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I, Town of Barnstable Building �J13 Y° .nt,`;..� ``x'����,. �"'".,., a w 9" "xv- a".: h .°°s°,3" ' ""s ,, t " : '+? .`: v I75- ':`.„ � 4 7k �VI 3' st FE:' s. y '" -fir ., .0 m Post This Card So That it isVisible From;the Street Approved Plans Must be:Retained on Job andFthis Card Must be Kept BAR'''*11 SS.E, ':` . a. '�'t'l ::ti';t .Y r a:,,,, nd .P 4 E g ,✓ -,: $' 0," h'� • 6"9 Posted Until Final.Inspection4Has Been Made4 4 : :, ,If , 5- �M . i,, s, -,s Permit Ma+ Where a Certificate of Occupancy s Requ d,su h Binding hall Not be Occup ed„until a,Final Inspe ,on been made tiu Permit No. B-17-4259 Applicant Name: CHRISTOPHER, MICHAEL Approvals Date Issued: 12/20/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/20/2018 Foundation: Residential Map/Lot: 335-011-001 Zoning District: RF-2 Sheathing: - Location: 3815 MAIN ST./RTE 6A(BARN.), BARNSTABLE Contracto rEName Framing: 1 t Owner on Record: CHRISTOPHER, MICHAEL Contractor:License s 2 � Address: PO BOX 887 '-:il '„' ' Est Project Cost: $1,000.00 BARNSTABLE, MA 02630 , Permit Fee: . X Chimney: _ $85.00 Description: Second Floor Bathroom, Former Closet and small bedro m o into Fee Paid_:. $85.00 Insulation: bathroom,Shower,toliet,vanity � .> 4 Date 12/20/2017 Final: Project Review Req: � 1 v .-. wl' — Plumbing/Gas Rough Plumbing: i 3 Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed byt his permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the.approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures hall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road,,and shall be maintained open for public inspection i for the entire duration of the work until the completion of the same. ,x f.r,- , ' , • ' V. Electrical The Certificate of Occupancy will not be issued until all applicable signatures',4', the Building and Fire Officials are provided on this'permit. Service: Minimum of Five Call Inspections Required for All Construction Work:' `,,'°' 1.Foundation or Footing i R Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation - - 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT .. -• - -..y, .;...��}.. y _ _. _ - - .. ,._. 1 f • .TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' T- I I (1291 -_ nPJ-MUIPootto RMap 35 - Parcel 0) I _ � Application . NCO Health Division g Date Issued /z /7 TI / .11S I BLtConservation Division � Application Fee Planning Dept. Permit Fee • Date Definitive Plan Approved by Planning Board 646 Historic - OKH _ _ Preservation/ Hyannis �4.�. f'YL � Project Street Address �g45--- AVA) �_ �^ ✓����� e Villa � / 14 4/,,, T g Owner / "//�ar�l, -/ �j4/'i AddressS,6S /P .7"-- . Telephone '772I-a1c - Oa 1O - >, Permit Request 6EC?O 1()0/1-- / ,q7oM7 4,444, /A5i7 /Q . '111,4/) 6.1100/4 7bi ��o/4 O vik- 0 81X /. , Square feet: 1st floor: existing`514+proposed 2nd floor: existing u: 3 proposed Total new Zoning District O� Flood Plain Groundwater Overlay Project Valuatio `J 006 Construction Type Lot Size da yo2 A Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ih' Two Family ❑ Multi-Family(# units) Age of Existing Structure /S0 Historic House: Ir es ❑ No On Old King's Highway: ®'Yes ❑ No Basement Type: ❑ Full 'Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) gLJ Number of Baths: Full: existing / new / Half: existing new Number of Bedrooms: 'i' -. existing _new 7_4_3 . Total Room Count (not inclu ing baths): existing / new First Floor Room Count 9 HeatandFuel: ea Type ue Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes C`rNo Fireplaces: Existing / New Existingwood/coal stove: at'Yes ❑ No p 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 ®'/ If yes, site plan review # Current Use Proposed Use _" 1 APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name �C�/I��/ ��'/ Telephone Number /7q— �)�✓0�) Address jRk ' fii-! S< b46 60X &7 License # 61 07.441 .6:22J0 Home Improvement Contractor# Email Abr412f6 O17O' vQ AP).C') Worker's Compensation # 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ,0/ DATE l//7/h ! FOR OFFICIAL USE ONLY ,J APPLICATION # . DATE ISSUED , MAP/ PARCEL NO. • , !I - s - ADDRESS VILLAGE , • .' OWNER - " d DATE OF INSPECTION: • 1- FOUNDATION - • - FRAME • INSULATION • fj FIREPLACE • ELECTRICAL: ROUGH ' - FINAL PLUMBING: ROUGH FINAL f • GAS: ROUGH • FINAL - FINAL BUILDING . z 1. DATE CLOSED OUT ASSOCIATION PLAN NO. 1. 