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_ _ _ ___� _ _� } I� �_ �vL,,l rd 3-3o-17 Town of Barnstable " 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17454 Date Recieved: 3/28/2017 Job Location: 359 MAIN STREET(CENT.),CENTERVILLE Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508) 398-0398 (Home)Owner's Name: DAIGLE,PETER M Phone: (508)367-0277 (Home)Owner's Address: 359 MAIN STREET, CENTERVILLE,MA 02632 Work Description: Add R-37 cellulose to the garage ceiling. 0) NJ Co Total Value Of Work To Be Performed: $1,300.00 Structure Size: y 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by.a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: William keduskey 3/28/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $1,300.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 3/28/2017 $85.00 XXXX-XXXX-X)WC-€ Credit Card 0299 L. I...........................:................................................... . Total Permit Fee Paid: $85.00 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 5/2/17 BUILDING UEP_I MAY 26 2017 Thomas Perry CBO Town of Barnstable TOWN OF BARNS-FABLL Building Division 200 Main St. Hyannis,MA 02601, RE: Insulation Permit B-17-854 Dear Mr. Perry This affidavit is to certify that all work completed for 359 Main Street, Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely,` William McCluskey t ' .... TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �`®t Parcel q Application # '/ O C9 r/ 01 Health Division Date Issued ¢�� q Conservation Division Application Fee Planning Dept. Permitx Fees) ; Date Definitive Plan Approved by Planning Board . Historic - OKH _ Preservation / Hyannis p Project Street Address 1' k'41_ Stf�C Village r,r� --Owner Address S&, P, Telephone 3 6Y y a1 Permit Request cel�SkA q 4. - �� G-�js (�r f ail C LA�1 h Square feet: 1 st floor: existing proposed 2nd floor: existing proposed, Total no Zoning District Flood Plain Groundwater Overlay E Project Valuation ? Q 1 d Construction Type c Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting.dgcurRntation. cn Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) C" Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Lighway b 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 �o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER-OR HOMEOWNER) 1I - _ Name II MCCIaL/Co'he 11c, Telephone Number ®8 3 Y8 3 9$ Address 1 License # _C tb S. r0.("Mo 4 r6� Home Improvement Contractor# Email Worker's Compensation # (j r n R 5 54 d U ALLCONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �o►-NwaM,3' SIGNATURE DATE 6 F . FOR OFFICIAL USE ONLY ' -APPLICATION # t t DATE ISSUED f t MAP/PARCEL NO. ADDRESS VILLAGE OWNER t • DATE OF INSPECTION: r FOUNDATION ti FRAME S ' INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �t DATE CLOSED OUT f` ASSOCIATION PLAN NO. a i g 'Regulatory Sen-ices sB�g Richard V.ScaL,D.ireclar- •63A arFo�.,�A l�u>lid��l<D;1vAsaon, Torn Peer}030049 Cummins OCW 200 Main Street,I1}'�+-,nis,�A 62:GU1' �e�t.3vavwnbarnsfablc_maus ' Ofcc: 508-8624038 fax: :08 r9Q-62 : . Property Ownex- us -Mp:lete ally Sign This .Section L�j sjM ildex aIS ler of the:stl��ect.��1'Opc�rl Hereby audjoiize ha to.Aet on rny3elf, in alI znattcrs xeltive to' o►k authorized by:this b.,t dig;pernut applic3uon for:. a (Address of.,.oW " 'Fool fences and am:'t]se iesponsibilk d the applicant. Pc )Is: axe not to be filled tr'utlllzel befrecnce is installed and;.all I.- jr)" pectiox S are performed and accepted: Signature� er Sisrnati2ze of flppl;c:�nt. Z'nnt,i�ame Paint Name zz// at . Q FOFMS 90W aTF-RPERVI.SSIONPOOIS Aei CERTIFICATE OF LIABILITY INSURANCE oA {�IM;DD�YYYY, � 4/12/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),-AUTHORIZED , REPRESENTATIVE.OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A,statement on.this certiticate.does not:confer rightsto the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT_ NAME:C .Risk Strategies Company Risk Strategies Company , o E (781)986-4400 FAC No:(761)963<4420 15 Pacella Park Drive ADS3:randolphcld@risk-strategies.com Suite 240 .. .. . - `,y,.„ ._ +fi INSURER(S)AFFORDINGCOVERAGE NAICt Randolph MA. 02368 . . P INsuRERASelective Ins.I of America. INSURED _ INSURER B:Allmerica Financial-Alliance Ins Co 10212 Cape Save, Inc INSURERC:S.tar Insurance Cc 7 D Huntington Ave IluRER D INSURER E: I.South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211375 '' 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'OESCRIBED HEREIN IS SUBJECT TO ALL THE,TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE - - POLICY EFF POLICY EXP LTR POLICY NUMBER. MMIDD MMI LIMITS X COMMERCIAL GENERAL LIABILITY f EACH OCCURRENCE $ 1,000;000 DAMAGE TO RENT A CLAIMS-MADE FxIOCCUR. F PREMISES Ea occurrence $ 100.,000 X S1994480 ib/16'/20i6 10/1M016 MED EXP:(Any one person .. $ 10,000. PERSONAL 6 ADVINJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES'PER:, GENERAL AGGREGATE $ 2.,0.00;.000 POLICY ECTT -LOC PRODUCTS-COMP/OPAGG $ 2,000,00.6 i • - OTHER; $ AUTOMOBILE LIABILITY COMBED $ 1,,000>060 -(Ea-acoid..) - ` _" BODILY INJURY(Per person) $ B ANY AUTO -- AUTOS�� XTOESLED A@HA46796600 .ry 11/6/2015 11/6/2016 BODILY INJURY(Per accident) X HIRED AUTOS I X I NON-OAUTOSWNED _ A. PeracadedDAMAGE. t' $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1 000 000 EXCESS LIAR. �*y, AGGREGATE $ 11,000,000 A CLAIMS-MADE , G't'`t.,3=I` `.--:,.. . ..... DED I X I RETENTION$ HIL 81994480 " '- -"'""` 10/16/2015 10/16/2016 '" $ - WORKERS COMPENSATION, OEPicers Included for X" .STATUTE ER AND EMPLOYERS'LIABILITY I YIN " ANY PROPRIErORdat /PPF2TNER/EXECUTIVE NIA Coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER:EXCLUDED? C (ManorylnNH) �:�; VC085540700 4/9/2016-�{•, I, - 4/9/.T017C E.L:DISEASE-EA EMPLOY $ � :500-000 If yes,describe under DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION.OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,.Additional Remarks:Schedule,maybe attadred If more space Is required) National Grid Corporate Services LLC d/b/"a National Grad, Action Inc, Colonial Gas Company and NStar' Electric are all included as Additional Insureds with respects-to the General Liability coverage of named insured as required by written.contract: CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRISED.POLICIES BE CANCELLED BEFORE. Housing Assistance Colporation �,3'' THE EXPIRATION DATE THEREOF, NOTICE WILL iBE DELIVERED IN Cape Light Compact. ACCORDANCE WITH THE POLICY'PROVISIONS.'' Barnstable Count 460 Lest Mdlll Street '. +` rl. AUTHORIZED-REPRESENTATIVE SL' T, +•.. a .S Hyannis, rA 02601 _ a Michael Christian/CLG'. 5iv .� 01999-2014 ACORD CORPORA710N. All rights reserved. ACORD 25(2014101.) = ' �� *; "'`'`The ACQRD name and logo are'registered marks of ACORD ' ' �. , „r �V INS025,(20iao1.) ' The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 0211.4-201.7 www massgov/dia Workers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anolicant Information Please Print Legibly Name (Business/organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth;MA 02664 Phone#:508-398-0398. Are you an employer?Check the appropriate bog: Type of project(required): 1. ✓]lama employer with 15 employees(full and/or part-time)! - 7: .❑New construction 2. am a sole.proprietor or partnership and no employees working for me in ❑I 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3F1.I am a homeowner doing all.work myself.[No workers'comp..insurance required:]t 9. .[,Demolition 0 4.❑I am a homeowner and will be hiring contractors to.conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation.insurance or are sole 1 L E J Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I`have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have'workers'comp.insurance: 6.Q We are a corporation and`its officers have exercised their right of exemption per MQL c; 14.[R]Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also.fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached:an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number: I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lic.# WC085540700 Expiration Date: 4/9/2017 Job Site Address: 359 Main Street City/State/Zip:Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and-expiration date). Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a.STOP WORK ORDER and a fine of up to$250.00 a day against the violator:A copy of this statement.may be forwarded to the Office of Investigations of the OIA for insurance coverage verification. I do.hereby certify under th pains and penaides of perjuo that the information provided.above is true and correct Si nature Date: 8 4 16 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town ofjtciaL City or Town; Permit/License Issuing Authority(circle on 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrica.Unspector 5.Plumbing.Inspector 6.Other Contact Person; Phone#:. Office 0f Con umer Affairs.and Business Regulation 1`0 Park Plaza- Surte 5.1:70 Boston,;Massachusetts 02116> , Home Improvement:Contractor Registration } Registration. 171380 1, Type Corporation , _mr ` Expiration. 3114/201.8 TO 419291 #� • -.-�, CAPE SAVE INC. } = -1 WILLIAM MCCLUSKEX. 61. — s M 7—D HUNTINGTON AVENUE.. m t SOUTH-YARMOUTH, MA 02:664: ' « s Update Address and return card.Mark reason for'change. . :� Address E]:Renewal: Employment Lost Card. . SCA 1 0 20M-05lti. - - c l![e`�pa�,r.,,zan�ue{ctl/z aC'/l�u:�aucfruelt - i Lcense or�re istration valid for individul.:use onl _Oftice of Consumer AH'airs.&Business Regulattoa' g Y a` HOME IMPROVEMENT CONTRACTOR: before the expiration date. ;If found'return for 7 _ Registration '171380: Type: Office of Consumer Affa►rs.and Business Regulation y Expiration 3/14/2018 Corporation 10 Yark Plaza-Suite 5170: Boston;_NiA 61116 CAPE SAVE INC. WILLIAM McCLUSKEY ;_N¢ .., 7-0 HJNTINGTON AVENUE— SOUTH YARMOUTH MA 02664 Undersecretary -Not valid' i signature . Massachusetts -Department of Public Safety Board of Building Regulations and Standards '01lllll:llll Ii II.J[l nC1.V Il1)1 JIILI.l L4ILV- AIC'Mft .License: CSSL 102776 WILLIAMJ MC('tusEbt �. 37NAUSETROA6 � ,5 o West Yarmouth MA " J.�..