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Home My WebLink AboutBLD-18-4165O�„YgR �r0 Office Use Only Permit# C Amount J F' wrr n Permit expires 180 days from issue date l (OS EXPRESS BUILDING PERMIT APPLICATION) TOWN OF YARMOUTH _ Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664�� (508) 398-2231 Ext. 1261 2 5 2018 CONSTRUCTION ADDRESS: SI Poi -rev -St BUtLDINGDE E T ASSESSOR'S INFORMATION: Map: / 3 Z Parcel: Z OWNER: 3*1 I,/in le/Sr y1e4 • yl9 • LN 113 CONTRACTOR:,JvorvN,lvtr. 77V -Fovn- Sr.. /Nsv►bordw4L MAMT2- 978-743• ❑ Residential ❑ Commercial Est. Cost of Construction S 3:roy Home Improvement Contractor Lie. # 1789.3 7 Construction Supervisor Lie. # C 5— 0 $p03q Workman's Compensation Insurance: (check one) ❑ I am the homeowner n I am the sole proprietor V1 have Worker's Compensation Insurance WG0116 961x3 Insurance Company Name: 2tN1eL Brener#'IKw4wee Co Worker's Comp. Policy# W( 01 3 6 46 103 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: # of Squares Replacement windows: # Replacement doors: # Roofing: # of Squares_ // ( f) Remove existing* (max. 2 layers) Insulation ✓ Old Kings Highway/Historic Dist.. a(✓jReplacing like for like / Pool fencing *The debris will be disposed of at: ?(S Coe- �ys-rtt• L✓J pui Aw% (z4 -t SSer /h4 nio ZS Location of Fdcility I declare under penalties of perjury that the statements herein contained me true and correct to the best of my knowledge and belief i understand that any false answer(s) will be just cause for denial orr/revocation of my liceenynsee� and for prosecution under M.G.L. Ch. 268, Section 1. Applicant's Signature: Date: Owners Signature (or attachment) Date: Approved By: Date: Building Official (or designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 R. of Wetlands: 0 Yes 0 No 0 Yes 0 No vloThe Commonwealth of Massach usetts Department oflndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia \Forkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTIII'G AUTHORITY. Avolicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone Are you an employer? Check the appropriate box: 1.7 1 am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp, insurance required.] t 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 proprietors with no employees. _ 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.= 6.❑ Weare a corporation and its officers have exercised their right of exemption per MGL e. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other Arty 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. LContractors 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 Policy # or Self -ins. Lic. Expiration 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 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 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalises of perjury that the information provided above is true and correct. Signature: Date: 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 #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -060034 Construction Supervisor CRAIG M .: 71 WALNUTT ST ' - OXFORD MA 01540 %f�rr1lt.% %�`1rrr.v Expiration: /Commissioner 011272019 �1- a riwxu wrim/!/ r 0 r�atvraircu/(.1 �e< of Consumer ABgin & Bgs{geu ReRg4doq !;Pnl ME IMPROVEMENT Cps KI. CONTRACTOR �"y�Registndow .178937 �; T ype- Expiration:.. 