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0621 SKUNKNET ROAD
11. 1, gli aI, 41. c,k�2'- jr MIM" '11- �Jf ,p �mg A vi* _'U'lM, t IM 7j. 'A ai� -`& fiv A �?R T n-, '4 _4xw, IN 111641 al a A 151Y k'J ,Eli, ON ap ilitz IN �gn.6,p p �tpl 4 r W�14 m; MW 31 5Z kq-, q Nq, "4,3FIR ggg cn, 4;,1 i3 1,5 "N" 1, V� P """'V, 0 "'M _IA��"T �pg, PI mv,, Q�Xgz�,IF mw�;mw, �,n Q K f N vlz .11 ,VIA 10" qK"..71 Ag". - -n�� �J, Vj A �A 31. I w ww'U'LO Old! tin gip flgg v gg, MIR,, n E811 Al -(p .v gv g Rv A� 'g EAG. 751u, � u, 1*2 M X Y Rl ORMN, X- MuM ww" AQ,i ?M 'N! 4" _NhIM,_3a Al W, wg�', �_oigg 'n gic VIA, A` i,51 "'leg INMIF2,-,,",;A A-1 MOM ,gg Mel WO m 116 - 1, Al2 "T, "M M4 m ZW, "w M "A ,4; 4' F A f,4 ,f� ®R n v �,�dv n A M, ul�M�R.,,,,,,11� 0, Of-Wt A,�!, -A 4�a, Meg i vllllls�l�ln, 'A N �z gv TMe �,mp-qT7 --A" k.—im"'e 'g , " 2 N ;, T �14 W, i4i VM v, , "I � . _114�q-,&"��,,5, V Ulm la3o�� o 38 n+e Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee aAaxsrAaM v 39. Thomas F.Geder,Director i639� A�� I �Fp N1� v Building Division Tom Perry,CBO, Building Commissioner. n 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint Map/parcel NumberL4J// 611 Property Address ( a1 f A vq 1N4&, �h �—OR 2?V tI'/kp- 041/5,esidential Value of Work r,�0 t a 4 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address y U/ate 7-ko Ra/ Imp de ' gP Contractor's Name e /L2/ lam? ✓Telephone Number ,4 V(/-r4-Fr/0A" . Home Improvement Contractor Lid nse#(if applicable) l r7 4 I'li pph Eta C S - �y � Cons ction Supervisor's License#(if applicable) # o PER 1 !l//IT orkman's Com ensation Insurance JULP 2 2013 Check one ❑ I am a sole proprietor am the Homeowner TOWN I have Worker's Compensation Insurance OF BARNSTABLE Insurance Company Name ,�J f 6 d'a' tL 6Y/aw/ Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. a Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over . existing layers of roof) ❑ Re-side � , /Gd fL�l.�I,C. 1rt1�l�l D out ' ad #of doors . (Replacement Windows/doors/sliders.U-Value Gt (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. ' Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Ho a Improvement Contractors License&Construction Supervisors License is requi y SIGNATURE: a / 0'�/ d 3 C:\Useis\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\9RE6ZUBN\EXPRESS.doc Revised 053012 0' ' r _ Office oflnvestigations _ 1 Congress Street,Suite 100 •Boston,MA 02114-2017 www.mass gov/dia workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information PIease Print Le 'bI v Name(Business/organization/individual):Capizzi Nome Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA-02648 Phone#:508-428=9518 . Are you an employer?Check the appropriate box: Type of project(required): 1:❑✓ .I am a employer with 40+ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6, ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet [7. ❑Remodeling ship and Have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' No workers' comp. insurance comp.insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.❑ I am,a homeowner doing all-Work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL ❑Robftepai rs, insurance requited]f c. 152;§.1(4), and we have no 12.,--� ��" employees.[No workers' l3,L�&er / 211IMODf l comp.Insurance required.] *Any app-acant that cheer box#1 must also fill out the section belgW, shaving their workers'compensation poly information's f Homeowners who sabmit this affidavit indicating they are doing M work,di then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached as additional sheet show.ing0he name of the sub-contractors and Mate whether or dot those entities have employees. If the sub-eontractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing warkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Associated Employers Insurance Company Policy.#or Self-ins.Lie.#WCC5010 547012011 " / ( / g to/Zip.Expiration Date: 12/25/201g Job Site Address: �° cl kUH/C� Ci /Sta ty . 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Id o hereby certify under the Pairs and penalties of perjury that the information provided above is true and corn.ec� Signature: Date: Phone#:508-428 518 Official use only.. Do'not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing Authority(circle one): Y:Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5-Plurimbing Inspector 6.Other Contact Person: - Phone#: - f i Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of , enclosed space. 1 Massachusetts -Department of Public Safety, Board of Building Regulations and Standards Construction Supervisor License: CS-074640 Failure to possess a current edition of the Massachusetts _ ,:., ,., State Building Code is cause for revocation of this license. GARY GUSTAFSQN For DPS Licensing information visit: www.Mass.Gov/DPS g S$ORT WAY SANIDWICx MA=025 J, ,J1/ F• ,� +4►�' Expiration commissioner 11/29l2014 �'le �a�r�nw�uneci i �✓l � e j4cwsa orre&t mfion v2W for1utvidnr1 only Office of Consumer Affairs&Business Regulation lam the a*hmfim cue. If Amd mtom to. OME IMPROVEMENT CONTRACTOR b;mt of CmsmerAM=Rnd Batsmesg REgWafaa` Registration.'