►.J1 �' Expiration Commissioner 061281201.7` q-ate Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 9/9/16 Thomas Perry CBO Town of Barnstable Building Division evJ�DJl1JG 200 Main St. Hyannis,MA 02601 SEP 7?016 A TOWN®'p BAR RE: Insulation Permit 16-2241J7J Dear Mr. Perry This affidavit is to certify that all work completed for 359 Main St, Centerville has been inspected by a•third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 2-OT I IR 02- Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis F�I}y� S E1►�T Project Street Address ?y� Village C ✓v�C/'✓� �� Owner Address_� � 5 �+ V4 h7 (Y-9 3- Telephone �) - kL// S Permit Request c�:+�1' cew a �i/ ti�1 Ion I c`G 6� S(__4_4&"C0pSi.5b a 34 - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Zwe Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes L3 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 i 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: ❑ eising ❑ new see_ 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 � Telephone Number Address TY;-' "� a4t- License # Home Improvement Contractor# Email Worker's Compensation #cav1� ALL CONSTRUCTION DEBRIS RESUL G FROM THIS PROJECT WILL BE TAKEN TO P.v SIGNATURE DATE -7- I ci " k� } ' FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER- r 1 , DATE OF INSPECTION: r kL t FOUNDATION ` FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL Y GAS: ROUGH FINAL FINAL BUILDING '" ah(v gg.SI f U2.8 DATE CLOSED OUT ASSOCIATION PLAN NO. I SNE > Town of Barnstable vl Regulatory Services. �& E' Richard V.Scali,Director. M Building Division Toni.Perry,Building Commissioner 200 Main:Street,Hyannis,MA 02601:: www.fown.barnstable.ma.us Office: 508-862-4038 . . Fax:: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder l Peter Daigle as Owner of the subject property hereby authorize Cotuit Solar:Jotin Vreeland to act on'my behalf; in all matters:relative to work authorized by this building permit:application for: 359 Main St.Centerville - (Address of Job) Pool fences and alarms are ahe responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final -inspections are performed and accepted. Signature of Owner Signature of Applicant - Peter Daigle - John Vreeland ...... .. . Print Name Print Name 7-14-16 Date #. Niassachu'setts-Department of Public Safety �Wy. Qoard of Building:Regulations:and Standa ds " Construction:Supervisor License:CS-107947 JOHN VREELANW* .1d . pee KAE..T ROAD M Mash eeMA 02619 J — f irati Commissioner 04/25/2018. . r .. Fold,Then Detach Along All Perforations .. ... ,.Q COMMONWEALTH OF MASSACHOSETTS'. t BOARD OF }. E LEC4i C I ANS.; ` fSSUES THE.pOLLOWING LiCEN �AS A r REGISTERED MASTER ECECTR4t;5'AN. �, COT ULT SOLAR,LLC, A FRANC I S J BRADY JR Po Box 1366 , t;,�� _ - :'PLYMOUTHiq A 02362 13b6.g, - , q. ?A06a a rr�/saatA 44RR7z 2. (C�fll2'III'"1.G+�%��C.rLf?�"tit�f.��G'..f� Office of Consumer Affairs nd Business Re�u�atiota< 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 - Home Improvement Contractor Registration Registration: 146276 F, Type: Supplement Card Expiration; 4/8/2017 COTUIT:SOLAR JOHN VREELAND:: tF, P.O.'BOX 89 7 i COTUIT;MA 02635 .r C r M hange. EY U daEc.Add iws and7cturn card,Mark reason fore. : P scn1 a 20u4ssnl 0 Address FI Renewal Employment LostCard: '� (rote of Gousum5r'Affairs.0 116sriness Regulatlon:: License or registration valid forindividul ue Only __. ^; be to If found return to: : . ME IMPROVEMENT CONTRACTOR fore the expiration date. ,. o... Office of Consumer Affairs and Rosiness Regulation ieglstratlom,_.14g27g Ype: 10 Park Plaza Suite 5170 IExpiratiorr: 418/2017 ... Supplement Card Boston,4iA 021.16 COTUIT SOLAR t JOHN VREELAND w� 3800 FALMOUTH RD. ` r MARSTONS MILLS.MA 02648 lJnderxecretary Not valid without signature ; t .. The Commonwealth of Massachusetts Department of Industrial Accidents 1:Congress:Street,Suite:100 Boston,MA 02114-2017 www mass.gov1dia ��'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers: TO BE FILED WITH THE PERMITTING AUTHORITY. :: Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cotuit Solar LLC Box . Address: .. City/State/Zip:Cotuit, MA 02635 Phone#:508-428-8442 Are you aaemployer?Check the appropriate box: Type of project;(required):: . 1.0 Lam a employer.with 12 employees(full and/or part-::time).* Z. New construction. 2.F1 I:am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.]. p. 3.�I am a homeowner doing alTwork myself.[No workers'comp.insurance required.]t 1h0 9 ❑Demol' n - 10 ❑Building addition 4.❑I am a,homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Elebtrical repairs or additions proprietors with:no employees.: 12.0 Plumbing,repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ ❑ I Roof repairs These sub-contractors have employees and have workers'comp.insurance?: 14. ✓ Other:So lar PV Installation: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4);and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box:#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing,all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an.additional sheet showing the name of the sub-contractors and state whether or not those,entities have ... employees: If the sub-contractors have employees,they must provide their workers'comp.policy:number. 7 am an employer thafisproviding'ivorkers'compensation insurance for my employees. Below is thepolicy andjob site information. Travellers Insurance Insurance Company Name:- . . 6HUB-4988P868-16 3-26-2017 Policy#or Self-ins.Lic.#: Expiration Date: 3 v� S� Job Site Address: a.w City/State/Zi pert e Attach a copy of the workers'compensation_policy declaration page:(showing the policy number and:expiration date). Failureto secure coverage as required under MGL c. 152,§25A is:a criminal violation punishable by a fine up to$_1,500.00 and/or one-year imprisonment,:as well as civil' enalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement:may be forwarded to the Office of Investigations of the DIA for insurance:. coverage verification. .: Ldo hereby certi nder the p 'ns and penalties of perjury that the information provided above is true and correct: :.Si nature: : Date:... 4....1�b . Phone#: 508-428-8442 Official use only. Do not write in this area,to be completed by city or town.offcial. City or Town:: Permit/License# Issuing Authority(circle one): 1.Board of Health.2.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6.Other: . Contact Person: Phone#: . 7DATE.(MM/DD/YYYY) ACERTIFICATE OF LIABILITY INSURANCE /18/2016 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). CONTACT, .PRODUCER NAME: .Lauren. .. �... �... 'NAME: -... ... . DON BUNKER INS.AGENCY AIc No EXt: ( PHONE: 7B1)312-7206 (AIC No), .. ..._ ...:.: '.--.:.: E-MAIL:.: ..-_ ._... .. ADDRESS: Lauren@donbunkerinsurance.com ' P.0 BOX 221 INSURERS AFFORDING COVERAGE - NAIC# HANOVER MA 02339, INSURERA: TRAVELERS INDEMNITY CO OF AMERICA(THE) 25666 :INSURED INSURER B: COTUIT SOLAR:LLC INSURERC: INSURER D: - 3800 FALMOUTH RD J. MARSTON MILLS MA 02648: INSuRERF: COVERAGES CERTIFICATE NUMBER: 38425 " REVISION NUMBER:." THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED:ABOVE FOR:THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF:ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT.TO ALL THE ,...TERMS . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ...:.: ADDL SUBR POLICY EFF POLICY EXP ' LTR TYPE OF INSURANCE :POLICY NUMBER MMIDD MM/DD/YYYY "LIMITS ' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED - CLAIMS-MADE F]OCCUR """ PREMISES (F.occurrence) $ MED EXP(Any one person) ._ $ - N/A ; ; � :�" �PERSONAL BADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $ :. PRO-POLICY ❑LOC :. :. :. .. .. - .. .. ... . JECT PRODUCTSGOMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY EOa BI EDtSINGLELIMIT.: $ MANY AUTO BODILY INJURY(Per person) $ ALL OWNED --SCHEDULED -- ... BODILY INJURY(Per.accident) $ .. ... AUTOS - AUTOS .- ... NIA "... ... - ... NON-OWNED $::. :PROPERTY DAMAGE - ' HIREOAUTOS: AUTOS -- _ ,._ .. .- :(Per accident UMBRELLA LIAB OCCUR - EACH OCCURRENCE $. . 771 EXCESS LIAB 'CLAIMS-MADE NIA ` "'" "-' AGGREGATE '$ " :DED. I RETENTION$ $ -- WORKERS COMPENSATION PER "OTH- -- X' STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A :NIA .6HUB4988P86816 03/26/2016 03/26/2017 (Mandatory in NH) - - ... .. - -' - E.L.-DISEASE-EA EMPLOYEE $ 500,000 "- If yes,describe under. - - DESCRIPTION OF.OPERATIONS below "-E.L.DISEASE-POLICY LIMIT. $::500,000. N/A . :DESCRIPTION OPOPERATIONS ILOCATIONS/VEHICLES(ACORD 101,Additional.Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only:Pursuant.to Endorsement WC 20 03 06 B;no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this:coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search:tool at wwW.mass.gov/IWd/workers-compensation/investigations/: - -.:... .... -... CERTIFICATE HOLDER " 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. Conrad.Geyser... 3800 Falmouth Rd:. AUTHORIZED REPRESENTATIVE ...: . Marston Mills MA 02648 Daniel M.Cro6Jey,CPCU Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101);. ;:: The ACORD name:and logo are:registered marks of,ACORD f x , r f ac �. Awill as V, t Cotuit Solar.LLC: . Project: . System:. 10.2kW DC (stc).. Site .Plan 508-428-8442 Peter Daigle. 34 - 30Qw modules Revision: Judy 12, 2016 / - � PO Box:89. 359.Main Street 10kW SolarEdge inverter " COTUI,T SOLAR,, Centerville, MA 02632 :: & 34 DC optimizers :.: Cotuit MA 02635 p • " 1. Warning:.Dual Power Source ., .. S econd Source is PV System 12 LG 300 W:. 2. Photovoltaic:AC Disconnect Modules . .. ..... .. .. Voc=39.8V, Isc=9:98A .. ...., „ Revenue.Grade PV Meter 12 SolarEdge P300 2#10,#6gnd ' DC Optimizers Outside, Voc 48, Isc 10.0. Utility: UL 1741/IEEE 1547 ... . .. Disconnect (2) .. 60 Amp Utlllt)/ .. SeNICe 3#s #send- MLO (11) LG 300:W 3/4c Modules : : 50A Voc=39.8V, Isc=9.98A... . . .. .... .. .. .. ..... .. . .... .. .. �I Roof.TOp 3#6 romex . 11 SolarEdge P300 2#10;#6gnd : junction Box• .: S DC Optimizers ... ... . olarEd e SE10000 US voc as, Isc 10.o Interior UL;1741/IEEE 1547 Inverter 6#10#6gnd co l 60A Main Pa Disconnect 20 OA A .. . .. � Panel 1) 200A Main Line;sidetap Breaker: 10 (11.).LG 300 W.. ... . .. .. � . .... .. . ... Modules Voc=39.8V, .Isc=9.98A 2#10,#6gnd ' 11 SolarEdge P300 ..... .. DC Optimizers Voc 48, lsc 10:0 : UL 1741/IEEE 1547 �. g Electrical Dia ram Cotuit Solar.LLC Pro'ect:.. System:. 10.2kW DC stc Revision July 1 J ( 5.08-428-8442 Peter Daigle 34.- 300w modules .. e' PO Box-89 . 359.Main Street . - 10kW SolarEdge inverter - 2, 2 COTU(T:S.OLAR,« Co tuit MA:02635 Ceriterville, MA 02632, : : & 34 DC optimizers - iAME S..: A : . CLANC :. PROFESSIONAL ]ENGINEER NATIONAL PARK, NJ 08063: : (856) 358-71125 FAX: (856) 58-1511 Construction Code Office Date: . July 13,2016. . . ... . Re: Cotuit Solar LLC,3860 Falmouth Rd.,Marston Mills,MA 02648 Subj Peter Daigle Residence,359 Main Street,Centerville,MA 02632 We have provided an inspection and review of the residence roof construction of the above named property in regards to verifying the-capacity of the existing roof for 'installation of a new Solar Panel Array. We.have found the residence to be,of wood:frame construction bearing walls with:a rafter framed roof. system. :The main roof is of.2x8 @ 16". OX. and is sheathed with 1/2". ext-ply sheathing and a single layer of composite:shingles,.Jhe existing roof structure bears directly upon the:exterior:stud framed wall :system. The existing rafters as installed meet the required load/span ratings :with sufficient capacity.to carry the minor additional load of 4_#/sf imposed by the.proposed solar array.per the details below. Installation of solar rack systems shall be as follows, Each panel row shall be supported upon 2 mounting rails. Rails shall be screw anchored through roof and directly to rafters below. Rail attachment points to rafters shall be sfaggered each row ivifh exception to the first fastener row from the gable end which is attached to two adjacent rafters. Silicone caulk shall be applied between the,angle foot of the mounting system,and the existing: roof,shingles:at each foot aocation. _... Typical mounting detail sketch attached. When installed per:the above'specifications the"system shall exceed 110 MPH.:wind & 30 PSF snow loads as required byMassachusetts 780'CMR table 1604.1 l. ..... . Should you have any further question or comment please feel free to contact our office. Respectfully, OF MES A. v, t�CV .:. �, .: .. .46775 y James A. Clancy lg(���tT Professional Engineer L '� MA License#46775 N I Fa�AR MoDucg'''�� PRo4a4eft TfE . 