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I I, I", '," �,i� 5 , _�!'_, ;, 4, "" ", , " 61 M in AN'i��q yi� '711) �,�Mxgqwvw ,�,J�,!�I� '-',,';,',,-,.� a " ,­,­­­jl� '�,,' " 11`� ,�,�,S � ­il�,`,,�,��,111",,��� i�::::: ,!,lo 1 I'.i�j",�l."", .4 ��... - - - ,,Ti,l . .I, .4, k", - -- ,� �Y�,��,W, , "I'll )!" � 1�*%­­A!� '. i� 1, I 1�,'! , w3bc.,­,o,zJ1 i "-,I, 4� ,�� - __ W Town of Barnstable Building ..' � .,,t`. ,7,; ,r�� +.,�' �8' tv� � � '� ,•` ors..e. .: e Post This.Card So That it`i"s;:UisibleeFrom the`StreetA ,„roved;Plans Must be;Reta�ned on Job andah�s Card�Must beKe 16 •- DARAttTEA'8t8. ,. �,. e� pP;. �,^� p, M Posted Until Final Inspec�tion�Has Been Made R Where a Cert�ficate'of Occui anc �s Re red,`such Building shall Not=be OccU�pied unt>fl a,Finai fhwectronshas been��ade Pei mit s ...per �"'7 .. .G .. :. ,_- ; ,.r,�. .,.Pv�..€ - -.'.'�_s. ,. ,' ..,.. .,, ...«di ,.,.�.:: :. ,�✓c...- .. .;a. .;r' a r ems.aMo , . ..,�s Permit No. B-19-1914 Applicant Name: Julie Jones Approvals Date Issued: 06/13/2019 Current Use: Structure Permit Type: Building-Shed' Residential-200 sf and under Expiration Date: 12/13/2019 Foundation: Location: 213 LAKESIDE DRIVE WEST,CENTERVILLE Map/Lot. 232 062 Zoning District: RD-1 Sheathing: Owner on Record: HOLLY POINT LLC Contractor Name: Framing: 1 Address: 2514 MAIN STREET V, t Contractor Licenser WEST BARNSTABLE,MA 02668 _ Est Project Cost: $2,300.00 Chimney: Description: Install 8 x 10 garden shed Permit Fee: $35.00 m Insulation: Fee Paid.. $35.00 Project Review Req: � Date 6/13/2019 Final: 4_W Plumbing/Gas Rough Plumbing: ' Building Official This permit shall be deemed abandoned and invalid unless the work auiho�nzedby this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which'ths permit has been granted. Rough Gas: a may., g All construction,alterations and changes of use of any building and structures'shall tie incompliance with the local zoning, laws and codes. This permit shall be displayed in a location clearly visible from access street or road,and shall be maintained openfor public inspection for the entire duration of the Final Gas: work until the completion of the same. -;sE Electrical tu The Certificate of Occupancy will not be issued until all applicable signares%'the Building and Fire Officials a re provided.on this permit. Minimum of Five Call Inspections Required for All Construction Work:' 4 s p q Service: 1.Foundation or Footing 2.Sheathing Inspection g Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed , 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: _ `��� C�� Vv � - F=���s . � ��U ���' �QZ`�`� . . � � 1 V" �\ � . . . __. __._J__._-,._. --e .., }_ TOWN OF BARNSTABLE BUILDING PERMIT APPLIM11 N r MapA 3 Parcel 06 R, Application # Health Division 13UILD►NG DEPTDate Issued 2f. /4, 19— Conservation Division Application Fee 50 0 Planning Dept. 'JAN 15 2016 Permit Fee f� (J U Date Definitive Plan Approved by Planning Board TOWN OF STABLE Historic - OKH _ Preservation / Hyannis Project Street Address 213 L G k1L5 i A__ a l ve, Wezi ` Village Owner Now Pr7 i(4 L L C ,f Address 25 y /11d,n S-` t�/e. ��44 Telephone S®� 3 661 a 3 0'1 Permit Request 1 nsf%it g-6n D� o� .31C� 1.�,��� SG f cr AotL ir-, y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0`7 0 Construction Type Lot Size V) a L Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S 01 a ki S r n LL C Telephone Number �� ?�Y G�� Address r ( 9 vl N,f License # d 0 Q S f-e- / t a 0,16 Cl Home Improvement Contractor# 1 J Email 1 A�b �ti`�( f i ivx, Worker's Compensation # ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE 1 FOR OFFICIAL USE ONLY - APPLICATION# GATE ISSUED y IAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION FRAME jy INSULATION i FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 'TOM retersen Architects 'Planners Construction Official January 13, 2016 Building Department for project at: 213 Lakeside Drive West Centerville, MA 02632 Re: Solar Panel Installation Mvlaire Residence 13 Lakeside Drive West Centerville; MA 02632 Dear Sirs. I've reviewed the proposed solar panel installation at this location to evaluate the existing roof. structure and the connection of the panels to the roof. Criteria: Applicable codes: 8"' Edition Residential Code(2009 International Residential Code with Massachusetts Amendments) 2001 Wood Frame Construction Manual Design.roof load: 35 psf live load, 10 psf dead,load,45 psf total load Design wind load: 100 mph,35 psf, Exposure Category `B' My findings are as follows. 1. The new solar panels will imply an additional dead load of 3 psi': The existing roof structure .(2x6 roof rafters @ 16"o.c.,.with 20 collar ties and 2x8 ridge, span=-t-/ 17'-0") is overspanned and not Buff iciest to bear this additional load. !n:order to supplement the existing structure at th.e roof plane receiving new solarpanels,we will construct a 2x4 bearing knee wall at each existing rafter where the solar rack system is attached. The knee wall will be constructed with.2x4's @ 16"o:.c., with a single bottom plate and,double top plate, with a resulting rafter span of I 1%0"maximum. 2. The solar panels are attached to the roofwith the So:larMo lnt-1 rack system by UN'IRAC. The rack system, roof connections and connection spacing are.rated for 100 mph. This project. requires the larger Solar Mount 1-2.5 beam(2.5" hibh)and spacing of flange foot connection to roofat 48"o.c. maximum. Flange footing connections to the rail are not required to be staggered. The flange foot connections to.the`roof are 5/.16"diameter.x 4" long tag,:bolts. I.therefore certify that t{ is installation complies with the applicable codes aitd design loads mentioned above and isacceptablc for approval. Please let me know if you have'any questions on this in.formimtion. Thanks! RED ARC Smff rely yours; �U.41PS0� O7WIA. el �N No.31621 z H 3 H.OWELL 3 Tong Petersen oy NJ OF M PS�PG Cc. Neal Holnigren., Solar Rising LLC 6 Country Lane•Nowell,New Jersey 07731 •Telephone 732=730-1763,i}ax.732-730-1783 { .a 1MaCSa?t"ttFrlr'#,.tros)€cg�'�; - ,w„ 4titt ar;Y c€r can vtr�xr4 t ' P"tigri#r la}+rxxKtr�. yy &tFC3Si Pthl14`P t x, i, ' -• - , Ye# ul #Fx#fit#iiuttwYiltrrwrt#tt tY1i f bc N ytot".ou Mot eP Stn:lsf, f4.#w#hp 1#'.;- •� � - a t�* #E17%C 11t e""wfi Lott of the - s #tt, f 2x10 #F `�a0 6 *�t e d t� aab �€4tv#tafy.�rra.t-�t#� � $t�,t•�.7 �+�� t �� r t Yet k a::ik ED ARC,y P 4� F. P O�PS �c�,�� �+ No. 31621 z rn HOWfLL, 4. f. O y m y NJ J P t Solar Rising LLC Project: Larry MUlalre i Solar Rising Building Permit Plans Sal508444-6284 __ - ,. . � I la r_ s Revision _ . .u1/9/15 , 213 Lakeside Drive West - I 1 .,.., . . ..,. 1 .- ", r PO Box 2623 Scale: s None Mashpee, Ma 02649: Centerville, MA 0263 �.2 _. .. ...., ... Drawn By. Neal Holmgren: ` y } /� {jI '�'�`i ��..,r'"rI'"� r"�Bu ... ,ei'a"f � ::i�i `r ' 4k+' `�' " +��, r" sr.