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Home My WebLink About223 West Great Western Rd - building permit solar wolfSears, Tim From: Sent: To: Subject: Sears, Tim Monday, April 25, 2022 2:58 PM Operations Solar Wolf Energy 223 West Great Western Rd Ted, I have reviewed your application for solar panels and there are some items needed 1. Plans showing panel location etc. 2. Engineer letter evaluating existing roof Please submit these items for review This email is considered a written denial of your permit application perSection 105.3.1of the Massachusetts State Building Code. Section 105.3.2 states in part that "on opplication for a permit for ony proposed work sholl be deemed to have been obondoned 780 days after the dote of filing, unless such opplication has been pursued in good foith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. L43 5100, within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us 1 EPA RECEIVED TMENT 2 This Scction For OfEcial Usc Ooly Tf /Date AppliedBuildiDg Pemit Numbor: I Buildhg Ofrcial (PriotNsmc)DatcSign6turc SECTION 1: SITE INTORMATION 1.2 Assessors Map & Parcel Numbers Map Numbc.ParcclNumbcr l.l Property Address: 223 W6sl G6El W$t6m Rd Yamoulh Porl MA02675 l.l a Is this an accepted street? ycs_ no-. Zoning District Propos.d Usc 1.4 PropertyDimensions: Frootagc (ft) 1.5 Building Setbacl(s (ft) Sidc Yards Rear YardFront Yard Rcquircd Provided Requircd Providcd 1,8 Sewagc I Muoicipal tr ( "R'Eleq lV E rnsFm$6rd$ffifi-E- 1.6 Water Supply: (M.Gt c.40,l5a) Public tl P.ivatc B 1.7 Flood Zore Information: Zotc: _ Outside Flood Zon€? Cbcck ifycatr apa 2 5 71122SECTION 2: PROPERTY OWNtrRSHIP' NT D City, Stat., ZIPName (Print) 50&367 1103223 W$r G.€ar W€slom Rd YemoL{r Pon MA 02675 &noil AddrcssNo. ard Stscrt Tclcphonc 2"1 Ownerr ofRecord: SECTION 3: DESCRIPTION OF PROPOSED WORK: (check &ll that sppty) Repair($ tr Alteration(s) tr Addition trNew Colstruction B Erdsting Building tr Omer-Occupied tr Accessory Bldg. tr Number of UnitsDemolition tr ROOFTOP SOLAT< SYS I EM WI I H A !iMAX I Mts I trK S(JU^tr I PANELS TO TOTAL AlooXWWork'?: INSTALLATION OF 30 SOLAR SECTIoN 4: ESTIMATED CONSTRUCTION COSTS EstimatEd Costs: (Labor and Materisls)Item l. Building $ 13!60 oo2. Electrical 3. Plumbing $4. Mechanical ([IVAC) $5. Mqchanical (Fire Supprcssion) tr Total Projcct CosC (Item 6) x multipticr - x Total All Faes: $- CheckNo. Chec&AEolEf C€shAmouDt: (!\Eq tr Ourstaditrg Balance Due: 1. Builditrg Perxoit Fe€: S tr Paid iu Fu[ LBdicate how fce is determhcd: tr Sta-odard City/Tovtl Fee 2. Other Fses: $ List: 6. Total Project Cost: ONE & TWO FAMILY ONLY. BIIILDTNG PERMIT Town of Yormoulh Bulldlng Dcpartmert I 146 Routc 28, South Yarmouth, MA 026644492 508-398-2231 ext. I26l Fax 508-398-0835 Massachusetts Stato Building Codo, 780 CMR Building Permil Applicatio To Construct, Repah, Renovate A' Demolish a One- or Two-Fanily Dwelling oe-6 1.3 Zoning Information: Lot Arca (sq ft) Requi.ci Providei Other tr Spec0: soLAR Brief Descriptioo of Proposed $ 195s120 $ $ 326s2 SECTION 5: CONSTRUCTION SERYICES 2-19-2024 Expiradon D!t. u Llccnsc Numbcr Lhl CSL Tr?c (!.. bolow) cs-0874 91 Typ.D6cription 5 000 eu. fL R Rcsr.icrcd l&2 D M RC Roofi c ws SF Solid Fucl BumiDg lialces I insulation 5,1 ConstructloD Supcrvisor Llc.nse (CSL) Ted Strzelecki Te Emsil addrcss 508-538-9445 Namc ofCSL Holdct operations@solarwolfenerg y.com No. and Strcct 582 Wauwinet Road Bane, MA 0 '1005 CiV/Towh, Stst , aP D Dcmolition 5.2 Registered Eone Improvcnrent Contractor (HIC) Solar Wolf Energy 508-538-9445 llIC Compary 771 Washi N&!c or HIC RcEists.nt Nanc nqton Street - I\rA 0150'1 