1EsoJN aA'MP 5/1611 S'S tw)r Bow .. IL 4: 9ksxRtyNy ; �y GX.4: ut6 ...- ZM90 pJtFve'� , TYr tL ..,.. Pv: P PR•o � J S A.CY G� James:A. Clancy, PE °j9Fq 601 Asbury Avenuesr National Park, NJ 08063 Massachusetts PE Lic#46775 Cotuit Solar.LLC Project:.. System: 10.2kW DC stc Attachment Plan. .. . � 5.08-428-8442 Peter Daigle 34- 300w modules ( > Revision July 12, 2016 N=W PO Box:89 359.Main Street 10kW SolarEdge inverter COTUIT:S:OLAR., Co#uit MA:02635 Centerville, MA 02632. :: & 34 DC optimizers 0 solar 0 0 SolarEdge Power Optimize : 0 Module Add-On For North America d P300 / P320 / P400 / P405 0 w 14, .... 4 . CD j PV power optimization at the module-level Up to:25%more energy Superior efficiency(99.5%) Mitigates all types.of module mismatch losses,from manufacturing tolerance.to partial shading �. Flexible system:design for .maximum space utilization Fast installation with a single bolt — Next generation maintenance with_module-level monitoring Module-level voltage:shutdownfor installer and firefighter safety USA-_CANADA GERMANY-ITALY-.FRANCE,_1APAN-CHINA-,AUSTRALIA-.THENET.HERLANDS-UK-ISRAEL ,_ . . WWW.SCIIaredge.uS` . .. . l ...Solar 0 0 SolarEdge Power Optimizer - Module Ad&Gn for North America ...... ...... P300 /'P320 / P400 / P405 P300. . _ P320 P400 P405 (for high power ...(for 72 8,96-cell (for thin film (for 60 cell modules) 60-cell modules) modules). modules) INPUT . Rated Input DCPower<'i 300 ......_...320..,....:, 400 405 W ............ ....... ............................. Absolute Maximum Input Voltage 48 80 125 .. Vdc (VOC at lowest temperature): .......... ....................:................................................................ ..............:............. ... MPPT_Operating Range 8.-48 8-80 12.5=105 Vdc ...............:................................ ..—......... ...... Maximum Short Circuit Current Isc 10 11 10.1 Adc -Maximurn DC Input Current 125._: 13.75 12 63 Adc ..... ............... . ..-.............................. ............... . Maximum Efficiency 99.5 % ....... ......... ........ ....._... ......... ..._........ ................................................ .............. Weighted Efficiency...................... ... 98.8 % .................................................................. . .._... Overvoltage Category... . II OUTPUT DURING OPERATION(POWER OPTIMIZER CONNECTED TO:OPERATING SOLAREDGE INVERTER) .. Maximum Output Current .. . 15.: _... Ad' . .. ............................................... .................................................................................... ......... . Maximum Output Voltage 60 85 Vdc OUTPUT DURING STANDBY(POWER OPTIMIZER DISCONNECTED FROM SOLAREDGE INVERTER OR SOLAREDGE INVERTER OFF) Safety Output Voltage per:Power Vdc.. Optimizer STANDARD COMPLIANCE EMC FCC Part15 Class B-,IEC61000-6-2,IEC61000-6-3 ......... ................................................................._.................................................. ..............- - Safety....•......... .•.. ...................•_.•: ... .fC62109 1(class II safe ),UL1741 IEC6,........ y RoHS:: Yes; INSTALLATION SPECIFICATIONS Maximum Allowed System Voltage 1000 Vdc ...................... ._.................... ........ . .... Compatible Inverters All SolarEdge Single Phase and Three Phase inverters' ....... ... ......... ....................... .............. ........ .. 128 x 152 x 27,5/ , 128:x 152 x 35/::. 128 x 152 x 48 .....:Dimensions(W x L x H) _ mm/in 5x5.97x1.08 5x5.97xi:37 5x5.97x1.89 _:Weight.(including cables)................ ............:..........760./1.7...............:...:... ...;.°..:830/1 8.....;... ......:1064/.2:3..:....: ...gr.�.�b....:. ._.. Input Connector .,.,...:.............:. .: MC4Compatible.,.,............,..,,.,.,........,..,...,...:.:...,,...,...... ........ Output Wire Type/_Connector Double Insulated MC4 Compatible Out ut VJIre Len h 0 95/3 0 1 2/3.9....._ ...•. m/ft p gt....................... ...................................................... ..�...... ..... ........ . ........................ Operating Temperature Range +185 C/°F Protection Rating..............::..... :......:. IP68/NEMA6P ........................................ .... ..................... .... ..... Relative Humidity..........:: : 0-100 .:: % . .................... ............ ................................,,,........................................ ...... ......... -I'I Rated STC power ofthe module:Module ofupto+5%powertolerance allowed: ....... -.....7 ....:.: ....:.: ...... ...... ...... PV SYSTEM DESIGN USING SINGLE PHASE THREE PHASE 208V,. . . THREE.PHASE 480V A SOLAREDGE INVERTER ' Minimum String Length - - 8 10. 18 (Power.Optimisers) ........... .......... ............. .............. ...................... ..................................... ........................ .... .. ....... Maximum String Length 25 25 50 �Power 0 timizers - .......,..p..Mi.... ... ................. ..................................... ......:. Maximum Power per Stringy 5250 6000 12750. W _................ Yes............... _.._........... Parallel Strings of Different Lengths or Orientations . . Izl It is not allowed to mix P405 with P300/P400/P600/P700 in one string. - .. .. .. ... flg4R=+�i=7isiirSil _ — -- a o . ..... .. SO � r' 00 � Solaffdge Single Phase Inverters For North America SE3000A-US / SE3800A-US / SE5000A-US % SE6000A-US / SE7600A-US / SE1000OA-US /SE11400A-US va rye : � s � Watts #F The best choice for SolarEdge enabled systems - Integrated arc fault protection(Type 1)for NEC 2011690.11 compliance '. Superior efficiency(98%) _ .: Small;lightweight and easy to install on provided bracket. Built-in module-level monitoring - Internet connection through.Ethernet or,Wireless Outdoor and indoor installation Fixed voltage inverter, DC/AC conversion only Pre-assembled Safety Switch for faster installation Optional=revenue grade data,ANSI C12.1 - -- liz- USA GERMANY-.ITALY-FRANCE_-JAPAN..CHINA=AU.STR.ALIA-THE-NETHERLAN.DS-ISRAEL . www.sofaredge.us : 0 o Single Phase Inverters for North America �.I a r SE3000A-US/SE380O.A-US/SE5000A-US/SE6000A-US/ . SE7600A-US/SE1.000OA-US[SE11400A-US . ... SE3000A-US SE3800A-US SE5000A-US SE6000A-US SE7600A-US SE10000A-US SE11400A-US OUTPUT Nominal AC Power Output. 3000 .3800 5000 .. .6000 7600 11400 VA .. 9980 @ 208V ............. .......... ................ ... ......... .. 10000�a 240V ... .. ......... . ... ... .. . .... . .. . 5400 @ 208V. 10800 @ 204V --Max.AC Power Output " 3300 4150 6000 8350 12000 VA" 5450@240V „•..._ 10950,�240V ............................................ ................ ..............: ........ .. ..... ................ . .. .... .. .. AC Output Voltage Min:Nom:Max.(�) ' 183 208'-229 Vac .... ................. ..... ... ................ ................ .. ... AC Output Voltage Min.Nom.-Max.hl .....240. 26.Vac..:.: ....... ....... AC Frequency.....om:Max: 593 60 60:5(with HI country setting 57:60:60:5) Hz 11 24 @ 208V 48 @ 208V ..Max Continuous Output Current...... .....1?.... ...t.......16......� .21.@ 240V. .,........25. 5.....,.(.......32. 2.. .... .. ...@. ...... ......47 5...... .. 42 24 GFDI Threshold 1 .. _. _ A .. ... . ..... . ........ Utility Monitoring,Isla nding Protection,Country Configurable Thresholds' ""' Yes ""' "" Yes INPUT Maximum DC Power(STC) 4050 5100 6750 8100 10250 13500 15350 W- ."............ .................. ....... . ................. ................ . .......... Transformer-less,Un rounded Yes ..........................g.............. ...... ....................................................... .........::.................:............................... .......... . Max Input Voltage................, 500 Vdc ....::...:...........::.............................................................................. .......... ... ... .......... .. Nom:DC Input Voltage 325 @ 208V/350 @ 240V Vdc 16 5 @ 208V 33 @ 208V Max Input Current(') 9.5 13 18 23 ' 34.5 Adc l ...�.........:.:...I.15 5,�240V..1...... .......�................I...... @_240V.. ..'................ ........... Max.Input Short Circuit Current 45 .................. Reverse Polarity Protection- Yes ................................. ................................................. ...................................... ...... ............ .... ........... Ground-Fault Isolation Detection 6001w Sensitivity Maximum Inverter Efficiency 97.7 982 98.3 - 98.3 98 98 98 % ..... .................. ... ................ ............... ................. .............:.. ............:... ..............,..,.� ..............:. ......:.... 97.5 @ 208V 97 @.208V CEC Weighted Efficiency 97.5 � 98.. � -97.5 97.5 97.5 :....................:................. .............. . .......:.... 98 240V ..... ..975 -240V °.......... ................ ........... @...... Nighttime Power-Consumption "" <2.5 ADDITIONAL FEATURES Supported Communication Interfaces ." R548.5,RS232,Ethernet,ZigBee(.optional) .......................... ..... ... ..... . ................ .................................................... Revenue Grade Data,ANSI C12.1 :,Optional(') ......................I.......-.......... ......................-...... ................................... Rapid Shutdown-NEC 2014 690.12 Functionality enabled when SolarEdge'rapid.shutdown kit.is'installed°..:. STANDARD COMPLIANCE Safety UL1741:UL1699B,UL1998,CSA 22.2 ... ........................................ "............................... Grid Connection Standards IEEE1547 ... ...... c. o ........................... ......................... ................ ............................................................... Emissions FCC partly class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG range 3/4"minimum/16:6 AWG 3/4"minimum/8-3 AWG ................................. ................... ......... ........ .. ......... ...... DC input conduit size/4 of strings/- 3/4"minimum/1-2 strings/ 3/4 minimum/1-2 strings./16 6 AWG. . AWG ran&? 