�'�/,I ':j h w,�' Z �f� 1llsl� e� a1:1 tx .d- use ess to ulatl® { �� � �, 10'Paxt�Pta�a Sure ?0 R�# I. �'y g®ston, �s: a6us- is ®2`116 pme �m .ro 0e 4 6!*ac or kegis Oiq P ` , Registration 175578 Type Supplement Card cprryaGaa 5128%2Q96 SOLAR . —1, LLG. 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The Commonwealth of Mtrssachusetts Department of Indust>ZnlAccadents 1_Congress Street,Suate 100 .,,4"l�,'--.--�.�%-"�.;r"���....-':���,'-i�.."..1,;.�'��--�'-1.',��':.,.::.-7,1"-�:...��.:�I':-;��-I...-'w�-��.-,.�-,:!��l�i,'-'!:.;�!1�.�.�j�.._�-,7�"'.,'-:'r:�I�.:_-.��..-.'-�1. ' Bvstort, MA 09I14 2017 www mttss gov/din 1�os Lers'Compensation Insurance 4ftidavtt _Butiders/Contractors/El oc'Oictans/Piumbers TO-S FILED\WTI TkIE'PERVIITTINC.UTItORITY Applicant Itifortnation } Please Print.Le4W. Maine(Business/Organizatton/Indtvtdualj Solar R!sing LLC ,. Address $759>;Faimouttl Road i3 8 Clty/StatelZlp Mashpee M-,026._ Phone# a08 744 6284 Are you an employer"Check t e appropriate box Type ofprojecf(required) I. [am a employer wnh employees(full and/or part time)' - Q htew consfrucUon!am a sole proprietor or partnership and have no employees working forme m �, 8 Remodeling any capacity IN6 workers comp insurance regwred] 3 [am a homeowner doing all workmyselt [tJo workers comp asurance regwred j c 9 ❑Demolition - `10 Q Building addition 4 am a homeowner and will be hiring contractors to conduct all - k on, ' property I will 0.ensure.that all contractors either have workers compensation insurance or are sole l I ❑ElectflCal:fepatrS Of addttlOnS ,proprietors wRh no employees j pl`umbmg tepatrs or additttns a o t am a,eneral contractor and I have hired-the sub contractors listed on the attached sheec These sub=contractors have employees and have workers comp insurance l3 o Rgof repairs 6 a we aze a corporahon;and its officers have'exercised their right of exemption per MGL c t4 Other Solar w 15� 1(�)`,and we have no employees fNo workers'comp insurance required j , `Any applicant that checks box#l must also till out the section belowshowing then workers compensa i n policy information t Homeowners who submit tkus affidavit indicating they are doing a11:Work and then hire offside contractors must subma anew affidavit indicating such -. tContractors that-check this:hoe must attached an.;additionalssheet shoe ing the name of the sub contractors and state whether or not those entihe's have employees If the sub contractors have:'employees_they must prouide,theu workers comp`poicy number l am an employ er that u provtiltno workers'compensation tnstrnnce jot my employees =Below is the policy anal job sue tnforiu:t:on ''_ Insurance C.-- ' --y Name T[ayelers itldeffrtntty CoYltpahy Poitcy#or Self iris Lie # tJB 586,7 $0 ." - E�cptration Date. ;i11J02/1'6 t f. Job Site Address L��\ 3 i � �Imo. �J�'�� City/Stage/Zip Attach a copy of the workers'compensation pohcv decfaratton page(showin; the policy nuritber and";exptraf man,date) Failure to secure coverage as regutred under MGL c i�2 §��A is a criminal vrolatton punishable by a fine up to$t �00 00` ,--.�-'1-.1-.-�--�-.:����:�-I�....��w-��,.:-,1..'-,��1..� andlor.one yeas imprisonment,as well as civil penalhes.n the form of a STOP WORK ORDER and a fine''of up to$2�0 0014 day against the violator A copy of this;statement may be forwarded to the Oftice'of tnvestigattonsof the dIA for tiisurance coveage,verification _ 1 do.hereby ce antler the pnzns anrd<penalh s ojperjury thtlf the tnjarmahon provzd tl above i.true and correct S i`nature . ..': Date 1 J02/15 Phone`.#. . Ojfcral use only Do riot write in-this area,to be completed 6y city or town oJficraL City or Town Permit/License# I: . dsswng Authority(circle one) I.Board of Health 3 BmCtlmg Department 3 City!Town.Gierk 4 Electrical Jnspector S PlumRi►ng Inspector ti.Qther Contact Person Phone# k Life's Good Hong) - LG Electronics, Inc.(Korea Exchange:06657.KS)is one of the globally leading companies and' g� technology innovator for electronics,information .i and communication products.The LG Electronics currently employs more than 91,000 people worldwide in 117 companies.In fiscatyear 2011, 45.97,billion USD of revenue was achieved. ' ; d LG is one of the world's largest manufacturers of mobile phones,flat screen Ns,air conditioners, ' ' twashing machines and refrigerators.As a.future- oriented company,LG enables others to use technology consisting of renewable energies. LG's high quality solar products are being manufactured in LG's leading production facility a r in South Korea. 2 us KM 564573 65 EN 61215 •l t Installation Light and Robust 0 <:::0 Convenient 9 , o With a weight of just 16.8 kg, LG modules are LG modules are carefully designed to benefit proven to demonstrate outstanding durability installers by allowing quick and easy installations Ligfit%lf.b�hs` C�nJq"vgnf - . against-external pressure up to 5400 Pa, 4+.stxl3.Yon throughout the carrying,grounding;and connecting stages of modules. . s e 100%EL Test Completed Extra Power All LG modules pass Electroluminescence !o minimize losses due to mismatch,LG produces _ F inspection.This EL inspection detects cracks and- 3 groups of solar modules which are sorted by its other imperfections unseen by the naked eye. current class.This enables MonoX"'to maximize the system's output by around 2%based off the theoretical calculation. Reliable Warranties Positive Power Tolerance LG stands by its products with the strength of a 3 LG provides rigorous quality testing to solar global corporation and sterling warranty policies. LJ modules to assure customers of the stated power LG offers a 10 year product limited warrant and a ""m`^"c 1 t Y P Y t outputs of all modules,with a positive nominal. 25 year limited linear output warranty. tolerance starting at 0%. t Z LP _ $, ,•g - t ram...r g d ,$r ,�,. �.: - .o .` `:,` s . llvl A v 7A uc ✓:, .� , s �' as ' ' a ® Mechanical Properties ®Electrical Properties(STC`) Cells 6 x 10 � � r LG26051C-G3 .Cell vendor LG power__..._.�.. PP) _...._.._ �_...__..... ... __...__ MaximumatSTC.(Pm pp Cell type Mdnocrystat(ine MPP voltage_(Vmpp)_ 312 Cell dimensions 156,.x..156 mm`(6 x 6 In MPP current Im #of busbar, 3 O en circuit Volta a Voc 38 6 Dimensions(L x W x H) 1640 x 1000 x 35 mm Short circuit current(Isc} $.82 . - _ _.. _..........._..... ._ 64 57 x 34 37 x 1 a8 in Module e.fficienc /° 15.9 Static snow load 5400 Pa(113 psf Operatin ,_Tem erature,°C 40-+90 Static wind load 2400 Pa/50 psf — - Maximum,system Volta e V 600 UL,1000 IEC Weight 16.8±0.5 kg/36:96;-ll lb Maximum seriesfuse ratio A 15 Connector type MC4 connector IP 67 Power tolerance(%) 0-+3 _.. _._...................,..._.._,.____._._. ...._.._..........,.,....__ _..