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commonweaR o`/rtaalat"Erns 2.Par1menl 0/3. �ervicw BOARD OF FIRE PREVENTION REGULATIONS Print Form Official se Only p Permit No. C--:/ — f'O Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Datc:6/25114 City or Town of. Yarmouth To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)21 Pawnee Rd Owner or Tenant Paula Godin Owner's Address Is this permit in conjunction with a building permit? Yes Q Purpose of Building Residential Telephone No. (508) 862-0659 No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Raise utility meter to 6' above grade to meeting flood plane clearances. rmmnlotinn nftha %nlln ino tnhla mm ho wniv,d by tha Inrnortn,. of [Viror r I ' t — ' Attach additional derail tjdesired or as required by the Inspector ojW fires. �� ^ z I Estimated Value of Electrical Work: (When required by municipal policy.) O� CCJ `r'� Work to Start:�3/14 Inspections to be requested in accordance with MEC Rule 10, and upon completion. co 6L INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless �R the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. —�, o CHECK ONE: INSURANCE ❑� BOND ❑ OTHER ❑ (Specify:) � 1 certify, under the pains and penalties ojperjury, teat the information on t Is application is true and complete: m FIRM NAME: NorthEast Electrical Systems, Inc. /% LIC. NO.:16790A Licensee: Erik Hohengasser Signature LIC. NO.:12810B (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:(508) 328-4749 Address: 10 Bedford Park Unit 1 Bridgewater, MA 02324 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Own tore nt PERMIT FEE: $ Signature Telephone No. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. n ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. rnd. o. o Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No of Zones No. of switches No. of Gas Burners o o Detection D an Initiating Devices No. of Ranges No. of Air Cond. Tons No. orAlerting Devices No. of Waste Disposers eat Pump Totals: Number Pons o. oSelf-Contained Detection/Alertin Devices No. of Dishwashers Space/Area healing KW Loeal ❑ unrecti ❑ Other Connection No. of Dryers Heating Appliances IC�V ecunty 'ystems:* No. of Devices or Equivalent o. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. or Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcations Wiring: No. of Devices or Equivalent OTHER: W w N a L11 C �o a z W c i2: c commonwaahIc o/ rrlaelaG/jttaalld OfficialUse/Only cs, c7 �a Permit No. 1JaParfmanl o/.lira Jirvica! Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rcv.1/071 Icaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC) 5 27 % MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dale: tl f N City or Town of- � 1,, x xA-t , To the Inspeclol of Tres: By this application the undersigned gives qoGce of his or her intention to perform the electrical work described below. Location (Street & Number) 4c Owner or Tenant ''Qct,' Owner's Address saw, Telephone No. Is this permit In conjunction with a building permit? Yes [jr No ❑ (Check Appropriate Box) Purpose of Building Sonar- J PV Utility Authorization No. Yh Ig Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Work: 1� 1 " Completion ofthe followine table may he waned by the lnwectnr of $Virtu. No. of Recessed Luminaires No. of CeLL�usp. (Paddle) Fans o. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Pfuerators KVA of Luminaires Swimming Pool o►.e ❑ n- rnd. rnd. y ►nergency Lighting tt intro lN of Receptacle Outlets No. of Oil Burners No. of Zones lN of Switches No. of Gas Burners o. Inl e n evl s . of Ranges No. of Air Cond. Tad uns No. of Aler Ing c . of Waste Disposers eat Pump Totals: Number Tons o. o e oa Detection/Alcrtin E of Dishwashers Space/Area lleating KW Municipal Low ❑ Connection N . of Drycrs heating Appliances KW Security vstems: No. of bevlecs or E ulvalcnt o. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or E ulvalcnt No. Ilydromassage Bathtubs No. of Motors Total IIP a ecommumcal ons Wiring - No. of Devices or Equivalent OTIIER: Attach uddainnal derail {f desired, or as required by the fttapector of IF airs. Estimated Value of Electrical Work: _ ((� _ (When required by municipal policy.) Work to Stan: a. S.A. P. Inspec�uo s to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such c v rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND [IOTHER [I (Specify:) I certif , under the pains and ettalties ojperjuty, that the information on this application is true and complete. FIR11I NAME: Co a LIC. NO.: I (3(n NCR Licensee: Mod+(.,,e_-,0o 'r, e,,s,,, Signature LIC. NO.: (lf applicable, enter "exempt"in the license number line.) $v:(�.,� \ Bus. Tel. No.• 4 q is .135$ Address: a 54-. MAur 4-r" L?=. h&AA4A=oru . MA( =%Jr`srt ) Alt. Tel. No.: :4:H' In- ESoT 'Per M.G.L. c. 147, s. 57-61, security work requires Dcpartmen of tublic Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not ha►e the liability insurance coverage normally required by law. By my signature below, I hereby waive this rcquircmcnt. I am the (check one) [] owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ s COMMONWEALTH OF MASSACHUSETTS �7.1►VE.7[•1.[•1��'l12 t-7l•lkyA f-• BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE. AS.A^� REGISTERED MASTER ELECTRICIAN' SOLARCITY CORPORATION {" f MATTHEW T"MARKHAM \ 24'SAINT MARTIN DR BLDG 2 UNIT 11 MARLBOROUGH MA 01752-3060 11;6MR' O7/�1/16.� 4 ROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) /8 GEC TO TWO (N) GROUND Panel Number( Inv 1: DC Ungrounded INV 1 ((�� - (1)In�vertRer� 284OVA EL 9 5 feed - (17)nPV� odulr 9226.2W GEN #168572 RODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number. 2305521 38QOWE 4 wNn Disco and ZB, AFCI 22550W PTC, H4, 46mm, YGE-Z 60, Block Frame, ZEP Enabled ELEC 1136 AIR INV 2 Voe: 37.6 VpmaX: 29.8 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTMER E 125A MAIN SERVICE PANEL E 100A/2P MAIN CIRCUIT BREAKER Inverter 1 (E) WIRING CUTLER -HAMMER METER 100A/2P Disconnect SOLAREDGE SE3800A-US-ZB-U (E) LOADS B C I :b. 4=NF SdorCity EI A 20A 2P / pC, 2 1 OC, -__------------------------- -GEC I S"V(e) ar 17 an MPI __ EGC-----------------------------1------ tEL4 ---------- -_rJ 1 N 1 0 EGCJGEC -, I I 1 1 1 1 1 . _ GEC T_{ TO 120/240V 1 I I SINGLE PHASE II UTILITY SERVICEj 1 1 I 1 1 1 1 I 1 ' I I I Voc* = MAX VOC AT MIN TEMP POI (1) Brwka0 20A%2P. 2 Spaea 20A / 2' OREAI(ER B (1) WDTLER-H �2 Nm-FwDle NEYA JR AC A (1) 52 2 SIYRMC4S. US NNSED GROUNDED DC -(2)fkaxld Rod; 5/B' x B', Copper - -0)CUILER- AMMER 0003(NB trand%Neutrd & 30A, Genwd Duty (OG) -(1)ZEP / 550-1196-002 Unhand Box Bracket [PKG B] C SdarOuard Monitoring system PV anSOLAREECE 3OD-2NA4AZS PoearBox Optimizer, =K H4. DC to DC. ZEP nd (1) AWG A sand Bare upper -( 11 (kound Rod; S/r x C. Copper (N) ARRAY GROUND PER 690.47(D). NOTE: PER EXCEPTION NO. 2, ADDITIONAL 1 AWG THVIN-2, Black 1 AWG THWN-2, Block Voc• - 500 VDC Isc .15 ADC ODE�iAWOT BE-REOUIRFn DERMD(NG�NLLOCATION._OE.