State ZIP No- and Strcet 1RAlnn Email addrcss ,n) ergy.comoDerations@solarwolfen 1,1 IIIC Rsgistation Nudtcr Expiration Date sEC ON 6: WORKERS, COMPENSATION INSURANCE AT,FIDAVIT (M,c.L c. rsz. S 2sC(O) Worker csom ceItrsurao mus cobe letedpetrsatlon subarC ittedID thiswith icahon atFlt:lemp toappl provideaffidavitthiswilltbeulialdentheofIssouancefbtbeuildiog SiElEd Affidavit Attached? yes E N0...,..,.... tr TION TO BE COIVPLETED WHXNSECIION ?ar OWNER AUTHORIZA FOR BI-IILDING PERT\IITOWNER'S AGENT OR CONINACTOR APPLES to act oD ![y behslf, i[ all matE$ rclative to wo* authorizcd by this building pcrmit appricatioo. I, as Owaer oftlrc subject property, hcreby au'lhorize rod stz€r..*i Prift O$'Dcr's Nema (Elccronic SiSaaturc) Please see attached owner auth WNERlbi7SECTIONo AOR DIITEORIZE DAGENTECLA.RA TION By enreliog Ey oa'e bElow, I hercby anest undcr thc pai.s and pe,alties of peruy that an of the information co*ained in this applicatioo is tue aod accuare to the best ofmy larorvledge and underrtatdilg zcd Ag.ot's Na$c (Elcc!.onic SigDatulc)DatePrint Owllcr's or 3-17 -22/ed NOTES: his/her arbitratio! Orvner ho obtains to dopermit AIot lvbowner htesorvork,unreAE coDtractorgistered theLN Home gmentregistered contractor iI haImproGn tIetoProgran),c)pol or utrderfrrnd GM.c..L 42A,.program guaranty Olher LDfonnation theon HIC caDlmporta be atfouldProgam l-oforoation the Cotrstructiotrwwrv.mass,gov/oca Llcense can fouodbe atSrpervisor wwrv.mas. gov/dpg Nurber of 2. WhcB subEtantial wod< is plamed,provide the infonnatior bclow: (including garage, finished bosement/attics, d€cks or porch) Nuber qf bathrooms Total 0oor arca (sq. ft.) Gross living area (sq. ft,Habitable room couqt Number ofbedoons Number ofhaltrbe66 Typc ofheatiq systeE Type ofcooling system Number of dcck9 porchcs Eaclosed 3. "Totsl Project Square Footagc" may be substituted for ,,Total projrct Cosf, Masoory Windo,w atrd Sidils Tclcpho[c affidavit rrsult permit. I Ar buiiding (Dot access oo 3-17 -22 Data The Commonwealth of Massachusetts Departmc of fndustrlal AccidentsI Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dla 1\:or*crs' compcnsstion Insurancc Aflidnvitr BulldErs/cort.{ctors/Electricians/p lumbers.TO BE FILED WITH TEE PERMITTING AUTSORITY. t Name (Busincas/OBloiz0rion/tndividua.l): Address: City/State/Zip;Phone # Aft you rn .fiploy.r? Ch.cl( th. ippropriatc box: l.! I rm a crnploycr witi _cmployEes (tult ard/or pan-tinr).' ?.E Lm s tob plopriclor or parlrcrship ind have no crnployc.s working fo, mc inany crpacity. [No ],/orkcrs'comp, insr:rancr rcquircd.] 3.! t am e homcowncr doint llt \{ork myscl( [No workcrs' comp. jhsu.ncc rcquircd.] t 4.!Irmahofi€o\rr'rE.ndwillb.hiri4cootra.rorstoconductallworkonmyprcp.rty l qill clLsuaa lhal all conG-actoas cith.r hsva l*!rkar!' cohpcnsadon insurrncc or rc sola Froprictoas with rro lmoloycca. 5.8 [ arn r genlral cooftcror and I havc hircd th! sub-coouaclors listld on th. ottachcd sbcctThcac suEcontr..tors havc cmployccr and havc woatels' comp illsuram..t 6.[ We rn r coqontio, srd its officss havc cx.rciscd thcir righr ofcxcmption pcr jvIGL c. i 52, $ I (4), and .r c ha!,/. no cmployecs. [No worl(.rs' compi insurancc rcquircd.l ny 'PPli:s tlur ch.ck5 box * i rnust,dlso fill ollt thc scctiofl below dlowinS rhcir u/orkcrs'compcnsation policy infontlatiollHorneownc.s who submit rhh afidavit indicating thcy aic doing ![ work and thcn hirc olEidc cont&rorc must submit r ncw afidavit indicsring $cl!tContractors tlut chcck this box must en chcd an additioDal shcrt showiog thc rEm. ofJre sub-conElctors and state u.hcther or not thosc cntitrls hav. Type of project (requir€d): 7. ! New construction 8. ! Remodcling 9. D Demolition l0 f Building addition I l.