8/212018.,'_. SUNRUN INC. Supplement ent Card CRAIG ORN 595 MARKET ST 29TH FL ": l SAN FRANCISCO. CA 94105 Unde�� Contact Info: Sunrunlnc 734 Forest ST STE 400 Marlborough MA 01752 Tel: 978-793-8584 Email: mapermits@sunrun.com Construction Supervisor Restricted to: Unrestricted -Buildings of any usegroup which contain less than 35,COD Cubic feet (691 cubic meters) of enclosed space. Failure to possess a current edition otthe Massachusetts Stan Building Code Is cause for revocatlon of this license. DPS Licensing Information visit: WWWWASS.GOVIDPS License or registration valid for Individual an only before the expintion date. If found return to: office of Consumer Affain and Business Regslatioa 10 Park Plaza - Suite 5170 Bruton, NA 02116 �y�4i7rd without sixgalure� The Commonwealth ofMassachusetis Department of IndustrialA ccidents I Congress Street, Suite 100Boston, MA 02114-2017 e www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTBJG AUTHORITY. ApOicant Information Please Print Leo[bly Name (Business/OManizatiorAndividual): Sunrun Installation Services Address: 734 Forest ST STE 400 r Madborough MA 01752 Phone M 978-793-7881 Are you an employer! deck the appropriate box: 1.® I am a employer with 35 employees (full andlorpItime).• 2Q lam a sole proprietor or pefmaship and have no employees working for me in any Eby. [No workers' comp, h mmmce required.) 3.M I am a homeowner doing all work myself [No workers• comp, btarance requited] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will enana that as contractors either have workers' compensation hm rare or we sole proprietors with no employee& 5.C] I am a general cmfta=and I have hired the sub -contractors listed on the atteehed sheet These subcostraraors have employees and he" workers' comp, amustuce.t 6.F1 Weare a corporation and its offncas have mmis d their right ofexemrptim per MGL a IA 11(41 and we have no employee& [No workers• comp, iusmance reT bed] •Arty applicmdthat checks box it must also 5ll our the section below shm t Homeowners who submit this affidavit indicating they are doing all work tContrwtors that cheek this boo must attached on additional sheet showing employees. If the sub-conttadon have employes, they must provide their Type of project (required): 7. ❑ New construction 8. Q Remodeling 9. ❑ Demolition 10 Building addition 1 LQ Electrical repairs or additions 12. [] Plumbing repairs or additions 13. Q Roof repairs 14, ® Other Rooftop Solar I thea him outside contracaas must submit a new affidavit indicating such. name of the and stats whether or not thoseem" have eme comp. policy mamba. lam an employer that is protddma workers' compensation insurance for my employees Below it the policy and job site information. Insurance Company Name. Zurich American Insurance Company Policy # or Self -ins. Lic. #: WC013696003 & WC013696103 Expiration Date. 10/1/2018 Job Site Address: 51 Winter St CityiStattrzip: Yarmouth MA 02675 Attach a copy of the workers' compensation policy declaration pave (showing the policy number and expiration date} Failure to 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 penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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. I do hereby certify ander the pains and penallfes of perjury that the information provided above is true and correct 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): r. . 1. Board of Health I Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone A � V• CERTIFICATE OF LIABILITY INSURANCE ire/2on l� 8 " 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), AUTHORED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed H SUBROGATION IS WANED, 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 Eastern Insurance Group LLC 77 Accord Park Drive Unit Bl Norwell NA 02061 HCAOMMTeNorlrell Risk South PHONE FAX LAM A"D FII INSURER(S) AFFORDING COVERAGE route MSURERA.COI®erre Insurance Company POURED Graham Waste Services Inc 215 Chief Justice Cushing Hwy Cohasset NA 02025 INSURERBArch Insurance Group, Inc. INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 Master 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 T TYPE OF INSURANCE POUCYNI M LER POLICY EF MM100ffYYYI POLICY EXP IMMMDrrfyn LIMITS A GENERAL LABILITY X COMMERCIAL GENERAL LIABILITY CAW -MADE [j] OCCUR BGSMST 2/31/2017 2/31/2018 EACH OCCURRENCE S 1000000 