(E) ELECTRODE 2 Awc PV WRE, Black Voc* - 500 VDC Isc .15 ADC OTr'r na IoF-0)AWG /1t1, "-2, Red ra O�(1)AWC pt1 THYM-2 Red Vmp .350 VDC Imp=7.76 ADC 110, O�(1)AWC /6, Sdid Ban Copper ECC Vmp -350 VDC Imp.7.78 ADC EEEELLLL(1)AWG /1% I1nM-Z Mite NEUTRAL VmP -240 VAC Imp -15.93AAC .....11l��......(1)AN 110, TH11N-2 Qeen.. j:CC....-(1),Condgtt.l0t.?/47.PVC,?ch �0.... ................................................................ ....... -0)AWN j4,1F1Nk1-7.. 0e*M.. TPP/9-(1)t:o*lk IN. 4/.47EMT.......... CON(' NRAL- THE INFORMATKN HXN CONTANED SHALL NOT BE USED FOR THE BE NE11T OF ANYONE EXCEPT SoL OW NC„ n mmm JB-026208 00 P"SEow+Ik 0 I , DLSCWflII! GODIN RESIDENCE DES01: Spencer Branch i� ,k olar ity. MwNTW 515tnk NOR SHALL IT BE DISCLOSED N YMCLE OR IN CompMount Type C 21 PAWNEE RD 4.25 KW PV Array PART TD OTHERS OUTSIDE THE RECIPIENTS WEST YARMOUTH, MA 02673 MODM' 24 St Martin OrN% WWI; Z unit 11 orout1, MA 01752 ORGANZATION. EXCEPT N CONNECTION IWTH THE SALE AND USE Or THE RESPECTIVE 17 YINGU YL250P-29b SHEET: REV: DATE: SOLAROTY EO IIPMENT. MTHOUT THE WRITTEN PER""ssI°" °r s°`"R°" INC.SOLAREDGE 5088620659 ME* THREE LINE DIAGRAM PV 5 2/28/2014 it T: (eS0) 63M 63ti-1029 (98)-SOL-mY (7e5.24e9) ..wdwvftycom NERTMPACE SE380OA-US-ZB-U .r ELECTRICAL CALCULATIONS Hardware City Model Voltage Drop Calculations Module: 17 Yincill YL25OP-29b YGE-Z 60 Vdrop= (Imp) (2'Length) (Resistance) / (Vmp) DC Converter: 17 SolarEd a OP300-MV Inv Power DC W PTC DC W STC Inverter A Im A Max. Len th ftWire Inverter A: 1 SolarEd a 38DO AFCI 3800 3768.49 4250 Input 8.39 45 AWG 10 Inverter B: I I Vdrop= (8.39 1 90 1 0.00124 1 Ohms) 1 466.17334 0.19 3800 3768.49 1 4250 Inverter Im A Max. len length ft Wire Output7.76 Vdrop= Comb. Drop (7.76 Im A 50 AWG 10 • 100 •0.00124 Ohms) 1 Max. Length ftWire 466.17334 0.21 Inverter A Stringing Inverter B Stringing String 1: 17 Modules String 1: Modules 1776 1 20 1 AWG 10 Strin 2: Modules String2: Modules Vdro= (7.76 1 40 •0.0012 Ohms) 0.1552 0 Voltage Drop Calculations •F 'C Photovoltaic Module Electrical S 'rications: Photovoltaic Source Circuit Modules to PowerBox Yn li YL250P-29b YGE-Z 60 Voc at Min Temp= 42.53 V Record Low Temp: 3 -16 Power (STC)= 250 W Voc= 37.6 V Max Average High Temp: 80 27 Power (PTC)= 226.2 W Vmp= 37.6 V Voc= 37.6 V Vmp at Max Temp= 27.42 V Vmp= 29.8 V Isc= 8.92 A Isc= 8.92 A Imp= 8.39 A Imp= 8.39 A Icont= 11.15 A Tvoc=-0.12032 V/deg C Tvmp=-0.12516 V/deg C AWG 12 Table 310.15(B)(16) Tisc= 4.46 mA/deg C Ampacity= 30 > 13.94 A Corrected Ampacity= 17.40 A > IIAS A Temperature Derate= 0.58 Conduit Fill Derate= I DC Converter Electrical S dfications: Inverter A Input Circuit (PowerBox to Inverter) Unused SolarEd a OP300-MV Powe- 300 W String 1 Vmax= 5501 Wire Length 45 Vmax= V Wire LengthEfficiency Factor- 0.987 Vmp= 350 V Vmp= V MA Vmin_input= 5 V Imax= 15 A Imax= A Vmax Input= 60 V Imp= 7.76 A Imp= Imax_lnput= 10 A Vmax_output= 500 V AWG 10 90'C:Table 310.15 B 16 90 C: Table 310.16 Imax_output= 15 A Ampacity= 40 > 15 A Ampacity= > A Corrected Ampacity= 23.20 A > 15 A Corrected Ampacity= A > A Temperature Derate= 0.58 Temperature Derate= Conduit Fill Derate= 1 Conduit Fill Derate= OCP= 20 A OCP= A DC Converter Electrical S ifications: SolarEdge 3800 AFCI Inverter A Output Circuit Service Volta e = 9 240 V Combined Inverter Output Circuit Service V01ta e = 240 V 9 Powe- 3800 W Icont = 15 A Wire Length 20 Icont JA Wire Long h Vmp_input= 350 V Vmax Input= 500 V AWG 10 90 °C:Table 310.15 B 16 90 C: Table 310.16 Imax input= 12.664 A Ampacity= 40 > 18.75 A Ampadty= > A Vmax_output= 240 V =Service Voltage Corrected Ampacity= 36.4 A > 15 A Corrected Ampacity= A > A Imax output= 15.83 A =Icont Temperature Derate= 0.91 Temperature Derate= Conduit Fill Derate= I Conduit Fill Derate= OCP= 20 A OCP= A CONFMT AL - THE 1WOMA71ON HEREIN 1HE CONTAINED SHAH NOT BE USED FOR eENMT OF ANYONE EXCEPT SOLUCITY INC. NOR SHAti IT BE DISCLOSED IN YAIOtE OR IN PART TO OHM OUTSIDE THE RECIPIENTS ORGANIZATION. EXCEPT IN CONNECTION WTH THE SALE AND USE OF THE RESPECTIVE S(RARCITY EQUIPMENT. 