___.._.,.,_... Junction box IP 67 with 3 bypass diodes ... .,,,. ._.____.._._ ..-.__._._.___ •STC(Standard Test CondrhDn)Irradanc=_1000 W!m°,module temperature ZS"C,AM 1.5 Length Of cable.; 2 x 1000 mm 12 X 3937 in 'The nameplate pa:+er output is measured and determined by LG Electronics at is scileand absolute discretion ........,.. ..... __.�_..........-___._.,,...__�...- ...�_.._._._._.. Frame Anodized aluminum ® Certifications and Warranty ®Electrical Properties(NOCT") Certifications IEC 61215,IEC_.6...1.7..30-1/-2,IEC 61701, 1 __._., _. ._....._...... . ..._...... ....._ DLG Focus Test':Ammonla Resl Lance Maximum power(Pmpp} 191 UL 7703 ISO 4001 MPP voltage(Vmpp� 28.2 Product warranty 10 years MPP current(Impp) 6 76. _ ......_...._._._.......-__. . ........... _._ ....._____.. _.._._.. Output warranty of.Pmax Opentucu t goltage(Voc) 35 6 (measurement Tolerance 4 3%) - Linear Warranty , -- - ---- -•• ------ -- - �•---- Shortcircuit current(Isc) ............................... '1)1st war.97%,2)After 2nd year;03%-annual degradation,3)80.2%for 25 years Efficiency reduction < ° rom(f t000Wlmz to 200 W/mz) 4'S ®Temperature Coefficients 'NOCT(Nominal Operating Cell Temperature):Irradiance 800Wfm`,ambient temperature 20'C, wind speed 7 mis 44 9±2°C _..........._.........................._,.......,..._._......._.._.._..,..__..,....,.....->....: _..,....._.._.........__...._ Pmpp -0.459%/K - 10/0,40 lo/o.ao Voc 0.343°/D/V( ® Dimensions (mm/in) fE Isc a Characteristic Curves C 10 ^ r F woo/39ai zan.w zz/o.eT 5.5'o.01x vloal 1000 W onm naos(aoo) fslao°r snort.mo) I Long sid°frame Short side frame 9 960/3'/RO U 8 800W o-,x,borm(a.:4 (W:t..c°ber,..e°mo°nnny rwks) K t to/o.-rt 6 600 W er°°°al°9 a) c t 4 400 W s-raa.otz w 3 - �~� Mo°nn�borenle°ol I 2 200 W 1 _ _...ia _.�_._, \t000(39.37 O-_..5�70 15 Y 20 25 _30� 35 40 Voltage IV) camo renors a I a �Q S m.5l0.06 140 ( _ € D-11 x o F _ o n o ^ x .� vpl E ,n E $ $' ° 0�6 .E 720 -_..._,. --.--._..._..'------`_------'------------------ o€ o C -- m Isic Voc ° ° D 80 ....... ° ° Waly Pm dXp 9aa/3'r" qa/0.31 60 -----------------._...__.._...._.-_.-__---_,...___-..__.._--------- 40 ----..-.-------------.-_.............__._..___._..---...___-_____ i oawa z ° o m m 4- I� f? o ._._._._.—__.. ---- __.—.------._.__ 35n.3a -40 -25 0 25 5o 75 90 Temperature{'C} 'The distance behveen the center of the mounting/grounding holes Q North America Solar Business Team Product spec i cations are subject to change vithout notice. ' LG Elecftonics USA,Inc "7 G Lhe s Good'is.a reglstrated trademark or LG Corp. 1000 Sylvan Ave,Englewood Cliffs; All other trademarks are the.property of their respective owners. bn ^dli NJ 07632 Lifers Good Cantact:Ig.solar@Iye.com Copyright(3 2013 LG Electronics.All rights reserved. wymdgsoiarusa.com 02/01/2013 rr ry _ Grid Tied Photovoltaic System DC Rating 7.44kW Larry Mulaire 213 Lakeside Drive West Site Details: All Work To be in Compliance with: Solar Rising Shall install a 7.44 kW Grid-tied 2014 National Electrical Code (NEC) Photovoltaic system comprised of(24) LG 310 21 C- 2009 International Residentail Code (IRC) B3 Modules with (24) Enphase Energy M250-60-2LL 2009 International Building Cade (IBC) Micro-Inverters. The Modules will be flush mounted.to the 2012. International Fire Code (IFC) Asphalt roof. MA 780 CMR 81h Edition ASCE/ANSI 7-05 Minimum Design Loads for Buildings and other Structures. Equipment Specifications: Modules: (24) LG Solar 31ON1C=A3 Inverters: (24) Enphase Energy M250-60-2LL _ ym �mA 41 Racking: Unirac Solar Mount � Attachments:.EcoFasten Flashing with 4" Stainless t'K Steel Lag Bolts ° Roof Specifications: Roof Asphalt ' 2X8 Rafters 16" ¢ Pitch: 25° Azimuth: 150° , Site Specifications: *h Yam. Occupancy: II Design Wind Speed: 110 MPH . ,*, °, Mean Roof Height: 22ft 13�1 `P* � 4. Ground Snow Load: 35 PSP Solar Rising LLC Project: Larry Mulalre Solar Rising,Building Permit Plans Sol 8' S08-744-6284 213 Lekeslde �rlve West Revision: 1/9/15 PO Box 2623 Scaler None ® Mashpee,.Ma 02649 Centerville, .MA 02632 Drawn By: Neal Holmgren i' k } Y } M1 P(# 7r ly 1 C. -Quantity of attachments = 30 @ 48" O.C. -Maximum UniRac Rail span 48"O.C. Maximum Allowable Cantilever = 16" -Racking and Attachment: UniRac Solar Mount with -lag screw, Hex Head, 18-8 SS 5/16" x 4" Length -Array Installed According to the UniRac Solar Mount Code-Compliant Installation Manual, Solar Rising LLC Project: , Larry M ulalre Solar Rising Building Permit Man Solar 508-744-6284 Revision: 1/9/15 PO sox 262s 213 Lakeside Drive Wept Sale: �F-F � None Mashpee, Ma 02649 Centerville, MA 02632 Drawn By: Neal Holmgren ;i .,�... WSla�1�sMS1'Irrt�Aattil Fsr� ws� � �+ aaa ua M w�, t h �en;..:wn+«.s+ .a•M' .vr... w-�' `.�wi.�iaGT•bfimrtim�'C"5� _`.W.+�3'KwnpsF"Nm.k�r SV` ,�yw.xu" r4rAFtr` .`vE"ilr? �,...:,:,:..,-.., ..._: �.,agw^'klxk'r #' mw, M?zc�;v�„a9u=,.rasa aar'��v-an* .�a.r•. - C:xirris�r 9ocaix lurabec' SVt a _ wY Sam Lood d,,vi`• 9rf,., Tire�ia+.isr:Y�lrSr kcantt Shan is `O Wii:h a M111 ilUD11'i arina"is t t:h of'0-113 in. required'at zacb errs!of(h xneraWr r, l rl, E flr t 2x10 lrust�ax `rti'ISa 1� .w._ 4E*Sh3 ,� y ' 2t�}jyCi44}C`Fa).,_......,. i ,fah x......... ....__...,.., .,r Project: Lai" MWaire Solar Rising Building Permit Plans Solar Rising LL;C 1 Sole 5os-744-6284 213 Lakeside Drive West Revision: 1'9'15 PO Box 2623 scale: None Mashpee, Ma 02649 Centerville, MA 02632 Drawn By: Neal Holmgren E ;�' '� ' Gr�enf'asten"Gfi-N�pciticttitiit3e CutShee`is:Gfl-L b " �l, LvJ A. �c 4r ( � Y l d` " S " SECTION A-A $i y e H � � ...e:�>wxs.. - � _. � �,_p-a^fi5�-� u�i�m:u+a.a iFeavPwrol Rn_aaN_frei;Ys eutavr k�.,l q,r�uz7 r:•iismtd;ircq�lqn_aH�-r.ecm�.teti'!73_...,..—_..._—.,.�.----,—..�- lr Solar Modules to be flush mounted to existing roof structure and set above shingles 4" Solar Rising LLC Project Larry Mulaire Solar Rising Building Permit plans IS(3 1 -. 