1 . • . Tom of Bar table .. , - • • Regulatory Services • pfr row Richard'_Scans,Director t o ' Btalang Division. _. t 0_*,..` Tom Peep,$ IIIg C�T�*"i�cinnrr $ s• -a� 200 Mazy Hya nnis,MA 02601 -emmMs ww44 arastafiTr-ma us • Office sos-862 4038 - Fa= 5os-790-623o HOMEOWNER LICE=>tZEZ'PTION / Ileasnitiat g l� iL e� .. / 47g/ JOB LOCATOR: V l :ft7' eiL . 77'Y-a1 a" ®a l 4 . -Epo " , # . T po 60x 8S1-1 . __ =BRENP 2�rfADDRESS: --- p O . . "Jim - • ... r zp code The cnuant exemption for"homeowners"was extendedto include owner-occupied dweUinas of six units or less andta allow . homeowners to,engage an individual for hirewho does not possess a license,provided.that-fie owner acts as supervisor DEF'IIEcILON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or iritLffiriR to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or riP�rhrrl st,-nettms accessory to such use and/or fan structures. A pear who constructs mare than one • home in a two-year period cT,71i notbe considera.ahomeowner. Sash'omcawner".shall snbmitto the Building Official on a formi acccpiableto tic Brf1 ngOfficial,thatbe/she cTia11be responsible for all such workpedonneduiderthebm7dine-permit (Section • 109.L1) • The tmdcrsign cd`fiomeownee as amen responsibility for Fungi—Tani—it wifhthe State BrrlirTrng Code and other:applicable codes, b• ylaws,rules and reg:actions_ - . . 1 The undersigned Thomcowner"cer[ffies d athWzhe understands the Town.ofBazristable Building Departanatnrinionno.inspection pro he/she will comply whTi said pmcxdmes and reqoiremcrs- l • g •cozener :v. - Approval ofBm7crnigOiroda1 • ' • note: Tree 5=31y dwellings roofRming 35,000 cubic feet or lager willbe requiredto comply with the State Brill rrm g Code Sedionf27.0 Crmrfrnthan('hint,ir1 ' D OWNER'S pox The Code sites that `gory homeowner performing work for which abiTfffTrg permit is required shall be exempt from the provisions of this sestina(Sendai.109-1.1-Igrensi gg of contraction Supervisors),provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this a empton are nnaware.thatthey are assuaning the responsibilities of a supervisor • (see Appendix Q,Roles&Regulations for Licensing Cans xtc an Soper visors,Secboa 2.15) This lack of awareness often results in serious problems,parficalarly when the h.omeaiva.e:r hires rolirPrmed persons. In this case,our Board cannot . 0. pr•oee cl against the urp4e used person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsr"ble'• T ' eonzmmmides as part of the To ensure{drat die homeowner is folly aware of his/her responsrbr*tics,many re e, permit appliratTnn,that the homeowner certify that he/she understands the responsrtiffil es of a Supervisor. On the last page of this issue is a form cnrreutly used by bCY ma towns. You may caret amend and adopt such a form/certification.for use in your community. - - p to s ESS.don Revised 061313 , — , r • , , ., • . . „!., .. •, t t. . . :1'" "i . . . • . . 9 . . . t ,.,1 0?THE Ibis, Town of Barnstable . . f-A% +90 • • . . Regulatory Services • • • • - ..r. MASS. zgl. • Richard.V.Sean,Director •. Building Division • . . . tomrerry,Building Conaoissicmer 200 Main&rept,Hyanthas MA.02601 • • • - • • . www-icoyar.larnstabIa.taa-ris. . 7 . • /4. • Fir 508-790-6230 °face: 508-862-4038 ' • • a. • . .. s• ..-- . 1 , 4- • • . Property Owner Must , .• • Complete ancl Sign_This Sec I 0 II:If US in Lfr, A Bni_Idet;' ,/• • • - . -\ ' - . ,, • • • - . 4 / / . . • ./ .• • - . . • • • / r . \ . I / • . IP • \ / , ` , -• t!..