1111MT 1HE MPoT7EN PETiMSSIOtT OF satARan wC .loe It m , J B-0 2 6 2 0 8 00 PRIJIM t»aI: t EWI[ Dtt GODIN, PAULA J GODIN RESIDENCE 21 PAWNEE RD 4.25 KW PV Array WEST YARMOUTH, MA 02673 PAGE MAIL 5088620659 ELECTRICAL CALCULATIONS OESX>t Spencer Branch \ -\%k i�„ olar ity. MOMIN srsmt Comp Mount Type C MODIAES: 17 YI W I YL250P-29b 24 sE Moft OrM. Bul*,g5a1, Only It b (6sO) 636-102�6 F (650) 636-1029 (W6 -SQL-an (765-2489) ..."cfty.r.orn SIM. I. DAD" PV 6 2/28/2014 INARMt SOLAREDGE SE38DOA-US-ZB-U r n \ nM Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS OfacialIlse Only Permit No. 1570 9 — 109 s Occupancy and Fee Checked (Rev.11/99] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC ). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: sT' — 2 7 — O 9 City or Town of: (l L . To the Inspector of Wires: By this application the undersigted gives r.. of ' or her intention to perform the electrical work described b ow Location (Street & Number) Ma Pare Owner or Tenant r,7 Ct14 �rN rE Telephone No. Owner's Address 3 1 ` Is•this permit In conjunction with a buflding permit? Yes © No ❑ (Check Appropriate Box) i P rpose of Building Utility Authorization No. 1 cn s IService Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters TiI / Volts Overhead ❑ Undgrd ❑ No. of Meters rvice Amps ;�,mb.:er of Feeders and Ampacity ,iton and Nature of Proposed Electrical Work: Lill - c Completion of the followin fable and be watvrd b' the lns rctor o Wires. o. o ota No. of Recessed Fixtures No. of Cell.-Susp. (Paddle) Fans Transformers KVA No. of Lighting htin Outlets No. of Hot Tubs Generators KVA o. o mergency Lighting No. of Lighting Fixtures Swimming Pool rnd -have ❑ mud ❑ Eatte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Gas Burners o. o Detection an No. of Switches InitiatingDevices No. of Ranges No. of Air Cana. Tons No. of Alerting Devices eatPump Number ons o. o onto e No. of Waste Disposers Totals: Detection/Alertin Devices Municipal No. of Dishwashers Space/Area Heating KW Local ❑ Connection El Other Heating Appliances KW Security Systems: No. of Dryers No.. of Devices or Equivalent o. of Water KW Si ns - - _ Heaters F�lBallasts No. of evices or uivalent e ecommu canons g: No. Hydromassage Bathtubs No. of Motors Total EP No, of Devices or Equivalent OTHER: ' Attach additional detail {fdesired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The tit undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECKONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) (Expiration Date) $ Estimated Value of Electrical Work: J!l D O (When required by municipal policy.) NWork to Start: S•—&;L g— Og Iaspcctions to be requested in accordance with NEC Rule 10, and upon completion. �I eert;%y, tinder the pains and penaitiet of perjury, that the information o this application is true and complete. FIRM NAME: T S LIC. NO.: Licensee: Q LL� �t (t �t t Signature LIC. NO.: (yapplicable enter "exempt" In the Iicru�e number line.) _ Bus. Tel. No.: Address: _\ , C Alt. Tel. No., OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. nw"Pr/Anent I PERMIT FRF,: s 19 AUG 1112010 v kLV�,N�GDZPI / EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231' Ext, 261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: IrS CONTRACTOR /-lrI,)AY �Q- 8 at OtTlee Use only �f n Permit a // / / (/ Fee SW 'amit eVircs 6 month, fror f y�/•n 0 u K A3(5 77- 3 I MaP: n q I Parcel: Vq 1 tie Amidr --- car-sS� U (G T 8 • (��� +� 0 Commercial IA Cost of Construction S _� , �j 010. 