[ Electrical repairs or additions 12. I Plumbing repairs or additions 13D Roof rcpairs Other14.n employees. If the sub-contracrors ha I arn an employer th biomulioi. !c cmployecs,ffirst Fruvid. thcir workcrs'policy number alis proyi.ding i,orkers' compensatiott ittsrtance for ruy employees- Below is the polic! ondjob lrrte Insurance Company Name Policy # or Sclf-ins. Lic. #:Expiration Date: I tlo hereby certifu uder tli pdins a d penalties ofpedury that the it{orhnlion provid.ed above is true and correcl Job Site Addrcss:_ .ttt .t " "opy or il,1,1l;".r"**.**""".", Failure to secure. coverage as required under MGL c. 152, $25A is a criminal violaion pun ishable by a fine up to $ 1,500.00and,/or one-year irnprisonment, as well as civil penattics in the form of a sTop woRKbRDrn aoja e,* of rfto $250.00 aday €ainst thc violator. A copy ofthis statement may be forwarded to the officc of tnvestigations of thc D[,,t io, iosu,"n".covcrage vcrification. dl ase onl!. Do not wrlte in this area, to be conpleted b! cil ot rov oflicidl Citv or Town: Issuing Authority (circle one): t' Board ofHeolth 2. Building Depsrhnent 3. city/Town clerk 4. Electricsl lnspector 5. plumbi'g tospector6, Otber Coutrct Pcrto[: phone #: OlJici, TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2*f exl 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT DATE: JOB LOCATION:223 wbJ G.€.t Wbstem Rd. Yamourh Pod, MA 02675 ..HOMBOWNER"NAME STREET ADDRESS SECfiON OFTOWN 50&367,1108 NAlviE PRESENT MAiLING ADDRESS HOMEPHONE 223 wer Gr€at wbslom Rd. Yamtulh Pon, [1A 02675 WORKPHOI\TE CITY OR TOWN STATE ZIP CODE Tbe current exemption for 'Homeowner' was extended to include owner - occupied dweilines of one or two uuits and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as suDervisor.(State Building Code Section 1 10 R5.1 .3.1) Definition of Homeowner: Peson(s) wbo owns a parcel of land on which he / she resides or intends to reside, on which tltere is or is intended to be, a one or two family attached or detached structure assessory to such use and / or fum stnrctures. A person wbo constructs more tban one home itr 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 resoonsible for all such work performed under the buildine Dermit.(Section 110 R5.1.3.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-Iaws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yamouth Building Department minimum inspection procedures and require. ments and that he / she wili comply with said procedures and require ments . APPROVAI OF BUILDING OFFICIAL INSTJRANCE COVERAGE: I have a current liability insurance policy or its subshntial equivalent, which meets the requirements of MGL Ch.l42. x Yes No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy , O&er 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. -/aZ Check one: Owner xAgentSiglature of O er or Owner's Agent h:hotDcowtrdicereiup HOMEOWNER"S SIGNATURE $TOWN OF YABMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext. 1261 Fax 508-398-0836 Office of the Buililing Commissioner BUILDING DEPARTMENT DEMOLITIONDEBRIS DISPOSAL Pursuant to M.G.L. Ch. 40, $54 and 780 CMR - Section 105'3' l ' #4' I hereby certiff that the debris resulting from the proposed work/demolition to be conducted at 223 wesr G6rt wssiem Rd Ya.hodn Po.t MA 02675 Work Address Is to be disposed of oat the following location:77'l Washington Street, Auburn, MA 01 50'l Said disposal site shall be a licensed solid waste facility as defined by M'G'L' ch. 1ll, $150A. -tu/3-17 -22 Signature of on Date Permit No. Information