}t••.k. .!••:•• •'.J:�:. 't5••fi.t\ r''t•. insurance:co. �: r` / ,,• nt i':t" ,3 ••,: nl:.. •l.•.t,,.�i' .'i••'ir. •'j.L':• 1 'J r• t•, .t'• .. S j •',,': .'r $ }:n.::.' ••ice ,� '�';:.J•}: Y. ;,i.:.:'[„h,+:. ''ri'��'••-l•. coin`9I3• uande:,cr .a. •;� ••t' ,•, t•• t. ' ifs: , address: y' l r.,•;.0 '3 -VIorii A: CHI, ,_ :ir' ' .•v>•.' i;y: h. i.} .a...t41 '.j..- %: .ai•'. j a Yy'r.a: ;:�.i,;, :i •5 .:1 • Y' :i•47r 'r• {j.y'ri ,�..•'�.. S '"�• •Sr •�t• o°'' .:,. .:3,.••:•'+:y.; - >. Y, •� a1.: :'�•.r. _ "•iJ,' :i �•,: .r•+4 ',{�,1,?f,rif.,r.4.: _'.1,:y •+,;.. 'r' 'i•.J'{` {.1 _ .i:..:t•�:' ••'v.. •:i�.: :a"•..i . t; ,J '..J.�. ..011CY' �i `---: insur'ance�'so: /' '� • •':. �' • / . .. . :• ...-;••.-.„. •.,%;.:;.:-'.:• 52 can lead to the Imposition of criminal per of a fine up to$1,500.00 and)or 5' ofMGL1 P e Section 2 A a••e as require und er rS secure cover q Failure to sec g one years'imprUanment as well as civil penalties In the form of a STOP WORK OILDER and a fine of$100.00 a day against me. I understand that a statement maybe for-warded COPY o f this statement to the Office of In of the Dl4for coverage verification I do hereby certify u er a sins arid' enalties of perjury that the information provided above is Prue and corfec4 Date ::z� 0 , Signature LJ�• Phone# �. � r—_7-c� ' ... Print name J official use on?y do not write in this area to be completed by city or town official permit/ilcense# ❑Building Department, ', city or town: ❑Licensing Board ediate res onse is required ❑Selectmen's Office❑check ifinsa P ❑$ealthDcpartment , contact person: phonef; ❑Other -i (r:v9edS 203) e3 Z•ao r nforn ation and Instructions• t 1 ers to rovide workers' compensation for*their. ViassachusettS.Gerter'al Laws chapter 152 section 25,requires all erne oy p loyees, A� quoted from the f`Iaw", an employee is.defined as every person in the service'of another under any contract �p lied, oral or written. or irnp of hire, express .• m to er is defined as an individual,Fartnec'ship, association, corporationnV�of a dether gea ed ai Tyernployer, or the ry two or eceiver or re of An e p y oint ent rise, and including the legal repres the foregoing engaged in a'] erP�01 to ees. 'However the owner of a individual,pership'• association or other legal entity, employing emp trustee of an y ' house having'not'znore than three apaitrnents and-who resides therein, or the.occupant,of the dwelling house of d trustee .lo _per to do,maintenance, construction or repair work on such dwelling house 6r on the grounds or another who emp,'ys . bu>Ig appurtenant thereto shall not because of suchemployment.bedeemed to be an employer. chapter 152 section 25 also'states That every state'or local licensing agency shall th for an ia u licant who hask MGL P of a license or permit.t0 operate a business or to construct buildings in the.cammo, Y PP.ddit on ,. ci the not produced acceptable evidence of compliance with the insurance ctracgfor the performance of public work until P of its olitical subdivisions shall enter into any p cot mnonwealth nor.any P resented to the contracting acceptable evidence of compliance with the insurance requirements of this chapter have been p authority. Applicants • ,• • . Please fill in .the workers' compensation affidavit completely,by checking the box that applies to yotu sitii'ation.:Please su 1 company frame, address and phone numbers along with a certificate of insurance as all affidavits may be submitted PP Y to the Dep�ent•of Industrial Accidents-for confirmation of insurance coverage. . Aho'be sure to sign an ate e • affidavit The affidavit should be returned to the city or town that the application for the perrrit or license is being requested, not{he b, i�trnent of Industrial kcciderxts-. Should you have any questions regardin 'the"Iaw" or if you are q workers'•compensationpolicy,please call the Aepartment at the numbeflisted elow. required to obtain a: , City or Towns . Please be sure that the affidavit is complete andprinted legibly. The Department pure arddin the a space at thdlicant Please f the affidavit for you to fill out nx the event tie Office of Investigations has to contac y g g PP be sure to fill.iu the perrrntlkcense number.which Will be used as a reference number. The.affidavits rnay.be,returned to an ements have been made. the Department by. or FAX unless other•axr g ations would lfice to thank you in advance for you cooperation and should The Office of Investig you have airy questions, please do nothesitate to give us a•call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents �C8 Oj�1fE�1�9I1S . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext-.40.6 • yoY � dw a, of Barnstable '(HE °•� R.egnlato y Servides. . a� Thomas F.Geiler,Director sa34,� 11', 33dI fug Division.'OIFD MA'S ' Tom Perry,Building Commissioner* ' 200 Main Street, Hyannis,MA 02601 , Office: 508-862.4038 Fax; 508-790-6230 • pmmit no, pate , . ,A.I'F7DAVIT • IKOME WROVEMENT CONTRACTOR LAW SUPPLBMTNT TO PERMIT APPLICATION • MGL 0,142A requires that the'reconstraotion,alterations,renovation,xepair,modernization,conversion, • •improyernan%;removal,demolition,or construction of an additiaato my pie-existing owi;er-occupied conta' ' ' at least one but not more than four dwelling units.or to structures which are ad acent to dm � g j butyl g such rosidence or building b e done by xegtstered contractors,with certain exceptions,along with other requirements, Type of Work: •�u�l� Siff � u Estimated Cost A 57 — Address of Work: Owner's Nerve; Data of Application; d� I hereby certify that: Re#stration is not required for the following reason(s): ]Work excluded bylaw ' []Jab Under$1,000 []Building not owner-occupied []Oster pulling own permit Notice hereby given that: , OWnP S PULLING MIR OWN PERMIT OR DEAIMG WITH UiZREGIBTERED CONTRACTORS FOR A.PPLICAB•,I;E HOMME MIPROYMaNT W ORHD 0 NOT JIM ACCESS TO THE.AMIMTION PRO GRAM OR GUARANTY FM UNDER MGL c•VIA,, SIGNBD UNDERPENALTMS OF ntimY -Iber6y apply for permit as the agent of the owner: AW .Q Data Contractor Name �e4istrationl�(o. OR a Owner's Name BpA;Rr 0r eanse Q EO BUICIM RE IV NSTIZUC` G e�rt Mbe� ^ w0790 3SlUpERSOR S S xDS�935 � 1 t WICCIgeM Re*tr 04 Tr. i 170 MA`RTIW ylP �g no.. 7g573 �. pSTERr/�F MA $oard of NO B4d�g Regulation�y ME IMpROVEME and Sfaadae dy ®r Re9'suvtion. C�NTRACTpR Pirat�on. :13487p , 3 �2006 WIL typo: ]n'' LIAM MARTiN,lfl dual M MA WILLIARTI . N 111 170 EVANS ST OSTERVILLE,MA 02655 Adt°i4iyhatoc AWE r Town of Barnstable ti Regulatory Services MUMSTABLEs Mnss. g Thomas F.Geiler,Director rFo�„p�°i Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, L0-4jug.'o 5elvrti r� , 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) F Signa a of Owner VDate Print Name Q:FORMS:O WNERPERMIS SIGN , , k NOTICE _ �° - 1 NOTICE TO TO, - - - YEE S..._ . 0 ES k 600`ashingtc n-Street,_Bost€ n,Massachusetts 02111 AS rLciui red-by-i'Maass-a.i)usetts:Generat:-L4tw, chapter f52,met:on '21,22 & 30 this rill give you not l (wc)_ have-provided iur-t3ayntenLlo our.intnred employees-Larder the chow mentioned ch�iptcrl�y insuring with: .- -HARTF.DRD-U1'NDE`,2 i:T€-R' NSvR04CE ..COMPAW -NAME OF IN-SURA_NCE COMPANY 0tv� TOWER SQUARE HART FzORDj -CT.-Iv 4tg3 e.y'ir ADiSS: F fN4i i QN 'F tI>?A:N ' �.i.1.._04..-TO 06-1..1..-05 , arc U ... FcrI DA-'rlj a— KEPRY ACC IW� RC BOX 1945 1 RTH-I-ASTHA1 -MA'02G5.1.. ® A 0-R NS�,�.dat1N �.s v i ADDRESS —� MARTI IILLI I?I 170 EVANJ 57 ^� a� GSTERVILLE MA 02655 ��. �Nflx"LO:ki'ER _ADL-R.LrSS F ' 3 21 RS.CONV�i�I✓NSA 1 1O)WO y :I Y ;SAT Inc above m-nod insurer is required in cases of personal injuries arisin ..uut gf and in,;tile_course:.of. _ YF Lei to-- i l- a&—cla-ate-sand.reasomtsle-hospital and medical tiervices in accordance with t e prow'-,�- of tlae'voriei-s'--Cciinnensati«n Act: A'co_ny of'the First Report ofIn�•ury mustAbe ivei `'l' ) lche injured"em.pl iyec�_ The employee may-select-his-or her o),NT-physician Thc.'rcasonabie Cost.cii the tit xvices provided by.the-tmatfng Ihysician 'Wilt be-paid-by:_the insurei,..if.tale treatmenI s-nei:��sary anti Fr. asonab.ly ?' connected to the�cc�rk r-elated iu}ury_ tat cotes-requirir<g hospt al W itio."46trt ln�ees ate{hVrehy rrc�til�ed-.. t that_the_imstirrer-la arraWd.d or'suer-'atteattion-at theJ. ��"'� a��'rrJe� a n a rxa r { NAME-OF H S AS:._. prs I i i � P I, 31 x68 1 F f, ; �I I f ..2KSL �v�c�s•, ` pT 0- /7 Fo c.civclq-7Yo f r►4 M n�� o�jt Tom,, Town of Barnstable *Permit# rMsy. .io Expires 6 ntontlisfront issue date snxt�srAat.E, Regulatory Services Fee + — nsnss Thomas F.Geller,Director 619 rED MA4 `� • �'° °' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PER Office: 508-862-4038 JUN 3 0 200 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE �jlo�lo� �- Map/parcel Number p /� Property Address Residential Value of Work Ato q.. [� Owner's Name&Address Contractor's Name _,Z �" /A' Telephone Number.Sr-d'—5 P 7�0 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: [] I am a sole proprietor ❑ I am the Homeowner �c I have Worker's Compensation Insurance Insurance Company Name e � Workman's Comp.Policy# ono Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) VRe--roof roof(stripping old shingles) All construction debris will be taken t(not stripping. Going over_�existing layers of roof) ❑ Re-side ❑ Replacement Windows. 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. ome Improvement Contractors License is required. Signature Q:Forms:expmtrg `i/�6L - 7 � r Revise053003 Town of Barnstable o� Regulatory Services Thomas F.Geller,Director Cb 16119, a1 Building Division pTF1) Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wyvw,town.b arnstable.ma.us Fax: 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section if Using A Builder I, as Owner of the subject property �elk) to act on.mybehalf, hereby authorize LC matters relative to work authorized by this budding permit application for: (Address of Job) aq oy Date Signa a of Owner . q Vj lee4 ✓ Print Name l r.mrvp Mo nV'I SMUF UZSSION � ✓1ze T�o7runw�aureea�i a�./�aaaac�ivaP,lla Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 134870 ipration: 130/2006 TYPe Individual WILLIAM MARTINJN:- WILLIAM MARTINi-l" 170 EVANS ST. OSTERVILLE,MA 02655 Administrator UPDATE PERMIT RECORDS: ADD CHANGE DELETE PRINT FEES HELP END CHANGE RECORDS IN PERMIT TABLE PENTAMATION----------------------------------------------------------- 11/19/04 PERMIT NO. 79432 PARCEL ID 211 001 002 153 INDIAN TRAIL PERMIT TYPE BREMOD RESIDENTIAL ALT/CONV DESCRIPTION REPLACE BULKHEAD W/ENTRY DOOR STATUS . C COMPLETED APPLICATION DATE 09/23/2004 DATE ISSUED 09/23/2004 EXPIRATION DATE DATE COMPLETED MASTER PERMIT VARIANCE VALUATION 2000 . 