._ 40 Type< �1Q Park? -Safte 5170 _ Expira -123%2014 Supplement CAPIZZI HOME.' ::r� ' : r, I - ROVE(U1MNC , GARY GUSTAFS 1645 Newton Rd. `'�'':.. "::_:' Cotuit,MA 02635 Undersecretary _ 7 _ SIN, 31.tirits+8sttnmtFa ` * r ti �� CAPIHOM-01 CBENISCH DATE(MM/DD/YYYY) '`�`��@ CERTIFICATE OF LIABILITY INSURANCE 6/12/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Chris Benisch R eers;&Gray Ins.-Dennis Branch PHONE 508 398-7980 Arc No: 877 816-2156 434 A/C No E,: ) ( ) South Dennis,MA 02660 n DRESS:cbenisch@rogersgmy.com INSURERS)AFFORDING COVERAGE NAIC# - INSURER A:Mar Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. Capiai Home Improvement,Inc. INSURER C: Capiai Enterprises,Inc. 1645 Newtown Road INSURER D Cotuit,MA 02635 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP - UNITS INSR WVD POLICY NUMBER MM/DD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO REWTM A X COMMERCIAL GENERAL LIABILITY MPB1075H 6/8/2013 6/8/2014 PREMISES Ea occurrence $ 500,000 CLAIMS-MADE I Jk I OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ - 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: - 'PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PET LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO M1M28044 • 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ 500,000 X AUTOS AUTOS PERTY D X HIREDAUTOS X AUTOSNON-OSED PERACCIDEAMAGE $ X UMBRELLA LIAB OCCUR , EACH OCCURRENCE $ 5,000,000 • EXCESS LIAB HCLAIMS-MADE CUB1076H � 6/8/2013 6/8/2014 � AGGREGATE $ - DIEDX RETENTION$ 10,000 $ 5,000,000 WORKERS COMPENSATION _ ,. WC ST TU MIT X O R - AND EMPLOYERS'LIABILITY - TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y r N WCC5010547012012 12/25/ 012 5/2013 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NI N/A (Mandatory in NH) E"L DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E"L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHORIZED REPRESENTATIVE , ©1988-2010 ACORD CORPORATION_ . All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD , Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, V�AM I f lAh flklf OWN THE PROPERTY LOCATED AT �d� L Sl<v M1z-Atr.7 01V- IN C&76RVi"el' , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY i FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 E MASSACHUSETTS STATE BUILD ODE SIGNATURE OF OWNED: 1{ OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: . RESPONSIBLE OFFICER TELEPHONE: TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION,.. Map Parcel y Application# o �/ t Health Division ` Date Issued Conservation Division Application Fee Planning'Dept. Permit Fee` 3� Date Definitive',Plan Approved by Planning Board Historic -- OKH s "Preservation Hyannis Project Street Address &2I VAI K/V ET ROA ,D Village C E N T EQ V/6-L -- Owner SuS,9N,' Torn fX E-W ITS Address 'G21. A0190 Telephone 50 r SS 3 f Permit Request /NS T I9'C L-,fh'l0,✓ OF TbGA 2 PpNE'C_r O^-' )eopl .4 S e.4 Pe T O/e /q 77 t EGE _r-K C: EYJSi��+-- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater,Overlay Project Valuation 2Z Gio.oa Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ur' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Flo On Old King's Hi hway:£.:U Yes . ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other , -ze Basement Finished Area(sq.ft.) Basement Unfinished Area(s ' Number of Baths: Full: existing new Half: existing flw Number of Bedrooms: existing _new �c Total Room Count (not including baths): existing new First Floor R `om COu�it { Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION �E'sovre.lE'(Vno,,✓lac. (BUILDER OR HOMEOWNER) d1111 /� Name (>AvO SOc.4&- v/n 721CA,4owfe- Telephone Number C- eo 2 2 91 —5J`S; Address o6a c-iY - &C 2 yAN 0t21c*_'0 vti,r e-S License# C S e- -Fe6 6 a /24rNN141", nor¢ 6Z'767 Home Improvement Contractor# l S9 819q Worker's Compensation # WIC fs9 f 56f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 y ~ 6 s r FOR OFFICIAL USE ONLY APPLICATION# 4 DATE ISSUED MAP/PARCEL NO. 7 `t ADDRESS VILLAGE OWNER S k DATE OF INSPECTION: s I� FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL • ` GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT m ASSOCIATION PLAN NO. T i >�§ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �,s Please Print Legibly Name (Business/Organization/Individual): 4M,4L �6�Tf(J`9C 0��&Nr �wC C'ry� U�SOlr4tC Address:&p/ rre a /et kjEX ed. SZ( /7Z 3 City/State/Zip: AIA(172'',��1/�IZ-,Jw,6nOr✓ Phone#: Poo IT?q �1 e11 Y Are you an employer?Check the appropriate box: Type of project(required): 1 am a employer with l o S 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y � 9. ❑Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[✓rOther St344►2 PANE1S 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: Al i 1ED N• A)y1 E121 f$4✓ 9110 t A46t—OMB (2A _ Policy#or Self-ins.Lic.