508-744-6284 Revision: 1/9/15 of 213 Lakeside Drive West i s i PO Box 2623 Scale: None Mashpee, Ma 02649 Centerville, MA 02632.. Drawn By: Neal Holmgren 1 D:UL :t3b AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MI /DD/YYYY) TUMM11FICATE IS ISSUED AS'A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S),AUTHORIZED REPRESENTATIVE IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder In lieu of such endorsemen s. PRODUCER CONTACT t. NAME: PAUL PETERS AGENCY INC PHONE 680 FALMOUTH ROAD FAX (A/C,Na,Ext): (A/C,No): MASHPEE,MA 02649 E-MAIL ADDRESS: 28LBR INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF ANWICA 3 SOLAR RISING LLC INSURER 8: INSURER C: PO BOX'2623 INSURER D: MASHPEE,MA 02649 INSURER E: INSURE R F: 07MCOVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TIFY H T H POLICIES F INSURANCE LISTEDBELOW AVE 8 ISW-E O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIAITSSHOWN MAY HAVE BEEN REDUCED BY PAS CLAIMS. INSR ADD SUB POLCY EFF DATE POLICY EXP GATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMWD1YYYY) (M)ADMYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ POLICY PROJECT Q LOC PEE GE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) SCHEDULE AUTOS BODILY INJURY $ (Per person) HIRED AUTOS � BODILY INJURY $ NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ —' DEDUCTIBLE RETENTION$ --$ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY We 5TATuroaY orHER YIN UB-5B677050-15 11/02/2015 ti102/20i6 X j uMITS ANY PROPERITORIPARTNER/EXECUTIVE M N/A OFFICERIMEMBER EXCLUDED? ACCIDENT E.L.EACH $ 1,000 ODO I yes,describee under (Mandatory in E.L.DISEASE-EA EMPLOYEE $ 1,000,000 under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,0D0,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIRCAT13 ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE INSUREDS MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYM13NT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA: NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IFTHE INSURED HIRES,OR HAS HIRED EMPLOYEES OUTSIDE OF MA, THISTOLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. . CERTIFICATE HOLDER �^^ .•. s.:t�--..»�......�...:.......a.,....,.,.,„,.,,,..,�,� ,„„„ ..�� ,,, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT` .VE ; ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD'� 9B1 8.2D1' 0 Cp ORPORATION. All rights reserved F LG NeON"z ; Mechanical Properties Electrical Properties(STC*) Cells 6 x 10 Module Type 31 O W Cell Vendor LG MPP Voltage(Vmpp) 32.8 Cell Type Monocrystalline/N-type MPP Current'(Impp) 9.45. Cell Dimensions 156.75 x 156.75 mm/6 inches Open Circuit Voltage(Voc) 40.4 u of Busbar 12(Multi Wire Busbar) ' Short Circuit Current(Isc) 9.96 Dimensions(L x W x H) 1640 x 1000 x 40 mm Module Efficiency(%) 18.9 64.57 x 39.37 x 1.57 inch Operating Temperature(°C) -40-+90 Front Load 6000 Pa 1125 psf Maximum System Voltage(N) 1000 Rear load 5400 Pa/113 psf 1�,tE -_ Maximum Series Fuse Rating(A) 20 Weight 17.0 t 0.5 kg/37.48 t 1:1 lbs Power Tolerance(%) 0-+3 Connector Type MC4,MC4 Compatible,IP67 =SIC(Standard Test Condition):Irradiance 1000 W/m',Module Temperature 25°C,AM 1.5 `The narneplate power output is measured and determined by LG Electronics at its sole and absolute discretion. Junction Box IP67 with 3 Bypass Diodes *Ile typical change In module efRdency at 200 W/m2In relation to 1000 W/O is-2.0% Length of Cables 2 x 1000 mm/2 x 39.37 inch Glass High Transmission Tempered Glass Frame Anodized Aluminum Electrical Properties(NOCT*) Module Type 31 O W C8PL1FICdtIgRS and WarrantyMaximum Power(Pmax) 226 Certifications IEC 61215,IEC 61730-1/-2 MPP Voltage(Vmpp) 30.0 IEC 62716(Ammonia Test) MPP Current(Impp) 7.54 IEC 61701(Salt Mist Corrosion Test) Open Circuit Voltage(Voc) 374 ISO 9001 Short Circuit Current(Isc) 8.03 UL 1703 *NOCT(Nominal Operating Cell Temperature):Irradiance 800 W/m',ambient temperature 20°C,wind speed 1 Ms Module Fire Performance(USA) Type,2(UL 1703) Fire Rating(for CANADA) Class C(ULC/ORD C1.703) Dimensions(mm/in) Product Warranty 12 years Output Warranty of Pmax Linear warranty* *1)1 st year 98%,2)After 2.nd year 0.6%p annual degradation,3)83.6%for 25 years Temperature Characteristics �J `mot s MCI` 46 t 3°C Pmpp -0.38%/°C 1 iwr mrax sues oar oKmx nmvd Sae smraa o-� Voc -0.28%/°C Isc 0.03%/°C Characteristic Curves u 800wreN N 6.00 6.00 60OW 4 uoauq eueem., - t 400 4Ww. - 2ouw w v liagi,.ty) e e n �3 0.00 500 1000 15.00 Mini) 25.00 3000 35.00 t 4n.en' Y500 a � s :_...-__ ._--- - - .. .. y 1m 60 .-.__----._,..___.___--------- ..�._....._�.,_..___._____v.. r 112 -ao .25 n q 25 so ''-rs so - *11he dilarim between the center of dm mounting/grounding holes. LG North America Solar'Susiness Team Product spedfiratiom are subject change without notice. .WL LG Electronics U.SA Inc OS-N2-60-C-G-F-EN-50427 `�lUO Life.Good- 1000 Sylvan Ave,Englewood Cliffs,N)07632 _ - Copyright®2015 LG Electronic.All rights reserved. Innovation for a Better Life Contact lgsolar@lge.mm 01/04/2015 www.(gsolarusacom n y r• LS 0 Vfe's Good I �4, �• "art ,a3�s': � �,, , LG Ne®N'"2 LG's new module,LG NeONT"'2,adopts Cello technology. Cello technology replaces 3 busbars with 12 thin wires APPROVED PRODUCT to enhance power output and reliability.LG NeONTm 2 y 60 cell demonstrates LG's efforts to increase customer's values D E C C beyond efficiency.It features enhanced warranty,durability, IDS 3 61215 performance under real environment,and aesthetic xmssPhouowxac Modules design suitable for roofs. ATM, ' b'Enhanced Performance Warranty High Power Output 111i11li TON 8lhlii avea. LG NeONTM 2 has an enhanced performance warranty. 0-Mi Ll,m- Compared with previous models,the LG NeON'm 2 The annual degradation has fallen from-0.70/o/yr to has been designed to significantly enhance its output -0.6%/yr.Even after 25 years,the cell guarantees 2.4%p efficiency,thereby making it efficient even in limited space. more output than the previous LG NeONTm modules. AGE Aesthetic Roof ;: lliO Outstanding Durability LG NeON`rM 2 has been designed with aesthetics in mind, With its newly reinforced frame design,LG has extended ---- thinner wires that appear all black at a distance. �-gil------l-— the warranty of the LG NeONT" 2 for an additional `....... The product may help increase the value of =- --— 2 years.Additionally,LG NeON"M 2 can endure a front a property with its modern design. load up to 6000 Pa,and a rear load up to 5400 Pa. • '• Better Performance on a Sunny Day Double-Sided Cell Structure _ �O� on LG NeON m 2 now performs better on sunny days thanks T"^ P y y ���6��lze e�`. The rear of the cell used in LG NeON 2 will contribute to 9_e3_ MINI U to its improved temperature coefficiency. MUMMILM generation,just like the front~the light beam reflected from the rear of the module is reabsorbed to generate a great amount of additional power. About LG Electronics LG Electronics is a global player who has been committed to expanding its capacity;based on solar energy business as its future growth engine.We embarked on a solar energy source research program in 1985,supported by W Group's rich experience in semi-conductor,LCD,chemistry,and materials industry.We successfully released the first Mono X®series to the market in 2010,which were exported to 32 countries in the following 2 years,thereafter.In 2013,LG NeONT°'(previously known as Mono X®NeON)won"Intersolar Award'which proved LG is the leader of innovation in the industry. Solar Property Owner Consent Form Owner: Julie Jones,Holly Point LLC Address: 213 Lakeside Drive West Town: Centerville State: MA Zip: 02632 Phone: 508-362-2304 I hereby give permission to Solar Rising Ile. and their representatives to pull the required permits for a solar