HomeMy WebLinkAbout55 Marshside Dr - building permit solar wolfONE & TWO tr'AMILY ONLY- BT'ILDING PERMIT
TowD of Yormouth Bulldlng DsPArtment
t 145 Route 28, South Yarmouth, MA 026644492
508-398-2231 ext t25l Fax 508-398-0836
Massachusetts Statc Building Code, 780 CMR
Building Permil Applicatio To Consb'uct, RePait, Renovale A' Deuolish
a One- or Tt'o-Famtly Dwelling
0
P
This Section For Oflcial Use tt
?-n-7LDatc Applied:Buildias Permit Numbor:I
Buildhg Officid (Plilt Non.)DsteSign6hr.c
SECTION 1: SITE INTORMATION
1.2 Assessors Map & Parcel Numbers
ParcclNumbcrMap Numb..
l-l ProDertv Addrcss:(6 i'nryt(,-t5'1q-1
l la Is this arl acc€pted street? ycs_ no-
l>(
1.4 Property Dimensions:R EC
t t Arca (sq f!)
1.3 Zoniog Information:
ZoniqgDistrict Proposcd Usc
1.5 Building Setbsck (ft)
YardSidc Yards
Required DrN{Ao[XEdAHiRequircdPmvidcdProvidedRcquircd NI
D
1.8 Sewage Disposal System:
Municipal tr On site disposal sysre{r D
I.7 Flood Zore Informrtion:
Zond _ Outside Flood Zonc?
Orcck ifycstr
l.6lvater Supply: (M.C.L c.40, {54)
Public tr PriYatc Cl
SECTION 2r PROPERTY OWNERSqIPI
City, Srarc, zIPNamc (Print)fc611'tflp1o"ttn tr1
EmoilAddressTclcphoncNo. alld Srcet
Anl,
r+ ^^A A2u1t\ArM(I}'ntr
n t3L(45 Nlf,*rsnsrd.
|l OwnerlRecord:
)ftr^, t<, P<'t r:l( tl
SECTION 3: DESCRIPTION Of EROPOSED WORK! (check all that applv)
Alteration(s) g Addition trOwner-Occupied o I nepairslg trNew Consruction B
trl. L crOther tr SpcciryNumber of UnitsDemolitiontrAccessory Bldg. tr
Brief Descriptioo of Proposed Work2 INSTALLATION TAL AOF /q SOLAR PANELS TO TO
IIHASMAT<IMEIEK KEIFTOP SOLAH sYS I EMtioo
Official Use OnlyEstimated Costs:
(Labor and Matcrials)Item
$a,l. Building
\ rfJs' , 6'u$
s3. Plumbing
$4. Mechanical (IIVAC)
$5. Mecbanical (Fire
Supr€ssio[)
tr Staldard City/Tovm Appticatioo Fge
tr Totat Projcct Cosd (Iten 6) x Eultiptiar
-
x
-
2. Othcr Fces: $-
List
Tordl All Fe6: $--
Check No. Chec& AEord Cssh A.Eouff--
bdicate how fee is dctcrmined:1. Building Permit Fec: $-
tr Paid iD Fu[E Ourstaldhg Balance Due:$/J ltrt6. Total Project Cost:
ED
RTI\,lENT
?2
IV
Frcnt Yatd
Existing Building tr
SECTIoN 4: ESTIMATED CONSTRUCTION COSTS
2. El.ectical
SECTIoN 5: CONSTRUCTION SER]/ICIS
Erpiratlon D.-
u
2-19-2024
LIit CSL Typc (rcc bolow)
clnscNumbcr
87491
Type Dcsc.iptjon
U d to 15 000 cu. n"
R Rcsr.icicd I&2 Fami Dwcll
lvl
RC Roofi Co
ws Window .!d Sidi
SF Solid Fucl Buming ce5
I iosul8tion
5,1 CorutructloD SupGwisor Llc.nse (CSL)
Ted Strzelecki
Emsil sddrcss
508-538-9445 operations@solarwolfenergy.com
Barre MA 01005
No. ond Stlc6t
CiV/Iown, St6i., ZP