and Instructions Mrssachusetts Ocncral Laws chaptcr 152 requircs all cmployers to providc workcrs' comp.nsrtion for thcir cmployces. Pursuant to this statutc, an arrplol€a is defincd as "...cvery person in the scwice ofanothcr undcr any contract ofhirc, cxpress or implied, oral or writtan." An cmployq is defrned as "an individual, pannenhip,.association, corporrtion or other Icgal entity, or any wJo or more ofthc foregoing cngaged in ajoint enterprise, and including thc legal rcpresontatives ofa deceased employer, or thc rcceivcl or trqstc? ofan individual, partnership, association or othcr lcgal cntity, employing omployccs. Holrcver thc owner ofa dwelling housc having not more than threc apartments and vrho resides thercin, or thc occupant of thc dwelling housc ofanothcr who employs persons to do maintcoance, construction or repair work on such dwelliog house or oo the gmunds or building appurtenant tbereto shall not b€cause of such cmploymcnt bc dee&ed to be an cmployer." MGL chapter 152, $25C(6) also stalcs that "every strte or locel licensing agency shall withhold the issuance or renewal of r llcense or permit to operate a business or to construct buildings in the commonlyeolth for any applicant who has oot produced ,cceptable evidence of complianca with the insurance coverage required." Additionally, MGL chapter I52, 025C(7) states'Neither the mmmonwealth nor any of its political subdivisions shall enter into any contract for the p€rformance ofpublic work until acceptabte evidence ofcompliancc rvith the insurance requircments ofthis chapter have been presented to thc contracting authority." Applicants Please fill out the workers' compensaiion affidavit complerely, by checkinE the boxcs that apply to your situatioo and, if uecessary, supply sutscontracto(s) name(s), address(es) and phone number(s) along with their certificate(s) of i.lsurancc. Limited Liability Companics (LLC) or Limited Liability Parherships (LLP) with no cmptoyecs otber than the mcmbers or partncrs, are not requfued to carry workers' compensation inswattce. If an LLC or LLP does have employe;s, a policy is required. Be advised that this afridavit may bc submittcd to the Departnent of tnduskial Accidents for confi.rmation of insurance cover€e. Also be sure to sign ard date the af{idayit. The affidavit should be retumed to th. city or lown that thc application for the permit or license is being rcqucstcd, not thc Departoeot of lndustrial Accidents. Shouldyou havc any questions legardiog tfie taw or ifyou are required to obtain a workers' composatioE policy, please call the Departmcnt at thc oumber listEd belo\r. Self-insured compaaics should enter their self-irsurance license number on the line. Thc Department's address, telephone and far number: The Commonwealth of Massachusetts Department of lndustrial Accidents I Congress Street" Suite 100 Boston, MA 02i 14-20i7 Tel. # 617-727-4900 ext. ?406 or I-877-MASSAFE Fax# 617'727-7749 www.mass.gov/diaRcviscd 02-23- t 5 Ciq or Town Ofiicials Ple&se be sure that the affidavit is complete and printed tegibly. Thc Depatment has povided a space at&e bottom ofthe affidavit for you to frll out in the event thc OfEc. of Invcstigatioos has to contact you regarding the applicanl Please be sure to fill in the permit/license aumber whicb will bc uscd as a rcference number. In addition, an aPplicant thet must submit multiple permi'./license applications in any given ycar, need only submit one afridavit indicating cuntnt policy iuformation (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy ofthe afiidavit that has been officially stamped or marked by the city or towr