•-r of the subject property • • / / . \ . ,, , • / ; . leteBypTT411-11:17-E *A. , / to act on ray br:F•t2Tf, . \ • ., / • ..., . in an m2t-tz.ts 3mill:iv' e to work P411-1-lo -/-4lytT-1;c • permit applicalion for: . \ / \ i' • • • • , • (.A4:11-ri a rp,a) . , . . :*... .--2ool fence's and alatoos are I it, - 1 senSilailirly`Of tilP applicant Pools ' • : i are.not to be filled.of 1. -2)4 efore • - is. ins- tailed PTO all En.il • inspections are pelf().11 imi - I li accep :4 . . . .: • • . / . • . . • „ • Signatnre of Owner / • Signatate o ' PpTirnr / i . , . . •' • . 1 • ; • Piint•Name / . PEI=Name • . • ' • \ ' I . .1 "D • . • . * ' , . . .• . . . . , ' . CZ:FORMS:OWINTERISKIESEENPOOLS ' 1 , • . ., The Comrnarrwealtls of Massachusetts • i nepartite g of rwhisfrialAc ext n Office of Investigations stig;ations _�._Jl= 600 Washington S'itreet Boston,MA 021I1 wine massgovJWia• Worker-s'—Comp ensa pan Insurance r ffi avat=B•uildex Confractors;ElectricianslPlumbers- App'bt t Informafron_ __- — — /� y h —-- Please.Print-Le.gi -y -----.....-. Name $neina, anizati l) /4 j, h/v E- V i/ �J/ , , —— Address: 3g 5 /V ou,i cctyiSt tetz /L � c► 3o any °774'- 1a - c% 10 1 Are you an employer?Checkthe appropriate box Type of project(required): I.❑ I am a employer with 4. 0 I am a general contractor and I n employees gull adfor part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sale proprietor partner- listed on the attached sheet 7. El Remodeling aim or FartII ship and have no employees. These sub-contractors have g_ 0 Demolition working forme in any capacity. employees andhave workers' 9. El Building adrt;5•on [No,�•.• -'camp.insurance cep-insuranat -ed_ 5. El We area corporation and its 10 0 Electrical repairs or adcations 3. ri I am.a homeouner doing all work officers have exercised their 1L®"lumbingrepairs or additions myself Ello workers'comp. right of exemption per MGL 12.0 Roafrepairs insurance required.]T c.152,§I(4),aadwe have no employees.[No workers' 13.0 Other core.insurance required.] *Any app!i thatcreedalox;1mmstalsofiIlo ttheseciionbelowshomagtheirworke 'comxposafiorspolicyin ua2iou. Haareotvaecswin submit this of ulat ii isa eating t !redoing all wort sadtheabbe outicrecoutractorsmost submit a new affidavit indicutin4 such_ Zcont actorstbatcbeckthisboxmustattachefisaaddittonslsheetshowingthemineofthesub-ccactor.andstatewhetherornottboseerrtitieshave . employees.Ifthe snbtaat actuss have employees,they roust provide their workers'•comi policy number. . I am an ecccpZoper that is providing workers'compensation insurance for ray employees Below is to policy and job site information. Insurance Company Name: •PoRcy;t or Self-ins.Lic.4: Expiratio'nDate: Job Ete Mdre. City/State/Erp: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Faririre to secure coverage as required under Section 25A of MM.c.L52 can lead to the imposition of criminal penalties of a fine up to$1,500:00 and for one-year imprisonment,as will as civil penalties.in the form of a STOP WORK ORDERand a fne • ' of up to$25100 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations oldie DIA,for insurance coverage verification. Ida hereby certiiff nr r the 'cs and lollies afpperjury tiurtthe information fled above is bare and correct • Siena-hire: Date: it".r/i---i2•45) i �7 Phone c9/C Oa/o i) Official use only. Do not ewrite in this area,to be completed by cifp or town official. City or Town: Permit/License i€ Issuing Authority(circle one): L Board*filial& 2.BuIding Department 3.City/Timm.Clerk 4:Electrical Inspector 5.PIuanbmg Inspector 6.Other Contact Person: ! Phone#: -- - - _- - - - _ - 6 ,, -Ti formation and Instructions �. . . Massa hresetts General Laws chapfa 152 regoiies all employers'to provide workers'compensation for their employees. this stelufe,an employee is defined as."