PREMISESN 3 100,000 MEDEXP(yy W, ) $ 5000 PERSONAL a ADV INJURY 3 1000000 GENERAL AGGREGATE S 2000000 GENL AGGREGATE X POLICY OMIT APPLIES PER: PRO Loc PRODUCTS -COMROP AGO 3 Included $ AANY AUTOMOBILE WBILRYCOM&NMar AUTO AALL UTO ED X SSCCHH� EO X HIRED AUTOS X AUTOS NON'OWNED 2/31/2017 2/31/2018 LIMITiEs 1,000,000 BODILY INJURY (PW PM9NI) $ BODILY EIAIRY(PerMXJtlMd) $ S S CoOisWn Ded $ 1,00 C. X UMBRELLA LucOCCUR EXCESS UAB CLAIMS -MADE raD 2/31/2017 2/31/2018 EACH OCCURRENCE s 5,000,000 AGGREGATE $ 5,000,000 OFTI I X I RETEW 10,00 s B WORKERS COMPENSATION AND EMPLOYERS' WINLnY YIN ANY PROPRIETORIPARINERIEXECUrIVE ❑ OFFICER/I.EMM11 EXCLUDED? IMMId.brT M NN) DESCRIPTION OF OPERATIONS Mow N rA I1808001 7/01/2017 7/01/2018 X WC STATU- X OT14 E.L.EACH AccmENT s 1 000 000 EL DISEASE -EA EMPLOYE $ 1,000,00 EL DISEASE -POLICY LIMIT S 1 000 000 DESCRPTON OF OPERATIONS/ LOCATIONS I VEHNX.ES (Ae.eN A MD IOI, A Mo RM.MA. ScMdlde, R e Apee. b epukeM Evidence of Insurance Sunrun Inc. 734 Forest Street, Suite 400 Marlborough, MA 01752 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Itoegel/JML ®1988.2010 ACORD CORPORATION. All rights reserve INS075MIm n, T%. arnRn... ..AI....n..rankfar.A...rA,.,.FArnon CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNWY) 9n 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 H SUBROGATION IS WAIVED, subject to the terms and Conditions of the PRODUCER 4rthur J. Gallagher & Co. nsurance Brokers of CA. Inc. License #0726293 1255 Battery Street #450 San Francisco CA 94111 INSURED Sunrun Installation Services, Inc. 775 Fiero Lane, Suite 200 San Luis Obispo, CA 93401 MIJILI: [DR—FI I Is) must have ADDITIONAL INSURED provisions or be endorsed. certain policies may require an endorsement, A statement on COVERAGES CERTIFICATF NIIMRFR- 1369609471 DFVI4IrH1 MI IMkRFD• 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 TR TYPE OF INSURANCE NSD Uum POLICY NUMBER POLICY EFF MWDD POLICY EXP MID LIMITS C X COMMERCIAL GENERAL LIABILITY CIAIMS4AADE [i] OCCUR X S5000oRetendon Y LA17CGL2303211C 10/1/2017 10112018 EACH OCCURRENCE $1,000,000 REMIS Esoaumnca $300,000 MEDExP ons ) $5,000 PERSONAL& ADV INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER PRO- INEPOLICT 0 LOC OTHER GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OP ADD $2,000,000 Total Policy Limit SIO.D00,000 AUTOMOBILE LIABILT-S ANYAUTO AUTOS ONLY AUTOSU�D AUTOS ONLY AUTOS ONLY Ea ecdtlaM BODILY INJURY (Per Pelson) E BODILY INJURY (Per ecddara) $ Per ecddeM E E B X UMBRELLA LIAB EXCESS LWB X OCCUR CLAIMS -MADE H17XC5023205 10/12017 10112018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED I I RETENTIONS S A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIM ANYPROPEMBER EXCLUDED? ❑ OFFICEt"InNH)E%CLUDED7 (Mandatary In NH) DysSACdasakheantler DESCRIPTX)N OF OPERATIONS below MIA Y WC013696003 WCAt3698103 10/12017 10/12017 10/12018 10/12018 X OTµ TATl1TE E E.L EACH ACCIDENT $7,000,000 E.L. DISEASE -EAE $1,000,000 E.L DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached M mon aped M mqulreM WC013696003 - $25,000 Deductible; WC013696103 - FL, HI, MA, NJ, NY, OR, VA, WI only. Named Insureds: Sunrun Inc., Sunrun Installation Services Inc., Sunrun South LLC, AEE Solar, Inc., Clean Energy Experts LLC, Sunrun Solar Electrical Corporation Re: Permitting within Jurisdiction. Town of Yarmouth 1146 Route 28 South Yarmouth MA 02664-4492 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED 01988-2015 ACORD 25 (2015103) The ACORD name and logo are registered marks of ACORD O�Y4"' J o e TOWN OF YARMOUTH BUMDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-39&2231 ext. 1261 Fax 50&398-0836 1 1 ( 191' • 1 Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section it 1-5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 51 Winter St Work Address Is to be disposed of at the following location: 215 Chief Justice Cushing Hwy Cohasset MA 02025 Said disposal site shall be a licensed solid waste facility as defined by KG.L. Chapter l 11. Section 150A. sign o[ app •tion Permit No. /•Lr. so�� Date APPLICATION REGULATORYAPPROVALS NOTICE Address of proposed Work: 51 Winter St Scope of proposed Work: Installation of an interconnected rooftop PV system. 