Nune ofCSL Hold6
582 Wauwinet Road
D Dcmolitioo
5,2 Reglstercd Eomc ImproycEent Contr8ctor (nIC)
Solar Wolf Energy
Tclc
508-538-9445
1864n0
HIC Rcgistration Nuobcr
Email addrlss
larwolfenergy.comoDerations@so
))I 1-A-
Expiradon Date
SECTIoN 6: WORXERS, COMPENSATTON BTSURANCE AtrFIDAVIT (rvI.G.L. c. 1s2. S 2sC(O)
vitorkErssationslEanceIIaffi<ia ustm be letedCompea aEd bmiftedsu with thiscomp
0ris affldavi resulI u]the denial theof ossuanc thet llb diI permlIag
Siglrd Affidavit Attacbed? Ycs NoE tr
AUTHORIZATION TO BE COIVIPLETED WIIEN
MRACTOR A?PLIES FOR BIIILDING PEfu\IIT
SECTION 7a: OWNER
OWNER'S AGENI'OR CO
to act oll ruy behalf, in all matters rclative to work authorized by this buildirg permit applicatjoa.
Prift Olvncr's Narnc (El.ctronic SignEtuc)Datc
Please see attached owner auth
I, as Onuer oftlrc subjecr plope y, hcreby au.,trorize
WNER,sEcTto b:AIITU ON7NooRoDRIZEGENTADECLA-RATI
By cn:ering my name below, I hEreby attest under the paias ard peDalties ofpciruy that all ofthe information
coatained in this applicatioD is tue aod accuBre to the best ofmy larorvledge and undcntandilg.
Plint Owner's or Ag.ot's Namc (Elcctonic Sigoature Date
-/oZ 3-17 -22
NOTES:
hfo[n8tion
OrvnAn who btainso buaiI to dodiogpermit anol lvhow_ner hireso aowork,lstered coDtractoruueg
re thelI Home(not gistered torContracImprovcmcot iI ha accessvec)(Hr theto afu),Progtur not itratioIorutrdertutrdpro8lamGMc.L.42A.guaranty thero ant the0n cI]I Proimport be atfoundgrart
ooIafornati theoo Cotrstruclylrw.mass.qov/oca tion S Llcens€can foundupervisor wvv.mass.sov/dDs
Number of
2. Whcn substatial wort is plaued,provid€ the information bclow:
Numb€r ofbatbrcoms
(including garagc, finished basement/anics, decks or porch)Total 0oor area (sq. ft.)
Gross living area (q. ft,
Type ofbeating system
Typc ofcooling system
l.Iuorber of deckV porchcs
EDclosed
Habitable room coust
Number of bedrooms
Number of balt/batbs
"Total Project Square Footage,' may be substituted for ..Total3 Project Cost''
Mason y
HIC Company Namc ortflaffi
77'l Washington Street
No. ard Strcer
Alhurn MA 01501
Cit /Town, SEtc, zIP
application. Failue to provide
3-',t7 -22
his/her
can
be at
l\iolkcrs' Compcn
Thc Commonweakh of Massach,,sctts
Dcpartmeat of Industr lal AccidentsI Co'l.gress Strcet, Suite 100
Boston, MA 02114-2017
www.mass.tou/dld
sstion IBsurance Aflidavit: BuildGrs/Cortrsctors/Electrlcians/plumbers.
TO BE FILED WITH TEE PERMITTING AITTHORITY.
Name (Busincsrortn!izttionnhdividuEl);
Addres:
l.[ I rm r crnploycr with _employccs (full !ndo. prn-tirnc),.