14 6 AWG .:................................ Dimensions with Safety Switch 30.5 x 12.5 x 10.5/ in/ HxWxD 30.5x12.5x7:2/775x315z184 ....... .................:...............:................:.......... ..... ..............:................................:... ..........775 x 315 x 260.:......... ...mm.... Weight with Safety Switch 51 2/23.2 � 54.7/24.7 88.4 40.1 Ib/kg ........................... ....... ............... ............ .... .. ....... ....... .................... .. ..... .. Natural .. :." convection Coolie , Natural Convection : and internal Fans(user replaceable) g : fan(user ........................................... ............................................:...........:... .... .. .. ...... .. replaceable) .... . ...... .. Noise - <25 .<So dBA _ ........................................... .. ....... ................................................ . ........ .... ..... . .... . ............ ......... Min.Max.Operating Temperature -13 to:+140/ 25 to.+60(-40 to t60 version available(5)) `F/°C Range_ ..-: ....................._......... ...... Protection Rating NEMA 3.R ..................... ...............,.................................................................,....... ....... hi For other regional-settings please contact SolarEdge support. A higher current source may be:used;"the inverter will limit its input current to the values stated." Inl Revenue grade inverter P/N:SEx�oCxA-US000NNR2(for'760OW inverter.SE7600A-U5002NNR2):' Rapid shutdown kit P/N:SE1000-RSM1.: :" I ' -40.versidn P/N:SExxxxA-US000NNU4(for 760OW inverter.SE7600A-US002NNU4). �/ ®sunsaEc 0 Professional SOLAR °S Prdolar® RoofTra& ... �products Intertel<4007217 Bonding a.nd Grounding.Guide ... ... UL2703 (Patent Pending) Applies to GrounclTrac®and SolarWedge® :. ^ mounting systems wh ich utiltza the Roo Tcac® raicl V amp design. . �• a For RoofTrac®Rail Bonding Splice Drill 1/2"holes t bottom of rails with 1 2"410 Irwin No buss bar rl. a / le t / �r • Unibit®using the rail support as a hole location guide. • Insert 5/16"bolt through support holes and hand thread into thread rail splice insert. Fasten to 15 ft-lbs. i B For Bonding Module Frame and Clamps to Support Rail _.: .: Green look washer indicates • Fasten pre-assembled mid-clamp assembly to module electrical bond frame,:to 15 ft-lbs.: e Frame Design: .. .: Modul ' double wall, aluminum, 1.2'-2.0"tall,0.059"-0.250" thickness, UL1703 or equivalent tested module. � . . UL467 standard tested bonding equipment for use with Professional Solar Products(ProSolar®)support rail. .Bonding of module to RoofTra&rail via ProSolar°rail channel nut using buss bar. Bonding of RoofTrac®rail to RoofTra&rail via ProSolar® UL467.tested Universal splice kit(splice insert and: splissplice upport): Assembled Self-bonding Self-bonding Mid Mid Clamp With SS Bus Bar _ Groundin of RoofTra&rail via llsco SGB-4 rail lu Clamp Fastened on Rail g g (solar module not shown) System to be grounded per National Electrical Code(NEC).. See NEC and/or Authority Having Jurisdiction (AHJ)for grounding requirements prior.to:installation;:See final run(racking to ground electrode)grounding equipment installation instructions for specific installation information. COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2015:All information contained in this manual is property of Professional Solar Products(PSP). TileTrac®is a registered trademark for PSP and is covered under U.S.patent#5,746;029.RoofTra&and FastJack6 are registered trademarks for PSP and are covered under U.S.patent#6,360,491..Roof rrac®bonding designs.patent pending.. ProSolar®UL2703 Bonding and Class A Fire Rating Page 1 of 4 professional :_= ProSolar® RoofTrac® .. SOLAR products Bonding and Grounding Guide (Patent Pending) , I I I I Can be placed 4. under module to ,01 hide connection ` if desired j For Grounding Connection • ILSCO SGB-4 rail ground connection Basic Wiring Diagram RoofTrac®Universal Ra il Bonding Splice :. Grounding Lug Grounding Lug sw COPYRIGHT PROFESSIONAL SOLAR PRODUCTS 2015:All information contained in this manual is property of Professional Solar Products(PSP). TileTra&is a registered trademark for PSP and is covered under U.S.patent#5,746;029. RoofTra&and Fast lack®are registered trademarks for PSP and are covered under.U.S.patent#6,360,491.RoofT6&bonding designs.patent pending.. ProSolar®UL2703 Bonding and Class'A Fire Rating Page 2 of 4 Intertek Listing Constructional:Data Report (CDR) 1.0 Reference and Address Report Number 100779407LAX-003 Original Issued: 14-Se =2012 Revised: 28-A r-2015 Standard(s) UL Subject 2703-Outline.of:lnvestigation Rack.Mounting Systems and Clamping Devices for Flat-Plate Photovoltaic.Modules and Panels. Issue#2: 2012/11/13 Applicant Professional Solar Products, Inca Manufacturer Professional Solar Products, Inc. 1551 S. Rose Avenue. ° 1551 S. Rose Avenue Address Address Oxnard;'CA 93033 � Oxnard, CA 93033 Country USA Country USA Contact Stan Ullman Contact Stan Ullman Phone (805)486-4700 Phone (805)486-4700 . .. . . FAX (805)486-4799 FAX (805)486-4799 Email s(cDprosolar.com Email s@prgsolar.com q. Page 1 of 63. This report is for the exclusive use of Intertek's Client and is provided pursuant to the agreement between Intertek and its Client. Intertek's responsibility and liability:are limited to the terms and conditions of the agreement. Intertek assumes no liability to any party, other than to the Client in accordance with the agreement,for any loss.expense or damage occasioned by the use of this report.Only the Client is authorized to permit copying or distribution of this report and then only in its entirety-Any use of the Intertek name or one of its marks for the sale or advertisement of the tested material, product or service must first be :approved in writing by Intertek:The observations and test results in this report are relevant only to the sample tested.This report by itself does.not imply.that.the material,product,or service is or Has ever been under an Intertek certification program. ProSolar®UL2703 Bonding and Class A Fire Rating Page 3 of 4 f Report No.100779407LAX-003 _ Page.2 of 63 Sep-Sep Issued: 14 2 Professional Solar Products,Inc. Revised: 28-Apr-2015 2.0 Product Description Product Photovoltaic.Racking,System Brand name ProSolar The product covered by this listing report is a rack mounting system.-1t is designed to be installed on a roof. It will be secured by means of Fast Jack or Tile Trac attachments, depending on the type of roof it is intended to be installed upon. The Rooftrac mounting system is comprised.of support.rails and top-down clamping:hardware.:This device can be used:on most standard construction residential roof- tops. This system is.in compliance with the.mounting, bonding and grounding portions of.UL Subject . 2703.This system:has the following:fire class resistance ratings: Class A for Steep Slope Applications when using Type 1 or Type 2, Listed Photovoltaic Modules. Class A:for Steep Slope Applications.when using Type 2, Listed Photovoltaic Modules with or without the wind skirt.Class.A for Low Slope Applications when using Type 1,.Listed Photovoltaic:Modules when a minimum of 1Z gap between the:roof surface and the bottom of the module is maintained. Class A for Low Slope Applications when using Type 2, Listed Photovoltaic Modules when a minimum of 14".gap between.the roof surface and the bottom of the module is maintained. - ..... ....... RoofTrac has different types of bonding and grounding, below is a list of them: Bonding of module-to-Roof Trac rail:via Weeb PMG Description Bonding of module-to-RoofTrac rail via ProSolar rail channel nut using buss bar Bonding of.module-to-Roof Trac.rail via Ilsco:SGB-4 Iugs: Bonding of Roof Trac rail-to-Roof Trac rail via Weeb Bonding Jumper-6.7 Bonding of Roof Trac rail-to-Roof Trac rail via Ilsco SGB=4 Lugs._. Bonding of RoofTrac rail-to-RoofTrac rail via ProSolar UL 467;tested universal splice kit(Splice Insert and Splice Support) _. Issuance of this report is based on testing to PV.module frames with a height of 1_1/4 inch to,2 inches The grounding of the entire system is intended to be in accordance with the latest edition of the National Electrical Code, including NEC 250: Grounding and Bonding, and NEC 690: Solar Photovoltaic Systems.Any local electrical codes must be adhered in addition toahe.; national electrical codes. ....:'.: This product investigation-was performed only with respect to specific properties; a limited range of hazards, or.suitability for:use underaimited or special conditions. The.following .: risks and other properties of this product .have not been evaluated' electric.shock, Ultraviolet light exposure. Models RoofTrac... . . .. . . .. _. . Model Similarity N/A Fuse rating: 20 A Mechanical Load::30 PSF Fire Class.Resistance Rating: Ratings Class A for Steep Slope Applications when using Type 1 and Type 2, Listed Photovoltaic: Modules: Class A for Low Slope Applications when using Type 1 and Type 2, Listed;Photovoltaic Modules ... . . .. . . Mechanical load was tested using 60 Cell Canadian'Solar:Modules model CS6P with 40mm Other Ratings frame height and maximum span of 48 inches using 4 inch and 6 inch TileTrac or FastJack posts with 1-1/2 inch tall RoofTrac rail. And maximum span of 72 inches using 4 inch and 6 inch TileTrac or FastJack with 2-1/2 inch tall RoofTrac rail. ProSolar@ UL2703 Bonding and Class A Fire Rating Page 4 of 4 dEo 6.3.i5 1 -13 Mandatory ( -Jan ) dat ry TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 Parcel 1 q.00 - Application # D®< 6 5 Q Health Division Date Issued 61 l Conservation Division Application Fee Planning Dept. Permit Fee IP Date Definitive Plan Approved by Planning Board / Historic - OKH _ Preservation/ Hyannis cg Q-�l l!%L Project Street Address 39 � 3T, Village Owner'>e- e,-(-:GAG ���i S LJ_ Address S_ /0 9h2 Telephone Permit Request i,y 2_ n n S�Gory �el--- � � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation mod ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 3 Z Historic House: ❑Yes XNo On Old King's Highway: ❑Yes 56o Basement Type: WFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 'god Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roor�Count ' Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ OtherPQ W c= Q Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coalstove: 0 Yes ' No Detached garage: ❑ existing ❑ new size Pool: ( fexisting ❑ 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 2-No If yes, site plan review# Current Use - - — - --—_ Proposed-Use APPLICANT INFORMATION `t (BUILDER OR HOMEOWNER) Nam2 Telephone Number Address � � License# co Home Improvement Contractor# «7Z(45 s Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO )0 SIGNATURE DATE f , ' FOR OFFICIAL USE ONLY APPLICATION# ±DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER ,r DATE OF INSPECTION: FOUNDATION E` FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING tl�s ti i DATE CLOSED OUT r ASSOCIATION PLAN NO. i . _. ' e vmmmlwea�th of h�assachrtset� . Deparfwgtt?fIftAutKaI21l ddera�- Q,�ceoffPaff adi7M • . g -660 Washbttta ,S&eet • - Bastvr�.