00 BOND 0 . 00 CONSTRUCTION TYPE 434 GROUP TYPE 1 CONTRACTORS 079573 WILLIAM MARTIN III ARCHITECTS/ ENGINEERS/OTHERS ENTER Y IF ALL ARE CORRECT OR N TO REENTER LEAVE BLANK- FOR NON-PROPERTY RELATED PERMIT. CTRL-I FOR HELP. j � 1 7 V VIA Aj n � •S a 4 4J I + I j Sco - �30 E PAR ED Foie: a,4 rc .zEFEecc,ICEr Z 7-.4/E 6UIZ-0/At/451 SA-VOWA/ O.1/ TH/S PLFaN /S /_OGfiTED O.V T�./E ,:;7 20UA.1,D .qS -T/-/O WA.1 HEeeO.V � AS NE �Ou//'7 cam en9inecr-�r�9 ". 1 Ci�/�L E.VG/.VEEL3 0�� 'F41A'V4&YooZ �:.•,� �.�•-��',�,,,-o:�;ter, ,t�A�` ` — —�+�.��- ----- - ^R'� err��Yt�Ci�7 J'f .SUPS/CYO e r 0Gcr:/a�Lyu��ic%iCiayw c�ruG�t`ccrulc�tc�.a� ARGEO PAUL CELLUCC[ (lYtPi Y� 1u/LL(�l1/ - c/LCdfl�i 73�7 KENTARO TSUTSUMI Governor may- F �� /LAG tf �,�� Chairman JANE SWIFT e�JIJOUYlI/ l JPiGLO THOMAS L.ROGERS Lieutenant Governor Administrator TEL: (617) 727-7532 FAX: (617) 227-1754 JANE PERLOV Secretary October 5, 1999 Mrs. Kathleen Silverryder 153 Indian Trail Road Centerville, MA 02632 Dear Mrs. Silverryder: The Board of Building Regulations and Standards has received a letter of complaint regarding . construction of your .home in Centerville, Massachusetts by the Town of Barnstable. The contractor was Mr. Timothy St. Pierre. I have enclosed copies of letters sent to the contractor and the District State Inspector, Jeffrey Putnam. The Board has a License Review Committee comprised of three members of the Board, that hears complaints regarding violations of the Massachusetts State .Building'Code committed by licensed construction supervisors. The first step in the process is the referral this complaint to the District State Inspector by the Chief of Inspections. If the report from the inspector states the case should be brought before the Committee, the case will be scheduled for a hearing. At the hearing, the Committee will listen to testimony from you,. the,Town of Barnstable, and the construction supervisor. The Committee will then decide whether the violations warrant a letter of reprimand, a suspension or a revocation of the construction supervisor license of the individual. The Committee may also decide that the violations were not true violations of the Massachusetts State Building Code and, as such, determine that there shall not be any action regarding the construction supervisor license of that individual. The License Review Committee cannot order the construction supervisor to repair any construction or refund any moneys paid by the complainant. The charge of the Committee is to only take action regarding the Construction Supervisor License of an individual. The, Committee asks that if the State Inspector contacts you that you assist him in his investigation and that if a hearing is scheduled that you make an effort to attend. If you have any further questions, you may contact me at the above address. Sincerely, BOARD OF BUILDING...REG. ATIONS AND STANDARDS /7 Marian E oylelle `-- Program Manager ; 1 a ARGEO PAUL CELLUCCI �rEP/ AacP/- dWoopm 7301 KENTARO TSUTSUMI Governor � 02-108 Chairman JANE SWIFT THOMAS L.ROGERS Lieutenant Governor TEL:.(617) 727-7532 FAX: (617) 227-1754 Administrator JANE PERLOV Secretary October 5, 1999 Mr. Timothy P. St. Pierre CSL # 66952 148 Arrowhead Drive Hyannis, MA 02601 Dear Mr. St. Pierre: The Board of Building Regulations and Standards (BBRS) has received a complaint from The Town of Barnstable regarding your Construction Supervisor's License (see attached letter). The BBRS is the issuing agency for your Construction Supervisor's License. The Board has a standing committee, the License Review Committee, which conducts hearings to determine the ability of a Licensed Construction Supervisor to continue to hold his/her license. The Committee begins the process of a hearing by requesting a District State Inspector to investigate the complaint to determine if a hearing is warranted. If the State Inspector returns his report stating the Committee should conduct a hearing, you will be requested to report for a hearing. You will be given at least ten days notice of the hearing. The License Review Committee, after a hearing, may suspend or revoke the Construction Supervisor License of an individual for violations of the Massachusetts State Building Code. This is all in accordance with 780 CMR R5, Construction Supervisors Rules and Regulations and the Massachusetts State Building Code (780 CMR). It is the Committee's hope that you will assist the District State Inspector in his investigation, if he contacts you. Failure to assist in.the investigation or to appear at the hearing, if scheduled, could cause suspension or revocation of your license. If you have any questions or comments, you may contact me at the above address or the District State Inspector, (Jeffrey Putnam). Sincerely, s BOARD ©F BUILDING-REGULATIONS AND STANDARDS Marian E. Dot- Program Manager 0 ARGEO PAUL CELLUCCI � � — �''�C�/' KENTARO TSUTSUMI Governor Chairman JANE SWIFT THOMAS L.ROGERS Lieutenant Governor Administrator TEL: (617)727-7532 FAX: (617) 227-1754 JANE PERLOV Secretary October 5, 1999 Mr. Thomas Perry, Building Inspector Town.of Barnstable. Building Division 367 Main Street Hyannis, MA 02601 Dear Inspector Perry: The Board of Building Regulations and Standards has received your letter of complaint regarding construction on the home of Kathleen Silverryder from Centerville, Massachusetts. The contractor was Mr. Timothy St. Pierre. 1 have enclosed copies of letters sent to the contractor.`.°anal.the District State Inspector, Jeffrey Putnam. The Board has a License Review Coriiinittee c*Omprised of three members of .:he Board, that hears complaints regarding violations of 'the Massachusetts State Building Code committed by licensed construction supervisors. The first step in th.e process is the referral this complaint to the District State Inspector by the Chief of Inspections. If the report from the 'inspector states the case should be bio agh&before the`Committee;.-the case will•be•:scheduled- fora hearing. At the hearing, the Committee will listen to'testimony from you, the District State Inspector, and the construction supervisoi. . The Committee,will then decide, whether the violations warrant a letter of reprimand, a suspension-.or a -revocation of the construction, supervisor license of the individual. The'Committee.may,also decide that the,violations were not true violations of the ll'iassachusetts State Building Code and, as such, determine that there shall not be any action regarding the construction supervisor -license .of that individual: . 'The License Review Committee cannot order the construction supervisor to repair any construction or refund any moneys paid by the complainant. The charge of the Committee is to only take action regarding the Construction Supervisor License of an individuai. A. The Committee asks that if the State Inspector contacts you, that you assist him in his investigation and that if a hearing is scheduled that you make an effort to attend. If you have any further questions, you may contact me at the above address. Sin erely, BfaAF OF,BUI DING-,REG I: O S AND STANDARDS' 7. 'Mariah,E Do Program"Manager {�- W 61icel ol JuMrl AA* ARGEO PAUL CELLUCCI � � �df17i 7`��7 KENTARO TSUTSUMI Governor may_. f_ __ �j� 02708 Chairman JANE SWIFT THOMAS L.ROGERS Lieutenant Governor Administrator TEL: (617) 727-7532 FAX: (617) 227-1754 JANE PERLOV Secretary October S, 1999 Inspector Jeffrey Putnam Department of Public Safety Paul Dever State School 1380 Bay St. CERC Bldg. Taunton, MA 02780 J Dear Inspector Putnam: Enclosed you will find copies of three letters, 1) a letter and reports from the Town of Barnstable; 2) a letter to the Construction Supervisor in question (Mr. St. Pierre) from Marian Doyle, BBRS staff member 3) and a letter to the homeowner. Please review all the material and investigate as to whether the Construction Supervisor License holder should be brought before the License Review Committee of the Board of Building Regulations and Standards. Upon completion of your investigation, please- respond by a written report to Marian Doyle of the Board of Building Regulations and Standards. This report should contain any violations of the Massachusetts State Building Code along with those section numbers and a recommendation as to whether this case would warrant'a hearing before the .License Review Committee. Sincerely, i Thomas L. Rogers Chief of.Inspections °FINE h►. The Town of Barnstable BMWSTABM Department of Health Safety and Environmental Services ArFDnw't°' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner July 12, 1999 Timothy St. Pierre PO Box 383 80 Enterprise Rd. Hyannis, MA 02601 Dear Mr. St. Pierre: Since May,this office has been trying to get you to respond to us concerning 153 Indian Trail. So far you have failed to respond, despite several letters directing you to do so. If you fail to contact this office within 48 hours we will turn this matter over to the licensing board of the BBRS for further action. Sincerely, Tom Perry Building Inspector Certified Mail#Z368 667 536 0-C ►Jc'�-C- �pF THE)� . ��, ; The Town of Barnstable MUM9� M �� Department of Health Safety and Environmental Services 10�En.59. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner September 15, 1999 t f State Board of Building Regulations&Standards McCormack State Office Building One Ashburton Place-Room 1301 Boston,Massachusetts 02108 RE: Request for License Hearing on Mr.Timothy St.Pierre Construction Supervisor's License#066952 Exp.3/11/00 Home Improvement Contractor#121240 Section R5.2.9.1 Gentlemen: As per your request,enclosed please find additional information concerning my letter to you dated September 13, 1999 and the above referenced licensee. Thank you for your attention to this matter. Please let me know if you have any additional questions. Sincerely, • Tom Perry BUILDING INSPECTOR Enclosure Al q:perry:991509a i . . ; The Town of Barnstable 9 M Department of Health, Safety and Environmental Services i639. `` Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 September 13, 1999 State Board of Building Regulations&Standards McCormack State Office Building One Ashburton Place,Room 1301 Boston,MA 02108 Re: Request for license hearing on Mr.Timothy St.Pierre, PO Box 383,80 Enterprise Road,Hyannis,MA 02601 Construction Supervisor's License 066952,expiration 3/11/2000 Home Improvement Contractor number 121240 Sect.R5.2.9.1 Gentlemen: The reason for this request is because of a house that Mr. St.Pierre contracted to remodel at�153TIndian::!