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22-A076 11 Ridgewood Drive
ECEIVED TOWN OF YARMOUTH " 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 JUN 2 3 2022 Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836 Aki�I09LD KI G'S HIGHWAY HISTORIC DISTRICT COMMITTEE APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as amended, for proposed work as described below & on plans, drawings, photographs, & other supplemental info accompanying this application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION. Check All Categories That Apply: Indicate type of Building: Commercial Residential 1) Exterior Building Construction: New Building Addition _Alterations Reroof Garage Shed _ Solar Panels VOther: 2) Exterior Painting: Siding Shutters Doors _Trim Other: 3) Signs/Billboards: New Sign Change to Existing Sign 4) Miscellaneous Structures: Fence Wall Flagpole Pool Please type or print legibly: Address of proposed work: 11 Ridgewood Drive, Yarmouth Port, MA Other: Map/Lot # 114/111 Owner(s): Chrismond Jean Jacques _ Phone #: (336) 327-3360 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: 11 Ridgewood Drive Yarmouth Port MA Year built: 1971 Email: jjchris2000@gmaii.com Preferred notification method: Phone Email Agent/contractor: Bruce A Junior Phone #: 508-291-0007 Mailing Address: 20 Patterson Brook Rd. Unit 1 W. Wareham, MA 02576 Email: permits.wareham@trinity-solar.com Preferred notification method: Phone �Email Description of Proposed Work: Install 13.20kw solar panels on roof. Will not exceed roof panel, but will add 6" to roof height. 33 total panels to be located on both from and back of home and to be partially visible from the public way. Signed (Owner or agent): Date: 06/21/2022 Ownerlcontractortagent is aware that a permit is required fro g Department. (Check other departments, also.) If application is approved, approval is subject to a t0 -day appeal period required by the Act. This certificate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shall be later. All new construction will be subject to inspection by OKH. OKH-approved plans MUST be available on-site for framing & final inspections. Revd Date: Amount q6. U Cash/CK #: Z7 Rcvd by: L,,,5. 45 Days: Date Signed: Approved Approved with Modifications Denied Reason for Denial_ Signed: 1 APPLICATION #: ;P" /kr,�-� (Tr in *1 +1 T'. r).- , I I t SOLAR' June 21, 2022 MA, Master Electric Contractor # 21233A MA, Home Improvement Contractor tt 170355 Rhode Island Contractors' Registration and Licensing Board Registration No. 39372 Rhode Island Renewable Energy Prof REPC-126 For other jurisdictions, please visit: http://www.trinity-solar.cr)m/about-us/locations-and-licenses Tristan Souza Applications Specialist 20 Patterson Brook Rd. Unit 1 W. Wareham, MA 02576 (732) 722-1278 Tristan.Souza@trinity-solar.com RE: Permit Application for Solar Installation Building Department: Town of Yarmouth Bldg Dept 1146 Route 28 South Yarmouth, MA 02664 RECEIVED JUN 2 3 2022 YARMQUI ho Enclosed please find an application and check for 11 Ridgewood Dr. Certificate of Appropriateness. If you have any questions, please contact me at 508-291-0007 x1231. Check attached Very truly yours, --�rl Tristan Souza Applications Specialist Wareham, MA and Rhode Island Offices 20 Patterson Brook Road, Unit 1 Wareham, Massachusetts 02576 www.Trinity-Solar.com 1 -877 -SUN -SAVES Ph: 508-291-0007 Fax: 508-291-0040 n GENERAL SPECIFICATION SHEET Proiect Address: 11 Ridgewood Drive, Yarmouth Port, MA FOUNDATION: Material: Exposure (Not to exceed 18"): CHIMNEY: Material/Color: GUTTERS: Material/Color: Asphalt R1 &R2 4112 ROOF: Material: p Pitch (7/12 min) Height to Ridge: Color: Pewter Gray SIDING: Material/Style: Front: Sides/Rear: COLOR CHIPS Color: Front: Sides/Rear TRIM: All windows & doors to be trimmed with: 1x4 1x5 (Circle one.) Material: Color: DOORS: Qty: Material: Style/Size (if not listed/shown on elevations): STORM DOORS: Qty: Material: GARAGE DOORS: Qty: MatT. WINDOWS: Qty/side:: Front: Left: Manufacturer/Series: Grilles (Required): Pattern (616, 211, etc.) Snap -In: Between Glass: Color: Color: Style: Color: _ Right: Rear: Color: Material: _ Grille Type: True Divided Lite: Permanently Applied: Exterior Interior STORM WINDOWS: Qty: Material: _ SHUTTERS: MatT. Style: Paneled Color: Louvered Color: SKYLIGHTS: Qty: Fixed Vented Size Color RECEIVED JUN 2 3 2022 YARMOUTH DECK: Size: Decking Mat'I: Color: Railing MatT Style: Color: WALLS/FENCES* (Max 6' height): Height: MatT Style: Color: (Show running footage & location on plot pian.) *Finished side of fence must face out from fenced in area. UTILITY METERS/HVAC UNITS: Location: Screening LIGHTS: Qty: Style: Color: Location(s): LIGHT POSTS: Qty: _ Location(s): Additional information: Material: Calor: 2 -Genera! APPLICATION #: ,�� it TOWN OF YARMOUTH OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE Applicant's (Owner) Name: ABUTTERS' LIST Chrismond Jean Jacques Property Address/Location: 11 Ridgewood Drive, Yarmouth Port, MA Hearing Date: Notices must be sent to the Applicant and abutters (including owners of land on any public or private street or way) who's property directly abuts or is across the street from the Applicant. Please provide the Assessor's Tax Map and Lot numbers only. The OKH Office will send out notices using the addresses as they appear on the most recent applicable tax list. Note: Instructions for obtaining the abutters Map and Lot numbers can be found on the Old King's Highway Department page on the Town website: www.yarmouth.ma.us Map Number Lot Number Applicant Information: Abutter Information: ECOVED JUN 2 3 2022 YAHMOUl h Application #: 22.,ftb-� b 8.2018 3 ll`l r1� Cif � � v.5 li !u efl Application #: 22.,ftb-� b 8.2018 3 a ¢9 st w AC4 O s z �i W � a EL w Ln w w 0 w w 1SiM Q w�V RECEIVED - JUN 2 3 2022 ,?-? -jp�j�6 s z V a tQ di � 2f F Iti r� Cl O @g77 dSr_ RECEIVED - JUN 2 3 2022 ,?-? -jp�j�6 ACORb® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD1YYYY) 5/13/2022 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 4000 Midlantic Drive Suite 200 Mount Laurel NJ 08054 CONTACT Mark GraSela PHONE FAX N : 856-482-9900 Arc No:856�82-1888 AnDREss: Che HilI.BSD.CerIM G.Com INSURER(S) AFFORDING COVERAGE HAILS INSURER A: Gotham Insurance Company 25569 GL202100013378 INSURERS: National Union Fire Insurance Company of Pittsburg19445 INSURED TRINHEA-03 Trinity Solar Inc. 20 Patterson Brook Road, Unit 1 INSURERC: Liberty International Underwriters INSURERD: W. Wareham, MA 02576 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 590414193 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. !NIS!LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF * LILY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY GL202100013378 6/112021 6/1/2023 EACH OCCURRENCE $2,000,000 CLAIMS -MADE [XI OCCUR DAMAGE ENTEO PREMISES Ea occurrence $100,000 MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [�] jfa F-1 LOC PRODUCTS -COMPIOPAGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY CA 2960145 6/1/2022 611/2023 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE $ Per accident $ A C X UMBRELLALIAR EXCESS LUIS X OCCUR CLAIMS -MADE EX2021D0001871 ELD30006989101 1000231834-06 511/2021 611/2022 611/2022 6!112023 6!112023 6/1/2023 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 DED RETENTION$ Umltxof$5,D00,OD0 $19,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC 13588106 611/2022 6/1/2023 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNERIEXECUTIVE OFFI C E RIM E MO E R E XC L U D ED 7 ❑ N 1 A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Automobile CA 2960145 6!112022 6/1/2023 All Other Units $2501500 Compf cellusion ped. Truck -Tractors and Semi -Trailers $2501500 DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached i(more space is required) Evidence of Insurance RECEIVED JUN 2 3 2022 CERTIFICATE HOLDER c u Evidence of Insurance ACORD 25 (2016103) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IV`ta r1_r-�> © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _.�??'A�b RECti ED The Commonwealth of Massachusetts LQLQ UN 2 3 2022 Department of Industrial Accidents ` Office of Investigations YAhsMUU"rl , KING'S HIGHW ' Lafayette City Center f 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Trinity Solar Inc Address: 2211 Allenwood Road City/State/Zip: Wall, New Jersey 07719 Phone #: (732) Are ou an employer? Check the appropriate box: 780-3779 Type of project (required): l.I am a employer with 300 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub -contractors Yarmouth Port, MA 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' q Buildingaddition [No workers' comp, insurance comp, insurance.: 5. ❑ We are a corporation and its 10.WElectrical repairs or additions required.] 