�4 O.�.IJ_Z - - Workers' Compensation B?sargnce Affidavit:B¢skiers/cantro ctDrsMeCtridAn&ThIaherS Aupiicaat Information Please Print Lem Name r MY/Staten iP. 4 `C u . �Cp •�. Phone_# �� .l • ' '�� � --; I F n employer? Check the appropriate bay a •4. I mm a Z`YPe of project Crequired)::��wifh ❑ general ct�tractor and I ayees(faIl and/or part time). have hired the sob-cautact� 6 ❑New c a'sole proprietor or pM±=- Baird on Tie-attached sheen 7. Q R.emoduling and have no employes 'These sub-oniractors have8. Q D�tion ng forme aaY capacity, employees.and hope wvrknrs'' ccn�.T, �e camp..msarance$ 9. ❑ g add�.and.] 5a•ccap�n ands 10.Q Medical mpaas or add�� b=eowner dig aIl•work officer;haveeAnrcised their Pr�aia.f [No wars' comb, right of emampthmper' P regaimd_]t c.152, §I(4), and we bane no 12.C1 Roof repairs emP�m. [No�' 13.Q othm comp.ice req�red.] *A-Y applicant that cb=km.box#1 mast also fM out fhe secfion below sbowiag ffici�wn k=1 compcasation policy i>¢a<o3a M t Hnmeownet�who snbm�fhis aiadaviE inr&cafiIIg$cyan doing aII work and ffieo lams outside clack coIItn�n;:mast subnrit anew affidavitin�cafing such. iG�atiacfacs ck ffiis box m it attached an additional sheet showing the name of the salt c �1QYees. If the sob-crmlraetns Kaye®P�=,�9 Est wa sand stair whe$a ornat those ewes hm,, piwidt fficir workeia'caa�,pnficyanmher. ram an erirpZoyer that is pravidzng workers'compensation zrr.surance for my employees Belaty is the policy and job site it fntmadom Insurance CompartY Name: Poticy#or Self ins.Tick BxpkudcmDafr: ---------------- Job Site Address: Attach a copy of the workers' cnmpensation policY�declarafxan / : p�Cshawiug the policy MUUber and espirafian dais). Fame tD.srmim coverage as regaired under Scadm25A afM'C3L e. 152 can lead to$ze ' o tip to$1,500.00 and/or one-yew=IPMC neirt, as.:ymn as ci7R s'hicm of cor al penalises af'a of up to$250.D0 a pmml�s is the fmm of a STDP WDR.K ORDER and a e clay against the violator Be ad Vmific a c�of this strtem�maybe ad to the Office of InYe of the DIA for msmance coves aECUL I do hereby certify under&e p d penalties a thr�the h farmafion provided above is frAe raid catrecG • � : Date: �,� z �. . �.Z� • Phone FROzerr usea �a. Da oat write in this 0-egtobecaarpletedTry city ar-town affici¢LTown:nhorifp(circle one): ofHealth 2.Bm'I�ug Department3.CftylTown Clerk 4.Mectricai Impectnr 5.PhFmh' Tns : mg pectar 'Contact Person: Phone#: w1f, ;TA U"UL IN u:lk:Ltd N.' u;:I)A!6t6 'I IL U t u; 1 ;I7rl Board-of Buildin- Re-ulations and Standards Office fC Consumer rPs&Bdsines R g ho Construction Supervisor License HOME IMPROVEMENT CONTRACTOR License: CS 103504 Registration: A.172458 Type: I x Restricted to: 00 Expiration 6/27/2014 DBA JEFFREY WILLIAMS �m J L ILLIAMS CO�NTRTJTI6N GsO; 10 WEEKS POND DR: JEFF WILLIAMS \ FORESTDALE,.MA 02644 1 10 WEEKS POND FORESTDALE MA 0211, t Undersecretary Expiration: 12/14/2013 i . 'Commissioner Tr#: 103504 r - x License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 e o i itho Igna uce oTME Town.of Barnstable Regulatory Services N Thomas F.Geiler,Director , 019. }, 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.Budder f as Owner,o. f the subject property hereby authorize . �� S to act on my behal� . in all,matters relative to work authorized by this building permit Ki Sf. �Pn1 w IR. oa 63 a (Address of Job) Pool fences and alarms are the responsibilit y of the applicant.licant. Poo ls. are not to be filled before fence is installed and Pools are not to be utilized until all final inspections are performed and accepted. Signature Owner Signature of Applicant.. print Name Print Name Date QFORMS:OVR4MPERMMSIONPOOIS Towi of Barnstable Regulatory Services HAM r neRmcrw_Rr_r„ : Thomas F.Geller,Director - Buiiding Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0266.1 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXXEWTION lease Print DATE: q JOB LOCATION: 3 / number street village "HOMEOWNER":r'1 . C Q1 JG 1>0 I, n hom phone# work phone# CURRENT MAILING ADDRESS: city/town state 3 " fi-� zip'code , The current exemption for"homeowners"was extended to include owner-occupied dweIlins of six units or less and to allow homeowners to engage an individual for hire who does not possess a lic supervisor. ense,provided that the owner acts as DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such-use and/or farm.structures. A Person who constructs more than`orie honie in a two-year period shall not be considezed a homeowner.'Stich "homeowner'shall submit to the Building Official=4 form acceptable''to the BOding.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 requirements. will comply with said procedures and 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 {I 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 am 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',l 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 fomr/cerfification for use in your community. Q:forms.homeexempt r x�*ylyR* �� W t i5 rn- {Y.1E I.:'S X P Fr.' 1. .f.�.. .�9 F 'F. .• ....F. ....V. ...•+..t i .r Y rl IOp, � ,PI h�' � •,: .•' 4iY•.' s t l:. rYF .... '. .o-;, w. • ....... �•z a,. ,y. t : .' t.% .Q) r t r j �J ^ 4 {y �, ft L M - ` .. 1 y .- 0�if SN ctdif "I * +t�4 t, A f.t ar ', `� A +r, w: ,t :•r ' k d. 7 F �y a. /' �-::4..25*'.1i"."I..:�'�.t.�A.-I.�. ``�F, �. 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Yll tar: a:u a ri nb 1'511 Y1. t,i.�)p. J _;�++ - gr y,. .f!: '�•/I� qe f`� C. ily. 40 tg' P f h .i0l ` S F r t - 1 . 1. M1 its=ti + ? �,�ii+4 RF :"l � � �. F: y 4rx r. +1 .. Af ;, r �.. ~:: A z' l .�1r �a Via.: t r s' a .w... r :. n I. ' /tAp'�s / ��y dwyp pJ�t 'A�•"• r Y - ' '' f,M+�1 t .,1 _I {'M '- , r, + 91Y F , l} .w,.�.4�.-;• a..' ffll.. ' t,.�il� , ���z, ,��',�i$�' n' �l !; , .' �:..4I �til+�; M�`R��f►V �A.�1r� 1 , �j"� �'.%, ? r 1. fy #00"' �1 �`:i^e Rti M� 1� /9'� I V .. J 81F ',n .�A' ., t'' _ 1. •� w' r t _�1` .Yes, 5 y+ �/�1 �y /fir :�y. �. it 41• W. A .. !/!fit I R� . . �1 +R9 �!✓jA ..ten •.� D. !Lq- ' l ' d { f. 'Gt { is t . 1 . .. ._ . . .. t t . . . I ..........Iitl4Z� lIiIittitt6 ItitIiltIttIl dlP vp . �L��i ���CZ vim.�� i3��c� • �' �� �1Z Z i'c ,`Ov t o\ s C S ;ice ti i�i G.�-•' a2 l Z 12 �! 5oN t) -4lf, f _ ,. i - . � � °�.. '"� :�. <b -mil �i�1���'2- �- <4 - � �� - '. . , .. ., t ,. .,. .. .� , ,°4 ., — � � � � , et ��1��� z.� � K i Nam. s-:�V . ` � .. r z� � � . � r:7,�� 2OX4O-4 NEW EXIST. - -� BATH BATH C4 \ RXISTINC r• M/BEDROOM 9-top EXISTING w BATH OXIS TING (BEDROOM A EA li n -L V •°P _ EXISTING A HALLWAY .... j ........... ■ m EXISTING ■ - LIBRARY BEDROOP A20X20 A20)00 A20X20 A20X20 28'-0■ EXISTING 4 NEW TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map LD Parcel - App ic�l ation # Health Division Date Issued Conservation Division Application Foe ` Planning Dept. Permit Fee �-r 00 'y Date Definitive Plan Approved by Planning Board o5 SOM Historic - OKH _ Preservation / Hyannis C Project Street Address - S / �6 37-1 Village_ CFArrI5 0, y 1 Owner �WCt �pIq' Address3�n S Telephone Sd 0 51 7.01 2 Permit Request lrs�V%. W t-- g ''IU D'Zi'�7 G�,a l ✓� / �-��' ,l�! L>c�sI=WU C� ��J► Square feet: 1 st floor: existing,,pa proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�S Construction Type Lot Size ��(o Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 35 Historic House: ❑Yes )kfNo On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑ Crawl XWalkout ❑ Other r� Basement Finished Area (sq.ft.) 3 dc) Basement Unfinished Area (sq.ft) god Number of Baths: Full: existing,_ new / Half: existing new Number of Bedrooms: existingOnew Total Room Count (not including baths): existing new 0 First Floor R000unt s-ns Heat Type and Fuel: YGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes VNo Fireplaces: Existing New Existing wood/coal stove: 0-Yes No Detached garage: ❑existing ❑ new size—Pool;Mexisting Elnew size _ Barn: ❑ existing ❑ new sVO- v..�,- � Attached garage existing ❑ new size _Shed:Wexisting ❑ new size _ Other: `== r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 5 ! Commercial ❑Yes ydNo If yes, site plan review # Current Uses �� � -- Proposed Use APPLICANT INFORMATION r' f (BUILDER OR HOMEOWNER) Name W (��avws Telephone Number 7 �J 0 3 — l 7 Address V v / License# C S y 3 57y 7 A/�t2 k ! Home Improvement Contractor# ! 72 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO tv SIGNATURE DATE / l Z FOR'OFFICIAL USE ONLY APPLICATION# # DATE ISSUED MAP/PARCEL N0. E ADDRESS ' VILLAGE ,: 4 OWNER - DATE OF INSPECTION: FOUNDATION x FRAME hL 2 ' t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL '4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO.'--- �OpTHE 11 Town. o eB arnstable Regulatory Services 9AarrsrABLE t Thomas F. Geiler, Director MASS. $p,Fa;9. Buildin D NMI ob s Thomas Perry, CBO,~Buil din g Conim.issioner 200 Main Street, Hyannis,N A 02601 www.#own:.ba-nstable.ma.us Office: 508-862-�403 8 a Fax: 508-790-623 0 R TLA:N REVIM, i . Owner: Map/Parcel: .2A 119 '06Z ti Project Address 359 f Y)NM1J S 1 Builder: The following items ),yere noted on reviewing: O MoKE DeTsc-rz e- umeszE R54v,M Fb (CO Aiso� a� BASrt�MF.,JT 2.F�Qv�%- g2 S C2� SmakE DE'i�Ct0�2 S �OvE2 l2.�o 5��. b)�'o' l7Er�e.'ro2S. Q.EQuuLj wsrA FF-e7 .'6F' BDeM DOOV-S C) SMokE DF-e mg, fRE.goagmf W —HE 1Cii�sE. of - STINT- d� Frp.ST F�OOZ keQume.E� C Sivtok�E pergi aas (ova lZ F) Reviewed by: F . Date: 7/3 012- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ti 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/.Organization/Individual): Address: —� c'> City/State/Zip: Phone#: 7-7 5'03— Are you an employer?Check the appropriate box: TTONew oject(required): 1.El am a employer with 4. ❑ I am a general contractor and I employees(full'and/or part-time).* have hired the sub-contractors 6. construction 2. I am a sole proprietor.or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have. 8. ❑Demolition working for me in any capacity. employees and have workers' No workers' comp.insurance comp. insurance.$ 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their . g 11.❑Plumbing repairs or additions 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' 13.0 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. I do hereby certify under the pai d penalties of pereiury he information provided above is true and correct Signature: Dater Phone#: /- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . I �TME' own.of Barnstable ryServices MAIM t RLA111LTitR{i f .. Thomas F.Geller,Director Building Division . Tom Perry,Building Commissioner 200 Mein Street Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Gornplete and Sign This Section .If Using A.Builder asY Owner of the subject property hereby zuthotize_ --r-15, to act on my behalf, in all rnattets relative to work authorized by this bi ild pettait. 