....every personin the service of another under any contract ofhae, '. emplebb or implied,oral or written." An employer is defined as`air individual,partnership,association,corporation or other legal entity,or any two or more of the ft.a egoing engaged is a Joint else,and inch ding tiie legal.k cj i..seatafives of a deceased employer,or the . receiver or trostee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparlmeats and who resides therein,or the occupant ofthe- . dwelling house of soother who employs persons to do math tF•,a„rp,construction or repay work on such dwelling house • or on the grotmds or bni1rrmg appurtena ttereto chall notbecanse of such employment be deemedto be an employer." • MGL chapter 152,§25C(6)also states that'every state or local fire r g agency shall withhold the issuance or renewal ofclicense or permit to operate a business or to Colastrict btaldtags in the common wealth for any applicant-who has not produced acceptable evidence of cdmpl;a.'Ice with the insurance coverage required." Additionally, GI,chapter 152,§25C(7)sites NPitherthe cornet wealth.nor any ofits poIhical subdivisions shall enter into any c6Ftract for the performance ofpnblio wo±uatml- stable evince of complies i cewith the ins raaca.. e chapter have lieen ented to the confract in• authority:' req�ente�of i \ F Applicants ' Please El oat the wu 'comprozmt on affidavit completely, checlangthe boxes ff,at apply to your situation anrT,if necessary,supply •. 0. . ••r(s)name(s), address(es)and II Tie numbers) alongwiththeir certifcate(s)of in cr,ran ce. Limited Liab - CCL ut aoies(LLC)or Limited .••.iity-ParCnerships(UP)withno employees other than the members or paainens,are not i"_u ued.to carry workers'comp=-. ation insurance. If an LLC or T r P does have . employees,a policy is required. :e advised fhatthis affidavit ay be submitted to the Department of Industrial Aooicir,rifc for confJimaiion.of" - coverage. Also be••. a to sign and date the affidavit The affidavit should be retomed to the city or town that■..,application for the p a,,..' or lir-rn se is being requested,not the Department of Tndn.et-riaT'j4cciteate- Should you have -n. questions ■; g the law or ifyou are reqi±ed to obtainaworkers' �Y p comp ensafion policy,Please call the Dep eat at the n■•"•,.erlisted below. Self-insured companies should ,frr their 'rr n e ber on the lu line. self-,n rnran ce h z� app City or Town.Ofacials . \ Please be sure that the affidavit is complete and printed.l-11J.Iy. The Department has provided a space at the bottom ' • of the affidavit for youth Eli out in the event the Offi... . .vestigations has to contact youregarding the applicant Please be sine to fillet the pennii'l license number which r I be used as arforeace number. In addition,an.appTiranf that must submit multiple permit/T,cense applications in=��+° given year,need only submit one affidavit mdirAting current policy i aformafion.(if necessary)and under"lob Site A i s— "the applicant should write"ail locations in (city or town)."A copy of flie-affidavitlfi at-has been officially •a•= . marked by flat city br t ovin may be provided to the - applicant as proofthat a valid affidavit is on me for •••••• -pa••.I or licenses Anew affidavitmust be filed oar:each year.Where a home owner or citizen is obtaining a license or perry,• not related to any business or commercial venture . (i.e. a dog license or permit to bum leaves etc.)said person is NOT.. uiial to complete this affidavit • . • The Office of Investigations would like to thank-you in ce for your -.,operation and shouldyonhave any questions, please do not hesitate to give us a call • The Department's address,telephone and fax number: • . . • . . filt Connraorriztatili of Massaoh. - - ,. ' • • - . Vvitat ial Aoci at '' , ,, 6QQII Street ,\ . B.o an,M&ail -To..IP 617-4'4'Y-4 tit 4-06 car 1477=I S E Fax#6I7` 27774 . Revised424-07 yr-vit w S g 1 m� g r OA 3 ' -o' -\,...n --Ibl). K-6-rei _ --1.) --/i- — z.„ ,.....„ ,\\, ..,k;k--?... _ , ,,,, „--J-- . , , .. , , . , k 3 fN4 1 • 1 acii-SWIMS 40 !' 01 , VAGOY' I ^'� O /I liar ( f . \-q-ots6 1 H %C ,m 1C'1 t 1gel tip,: h -7 • ‘11110 , , 1 V . c9,' t Liq ' , +,1n ,,,r-., ' ‘ ''- . ,4)( 0/Cif f ..-.4% 0 .o-4 7 11 • gyi. G, • .iw a t; _ w 6,2-42.