1E I &n ! Nolo propiicto. or F.tr.rihip iid h.vi ro cmploycts working for mc in.ny clFcity. [No \rorlclrs'conp, inrunncc rcqlirca.]-
3.! I am e hcnco,.nr{ doint dl vro* rrrysclf (No u/o.Lcrs. comp, in$t!nc. rcquirld.l r
4 ! I am a homcorwrr and will bc hiritB drEa.rors b cooduct.ll wo* oo n, pmpcrty. I willensuaa tlal all conEacloc aidEa hrva e,ottars, conpcnsuion irsuoncc or-rc solc '
propriclo.s with Do loDloyc.s.
s.fJ I .m a glocr.l contacror lrd I tEvc birrd th! srlb-cooEelo.i tiltld on rl}! .drchrd shc.tThest sugqgnfaclgB blra c$plora.s td hav. \r,o*e", *rp. i*u,"o".f -- '-- -"--'
6.[ Wc ert r capontiofi &d its otIlc..! ]Evc cxcrcircd thcir righr ofcxctllptirrn prr ivlcl c.l52, r l (1). ard vr hw! no cmploy!... [No work rs, "orp]ln*tar*",.quiri.t'
-- -'
City/StateZip:Phonc #:
lAnv applicrnt tlut chccks hox # t must rlso fill ol.a lhc scction bclow showing dEir u/orkcrJ' compcnsation policy informatiorrHomcown.rs who submit this rfiid.vit indicating dtcy arc doing lll work and thcn hirc outsid. conts&tors must $bmit ! ncw nfrdsvir indicsting suc[lconr&to.s that chcck tllis box must attachcd an addirio.al sl1€ct showing the rrm. of thc suuaonElarors aDd ltEtr whcthd or not tholc
Type of project (rlguirrd):
7. ! Ncw construction
8. ! Rcmodcling
9. D Dcmolition
l0 fl Building addition
I l.! Electrical repairs or additions
l?.! Plumbiog repairs or additions
13.IRoofrcpain
Other
lf lh? suEcoruraDtoE havc cm?loyccs, thcy
I arn an emploler that is Ftroviding worken'
btlormalion.
must p(ovidc th.ir workcn'comp. poticy numbcr
cntitils hav.
compensation lwarcnce for my emploleet Below is the poticy and job site
lnsurancc Company Name:
Job Site Addrcss:_
l,ttn.t u .opy ot y;"rn* rr*rA"*" *Orailuc to sccule coverage as requircd. under MGL c. l5l $25A is a orimiual violation punishable by a fine up to s1,500.00and'/or one-year imprisonmenL as well as civil penaltics inihe torm of asiop wonxbropn *jran" oi'ufto $zso.oo aday €ainst thc violator' A copy ofthis statement may be forwarded to thr officc of hv"stig"tion. ortt " ore.To, iusuoncecovcrage vcrification.
Policy * or Self-ins. Lic. #Expiration Date:
I tlo hereby c$tify ruttlertlrc pains au.d penalttes olperjury lhar the ir{on talion provided above is true and correcl
l: 3fif rt'*'* 2' Building Dcparhaent 3. citv/Tox.o crcrk 4. Erectricsr lmpcctor 5. prumbi,g tnsp€stor
PermiVLicense #
Phone #:
OfJicial use only. Do ol wrlte in this arco, to be cohpleted U city ot tow,t o[Jicial
Contrct Person:
lssuiog A[thority (circte ore):
City or Town:
Aft you rn afiploycr? Chccl( thr.pproprl.ta bor:
t4.E
DATE:e< lwshsJOB LOCATION: -J ),tl,.l Dr Ynrurr.,xn6,4 AA
PLEASE PRNT:
"HOMEOWNER"
02Lll
AME STREET ADDRESS SECTIONOFTOWN
,8'nU l.)