may be Providcd to the applicant as proof that a vaiid affidavit is o! filc for futurc permils or licenses. A oew affidavit must be filled out each year. Where a home owner or citiz-en is obtaining a license or permit not.elated io aoy business or commcrcial ventrre (i.e. a dog license or permit to bum teaves etc.) said person is NOT required to compl?te this a{Iidavit. bsoLAR woLF 100 Davis Street Douglas, MA 01516 Office 1: (888) 8784396 Office 2: (508) 839-2222 Owner Autho rization F orm We the undersigned, hereby authorize Solar Wolf Energy Inc to act on our behalf in all manners relating to the installation of a photovoltaic system at the location 223 wesr Great western Rrt rmnrlfh Pnrf IVla 0)6175 This includes but is not limited to financing paperwork, interconnection documents, building & electrical permit applications, applicable rebate applications, etc. This atthonzation 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. Signature of Owner 'tl I ',t2 t2021 Date Doc lD: 74fd976db8eb6e81 0e8c8a4561 35ca4eB0e1 766 42 The Commonweallh of Mossachuselts Depa me of Industfial Accidents Olftce of Investigations LaJayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass,gov/dia Name (Businesyorganizatio.y'tndividual): Solar Wolf Enefgy Address: 771 Washinqton St .i= Are you an employer? Check the appropriate box: I am a general conuactor and I have hired the subrontractors listed on the attached she€t. Th€s€ suLcontractors have employees and have workers' comp. insurance.l We are a corporation and its officers have exercised their right of exemption per MGL c. 152, $ l(4), and we have no employees. [No workers' comp. insurance requirrd.] employecs (full and/or pan-time).. 2. E I am a sole proprietor or partn€r- ship and have no employees working for me in any capaciry. [No workers' comp. insurartce required.l 3.E I am a homeowner doing all work myself. [No workers' comp. insurance required.l i 4.n s.E 1.ffi Iam aemployer with 6 Ci State/Zi : Auburn, Ma 01501 Phone #: I am an emploler that is providitrg worken' compensation insurunce lor m1 employees. Below ls the pollq on.l job sile inlomalion. lnsumnce Company Name: Leib lnsurance Job Site Address 113 Aroat Y{o-r^ (l CitylStatelZip:It. Attach I copy of the workers' comp€nsetion policy declaretion prge (showing the policy number rnd €xpirstion dttc), Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imPosition ofcriminal penalties ofa fin€ up to $ I ,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to S25O.OO a day against the violator. Be adyised that a copy ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insuranc€ coverage verification. do hercb! certW under the pains of pedury lhal lhe inlotmatiol provided qbove is hue and coreclI S )-z-L Phone #: OlJiclat use onl!. Do nol wrlte ln this srca, to be conpleled b! ciry ot lown olliclal lssuins Aulhoritv (check oIle): ifiliT"?o" ri *l,li"itl"u'r,io"* r"o"rtment 3.EcityrowD cterk 4E Ehctricrl lBspector 5Dlumbirg Phore #: City or Towtr: Inspcctor 6.Eother Co[tact Person: PermiUliceose #- Workers' Compensation Insurance Affidavit: Builders/Contrectors/Electricians/Plumbers Anplicant Information Please Print Leeiblv .Any applicsnl thst checks box # I must slso fill out the scction bcloiv showiog lheir \ o.kcrs' co.Ipcnsation policy infofinalion.i Horncowncrs who submit this amdavit indicating thcy srE doilg all wo* ,nd $m hirc ortsidc contraclors musl grbmil a not amdwit indic.liog such lcontractors that check this box must att chEd an ldditional shcct sho\rin8 the namc o[ thc sub.conldctors and slate whcther or not thosc entilies have employars. If dlo subtofltraators have employccs, thcy must p,ovidc thcir worl(cls' comp, policy numb6. Policy # or Self-ins. r-ic. #: WC2-31S-614936420 Expiration Dste; OB/1 0/2022 Type of projecl (required): 6. n New construction 7. I Remodcling 8. fl Demolition 9. f] Building addition lO.! Electrical reprin or additions I l.E Plumbing repain or additions l2.n Roofrepairs r r.fi otherSqlar !aglalla!!sn 4125122 . 