28 (330w) Panels 9.24 KW'DC Date: Based on the scope of work described above, the applicant is required to obtain approval sign -offs from the following departments as checked -off below: MMUS Health Dept. — 508-398.2231 eat. 1241 Conservation Comm.— 508.398.2231 eat. 1288 Water Dept.— 99 Buck Island Rd. phone no. 508-771-7921 Old Slags Hwy. Hcst Comm.— 508-398-2231 eat. 1292 Engineering Dept.— 508-398-2231 eat. 1250 Pin Dept.—Jon Sawyer/James Armstrong, 96 Old Main St. SY Note: Please call lire Department for an appointment. 508-398-2212 Other. Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. Receipt Acknowledgement: Rev: Aug. 2013 ' DocuSign Envelope ID: 022A6AC1-6EtA4D6E.AO80-8F51BAD260FD `,..�sunrun® NOTICE REGARDING ADDITIONAL ROOFING WORK REQUIRED Based on your solar design, visual Inspection of your home, and Sunrun quality requirements, Sunrun has determined that additional work needs to be completed prior to the installation of your solar energy system. This additional work may include: • Localized roof surface repairs • Replacement of the roofing surface of the entire roof plane where the solar system will be placed • Other roofing work required to be completed prior to solar installation Sunrun Intends to provide this work at no cost to you through a licensed contractor or through Sunrun, unless concealed conditions are found that require repairs as explained below. ROOFING CONCEALED CONDITIONS When completing additional work, Sunrun/Sunrun's contractors sometimes discover concealed conditions that may prohibit advancement of Sunrun work.The repair of these concealed conditions will not be the responsibility of Sunrun/Summrfs contractors. If Sunrun cannot complete the repairs, Sunrun can provide a list of qualified local contractors, and you can contract directly. If you decide not to make the repairs, Sunrun may decide it is not feasible to continue with your solar energy system installation, and Sunrun may cancel your Agreement. EXCLUSIONS Exclusions from the roofing work include, but are not limited to: • Full home reroofs CANCELLATION CHARGE If you cancel your Sunrun agreement after Sunrun pays to complete the work, you agree to repay Sunrun the cost of materials and labor Incurred on roof repairs. Sunrun will not return your roof to its original state. ROOFING LIMITED WARRANTY Separate from and in addition to the roof penetration warranty set forth in your Customer Agreement, Sunrun provides a 1 (one) year warranty that your roof will not leak as a result of the workmanship of Sunrun's roofing contractor. The warranty commences on the day Sunrun's contractor completes the repairs. During the warranty term, Sunrun will arrange to repair or replace any roof surface materials Incorrectly installed by the Sunrun's roofing contractor, at Sunrun's expense. Sunrun will also assign the manufacturers warranty for the roofing material to you. If the roofing repairs leak for any reason other than faulty workmanship by Sunrun's contractor, you should make a claim under the manufacturers warranty. Sunrun will provide you reasonable assistance in contacting the manufacturer if requested by you during the warranty period. ELECTRICAL. LIMITED WARRANTY Separate from and in addition to the workmanship warranty set forth in your Customer Agreement, Sunrun provides a one (1) year warranty on additional electrical work it performs. The Warranty commences on the day Sunrun installs the new electrical equipment