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HomeMy WebLinkAboutbld-23-003377 12JZZ/Zit ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 • 508-398-2231 ext. 1261 Fax 508-398-0836 ' Massachusetts State Building Code,780 CMR .,e Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling; This Section For Official Use Only ' RECEIVED Building Permit Number: 130)-._ _.66)3)1 Date Applied: DEC 12 2022 ,4/1/Buildin TFicial(Prinnt ature bDING DEPARTMB Lay - - NT SEC N .SITE INFORMATION 1.1 Property Address: I.2 Assessors Map&Parcel Numbers 11 8 w �-cYi won CA. -1 a aoo 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY Y OWNERSHIP' 2.1 Owner' sL�of-CLI rd: � , uO CI� Y� r' to ,I 1- v Oa&& LI Name(Print) City,State,ZIP 1 8 W ►i-C W o o Gl v_01 5o8 co-21/0 3 i-rriaperri ir.5 e n� No.and Street Telephone mail Address . ori SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition 0 I Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work^: rk S Q+i 3 (\ 6 X c C� L Can ►-o 0 10V -- -A/vl ' K p° a i./.(.) 13.�oi 0 ►E-1 t,-) SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 7 86 ti J 1. Building Permit Fee:$ 1;cn Indicate how fee is determined: / � /' ❑Standard City/Town Application Fee 2.Electrical $ i `1 i"l , vV ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ M� 4.Mechanical (HVAC) $ List: ajfc - 3no3d. ,7 5.Mechanical (Fire $ Suppression) Total All Fees:$ • n �� Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ d dtJ ❑Paid in Full 0 Outstanding Balance Due: S • ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: ` ' B "\--00 uo n n1 Scope of Proposed Work: Date: Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept.— Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each 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 your cooperation. Receipt Acknowledgement: oq iz-z Applicant's Signature Date Rev.Jan. 2019 r SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) -0140 rl ' "l License Number Expiration Date Name of CSL Hoo der � ' , Q 5 M „Q s 1i gn d List CSL Type(see below) V (Noo..and Street l� J� r f/l7j(^ ( r n! V(�J Type Description -raun!Ur / ' ' V 1 O 8 U Unrestricted(Buildings up to 35,000 cu.ft) vv` v R Restricted l,k2 Family Dwelling City/Town,State,ZIP IvI Masonry RC Roofing Covering WS Window and Siding 2 (�J SF Solid Fuel Burning Appliances ✓ (J �aoi I I Insulation TPhone ddress�LpSu,cur,• ("ten D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 U/I 1r/' J(l r1S�Pt►.11 41(..Yl lJ I l � � Q d'� � HI Registration Number Expi ation Date F C Co any Name or HIC Re istrant Name V 1 �+� ,tom P S�1 r l V enS})'r�'.t i'Yl i &41(Lin ►.. nddS '[ Street rn� O�T7 9 '1(J 97b 7q 7 ) Email address .(0m U State,City/Town, tn ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. &CLC �Print Owner's NameLa( tronic Signature) Date • SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this ap do . e pp l a o the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(El onic Signature) e NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts t ' Department of Industrial Accidents I 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le4ib[y Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): IC i am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. Remodeling 3. I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work onproperty. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or e sol 11.