#: WC Expiration Date: Job Site Address:a21 .S'/ 1L-,6A-t-t— 9614-1 City/State/Zip:(Zkt-At-'-vi tLt, N+A- 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 fonn 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 ce under ams and penalties of perjury that the information provided above is true and correct. Si natur . r Date: ti GS _ Phone#• 2�l �J apt r 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#: *tr;,r ;C ""CuI l; ` II("� t� . r ill' 8 I{ � rrr �, , ._,_.. iI Yl l\J�I (/1�j)� F` .A, ) r L� 1` f f - ....._ .._ .._..,..._ ,..—. .,a...... .........4.-_ - _ ON I Irk[ 1 . r ) ,)n t(e�ry alw^ry {nlic�ourhtl ,)1,�L1( ; 9.LG GOti 3!ip>- _._._. hax )IGJ�A3 <)�iSS If°91zs'M'R* 1FJ AIR.. I,j I')6�t9f:.F) lk`E R� IlR�1R :'� '.� 1 :: r nc IJi.cel l�)c)]:'i:):1 1ra!ru;:r.i.c�. :f.clstl'c<:u).t.'e 1?:r()is:(-?rag(_[ r;)i.' C'a'I. gfa o 11WO .I4,A ION L� ONLY �)ND €;f.3mm-.12�i MCI (Flf�1 R!v liF)C,N T., 4.f k� i:-10 Gcl;Jt, Ji.j.(.ivte'..I.I.. St:leeL, 'ff):I-l. E!t)L[)I.{'{. '('r1I`t3 (`:L:(£'P'{t'(4�'I{: 1101 NOT AMEND, I..�i'6i_N!_t (_)I Ll:f.('.'jf:U},3(i_i(_)J. 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(o7,1- - — Aleaozzinzo�z{crea��L 4 //�xklculuCaeCG Board of Building Regulations and Standards Construction Supervisor License License: CS 98660 Expiration:: 12/7/2011 Tr# 98660 Restriction: 00 DAVID RICHARDSON 35 MAY AVE RAYNHAM,MA 02767 Commissioner ��I).e �4))L'7Yla)L[UP,[L�Lf2• 4�v'G'(.ptiJ!!,(9LLl6P,��Q Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 159879 Expiration: 6/9/2010 Tr# 269363 Type: Private Corporation GLOBAL RESOURCE OPTIONS dba GRO SOLAR DAVID RICHARDSON 601 OLD RIVER RD SUITE 3 WRJ,VT 05001 Administrator -i � l �J M BY:.......------------. Dec 21, 2008 Tom &Susan Fredette gr 6. 621 Skunknet Rd Centerville, MA 02632 RE: Renewable Energy System Proposal Dear Tom &Susan, Thank you for your choosing groSolar. We appreciate the opportunity to serve your renewable energy needs. At groSolar,we use only quality products from reputable manufacturers. Our engineering expertise and experience in the field allows us to design and install low maintenance, high performance systems that meet your needs. Design Assumptions We understand the following about your location and system goals: -The roof of your home has a 12 degree pitch and face approx 270 degrees w magnetic T. 4 -The inverter and associated components for your pv system will be mounted in the basement near your train electric panel -You desire to reduce your carbon footprint and its corresponding impact on our environment by as much as is practically possible I Page 2 Option I: Clean Energy Option UT-2730 This system is comprised of 14,195-watt Evergreen photovoltaic modules totaling 2730 watts of peak DC power, and will be mounted on the west-facing roof plane of your home. This system offsets approximately 66 tons of carbon pollutions,the equivalent of planting approximately 7.9 acres of trees.2 The price of this system is $22,610.00(installed) Less Mass Rebate $ 9,555.00" Additional discount $ 665.00 Total to groSolar $12,390.00 Less federal tax credit $ 3,717.00`* Less Mass tax credit $ 1,000.00 Total after all incentives $ 7,673.00 I Data is based on carbon reduction as compared to coal burning electric generation. 2 Data is based comparison to coal burning electric generation *Incentive is subject to availability and approval by the state. 'This system should qualify for a federal tax credit of 30%of the net cost of the system. Please consult with your tax advisor for more details. , Scope of work- PV _ Deliver equipment to site Prepare installation area for module installation Install modules and racking. Wire array and run conduit to main panel.Pull wire through conduit Connect to main. Install and program inverter Submit net metering paperwork. Provide owners manual and one line diagram of system for client Mounting price is subject to change Upon engineering review.Any cost changes will be discussed with client before proceeding. l I n a ' Page 3 Terms&Conditions: These designs and estimates are based on the following 1.) Prices quoted are valid for 30 days unless otherwise notified by groSolar. 2.) Proposal is subject to final engineering review.The approval will be given within(5)business days. 3.) A deposit of$1,000 is due to begin the process.This is non-refundable unless your state rebate program or your utility denies your application,if applicable,or if applying for a loan and it is denied,or if groSolar cancels the order for any reason,or if a price increase occurs which is unacceptable. Proof of rebate,utility and loan application rejections is required for refund.The$1,000 shall be credited to the system cost 4.) A deposit,totaling 50%of the purchase price is due 10 days after signing or immediately after the State Rebate Application has been accepted,to hold the order and guarantee price for up to 6 months.The remaining equipment balance is due upon delivery of the equipment to the site. 5.) If the job is accepted as turnkey installed for a fixed price,groSolar retains the option to present the owner with cost changes for unforeseen site conditions or changes to the original scope of work. It is the policy of groSolar to discuss any cost changes prior to the continuation of installation. 