During the warranty tens, Sunrun will, at Its expense, repair or replace the panel If it is damaged due to Sunrun's workmanship. Sunrun will also assign the manufacturer's warranty for the panel to you. ti the panel malfunctions for any reason other than faulty workmanship by Sunrun, you should make a claim under the manufacturer's warranty for repair or replacement of the defective panel. Sunrun will provide you reasonable assistance in contacting the manufacturer if requested by you during the warranty period. sigraaae: Print Name: wi l l i am A Shaw Date: 11/30/2017 SUNRUN INSTALLATION SERVICES INC.1 595 Market Street, 29th Floor, San Francisco, CA 94105 1 888.GO.SOLAR EnFun A's OWNER'S AUTHORIZATION FORM For Permit Application(s) Sun u nc .855. S R s nrun.co The sole purpose of this form is to provide Sunrun, Inc. with the necessary permission from the Owner to file permit application(s) for such project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Owner's Name: William A Shaw Solar Signa Owner's Authorized Company: Sunrun, Inc. Company's Address: 595 Market St 29"' Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA CSLB #969975. 0 rID40702030J TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,AIA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for'Homeownerwas extended to include owner— occupied dwellin." of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 110 85.1.3.1) 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 attached or detached structure assessory 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 110 R5.1.3.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, Hiles and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked M please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware thatthe licensee does nothavethe insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent h1omwwn i=emp Check one: Owner Agent r oY'�Pi ' ONE &TWO FAMILY ONLY — BUILDING PERMIT APFUCknoNTOCONSIRUCF REPAIR.PMOVAMORDEMOUSHAONE ORTWO FAMILYOWEUINO -.4 Town of Yarmouth BuHding Department V. 4 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 I Of Date PuoType � La L adarsueee a„e 132 /72 Dah_ �q ms PIN 112. ' tlenr tdktatsf) F,aaapq tnitbre�pe TMtl3ecam for Cft*U8* CMW StdkMd FennitMltmbefCv— - - e : D8B! ltidtiert �aCYr4p[i3\a}�a�•}:taa✓a`\sY N.. \aty �w� \. �t .�,~ :.i�`•`.r. , Seglmi t • stfs h>frR tlse 5 e 11.1 P"Peft A++e.a is ZW" bft of, 51 Winter St Yarmouth Port MA 02675 Single Family Zoning District Proposed Use 1.2 aeerey le0eeks� Frond Yard Side Yards Rear Yard P�avrded Neq*ed Ro".9 Provided 1A wiefte Appy ;r n • a fie. i Sq 13 Flood2bry kidRutlpc, ppp . PuUee Pdvele IbnK BM Seelfbrl T'• AWgdzed it OwweeMReeaNr ' William Shaw 51 Winter St Yarmouth Port MA 02675 Henn;;.0 Ma& g Ad&VU 414-418-4948 Telsptcne it Address: ZZ AgeeU Stephen Kell 734 Forest ST STE 400 Marlborough MA 01752 ' Nuee Ma"AddresS 978-793-7881 Telephone . Fax Secttaf 3 CCornf xftn Servlws 3.1 e0e� Crai constirggithe Nae ApOmble ❑ CS -080034 734 Forest ST STE 400 Marlborough MA 01752 Litse" Water 01/22/2019 978-793-8584 mapermits@sunrun.com tones Tekphww EmaelAddress: 32 Hone Caltrador G*O*" M" Sunrun Inc NotAppGra6le 0 734 Forest ST STE 400 Marlborough MA 01752 mapermits@sunrun.com 937 Address Email Address: Liber Qµmbw — 06/02/2018 978-793-8584 Slrdepee rs FvPeaSonoue I Of 3af:OVIF.'+��u�nma vuui m�aou�,•u.:aw.�...�..�.....-... .., _-- -. -. Workers Compensation Insurance aGldwAt must be completed and submitted with this apPlicadon. Failure' to provide this affidavit wig result In the denial of the Issuance of the building permit. Signed Affidavit Attached Yes ..?5..... No .......... Sectiort'L- Desai of Mdlt (dieclt dt appYt") New Coasncftn ❑ ffo. at Sedmonn w0. at.bflroans Extstlrq e►dq ® Aepak(s) m a m ❑ I MOM ❑ Accessory Bldg, O Type Oemofitfon Other Spedr-- Detailed Description o 'Proposed Work — Please Itemise All Work Being Done: Partial Strip and Re -mf on Roof plane that will have solar Socllbn S Eftra ted ConatntcdM Costs Item Es&rded Cad (Dollars) to be Cho* Bekm rambled by permit apptleartt 1. 