installation on my property. /5 Prope Own Date Solar Rising Date 12- 1It� CAPE COD INSULATION IIlIY GLASS IIurms IPRAT TION SUSPINGIG YATTf OUfilll INSULATION [IIlIN01 1-800-696-6611 =Y Town of B x Barnstable _� ) Regulatory Services Building Division , 200 Main St Hyannis, MA 02601 Date: '- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village a�3 kal>mh bit tJ Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (X) Slopes ( ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) ,6 V,e r `, (VO r Al. J �l it �f�tl Sincerely 2Hr E ssi r, President Ins ation, Inc. �l -hr 4v �t, , �" Town of Barnstable *Permit# Expires 6 mo hs-rom iss e Regulatory Services Fee BARMSTAB 0 MASS. 163q. y [ Richard V.Scali,Director lAb Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 00 Z Not Valid without Red X-Press Imprint Map/parcel NumberC��' � • Property Address 9,43 J. K e- —de �C �PS� �'^ �'e VV1�4- dResidential Value of Work$ Sao O. Minimum fee of$35.00 for work under$6000.0,0 Owner's Name&Address J,u iJ g �2f�y/ 1-imiy �. 'w/'. kD,nn�1b�, Ho O,?le �2 Contractor's Name ;/;�/.'.Oi� Telephone Number �,q jf ? 76 �6 a Home Improvement Contractor License#(if applicable) �a G Email: Pq!a S�,u�c, t� 1 LIyUX. G Construction Supervisor's License#(if applicable) C s D Co�S [6Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑�I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. i. Permit Req st(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&FirePermits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission., A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Office of Consumer Affairs and Business Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C�nt�etor Registration Registration: 126252 Type: DBA 25135 Expiratio : 5/6/2016 Tr# a n It M. A. SLIWA HOME IMRPOVEMENT MICHAEL SLIWA a .... -� P.O. BOX 1461 A ,J �= ' MASHPEE, MA 02649 ` `w 1 —�4— Update Address and return card.Mark reason for change. — Address Renewal Employment Lost Card CA 1 Co 20M-05/11 910" `v r1 i;t.i� 'jaU0 jSS'WW0 1 Massachusetts -Department of Public Safety Board of Building � Regulations and Standards Construction Supenisor License: CS-082655 MICHAEL A SLIWA PO BOX 1461 _ MASHPEE MA 9264 - - _ - Commissioner Expiration �_ 10/04/2016 the Commonwealth of-Vassachusetts Depart welrt of Inndmtrial Accidents awe of Invfffigafions _ 600 Washingion Street — -- ----Boston_ n,Ys n1}dlmaS gov1dia Workers' Campensafran Insurance Affidavit:Bmlders/ContractorslEIectr cians/Phmbers Applicant Information Please Faint Legibly era Address: City/Stater Phone±CEC& s3 — f/0, y Ai�an employer?Checkthe appropriate box: Type of project(required)- 'have I am a general contractor and I T6. ❑New project construction 1. I gut a employer i�ith.�_ ❑ employees(full and/or part-time).* leave hired.the sub-contractors s 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling slip and have no employees. These sub-contractors have 8. ❑Demolition wonting for mein any capacity employees and have wodmrs' 9. ❑Building addition [No u,-orls�cs' comp.insurance comp.insuranHSP required-] 5. ❑ We are a corporation and its 10❑Electucal repairs or additions officers have exercised their 3111 am.a hameoumer doing all wank 11.0 Plumbingrepairs or'additions self o workers' right.of exemption per MGL �' � - 1?-❑ irs Roofrepa insurance required,]i c.152,§1(4h and we have no n employees.[No workers' 13.ErOther . L&W comp.insurance required-] 'flay appbc=ffiat chedrs box i%l amst also fll out the section belowsboWMg their VM&eW compeasatwupolicg information- I homeowners who mbmrit dun of hwit indkz=z they are doing an wal and deg hire outside contractors wrest sobMit anew affidavit indicating such. ICouu1ctors that check this boor must attached au addiiianal sheet showing the name of the sib-cam=ct=and stale whether or not those entitks have employees.Ifthesub caatractnrshave emgiayee%they=isrpsmm--ide dkdr nwrlrers'comp.polio number. I ana ara ernpiayer tJeatis prmztIin yvarkers'caarrperasaliara iizsnrarrce for m}*enrpIaj�ees Betaty is thepoticy and job site inforrnadon. Insurance Company Name:�G�a(it' Policy 4 or Self-ins.l..ic. ja0S"/S` E-cpiration Date = Job Site Address: a 13 eL 4rke S 14,e D✓„ (,ems 7L City/State/Zip: OGj l A:5 le apy. Attach a copy of the workers'compensation policy declaration page(showing the policy masher and expiration date). Failure to secum coverage as required.under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,50D OD and/or one-year imprisontuent,as wa ll as civil penalties.in the form of a STOP WORK ORDER and a EM ` of up to$.25O.DO a day against the tizolator.-Be advised that a copy of this statement may be forwarded to the Office of Iavestrgations of the DIA for insurance-coverage verification- I d0 hereby ccerhfy antler tF pahis andper ' s o,�- j'uty thatthe iriformaf vapmidedabmv is(rare and carrect Sitmattare: Date' Phone ikLtl 4 Official use only. Do not write in this area,to be campleted by city ortotwn official City or Town: PermitUcense If Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1rowa Clerk d.Electrical Inspector 5.Plu mbmg Inspector 6.Other Contact Person: Phone#: luformation and Instructions ` Massaclimefts General Laws chapter 152 requires a eroployers'to provide workers'compensation for their employees. PMM=t-to this sfmatute,an.emplayene is defined as-"-.every person in the service of another under any contract ofhire, empress or nnplied,oral or written.- An errp&yer is defined as"an individual,paminersbip,associaii-an,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 trash of an individual,partnership,association or otherlegal entity,employing employees- However f$e owner of a dwelling house having not more than three apartments and who resides therein,or the occapant of the - dwelling house of another who employs persons to do mamtmance,consftuction or repair work on such dwelling house or oa the grounds or building appvrbenant 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, §25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpnblic wort.-,until.acceptable evidence of compliance with the i„suran ce.. regviremcuts of this chapter have Been presented in the contracting ar>fhodtyf Applicants Please fill oirt the workers'compensation affidavit completely,by chacl a boxes that apply to your situation and.,if necessary,supply sub-contractor(s)name(s), addresses)and phone ntmmber(s)along with their certificate(s) of hinar-once. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry woricers' compensation instnance. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavit maybe submit-bad to the Department of Industrial Accidents for confirmation of ins ran ce coverage. Also be sure to sign and date the affidavit The affidavit should be retommed to the city or town that the application for the permit or license is being requested,not the Department of harh,strial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compsation policy,please call the Department at the number listed below. Self-insured companies should enter their en self-insrrrar,ce lic=o number on the approltiate line. City or Town Ofa-cials . Please be sure that the affidavit is complete and primed 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 pen mitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple per i-tlIicans5 applications is any given year,need only submit one affidavit indicafng current policy infblnation Cif necessary)and under"Job She Address"the applicant should write"all to cations inn (CitY or town)_"A copy of the-affidavit that has been officially stamped or marked by time city or town may be provided to the applicant as proof that a valid affidavit is on file for fvinre permits or licenses_ A new affidavit must be fiIled out each year..Where a home owner or citizen is obtaining a license or permit not related to any business or commercial vemmtise (Le,. a dog license or permit to bum leaves etc.)said person is NOT mquixud to complete this affidavit: The Office of Investigations would Imke to thank you in.advance for your cooperation and should you have any questions, please do not hesifate to give us a call- The.I?eparoaenfs address,telephone and fax number. 'The CaG=janWeattlr of MassachuszM , Depari ment of 11iCIMtdal Accident% 600 washivan Stcf-,tt BMton2 MA.G1 I I I `f6-L 4 617-'27-49GO Qxt 4-06 or 1-V7-MASS, � Fax 9 617-727-7M Revised 4-24-07 -ma.s45-gaVjdia e a • RARNSfABLE « Arf amp Town of Barnstable -------- Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section.. .-- If Using A Builder as Owner of the subject property hereby authorize �rU�c�i/ �,,6f,�_ to act on my behalf, in all matters relative to work authorized by this building permit application for: NA pz6 3 2- (Address of Job) Sign e of er Date Flu )ia �n e_.Sr, - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side.: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services �°UTHE toly� Richard V.Scali,Director k Building Division BARNSTA13M Tom Perry;Building Commissioner BIAss. 9 1639. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: - city/town state zip code The current exemption for"homeowners"was extended 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. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ACC U® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 6/1672015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE.POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy((es)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER NAMEA NOrah Mccormick Waquoit Insurance Agency PHONE (508)540No.Fift -1919 FAx 516 Waquoit Highway EMAIL ADDRESS:nmccormick@mccormickinsurance.com 08)457-1269 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Waquoit MA 02536 INSURER ANorfolk 6 Dedham Mutual 23965 INSURER B:Ace American Insurance Compan M.A. Sliwa Home Improvement INSURER c: M.A. 31iwa INSURER D P.O. Box 1461 INSURERE: Mashpee 14A 02649 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1561602358 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE S R POLICY NUMBER MPOUCY EFF POLI IMMIDD O YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 300,000 CLAIMS MADE A OCCUR 15 - PREMISES Ea ocaurence $ 50,000 R0310757 4/16/2015 4/16/2016 MED EXP(Any me person) $ 5,000 PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 600,0.00 X POLICY a JECT LOC PRODUCTS-COMPIOPAGG $ 600,000 OTHER $ AUTOMOBILE LIABILITY coMBI ED INGLE LIMR $ Ea acaderd ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acrtiderd) S HIRED AUTOS NON-OALIT SWNED PROPERTY DAMAGE $ Per acciderd $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION PER 0 AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 B M—daR/M n NKI EXCLUDED? N 1 A (OFFICER/MEMBER FICE /M in 6S62OB2E23120515 5/24/201S 5/24/2016 E.L.DISEASE-EA EMPLOYE -$ 100,000 If yes,describe under DESCRIPTIONOFOPERATIONS-bel. EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space Is required) CERTIFICATE HOLDER CANCELLATION- SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE Town of Falmouth THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Norah Mccormick/DJM C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)` i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-�� y Parcel Application Health.Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address UJ ' Village Owner Address . Telephone Z-3 0 Permit Request rl XV Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain 'L, Groundwater Overlay Project Valuation Construction Type (� �w I Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family -Erl Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Areas 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 Ln Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other V f r— Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Au orization ❑ Appeal # Recorded ❑ Commercial ❑Yes. o If yes, site plan review# Current Use Proposed Use ' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ), /y'b Z' q 4L Address License # too* '�✓ Home Improvement Contractor# `15 6/0 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS RO ECT WILL BE TAKEN TO � . SIGNATURE TE '� FOR,OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 1; INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING i� ' DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigadons 600 Washington,Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information - Please Print Le ibl Name (Business/Organizaaon/Individual): laC /; Address: �� VGo Ul, Cal/" City/State/Zi :`'00 ` V U�L��,( �� Phone Are you an employer?Ch c'kqheappropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I Type of project(required) / employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction Z:❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Q Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp, insurance.$ 9•. 0 Building addition required:] 5. We area corporation and,its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Roofre insurance required.] t c. 152, §1 .(4), and we have no pairs n 3a.❑ I am a homeowner acting as a employees. [No workers' 13. Other_r� (,{,��{l'(,6V1 general contractor(refer to#4) comp. insurance required.] 'Any applicant that chocks box#1 must also fill out the section below showing their workers'compcnsationpolicy 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 bog 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. !am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site . information. (,� I . Insurance Company Name: /�'[t \.. G�f`� �.