-475/11 . . .. • sr • • • • • . '• Of...7i • • • • • . , T-v__ 103 //X6 I/X ardicoil oxi -8d-e93311\ ) cia< 1,14601 11 6.0t6 (6\6- P') \I V TN �5 fi�o� 7\n �X�� �r��2�m — - ,, �� , "r $xl9 - r);-- d I_ e 0 l i- - - ..-- M 2,. I /0/ fvf ' m c 5 ' 0 � h TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION cam ) l 6(e(C2 Map. 3� Parcel ( l / Application # Health Division Date Issued /0-2-_4 i Conservation Division Application Fee 1(.4 ( Planning Dept. Permit Fee Q . Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 3 315 in Al 4 5T• / . Village 6 i-F2 5-" 6-LE re,D, 064, 1-84 c• . 1.3V)5 imfi-t nr 5 . /K ', Owner YYl c,h a ( 6--TO Address e ithR 5-m-1L� nn/j- O 2 30 Telephonegtf a1--t Z) Permit Request 1/ / 5T*L�. , 0 ✓&*L-fib /� � ,�� ¢+ (-"r/M-R. 11-1\k- AA) 2 s a L 1-2_ A -k-- CAS Rprie1 as c c 'o? I'V(o volt Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay • Project Valuation 11)700 Construction Type Lot Size - Grandfathered: ❑Yes ❑ No If yes, attach supporting do`E cementation. ...0 '-3 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) r .f , Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Higyway: ❑wYes U 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 0 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 # Re6L;Jed ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDE' a HOMEOWNER) Name W t (L( nn 5 UL,L I (0-pi Telephone Number — T 3 3 ` 9 S 0 cst • Address' 'e< : °x 12( 6 License # c- S — 0 ° 5 3 .FLET.r}-,4 6 2 LC), ► c� ( 5 I Home Improvement Contractor# Wc5 3 (5 3 -qS 5 Worker's Compensation # C(3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ,ded DATE ! � ` I -I - 4 ' ,. FOR OFFICIAL USE ONLY APPLICATION# . , DATE ISSUED ... r 4-1.._. , • MAP/PARCEL NO. ., • . . . . • ADDRESS .. . , VILLAGE .• . , OWNER , . ' ... . . . -4 DATE OF INSPECTION: . $ $, * arFOUNDATIONJL,,,,ti;ii" 1)'• -:,11.,,A0L't-k-.lc 0 • . . - FRAME -- - - — . INSQLATION), •.: FIREPLACE l• dr ELECTRICAL: ROUGH - . FINAL PLUMBING: ROUGH FINAL • ' L , GAS: ROUGH FINAL = ' , i FINAL BUILDING 4,. . . .4 . DATE CLOSED OUT • ,-' - ,... ASSOCIATION PLAN NO. . . - - ,,_ c -A51-6p The Commonwealth of Massachusetts Department of Industrial Accidents riZ /= SilOffice of Investigations o -4' 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Blue Selenium Solar Address:17 Jan Sebastian Dr. Suite 12 • City/State/Zip:Sandwich, MA 02563 Phone#:508-833-9500 Are you an employer?Check the appropriate box: Type of project(required): 1.D I am a employer with 12 4. I am a general contractor and I 6 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. D Demolition employees and have workers' working for me in any capacity. 9. 0 Building addition [No workers' comp.insurance comp.incurance.1 required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 13.0 Other Solar PV System 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:Liberty Mutual Policy#or Self-ins.Lic.#:WC5-31 S-378547-013 Expiration Date:6/15/2015 Job Site Address: -3 3 I t o i liNf 5 T` / _b City/State/Zip: STH /v Z Attach a copyof 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 ce er p ' a ' of perjury that the information provided above is true and correct: Si afore: Date: q Phone#: 5088339500 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#: 'ACO CERTIFICATE OF LIABILITY INSURANCE DATE/10/ D m'D" ) `� 9/10/2014 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 Crystal Isbis NAME: ryter C.L. HOLLIS INSURANCE PHONE 1: (508)295-9500 (r;NDG(508)295-9898 140 Marion Rd ADDRESS:crystal@ insurehollis•cora INSURER(S)AFFORDING COVERAGE NAIC a Wareham MA 02571 INSURERA:Hanover Insurance Group 22292 INSURED INSURER a:Safety Insurance .. 39454 BLUE SELENIUM SOLAR LLC INSURER c:Liberty Mutual 33600 17 JAN SEBASTIAN DR INSURER D i UNIT 12 INSURER E f SANDWICH MA 02563 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1413001422 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION.OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE tHHSR WVD POLICY NUMBER (MM DIYYYYY1 (MLICY EFF GM DDIYYYY) UMITS P 3 GENERAL.LIABILITY EACH OCCURRENCE $ 1,"000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,000,000 A " CLAIMS-MADE'E OCCUR DBN9478699 3/9/2014. 