35'9 r�pi�V �T (Address of Job) "Pool fences and alarms are the responsibility of the a licant. .Poo .. ls. are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. 117X S tote o et � Signature fAppIi ant Print Name Print Name - 42 t Date Q_FORMS:O WNERPERMISSIONPODI�S $aacnstable 4 Regulatory Services t . R�RNL 1'ARf� : Thomas F.(Teller,Director Building Division Tom Perry,Building Commissioner 200 Main Street; Hyannis,lA 02601 www.town.b • arnstable.ma.us office: 508-80-4038 Fax: 509-790-6230 HOMEOWNER LICENSE FXDWTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER,: name home phone# work phone# CURRENT MAILING ADDRESS: ct#town state zip code . The current exemption for"homeowners"was extended to include owner-occupied dwe iinve. to allow homeowners to of six units or less and 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. h "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 buil ing pit, (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 Depar(arent minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner a Approval of Building Official Note: Tbrce-family dwellings,containing 35,OD0 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S Exy-W11ON, ; The Code states that "Any homeowner porfornung work for which a.building pemut 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 ti are on exemp unaware that they are assuming the responsibilities of a supervisor(see App Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of aware endix Q, ness often insults in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carnrotproceed against the unlicensed person as it would with a licensed a'upervisor. The homeowner acting as Supervisor is ultimately responsible To ensure that the homeowner is fully aware of his/her rrsponsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the rmponsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/ctx* ification for use in your community, ZJbrms:homeexempt lc�x. Office of Co;�=—Aff.—VS BdsinesfR gg q HOME IMPROVEMENT CONTRACTOR - t Registration: 172458 Type: i Expiration 612 /Z014 DBA Licence or registration vali 111 before the expiration date, d for fndividul use pnl J L 'ILLIAMS CONSI R 1 T NCO_ rY Office of Consumer If found return to: Y 10 Park Plaza_ off rs and Business ai JEFF WILLIAMS � � " SwteS _. Boston,MA 02116 170 Regulation 1C.WEEKS POND DRr FORESTDALE,MA 02644 �' Undersecretary 'rl /.I ° i itho i na g ure � ment Of.§' li1i� S tii � N.la aeNu+ztt. ' Di; ourd<ot Buld'►n� Re`-`Ulation� and Stundal'd' B ervisor License. Construction Sup License: CS i035c 4 Restricted to: 00 JEFFREY .WILLIAMS . 10 WEEKS POND A 02644 OW FORESTDALE, . Expiration: 12/1412013 u;nmisimer. . - - - - --' v :y "-. h.'Df .ors "+«. ' 4 .sa p�e:, .rd- ,�_�'''4"t;.�"� �r1 r..,k�� .� •. . .. ..; ..�-., �•'£' rv. 4�'s>, �y nry:aC 'S"_ -�is� by - aaa. ..�,G }#r. -d'+v�,r >.y..'!r'f ..s......� . - ., v. -�..-.. x �...... - .a. '.t •iy.n �'a"a�,3eC. n+,�,.4,-.�,yew-,,,.:k�-.�ahs✓.x•.F'-,.' vr.r.,�ice.r,..s.-�.X 3:vk+n..r� .a-.::uO„i�`ay.�Cr�°.t,'''kw.!?r�,...w.-...,,r..,u+�,*e�c-�'"�..s�:.�.3.,.s..�,"".' a�u"..n.m:si�., s*��;r.i' x's..wu.,.. .:-r£-..+f �la�'�'�75�. � a3u.�eo-„�, .*m.- .�x�,M.ntt!u e!r' ,�?�a f�ii7 )-•.....�_`^• -:'tom•. .Y�ev". #rtes,K+a€ 3 -.�+,.� ,,...- ., �:'t:, . ..-"•;'xt'- -�* r.. �....,. .,.... v r; . .� .:-:.v :rv:^,-. r,..:u �w ., 'Y;tf `d.'"'�?.�".«rFF.d`' ..e,�i;:3P c ">xr r'3w x-:,a...v.`5s.,4.;..ti:.r:._.>«.,...,<. .�>X.... ...,�. 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T.,. ='�:"y #--j . :� � ' �+ -�'�• cam• t 1y�. � wt �--�1 . � a�� -�� ��� � �� . a1 r - il EXISTING ii ij Ram-- mann ® �•p li ....................... .........................i it I l i i EXISTING � =ima i • .Eno" EXISTING'FIRSTT FLOOR PLAN I=.— EXISTING SECOND FLOOR PLAN o LEFT ELEVATION ROME ® X ..TM EXISTING r uzu EXISTING E ISTING e EXISTING WALLS '� _noon . NEWO ..v •o• u EXISTING t NEW b SECOND FLOOR PLAN FRONT ELEVATION DAIGLE RESIDENCE ADD DORMER NAND BATH �^Ao�f�®/ / �JY�Y�o�®/ / p1-12-I3 opJB" .-i;:3 ✓B Designs `35S MAIN STREET TO EXISTING BEDROOH. CENTERVILLE,HA. 4I e a .ePw.,•,�wa z...-........ - - -.a n• rw.c .. L 4"; .ePwu.ew wa�ee .- e,av*+e• .................... ............................................. F ... .............. . .................................... .. i ...................`. .............................................Il.......... {.: tiro 3 ..$............................................................... �r•'-...-. - w>emalwwa - IN ..b m•wui.eo..xo vl•wuiaaawc ww - i.•aln nma - ...................................... ..... 5 �•*Ma «�cu�iw�e .b............... ............................. 1.- : : E euu.aw prole :. i eww«oat �n � � ..................... .............................................! �..t..� ...T.. eau , 1..i.. e..�....i.. ..' _ x .` . ......................................... —M1 . ! ,: aen un ee.n .wm.e'nmw nip. .. ......................................:.........i .• n11 9Ao .. EA,v 5 DO hiER....li...........................+ I d a E�dSTEN31 _ exie.ma ..... ad a.w.ac I ........ ................... ...........................- • EAVE DETAILS. ........4R. .IISZI$....1$...................... :� `u�•'w , e ! ig ' _ •, , it FLOOR FRAMING PLAN q-.q � .1:..1.-1-1 1.1.,.1...4 i I..q...l...1...1-., �-• f - GROSS SECTION DETAILS { ROOF FRAMING PLAN x EXISTING .EXISTING 9 ' � uva. � L 11D LL S•n.G I.. EXISTING E ISTING } � EXISTING SHEAR WALL LEFT ELEVATION SHEAR WALL FRONT ELEVATION . DAIGLE ' RESIDENCE ADD DORMER AND BATH OI-17-12 oRJB er •Z.al3 w ✓B Designs ' - '" 355 MAIN STREET TO EXISTING BEDROOM. =I„ . CENTERVILLE,MA. its.-ssu , MABBACNIl9 B CNEOKLIBT FOR 1.19wCeO PevE wwe u,m COMPLIANCEr1B0 OM ...... • MR" E %moNmE a WIND ZONE . - L] , APPLICABILR a o•—1.a u»rr exeeme•w v acne w...ee mv.mnm.lerovu..eramL� � 1 ...................... v.....................•----..-.... Roof FR.niNB emv.a umM.......--..- rn>u................................. eua¢w+a,.nw nvw.m, w as ..dm .n m.u.....................................1'�s',•'•��L ,n w.m.a.am mm.uuv, .ae sw rw em arnea.:..:.:::..::..an....................................... IJ FRAMMG LOHNECTIONB w.LL FnAn»a .. eem...mrnu.rcv u,rx r,.nro corwcwx.....rt.eu u..........:.................................. M.,ATIO"N'-_ - l.]ANCHORAGE TO FOUNDATION°................................................................. w mm ».uFra,w.n memam oe v.•r,xa�rt.wr nrcu.vnK.ucv»..u........Trve»mxc,ne ov. ". ♦ ..: ea.teP.vauexou............................u.............--....-........--....-...L_M. \ ..•'.. •'y'.'..':: en,.r.Oxe.une.m:ammarun.........mvm...................................1»Ia•a•_.L : \ .:,'.:,'.'.ti::::•: .. eau enemwMcoc,m.....................r rou...--..........I.........---.....--.�»,Y�! IIII �•. .. .. ..,.. .. w...... .......................m.u.......--.................--........ _2 w l a•�L I m.¢e>xu aP rue,r,.r.ro nvnew.r.w .............Ira W n•,>•.wl..................................�(- urnR mwRc'rmw '••''~a:...-....-......-......................1n t¢' ' w.a '•,M.ne,u •.. •„u.. _ ,.r riL u¢nvr uuL.ervm..t r ee,mwnne Ws r run vrame nn u............................. n.a.n naa,aat.•,e.e4w¢evau a nt'.mnm wY VY°i.�u.»uuw m°eeti w,w ,• m _ n t.�L inlnn .: r.ne,u•e corwx�at ����¢.s.w,uu r n. :ma•,a ree erro.,en Io.oeu.w duu o,a•muu..me v..................................... Yi _w.eau �.::•. �I - .................... w we...........................rt.eu v.2e wu., d.l WALLB mew ,. - T o.0 r.w•• 1 Ac.a.deuem vu¢a............................man•m,.Wu........_-...........T.OIGYr.ro'_.L •.. „•� voxao.o¢e.,we duu....... .eu.................nn o.ro. u......-.---.-.-..-.--.Tslph I l4�L •.� d.u.rmm.c°a.................................�xv ......... v..-...-........--..J�q.0 ec�L •.r' °c ......�. - n.rma xu en.rm awe.lx n wrmrox._ mm.� e. rmw:r.ao ' ,•, ..an orrun....-...._- 4.]EKTERIOR WALLS• ....... ._- rt.eun.-..._.....................»a.i.mm» - u»,u ':'•' GENERAL NAILING SCHEDULE " _ a..u�eo a°4°°.u.�.._......................r.aun.--.-...--.._........-.....si,.:_nBla»� •,,, - a.°a aw.xa .nr•.. .r.a.a nx a,x>y..lom.»a..n.sr._"-»an...----... e.. aa.as r. ................................................................................ �.. ..- � .. .:� » .':.�'• ...........................ins ...................................mom wxe�,eip.6'd.Na�o,�vaw................eu v...--...:..............-......--..........i ur.,u Fa.a w�oAax wu,......-..._ .e.e......................................... rt i •e..'n.,.s..'e. o»m..w.Fe. , mw e..ax.a..¢e.w..m.•.ra,a ween a.el»a em ard.Na.orw.«.cele>Hxn,o r. v xuoe.en.xe..................................,.eu v.--................--.......�vr .urun.nuo...............................n.w.I..--.-.--........--....-...irr i..Ir��.- R..m»n•vm.an.o.•Iw.................rt.au».......................-..-.........--.i.mac-. MAXIMUM WALL STUD HEIGHT STUD SPACING „¢a xo.wm ewmn au.ones,..,.��m.J,mo.ara+>n..a maaA r<oreaw.m.cor.w.e.,o...0 nIm "•'O°'w'•+-'-•'-"'-••--•----•••-•-••-�n.eu N..•----------•-••-----•-----.-cn s-+.r n� � RAFTER CONNECTION AND WALL SHEATHING ..0 n.n w.,..........................._..n.eu e...-.---.----..--... .-......... ,a amu ua.nm �' •xu wn,o.uar a• .................. ron»..vnue ar ru¢o,ereaw•....................................................... er•�L a Iw Iu.l ewr•aa,l..................................Ise,eu...-............-............_-........... eoe.x.¢o.can.............................n.eu n o,xen..u..,..--............—».mnx.¢.r.c.Ie..........................._rtmw....-.--:--.-....--..-:---....-.....—» aer PArs mror> >'. lax. l .r w.. aow.ox xuu rt..0 m......................_.........-..-._ .• .lxa l ssa a :'`I _. ' - n.,awr rm..Rex,.w.,»e................Ir.eum,.-..-.......-............--.-......._ - ...adnox..ww,Hn..o,du.nw ern,»¢,..•I o.eax remora......................_¢� ' v. l-tt. > av vo -. .:..!............. .»..imam o....a,ore+.Ia........................................................aa<av tee_ eia..wa ran...............................ron u.-..-......-.........--..--.............— ruamae u¢•r.Gw............................rtbu a a,rmrt.r ur....-.--........-.-._x� !6 P.O6 MOP! •' laxn > 9le .. �.'e..•. u.¢r.cm...........................-rt.eLe W.-.................._•---...-..-.-..-._u sr.rb 4ul Y.. w.an a.a.e m a ex nx a�,m........-•--- _ �;; j'; ;.�..aax,nbmx an.a,a.aa,R.ax ...rt.e.•m...........................--..........noaea Im..e�ex,exo,wx. Io� >.lxn . uee aaD ,....•,.'• .,:; :�r• , d.0 auw»e »ela•mo .......- Ir .axn • sv nA .; •n B.1�orOFr�n� TABLE S. WALL OPENINGS-HEADERS :;. IN LOADBEARING WALLS :.'•:.'e,.'e..•...'•..'e,.e..e:°.'I ,oar e.o.x.w....................................r�»..m.__...._.