(✓ �1� (�I�GL e/ Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip:• ��- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a- fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties*in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the'violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. x I do hereby certi un the pains and penalties of perjury that the information provided above is true and correct. Si a _. .Date: Phon #: 0,(j`icial use only. Do not write in this area, to be completed by city or town officiq[ City or Town. Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.{City/To 6.Other wn Clerk 4. Electrical Inspector 5. Plumbing Inspector �, Contact Person: Phone#: r From:Rogers&Gray InsuraFax: To:+15087785735 Fax: +15087786735 Page 2 of 2 0313012015 10:04 AM CAPECOD-27 BDELAWRENCE A�o�RL7., CERTIFICATE OF LIABILITY INSURANCE FDATE(tMIDO Pf1"r1') 3130/2012015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONE _ I NAME: 1 Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,E-M No -- Eat. A/c No: (877)816-2156 South Dennis, MA 02660 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC a_1 INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY 39454 Cape Cod Insulation, Inc. INSURER C:Endurance American Specialty Ins.Co. 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 — INSURER E: INSURERF; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL bU13R1 POLICY EFF PO ICY P LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0003000 CLAIMS-MADE P(I OCCUR CBP8263063 04/01/2015 04/01/2016 PREMISES Ea occurrence) 100,000 MED EXP(Any one person) $ 5,000, PERSONAL&ADV INJURY $ 1,000,006, GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000IR - ,000 X POLICY a JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 _ 1B ANY AUTO TBD 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( 1 X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peracciclent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 C EXCESS LAB CLAIMS-MADE EXCl0006635000 • 04/01/2015 04/01/2016 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate WORKERS COMPENSATION 1 PEROTH- $ 2,000,000i AND EMPLOYERS'LIABILITY YIN STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431900 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,00 0 R/OFFICEMEMBER EXCLUDED? N❑ NIA _.ENT _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $. 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORO101,Additional Remarks Schedule,maybe attached if more space is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided underthA General Liability and Auto Liability when required by written contract or agreement With the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULDANY OFTHEABOVE DESCRIBED POLICIES BECANCELLED BEFORE Cape Cod Insulation,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE VUTH THE POLICY PROVISIONS. t South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety :.Board of Building Regulations and Standards Construction Super)iscir License: CS-100988.. ' HENRY E CASSIo 8 SHED ROW r WEST YARMOUm li `✓, " 15l Expiration Commissioner 11/11/2015 z Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tray 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE — SO. YARMOUTH, MA 02664 — Update Address and return card. Mark reason for change. SCA1 +i 20M•05/11 Address Renewal Employment ❑ Lost Card depao�u��zaiacueu.�C/n�C%�/Z�rwoac/ueeCtt a\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation xpiratfon:,;.::1;21:1. (20:1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD HENRY CASSIDY 18 REARDON CIRCLE" SO. YARMOUTH, MA 02664 Undersecretary_ N valid wi ut sign e h mass savePAIVICIPATING sa-w ftwo omm eficMnev - '•■ram PERMIT AUTHORIZATION FORM 1, JULIE JONES ,owner of the property located at: (owner's Name,printed) 213 Lakeside Dr W' CENTERVILLE (Property,Street Address) - (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed ' below to act on my behalf and obtain a.building permit to perform insulation and/or.weatherization work on my property. Owner's Sig-ature y� I Date FOR CSG OFFICE USE ONLY, Conservation Services Group has assigned the following Mass Save Home Energy Services Participating- Contractor to tlie above referenced project:, y W F, Participating Contractor Date For Office Use Onty Rev.12132011 .. _ �_ �.�., � ...�.• -- --__ ��- —-� ew, ti, ii C f-M �.1� \ � d ._ a a ova�.�� � � ��,�::.� ;, a -� '� `� ("��'� C�/�� D� a vim' ,. d r,,1 .� �' � ` � Engineering Dept. (3rd floor) Map 3 Parcel 10fo °� r Pefmit# - House# 1,3 Date Issued Board of Health(3rd floor)(8:15=`9:30/,1:00-4:30) IS--46Lt P3 Fee Conservation Office(4th floor)(8:30- 9:30/1:00 SEPTIC SYS EM MUST INSTALLED IN COMPLIANCE Planning Dept.(1st floor/School Admin. Bldg.) VI1 H H � AND Definitive Plan Approved by Planning Board 19 EWV1R0NM `�OW&4 R I S_. TOWN OYBARNSTABLE 'F°"��'� Building Permit Application Project Street Address e'E s/, K4 C/6- 5 Village e�;5�y7f 99L41LE Owner Z 111,464 'J Ate! & ),ZS IT_P�vr S Address X14 .4a_" /ems '02. Telephone s Permit.Request 4G T j S `*EGC ,J Sanely i✓✓G , /IVS7�q// SLi 2h�Yl S , /—tJi.�AOuJ G.O A L f0 x// /��/h /�/.v/NG/,e 4 Y A--,4.P of A%��rif6o 6�949" First Floor square feet Second Floor square feet Construction Type 0 Estimated Project Cost $ !d/ocq�> Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl Ud"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 .3.. New ^ Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Z(Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes u0<0 Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) Z a o?A ❑Barn(size) ❑None ❑Shed(size) / ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# /iJ //g Recorded❑ Commercial ❑Yes Er% If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number •2— �3 Address 4S GE�A6L Ste_ License# OD 8f ytJEsSi/�AQ�t1S ,0 M4 Home Improvement Contractor# //,C_5/—y Worker's Compensation# - NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN AS BUIL SHOWING EXISTING AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1.2 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. . DATE ISSUED- - j'N• - F 3 `, - ,�, r .. ' ;} `" '-k MAP/PARCEL NO: ADDRESS f VILLAGE; OWNER1 f i DATE OF INSPECTION: FOUNDATION FRAME • . � i � � ' , �� INSULATION FIREPLACE i t ELECTRICAL: ROUGH ' FINAL PLUMBINGJIROUGH FINAL GAS: e"3 'M -ROUGH FINAL ' a ri FINAL•BUILDINGS j�/"tea' �,,,,, r r•. r { v cr DATE CLOSED'.OUT vj t ASSOCIATI1� LA iT*NO. t t • 1 1 1 � V . The Town ®f Barn ..table $� Department df genith Safety and Envfro"i entaI Services Building Division 367 Main street,Hyannis MA=601 RaMan G:.