2:5O PM Licensee Details Demographic Information Details ull Name TED C STRZELECKI ner Name License Address Information itv: tate: ipcode Barre MA 01005 United Statesun License Information cs-08749'1 Building Licenses 212512011 Active Construction Supervisor 313112022 2t19t2024 4t25t2022 License Renewal cense o n BU n SES AsoSstutacSahneRAS no License vpe: rofession: ssue Date: icense Status: econdary License Type: Date of Last Renewal: Expiration Date: Today's Date: Prere site Information No Prerequisite lnformation Complaint Number: Complaint Status: Date Complaint Received: Date Complaint Entered: Violation Code: Violation Type: Violation Description: Sanction: Sanction Start: Sanction End: 2008447 agency l profocomplaint statusl00 811912008 12:00:00 AM 212412011 12:00:00 AM agencyl prof0violation type2 Suspend Suspension 71812010 1 2:00:00 AM No Available Documents htlps://madpl.mylicense.com^/erification/Details.aspx?result=c84f50a1-2cae-4a6d-b76a-f3461cd6427 1t1 Commonwealth of Massachusstt., Division of Professional Licensura Board of Building Re ulations and Standa, Cons isor \ cs-087491 TED C STRJZ $n ires: 02/1gl 2022 EL Fatnh{ -\v582 WAUWI BARRE MA f Comrnissioner K ,fue I!IJt L dr,{" .t z4t7 Massachusetts c@af Covtlpl"erbwContractors Academy A PDH Academy ComPany Ted Strzelecki cs-087 49r hos completed the Massachusetts Contractor Classroom Renewal Course Part 1 Approval # CS-0102L2 Code Review 2 hours Workplace Safety 0 hours Business Practice t hour 02117 12022 Energy 0 hours Lead Safety-,lhour Elective 2 hours Coordinator: Annie Schultz, Program Manager Coordinator N umber: CD-000102 tf you hove ony comments obout this course offering, pleose moil them to the Boord of Building Regulotions and Standords, CSL, Continuing Education, One Ashburn Place-Room 7307, Boston, MA 02108 .%i"9".-*-.rr"*Z/r/..%aue*t";a Office of Consumer Affairs and Business Regulation '1000 Washington Street - Suite 710 Boston, Massachusetts 021 18 Home lmprovement Contractor Registration Tvpe: Registration: Expiration: Corporation 186400 11tO612022SOLAR WOLF ENERGY INC 771 WASHINGTON STREET AUBURN, MA O,I5O1 . z, /,.,,,,,..,.,,,.t.t,/ /'/ -,.-,,,,,...-./1. Offlcs of Con m6r Afl.lr; & Bu3ln.33 R€gulrtlon HOME IMPROVEMENT COMTRACTOR TYPE: CorDor"atimReolstrrtion Exolration186400 11106n022 SOLAR WOLF ENERGY INC, TED STRZELECKI 771 WASHINGTON STREET AUBURN, MA 01501 l*-ta /.r*" updat6 Addror6 and Return Card. Rogistration v.lid for lndlvidual use only bororo the oxpiration dalo. lf iound roturn to:Offic. ot Conaum€i Affairs and Bu6inors Rogulation l00OWashinglon Stroet - Suite 710 Boston, MA 02'll8 Not valid without signatureUndersecretary to/202 IoaTE.(tflroo,YYYY) THIS GERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND BELOW. TH18 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THE AFFORDEOCOVERAGE THEBETWEEN rssurNG POLICIES THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, NO RIGHT9 UPON THE CERTIFICATE lf SUBRO€ATION lS WAIVED, .ubr.ct to lhc t.m. .nd condltlons ot the A thternant on an or pollclca mly nrqulna an thls to tha coiliflcato holder ln lleu ol 508 -7 92 -0{11 NAUTII,US IJTBERTY MTITUAI' PR@UCERLcLb Inaurancc 53? Park Avcnu. slorceBtcr, UA 01603 CERTIFICATE OF LIABILITY. INSU