(] ElectricaI repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 2'❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5_ Plumbing Inspector 6.Other Contact Person: Phone#: ,-----' SUNRINC-02 LWANG2 ACORO DATE(MM/DD/YYYY) �,, CERTIFICATE OF LIABILITY INSURANCE 8131/2022 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0C36861 CONTACT Walter Tanner NAME: Alliant Insurance Services,Inc. PHONE FAX 560 Mission St 6th Fl (A/C,No,Ext): (A/C,No): San Francisco,CA 94105 Miss,Walter.Tanner@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Evanston Insurance Company 35378 — INSURED INSURER B:James River Insurance Company 12203 , Sunrun Installation Services,Inc INSURER C:American Zurich Insurance Company 40142 775 Fiero Lane,Suite 200 Ph#805-540-7643 INSURERD: San Luis Obispo,CA 93401 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, 4 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LIRINSD WVD (MM/DD/YYYYI IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR MKLV5ENV103749 10/1/2022 10/1/2023 DAMAGETORENTED 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X Year LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Retention:$100,000 i Per Project Agg $ 5,000,000 AUTOMOBILE LIABIUTY (EOaadentSINGLE LIMIT) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSO ONLY AUTOS BODILYBODILY INJURYp (Per accident) $ A U OS ONLY _ AUTOS ONLY (Per a dent)AMAGE $ - $ B I UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE 001072261 10/1/2021 10/1/2022 AGGREGATE $ 4,000,000 DED RETENTION$ _ $ C WORKERS COMPENSATION y PER X STATUTE ERH _ AND EMPLOYERS'LIABILITY 'WC 614287601 10/1/2022 10/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y., N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ri (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation Policy WC614287601 Deductible:$1,000,000. Re:Permitting within jurisdiction. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664-4492 AUTHORIZED REPRESENTATIVE .--(. c-�L---C ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts ' Department of Industrial Accidents 9 ' Office of Investigations 1. Lafayette City Center l= 2Avenue de Lafayette, Boston, MA 02111-1750 °�M v �" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sunrun Installation Services Address: 225 Bush St STE 1400 City/State/Zip: San Francisco CA 94104 Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1.® I am a employer with 50 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ 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 employees. [No workers' 13. ] Other SO t C„C"-- comp. insurance required.] *Any applicant that checks box#I 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: American Zurich Insurance Company Policy#or Self-ins. Lic. #:WC614287601 Expiration Date: 10/01/2023 Job Site Address: 1 VV ( �l�V I- 0 Q a City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: u_25' Date: (Z/0 7 /' 7 - Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5E:'lumbing 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 a joint 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-contractor(s) 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Fax (617) 727-7749 Revised 7-2019 www.mass.gov/dia Jr IP Commonwealth of Massachusetts wp which contain DivIsion of Professional Llcrosure Unrestricted -cgs ofany�g s)of enclosed d Board of BUlldrng Regulations and Standards less than 36,000 cable feet C w11 -c t+.I1'06flt Upgrvisof sue' CS•040622 6aires:08/01/2023 STEPHEN A KELLY 16 PARKWAY-ROAD STONEHAM 4 021N .. 'VOISVI:10-tV .15 H , , Four.to possess a current edition of the Massachusetts Comrniasiohtlr t /(. �JGntl a State Budding Code is cause for revocation of this license.a For information about this license CaN(017)727-200 or visit wwwlnass.gov/dpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvsnen_;_ _...__ istration t /_/,' �1c - i i^ _ Type. Supplement Card SUNRUN INSTALLATION SERVICES INC. (T - � 10/120 21 WORLDS FAIR DR _ - --- Eypuation: 113/2024 SOMERSET,NJ 08873 __l 7r. __1� Update Address and Return Card THE COMMONWEALTH OF MASSACHUSETTS Ofllos of Consumer Affairs&Business Regulation Registration veld for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date.8 found return to: TYPE:switAoieet ceo Office of Consumer Affair.and Business Regulation KRIS gn 1000 Washington Street•Suite 710 180120 t 0,132024 Boston,MA 02118 SUNRUN INSTALLATION SERVICES INC. STEPHEN KELLY 225 BUSH STREET /(/ �a�� , SUITE 1400 `' '.4G.h —rl—} SAN FRANCISCO,CA 44104 Undersecretary N t valid without gnature Stephen A Kelly 695 Myles Standish Blvd Taunton MA 02780 TEL: 978-793-7881 Email: eastmapermits@sunrun.com TOWN OF YARMOUTH $1 BUILDING DEPARTMENT ° ls. rxcrtc,s<<4'< 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA'Ib: JOB LOCATION: \ ( i w o o d NAME c h &r S;l'KEENOu i- La-ECTSo QF TQ 2 "HOEOWNER" a NAME HOME PHONE WORK PHONE PRESENT MAILIITG ADDRESS CITY OR TOWN STA I'I ZIP CODE The current exemption for `Homeowner' was extended to include owner—occupied dwellings 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 R5.1.3.1) 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 buildins 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, rules 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 l 1 ti APPROVAL OF BUILDING 01~1-1CIAL 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 ves, 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 that the licensee does not have the insurance coverage required by Chapter 142 of e M s Gewal Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:horneownrlicexernp §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR - Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at I t ' �, )4n Vv© d P J Work Address Sunn;n Is to be disposed of oat the following location: ' mt 69` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. •Aef141.' 0,/oq22� Signature of Application Date Permit No. DocuSign Envelope ID:B318090E-F5AF-48E3-B9CD-2FBB8A62E3B0 Sunrun BrightSaveTM Agreement Richard Voutselas 118 Witchwood Rd, Yarmouth, MA, 02664 Take Control of Your Electric Bill SO 25 Years $217 $0 .21 0 Deposit due Agreement Term Length Monthly Bill for Year Year 1 Cost per kWh Today (3.5% annual increase One (plus taxes, if applicable; (excluding upfront in monthly bill) includes $7.50 discount for payment, if any) Auto-Pay enrollment) WE'VE GOT YOU COVERED WITH OUR WORRY-FREE SERVICE , Er 3 „ ' .4e) Viif ' ''s9 We provide hassle-free We monitor the system We warrant, insure, Selling your home? design, permitting, and to ensure it runs maintain and repair We guarantee the buyer installation. properly. the system. We will qualify to assume also provide a 10- your agreement. year roof warranty. A SOLAR SYSTEM DESIGN FOR YOUR HOME You get a 12.41 kW DC Solar System With 34 Solar Panels and 1 Inverter(s) Which will produce an est. 12,412 kWh in its first year And offset approx.80% of your current, estimated electricity usage YOUR SALES REPRESENTATIVE: Anthony Gallo anthony.gallo@sunrun.com (857) 250-7495 DocuSign Envelope ID:B318090E-F5AF-48E3-B9CD-2FBB8A62E3B0 By signing below, you acknowledge that you have reviewed and received a complete copy of the Agreement without any blanks. Such Agreement shall be the complete understanding between the Parties. SUNRUN I iNs fpN SERVICES INC. Signatur : CALA. sa S 90F56FD25D954C9... Print Name: Carlos solano Date: 10/20/2022 Title: Project Operations Federal Employer Identification Number: 26-2841711 IF YOU CHOOSE TO PAY BY CHECK, MAKE CHECKS OUT TO SUNRUN INC. NEVER MAKE A CHECK OUT TO A SALES REPRESENTATIVE. OUR SALES REPRESENTATIVES ARE NOT AUTHORIZED TO RECEIVE CHECKS IN THEIR OWN NAMES. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE TENTH EFFECTIVE DATE. PLEASE REVIEW THE ATTACHED NOTICES OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. Customer "PriraimpAccount Holder Secondary Account Holder (Optional) --D�i Richard Voutselas Signature 10/20/2022 Date Print Name Email Address*: rvoutselas@mac.com Mailing Address: 118 Witchwood Rd Yarmouth, MA 02664 Phone: (508) 922-2203 *Email addresses wi//be used by Sunrun for official correspondence, such as sending monthly bills or other invoices. Sales Consultant By signing below/acknowledge that/am Sunrun accredited, that/presented this agreement according to CS*Jr? Code of Conduct, and that/obtained the homeowner's signature on this agreement. 1.n i a,o. gunn,sa 7 t16 161624 Thiago Barros Print Name 1554049374 Sunrun ID number Sunrun Installation Services Inc. 1225 Bush Street, Suite 1400, San Francisco, CA 94104 1 888.GO.SOLAR I HIC 180120 Contract Version: 2020Q1 V1 Generation Date: 10/20/2022 Proposal ID: PK4A3VFZDCVL-H Version 2020Q1V1 21 NOTES AND SPECIFICATIONS_: AWARNING INVERTER 1 •SIGNS AND LABELS SHALL MEET THE REQUIREMENTS OF THE NEC 2020 ARTICLE 110.21(B),UNLESS SPECIFIC INSTRUCTIONS ARE REQUIRED BY SECTION 690,OR ELECTRICAL SHOCK HAZARD PHOTOVOLTAIC DC DISCONNECT IF REQUESTED BY THE LOCALAHJ. - _--- •SIGNS AND LABELS SHALL ADEQUATELY WARN OF HAZARDS USING EFFECTIVE MAXIMUM SYSTEM VOLTAGE 480 VDC WORDS,COLORS AND SYMBOLS. TERMINALS ON LINE AND LOAD •LABELS SHALL BE PERMANENTLY AFFIXED TO THE EQUIPMENT OR WIRING SIDES MAY BE ENERGIZED IN METHOD AND SHALL NOT BE HAND WRITTEN. LABEL LOCATION: •LABEL SHALL BE OF SUFFICIENT DURABILITY TO WITHSTAND THE ENVIRONMENT THE OPEN POSITION INVERTER(S),DC DISCONNECT(S). INVOLVED. PER CODE(S):NEC 2020:690.53 •SIGNS AND LABELS SHALL COMPLY WITH ANSI Z535.4-2011,PRODUCT SAFETY LABEL LOCATION: SIGNS AND LABELS,UNLESS OTHERWISE SPECIFIED. INVERTER(S),AC/DC DISCONNECT(S), •DO NOT COVER EXISTING MANUFACTURER LABELS. AC COMBINER PANEL OF APPLICABLE). PER CODE(S):NEC 2020:690.13(B) WARNING: PHOTOVOLTAIC AWARNING POWER SOURCE LABEL LOCATION: DUAL POWER SUPPLY INTERIOR AND EXTERIOR DC CONDUIT EVERY 10 FT, SOURCES:UTILITY GRID AT EACH TURN,ABOVE AND BELOW PENETRATIONS, ON EVERY JB/PULL BOX CONTAINING DC CIRCUITS. AND PV SOLAR ELECTRIC PER CODE(S):NEC 2020:690.31(0)(2),IFC 2012: SYSTEM 605.11.1.4 CAUTION . LABEL LOCATION: UTILITY SERVICE METER AND MAIN ■ SERVICE PANEL. PER CODE(S):NEC 2020.705.12(C) - -- AWARNING IDSHUTDOWNSWITCH MULTIPLE SOURCES OF POWER POWER SOURCE OUTPUT CONNECTION R SOLAR PV SYSTEM '�' DO NOT RELOCATE THIS SOLAR PANELS OVERCURRENT DEVICE LABEL LOCATION: ON ROOF INSTALLED WITHIN RAPIDSHUT DOWN S u n r u n LABEL LOCATION: SWITCH PER CODE(S). NECN202020:890.58(q(2),IFC ADJACENT TO PV BREAKER AND ESS 2012:605.11.1,IFC 2018:1204.5.3 OCPD(IF APPLICABLE). — PER CODE(S):NEC 2020 4^ 705.12(8)(3)(2) _ AWARNING SOLAR PV SYSTEM EQUIPPED _ #180,20 MILES STANDISH BLVD TAUNTON I.0P9079l PHOTOVOLTAIC SYSTEM WITH RAPID SHUTDOWN F.0 COMBINER PANEL DO NOT ADD LOADS _. CUSTOMER RESIDENCE: RICHARD VOUTSELAS LABEL LOCATION: 118 WITCHWOOD RD, PHOTOVOLTAIC AC COMBINER(IF YARMOUTH,MA,02664 APPLICABLE). 3" TURNRAPIDSHUTDOWN MAIN PANEL (INT) PER CODE(S):NEC 2020:705.12(D)(2)(3)(c) SWITCH TO THE"OFF' LAfTI AA,�s 7 TEL(508)922-2203 POSON TO SHUT DOWN APN:YARM-000078-000200 PV SYSTEM DISCONNECT PV SYSTEM AND REDUCE PROJECT NUMBER: MAXIMUM AC OPERATING CURRENT: 42.0AM SHOCK HAZARD IN THE INVERTER (EXT) 223R-118VOUT NOMINAL OPERATING AC VOLTAGE: 240 VAC ARRAY. El PRODUCTION METER- SERVICE 415)580-6920 ex3 FUSED AC DISCONNECT- ENTRANCE DESIGNER: :.4CEL LOCATION: RIZWAN ALI DISCONNECT(S),PHOTOVOLTAICSYSTEMPOINTOF 118 WITCHWOOD RD, YARMOUTH, MA, 02664 SHEET INTERCONNECTION. PSR CODE(S):NEC 2020:690.54 LABEL LOCATION: PER CODE(S):NEC 2020:705.10,710.10 S IGNAGE ON OR NO MORE THAT 1 M(3 FT)FROM THE SERVICE DISCONNECTING MEANS TO WHICH THE PV SYSTEMS ARE CONNECTED. REV:Al 12/8/2022 PER CODE(S):NEC 2020:690.58(C) PAGE PV-5.0 Txnpl.h wLon_40.87