= Office: 508-1,790-62-77 BL iIdinz C.: Fax: 508-7,90-6Z30 For office-use only Permit no. Date AFTMAVIT HOME MWROVEML ENT CONTRACTOR LAW t SUPPLEMMNT TO PERMIT APPLICATION ` MGL a Z 14A requires that the reconstruction, alterations, reaovIItfon, repa ir, moderni=tion. conversion, improvement, removal, demolition, or construction of an addition to any pre-esistin: owner occupied building containing at feast one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, wit` certain exceptions.along with other requirements Type of Work: /L'1�f�'R ���'y—� Est. Cast �Di OOC� Address of Work: �/3 Owner's Name Date of Permit Appiication: I hereby certify that: Reqvistration is not required for the following renson(s): Work esriuded by law _Job under 51,000. adding not owner-occupied Owner puffing own permit Notice is hereby. given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITS UNREGISI'ERF.O CONTRACTORS FOR APPLIG_VBLE IEEOME MoRovEdENT WORK DO OGRAM OR GUARANTY FUND UNDER MGNO 142A � ACCESS TO TM ARBITRATION PR SIGNED UNDER PENALTIES OF PERJURY I hereby apply fora permit as the f the 1,2-12 Contractor flaffie Registration No. Date The Commonwealth of Massachusetts Department of Industrial Accidents `_ \ office ollnyeSM21180S 600 f f'ashinr ton Street ` Boston.Ma.u. 02111 Workers' Compensation Insurance Affidavit �hplic•tnt information• Please PRINTlebtil(�`^ _ name: ekllwl S M CGt:J/GG/,41►a� locition• �s CGS S cLv Get s i AWILS /1?�0. Phoney C I am a homeowner performing all work myself. 2-nm a sole proprietor and have no one working_ in any capacity [I I am an employer providing workers' compensation for my employees working on this job. cointmov name: idd ress• city: phone#- insurance co JPolicy# [� I am a sole proprietor. general contractor, or homeowner(circle otte) and have hired the contractors listed below who have the following workers' compensation polices: compnnv nime: address: cin•• nhonc#• - insur-nce rn policy# comnanv nnrrtc address• — riry nhonc#: insurance co nolic� # Attach additional sheet ifneccsiat?;..: Y.._:;._•'_:;�..- ,:,...,y. r�..v.....:a�.:.w.+r....� a.�r..v: .: ►..:'. `�...,..,-. .. Fniiure to secure coveraJ!c as required under Section 25A of 111GL 1.52 can lead to the imposition of criminal penalties ol'a line up to S1.500.00 andiur une%ears' imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the ORicc of Investigations of the D1A for coverage verification. I do herehr certify tut( tits sins and •rtaltics of perjun•that the information provided above is true and correct. Si^_nature �' Date Print name .J6�,t,If ---phone 3S•Z 3�� SO�' :. official use unh• do not write in this area to be completed by city or town official ' city.or town: permit/license# r•illuilding Department C3Liccnsing Hoard I] check if immediate response is required c3seleetmen's office l' '. C311calth Department contact person: P hone#: r'1Othcr. u1. h.� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovees to provide workers' compensation for the employees. As quoted from the an emph ree is dcfined as every person in the service of another under an\• contract of hire, express or implied. oral or written. An emp/urer is dcfined as an individual, partnership, association. corporation or other legal entity, or ally two or mor, the foregoing enuagcd in a joint enterprise, and including the le al representatives of a deceased emplover. or the receiver or trustee of an individual , partnership. association or other legal entity, employing* employees. However th,, rnvner 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 ho: or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe: MGL chapter 152 section 25 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, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence ofcotnpiiance with the insurance requirements of this chapter h been presented to the contracting authority. Applicants Please fill in the workers* compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers 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 requires to obtain a workers' compensation policy, please call the Department at the number listed below. . Co- nC rowns Please be sore that tite affidavit is complete and printed legibly. The Department has provided a space at the bottom o; the affidavit for you to 1-111 out in the event the Office of Investigations has to contact you regarding the applicant. Plez be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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 question: please do not hesitate to give us a call. '... ,�.._ ....-.— ...... .-�...wo... ..� � _.-..�..-.. -.�.�+�.•re.�!'w+��a....,-.n..�w�. ....: ..-..-•.�+w-.w-r�..o.n:rs_'�r-.n"vn�,��o.+...-�-^' 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 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 _ 508 477 2066 P.. 01 - Aug-22 -97 03 : 33P DFt<&T F LLE # MIP 7409 CENSUS TRACE'"# 228 CL [ENT : Dunnincy, Forman x-irrane 1'&rty DEED BOOK PAGE j OWNER: „ _ PLAN K APPL I A Will K, SS RS PLAN PLm a MORTGAGE 1 NSPECT10N' P ..LAN of LAND LOCATED AT '213 LAKES.IDE..DRIV CENTFRVILLE; MASSACHUSETTS k SCALE : 1"= 50' AUGUST 15, 1997 ; + _) 13 j .� U �.� u,,, a I CERTIFY TO DUNNING, FORMAN, KIRRANE 8 TERRY, BANKAMERICA MORTGAGE, AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPER VISION , THE LOCATION OF DWELLING AS SHOWN HEREON IS ��Jhof►,�5 IN COMPLIANCE WITH THE LOCAL APPLICABLE ALAN ZONING BY-LAWS WITH RESPECT TO HORIZONTAL M DIMENSIONAL REQUIREMENTS , U QRADY H No.37732 THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A �� A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY #250001- 0005C DATED 8/19/85 BY THE F. I .A . w Kenn-6t1 R. V6 rrel rz Engine&fng, Inc. PO. Dox 1903 New 0cd(%)rt1,.'M:A 0274 1-1 903 508 992.0020 •Fax: 508 992-3374 GENERAL ROTES. (1) The declarations bade above are on the basis of my knowledge, information, and be!icf as the result of a mortgage plot plan tape survey inspection made to the normal standard o► care of,•registered land surveyors practicing in Massachusetts. (2) declarations are made to the above named client only as of this date. (3) this plan *as not wade for recording purposes, for use in preparing deed descriptions or for con— structions. (4) verifications of property line dimensions, building offsets, fences, or lot configuration bay ✓ �O�IY!//)1O41CllP,ILLGfL Qy v'l�iuOUCLC/LClil e DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION,;.SUPERVISOR LICENSE _ Number Expires: Restricted To BB N XWILLIANS 45 CEDAR ST W BARNSTABLE, NA 02668 HOME IMPROVEMENT CONTRA; �,. .Regist.atien 116599 :TYPe - INDIVIDUAL Expiration 06/28/98 DENNIS M MCWILLIAMS aENNIS M: MCWILLIAMS ADMINISTRATOR 45 CEDAR ST / Box 15 W BARNSTABLE MA 02668 i w1 I tiL. i 7r•-2N � a to r 4'-5 r /4" r /2~ 2!d'- r r /:9 V-4 9/4" co 00 j 11' 0 I ., - w < r �S 9- �S r 1 ..1 --�rf'rrS twAl.C.. . . iv w � Q r I 44 S 1 IN a L _ UO a r .d , N ;. ..... ,. ..�. j i C �" 3 p � AL � � q c o G DRAWING T]�; S r 7'-2 r /41, r i -fo" 2'-r7 I /2~ 4'-4'� r /4~ 20'-01 r 5•-4~ SNEET NUMBER: s i {