� ,,Trail=RoaC-Centerville;MA:. In early May the homeowner,Mrs.Silverryder contacted our office about the work that Mr.St.Pierre had performed on the house which she owns jointly with her husband. The project consisted of elimination of a rear deck,installation of a new deck,and expanding the existing kitchen approximately 156 square feet. The homeowner contacted our office because Mr.St.Pierre was refusing to come back to fmish the job. When I checked into the paperwork and computer logs,it was discovered that except for the foundation on October 16, 1998,no further inspections were performed or requested on this project required by Section 115.2 of the Sixth Edition of the Mass. State Building Code. I sent a letter to Mr'. St.Pierre on May 4, 1999 requesting him to contact our office about this matter with no response. Further letters were sent by registered mail,return receipt,with no response. The letters were accepted because we received the receipts. These people are both disabled and are at their wits end over this matter. When we received no response to our second registered letter pursuant to Section 119,a Stop Work Order was posted on 7/30/99. This office looks forward to your response on this matter;and if we can be of assistance,my personal phone number at the office is 508-862-4034 and the main number is 508- 862-4038. We thank you in advance for your help in this matter. Sincerely, Thomas Perry Building Inspector TP/lb g990913a UNITED STATES POSTAL SERVICE First-Class Mail Postage,&Fees Paid USPS "" Permit No.G-10 9 Print your name, address, and ZIP Code in this box O h; Town of Barn," BUIlding nivisljn 367 Main St. s , Hyannis,MA 02601 I ai SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the F1 ■Complete items 3,4a,and 4b. following services(for an q ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. Attach this form to the front of the mailpiece,or on the bads if space does not 1. ❑,Addressee's Address ■ 'Return Receipt Re uested'on the mail piece below the article number. m d P 4 p 2. ❑ Restricted Delivery rn J The Return Receipt will show to whom the article was delivered and the date .. c delivered. Consult postmaster for fee. °• •0 3.Article Addressed to: 4a.Article Number ST. P, E 4b.Service Type 0 Q�' 3 ❑ Registered O Certified ¢ rn ¢� b ❑ Express MA o26OI ❑ Insured H ¢ �{ N�!S /n / ❑ Return pt for Merchan ❑ COIF 7.Date o livery w V� 0 z ;, 0 5.Received By:(Print ame) 8.Addresse Address(On tf equested c W and fee is p L m ¢ USYS t- 6. re dr see or t) 0 h I PS Fo 1, De ber 994 102595-97-13-0179 Domestic Return Receipt I °F THE w The Town of BArnstable BAMSrnst.E. 1'N6A38.9� `0�' Department of Health Safety and Environmental Services ArEn �" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 25, 1999 Timothy St. Pierre PO Box 383 80 Enterprise Rd. Hyannis, MA 02601 Dear Mr. St. Pierre: As of this dateyou�have=stfiffi t:contacted-this office m-regards to 1`53 Indian Trail'R'vin _ _ - 'Centerville! It is imperative that you do-so-immediately _`There_:are�many issues with this project that need to be resolved. Sincerely, Tom Perry cc: Charles Case File Certified Mail#P 339 592 445 A d i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Print your flame,address, and ZIP Code in this box• Town of Barnstable Building [Division 367 Main St. Hyannis, MA 02601 Ct 1. �:��erittl.:it{��t1it��ttt1�n(�r�t�rt�titt�rtt�a��tt�lii��tei f d SENDER: 1 also wish to receive the W ■Complete items 1 and/or 2 for additional services. in ■Complete items 3,4a,and 4b. following services(for an i ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. !� ■Atttacc this form to the front of the mailpiece,or on the back if space does�t 1. ❑ Addressee's Address permit. ■Write'Retum Receipt Re uested'on the mail pi below the article number. ■The Return Receiptwill show to whom the article was delivered and the date 2. ❑ Restricted Delivery a C delivered. Consult postmaster for fee. 0 3.Article Addressed to: 4a.Article Number cc MO i�ty3�8 &to7 536 /Y f flc�,Ut-� 4b.Service Type ( Q p X 8 ❑ Registered - ❑ Certified gliA© ��SG ❑ Express Mail ❑ Insured U ¢ O eRetum Receipt for Merchandise ❑ COD `o a f�/,4AJ�J)S, 7.Data of olive z 5 5.Received B •(Print ame) B.A d ssee's Address(Only if requested � l and fee is paid) r 6.Sin d s r Age Qe t— orm - er 99 102595-97-B-0179 Domestic Return Receipt °FTMe tom_ . "� The Town of Barnstable anfaysrnsM 9� Department of Health Safety and Environmental Services ArED Ma+A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 4, 1999 Timothy St.Pierre PO Box 383 80 Enterprise Road Hyannis,MA 02601 4 Dear Mr. St.Pierre, This letter is in regards to a project that you had contracted to do and pulled a Building Permit#33223 at 153 Indian Trail Road in Centerville. The records we have indicate that,pursuant to the Massachusetts State Building Code,there were no framing,insulation,electrical or plumbing inspections done on this project. There are also a number of issues that were left incomplete and need to be corrected. Please contact this office within seven(7)days in order to see how this situation can be rectified. Sincerely, Thomas Perry Local Inspector cc: Owner Charles Case File 0 g990504a i�. • E l Map Parcel Permit House# ll pp ,�- Date Issued B and of Health(3rd floor)(8:15 -9:30/1:00- 3$) �, h Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) ' fFP 10 Sy Planning Dept.(1st floor/School Admin. Bldg.) �� s � �� Definitive Pian Approved by Planning Board 14:A, 19 A EN QANc TOWN OYBARNSTABLE A It; Building Permit Application Project Street A fress .,/5-'3 Village Owner W 1LA S,�/�/L2.y/3�s� , Address /_' 2 ��/n�A ,541•1 124 , Telephone Z, � G( � _Permit Request .4,LO,t2t2niJ - /�/7' e—AA". )QD 0 ;e1n 3,g i X, & 7 -First Floor square feet Second Floor square feet Construction Type WwD Estimated Project Cost $ zo , ra e)d Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure $ ,2, Historic House ❑Yes No On Old King's Highway ❑Yes JNo 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 No.of Bedrooms: Existing O—� New Total Room Count(not including baths): Existing "7 New First Floor Room Count Heat Type and Fuel: ❑�Wo �/Oil ❑Electric ❑Other Central Air ❑Yes Fireplaces:Existing 1 E New Existing wood/coal stove ❑Yes UNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) p)Attached(size) �/� X 2? ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes (/No If yes, site plan review# Current Use Proposed Use 11 Builder Information Name j ' - 1 STir Telephone Number Addressj /?iSr ✓ License# f�`G )A dam! Home Improvement Contractor# /t � ccJJ Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE BUILDING PE MIT DEENIED !;MLOWING REASONS) f FOR OFFICIAL USE ONLY _ FRERMIT ISSUED - 4 I AP/PARCEL NO. • r _ i •n ADDRESS ' VILLAGE _. r OWNER DATE OF INSPECTION: t d FOUNDATION FRAME INSULATION - FIREPLACE •ELECTRICAL: ROUGH FINAL ' y PLUMBING: ROUGH FINAL GAS: ' ;: ROUGH FINAL g ' FINAL BUILDING fi DATE CLOSED OUT ASSOCIATION PLAN NO. w `MAScheck COMPLIANCE REPORT ' Massachusetts Energy Code MAScheck Software Version 2 . 0 Permit # i Checked by/Date CITY: Hyannis ' STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric- Resistance) DATE: 9-1-1998 DATE OF PLANS: 9\2\98 TITLE: 315 SiLVERRYDER PROJECT INFORMATION: Addition & exterior deck 11 ' x14 ' kit . extension COMPANY INFORMATION: Timothy P. St -Pierre d/b/a Saint Const . Co. 80 Enterprise Rd. Hyannis , Ma. 02601 COMPLIANCE: PASSES Required UA = 30 Your Home = 30 Area or Insul Sheath Glazing/Door . Perimeter R-Value R-Value U-Value UA -------•------------- _ __ CEILINGS 182 38 . 0 0. 0 5 WALLS: Wood Frame, 16" O.C. 93 14. 0 3 .0 6 GLAZING: Windows or Doors 16 0 .400 g DOORS _ 21 0 . 350 7 FLOORS: Over Unconditioned •Space 182 30 . 0 6 HVAC EFFICIENCY: Furnace, 78 . 0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans , specifications , and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST -Massachusetts Energy Code MAScheck Software Version 2. 0 315 SiLVERRYDER DATE: 9-1-1998 Bldg. ; Dept . ; Use I I CEILINGS: [ ] ; 1 . R-38 Comments/Location WALLS: [ ) ; I . Wood Frame, 16" O.C. , R-14 + R-3 Comments/Location I I WINDOWS AND GLASS DOORS: ( ] ; I . U-value: 0. 40 For windows without labeled U-values , describe features : # Panes Frame Type Thermal Break? ( ] Yes { ] No Comments/Location DOORS: 1 . U-value: 0 . 35 Comments/Location I I FLOORS: [ ] ; 1 . Over Unconditioned Space, R-30 Comments/Location I HVAC EQUIPMENT EFFICIENCY: [ ) ; 1 . Furnace, 78 . 0 AFUE or higher Make and Model Number THERMOSTATS: [ ) ; Adjustable thermostats required for each HVAC system. I I AIR LEAKAGE: [ ] ; Joints , penetrations , and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. I VAPOR RETARDER: [ ] ; Required on the warm-in-winter side of all non-vented framed ceilings , walls , and floors . I MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values , glazing U-values , and heating equipment efficiency must be clearly marked on the building plans or specifications . I DUCT INSULATION: [ ] ; Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing .air and water systems . TEMPERATURE CONTROLS: [ ] i Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . MJ SC REQUIREMENTS: [ ] ; Refer to 780 C�xN(R, Appendix J for requirements relating to swimming Pools , HVAC p 4,-ing conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) --------- r r UEPAOENT OF oi!ei T� ASTRUCTION SUPEP..VT OR f Cc @66952 -mo:rHy r.8 A.R R 0 114 E Ai" R "low PAW-. AA 'HOME IMPROVEMENT CONTRACTOR RegistTation IZ1240 -T�pe 1001VIDUAL Expiratioi. 04/18/00 TIMOTHY ST. PIERRE iA TIMOTHY P. ST.-PIERRE 80 ENTERPRISE RD ADMNMTWFPR ...,HYANNIS MA 02601 !40 tpy,_ .�.'Y The Town of Barnstable ELARMARM • MAM16 9. `0$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date 23/"71y 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: _APQ-h®1ti Estimated Cost Address of Work: Owner's Name: Date of Application: 31—/ S1 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 Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: r/ � Date r ctor Name Registration No. OR Date Owner's Name q:fortm:Affidav r The Commonwealth of Massachusetts Department of.Industrial,Accidents ' ..