3/9/2015 MED EXP"(Any one person) $ 10,000 — PERSONAL 8 ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 GEM.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OF AGG $ 2,000,000 1 POLICY ri C r"LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT —. (Ea accident) $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ 20,000 AU.OWNED 3-1-SCHEDULED 6225811 10/28/2013 10/28/201.4 BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS 4O,DOO X HIRED AUTOS X ONON-OWNED AmsIPRmOP DAMAGE. $ EXT $ X .UMBRELLA 1JAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UA8 CLAIMS-MADE 3/9/2014 3/9/2015 AGGREGATE $ DEO I RETENTIONS OBN9478699 $ C" WORKERS COMPENSATION sy WC STATU- OTH- LIABILITY AND EMPLOYERS' ABILITY Y I N X TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E,L EACH ACCIDENT" $ 500,000 OFFICER/MEMBER EXCLUDED? n N 1 A ' (MBnttatoly In'NH)` )FC5-31.9 37115 4 7-1 4: 66/1S/2014 5/15-/2015 'EL DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTK)N•OF OPERATIONS below E.L.DISEASE:-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES.(Attach ACORD 101,Addtdonal Remarks Schedule,If more space Is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN MICHAEL CHRI$TOPHER ACCORDANCE,WITH THE POLICY PROVISIONS. 3815 MAIN ST/RTE 6A " BARNSTABLE, MA 02630 AUTHORIZED REPRESENTATIVE C\t. .a6k ACORD 25(2010106) ©1888-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD ✓vl , ck-i-e-4 5-1-1) P i--/--R 6- , ,____,_ _ Qce c690470nowtoectx,a igAtma c'`'' ice Office of Consumer Affairsand Business Regulation _„ ' 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166151 Type: Supplement Card Expiration: 4/29/2016 BLUE SELENIUM SOLAR LLC WILLIAM SULLIVAN . 17 JAN SEBASTIAN DRIVE SUITE 12 • - SANDWICH, MA 02563 Update Address and return card.Mark reason for change. SCA 1 0 20M asn i ❑ Address Li Renewal C Employment 0 Lost Card ffice of Consumer Affairs&Business Regulation License or registration valid for indivi.dul use only 1.= �' before the expiration date If found return to: • c `miJME IMPROVEMENT CONTRACTOR _L(- Office of Consumer Affairs and Business Regulation egistration: 166151 Type: 10 Park Plaza-Suite 5170 Expiration: 4/29/2016 Supplement Card PP Boston,MA 02116 BLUE SELENIUM SOLAR LLC WILLIAM SULLIVAN 17 JAN SEBASTIAN DRIVE SUITE e --76 : A f ANDWICH,MA 02563 Undersecretary Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-005813 WILLIAM M SUIEIV PO BOX 1210 2 0 Welifleet MA 02a7 ` 41 • Expiration Commissioner 01/03/2016 . C. t5Th P (-( DARN6PpBiz, 9b 1659. Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner by . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us_ Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder OK (16L I At 51 -(-02 I, ofhk G k ci e I C n TO Pi -g ,as Owner of the subject property hereby authorize 13L YV\ c LD(Kto act on my behalf, in all matters relative to work authorized by this building permit application for: • 37A 5 nl s� / . bA b ST L I A (Address of Job) 1 0 2( 3 O t), 2_)/Sign ture of Owner Yh i c%k oce C --t p I� Print Name If Property Owner is applying for,permit,please complete the Homeowners License Exemption Form on the reverse side. T:IKEVIN_DDBuilding Changes\EXPRESS PERA4IIT\EXPRESS,doc Revised 061313 vn. C i Ji s-7 e.(&& 11) i,,, 'PronAer and OonBdentlal hfortnoUon. D ne daaut prior ntl rem REVISIONS: Blue Selenium Solar,LLC to proMbitad' NO.I DATE I BY I ECN# .o _ 20' - [ 1 1'-4"TYP RAFTER SPACING I I I 6' I I I - I I I I I I. J 5'-54rr _ 1 r4-a [ -...