NAtvIE HOMEPHONE WORKPHONE/orR-r.rnPRESENT MAILN\G ADDRESS Sr+rru GI
CITYORTOWN STATE ZTPCODE
The current exemption for 'Homeowner' was extended to include owner - occupied dwelliaes of one or two units
atrd to allow such homeowners to engage an individua'l for hire who does not possess o license, orovided that such
homeowner shall act as supervisor. (State Building Code Sectioo 110 R5.1.3.1)
Defi nition of Homeowner:
Penon(s) who owns a parccl of land on which he / she resides or intends to reside, on which tlpre is or is intended to
be, a one or two famiiy attached or detached stnrcture assessory to such use and / or farm structures. A person who
constnrcB more than one home iu a two-year period shall not be considered a homeowner; such "homeowner" shall
submit to the buiiding official, on a form acceptable to the building official, that he / she shall be resoonsible for al1
such work performed under the buildins perq{t. (Section i10 R5.1.3.1)
The undersigned 'homeowner' assumes responsibility for compiiance with the State Building Code and other
applicable codes, byJaws, rules and regulations.
The undersigned 'homeowner' certi-fies that he / she understands the Town of Yarmouth BuildiDg Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements .
HOMEOWNER"S SIGNATURE
INSURANCE COVERAGE:
I have a cunent liability insurance policy or its subsrantial equivalent, which meets the requiremeots of MGL
Ch.l42. x Yes No
If you have checked ves, please iudicale the qpe coverage by checking the appopriate box.
A liability iosurance poliry , OSer type of indemnity Bond
Check one:
Owner AgentSi$ature of or Owne.r's Agent
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarrnouth, MA 02664 508-398-2231 ext, 1261
HOMEOWNER LICENSE EXEMPTION
APPROVAI OF BI.IILDING OFFICI,AL
OWNER'S INSURANCE WAMR: I am aware that the licensee does not have the insurance coverage required by
Chopter 142 of the Mass. General Laws and that my signature on this permit applicatiori waives this requirement.
-/a/ Saja/a4/)
h: homaowM{iccredp
$TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 ext. 1261 Fdx 508-398-0836
Oflice of the Buittling Commissioner
BUILDING DEPARTMENT
DEMO LITION DEBRIS DISPOSAL AFFID AVTT
Pursuant to M.G.L' Ch. 40, $54 and 780 CMR - Section 105'3'l' #4'
I hereby certifi that the debris resulting from the proposed worvdemolition to be
,/conductedat )5 tvtr hsrrJu D.5
Is to be disposed of oat the following location:771 Washington Street, Auburn, MA 0'150'1
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
ch. 111, $1504.
Signature of lication Date
Permit No.
Work Address
7oZ Sa,<&*;3-',t7 -22
10/2021
THls CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERIIFICATE I'OLDER, THI3
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AiIENO, EXIETIO OB ALTER THE COVERAGE AFFOROED BY IHE POLICIES
BELow. THlg CERnFlcAIE oF tNsURANcE ooGs lroT coNsTrTuTE a CONTRAoT BETmEN THE rgsUrNG rNsuRER(s). AuTHoRlzEo
REPRESENTAIIVE OR PROOUCER, AND THE CERTIFICATE HOLDER.
isr{ntcateToiaatls .|r AoDlTloNAL lNSuREo, tha pollcy(|..) mu.t h.vo ADqITIONAL INSUREO provl.loir or be endor..d,
It SUBROGATION lS WAIVEO, tubr.ct to thc t rm! lnd condltioni ot ifi. pollcy, c.rtllo pollcl.a mry r.qull! en .ndoriement. A .tatem.nt on
lhlt cartlflcat. doat nol conf.r rlghtr to tha c.(lflcata hold.r in llcu ot.uch andoraamanl(t)
llrPORTAtlT: ll th.
s08-r92-0{11
I}ISUREF A . NAUTILUS
I,TBBRTY NUTUA!
o.#CERTIFICATE OF LIAEILITY INSURANCE
iRoDucEiLalb Inauranca
537 Perk Avcdu.
worcoBt... uA 01603
TSUREO
SOLIN WOIJ' ENENCT
? 11 WASHINOTOX St
AUBURII XA
COVERAGES CERTIFICATE NUI/lBER
CANCELTATION
REVISION NUMBER:
woaxEis coFEllSaTIol{
AIO EMPIOYERS' TA6ILI'Y
B!