6.) If the job is NOT accepted as turnkey installed for a fixed price,groSolar is available to install the systems and/or to work with your contractor to complete the installation. Our average hourly rates are$55 plus half rate for travel (rates may vary by state).General installation materials will be required,including but not limited to conduit,wire, pipe,insulation,fittings,and hardware.These items are readily available to any qualified contractor. 7.) If the job is held up for reasons beyond groSolar control,and equipment costs increase during the interim,groSolar retains the right to present the owner with cost changes. It is the policy of groSolar to discuss any cost changes prior to the continuation of installation. 8.) It is the customer's responsibility to obtain building.plumbing and electrical permits,if required,unless noted otherwise. groSolar will help to provide all information required to obtain those permits.The customer will be responsible for additional costs that may be associated with this task. 9.) Should a state licensed electrician or plumber be required for any portion of this installation,the customer will be responsible for additional costs that may be associated with this task unless noted otherwise. 10.) Should finished walls/ceilings need to be refinished after the groSolar equipment instmllation,the customer will be responsible for additional costs that may be associated with this task. 11.) It is the customer's responsibility to arrange for both underwriter's electrical wiring inspection and the Utility inspection as required(in that order),unless noted otherwise, groSolar is available to help with these tasks. The customer will be responsible for additional costs that may be associated with these tasks. 12.) groSolar will provide one-line drawings of the entire system,including but not limited to AC connections. groSolar will provide all the system documentation,training and warranty information on all equipment provided. 13.) There is no guarantee of overall energy produced,as environmental and personal factors play a large role in ultimate generation and use. , 14.) groSolar is not a tax advisor. Please consult a financial advisor regarding tax credits and filing. IS.) groSolar reserves the right to use photographs of your installation for marketing purposes. 16.) groSolar is not responsible for the removal of trees.groSolar makes a strong effort to advise our clients of the trees which are likely to pose a shading issue but will not be responsible for identifying trees which may not initially present themselves as a shading issue.If trees require removal after installation to iron-ease system performance it is the responsibility of the client to have them removed. Page 4 Thank you for your environmental diligence and the opportunity to serve your energy needs. We truly admire your decision to invest in sustainable energy and appreciate your confidence in groSolar. With warm regards, �� ' 4 G fGi (�1a31a� �d W� groSolar p�.GIC � 11 q 3 �alaae� Charlie Noury groSolar ►/We elect to purchase Option(s)# ,with/without turnkey installation and have included a deposit of$ Schedule of Payment: 1) $1,000 due with signed proposal. 2) 50%of system cost is due immediately after the state rebate has been accepted, or upon release . of loan funds. 3) 25%of system cost is due at time of equipment delivery. 4). Balance of system cost less initial deposit(s) is due 15 days after installation. Your signature below, states that you have read and agree to all terms outlined within this proposal and are including a d in the amo pecified to initiate the work order for this project. X r'�-- Date: (T san Fredette) r f Tom & Susan Fredette, 621 Skunknet Rd, Centerville MA 02632 AC Disconnect Switch Main Breaker Panel Utility Meter Fs rter(s),DC Disconnect witch and PV Meter PV.Array Tree(s)being A _.:. removed Array Angle: deg. 10 Azimuth: deg.270 Customer/ Location: Tom Fredette Drawn By: System Type: PV grid tied Installed By: groSolar Date: Drawing Type: Site Sketch groSolar brilliant energy solutions Page: Revision: Rn1 nki River RH White River.Ir:t VT nFinni _ _.. j0 se�� Electrical Characteristics Mechanical Specifications Standard Test Conditions(STQ' 37.5-- - ES-180 ES-1 90 ES-195 -�°'6 GROUNDING HOLE RL.T or RL-TU RL-T or RL-T`J RL-T or RL-Tu 13.5 SL-K or SI:KU' SL-K.r SL-KU' SL-K m SL-KU' - 11 Pmp2 180 190 _ 195 t Pt°lea (%) -2/+3 -2/+2.5 -0/+2.5 -- Pmp,max (W) 186.1 194.9 199.9 0-26 Pmp,min (W) 176.4 186.2 195.0 m I \ -toxR /4'114" FO o BOLT Ppt�3 (VV) 159.7 168.8 173.3 I �� JJNCTION BOX (IPS4) Vmp M 25-9 26.7 27.1 . m CABLES(AWG12) v Imp _ (A) 6.95 7.12 7.20 V.c M 32.6 32.8 32.9 CLEAR ANODIZED _ ALUMINUM FRAME h� (A) 7.78 8.05 8.15 Nominal Operating Cell � Temperature Conditions(NOCT)4 Pmp (W) 129.0 136.7 140.1 _-MC")CONNECTORS Vm p (V) 23.3 23.8 -23.9 (Type 3) Imp (A) 5.53 5.75 5.86 t - N I V°� (V) 29.8 30.3 30.5 I g 6- 4x 0.16 _ GROUNDING HOLE Ise (A) 6.20 6.46. 