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.❑ Roof repairs insurance required.] + c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance requirea.l *Any applicant that checks box N 1 must also fill out the section below showing their workers' compensation policy information, r Homcowncrs 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. am an employer that is providing workers' compensation insurance for my employees. Below is site policy and job site information. Insurance Company Name: American Guarantee and Liability Ins Co Policy # or Self -ins. Lic. M WC 13588108 Expiration Date: 06/01/2023 Job Site Address: 11 Ridgewood Drive City/State/Zip: Yarmouth Port, MA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL, c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I da Irereb r�eclify�VR r the pains and penalties of perjury that the information provided above is true and correct. (508) 291 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License #E 06/21/2022 Issuing Authority (check one): I❑Board of Health 20 Building Department 3.00ty/I'own Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.❑Other Contact Person: Phone 4 C: � & 7 $ q�� � 09 Q §J7 qa/off <���� LL w«/2 § ° CO M 0 / zok�«a � 00 q E 2 ° Lu � 0 ECE|VED ] U N 2 A 2022 fAKIQUIh k 0 § k zi a 2 � I ,;gx[A"� i RECEIVED JUN 2 3 2022 rARMOUTr, C Commonwealth of Massachusetts �,: Division of Professional Licensure Al Board of Building Regulatious and Standards Constructiop��i46o 1 & 2 Family ' li C S FA-067961�pires: 0711312022 BRUCE A JUNIORJ 8 SOMERVIL4 S7 MARSHFIELD,:MA p*:,�ow' ?, i♦C Avolsh Commissionerirn. �Frnc2� ( r ; n ; +x jr- NJ, Electrical Contractor business permit number34EB01547400 \T�r),_, , I I t NJ, HIC reg. # 13VH01244300 SOLAR For other jurisdictions, please visit: http://www.trinity-solar.com/about-us/locations-and-licenses ECEIV - ,SUN 2 3 2022 HOMEOWNERS AUTHORIZATION FORM I, YAHMOU I t -i (print name} d KING'S HIGHWAY am the owner of the property located at address: 11 Ridgewood Drive Yarmouth Ma 026; (print address) hereby authorize Trinity Solar Inc. ("Trinity Solar") and its employees, agents, and subcontractors, including without limitation, , to act as my Agent for the limited purpose of applying for and obtaining local building and other permits from the Authority Having Jurisdiction as required for the installation of a Photovoltaic System, Battery System, roofing or other Trinity Solar offerings located on my property, applying and obtaining permission and approval for interconnection with the electric utility company, and registration with any state and/or local incentive program(s). This authorization includes the transfer/re-administering, and/or cancellation of any existing permits on file for the purpose of updating/applying with an alternate subcontractor. Without limitation to the generality of the foregoing I specifically authorize Trinity Solar et al. to populate technical details, fill-in, edit, compile, attach drawings, plans, data sheets and other documentation to, date, submit, re -submit, revise, amend and modify application, submission and certification documents ("Approvals Paperwork"), including those for which signature pages are included herewith for my signature, in furtherance of the related transaction, and I am providing any signatures to Approvals Paperwork for purposes of the foregoing. Trinity Solar will provide copies of Approvals Paperwork when submitted. My authorizations memorialized herein shall remain in full force and effect until revoked. I acknowledge that these authorizations are not required to proceed with the transaction and are not a condition of the related agreement included herewith but are being given for my own convenience and benefit in order to expedite the approvals processes. Electric Utility Company: Ever50urCe Electric Utility Account No.: 14557770030 n tris Utility Account: Customer Signature Print Name 5/10/2022 Date Corporate Headquarters 2211 Allenwood Road Wall, New Jersey 07719 1 -877 -SUN -SAVES Ph: 732-780-3779 Fax: 732-780-6671 www.trinity-solar.com FOR INFORMATION ABOUT CONTRACTORS AND THE CONTRACTORS' REGISTRATION ACT, CONTACT THE NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY, DIVISION OF CONSUMERS AFFAIRS AT 1-888-656-6225. ® ma s J m O �3 Lu H U) Lu U? 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