ANYPROPRIETOF/PARTI{ER'E.XECUITVE
OFFICER/UEJVBEREXCLT-IOEO?I
I
CERTIFICATE HOLDER
HAVE AEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLrcY PERIOO
ANO CONDITIOflS OF SUCH POLICIES. LIMITS SHOW! MAY HAVE BEEN REOUCED AY PAIO CLAIMS.IFICATE
USIONS
CERT
EXCL
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW
OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THISINDICATED, NOTWTHSTANDING ANY REOUIREMEI'IT, IERM OR CONDITION
BY THE POLICIES O€SCRIEED HEREIN IS SUBJECT TO ALL THE TERMS,MAY BE ISSUED OR i/IAY PERTAIN. THE INSURANCE AFFORDED
oa[A6tloHElqrEo _
PREMAES IE.oe!,rtd)
MEO EXP (Anv @ D.Eon)
r 10 0,000 .
!L, ooo, doo
r 5, 000
P€RSONAI- A AOV INJUFY ! 1, O00,00O
t 2,000,000GENERA AOGiEGATE
! 2,000,000PROOI]CTS . COMP.'OP AGG
5
Nrr1207723
*,u*o. fi] o."r*
6EN'I AGoREGATE IIMIT APPIES PER:' r---l PeG T---]PqrcY L ] J€CI L I
X
N
LOC
saOolLY IIUURY (PU p.l6)
$
I
AOOILY INJURY (P, reid.n0 3
-ewor6iur.ur-nvI lexveurol 1 o,vro l--.1L j aLnosofiLY L-lI |{REO I rl-l**** il
scSeouLEo
I
s
!DEO
€lcEas ua8f
a 1,000,000
3 1,000,000
DISE'SE, POLICY UMII
oa/r012022 E L, OEEASE. EA
31,000,000
T_
1,",oa/r0/7o2t- 31S - 51{936 - 020
I
I
YAAI{OIIIE tOI{!' III,.L
11{5 ROrrfE 28
Yln}l()IrrE PoRr, xl 02664
ACORD 25 {2016/03)
TION. All rights .!s.rvod.
si:
The ACORD n.m€ .nd logo ar! r.gLt rid m.rt5 oa ACORL
lNSUflER(!) AFFORO[i6 COVERAGE
A
5
L
I
DESCRiPnOI OF OPEMTloTaS / tOCArlOllS I \rEtllCLEg IACORO 10t, Addliodl R.rort. sctrduL. 6., b..tb.h.d i 'rl@.r.e i. r.addd)
l
SHOUID AI{Y Of IHE AAOVE OESCRBEO POLIC1ES B€ CAI{CEI-rID AEFORErHE EXPIRATIOT{ DATE IHEAEOF, IIOTICE wlLL BE O€LIVEREO IX
AC@RDAI{CE WITH THE FolICY PRO\'lsrc)IIS.
Commonwealth of Massachusett
Division of Professional Licensur*lu,
Board of Building R ulations and Standai.
Cons(r1r$t isor
cs-087491
TED C STRZ
#Exp ires: 02119/2022
ELE
582 WAUWI
BARRE MA
NET
010
/
)t
Commissioner K da*'or*
I
It't.l;I.IIIt't'I
I
/
24t7
Ma$sachusetts af Cantpl"efrLowContractors Academy C
A PDH Academy Company
Ted Strzelecki
cs-087 491
has completed the
Massachusetts Contractor Classroom Renewa! Course Part 1
Approval # CS-0102L2
Code Review 2 hours
Workplace Safety 0 hours
Business Practice I hour
o2l17l2O22
Energy 0 hours
Lead Safety t hour
Elective 2 hours
Coordinator: Annie Schultz, Program Manager Coordinator Number: CD-000102
lf you have any comments about this course offering, pleose mail them to the Boord of Building Regulations ond Stondords, CSL,
Continuing Educotion, One Ashburn Place-Room 7307, Boston, MA 02108
,%#.3"-r-rrror"o,Z./r/-%rrJrird"/b
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 71 0
Boston, Massachusetts 021 18
Home lmprovement Contractor Registration
Type:
Registration:
Expiration:
Comoration
186400
111O6t2022SOLAR WOLF ENERGY INC,
771 WASHINGTON STREET
AUBURN, MA 01501
Update Address and Return Card.
. r,. 'a.,,.,,,,,,., ,,,///; //. //.t).,-,t-.././1.
Otflc. of Coniurni Aff.lrt & Buin... R.guErbn
HOME IM PROVE}I E}T COiTTRACTOR
TYPE: CorDdatonRedffion Expirrtlon1S.(X) 't1t06no22
SOLAR WOLF ENERGY INC,
U n dersecretary
ReeisHion valful fo. individual uso only
boforo tho oxpiration dat6. lf found roturn to:
Otfce of Consum€r Affairs and B!6inoss Rogulation
t0O0 Washlngton Street - Suite 710
Boston, MA 02118
TED STRZELECKI
771 WASHINGTON STREET
AUBURN. MA 01501
tZ..-( A i':*a./|Not valid without signature
h*soLAR ryoLF(D rnr-
100 Davis Street
Douglas, MA 01516
Oftrce 1: (888) 8784396
Oftrce 2: (s08) 839-2222
Owner Autho rization Form
We the undersigned, hereby authorize Solar Wolf Energy Inc to act on our
behalf in all marulers relating to the installation of a photovoltaic system
at the location 55 Marsh-side Dr Yarmouth Port. Ma 02675 This
includes but is not limited to financing paperwork, interconnection
documents, building & electrical permit applications, applicable rebate
applications, etc.
This atthoization is valid only for items pertaining to the installation
and commissioning of a solar power system to be installed by Solar
Wolf Energy Inc.
Signed under the pains and penalties of perjury.
y*Xai*L. L-C6*l-'%aJ-bL nc_ntt.t_
Signature of Owner
08121 12021 08t21t2021
Date
Doc lD: aTdbea b848 1 87ceaa90 1 46756a00858bcm2248
The Commonwealth of Massachusetts
Dcportment of Industriol Accidents
Otlice of I nve sl igations
Latayette City Cenler
2Avenue de Lafoyelte, Boston, MA 02111-1750
www,mass.gov/dia
Name (Businesrorganizatiory'lndividual)
Address: 771 Washinoton St
: Solar Wolf Energy
Ci lStatelZi : Auburn, Ma 01501 Phone #:
rAny applicant thsr checks box i I mlrst also fill out thc scation bclow showiog liair $o*cls' conrpcns.lio[ policy information.t Homeowners who submit this amdavt indiclting thcy srE doing all work sod th€n hirc oursidc contrsctors must submit 6 ne$, allidrvit indicating !uch.
,Conlractors lhd chect this box must atucb.d r,l sdditional sh€rt showing ole nalllc otlhc sub-contractors and state wh€ther or not lhose entities hsyc
employccs. lf the sub-cooEactors havc employces, lhcy must paovide thcfu workcrs' cornp. policy numbcr.
I am an emplolet lhal is providing worlrcn' com?errsotlon insurance lor m! employe8. B€lo\t ls lhe pollc! ond irb si@
inlomafion.
hsurance Company Name: Leib lnsurance
Are you an employer? Check thc &ppropriste box;
I.ffi I am a employer with 6 4 E I am a general contactor and I
employees (full and/or pan-timeJ' have hired the sub-contractors
2. I I am a sole propriemr oi panner- listed on the a(ached sheet
ship and have no employees These subtontractors have
working for me in any capacity. employees and have workers'
[No workers' comp. insurance' comp' insurance l
required.l 5 f) We are a corporatioo and its
3. E I am a homeowner doing all work ofiicers have exercised their
myself. [No workers' comp. right of exemption per MGL
insurance required.l i c' 152, $ l(4), and we have no
employees. [No workers'
comp. insurance required.]