-=� Office olfatresM92 Mans ' 600 Washington Street _ Boston,Mass.• 02111 Workers' Compensation Insurance Affidavit name: p- � location e ® city phone# -2 .� ❑ ?am a hoidcowner performing all work myself. ❑ I am a sole p �prietor and have no one working in a11v ca acity / „„ ❑ lam an employer providing workers' compensation for my employees working on this job. com anv name• address: city, phone#- insuynnee co. PnHCV# SEEN/,MUM WA a I am a sole propriet eral contractor. or homeowner(circle one)and have hired the contractors listed below who have the following workers compensation polices: ....... conmvanv name address: d � hone#• ��• � � ....... . • n<:::: :::. Insurance c Poli ct cam anv name: address• dtv phoneIICV #� ... ..::.::: ....:....... . insurance co. Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a Me up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the forth of a STOP WORK ORDER and aline of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Olflce of Investigations of the DIA for coverage verification I do hereby certify`un#rr-th airs and e� a ry that the information provided above is true and correct Q Signature / Date /'�� ✓ �,,/_ Priest name' Phone# l��L)�� ?� �5 ofIIdal use only do not write in this area to be completed by city or town of1►dal city or town: peradocense 0 Mulldlnq Department ❑Lleensing Board ❑checkff lnunediate response is required Me a rtm n Heaalthlth Department contact person phone#-- ❑Other (revues 9/93 P7A! Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their emplovees. As quoted from the"law", an employee is defined as every person in the service of another under any caasac 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 . 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 auv''ia�,cr who --Ivy y Tav-vr% a to rin maintenance , construction or repair work on such dwelling house or on the grounds o: rr.,......... building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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. PER Applicants Please fill in the workers compensation affidavit completely, by checking the box that applies to your situation and supplvmg company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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/licease number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax nnuber: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imiesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 ,oF.HE,�,�� The Town of Barnstable o� MRNSTABLE. Department of Health Safety and Environmental Services MARSL . � t6�9• `0g PlEDMP��' Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location f 4-,j 1 E41 I Permit Number Owner S d (Uf-L- -De Builder One notice to remain on 'obsite one notice on file in Building Department 60�� 2. C�f-e- J � g P •The following items need correcting: 3400 n.-2 /[00 tj 7-f c'- CDz:) r r /3,4 C IF ctJfF2�) T 2 j C( dl, 1,9 (29 X& 7— J 1: L7(. -e A/ G/,*te,,Z W g r e/V ,�P-rrW 2 e kka-r-C �2cr-i2(C_A- NZ) 4Ec-r2Q Please call: 508-862-4038 for re-inspection. Inspected by C_.' Date t 4, TD`ON OF BARNSTABLE WOOD STOVE PERMIT PARCEL ID 211 001 002 GE'OBASE ID 32845 ADDRESS 153 INDI% AN TRAILI PHONE Centerville ZIP LOT 2B BLOCK � .LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 10387 DESCRIPTION WOOD STOVE PERMIT TYPE BSTOV TITLE STOVE PERMIT Department of Health, Safety CONTRACTORS: and Environmental Services i ( ARCHITECTS: TOTAL FEES: $50.00 ��ME BOND $.00 C014STRUCTION COSTS $.OD Q� '753 MISC. .NOT CODED ELSEWHERE 1 PRIVATE P:iC ��"'gpgTABLE, *' MASS. OWNER SILVER, KATHLEEN 39. A� ADDRESS %SILVERRYDER KATHLEEN 153 INDIAN- TRAIL CENTERVTLLE MA ` . BUILDfi1C DIVISION DATE ISSUED 09/15/1995 EXPIRATION DATE BY /< DIVISION APPROVALS FOR CERTIFICATE OF;OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING:' DATE: COMMENTS:` •a . tN 1 PLUMBING: — �' DATE: I1 COMMENTS: .f ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: 5 HISTORIC: ' DATE: COMMENTS: FIRE—DEPT.:• DATE: COMMENTS: _ a OTHER: DATE: COMMENTS: TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. f ="�N OF BARNSTABLE .71 .. E_ . 'WOOD STOVE PERMIT PARCEL III 211 001 002 GEOBASE ID 32845 ADDRESS . 158 INDIAN TRAIL PHONE Centerville <; ZIP : - LOT 2B BLOCK LOT SIZE DDA DEVELOPMENT DISTRICT CO PERMIT 10387 DESCRIPTION WOOD STOVE PERMIT TYKE BSTOV TITLE STOVE PERMIT Department of Health, Safety � CONTRACTORS and Environmental.Services ARCHITECTS: i TOTAL FEES: $50-00 Y �tME BOND $.40 CONSTRUCTION COSTS. $-00 �T , 753 MISC_ NOT CODED ELSEWHERE 1', PRIVATE P.'t srABLE, •' MASS. 1 1639. ` OWNER SILVER, KATHLEEN ADDRESS %S I LVERRYDER, K,ATHLEEN i 153 INDIAN TRA i CENTERVILLE. MA t BUILD NQ DIVISION DATE ISSUED 09/15/1995 EXPIRATION DATE BY �. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALL OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. INSULATION.3. NSPECTION BEFORE OCCUPANCY. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL POST THIS - S IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH C' OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON-• INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOTSTARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY. VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 506-790-6227 rA BUILDING PERMIT �v . ,� Co 22eC i 1 i , The Town of Barnstable QIFtf�E� - Permit# Massachusetts �Date �- A SOLID FUEL STOVE PERMIT / Fee �a This constitutes an official stove permit after inspection and approval by the building inspector. Owner ��tilE7�,/b Telephone no. 77.E Address of Property �& 74-41 Village Location and Stove Type tlkc /1gc,' pt,i� cn�N �� I� �G Date: �7,' ( `r• 70 Building Inspector /'� The solid fuel burning stove at the above location passed: failed: inspection. -a M r' /k 0 IL Assessor's map'and lot number .... ......... %1HE Sewage Permit number .......Y6- 4 ......................................... BARNSTABLE, House number ..................... ....... ........................ 90o MASIL 00 t639- WAY TOWN OF BARNSTABLE BUILDING INSPECTOR �.................. .-APPLICATION FOR PERMIT To .... ......... .......� ................................ TYPEOF CONSTRUCTION ..... .M ...................................................................................... .......... ....0....................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: -77Vr� Location ... .....�n............................... .................................................................. ProposedUse ......S� .. ..................... . ..............I............................................................................................................. �h...................... Zoning District ........................................................................Fire District Name of Owner ...............Address ....9.�A...... 7?.-r, t-4 7............................. ...... ........................ Name of Builder ....................Address Nameof Architect ............................................................Address ................................................................................. Number of Rooms .....S,�. ................................................Foundation ................................. Exterior ..............................................Roofing ....A--4( .LA.......................................................... ............................................Interior ...... ................................................ Floors C�;��t ........ Heating ..... ....... .............................Plumbing Plumbi,g ... .. . e4, .......................................... Fireplace ..... v.................................................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 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 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 .... .......... NEW MILL CREEK R. T. A=2 _-1-2 all - r - No ..,30538 Permit for ...1 Z...StorX... ........ Single Family Dwelling. Lot #2B 15 I dian Trail Location ...........................t.............. .... ................ Centerville ............................................................................... Owner ......,New Mill Creek R. T. ................................... Type of Construction ....Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted .... .............19 87 Date of Inspection ....................................19 Date Completed ...................;..................19 r, v�y� °•°ew TOWN OF BARNSTABLE BUILDING DEPARTMENT i �saaer = TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been'issued for the building authorized by BuildingPermit #......••.. 5�................................................................................................................._................. »..».......»» . issued to .AE'..4v..../1n.CI...C'r'C `�...� ............ . ��J Please release the performance bond. •.cyty. �;y'+••---'rr .+.:er:y;.: ,. Y.+ - --r.t.Y'-w. ;:.�..•-. ti,,.,., :, s,.ti} :fit ;,r ... ,.. �sr�+,: .r�ywyr,.„, „�„. ..,..._,� �_.: try- -�r-.--.n.. .+rrF. y r-• _ 1 ' 0�THE Tp TOWN OF BARNSTABLE Permit No. ..30.5 8..... BUILDING DEPARTMENT F s.arn Cash ................ ■.,. TOWN OFFICE BUILDING 4 =bsv AFC 4Y�' HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to New Mill Creek R. T. Address Lot #2B, 153 Indian Trail Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE-VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. . ..... March 28,......, t9................ ....,..:6: .. Building Inspector / 44. VII r / Illj C�,E?T/F/,E-D_ pLyT F�L�7�V P)eE PAR ED Fo12: LOC.P-7-10 t/: l►. JT�i4�1 TZ-� Lam+ CT�Z�/i�-i.� 0-7 _ 77 r31/-- .3Oct 4 — I s-�/E.eEBY� CEeT/FY TN�iT T.�•/E BU/LD/�/G 1 NON/tiJ Oti Tom//S PLAti/ �S LOCF7TEa THE GeOc/,�/D Fay �/,/OW.�J HECt'OtiJ. AsNE Gs�1 c�ocun cam en9ir�ecr-ir�9 i� o 'TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING "1 ERMIT A=211-1-2 DATE c)1 2 i �. 19 87 PERMIT APPLICANT T ..,�,:..� ., ADDRESS 2-,�. ruln.*nauuidD1A349 Blakely 61-rlE1eEs i t •�' (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO--Fl 1 )F• 1 T•1 UMBER OF >.(11.L(�_�.D C� (11 1 STORY it nl jl u F�II(l11'l/ pwellin(OWELLING UNITS T'P OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) i,r"f"t 0211 153 Tri(37 an T -.t j Ce( l-t:er illE! ZONING RC (N0.) r (STREET) .F DISTRICT_ BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION •.• (TYPE) REMARKS: v'ewc)ge I3o. AREA OR VOLUME 9 ��(3 _qff Ff' ESTIMATED COST s HO,'000. OG FEEPER 87 87 _ 5Q ((BIC/SOUARE FEET) OWNER _ I'laow M 1'P!�]�_ k T. ADDRESS BUILDING`DEPT. /`'� % `; BY 1 % ME OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 �QrIG/J` �G�� 2 2 _ 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT i ox OTHER BOARD EAL � 6�8 PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION WORK SHALL NOT PROCEED UNTIL THE INSPEC� � INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SI,, MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTIOP I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. Law Offices Of Charles E. McDermott Route 6-A/Post Office Box 458 West Barnstable/Massachusetts 02668 617 362 4555 June 3, 1986 Mr. Joseph M. Daluz Building Commissioner Town Hall Main Street Hyannis, MA 02601 RE: Lot 2B containing 35,363 square feet as shown on said "Plan of Land in Barnstable (.Centerville) , Mass. for Philip H. and Mary M. Dallow, Scale 1" = 40' , October 18 , 1984, Baxter & Nye, Inc. , Registered Land Surveyors, Osterville, Mass" for Philip H. Dallow and Mary M. Dallow to. George W. Blakely. Title Reference: Book 1953, Page 135. Dear Mr. Daluz: Please be advised that the aforementioned Lot 2B has been held in separate ownership since October 31, 1984 . Kindest regaa-,-a, rds, G Charles E. McDermott CEM/mm �,I TOWN OFl�AAKJ4AgL-r--A55E550R5 MAP a1 V I LOT ZON/NG : F�P I 5ET8ACKS: FRONT: �5 j'51DE5= (D' REAR- I LI) NeLU I 1 � ji. Jr. % I i o EDWARD I E f3 � MMK AT L LAB [D::5ENA69. PLAN.. LEGEND: t Locus : Lo-r Z5N IKJDI&Kj TRAI L,Ceor6.vI Lt_-E CONTOUP5 (EX15T.) ------ (PRoP,)—P---o--- REFEREKCE: �i�A+►.1 1�1 :�c!�i ^� �AG1�q 2 CONC.BOUND ■ .C6 PREPARED FOR: •° TEST NOLE '� �J SCALE : In=4O DATE: AAessor's map and lot number .... ....... SEPTIC SWIM MUST THE --n INSTALLED IN COMPSewa�e P 6400-:4 number �(�............................................. WITH TME a STABLE. ................. ENVIRONMENTAL CLOD AS& House number .... .... ... . 1639- TOWN REGULATION TOWN OF, BARNSTABLE BUILDING - INSPECTOR . t.A APPLICATION FOR PERMIT TO C ............................... TYPEOF CONSTRUCTION .......W". .04...... ...................................................................................... .......... .. .......................1911 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Z'k_ ...................... C Location ....................... .............................................. ProposedUse ......... ............. ............................................................................................................................ Zoning District ........................./ ...............................................Fire District ................... 77;��....91�7 .................... Name of Owner X.�.... ...............Address ........ Name of Builder ....................Address ...... i........................ Name of Architect ............ . ................Address ................................................................................ Number of Rooms ....5,k C.....................................................Foundation .......&(-C-u cti................................... Exterior .....................................................Roofing .... .......................................................... Floors ...c�!!r- -wood .Interior .....s ................................................ Heating ....... ................................................Plumbing . V. 0 ti............................................ Fireplace ... ................................................Approximate. Cost ........D ....................... ........ Definitive Plan Approved by Planning Board ----------19 Sq- Area .../0.xw........ Diagram of Lot and Building with Dimensions Fee ........ . ....... .... 72 SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To of Barnstable regarding the above construction. S at the ............. Toot. Name ......... ......... ........ ..................... . ............................ Construction Supervisor's License .... V.......... NEW MILL CREEK R. T. 3053B 1 1 Story 2 0 Permit for .................................... Single Family Dwelling J,............................................................................ Jot #2B, 153 Indian Trail LocatiO'n ...l............................................................. Centerville . .......................................:....................................... New M` 11 Creek ' R':.- T. LOwner ..................................................... ............ Type of Construction .......Frame................................... .. ................................................................................ Plot ......................... Lot ................................. -Perm-it Granted ........... .....-19 87 Date of Inspection. .............. .....19 'bate Completed ....... 94 aC cc M Assessors map and lot number ..5;W 1....1.................. _ "Was I148TALL£6 IN COMPLIANCE Sewage Permit number ..... .. .. ...:......................... . WITH ARTICLE II STATE ""' SANITARY CODE AND TOWN RTM,.jE-- yOFTNETp�y TOWN OF BARN . E6SHSTODLE, i 039. .•0� DUILDIAG INSPECTOR am a• 3 C APPLICATION FOR PERMIT TO ..... ..A......................................... ..... ............................ TYPEOF CONSTRUCTION ........ .................. .................................................................... ........ ..... .... .......1.(...............19.. y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inform ion: Location ......�..! ..�.!..!► .....7 .�:..........�rt/.Pf.� ....................................... .............................. ..Proposed Use C.4.P:4 ..... ..V... ....... a I .... ..�1..1.................................................................I......................... p Zoning /P strict .... ......!......... .. . .. ... .. ...........................Fire District �� r� ... 2 .................... Il �,l.d W ......................Address I h �. Name of Owner ..... ... ........��........ ........... ......1.....�1................ ..�'tI.Q.I,.:i.»....................... ......... L i Name of Builder ......,.. :... :. .....................Address f G........� /.fit. .................. ... ........... Nameof Architect .:................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation Exierior .....................................................................................Roofing .. ............................................................. 1.Floors ..... . ............... ........ .............................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ..... �. ..................................Ie Definitive Plan Approved by Planning Board ________________________________19________. Area &'c) 6j(j S,t .. Diagram of Lot and Building with Dimensions Fee ............` .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH P O- c 2 � T U...- _ 20 � �0 I hereby agree to conform to all the Rules and Regulations of the To n of Barnstable regarding the above construction. Name : ..................... Darllow, Philip H. & Mary M. 1 09 add to single / ®(j / No ................. Permit for ............................... ............ amily dwelling.................................. 0 Location / Indian Trail Way ............................................ Centerville ............................................................................... i Owner ........Philip D. & Nary M. Darllow .......................... r§ . Type of Construction fr. ...........ame _ .... ...... 1 ................................................................................ Plot ........................ . Lot ................................ 32 Permit Granted ......�P1 7� Date of Inspection ...... :.....:.......................19 Date Completed -PERMIT. REFUSED ................................................................ 19 .......... ...................... ................................. s ..V ............. ...:.......... ................................... . A. .:....I... . ...................................................... �.►............ ......... ........................................................ 4k9ved ................................................ 19 •.................................................................... ............................................................................... - �� i 1TI _ I ► r I I I 1 I I { t I I I I I I I I II I I r I _� 1 I ► I I I I. I OND � I kk.. to r 1 si f i 1 I ' I � � e t• I I I I I A I ` - I I _ ; I I � , Y i �' i_��i . _ --�-- � '� � I � �r_ l ! --- — I I � � I I � I � � t � I I � � I i � I � � ( � --�-x ,. . . I I �� j � I � � I � I I � �. I E � I I � i I � � ' � � t � I � � i ! _ _ _ III F _ +_ —,i I I i _ _ t __ _._ - _ ( �� . — - -— ._I_ —_. I I k I— �--�a�: - I � � i ._ _ T T ��__ - � - --�-i I-: j-� � f +-: 1. I -- � I I - _ _... - �- � � - r-- I- -�-�- -C � �� I '- - - - � . _ -- - I I ��i _._ � � � --- w ----- t..� _ _- -- -�- a _ � �` '`�-:� � , e � �., � � ' � � i '-.I-�-_ i -- �r - - - � I � �� -�--�-�-�-�-��-�-i-I� I ' � ' '--;-�- � --r-: I I f I —-�� t ��, i,,—;�!--�.-- C � , �; , I � ' �. - - -- _ - � -- t� _ _ _ _ _ � - I � i ., �-i I _� -�—j --=—i---r---i—� i � , � ' � I _-+ --�---� � -� -' � � � I � -� i -�--�,--+ � I � I � �__r _.,____I I � � -I - - .. .is ABBREVIATIONS ELECTRICAL NOTES JURISDICTION, NOTES A AMPERE . 1. THIS SYSTEM IS GRID-INTERTIED VIA A t AC ALTERNATING CURRENT UL—LISTED POWER—CONDITIONING INVERTER.' BLDG BUILDING 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. CONC CONCRETE 3. A NATIONALLY—RECOGNIZED TESTING DC DIRECT"CURRENT LABORATORY SHALL LIST ALL EQUIPMENT IN EGC EQUIPMENT GROUNDING CONDUCTOR COMPLIANCE WITH ART. 110.3. (E) EXISTING 4. WHERE ALL TERMINALS OF THE DISCONNECTING EMT ELECTRICAL METALLIC TUBING' MEANS MAY BE ENERGIZED IN THE OPEN POSITION, FSB FIRE SET—BACK A SIGN WILL BE PROVIDED WARNING OF THE GALV GALVANIZED HAZARDS PER ART. 690.17. GEC GROUNDING ELECTRODE CONDUCTOR 5. EACH UNGROUNDED CONDUCTOR OF THE . GND -GROUND MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY . HDG HOT DIPPED GALVANIZED PHASE AND SYSTEM PER ART. 210.5. CURRENT 6. CIRCUITS OVER 250V TO GROUND SHALL _ Imp CURRENT AT MAX POWER COMPLY WITH ART. 250.97, 250.92(B). � Isc SHORT CIRCUIT CURRENT 7. DC CONDUCTORS EITHER DO NOT ENTER kVA KILOVOLT AMPERE BUILDING OR ARE RUN IN METALLIC RACEWAYS OR kW KILOWATT ENCLOSURES TO THE FIRST ACCESSIBLE DC - LBW LOAD BEARING WALL DISCONNECTING MEANS PER ART. 690.31(E). ; MIN MINIMUM 8. ALL WIRES SHALL BE PROVIDED WITH STRAIN (N) NEW RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY NEUT NEUTRAL UL LISTING. NTS NOT TO SCALE 9. MODULE FRAMES SHALL BE GROUNDED AT THE OC ON CENTER UL-LISTED LOCATION PROVIDED BY THE f PL PROPERTY LINE MANUFACTURER USING UL LISTED GROUNDING POI POINT OF INTERCONNECTION HARDWARE. PV PHOTOVOLTAIC 10. MODULE FRAMES, RAIL, AND POSTS SHALL BE SCH SCHEDULE BONDED WITH EQUIPMENT GROUND CONDUCTORS. b S STAINLESS STEEL ` STC STANDARD TESTING CONDITIONS TYP TYPICAL. UPS UNINTERRUPTIBLE POWER SUPPLY V VOLT k - Vmp VOLTAGE AT MAX POWER Voc VOLTAGE AT OPEN CIRCUIT VICINITY MAP INDEX W WATT 3R NEMA 3R, RAINTIGHT PV1 COVER SHEET rII PV2 SITE PLAN PV3 STRUCTURAL VIEWS PV4 THREE. LINE DIAGRAM LICENSE GENERAL NOTES cutsneets Attached GEN #168572 1. ALL WORK TO BE DONE TO THE 8TH EDITION X - ELEC 1136 MR OF THE MA STATE BUILDING CODE. 2. ALL ELECTRICAL WORK SHALL COMPLY WITH THE 2014 NATIONAL ELECTRIC CODE INCLUDING: MASSACHUSETTS AMENDMENTS. MODULE GROUNDING .METHOD: ZEP`SOLAR AHJ: Barnstable REV BY DATE COMMENTS REV A NAME DATE' COMMENTS UTILITY: NSTAR Electric (Boston Edison) J B-0262022 0 O PREMISE OWNER: DESCRIPTION: DESIGN:CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: CONTAINED SHALL NOT BE USED FOR THE SILVERRYDER, KATHLEEN SILVERRYDER RESIDENCE Jao wen `�OIarC' BENEFlT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: 'WO NOR SHALL IT BE DISCLOSED IN WHOLE OR IN CompMount Type C 153 INDIAN TRAIL 3.38 KW PV ARRAY" V . PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT IN CONNECTION NTH MODULES: CENTERVILLE MA 02632 y 24 s►. Martin Drive,Building 2, Unit 11 THE SALE AND USE OF THE RESPECTIVE (13) TRINA SOLAR # TSM-260PD05.18 PAGE NAME: SHEET: REV DATE Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE T: (650)638-1028 F:'(650)638-1029 PERMISSION OF SOLARCITY INC. 5083646027 ) PV 1 10/1/2015 (866)—soI-CITY(7ss=248s> .nnsolarcityaom r SOLAREDGE SE3000A—USOOOSNR2 COVER SHEET. PITCH: 22 ARRAY PITCH:22 MP1 AZIMUTH:221 ARRAY AZIMUTH: 221 MATERIAL: Comp Shingle STORY: 2 Stories C3 K. IUKI 0 ST UCTURAL v N0.51993 O �FGISTE�� ►onrw.E Arai\ 153 1nd\an STAMPED & SIGNED FOR STRUCTURAL ONLY (� Digitally signed by Humphrey (E) DRIVEWAY Hu rn p 1 1 re Kariuki DN:dc=local,dc=5olarCity, l u=5olarCity Users,—ouBeltsville,cn=Humphrey y Ka r i u k.* --Kariuki;' �� email=hkariuki@solarcity.com � Date:2015.10.06 07:12:28-04'00' LEGEND AC M Q (E) UTILITY METER & WARNING LABEL INVERTER W/ INTEGRATED DC, DISCO Inv & WARNING LABELS FDC g2g DC DISCONNECT & WARNING LABELS LEA AC DISCONNECT & WARNING LABELS J DC JUNCTION/COMBINER BOX & LABELS 0° DISTRIBUTION PANEL & LABELS Lc LOAD CENTER & WARNING LABELS ODEDICATED PV SYSTEM METER O STANDOFF LOCATIONS a - - CONDUIT RUN ON EXTERIOR M 1 --- CONDUIT RUN ON INTERIOR GATE/FENCE 0 HEAT PRODUCING VENTS ARE RED I, `I INTERIOR EQUIPMENT IS DASHED . . L_�J SITE PLAN Scale: 1/8" = 1' 01' 8' 16' y� WA JB—0 2 6 2 0 2 2. 00 PREMSE OWNER. DESCRIPTION: DESIGN. CONFIDENTIAL— THE INFORMATION HEREIN [INVERTER: B NUMBER �\\ CONTAINED SHALL NOT BE USED FOR THE SILVERRYDER, KATHLEEN SILVERRYDER RESIDENCE Jao Wen SolarGty. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., UNTING SYSTEM: �� NOR SHALL IT BE DISCLOSED IN WHOLE OR INomp Mount Type C 153 INDIAN TRAIL 3.38 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENTS ULLS CENTERVILLE MA 02632 ORGANIZATION, EXCEPT IN CONNECTION WITH 24 St.Martin Drive,Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE 13) TRINA SOLAR # TSM-260PDO5.18 SHEET: REV: DATE Marlborough,MA 01752 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME T: (650)638-1028 F: (650)638-1029 PERMISSION QF SOIARCITY INC. OLAREDGE # SE3000A—US000SNR2 5083646027 SITE PLAN PV 2 10/1/2015 (88B)—SOL-CITY.(765-2489) www.solarcity.com PV MODULE` S1 �(E) 2x8 5/16" BOLT WITH LOCK INSTALLATION ORDER & FENDER WASHERS - LOCATE LOCIRAFTER, MARK LE TE - ZEP LEVELING FOOT (1) LOCATION, AND DRILL PILOT „ ZEP ARRAY SKIRT (6) HOLE. \ (4) (2) SEAL PILOT HOLE WITH POLYURETHANE SEALANT: ZEP COMP MOUNT C 12'-9" ZEP FLASHING C (3) (3) INSERT FLASHING. (E) LBW' (E) COMP: SHINGLE q SIDT T nn i - E VIEW OF MP1 NTS (E) ROOF DECKING � (2) � INSTALL LAG BOLT WITH 5/16",DIA STAINLESS (5) SEALING WASHER. STEEL LAG BOLT LOWEST MODULE SUBSEQUENT MODULES INSTALL LEVELING FOOT WITH MP1 X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES WITH SEALING WASHER (6) BOLT & WASHERS. LANDSCAPE 64" 2411 STAGGERED - (2-1/2 EMBED, MIN) PORTRAIT 48". 19" - v (E) RAFTER RAFTER 2X8 @ 16" OC `ROOF AZI 221 PITCH 22 STORIES: 2 ARRAY AZI 221 PITCH 22 S 1 C.J. 2x6 @16" OC Comp Shingle Scale: 1 112" = 1' IF or G K. _ — 0 RI I ST UCTURAL t v NO.51933 ' �FG/ST6��o ccc�'S/ANAL� 4 STAMPED & SIGNED _ FOR STRUCTURAL ONLY J B-0 2 6 2 0 2 2 0 0 PREMISE OWNER: DESCRIPTION DESIGN: CONFIDENTIAL A THE INFORMATION HEREIN JOB NUMBER: +\,!r Solar it CONTAINED SHALL NOT BE USED FOR THE SILVERRYDER KATHLEEN SILVERRYDER RESIDENCE Jao Wen BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM �I0 NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 153 INDIAN TRAIL 3.38 KW PV ARRAY y. PART TO OTHERS OUTSIDE THE RECIPIENTS MooutFs CENTERVILLE MA 02632 ORGANIZATION, EXCEPT IN CONNECTION WITH , 24 St. Martin Drive,Building Z Unit 11 THE SALE AND USE OF THE RESPECTIVE (13) TRINA SOLAR # TSM-260PD05.18 PAGE NAME SHEEL REV. DATE Madborouo,MA 01752. SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN INVERTER: T: (650)630-1028 R (65D)63B-1029 PERMISSION of SOLARCITY INC. SOLAREDGE SE3000A—USOOOSNR2 5083646027 STRUCTURAL VIEWS PV 3 10/1/2015 (888)-SOL-CITY(765-2489). www.soiarcity.com, } GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) #8 GEC TO ONE (E) GROUND Panel Number: NoMatch Inv 1: DC Ungrounded INV 1 —(1)SOLAREDGE SE3000A—USOOOSNR2 LABEL: A —(13)TRINA SOLAR ## TSM-260PDO5.18 GEN #168572 ROD AND ONE (N) GROUND ROD AT Meter Number:2244288 Inverter; 30 OW, 240V, 97.59a w/Unifed Disco and ZB,RGM,AFCI PV Module; 250W, 236.9W PTC, 40MM, Black Frame, H4, ZEP, 1000V ELEC 1136 MR PANEL WITH IRREVERSIBLE CRIMP Underground Service Entrance INV 2 Voc: 38.2 Vpmox: 30.6 INV 3 Isc AND Imp.ARE SHOWN IN THE DC STRINGS IDENTIFIER �E 150A MAIN SERVICE PANEL E� 150A/2P MAIN CIRCUIT BREAKER Inverter 1 CUTLER-HAMMER ` 150A/2P Disconnect 2 SOLAREDGE SE3000A—USOOOSNR2 (E) LOADS A L1 Znov ~— L2 �— N 1 20A/2P ____ GND EGG DC- DC- A ------------------------------------- — GEC ---TN DC- DC_ MP 1: 1x13 I B I GND —. EGC— -------— ——————————————————— EGC-----------------r.J N I c EGC/GEC - - I I I I I II _ GEC_r— 1 TO 120/240V SINGLE PHASE UTILITY SERVICE I I I I I PHOTO VOLTAIC SYSTEM EQUIPPED WITH RAPID SHUTDOWN Voc* = MAX VOC AT MIN TEMP POI (1)SQUARE D Q 220 PV BACKFEED BREAKER A (1)CUTLER—HAMMER III DG221URB PV (13)SOLAREDGEP300-2NA4AZS Breaker, A�2P, 2 Spaces, Plug—On Disconnect; 30A, 24OVac, Non—Fusible, NEMA 3R AC PowerBox ptimizer, 300W, H4, DC to DC, ZEP DC —(1)Gro/qd Rod —(1)CUTLER—�IAMMER j DG030NB (1)AWG 86, Solid Bore Copper 5 8 x 8, Capper Ground/Neutral it 30A, General Duty(DG) nd —(1)Ground Rod; 5/8" x B', Copper (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO.'2, ADDITIONAL ELECTRODE MAY NOT BE REQUIRED DEPENDING ON LOCATION OF (E) ELECTRODE 2 1 AWG#10, THWN-2, Black (2)AWG#10, PV Wire, 60OV, Black Voc 500 VDC Isc =15 ADC OR(1)AWG�Q THWN-2, Red 1 I )iF(1)AWG(16, Solid Bare Copper EGC Vmp =350 VDC Imp=9.53 ADC II LL(1)AWG#10, THWN-2, White NEUTRAL Vmp =240 VAC Imp=12.5 AAC .... .L. .. (1)Con0uit Kit..3/4*.EMT. . . . . . . . . . . . . ... . . _ . . . . . . . , . . . . . . . . .. . . . . . . . .-(1)AWG$8,,TH.WN7?,,Green . . EGC/GEC 0)Condult_Kit;.3/4".EMT. . . . . . . . J B-0 2 6 2 0 2 2 0 O PREMISE OWNER: DESCRIPTION: DESIGN: CONFIDENTIAL— THE INFORMATION HEREIN � JOB NUMBER: �\\!s CONTAINED SHALL NOT BE USED FOR THE SILVERRYDER, KATHLEEN SILVERRYDER RESIDENCE Jao Wen Ali% IarCi ty. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MOUNTING SYSTEM: �•� NOR SHALL IT BE DISCLOSED IN WHOLE OR IN Comp Mount Type C 153 INDIAN TRAIL 3.38 KW PV ARRAY PART TO OTHERS OUTSIDE THE RECIPIENT S ORGANIZATION, EXCEPT IN CONNECTION WITH MODULES CENTERVILLE, MA 02632 24 St. Martin Drive, Building 2,Unit 11 THE SALE AND USE OF THE RESPECTIVE (13) TRINA SOLAR # TSM-260PDO5.18 SHE: REV: DATE Marlborough,-MA 01752 SOLARCITY EQUIPMENT, WITHOUT IHE WRIITEN INVERTER: PAGE NAME L• (650)638-1028 F: (650)638-1029 PERMISSION OF SOLARCITY INC. SOLAREDGE SE3000A—USOOOSNR2 5083646027 THREE LINE DIAGRAM PV 4 10/1/2015 (BBB)-SOL-CITY(765-2489) www.Warcity.com - e o o •e - o Label Location: Label Location: Label Location: (C)(CB) o (AC)(POI) (DC) (INV) Per Code: Per Code: 4 _ o'o ..a Per Code: NEC 690.31.G.3 eo o e NEC 690.17.E h e o . o- o NEC 690.35(F) Label Location: o :o . - o 0 0 - TO BE USED WHEN (DC)(INV) ° ® � o- o o . -o s o • oe '- INVERTER IS D O Per Code: UNGROUNDED NEC 690.14.C.2 Label Location: Label Location: 0 0 0 ' '0 (POI) - -o (DC) (INV) �� ° ° Per Code: 0 Per Code: 'd►.-o n o o e 0, NEC 690.17.4; NEC 690.54BUM - -o o NEC 690.53 e • :o 0 ors o - , Y^IN e- G1 Label Location: °'C °L ' n WA o (DC) (INV) -Per Code: ° -n o NEC 690.5(C) Label Location: o e o- O (POI) Per Code: NEC,690.64.B.4 .. Label Location: (DC)(CB) ^' Per Code: Label Location`. NEC 690.17(4) © (D)(POI) Per Code: e.o o e o 0 0 �W NEC690:64.6.4 - n e T - Label Location: o (POI) Per Code: Label Location: eo .o IN oMMO�M - NEC 690:64.B.7 AC POI o 0 0 - o (AC): AC Disconnect H ( )(POI) Per Code: °e (C): Conduit NEC 690.14.C.2 (CB): Combiner Box ` (D): Distribution Panel (DC): DC Disconnect (IC): Interior Run Conduit Label Location: (INV): Inverter With Integrated DC Disconnect �A (AC)(POI) (LC): Load Center Per Code: NEC 690.54 (M): Utility Meter ep, - rip e e (POI): Point of Interconnection CONFIDENTIAL— THE INFORMATION HEREIN CONTAINED SHALL NOT BE USED FOR �� j" 3055 Clearview Way' THE BENEFIT OF ANYONE EXCEPT SOLARCITY INC., NOR SHALL IT BE DISCLOSED �► San Mateo,CA 994ay 02 IN WHOLE OR IN PART TO OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, Label Set THE WRITTEN PERMISSION OF SOLARCITY INC. Solaltit T:(650)638-1028 F:(650)638r1029 EXCEPT IN CONNECTION WITH THE SALE AND USE THE RESPECTIVE I� (888)-SOL-CrrY(765-2489)www.solarcity.com SOLARCITY EQUIPMENT, WITHOUT o j - r ',SoiarQty I ®pSolar Next-Level PV Mounting Technology '^SolarCity I ®pSolar Next-Level PV Mounting Technology Zep System Components for composition shingle roofs ,',,_Vpl-r\oof Grown d Zep 7ntedwit (rey,side sh—) 'T_�_ Leveling Fool Zep Compatible PV Nodule J _ Zep Groove Roof Anachmmt Array Skirt Description , r�A PV mounting solution for composition shingle roofs CGMP1110 Works with all Zep Compatible Modulesr:Q...'`- • Auto bonding UL-listed hardware creates structual and electrical bond • Zep System has a UL 1703 Class"A"Fire Rating when installed using U` LISTED modules from any manufacturer certified as"Type 1"or"Type 2" Comp Mount Interlock Leveling Foot Part No.850-1382 Part No.850-1388 Part No.850-1397 Listed to UL 2582& Listed to UL 2703 Listed to UL 2703 Specifications Mounting Block to UL 2703 Designed for pitched roofs Installs in portrait and landscape orientations Zep System supports module wind uplift and snow load pressures to 50 psf per UL 1703 • Wind tunnel report to ASCE 7-05 and 7-10 standards �p • Zep System grounding products are UL listed to UL 2703 and ETL listed to UL 467 • Zep System bonding products are UL listed to UL 2703 • Engineered for spans up to 72"and cantilevers up to 24" • Zep wire management products listed to UL 1565 for wire positioning devices Ground Zep Array Skirt,Grip,End Caps DC Wire Clip • Attachment method UL listed to UL.2582 for Wind Driven Rain Part No.850-11.72 Part Nos.500-0113, Part No.850-1448 Listed to UL 2703 and 850-1421,850-1460, Listed UL 1565 ETL listed to UL 467 850-1467 - zepsolar.com zepsolar.com Listed to UL 2703 This document does not create any express warranty by Zep Solar or about its products or services.Zap Solar's sole warranty is contained in the written product warranty for This document does not create any express warranty by Zep Solar or about its products or services.Zap Solar's sole warranty is contained in the written product warranty for each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely each product.The end-user documentation shipped with Zep Solar's products constitutes the sole specifications referred to in the product warranty.The customer is solely responsible for verifying the suitability of Zep Solar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. responsible for verifying the suitability of Zep Solar's products for each use.Specifications are subject to change without notice.Patents and Apps:zspats.com. 02-27 15 ZS for Comp Shingle Cutsheet Rev 04.pdf Page: 1 of 2 - 02 27 15 ZS for Comp Shingle Cutsheet Rev 04.pdf Page: 2 of 2 _ t w • solar=oo $o a r=oo SolarEdge Power Optimizer !fin Module Add-On for North America P300./:P350 / P400 , SolarEdge Power Optimizer w . ,. f *4i'§a. M .P350 P400'';d,, Module Add-On For North America :Y`g P3 �. (fog-(for 72-cell (for 96•cell PV r 60-cell PV PV module modules) r`:..modules)s I INPUT- v, ?is: `f -Rlrt.,,;§,..n.`. ss 'e� f,"_..€ w*',... .at+,T r;" ,..mow,.. ,' ' r.. -^g'w ,.'.� r ,.r - _ -P300 / P350 /- P40® Rated loPut DC.Powerul..." 300 350:Hr4D0... W n - . . O - Absolute Maximum Input Voltage(Voc at lowest temperature) 48 ,60 80 Vdc - - ..' 8 48 ..8..F0 ..... ......8-80.. ... Vdc.. - .: 'w. r e: ................. ............ ... ... Maximum Short Circuit Current(Isc) 10 Adc - - .. ..... .. ....- y. �., - .. Maximum DC Input Current 12 5 Adt Maximum Efficiency. ...... ...'..99.5... ........ % .. ..Weighte.d.Efficiency .. .. ..... .. ...... ............ ... ......98.8 .... ... ...% , .. OU ON:(POWER OPTIMIZER CONNECTED TO OPERATING:INVERTER) '" " £:C., x >'.•"'t"'t " "•" a ervoltage Category 11 - OUTPUT DURING-0PERATI N. - ..• e:. .© , Maximum Output Current .f. 15. .Adc - - '• I ,r mum Output Voltage ........ .... ..... .... .. .............. ... ..5U.... ......... ....... Vdc Maxi OU TUT.DURING STANDBY(POWER OPTIMIZER DISCONNECTED CONNECTE--D FROM INVERTER 0R INVERTEROFF),&'�•'.a a,Si ' - Safety Output Voltage per Power Optlmfzer 1 Vdc - )STANDARD COMPLIANCE>a*,,+' +rc�- ;R�,.s _r`��'=,s7 .`9t,.."-t,' ,:7Vw Utr ":R'P*" ;, mamas - a EMC FCC Part15 Class B IEC61000-6-2.IEC61000 6 3 - - ,,._.f.. ..IEC62309-1 lclass ll safety),.UL1741 RoHS Yes..' " - - - •,._ ., - z•` INSTALLATION SPECIFICATIONS , "#'.sfi r t,w.fi1, ::::.,ut..r.•c'.,..x...r ..,^ ..,x:.._., .w.;''S. _ - - .r ;,, :.' - Maximum Allowed System Voltage 1000 Vdc '- - ..Dimensions W x L x H........................................... 141 x 212 x 40.5...5.55 x 8.34 x 1.59... .. m ...in ...... .... .. ........ ......... .. .. .... .... - , Weight linduding cables) .. 950/2.1 gr/lb ..In ut Connectors .. ........... "... ...... ..... ... .MC4/Amphenol/Tyco. ............ ........ .., :..' y'_ 3rp •,_ .; "' - _ .. ... ..... ....... ..... ............ ... J � Output Wire Type Insulated;Amphenol , tk , .. .. ... ... .. .. .. .. .... ... .. .. ••Outpu[W�re Length... 0.95/3.0.. ...1.2/3.9.. ..m./ft ... ...... ............. ............... ...... .......... Operating Temperature Ran e - L..40 +85 -40-+185... .C/-F... «. • : .. ... .... ...... ....... ......... ... ..... .......... ........ ... - FProtechon�Rating IP65/NEMA4... - - _.. ........ ..... .... ............... .... ......... .. .Relative Humidity _...0..100. ...%. sTc a tl1 g% t e - _ :n,o� eeo wro a o...R[etl of tM1 Ic.Mo f I r t ' '' ,� • PV SYSTEM DESIGN USING A SOLAREDGE ';+'. x"`•''" r"'="THREE PHASE�: ..THREE PHASE_ .y, " ,s's -+A'.•: �r��. S .. rp SING LE.:PHASE '=z, _ . ', _ - �,� � '• ."- � -. � .� - INVERTER.. of'+.,«ens : X, _ :'»Tft a.x�ak:.i x,v.._-css:-. �..u;,_g,s,',�208V,: t,_ ...R,�.,_s.460Vs_,:. 'PV;power optimization at the module-(eve) - Minimum StringLength(Power Optimzers) 8 10 18 _ .-. ............. ... ... ............................ ...-..'... .... .. ...... Up to 25%more energy "- a Maximum String Length(Power Optimizers)... .. ... 25 25 50 - _ . . a,. l -, _ - ... .. ... ......... v VJ + _ Maximum Power per String 5250 6000 1275'0 - ' _ Superiorefficiency(99.5%). _ .. .... ...... ... - , Parallel Strings of Different Lengths or Orientations- Yes - Mitigates all types of module mismatch losses;from'manufacturing toleranceto partial shading - .'. .'. _ "' """"""'"' """""" """' '',' - '"'"' "'"" . . _ - ..... ....... —.Flexible system design for maximum space utilization .- - "+ - Fast installation with a single bolt - ° - - - q,,.. _ n,.' -Next generation maintenance'with.module-level monitoring P — Module-level voltage shutdown for installer and firefighter safety �{9'.,R�' ,`. ate: } USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA WWW.SOIaredge.u5 ' S THE Yirin-amount MODULE TSM-PD05.18 _ Mono Multi Solutions DIMENSIONS OF PV MODULE ELECTRICAL DATA @ STC - unit:mm t Peak Power Watts-PMA%(Wp) I 245 250 , 255 I 260 941 i Power Output Tolerance-PMnx 1%) - - 0-+3 THE LJ'LL`.,•r1MoUnt EPurE �_ Maximum Power Voltage-VMP(V) 8.2 I 3.27 I 30.5 30.6 surunON Maximum Power Current IMPP(A) 8.20 8.27 8.37 8.50 .. - .. �' c ,Open Circuit Voltage-Voc(V) 37.8 38.0 38.1 ( 38.2 I wsrnwrNC Wolf 1 Short Circuit Current-Isc(A) 8.75 8.79 8.88 9.00 T - _ 1 . 'M O D U L E _ Module Efficiency qm(%) .j 15. 1 ' 15.9 STC:Irrotliance 1000 W/m',Cell Temperature 25°C,Air Air Mass AM1.5 according ding to EN 60904-34-3. Typical efficiency reduction of 4.5%at 200 W/m'according to EN 60904-1. ` ELECTRICAL DATA®NOCT ® CELLMaximum Power-P-(Wp) + 182 i 186 1 190 1 193 _ - Maximum Power Voltage-VMP IV) 27.6 28.0 28.1 28.3 MULTICRYSTALLINE MODULE Maximum Power Current-1M,P(A) 6.59 ' 6.65 6.74 6.84. 6003 CAOUNOING HOLE 1 1 A A Open Circuit Voltage(V)-Voc IV) 35.1 35.2 35.3 35.4 WITH TRINAMOUNT FRAME "NMNHarE , Short Circuit Current(A)-Isc(A) 7.07 r 7.10 1 7.17 � 7.27 NOCT:Irradiance of 800 W/m'.Ambient Temperature 20°C,Wind Speed I m/s. PD05.18 tz 2�T,p�1�cP�V-260W B tso Back View POWER OUTPUT RANGE MECHANICAL DATA r 11 Solar cells Multicrystalline 156 x 156 mm(6 inches) Fast and simple to install through drop in mounting solution cell orientation 60 cells(6 x 10) j 5• d Module dimensions 1650 x 992 x 40 mm(64.95 x 39.05 x 1.57 inches) i �` Weight 21.3 kg(47.0 Ibs) I MAXIMUM EFFICIENCY Glass 3.2 mm(0.13 inches),High Transmission,AR Coated Tempered Glass ' . A-A +Backsheet White P Good aesthetics for residential applications 9Frame :Black Anodized Aluminium Alloy with Trinamount Groove + ! IP 65 or IP 67 rated I-V CURVES OF PV MODULE(245W) J J-Box ®I--+37o _ Photovoltaic Technology cable 4.0 mm'(0.006 inches'), Cables IO.m 1200 mm(47.2 inches) POWER OUTPUT GUARANTEE 8. - Fire Rating r Type 2 t .00 BOOW/m' Highly reliable due to stringent quality control _6m 1. �\ � - Over 30 in-house tests(UV,TIC,HE and many more) sm As a leading global manufacturer • In-house testing goes well beyond certification requirements a.m TEMPERATURE RATINGS MAXIMUM RATINGS of next generation photovoltaic _ im roducts,we believe close 2.m 2gOW/m' Nominal Operating Cell Op erational Temperature 144°C(+2°C) t-40-+g5°C P Temperature(NOCT) j cooperation with our partners om 1000V DC(UL)Maximum System 1000V DC IEC) { is critical to success. With local ow. 10.m 20.m 30m 40.m Temperature Coefficient of PMA 0.41%/°C Voltage presence around the globe,Trina i5 Voltage(V) Temperature Coefficient of Voc I-_0.32%/°C Max Series Fuse Rating 15A able to provide exceptional service Tem . -_ f and supplement our innovative, conditions reliable products with the backing • 2400 Pa wind load of Trina as a strong,bankable - - 5400 Pa Snow load .- WARRANTY .I partner. We are Committed - 10 year Product Workmanship Warranty to building strategic,mutually beneficial collaboration with 25 year Linear Power warranty installers,developers,distributors (Please refer ro product waaanly for details) a� and other partners as the backbone of our shared success in - -` - - - - - ` - - - ` CERTIFICATION driving Smart Energy Together. LINEAR PERFORMANCE WARRANTY PACKAGING CONFIGURATION a I 10 Year Product Warranty•25 Year Linear Power Warranty `„�� a L Modules per box:26 pieces w Trina Solar Limited 1. www.trinasolar.com H Modules per 40'container:728 pieces + r A Addlttonol volt,. 1 ( U I,ahl r/trio COMPnANi _ a " 0 90% � Sol,,,,,tffl2or WOrro„n" CAUTION:READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. GaMFAl�6 1 1 6 ®2014 Trino Solar Limited.All rights reserved.Specifications included in this darasheet are subject to �Q 5��ow�solar 1;80% -- _ T _ T_ Trun- asolar / . t change without notice. Smart Energy Together i Years 5 l0 15 20 25 Smart Energy Together p°pr4vnre 3 irinastandard _[31ndu nystandard,�_.`� 1 - THE TPlnean)ount MODULE TSM-PD05.18 Mono Multi Solutions DIMENSIONS OF PV MODULE ELECTRICAL DATA @ STC ,) unit:mm Peak Power Wafts-P_x(Wp) 250 1. 255 260 - -.265, Power Output Tolerance-Pmnx(%). 0-+3 MY[�DRR= M00n Maximum Power Voltage-VMP(V) 30.3 30.5 30.6 30.8TY Y t uNcnoN o ° `Maximum Power Current-IMPP(A) 8.27 8.37 8.50 8,61 "# t I "nmerurt Open Circuit Voltage-Voc(V) 38.0 I 38.1 38.2- 38.3 Short Circuit Current-Iso(A) 8.79 8.88 _ 9.00 910 �}• - 7F INSTRLLING NOLE 11 . MODULE. $ 'Module Efficiency q!n(%)_ F i 15.3 15.6.,. _ 15.9- .� 16.2it STC:Irradiance 100o W/m-,Cell Temperature 25 C,Air Mass AM1.5 according to EN 60904-3. Typical efficiency reduction of 4.5%at 200 W/m according to EN 60904-I. o ELECTRICAL DATA @ NOCT t - Il Maximum Power-PMnx(Wp) - 186 y 190mY 193 I y197 1. ' ® 11 Maximum Power Voltage-VMr(V) 28.0 28.1 28.3 f 28.4 - MVVULTICRYSTALLI LLLN~~LE MODULE !!! um P urre - 3.74 35.4 m 5 5 III Maxim Power C nt IMPP(A) 6.65 6 6.84 1 6.93 ".. NOINC NOLE P - � . - y PD05.18 A ? 1 Open Circuit Voltage(V)-Voc(V) 35.2 5.33 . tF WITH TRINAMOUNT FRAME E Short cirau}current(A)-lsc(A) l 7.10 j 7.17 _ 7.27 735 ' j - NOCT:Irradiance at 800 W/m',Ambient.Temperature 20-C,Wind Speed 1 m/s. - r. 812 1 180 - 250-265W - - Bock view. -� MECHANICAL'DATA - POWER OUTPUT RANGE' t Solar cells r Multicrystalline 156 x 156 mm(6 inches) Fast and simple to install through drop in mounting solution (Cell orientation 60 cells(b x 10) ' j Module dimensions 1650 x 992 x.40 mm(64.95 x 39.05 x 1.57 inches) _ r$ Weight 19.6 kg(43.12 lbs) - p3 v 1 6• _ _ Glass 3.2 mm(0.13 inches),High Transmission,AR Coated Tempered Glass MAXIMUM EFFICIENCY 1 { � �Backsheet. White - s Frame - �Black Anodized Aluminium Alloy ® Good aesthetics for residential applications , J-Box IP 65 or IP 67 rated �A,�r A 'Cables I-Photovoltaic Technology cable 4.0 mm2-(0.006 inches'), 0--+_,t� __ I.1200 mm(47.2 Inches) . { III POSITIVE POWER TOLERANCE I•V CURVES OF PV MODULE(260W) ' to.00 Connector H4 Amphenol '' - ' Fire Type 1 UL 1703 Type 2 for Solar City __• / Highly reliable due to stringent quality control } {f • Over 30 in-house tests(UV,TIC,HE and many more) # a 600 AS q leading global manufacturer `® • In-house testing goes well beyond certification requirements .' �. Goowm� TEMPERATURE RATINGS - MAXIMUM RATINGS .. . of next generation photovoltaic �1 PID resistant r �- Nominal Operatin Cell 'Operational Temperature -40-+85°C r products,we believe close ! 1'00 Temperature rating(NOC 44°C(±2°C) i cooperation with our partners 4 3.00 `p tt Maximum system t000V DC(IEC) - y; Z.00' Temperature Coefficient of P.- l-0.41%/°C 3 Voltage 1000V DC(UL) ! i is critical to success. With local f 1 t! presence around the globe,Trina is - - , ''0° - Temperature Coefficient of Voc 1-0.32%/°C Max Series Fuse Rating_ 15A , able to provide exceptional service °'°° - - Certified to withstand challen in environmental ti ° to 2° 3° 40 s° �TemperatureCoefficientoflsc ;oos%/'c to each customer In each market g g --- and supplement our innovative, a conditions tt P"e•M reliable products with the backing t 2400 Pa wind load a ' } of Trina as a strong,bankable WARRANTY \ t V W., • 5400 Pa snow load t'j partner. We are committed - - - 10 year Product workmanship Warranty - - to building strategic,mutually - - CERTIFICATION - i beneficial collaboration with I-inear Power warranty 25 year installers,developers,distributors. f $ VL us SA' (Please refer to product warranty for details) 4i . and other partners as the I , uvne a ❑3 backbone of our shared success in driving Smart Energy Together. ~LINEAR PERFORMANCE WARRANTY Eu-RB wEEE f' PACKAGING CONFIGURATION o cownPunN, p pieces per box:26. " w 10 Year Product Warranty•25 Year Linear Power Warranty Modules� j - t Trina Solar Limited ( r 9 1 .. Modules per 40'container:728 pieces WWW.frInaSOIOLCOm (- -y 1009; z - - o Addltionol vo/ue nr Trl ty v 9o%.. 4 no Solor's li Ir o a i 1 + .. o I� '`, hegr warrant, CAUTION:READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. ' r� s� c ry - I�Or�I�I( �'`� 02015 Trina Solar Limited.All rights reserved.Specifications included in this datasheet are subject fo 4Y basolar 80% TY unasollar change without notice. / Smart Energy Together Smart Energy Together A Years 5 to 15 20 25 .CpMPP'�0. ` ❑Trina standard [3;Inrlusrry standxd _ J ` so I a rKoMo — Single Phase Inverters for North Amer►ca s oa r ° " SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ SE7600A US/SE10000A US/SE11400A US y SE3000A-US SE380OA-US SE5000A-US SE6000A-US SE760OA-US SE10000A-US SE11400A-US OUTPUT 9980 S 0 I a r E d g e Single Phase Inverters „ :..'Q C Nominal AC Power Output 3000 3800 5000 6000 7600 1000 @ 240y 11400 VA 5400 @ 208V 10800 @ „ Max AC Power Output 3300 4150 6000 8350 208V 12000 VA For North America I .., .. 5450.@?40�............ ... ... �0950.�240�. ...... ....... a AC Output Voltage Min:Nom:Max.lti 183 208-229 Vac SE3000A-US/SE380OA-US/SE5000A-US/SE6000A-US/ ........ .. ......Min.No .Max.... ................ ................. ... ...... AC'Output Voltage Min:Nom.Max!ti SE7600A-US/SE10000A-US/SE11400A-US 211 .24o-264Vac ........................................ .. .................................. ................ ................................................ ...................... . AC Frequency Nom:Max.ltl 59.3-60-60.5(with HI country setting 57-60 60.5) Hz - „ -. ..... 24 @ 208V 48 @ 208V Max Continuous Output Current 12 5 16 25 32 47.5 A ........................................... ........... I.................21,(•al,240V ... ......... .42 @.240V......... - • GFDIThreshold ...... ....-. . 1 ...... ......... ... .. .. ....................... 1":. .. Utility Monitoring,Islanding Protection Country Configurable Thresholds Yes Yes :INPUT f Maximum DC Power(STC)fi 4050. 5300 6750 8100 10250 13500 15350 W rq� z5 sfor ... .Ungr.... ... :::: .... ... ...............:::::.. ........ ::::::............::::::....................... are a Maxslnput Voltage rig............. .500.. .Vdc mVe _ ......M....ro............ ........... ................. „� Watta tea,! •.Nom.DCInputVoltage u 325@208V/•3S0@240V.. .. •••..•..,,•.•. .Vdc .. nded i ........................ ................ ............ ....... ....... .... ...... .. .... _..,,,.. .. .. @ 208V @ 208V... Max.Input Currentlti 9.5 13 16 5 18 23 33 34.5 Adc .........P................................ ................I...............I..15;5•(a1 240y..1................I................I..30S @ 240V..I............................. Circuit Current 45 Reverse Polarity Protection Yes f. ..........................................................................:............................................. 1 - Ground Fault Isolation Detection 600ko Sensitivity , Maximuminverter Efficiency.,••,••.•. •,; 97.7 98.2 98.3 98.3 98 98 98 @ 208V CEC Weighted Efficiency 97.5 .. ... 98 97.5........... �24 ..08V........97.5..... .....97.5 91 240V .... ...... ......... . ...97.5..... % ... 98 Nighttime Power Consumption 42.5 <4 W ADDITIONAL FEATURES Supported Communication Interfaces R5485:RS232,Ethernet,ZigElee(optional). - '- Revenue Grade Data,ANSI C12.1 Optionall'i ..... .. .. . .... ... .. ........ ..... ...... 1 - Rapid Shutdown—NEC 2014 690.12 Functionality enabled when SolarEdge rapid shutdown kit is installed(") - .. 'STANDARD COMPLIANCE B 1" Safety._.._....._. •.:..•.. ........................................ UL36998,UL3998,CSA 22.2... - - Grid Connection Standards.......... ............................................... IEEE1547......................................................... ......... -` - - --' r `• Emissions . . .. •••FCC partlS class t INSTALLATION SPECIFICATIONS a - .•,_,-..�{ - :: �' - AC output conc1uitsize/AWGrange ................... „3 "minimum/166AWG...._,••„•..__ .,.•.. 3/4"minimum/83AWG •••••••.. d t „p.-�•. .,'.'� _ �• +- •DC n . size. °.strings/ •....•••..• .... .... minimum/1-..strings/ ................... ... minimum/1-2 strings/16-6 AWG 1 AWGran&?........Ze..#........... .. .. AWG... ..Dimensions with Safety Switch .. ........................................................... .................. ......30.5 x 12.5 x 10.5./...... ...in/.... .......... ...... ................ ............... ........775 x 315 x 260 ..... 3/4" .• 305 5x184 x125x72/775x31 ,, •. : „„ •Weight with Safety Switch............. ... 51.2/23:2 .....7/24.7 88.4/40.1.....••......Ib....... ... ............. ....... ............................... ....... .. .. Natural convection Cooling Natural Convection and internal Fans(user replaceable) fan(user The best choice for SolarEdge enabled systems .....•..•.••:.........`........ .`ep'a`eable).•••••...• 0 Noise <25 <5 qBA - Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance Min:Max.Operating Temperature -13to+140/-25to+60(-4oto+60 version available")) 'F/-C Superior efficiency(98%) Range............. ............................................................................. ...................................................... ...................... .Protection Rating NEMA 3R — Small,lightweight and eas to install on provided bracket isi ..,,hh r........................................... ........................... y p For other regional se t rigs please contact SolarEdge support. - pi A higher Current source may be used;the inverter will limit its input current to the values stated. — .Built-in module-level monitoring MRevenue grade inverter P/N:SE—A.U5000NNR2(for7600W inverter.5E7600A-U50021,11,11t2). i4 Rapid shutdown kit P/N:SE1000-RSD-51. — Internet connection through Ethernet or Wireless isi+30version P/N:SEx—A-USOOONNU4 ifor7600Wimerter:SE7600A-US002NNU4I. — Outdoor and indoor installation Fixed voltage inverter,DC/AC conversion only Y ? — Pre-assembled Safety Switch for faster installation — Optional—revenue grade.data,ANSI C12.1 0 USA-GERMANY-ITALY-FRANCE-JAPAN-CHINA-AUSTRALIA-THE NETHERLANDS-ISRAEL www-solaredge.us � . 1015 - awer r ,. 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