6.59 -- (C) m..O ° (NOCT 45.9 45.9 45.9 - , I ct35.9 lNc HOLE 35.9-- - - . '1000 W/m',25'C cell temperature,AM 1.5 spectrum; „4 . 2 Maximum power point or rated power - All dimensions in inches;m ule weight 40.1 Ibs' 'At PV-USA Test Conditions:1000 W/m',20'C ambient temperature,1 m/s wind speed Product constructed with 108 poly-crystalline sili\ n solar cells, anti-reflective '800 W/m',20'C ambient temperaave,1m/s wind speed,AM t.S spectrum tempered solar glass,EVA encapsulant,polym ack-skin and adouble-walled "RL-T and SL-K models suitable for use only in systems where the DC negative pole of the array is hard grounded;RL-TU and SL-KU models suitable for use anodized aluminum frame. uct packs tested to International Safe Transit in electrically unergrounded systems where local regulation allows Association(ISTA)Standard 28 an N EN ISO Standards 12048,13355,2244, 10531.All specifications in this product information sheet conform to ENS0380. Low Irradiance See the Evergreen Solar Safety,Installation and Operation Manual and Mounting Design Guide for further information on approved installation and use of this product. The typical relative reduction of module efficiency at an Due to continuous innovation,research and product improvement,the specifications irradiance of 2.0OW/m2 in relation to 1000W/m2 both in this product information sheet are subject to change without notice.No rights at 25°C cell temperature and spectrum AM 1.5 is 0%, can be derived from this product information sheet and Evergreen Solar assumes no liability whatsoever connected to or resulting from the use of any information Temperature Coefficients contained herein. ` Pmp (%/°C) -0.49 Partner: Vnp 0.47 Imp (%/°C) -0.02 V c (°i°/°C) -0.34 System (Design Series Fuse Ratings 15 A UL Rated System Voltage 600 V; ' 'Also known as Maximum Reverse Current ` ELECTRICAL EQUIPMENT i CHECK WITH YOUR INSTALLER S195_US_010408;effective April 1"2008 Worldwide Headquarters Customer Service-Americas and Asia 138 Bartlett Street,Marlboro,MA 01752 USA 138 Bartlett Street,Marlboro,MA 01752 USA Evergreen Solar,Inc. T:+1 508.357.2221 F:+1 508.229.0747 T.+1 508.357.2221 F:+1 508.229.0747 info@ever reensolar.com sales@evergreensolar.com www.evergreensolar.com g ` f :C'U N I RAC Unirac Code-Compliant Installation Manual SolarMount Part III. Installing SolarMount The Unirac Code-Compliant Installation Instructions support applications for building permits for photovoltaic arrays using Unirac PV module mounting systems. This manual, SolarMount Planning and Assembl overns installations using the SolarMount and SolarMount HD (Heavy Duty) systems. ---- [3.1.] Solar nt rail components G - ® / -- �, - o •. yA'�*.'•�•^ •Figure 4.SolarMount standard rail components. ® Rail —Supports PV modules. Use two per row of Includes 3/8"x 1/4"bolt with lock washer for attaching modules. 6105-T5 aluminum extrusion,anodized. .. L-foot. Flashings:Use one per standoff. Unirac offers appropriate flashings for both standoff types. ® Rail splice—joins and aligns rail sections into single Note:There is also a flange type standoff that does not length of rail. It can form either a rigid or thermal require an L-foot. expansion joint,8 inches long,predrilled. 6105-T5 0 Aluminum two-peice standoff(4"and 7") —Use one aluminum extrusion,anodized. per L-foot. Two-piece:6105-T5 aluminum extrusion. Includes 3/8"x 3/4'serrated flange bolt with EPDM ® Self-drilling screw—(No.10 x 3/4") —Use 4 per rigid washer for attaching L-foot,and two 5/16'lag bolts. splice or 2 per expansion joint: Galvanized steel. 0 Lag screw for L-foot(5/16")—Attaches standoff to rafter. 0 L-foot—Use to secure rails either through roofing material to building structure or standoffs. Refer to ®i Top Mounting Clamps loading tables for spacing.Note:Please contact Unirac for use and specification of double L foot. ® Top Mounting Grounding Clips and Lugs ® L-foot bolt(3/8" x 3/4") —Use otie per L-foot to secure rail to L foot: 304 stainless steel. Installer supplied materials: 0 Flange nut(3/8")—Use one per L-foot to secure rail to Lag screw for L-foot—Attaches L-foot or standoff to L-foot. 304 stainless steel. rafter.Determine the length and diameter based on pull- out values. If lag screw head is exposed to elements,use stainless steel. Under flashings,zinc plated hardware is ® Flattop standoff(optional)(3/8") —Use if L-foot adequate. bolt cannot be secured directly to rafter(with file or shake roofs,for example). Sized to minimize roof to rail spacing. Use one per L-foot. One piece:Service Waterproof roofing sealant—Use a sealant appropriate Condition 4(very severe)zinc-plated-welded steel. to your roofing material.Consult with the company currently providing warranty of roofing. Page 14 02/11/2009 16:12 FAX 1a002 ///.!' �PfFYMI)/.OYBF/lyl1��. G...:(/f.Y,•LN/!:/�ll9f��J ........._._._._.. ..V. . / � /�.' .// .� ' /�"(� J�f 'IC>U9)tlJ3lJJt//.RIX��fF f/J•,+"!