Policy # or Self-ins. Lic. #: WC2-31 5-61 4936-020 ExPiration Date: 0811012022
lousitcmaress: 55 M06nsrch -or
Citylstate/Zip:
Altsch s copy of the workersr compensation policy dcclarrtior prge (showing thc policy lumber snd erpirstior drtc).
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties ofa
fine up to $1,500.00 and/or one-year imprisonrn€nt, as well as civil penalties in the form ofa 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 forw'arded to the Office of
lnvestigations ofthe DIA for insurance coverage verification.
I do hereb! cefiify under the pains oJ perjar! lhol lhe infonralion pnvided obove is hue aad cotecl
!Crm. tf^pl
.>
Phone #:
Olficlal use ont!. Do not $'ite in this arca, lo be con pleted b! ciry or town olliciol.
3ECity/fown Cterk 4.E Ehctri{:rl t$pccror SDlumbhg
Phore #:
check,fItrI
one):Issui rg Authority (
Board of Health Buildirg Depsrlment
PermiUlicense #
Insp€ctor 6.Eother
Contact Pcrson:
Workers' Compensation Insurance Affidavit: Builders/Contrsctors/Electricians/Plumbers
Anolicant Information Please Print Lesiblv
Type of project (required):
6. I New construction
7. I Remodeling
E. f| Demolition
9. E Building addition
lO.[ Electrical repain or additions
I l.[ Ptumbing repain or additions
12.! Roof repairs
l 3.m othersqlAllnsta!!al!en
City or Towo: _
TOWN OF YARMOUTH
1 146 ROUTE 28, SOUTH YARMOUTH, MA 02664{451
Telephone {508) 398-223 1 Ext. 1292-Fax (S08) 398-0836 '.it t)
OLD KING'S I{IGHWAY HISTORIC DISTRICT C
APPLICATION FOR
CERTlFtcATE OF APP ROPRIATENESS
Application is hereby made for issuance of a Certilicate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 asamended, for proposed work as described below & on plans, drawings, photographs, & other supplemental inlo accornpanying thisapplication. PLEASE SUBMTT 4 cgpies OF SpEc sHEET(S),& SUPPLE[iE HTAL INFOR'TIATION,
lndicate Building:
Addition
ii .
rt .',t/'.tr "1 :
1) Exterior BuildinoItn", ffi
Construction
Solar Panels
Building Garage
Other:
2) Exterior Painting:Siding
3)
4t
Please type or print legtbly:
Doors rim Other:
to Sign
Wall
Address of proposed work, 55 Marsh side Dr Mapllot #150,16
owner{s}: 1?nt: Brinklr ,Snd g"indv 8e*
- _- . pnone * _s0B-712-] 398Allapplication8rnustbegubmittedbyowneioiiccomp@pproving@.
Mailing address: 55 Marsh side Dr. Yarmouthport, Ma 02675 Year built: 1993
tn,r,, DodyZ{29@comcast.net Preferred notiticataon method:Phone
AqenYcontractor:Solar Wolf Energy Phone#: 5AB-g3g-2222
Mailing Address: 771 Washington StAuburn, Ma 01SOi
a*r,,, alisha.v@solarwolfenergy.com Preferred notilication m ethod:PhoneDescrlotion of Prop-sFed Work:
lnstallation of a 4'69kW roof mounted solar array using 14 SPR 335W panels with built-in microinvertersand a SMART meter
Signed (Owner or agent):
Owner/conlrac!orlagent is
lf application is approved,
aware lhal permit ls required lrom the Building Department.(Check other departmenls,also.approval ts subjecl to a l0-day appeal period requited by lhe Act.)
This ceriiticale ,5 good tor one year from approval dat€AI'new construclion w,ll be Eubjecl to rnspection by OKH laler
inspeclions
Approved Approved with -_Modil'ications Denied
Reason for Denial.
Signed:0tr I
,15 Davs:
Rcvd Dale:
Amount
CasffCK #:
Rcvd by:
1
Date Signed /(t.tl-Z<r1l
APPLICATION #"
|*lpoor l]o,n*.
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MUST be