0 D home Improvement Contrnctar Tic. N__ � ) v 7 � v Construction Su�� Lic. # a L{ l) Wmkman's Compeaaetion bmaaoce: (check one) ❑ I am the homeowner 0 I am the sole proprietor�Qve Worker's Ceimpmsatim hrs mmrc Inswance Company Namc t'/'f (�T G� IBC G ✓ a Worker's Comp. Policy#_ J V) `c q D Teat WORK TO BE PERFORMED (Faro Retardant Certificate attached) r u s w'xd Stove Shed idiog M of Squares uplaeemont door # �Q R`.placnned windows: # oRereocaer cS�Ide� nor �nd+rs�n �°/t.4'1-1Jher*ld ( ) Stripping old shingles* () gOing ova layers of esistiog roof 'The debris will be disposed of I declare mdw perultiei of perjury Will be just cause for denial o- Applicant's Signsturs: Owners Sigrudure (or ❑ Old Kings Highway/Historic District �RoormeSiidiog (Lace for Lice) eodained are truer and correct to the best of cry knowledge and belief. I understand that any Was snswer(s) srpreswAioa under &LO.L Ch. 268, Section 1, a Date: / ?mil v Approved By / Date Building ORicial (ordesignee) Zoning Distric FGstorical District: ❑ Yes No Water Resource Protection District ❑ Yes �o - Flood Plain Zotra: Yes ❑ No Within 1001 of Wetlands. [�—Yes ❑ No 3,nl The Con;' monweal(h of Massachusetts -' Department of Industrial Accidents gffice ofliivestigations 600 Washi;tgton Street Boston, MA 02111 lvwminass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/organization/Individual):. l% ZZ— i t1�'t: D rfl It L h t Address • D GL City/State/zip: (, a Ai Phone.#: t �Zt� • 9 S/ Y Are you an employer? Check the appropriate )fox: 1. a employer with * 4. ❑ I am a general contractor and I Type of project (required):. 6. ❑New construction employees (full and/or-.* have hired the sub -contractors ❑ I am a 'sole proprietor or partner- meted on the attached sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. : employees and have workers' 9. ❑Building addition [No workers' comp. insurance required.] comp. insurance.=' 5. ❑ We are a corporation and its' 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 1219loof repairs insurance required.] t c. 152, § 1(4), and we have no 1 S/ •d 3�Ather / r o + r'. employees. [No workers' comp. insurance required) r t' olt r e m 1•n t *Any applicant that checks box #1 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 thrn hire outside contractors must submit anew affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 thepo/icy andjob site information. , 1 I l Insurance Company •e- I Y1 v Yva. CID it '/- Policy # or Self -ins. Lic. M S "r 3 Z Expiration Date: ZT Z) Job Site Address: W 4 `e IL City/State/Zip: W /7htdd2%7.3 Attach a copy of the workers' compensation policy declaration page (showing the policy numb 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 S 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 th4 violator. Be advised that a copy of this statement may be forwarded to the Office of ature• Date: �1�� 2,J/y [one #: ? t7�0 ��Jl� .