•/•/A'A;NAi.YLtR,�alfp __n\ eunrd ut 11u111ing Regulations and Ntandards ! Board of Building Regnlnlions aad Standards _ HOME IMPROVEMENT CONTRACTOR Construction Supervisor License Registration: 159879 License: CS 96660 Expiration: 6/9/2010 Tr# 269363 ' Type: Private Corporation Expilatlon: 12/7/2011 Tr# 98660 Restriction: 00 GLOBAL RESOURCE OPTIONS dba GRO SOLAR DAVID RICHARDSON DAVID RICHARDSON 601 OLD RIVER RD SUITE 3 « 35 MAY AVE di�1•• —� WRJ,VT 05001 Administrator RAYNHAM,MA 02767 Co►nmiasioner Llcoosc or registration valid for individul uge only before the expiration date. If found return to: 00-35,000 cf enclosed space Board of Bullding Regulations and Standards IA-Masonry only One Ashburton Place Rm 1301 1C- 1 2 Family Homes Bosron;•Ma.02108 Failure to possess a current edition of the Massachusetts Stntc Building Code is cause for revocation of this licenso, Not Without signature - hJ 0 Cj Cr., ca (.J1 m I S a • r Dave Richardson R�gionalgProject Manager t lio Elm St:. . Bridgewater, MA 02324 dave@grosolar.com �✓ www.groSolar.com t p ...:.....f..4�.f.. )7//V I Assessor's ma and lot number ........C/ . ., `G -ewage Permit number .... ..........................:.....'".. r Z 33 STABLE. i z v�-House number ...... .................................................. 9 MAO& 0� d ON Ia�9 L TOWN OF BARNSTABLE BUILDING INSPECTOR rr APPLICATION FOR PERMIT TO t�v I ..� f ............................................................................... TYPE OF CONSTRUCTION .... ...... �1 ...................'�.......... �t✓F„'///.......................... �/� ..................19, , ................. TO THE INSPECTOR OF BUILDINGS: ,'. The undersigned hereby applies for a permit according ,too the following information: Location .. ,.p...._......... ...... UvV�rt1P ...( ..... �.`vv�........ .............. ................................... Proposed Use .... .fi/P„ }'69/i-t(.Jy?' .........'�. '//ivs...............................................:............I......................... Zoning District . Fire District .1�...'.`... .5.1....................................... Name of Owner .. .. . . F'!rr t.........f...........`.....`.`..`..'.............Address ..... �1..'l........ i . �C../: /tX�N!,v......`..`.. Nameof Builder ....................................................................Address ............................ .................................................... Name of Architect ..................................................................Address .............:........................................ ............................... Numberof Rooms �...............................................Foundation 1��.......x....... . .... .....�D......................................... Exierior —11 wG0d ...Roofing .�?1.!'e.��, Floors . �� r"i' GG...... G°.....r.......................................................Interior ...... ......................... Heating � ........Plumbing .................................. ©�� '�;/0a.. ..A Approximate Cost 'S Fireplace ............................................................................:... pp :. ..."........................................0......... Definitive Plan 'Approved by Planning Board _---------------19 Area S / 17 Diagram of Lot and Building with Dimensions Fee '" P —.................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH LV I 32,a wa _ k �i/ t { ICUPANCY PERMITS REQUIRED FOR NEW DWELLINGS . t I hereby agree to conform to all the Rules and Regulations of the T . n of Barnstable regarding the above construction: �, �wk , . w Name ! ......................................................0........ :47- ©/4/ Construction Supervisor's License .................................... y, MANNI, ROBERT L./G A=169— I. No 2 4 5 2 7... Perk it for .... .torX S ingie...Family..DW.ej.j.jKxg......... ....... LocationLot #4 0 , 621 Skunknet Road.... ` ............................................................. Centerville ...........................................:................................... Owner .....Robe. rt...L. Manni_........ ....... ............. ............................. Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted ....November 9, 19 82 Date of Inspection ....................................19 Date Completed ......................................19 r� f j Assessor's map and lot number'. � 1....-`� /� y T E Swage Permit number .... 0 SF Q-fie S. B6HB^9BTODLE, OUSe number ............�P.Z�................................................... �� 9° a ., s6 - T Vli1T4� ar `e TOWN OF BARSAM, t� . T . { DUILDIHG INSPECTOR ,-APPLICATION FOR PERMIT TO ...... .?. . ............... ....... .................. ............................................................ TYPE OF CONSTRUCTION• .... t .: .. 11! ... :'" f.l.!�!... �!✓..� ............ ........ t TO THE INSPECTOR OF'BUILDINGS:the undersigned hereby applies for a,permit.according' to the following information: Location ..�.0..� ..... ..... �U►v�jtJ{'1.1........`...� ......C�',"V. .. . .............. .................................. ProposedUse ...... .... '.. . Y.........