---_ 22'-7" RESIDENTIAL SOLAR F` ;Ins PHOTOVOLTAIC INSTALLATION: CHRISTOPHER, MICHAEL 3815 MAIN ST., I els ti ' BARNSTABLE, MA 02630 90 :;a VI G , BLUE SELENIUM SOLAR, LLC BARNSTABLE, MA +� tl l 17 JAN SEBASTIAN(508)833 9 0.SUITEIMA ,BLUES LC MA 02583 1.J ; `l Y 0 PHONE IAN DRIVE, 4 12,SANDWICH, M WIND SPEED= 115 MPH ) �' SNOW LOAD=25 PSF DRAWN BY:OC I DATE:09-29-14 I SCALE:N/A I SHEET:1 OF I BORDERC NAME: DWG NUMBER-REV CHRISTOPHER-3815 MAIN ST. 01832-00 .411 •a Ol otosefery end Cp,10 Sel Inform. Blue Selenium Solar,l LIC le gMlbited' NO.I DATE REVISIONS: BY I ECN B • i-2x6 RAFTERS 16"O.C. I 6' _■ 34° " SUNEARTH COLLECTOR Ale .� �. 10.5° 39.15 �- 5' NOTES: RESIDENTIAL SOLAR 1.)4 SUPPORT STRUT 42"OR 52"LENGTH PHOTOVOLTAIC INSTALLATION: 2.)2 FRONT/REAR FOOT 63.75"O.C. 3.) 16x 5/16"x 4-1/2"SCREWS,2 PER FOOT CHRISTOPHER, MICHAEL 3815 MAIN ST., BARNSTABLE, MA 02630 0 BLUE SELENIUM SOLAR, LLC o ' 17 JAN SEBASTIAN DRIVE,SUITE 12,SANDWICH,MA 02563 BARNSTABLE, MA PHONE(508)833-9500,WWW.BLUESEL.COM WIND SPEED= 115 MPH SNOW LOAD=25 PSF DRAWN BY:OC I DATE:09-29-14 I SCALE:WA I SHEET:2OF2 I BORDER:C NAME: DWG NUMBER-REV CHRISTOPHER-3815 MAIN ST. 01832-00 .. 4fitoalwihk fit 1 THE , P_n 1 SERIES ilk , GLAZED FLAT PLATE SOLAR COLLECTORS 1 0 III[ II III IIIH[. Models EC and EP SPECIFICATION SHEET 1 THE STANDARD IN SOLAR WATER HEATINGTECHNOLOGY • Stainless Steel Fasteners Riveted Corners Low Iron Tempered Glass --- — Low-Binder Fiberglass Insulation Rigid Foam Insulation • Secondary Sili s_t cone Glazing Seal • Black Chrome or • - r7�,{ - ,, `,., Moderately Selective _` k , ~" ` Black Paint _ may- Absorber Coating �. t �-- _, a".3•` 5 A • Copper Absorber Plate Integral q Mounting • Type M Copper Riser / Channel Tubes and Manifolds 4 Extruded Anodized Aluminum Casing and • EPDM Grommets Capstrip Vent Plugs Primary.EPDM Glazing Seal • 15% Silver Brazed Joint Painted Aluminum Backsheet PROTECTING OUR ENVIRONMENT-SINCE 1978 , ti L UH[HHIUIo[. EMPIRE SERIES SPECIFICATIONS Q,� .,--- o O r°CO _. g.Qom' Da; a`; ,N`z f`ah o .c -c r ,,, + �� P Q o 4 4� F `-, �' a v c (� ,. C� e tic<-t o H D v ti� ,va. ,p y D= J O 2 �c OQa tiO= Za ti¢ EC/EP21 40 76 3.1/4 21.12 18.70 70 .0.72,. 0.54 0.003 12 160 43 3/8 1 71.25 EC/EP24 36 1/8 98 1/4 3 1/4 24.61 21.88 80 0.78 0.62 0.005 12 160 39 3/4 1 93 5/8 EC/EP32 48 1/8 98 1/4 3 1/4 32.79 ' 29.81 106 1.00 0.83 ' 0.006 12 160 51 3/8, 1 93 5/8 EC/EP-32-1.5 48 1/8 98 1/4 3 1/4 32.79 29.81 115 1.41 0.83 0.004 25 160 51 3/8 1 I/2 93 5/8 EC/EP40 48 1/8 122 1/4 3 1/4 40.81 37.33 ; 141 1.20 1.04 . 0.009 12 160 51 3/8 1 115 5/8 EC/EP40-I.5 48 1/8 122 1/4 3 1/4 40.81 37.33 150 1.61 1.04 0.006 25 160 51 3/8 1 1/2 115 5/8 MODEL EC THERMAL PERFORMANCE RATINGS* MODEL EP IP Units IP Units BTU/ft-Day BTU/ft2 Day ' Category CLEAR MILDLY CLOUDY Category CLEAR MILDLY CLOUDY (Ti-Ta) DAY CLOUDY DAY DAY (Fi-Ta) DAY CLOUDY DAY DAY Ti=inlet fluid temp 2000 1500 1000 r=inlet fluid temp 2000 1500 1000 Ta=ambient air temp BTU/ft-Day BTU/ft'Day BTU/1t-Day Ta=ambient air temp BTU/ft2'Day BTU/ft7'Day BTU/ft2'Day A(-9°F) 1,360 1,020 690 A(-9°F) 1,290' '. 965 645 13(9°F) 1,250 910 580 8(9°F) 1,210 890 570 C(36°F), 1,070 745 ... 420 C)36°F) .,:. 1,035 720 410 D(90°F) 700 400 120 D(90°F) 600 315 70 E)144°F) 330 95 E(144°F) 150 • - - A-Pool Heating(Warm Climate) B-Pool Heating C-Water Heating(Warm Climate) D-Water Heating(Cool Climate) E-Air Conditioning/Industrial Process Heat. Thermal performance is obtained by multiplying the collector output for the appropriate application and insolation level by the total gross collector area. *Collector ratings are derived from the Solar Rating&Certification Corp(SRCC)Document RM-1 and Standard 0G-100. ENGINEERING SPECIFICATIONS (Performance specifications subject to testing error of+/-3%) The following shall be the specifications for the solar collectors.Collectors shall be thermal isolation of the foam from the absorber plate.Total thermal resis- SunEarth Empire model and shall be of the glazed liquid flat plate type. tance shall be a minimum of R-12.The sides and ends of the collector shall Collectors shall be tested in conformance with ASHRAE 93-2003 and Solar Rating be insulated with a minimum of 1 inch foil-faced polyisocyanurate foam and Certification Corporation (SRCC)Standard 100-05, and have their