-slc:n.uwu.er roa.>�L ,�w•a,...,m.raxxmroxe.r m.oe..,»a e.... .. :••:.'e::'e':'�::' o- . r en..,..w,. w�.o.x+e,m.0•...r. .................................... w.........................................,rt.e..m..'-.--.......-.....-...-... .�.n,.r rax udan�,n muu.re,w u•n re.rt................. . .........:........•]un, e.m a.a..n.r.ro»aen. a.e..¢.¢.mRaede,..................... naa,.m,......-....... ...m.ra+xmmx..r.nwo�.u..m duu ..ar,m.,r ro»�z,o.. »m..m.ue•m.o oaw ra..n°..a.uo.wRe w .ar.n............._.-....-...............--.n..0 .......... � '1.o•asrnx.aPw�m xem.,er�..e.n.wu.e.r.Rnmm raw w a.00m m.w r..car,n,,«.w.r we.rw« .. ..u,r...»e.o»°rannox x.u..-.-.;.-.rte.e w.....................................�ie.n. .mu,vA.a..xa.»»,.....m.m¢ .............. ..--.......-.....-. ..,w.anon.u.uw»o-.m.nR.u,sw.uae.rx��dnr x.wxe,u wmxxe...,uwu ne..m-,a..e¢ STUDS AND HEADERS ,wr wr..x»e,xnevn.......................... ............. . ...JO_...w•ur�L . .mm�..eu n.m ii.m mu,m o•r....wv,.•w.,m ewnw...:.,.,m.e.,w•.w re ad.n...mw. .00.»..awo..mean>..............................u>L.-...--_.....-.-.........---...-...---.. wl AROUND WALL OPENINGS _ ba.DeRee. DeWG" �i/vv��011®/ /�E6/6N-qeC®/ o � S _� _y • DAIGLE RESIDENCE ADD DORMER AND BATH Cam✓ OI-11-17 JB .3yP, . JB DBs/9'ns ' 355 MAIN STREET TO EXI5TIN6 BEDROOM. ..a..a _ENTERVILLE.MA, /eGpJ 19F%N FTHETp� Town of Barnstable Regulatory Services ` '" M ` Thomas F.Geiler,Director y ass.MASS. g 1639. a`0 Building Division Tom Perry. Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 April 30, 2002 Mike Daigle 359 Main Street Centerville, Ma 02632 Re: Sun & Sea Jet Ski Rentals Dear Mr. Daigle; It has come to my attention that you are operating a jet ski rental business out of your home. Our research indicates that you have not registered as a home occupation nor have you obtained zoning relief. It is imperative that you contact this office immediately in order to resolve this in an expeditious manner. Failure to comply may result in a per diem fine up to $300.00. Your anticipated cooperation is appreciated. Since -rel�y Y � � w w Thomas Perry Building Commissioner d (V-41 -Q-7 001- 7E Q, s��CQ ("� 7/23/01 10 a.m. File: Received call from Tom Quinn, 351 Main Street, Centerville 508 726-2600 or 508 539-2701 Complaint 7 unit jet ski operation at 359 Main Street, Centerville. Property owned by Peter Daigle. Business, Sun & Sea Jet Boats, being operated by his kids. 7 jet skis being launched between 6:30-7:00 a.m. Fuel and oil stored on site. 55 gal. fuel tanks. No special permit in Town of Barnstable according to Mr. Quinn. Extremely hazardous situation. He spoke to Gloria who referred him to the Board of Health. No one has done anything. He doesn't think anyone has even visited the site. You wouldn't see anything at this time of day--would have to go out 6:30-7:00 or late in the day. He is very angry and concerned. He'll call the Fire Department but wants to talk to the Building Commissioner. He thinks the Building Department needs to nip this in the bud before there is an accident. Spoke to Gloria. She received complaint 7/19 (see attached). She has referred to R. Jones re business and is waiting for report. She also referred to Bd. of Health and thinks Ed Barry has been out. Gloria has visited the site. She has tried to reach Atty. Daigle without success. She will follow up today. Spoke with Mr. Quinn who said jet skis are being maintained, fueled and stored at the Centerville address and are being transported by trailer to Yarmouth. Mr. Quinn described a series of issues with this neighbor relating to access to the property and a fence. Gloria spoke with Mr. Quinn and the neighbor at 359 Main St. Mr. Quinn lives about 1 1/2 miles away and is the relative of the owners of 351 Main St. Gloria has determined that the owner of 351 Main St. is operating an upholstery business which will not be allowed. She will investigate the jet ski complaint and they will not be allowed to operate a business at that location. 0 ' Building DepartmenE ComplainUBqui y Report Assessor's Date: —/9 —0/ Rec d by: Complaint Name: Location Address: WP Originator Name Street: Village: S�' 7ap• Telephone:D/E Complaint Description: ` Inqui y Description For Office Use Only Inspector's c� _0/ Spector. Action/Comments Date• follow up Action Additional Info. AMIdled Cop),DisvibLdon: White-Depamnent File Yellow-Inspector Pink-Inspector(Return to Office Manager) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'SEPTIC SYSTEM MUST BE ' Map 2 4- 119--c)O2 Parcel INSTALLED IN COMPLIANCE Permit# - � Health Division /- 14 �,` E WITH TITLE 5—ENVIRONMENTAL CODE ANIDate atelssued Conservation Division e S _ TOWN REGULATIONS w Fee' y6s ' Tax Collector Treasurer Planning Dept: Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis a Project Street Address ° 0 1 (h 1 Y') t A Village 0--c-ri 4601 U- 1 ;f Owner re der i Address J��.i.,-� Sfi `�n r1f (� Telephone �� � 7 / " S ' Permit Request W i m 1 �U 0 6 ` 1 L Square feet: 1st floor: existing UOD proposed 041 2nd floor: existing -;&6 proposed U Total newer Estimated Project Cost Zoning District ( -- Flood Plain Groundwater Overlay Construction Type Lot Size -4 ' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family t Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes NNo On Old King's Highway: ❑Yes OMo Basement Type: ..-®Full ❑Crawl w ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq,ft) SUU S� `Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing new r Total Room Count(not including baths): existing new YJA First Floor Room Count _21- Heat Type and Fuel: *Gas, ❑Oil ❑ Electric ❑Other ' Central Air: ❑Yes ❑Jo Fireplaces: Existing New Existing wood/coal stove: ❑Yes i-No Detached garage:Zkxisting ❑new size Pool:❑existing t i.new size r6 Barn:0 existing ❑new size Attached garage:❑existing ❑new size _ Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ` 6412ee-, Telephone Number Address License# ' Home Improvement Contractor# A Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING•FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Z DATE 1 FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED MAP/PARCEL NO: 1 ADDRESS VILLAGES { ! OWNER DATE OF INS ECTION -� FOUNDATION' _ yy FRAME" �' =' *, ' " ; ' ;• ' INSUL•ATIO�N I Cl FIREPLACE' t'-3 ELECTRICAL., ` ROUGH FINAL « ' , PLUMBING: r ROUGH FINAL t GAS: - `' yROUGH FINAL 't FINAL BUILDING d I L DATE CLOSED OUT ASSOCIATION PLAN NO. _ The ommonw Department of Industrial Accidents Office oflosestegaONS 6� 600 Washington Street Boston,Mass. 02111 Workers, Com ensation Insurance Affidavit name: <-' r C location: a�� ' MA 0 vhone# city ❑ I am a homeowner performing all work myself. ❑ I am a sole 'etor and have no one worlan in aav capacity tmsation for my employees worlang on this job. Iam an employer P> .....:.:...:::::::.::.: ;.;::::: :..... .... a n addt'ess: :.:.:. .::.;.?....:?..:::.,...::.:::;..:;i ..:.............................. _ ......... ;'>•'::;::.::; hone cttv:... :.,.,........... ::,...' insurance ca. ;:. ohcv /// general , omeowner ' cle one and have hued the contractors listed below who am a sole proprietor, contractor have Iices: workers compensation po .............. _: _:._ ;>;;: ::.;:.;:.:: .;;::;::.;:.;:.;;;;:?.::??.;::<?.:::.-:::::.::.;;:::::::?.:?::;::..::.::::?«:::..::::.:.;:.:<. ; the following mP..., :::..,:.:.,:.::. ::........;:.:::..::..:. ::.::. :::::::...:,:::::.::.::::,::'.;:.:::::::::?.;:::::. m an n ::....... ....,......::,,..,,.......:,:.:.:.... . ... 4:i:iii::;i:: •:::i::::::�:ir:::::::::::. ::isi:> .`i::::�i:::::4Si::iii::i:::::{i?::>�:t�:<iS:S::}:?:� :>:y,{.::•i:•>i:•':>'.`i:?;:} •:?4i>:;i?::::':•>:}.`•`?`??:•:>:�.:. >:. y� . ......:. . ....:...........:.:•:•::::::::::.::::?•::•?:•::?•i:?•::?.}:}S:;isj{:j'i::ism::�ii:::>:':?::::::iii:�:i::i:•:i:;}::-i::ii:•is;:i�i::r::::i.2:::>}>`::::::• hOne . y. .............................:.... ...... .....................v:::::::::::::n..•n�:.v�+r....r...:•::?w:::x• .........:..::4i:J::•:'.;::: ...... .:.ii:??L;::i:•ii:{Li}istvti:v:•:iii:is{i::?:?;:ij}::•'r:•iii:�i.•.....:......... v n ::;:::::•:::::. come MULL addr.esr o Ci . .::.:..::................ . ..::.:::.....::........... insurance co;.. .....:::.;,;.;,,,.:?.:.:,:<?:,:?.,,:.,.... oli gai>nt a to aecnre coverage as.req>deed snider Section ZSA of MGL 152 can lead to the�positioa of erimind penalties of a Sae up to S1.SOO.QO and/or Fa yam,imprisonment as reell as civil penalties is the form of a STOP WORK ORDER and a Sae of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage vedffcatton, I do herebyunder the P�mtd penalties of ped�'thai the information provided above is trues and correct Date -- Signature Print name '" oflacW we only do not write in this area to be completed by city or town ofHdsl permli icense t# a��gg Bo� -_ ent city or town: OSciecimeWs Ofdce check if immediate response is required ❑neaith Department contact person• phone#; other ltcvsua 9/95 PIA) • • :11�/ 1 • :4 • •/ :•• I I ;.•1 is) • a • • • I - • r) •IIII•i/1 .Y• •It • • :II• I • •li(oliv-:691ifelve use .it II ;./ • qt:klfel 011widWs�1 .11 •III • I ••• • IIII• w• • • • :1• • 1 / / L so I/ • I • •I:1 I I •M • •11 • •• Iran a • •IfI -4 :/IIII •1 .11 10A IvAslopIr• I • • •11 • :11 • � • 1 • /I �1/1 • .11• 1 • II ' •1 •Y. • �+ �.11 Y.1• • 1:• rs ►• WII• • •I It ' . • / 1 • •1 • •1:.1 1 1• •M .1■ •11 • • /G •C :..11.1 :•111• • 11 :••n• • • :1 II • •• •�• •1 • • I • •• - 1 11 • / • 11 • 1 / / r III:III•. ./1• 1 • wv 1 � 11 .i �11/ •1 1/ • Ilr .111 • tl • • 111 • •• • I • I q • 1• :IIII• • r�•/ •11 • • • 11 111 i1/ 1 •I/ • 1 «• •11 •I �1• 1 •••Ir, •11 1 • 1 • I U • 1• •I •11 11 I •b•• • • I • • • • �11 /1 II�/ • I I I • •�% • 1 • �.111I • 11 �111 • • �_•11 �/ • / .11 .+IIII • :.1 1 I M 1 •I I • •'.11:.� 11 .1 1 I 1 '1 1 1 :l 1 I : I 1 1 1 1 1 I I r" 1 • 1 / 1 I 11 1 1 d4:gel ILI I1 I 1 111 ILI• I r 1 1 1 1 f. 1 1 1 11111 1 1 1 1 1 1 1 1 1 1 • 1 1 1 • 1 1 ' 1 1awl)11 1 1 1 I lf4I i 1 kj 1 I jr.i1 r' 1111�3 :•I 11 ••r f1•11 • �•% I 1 • .11 • It. r • i 1• ✓. •/I IIIJ k'Ifoll Oki -111.1 1111 Sjr.01 1••1111 qI.1410 11 •=. 1•I.11 .11 •1 / 1 • •••II. •/•1 •Y. • •i./• •1 Y•11It1 1 • I11 •1 IIf. 11 I r �• 111 �.11 ..•11. •I 111 MI 1 /�/ 1 •�-.1 • -••11�• 1• /1 V•I11■ •• 1 mm"E"jM� 2��jjjjjjjjj��jjj��jjjjjj�����j�����jjjj�j�jjjjjj/jj�jjj���jjjj/�j�jjj • III / 11 • • •. �1 Y•11•II:.• Y;1. 011 II • 1 V•IIt11 �./- 1 • tll .•11 • 11 box that .11 1 to ymir `t 111 .t• •11 .11 / •.• I'• •IIII•.11 1 .111.� 1 • .11 1 D / •11 111111 1:•1 •II ' n• 11/ V... •1• V+.11' •1 11 1 ,Ir V all affibvfts 11 b I fail i• • 11 • 111.•/1 •1 1 •11 •I • V« •i.11A 1.1 r•n:Il•11 .1• •II ofm* smz=cov=Bc. 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III ' 1 1 1 1 / I I I I 1 1 1 1 1 1 1 I / . 1 III / 111 .