•' Official use only. Do not write in this area, to he completed by city or town officiaL City or Town: _ Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: , Phone #: 0 Office or Consumer Affairs & B siness Regulation License or registration valid for Individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratlon.rag00740 Type: Office of Consumer Affairs and Business Regulation Expiration: c6R.af2012 Private Corporation lOPark Plaza - Suite 5170 Boston, MA 02116 WIZZIHOMEIMiiRQVEMENT Mr. Thomas Capizzi,_t== 16451 Rd. 1 *�; -7'�� Cotuit, MA 02635Key Undersecretary Not valid u signal re N1a..achuset Is - Department of Public Saret� Hoard cr Building Regulations and Standards Construction Supervisor License License: CS 74640 Restricted to: W 7 � GARY GUSTAFSON.�°~ 8 SHORT WAY a °� SANDWICH, MA02563 '„� ( uuwii..i•�urY EAp¢at io n: 11/29/2010 TrV: 7755 Client#: 47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE ° ATE (MWDgD rn 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(les) must be endorsed. It 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 Rogers & Gray Ins. -So. Dennis Route 134 P. O. Box 1601 South Dennis, MA 02660-1601 CONTACT NAME: Karen A Walther, CISR PHONE 508-760-4630 ac Na508-258.2230 En:434 -ML ADDRESS: waltherka@rogersgray.com UGE CUS OMERIDR: INSURERS AFFORDING COVERAGE NAIC • INSURED Capizzl Home Improvement, Inc. Capful Enterprises, Inc. 1645 Newtown Road INSURER A: National Grange Insurance Co. INSURER B : ACE Property & Casualty Ins. Co INSURER C: Cotult,MA 02635 INSURERD: INSURER E : INSURER F : GOVCKAGt5 CERTIFICATE NLIMRER- RFVISIr1N 1JIIMRFR• 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 LM TYPE OF INSURANCEADDLW POLICYNUMBER POLICY EFF MM/DDNYYY) POLICY EXP (MM/DDNYM LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAJMS-MADE a OCCUR MPB1075H 6108/2010 06/08/2011 EACH OCCURRENCE f1 OOO 000 PREMISES Eaoowrrence f500000 MED EXP (Any we enon f10000 PERSONAL 6 ADV INJURY f1 000 000 GENERALAGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY PR0. LOG PRODUCTS-COMP/OP AGG f2 OOO 0-00 If A AUTOMOBILE LIABILITY 'ANY AUTD ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS M1 M28044 6/08/2010 06/08/2011 COMBINED SINGLE LIMIT (Ea accident) f500000 BODILY INJURY (Per Person) f X BODILY INJURY (Par accidald) f X PROPERTY DAMAGE (Par accident) f X Uninsured $2500001500000 Underinsured $250000/500000 A X UMBRELLA LIAR EXCESS LIAR X OCCUR CWMS-MADE CUB1076H 6108/2010 06/08/2011 EACH OCCURRENCE f5 000 000 AGGREGATE fS OOO OOO DEDUCTIBLE RETENTION 10000 f X f B WORKERS COMPENSATION AND EMPLOYERS' EMPLOYERS' LIABILRY Y I NFR �CUT ICER/MEM ER PEX UDEED E (Mandatory In NH) N yea da' under DESCRIPTION OF OPERATIONS below NIA NWCC45843208 2/25/2009 12/25/2010 X WC STATU- E.L. EACH ACCIDENT S1,000,000 E.L. DISEASE. EA EMPLOYEE 31,000,000 E L. DISEASE - POLICY LIMIT 1 f1 00O 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdditIonal Remarks Schedule, If m rs apace Is required) Carpentry Town of Yarmouth 1146 Main Street, Route 28 South Yarmouth, MA 02664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION_ All rinhtt ratarvad ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S52570/M52541 KW 0 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS Page 7 of 7 LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT - u OWN THE PROPERTY LOCATED AT I I�z t.Jne2 �q) IN/ MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: e 04 OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: APPLICANT'S TELEPHONE: RESPONSIBLE OFFICER: 1645 Newtown Rd., Cotuit, MA 02635 508428-9518 RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade, (MEC), 527 CMR 12.00 OF k 9 WTTACMElS! �wnU O TOWN OF' C (PLEASE PRINT IN INK OR TYPE ALL LMOM Ili o (OFFICE USE ONLY) By Fee: $ PERMIT NO. Date: /0 ^ U To the Inspector of Wires: By this application the un e_rslgnccIg<ves notice of his or her intention to perform the electrical work described below. _ r, Location (Street & Nurnbc, F G Owner or Tenant % f C U C E Owner'sAddress A) '15 aw iTe-E Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Dwd I t 11 a 'Utility Authorization No. Existing Service Amps / Volts Overhead New Service Amps / Volts . Overhead❑ Undgrd [3 Undgrd C3 Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: K t N1 ':�ic mci No. No. of Meters No. of Meters t> V• WCom letion o the ollowin table may be xaived by the Inspector o {fires RecessedNo. of f sI211'addle) Fans No. o ota Transformers KVA No. of Lidting Outlets No. of Ilot Tubs Generators KVA No. of LightingFixtures Above n- SwimmingPool md. ❑ md. No. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat um Totals: um er — ons — K — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Other ❑ Connection No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail J desired, or as required by the inspector of Nines. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. A CHECK ONE: INSURANCE M BONDE) OTHERQ (Specify:) M Estimated Value of Electrical Work: 3 n t7 '— %Work to Start /O —%^Z) 6 Inspections to be requested in r the ai I certify, undeand pen es ppf perry, that the inform, `FIRM NA Lt E:Li-..Q-S O Ij toti() hl-"-ut-3 v Ht4u-._ btgn. enter "exempt" in the license�c ber li c.) DOWNER'S INSURANCE WAIVER: I am aware that the Licensee does not below, I hereby waive this requirement. 1 am the (check one) owner E] Owner/Agent Signature [Rev. 04/OOJ (Expiration Date) (When required by municipal policy.) rt gl;.,with MEC Rule 10, and upon completion. i is true and complete LIC. NO. LIC. NO. Bus. Tel. No.: a i'U Alt. Tel. No.: : the liability insurance coverage normally required by law. By my signature owner's agent. [ Telephone C� ONE & TWO FAMILY ONLY — BUILDING PERMIT APPLICATION TD CONSTRUCT. REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUNO o y Town of Yarmouth Building Department �•* - 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 Use only Planning Board Information Assessors Department Information: Permit N . Dale _ Permit Fee Plan Type Endorsement Date wo r 2 / t ecording Date NewDeposit Rec'd. S 1_ Date L plan no t e Prop" Dimensions: Net Due S triter tot -Area(SO Frontage (h) Im oq,&M TNP Section for Oka Up Building PermitNumber1l. Da laduad: 8(ynaWrx. ^ �.:.%, CertHf�sOtl7a(tpartcy• ' ' .!; Billdot0 OlerJek f y Oatt:. d M naf ngti ; Section I - She Inform Don Use t3rou : R•4 T : 5-0 1.1 ftpertr Arioasr 1.2 z qq Information: as Zoning District Proposed Use 1.3 MWIdbng SoUsta rs (ni Front Yard Side Yards Rear Yard Required Provided uired Provided q ired Provided 1.1 Water iuPPMQ IY r G 40. i sot 13 Flood ICrle 4ionmWorc Contracts: Public Pdvate IZongG BFE: Section 2 -rly OwnersN Authorized 2./ Owner o1 neoonk yc,,JU, rr , Name (print) Mailing Address Signature Tale e Zs A"Marlsod Agents L jerzl �/t A!. A.N.12JLJ ' Name ( Mailin (print) g Address $tlC lure phone Fax Section 3 - Constnxt(on Services 3.1 LleeneN Conetsvollen fsrpNNson %L YN! L (S License Number nddr - j—� Expiration ate S Ph ALFLeillatered Im ovemetM Contract Company loom __� at Appicada Q License Numbe Expiration a tu feleptJ r1 S� -1 OVER 9ectlo a tic C6 AffldttvK �r:dt t 26tR Workers Compensation Insurance affidavit must be completed and submitted with this application. Fallurs to provide this affidavit will resuR In the denial f