thermal sheathing board. performance rated according to SRCC Document RM-1.The collectors shall be ABSORBER PLATE AND PIPING certified by the SRCC and the Florida Solar Energy Center(FSEC),and listed by the The absorber shall consist of a roll formed copper plate of no less than.008 International Association of Plumbing and Mechanical Officials(IAPMO). inch thickness. all a minimum of 1/2 inch O.D.Type M copper GENERAL tubing on no moreRisers than sh 4be 1/2 inch centers continuously soldered to the The dimensions of the collector shall be inches in length, plate utilizing a non-corrosive solder paste with a melting point of 460°F. inches in width and 3 1/4 inches in depth.The collector casing The risers shall be brazed to 1 1/8"O.D.Type M copper manifolds(1 5/8" shall be an anodized aluminum extrusion(alloy 6063 T5), minimum thick- O.D. on models EC/EP-32-1.5 and EC/EP-40-1.5) utilizing a copper phos- ness .060 inch, with an architectural dark bronze finish. The casing shall phorous brazing alloy with no less than 15 percent silver content,and con- have notched framewalls for ease of plate removal and reinstallation.Sheet forming to the American Welding Society's BCuP-5 classification. EPDM metal screwed fasteners shall be stainless steel (18-8#10). The backsheet shall be painted textured aluminum not less than.014 inch thickness.A 1 grommets shall isolate the manifold from the aluminum casing. The inch vent plug shall be installed in each of the four corners of the backsheet absorber plate shall be designed for 160 psig maximum operating pressure. to minimize condensation.An integral mounting channel shall allow the ABSORBER COATING AND PERFORMANCE CURVE solar collector to be mounted without penetration of the extruded alu- A)Black Chrome(EC Series):The absorber coating shall be black chrome on minum casing. nickel with a minimum absorptivity of 95 percent and a maximum emissivity GLAZING of 12 percent.The instantaneous efficiency of the collector shall be a mini- The collector glazing shall be one sheet of low iron tempered glass,with mum Y-intercept of 0.735 and a slope of no less than-0.730 BTU/ft2 hr°F. a minimum of 1/8 inch thickness (5/32 inch on EC/EP 40), and a mini- B)Moderately Selective Black Paint(EP Series):The absorber coating shall be mum transmissivity of 91 percent(89 on EC/EP 40).The glazing shall be a moderately-selective black paint with a minimum absorptivity of 94 per- thermally isolated from the casing by a continuous EPDM gasket. There cent and a maximum emissivity of 56 percent.The instantaneous efficiency shall be a continuous secondary silicone seal between the glass and cas of the collector shall have a minimum Y-intercept of 0.726 and a slope of ing capstrip to minimize moisture from entering the casing. no less than-0.910 BTU/fe hF°F INSULATION The insulation shall be foil-faced polyisocyanurate foam sheathing board of Note:Please refer to the SRCC website at www.solar-rating.org for the a minimum 1 inch thickness,siliconed in place to the aluminum backsheet, actual y-intercept and slope for each collector. covered by low-binder fiberglass of a minimum I inch thickness,providing Due to SunEarth's policy of continuous product improvement, specifications are subject to change without notice. MANUFACTURED BY: AVAILABLE FROM: 4 OOEIIOIIIM[. 8425 Almeria Ave.•Fontana,CA 92335 .,00111E, +, (909)434-3100 • Fax(909)434-3101 `2 ' O www sunearfhinc.com ' «"~" 5 RECYCLED PAPER-SOY BASED INK`r,,,r,.�"`t• 8 rk C -1-T-) fitijz. s,.111t) ,. . . . . . , LI f u 'ti .. ....1i)....s.a . . . i ,, 1 .1, . s r , ,_ ___10 ,..........., i 1 ..,...:,,ci , . , , , .......&_ . . • . , , . • , i . , .. , ,.,..., , 1 ... . , , , 1 • . ,., ,.. . n i .. ,r..___ _,... 1....„,_ ,..t .., 1 ..„, ot ,... . . ki I , 1 .„...,... , a , . i , wmotaTEA 1; s4ILTR A -------. . -..,2,-; —-- 4'''' - A "----r--• , — ..,. 4,. .... .1., ..* 4F, g i . ..„,.. ‘,...., — ..., , i ... 1 ,... 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