� � .............................................................� Zoning District ....... ....... .....�1�:...............::....: ..............:...Fire District ........... ..... .................................. Name .of'Owner . . f'.t5 -..�'� j4•,�< ... .... � ...... ....... :. :.. . .......................t'.�..... ..Address .. ..... ''`Ili......... Nameof Builder' .:..........11....................................................Address ..................................................................................... Name of Architect ................Address ................................................................................... o Number of Roms .......................................... . Foundation :.................. ........ . � Q Exterior . .. ......... g .y,. .Sr(' .............................................. ........CJ .. w Roofing f/ , Floors . 4 .....................................Interior / ..... . ................. 1�49- .............................................;................ ... Heating !Plumbing ................................................... ............... - I ' ..................................... ......A roximate Cost S ©�� Fireplace ...... ..... Definitive Plan Approved by.Planning Board _'R_�__------------------19________. Area ..............'............... 17 Diagram of Lot, and -Building, with" Dimensions Fee. ......... SUBJECT, TO APPROVAL OF BOARD OF HEALTH b CCUPANCYPERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tawn of Barnstable regarding the.above construction. . ' Name .. ... - ....................................... Construction Supervisor's License ................................. r i MANNI, ROBERT L. 4 y 24527' 12 Story No ................. Permit for .................................... F Single...Family'...Dwelling.............. • • Location Lot #40 621 Skunknet•••Ro d Centerville. :........ ........ � r'` � - ±> � '' �, ,• ;r .. Owner .. Robert L......Marini ........x.......... Fram Type of Construction .. ..... �......... , .......... ,• i .� �. � � � .a ^' � , 1 Plot ............................ Lot ................. .. ' November 9 82 Permit Granted .... .................................' .19 "f r Date of Inspe do of ..•?`.....lr Date Gom lete ` --3.......:19 A i r a•�. s 1. �r _07 c) .66 7- 4-40 i 0 3Z Mr I \1 /70,o 0 ! PLAN Shl0 WIN G FOUNDATION LOCATION - OWNED 8Y• - - - - -- twu Ia!0 SCALE / _�Q --- DATE: (::I,-7,_ 50, 0 0 a Z W NORMAN GROSSMAN -------REGISTERED LAND SURVEYOR _�a m .4 0 N e �yZff)td • I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED OF A14S >,j� ON THE LOT AS SHOWN AND CONFORMS TO THE TOWN opt' 'ey w 0 0 a OF,B4.etl,S 34a"ZONING REGULATIONS REGARDING toGROSSMANRMA �x� 6RSSMd� -; SETBACNtiS FROM STREET LINES AND LOT LINES . ,pP40 NORMAN GRVSSMAN R.L.S. DATE [3to; �„o•„ TOWN OF BARNSTABLE Permit No. 24527 a�n� = Building Inspector Cash -- ---- -- req ` x °""Y�- OCCUPANCY PERMIT Bond Issued to f ?ere T, Mahal Address lot #40 621 Skimknet Road, 'Centerville Wiring Inspector / Inspection date Plumbing Inspector 1 94 Inspection date Gas Inspector Inspection date Engineering Departrri iht' Inspection date Board of Health f. ,. � ► �/�2 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i Building Inspector G. TOWN OF BARNSTAB Map ` Parcel < Old Health Division b Conservation Division Q o 6 Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board y a PERMIT NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS • " OWNER DATE OF INSPE Town of Barnsta e� OF BARNSTABLE �f1NE Regulatory Servi g Y �-" APR 20 Pm 1: 04 s w Thomas F.Geiler,Director + 1ARNSTABLE. y 6 SS. Building Division Mai"� Tom Perry,Building Commissioner I VISION 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# © FEE: $ C_ SHED IST TION 120 square feet or less Location of shed(address) Village. Property owner's name Telephone number Size of Shed Map/Parcel# i Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A '� DATA i aer' t .LET .60 7- ¢0 t a pry .\ ro'h.;' •..._ of 14 c' 3.Z.-e �1 r An xY J sti PLAN srow �v. Y� • FOUNDATION LOCATION MAS ".R c - OWNED BYE .*eo,6 ex XII'llo fl fl SCALE _110 ©ATE C r, NORMAN GROSSMAN -------REGISTERED� LAND sui 1V'YOR � HEREBY CERTIFY THAT THIS FOUNDATION /S LOCATED. tN OF t s. Pt9 Yy� 4 ON.THE LOT AS SHOWN AND CONFORMS TO THE TOWN ��y k OF,8 eV_;Wa ZONING REGULATIONS REGARDINGlll'i ° Mk b GROSSMAN , s SETBAC96 FROM STREET' LINES AND LOT LINES . MM ' .._ �-.=_�.��g ��r ��G--'ram' �f�. ��-.;_'..:� -�'•:' S(,1 R NURMAN ORnSSMAN R.L.S. DAPTE • ei y./ .i. _ -F,•E.+a4 ivn .d'"U ,n.... o � � /0cA Assessor's Office(Ist floor) Man ref Lot 4 Permit# j 7�,2 ► �, ,Conservation Office 4th floor 2 li o S"� Date Issued Board of Health 3rd floor _,#Rb — Q rA/ y 000m 7bi Engineering De" . Ord floor House# E GUST BE Plann n Dept. 1st floor/School Admin.Bldg.): INS MPUANCE Definitive Plan Approved by Planning Board 19 5 ' ENVIR AL CODE AND (Applications processed 8:30-9:30 a.m.