3300 O CQmwvaftn-C.Orra dwkn Filing 2. Electrical aPP b10) 3. f328 ® Old tar4'a li 4m V d Hidmieal 4. Med+rtled Cord h akce mwC V i Fku Protection (y appo=b1m) e.Tobdn(1+2+3+4+5) 3300 7. raid Sgrare Ft. the hoer a.eetaet Secifdtt7fl+OYrrMA-l3heeampt "Medea ewnee'tAdonta<ConhaetorAppQasfor Pertnft as owner of the subjed PmP" hereby authorize to act on my teW, In ad matters relative to work authorized by this building pemut appikaWn. stw mmd Ora,« 099 1 Stephen Kelly , asOwnedAuthodzedAgent hereby declare that the statements and Information on the foregoing application are true and aceurate. to the best of rrty knowledge and belle!. Signed under the pains and penalties of peri O Stephen Kell Prod name � oat* t. is. 99 2 d 2 ter uttice use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Some Improvement Contractor law Supplement to Permit Application MOL a 142A reynara tint the 're oo. Ardenk rmmlda% npsir. modemh dm. cooreesiak improremmt, reuoml, demolition or eon*ucdm of m additim to my pro-adstbi br Wol rmhbbi at least mo but not more rho fear dweilioi rents a snssctuch ss whiam add arch ruidwm a bmldmg' be dobe by me teta! cMM1ctx% wilt certain =qdm% Rices wi& other nquireaeots. 1 Type of Worm Partial Re -roof Ft. Cost $3300.00 Address of Work • 51 Winter Street Ow=Nm= William Shaw Date of Permit Application: ROg�ation is not required for the fallowing remorr(s): Work euladed by law Job under $1.000 Bvr7dm9not owner occupied own Otber (specify) P Notice is bereby given that OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGMTERED CONTRACTORS FOR APPLICABLE HOME WROVB4EN'T WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signedwmder penalties ofpciur ' I hereby apply for a pe&k as the agent of the owner. 1/18/2018 D _Sunrun Inc- Craig Om 178937 Coritrxtor Nares Registration No. OR: H I e- Notmidatand'mg the alcove notice I hereby apply for a permit as the owner of the above Property: Date Owner Name TOWN OF YARMOUTH A p BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLE9.SEPRIAT. Job Location: 51 Winter St Yarmouth Port Number Owner of Proeerty: William Shaw Stan Map Construction Supervisor. Craig Orn CS -080034 978-793-8584 Name License No. Phone No. Address 734 Forest ST STE 400 Marlborough MA 01752 Licensed I)esignm (lrotherthan Superri ) Name 2.15 Responsibility of each license holder. License No. 2:15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuantto the state building code and the drawings as approved by the building oE�cial, 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.153 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit 2.15 .4 Any licenseewhoshallwillfullyvio(ate subsections 2.15.1,2.15.sora.15.3orarryothersecdonofthese rules and regulations and any Procedures, as amended, shall be subject to revocation or license by the board. suspension of 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these Hiles and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109. 1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a c urent lability Insurance policy or its substantial equivalent which meets the reWrements of MGt Ch. 152 Yes Q No If you have checked yn please Indicate the type Coverage by cheddng the appropriate box A lability insurance poilcy El Other We of Ind&" ❑ • Bond OWNER'S INSURANCE WAIVEFt I am aware that the 1cwmed=ndhMthe insurance coverage required Chapter 152 of the Maga General taws, and that my signabue on t this permit apploatlon waives this requiremen Check one: Signature of Dune. ar owrW:Imgertt 0,,,,er rJ Agw* Q Signature: �' ,.�.-.e Building OfildalApproval: