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HomeMy WebLinkAboutBLD-23-000472 . _ /? a.,"ktk 7/Zq/21 ONE & TWO FAMILY ONLY-BUILDING PERMIT ---..._.-.ry,.-,,,, _ Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 �' a 508-398-2231 ext. 1261 Fax 508-398-0836 '' . Massachusetts State Building Code,780 CMR ' 2Q22 Building Permit Application To Construct, Repair, Renovate Or Demolish - ." a One-or Two-Family Dwelling B U I L D-4.'1 By, fi This Section For Official Use Only "" ^-i Building Permit Number:80-A I b 6 Q 477; Date Applied: . Building Official(Print Name) gnature . Date SECTION 1:SITE INFORMATION . 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 24 Hazelmoor Rd, Yarmouth, MA 02664 1.1 a Is this an accepted street?yes X 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 Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,I54) 1.7 FIood Zone Information: 1.8 Sewage Disposal System: PubiicX Private 0 Zone: _ Outside Flood Zone? Check if yes❑ MunicipaX On site disposal system 0 SECTION 2: PROPERTY OWNERSI 1 2.1 Owner'of Record: Winslow Thayer Yarmouth, MA 02664 Name(Print) City,State,ZIP 24 Hazelmoor Rd 774-212-7268 samwln6@comcast.com No.and Street Telephone Email Address ' SECTION 3:.DESCR.IPTION OF PROPOSED WORK2(check-all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units , Other yXSpecify: Rooftop Solar Panels Brief Description of Proposed Work2: Installation of an interconnected rooftop PV system.8(340w)panels.2.720 KW DC. No structural changes required.No ESS. SECTION:4i ESTIhi IATED CONSTRUCTION COSTS. : Item Estimated Costs: •(Labor and Materials) Official Use Only 1.Building $ 421 :1.:Building Penu.Et'Fee.$ . ,.. .) Indicate how fee:is determined: 2.Electrical $ 983 Cl Standard City/Town Application Fee: 3.Plumbing 0 0 Total Project Cost'(Item:6)x multiplier. . x $ 2. Other.Fees: $ =. . .. • .. . . 4.Mechanical (HVAC) $ o List 5.Mechanical (Fire Suppression) $ 0 Total All Fees.$ :- - 6.Total Project Cost $ Check No, Check Amount: Cash Amount: ' 1404 ❑Paid in'Full ❑Outstanding b Balance Due: ''. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Roland M Brandt CS-085141 03/21/2023 License Number Expiration Date Name of CSL Holder 734 Forest Street,STE 400 List CSL Type(see below) U No.and Street • Type Description Marlborough,MA 01752 U Unrestricted(Buildings up to 35,000 cu.ft.) _ City/Town,State,ZIP R Restricted 1842 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-319-5682 centralmapermits@sunrun.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Sunrun Installation Services 180120 10/13/2022 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 734 Forest Street,STE 400 No.and Street centralmapermits cr sunrun.com Marlborough,MA 01752 978-319-5682 Email address City/Town,State,LW 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 X No ❑ 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 Sunrun Installation Services to act on my behalf,in.all matters relative to work authorized by this building permit application. See Agreement 07/27/2022 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AU'1 HORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in 's application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) 07/27/2022Date • 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.gov/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" t;tlr1tr11e111vve.elttt 11t mas.,,a1 t11ts€'tis Pivl%lltn t1f Pr1otesclltriai 111.ensure 8o, ret or Building Regulations and Standards t',)oslruCtit i ` op rvist r �.S-0851, ke Expires: 03/21/2023 ROL 4 BRANDT 305 F ST W I N C Al MA 01475 =� ♦4` Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card SUNRUN INSTALLATION SERVICES INC. Regisiration: 10 225 BUSH STREET Exxpiration: t01 1 13f2022 SUITE 1400 SAN FRANCISCO,CA 94104 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date.If found return to: Reorstrahnn agitation Office of Consumer Affairs and Business Regulation 180120 10/132022 1000 Washington Street-Suite 710 SUNRUN INSTALLATION SERVICES INC. Boston.MA 02118 ROLAND BRANDY i A 225 BUSH STREET SUITE 1400 Undersea=ta Not valid without signature SAN PRAN-ISCO.CA 94104 - ty Mglige Roland Brandt License=CS-085141 Exp 3/21/2023 Tel#978-319-5682 Mailing 734 Forest ST STE 400 Marlborough MA 01752 Email:centralmapermits@sunrun.com �.....N SUNRINC-02 TWANG A�ORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/10/2021 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 NAME: Walter Tanner Alliant Insurance Services,Inc. PHONE FAX 575 Market St Ste 3600 (A/C,No,Ext): I (A/C,No): San Francisco,CA 94105 E-MAILDSS:Walter.Tanner@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Navigators Specialty Insurance Company 36056 INSURED INSURERB: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 INSURER D: 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, 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 LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR LA21 CGL230321IC 10/1/2021 10/1/2022 DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X PE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Retention: $100,000 Per Project Agg $ 10,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ B _ 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 TA _ $ AND EMPLOYERS'LIABILITY X STUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC614287600 10/1/2021 10/1/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation Policy WC614287600 Deductible:$1,000,000. Re:Permitting within jurisdiction. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664-4492 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) The ACORD name and loco are reaistered marks s of ACORD1988-2015 CORPORATION. All rights reserved. ACORD ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 24 Hazelmoor Rd, Yarmouth, MA 02664 Scope of Proposed Work: Installation of an interconnected rooftop PV system. 8 (340w) panels. 2.720 KW DC. No Structural changes required. No ESS. Date: 07/27/2022 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. Rec-i.t A nowledgement: fieff 54tsaratfl 07/27/2022 Applicant's Signature Date Rev.Jan. 2019 The Commonwealth of Massachusetts Department of Industrial Accidents ,� Office of Investigations Lafayette City Center • 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): Sunrun Installation Services Address: 225 Bush St STE 1400 City/State/Zip: San Francisco CA 94104 Phone #: 978-319-5682 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 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. Remodeling❑ shipand have no employees These sub contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.= 9. ❑ Building addition [No workers' 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] T c. 152, §1(4), and we have no 13.� Other Rooftop Solar 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. i 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. #:WC614287600 Expiration Date: 10/01/2022 Job Site Address: 24 Hazelmoor Rd City/State/Zip:Yarmouth, MA 02664 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 hereb rti and he pains an penalti of perjuiy tl tie information provided above is true and correct. Signature: 0 Date: 07/27/2022 Phone if: 978-319-2021 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 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: o� YAR E TOWN OF YARMOUTH o BUILDING DEPARTMENT )-3 _ 114� Route�S, South Yarn ©uth, CIA 02664 S08-398-223I ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE': 07/27/2022 JOB LOCATION: Winslow Thayer 24 Hazelmoor Rd,Yarmouth,MA 02664 NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Winslow Thayer 24 Hazelmoor Rd,Yarmouth,MA 02664 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 24 Hazelmoor Rd Yarmouth Massachusetts 02664 CITY OR TOWN STATE 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 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,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 APPROVAL OF BUILDING Orr'ICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. YesX No If you have checked yei,please indicate the type coverage by checking the appropriate box. A liability insurance policyX 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 the Mass. General Laws and that my signature on this permit application waives this requirement. (-2...41041 Aseikasior, Check one: Signature of Owner or Owner's Agent Owner AgentX h:homeownrlicexemp sunrun j ■ t • Sunrun Inc. 1.855,4SUNRUN sunrun.corn OWNER'S AUTHORIZATION FORM For Permit Application(s) 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: Winslow Thayer Solar Project; ssbY� Signature: L DF70DEOOD143411... Owner's Authorized Company: Sunrun, Inc. Company's Address: 595 Market St 29th Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA CSLB#959975. NJ#13VH07020300 sunrun Astray.1.6 June 27,2022 PILIL CAT 1 Subject:Structural Certification for Proposed Residential Solar Installation. 4,.P\tH OF ygssq Job Number:221 R-024THAY;Rev A � SAMUEL CY Client:Winslow Thayer BROWN rrri a CIVIL —I Address:24 Hazelmoor Rd,Yarmouth, MA,02664 " No15503 `" -. FTC%\, �roNAI Attn:To Whom It May Concern Signed on:6/27/2022 A field observation of the existing structure at the address indicated above was performed by a site survey team from Sunrun.Structural evaluation of the loading was based on the site observations and the design criteria listed below. Design Criteria: •MA 9th Ed.CMR 780(2015 IRC/IBC/IEBC),7-10 ASCE&2015 NDS •Basic Wind Speed V= 140 mph, Exposure B •Ground Snow Load=30 psf,Min Flat Roof Snow Load=25 psf Based on this evaluation, I certify that the alteration to the existing structure by the installation of the PV system meets the requirements of the applicable existing and/or new building code provisions referenced above. Additionally,I certify that the PV module assembly including all attachments supporting it have been reviewed to be in accordance with the manufacturer's specifications. Results Summary(Hardware Check Includes Uplift Check on Attachments/Fastener,Structure Check Considers Main Structure) Orientation Attachment Spacing/Cantilever Configuration Max DCR Result Landscape 64/25 Staggered 52% Pass AR-01 Portrait 48/24 Staggered 62% Pass Roofing Material Pitch Structure Check Comp Shingle 25° Pass • 225 Bush St.Suite 1400 San Francisco,CA 94104 • 1 ._. ,. < 3D N� • mAmZ3CD co (� DO • 011D mDo<O{ C) z Z D 2 Z om Z oo A OC O Z Zm moD ,m0 Zx-Ir3 `.I 0,.. K � KDm r.. 73OCn m K,,i ? 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