� II II 1 ,4°F 1ME t The Town of Barnstable �� LEST" � 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 t Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: U O L' Estimated Cost 101 0 Address of Work: 3 t t� st C'94,t&tt"ti IAA-- (l IL'`� L Owner's Name: W Date of Application: 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 ivowner 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. Date Contractor Nam Registration No. OR - Date Owner's Name g1orms:Affidav " .o• Department of Health Safety and Environmental services Building Division PAM ' 367 Main Street,Hyannis MA 02601 9 t61�. �'°rEa ram►+° Office: 508-862-403.8 Ralph Crossen Fax: 508-790-6230 Buildine Commissi. HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: Oe n )e YV I number street �-7 village ..HOMEOWNER": e a r C ` I C 09") q 7/- �(0 name y� home phone# work phone# CURRENT MAILING ADDRESS: IVA- city/town te 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 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 Ho er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will bef 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 to amend and adopt such a form/certification for use in your community. 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L D CAT!O 1V EN fs' ►Vt- G 46 ,, _ ,. SCA -',E /" - 0� G.Ar:F '' .: .. . =a . :: R.E - 1 R:E.NCE BS:l14o L o,T AS S^NOfwN .A( ,4 FLAN : �PEcO ,.G � '`C. /L , 8, ,, , . v . / N FNE' ,,BA'RNS=T'A. BL-E C''QUa/�''Y„ I . . �R £ 6-/STRr oF., OfEDS `PLAN,,BO'OK ..: . , 3 0!_. PAGE - . , REB tAN`p Su VFyoR I. -/'HE'Ro—f-a ,',. 'C 'RT/"FY.. TH. dT TH.E .f O`d;fl�Q,AT/4N . . - . SHOWN ON -T"'NIs PL AN- /S l PC'-ATl� Q�N =. , - r,Hf -:GR0. !lNo SAS. SHOWN- Hf.R£:.ON A:N0 . TRA7' ,/ T. { G:f3NF'6R.W 7r0 , X G : ,N BU/L/0/NG S,r_rJACpK�} REQ-If/:R,pEAEFN?'S Of ; i -_ TNT ro avN a.F ; : _,. .. - 03/24/00 00:41 FAX 5083945567 AITANTIS DESIGN 02 LP i s y� � - n re I � i- , • o • c� _ ALUMINUM 4" MIN. CONC. DECK o CLIP ANGLE - 3-"W 9"x-I*4" -� �. 5/8 O ALL -� o THREAD ROD Xx [COTE ALL BACKFILL SOI BE SEE INSTALLATION 1/4" 2 NOTES o I r 7- 3/8"0 M.BOLTS, DIAGONAL BRACE " NUTS, AND WASHERS 2"x 2"x 14 GA. AT 8-0 co TYP. EA.PANEL END MAX.) lip M C EEP CONCRETE TYPICAL 14 GA. OOAERERGAV PANEL POLPMTE z - -- STAKE L-2"x 2"x - 20 MIL THICKNESS I6 x 14 GA. VINYL LINER o- . DEADMAN PLATE r � F L- 8�x B'x QL 8tX 2" VERMICULITE 14 GA. OR SAND_ o •� P".0i " N 1 03/24/00 00:41 FAX 5083115567 AITANTIS DESIGN 01 � I07) • LC CAT W �I s saws. ' I ASSURSMS>�A Lor ,N��Z D TALLERS apel mm. Ldiar (044t) fmrsr SCPIIC TAW •01 V - i J.E H m kr Y:(type) ) No.opmM onni LF { I BLTQaEILOIt R �wrrr wre DAB: !D � X. s • w Ilw�� Q 1 1k $=edlAfthms PWH4 - - feet Ptt Uhler hD adas Sm A Y (V say w1b axis as do or Rio Fat B4F or M►ldrd L=oft pad*at esht •idin 3w rat 1 Fift I�artoa�► ��7"� I � 3f St 0 . THIS 1S A TYPE II POOL AND T PI 11 DIVING EQUIPMENT MUST BE USED. CONSULS DI IOARD RANUFACTURER'S SPECIFICATMNS FOR INSTALLA THE WATER LEVEL SHOULD BE PO MORE THAN 6- BELOV THE COPING RECEPTOR (hang tab) S ' . THESE ARE FINISHED DIMENSIONS, ZEADY FOR THE LINER, ROUGH EXCAVATION SHOULD BE ' TO 3' DEEPER 1N EACH INSTANCE IIIMIENSMNS ARE FRO l dSIDE POOL PANELS. •rraA U Warr 0A N Z CJWMW a AVAWW crywM#APweW. r,�can�nwcra�rrrrrms��� :ueae�ro��wwrr�..a�rro,uoRroraerx.m y►�err�aaeA:io+rta�a� r 7 C+anarwara. -,-Assessor's map and lot number ......... `r�� �...l�.� S/( o THE` o ......... . i t _ P Sewage Permit numbers�� tom... !L��..R,T ......:::..... Z BABHSTAM L House number ............................. �..... yO MABa y p 039. 9� MR Ar i TOWN OF BARN STABLE r BUILDING INSPECTOR W �r kr APPLICATION FOR PERMIT TO ...................................................................i............. ......................................... ti3u, s'tz11 �� �? �. ^, \ TYPE OF CONSTRUCTION ' °� 1r, ........................................... ........................ . ........ ...................... / I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................�. �� .... .... 'Y) ....5 -.... � .}"'.) �.�.�.�.�G.. .................... ................................... Proposed Use ........)n....... �.a�`n.. .!..............�. .3.x... .s / . ............................................................. .. .. r Zoning District ..............................Fire District ...............� Name of Owner a�cVt !. hlc 4 S Address 3�� I h 1G ..................................... z.........................................'............... Name of Builder J2!� �un�1c Up�c��, ....,Address ...1 ►�`' ! S �S3.. Y.,.......................... J....................... Name of Architect Ste 'L ..................Address Sep? <............................................................. Numberof Rooms ......... ......................................................Foundation ....... ..................................................................... Exierior ....................................................................................Roofing ..........r........................................................................ Floors ....... .............................................................................Interior ..........,:.............................................. Heating .... ............................................................................Plumbing .........................................................................:....... Fireplace ............ ............................................... ......... ........Approximate Cost ......... .................................. Definitive Plan Approved by Planning Board -------------------___---------19--------- Area /.2..x,�........... ', Oa Diagram of Lot and Building with Dimensions Fee ...... ...,,s............................ 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 . .�` {��. � �1. ......................... Construction Supervisor's'License MzSS GG E7 t SHIELDS, ROBERT A7--208-119-2 No U.440...... Permit for A �9-..Swin¢ttin 2001 .........ZgQesgqgy..to Dwelling....................... Location ... Mjn.5trfit; ..................C� tp-.Willp..................................... Owner .....Robert. Shields ............. ............................................... Type of Construction ...Frame............................ .. ........ ................................................................................ Plot ............................ Lot ........... ..................... May 15, 84 Permit Grant6d ........................................19 Date of Inspection ....................................19 Date Completed .......................................19 or, tit b -'s map and lot number .. ....................................I... TIC SYSTEM MUST IB3 Sewage Permit number ....... ............................. INSTALLED IN COMPLIAN BARNSTABLE, Houser ?V--- 3 ARTICLE 11 S House number ......................................... ....................... TATE VASL 039. AND TOW TOWN OF BX-RNSTABLE TECTOR BUILDING 10S 0 .............................................. APPLICATION FOR PERMIT T ...................................... TYPE OF CONSTRUCTION ......WPQ .. ................................................................................ .................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location359....M6AQ...... 6?e��107-'mu (.QJJ!�' ............................................... ......... ...................................................................... Proposed Use .... ..... .................................. �" C" CA-0 ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .......... .1(�' --Address ..... Name of Builder �ss B< a.......... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .....�........................................................Foundation ...... ......... Exterior .............Roofing ... ft!W.40-'<................................................. Floor, .......................................................................Interior ... 5.Tu...I..................................................... Heating ....4r LJ .... ........... .............. ..... Plumbing ....... ...................................... Fireplace ..... ...........................................................................Approximate Cost .......55 ocno .......................................... ...... Definitive Plan Approved by Planning Board -----------—------—----------- Area ........................................... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH '2-0 94F 3-34?d 2 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......41-164/L" ................................... Michael Realty Trust 20974• ... two sto?y........ !a .... ........... Permit for ....................... C single family dwelling e, .............................................................................. Location 359 Main Street ........................................................... ille ..........................Centery ..................................................... Owner .......................................... ...................... Michael Realty Trust Z, Type of Construction .....................f.rame........... L/ T, ..:.............................. ............................................... Plot ............................ Lot ................................ � January 17�. 79 Permit Granted ............................... . -_3 9 Date of Inspection ...... ........19 /*... s� - n F Date Completed 9 PERMIT REFUSED q ............................. ............................. ....... 19 .......1. .............. . i, 0 -/ ... .... .. ................. .... ..... ... ............. ... .. ... . ...... .... . .... .. .. . . . . . .... ................ ......... `_ 1,,.,, f ; { y + . . ................................................................................ Approved ................................................ 19 .......................................................... .................... ........... ........ t TOWN OF BARNSTABLE Permit No. ----------__.------_-_------ tAasxa.c , - Building Inspector ' ...� Cash -- --------------- a Val OCCUPANCY PERMIT Bond ----_-_-_------ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Michael Realty ?'mist. Address pn,r r:tA'?, OSter-tri Ile MA r � I Wiring Inspector; Y '' — Inspection date Plumbing Inspector j = Inspection date Gas Inspector Inspection date Engineering Department - %� „�� i -`� -',J Inspection date 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. ................................................ 19......_ _ ....................................... ... ......................................................._.._._._ IL— Building Inspector Li"I�0�'..',���Kt.��.;,"I�,!i-@.�,I�rr"-,_I��,,"�nl-"�_�,."",`,,,_1" ""1II :''.- � "-I.-, �I,� � �-, .I' � �" .i.:�;.'�. ".jL�- � ",, ._. 4 �A5 , �-- " �. ..1 , ," , :11�- , ^A. -" r . ;,-., 4_ .-1_�i..!,.�_-k. - �.-..qI'�,;1" .' ?1. 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