& 1.00-2.00 p.m. TOWN REGULATIONS TOWN OF BARNSTABLE r! i Building Permit Application Project Street Address Village CFIV7—�1/���� Fire District Owner /' i.;A/✓.<' A 17 C_ Address �r,?/ S��„z/r�� Cyr✓f'c/1, �'1� Telephone e Permit Re/uest: 2 —Ln, % , oZ r RCZoning District Flood Plain zf� Water Protection Lot Size 1 45'0 X /U 0 �Jr,O��/ Grandfathered Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Existing Information Dwelling,Tvpe: Single Family Two family Multi-family Age of structure o?_ Basement bN :Historic House Finished .r .Old King's Highway Unfinished y 'Number of Baths ��L . // No.of Bedrooms 3 Total Room Count(not including baths) (D First Floor Heat Type and Fuel 0/// Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone number Address License# Home Improvement Contractor# Worker's Com usation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I/Kj�roiect Cost ' Fee SIGNATURE-2L-- DATE Z', /D e �S BUILDING PERMIT DENIED, R THE FOLLOWING REASON(S) 2� BPERM T FOR OFFICE USE ONLY ADDRESS VILLAGE OWNER DATE OF IP ISPECTION: FOUNDATION FRAME , INSULATION ; FIREPLACE ' ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSEDGKM °' J ASSOCIATE PIANO� w 11/02/94 17:02 la6177277122 DEPT INT ACCID e 001 , . /2 // - - Coirunoluuealtli of )Wajjacfzu-iettJ AWIMP 2 *artMetd o1JncLtria.[—Acccdanb 600 1/VwL-jton Stneat .James J.Campbell /..?olton, //lamachulst6 02f f f Commissioner Workers' Compensation insurance Affidavit (aoeasec�pamaue) with a principal place of business at: (QtY/stseelziP) do hereby certify under the pains and penalties of perjury, that: Q I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy ?lumber O I am a sole proprietor and have no one working for me in any capacity. O I am a sole proprietor, general contractor or omeown 'rcle one) and have hired the contractors listed below who have the followin wecompensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number I am a homeowner performing all the work myself. cow;of&..s 5_tG'nent will be folvr<reed tc d:e Office of Investispeors of d;e DIA for coverage verifiUtion and that to secure cc.erage L<rec:,-ed unC-cr Sctt:on 2 f,of MGL 152 car,iuc-ro;he inpcsition of ciminai per,ztt.res consists¢of a fine of up to<_150C.00 anGfcr onc- YQ—, 1M-1rLC.^f-n;,-, wc! as civil rF^2IUe:in t". fcrrn cf; STOP WORK 0RDER and a fine of s i00.00 a eay apinst me_ Signed this 7-# 0� day of '* 4F4!�/42e-- 0,2- 19 Licensee/Permitt Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 i TOWN' OF BnR\STi31,E BUILDING PERMIT 37-//dZH of�rqy� B,RNsz� The Town of Barnstable `eg Department of Health Safety and Environmental Services r+u�' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: - 508-775-3344 Building Commissioner, For office use only 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: ^I In'Af 40e,r l Est.Cost 43 00 Address of Work:_- [J�/ �����/✓ 7�` L� �� c�r�tI� (!C� M M .;. Owner Name: 5�;S/?AJ "i rra ta l GEC 2C` Date of Permit Application: --/ ` 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-oocupied L,/ O«mer 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 name R 'stration No. OR cwz� :f7 Date. Owner's • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please-print. - ` D AT v E �/(� a . . . � JOB LOCATION (O o�� �/w % ���C.�:led z e Number Street address Section of towns TF �`� �C.• a�J^' �...c�3- 54541 i "HOMEOWNER" 5,57 Name ,,,Home aphone . F _:> Work phone PRESENT MAILING ADDRESS ate/ ' City/town State Zip code The current exemption for ' "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow su ch uch homeowne rs divid to engage a - ual for hire who doehn in s not possess a lice acts as s license, provided that the owner supervisor. DEFINITION OF HOMEOWNER: Person(sY who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six 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 ermit. (Section 109. 1.1) The undersigned "homeowner" assumes responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department min*mum inspection p ocedures and requirements and that he/she will comply wit aid procedures d requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building .Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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) ; d provi ed that ..if, � Home Owner engages a person s) for hire to do.'such r work that�'such'�Home'9'Own shall act as supervisor. " ex Many Home Owners who use this exemption are unaware that ..they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for .licensing Construction Supervisors, Section 2. 15) . :This lack of . awarenes often results-:in 'serious problems, particularly when th`&'Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed_ Supervisor. The Home"Owner-`actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her. responsibilit es,. man communities require, as part of the permit application, that the Home,-Owner 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. f'. 41�2i �2Lev�l ecti fAlrA R- dal .,ry / }� Tia k 12,U CDMotes TK.rR jt I -F- I T I I r7�cp"� ov dwsl� 2. 7�. r a - .w++• r ' "r