RANCE The ACORD name and bgo are rogbbred marks of ACORD IIISURED SOLAR WOIJF. ENEROI 7'7]. $TASHINGTON 8T AUBURN UA COVERAGES REVISION NUMBER: WHICH THIS THE TERMS, EACH OCCURRENCEx 1 000, 3 100 000 . EXP om 5,000 1,O00,00o 2,000,000 2 000 000COMPrcPAGG I N NN12 07723 o6lo8/2021 o6l 08/2022A x LIMIT PER: LOC APruEStlPRo..JECT GENERAL UABILTTY CLAIMS.I'AOE OCCUR s BODILY ltaJuRY (Per pryu)$ EODILY INJURY (P€r BEidqnt) s s AUTOIOBILE LiASIL]TY OWNED AUTOS ONLY HIREDAUTOS ONLY SC}IEDULEDAUTOS NON-OWNED AUTOS ONLY ANY AUTO AGGREGATE Ui.SRETLALIAS EXCESS LIAB 1,000,000E.L. DISEASE. EA S 1,000,000 1, o0o, o0o oe/Lol2o2L o6/LO/2022it/wc2-31S-614935-020 drsibe AND EilPLOYERS'LABIUTY DESCR|mO]|OFOPCRATIOIISTLOCATIONSTVEHICLES IACORDl0r.AddldomlRemrltsch.dolo.nrv I b. tttlch.d if m 3p.€ i3 rcad.rd) YE,RUOI'TE TOIfN ITAI,L 1145 nOIIrE 28 YANXOIITE PORT, UA 02654 SHOI'LD At{Y OF TTl€ AAot'E OESCRBED POLIOES BE CA}ICFLT FD BEFORE THE EIPNANOil OATE THEREOF, NOTICE wlLL BE T'ELNEREO IX ACCOROAIICE wlTH THE PC'IICY PROVISIONSI' AUYHOREED ACORD 25 (2016103) All rights resowed. ti, INDICATED.OTHEROR WITHDOCUMENT TORESPECTOFCONDITIONANYTERM IS TOSUBJECT ALLDESCRIBEDPOLICIESHEREINBY REDUCED BYLIMITS ANY MAY OR MAY AND CONDITIONS OF SUCH IYPE OF IIISURANCE PERSONAL E AOV INJURY GFNFRAI AGGREGATE POLICY '( FACH TX:CIfiIRFNCE s $ __._ '_OCCUR CUIMS.MADE (nFn i.l,B 9l n- F I NISEAqE. PflICY LIMIT Y'NtrE i TOUI/N OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH. M4O2ffi4.4451 Telephone (508) 398"2231 Ext. 1292*Fax (508) 398-0836 ffiffiffiffifrvffiffi fffHH 5',t*zt //thi'vlc-ril i r r OLD KING'S HIGHWAY HISTORIC DISTRICT CO APPLICATION FOR qHBTTFT*AJE OF Ap.P.IROPRIATEN ESS Application is hereby made for issuance of a Certificate of Appropriateness under $ection 6 of Chapter 470, Acts of 1973 as amended, for proposed work as described below & on plans, drawings, photographs, & other supplemental info aecompanying this applisation. PLEASE suBMlT4jggies oF SPEC SHEET(S), ELEVA &AL INFORMATION. lndicate Building Building: Addition Commercial 1 ) Exterior Buildino Conslruction:' [*lrn"o l7lro,". Paners Other: 2) Exterior Painting:Siding 3) 4) Please type or print leglbly: to Existino Sion [lt'*o* Tpoor Address of proposed work. Wall 223 West Great Western Rd Map/Lot #108,39.1 JamiCarder Mailing address: must submlttod by owner or accompanied by letter from ownor 223 W, Great Western Rd. Yarmouth Port, Ma 42675 Email:Jami.Carder2Ol 2@gmail.com Preferred nolifrcation m ethod : AgenUcontractor:Solar Wolf Energy Mailing Address:771 Washington St Auburn, Ma 01501 Year buitt 2003 Phone Email:al isha.v@solarwolfenergy.com Preferred notifi cation method:Phone Descrlption of Prooosed Work: lnstallation of a 10.05kW roof mounted solar array using 30 SPR 335W panels with built-in microinverters and a SMART meter Signed (Owner or agent): Approved Appmved with _Modifications Reason for Denial; **Denied 1 ), o'MEt/conlractorlagent is "*rJtnrr a permil is required from the Building Departmenl, (check other departmenls, also.)ll application is approved, approval is subiecl to a 10day appeal period required by the Act. This certificate is good lor one year from approval dale or upon date of expiralion of Buildlng Permit, r,rdrichever date shall be later^All neur construclion will be subject to ln$pection by OKH. OKH-approved plans MUST be available on-sile for framing & linal inspeclions. n.ro o.r", fl/l{f,?l a.ount LfU.ltS Cash/CK#: llJlrlLt.Rcvd by: 46 Daysl Date Signed Signed: APPLIcATToN #. Al' A\* [-l ooo,,. fh,i* [lo** l Structures: i 1 Phone#: 508-839-2222 0"t", lllllerut )1-3. ,r$ ,,r,-*,n72o' o" /' r/'t, z