the Issuance of the !wilding permit. Signed Affidavit Attached Yes .. ..... - No .......... Section I. D of PMpc1Nbrk checft at ) Ncw Cm*ucdm (3NIL d e aroana ffa of ththowv eft" aft O I R#Ws) O 1 Ajtwft ne O I Adet m O Accow"80% ❑ Type Demolition ONer Specify. Brief Description of Proposed Work C Sectlbn a- EsdtnatsdCdnst ucft Casts Item Estimated Cost (Datiara) to be Check Below compbted by permit apptkam 2 Elwbkat 114` A d . at-, ❑ Consavatlon•Commbslon Mn (it applicable) 3 / ass 4. Medw+kal (HVAQ ❑ oid Kings Highway 6 Hlatorkal S. Fire Protection B. Total . (t + Z + 3 + 4 + S) Commission appmvel (if appaeaD10) 1. row t3* a FL (w haw a aftlo" . a ContrackwAwRos for 1, , as owner of the subject property hereby authorize to act on my behalf, In all matters relative to work authorized by this buUding permit application. SlgnMtae d Own*r oat* 7b - Ul , as Owner/Authorizod Agent Pore" declare that the statements and information on the foregoing application are true and accurate, to the beat of my knowfedge and boost. Signed under the pains and penalties of perjury. pf" name A /4L1 1 9. 1!. 99 2 01 2 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location:_ Number Street Village Owner of Property. Construction Supervisor: _/ U , Name Address: License No. Licensed Designee: 4: -z r, ✓ter►—� 1 (If other than Supervisor) Name License No. No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contactor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shalIwillfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures anti the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked Xu, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bond OWNER'S INSURANCE WAI R: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Agent Owner U Agent rJ q6) Signature: T— /ter 1 � Building Official Approval: The Commonwealth of Massachusetts ' Department of Industrial Accidents Office ofInvestigatlons 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affldavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name Musiaess/l Tsnizstiodlndividual)• Address: � 1ar,ota CF,GIP: Phone #' Are you an employer? Check the appropriate box. 1. 111 am a employer with 4. 111 am a general contractor and I employees (fWI and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance requirefl 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 3a. ❑ 1 am a homeowner acting as a — general contractor (refer to #4) have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers, comp. insurance.= 5. �] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, 110), and we have no employees. [No workers' comp, insurance required.] Type of project (required): 6. (] New construction 7. Remodeling 8. 0 Demolition 9. Building addition 10.0 Electrical repairs or additions 1113 Plumbing repairs or additions 12.El Roof repairs 13.❑ Other 'Any applkant that checks box #1 must also fill out the section below showing their workan' compen>.pod 0oBcy infomution t Homcownen who submit this aMdavit indicating they am doing all work and then hire outside eonaseton tCoetrsetors that check this box must attached an additional sheet showing the name of the sub eontracton and state must submitew amdavit indicating such wbetA n of not those dtia have employees* if the sub-eoatneton have employees, they nnut provide their worker' romp• Policy number. / am an employer that Isproviding workers' connpensadon Insurance ort Information. t f r om' yeel Below is the Polley and fob site insurance Company Policy # or Self -ins. Lic. Job Site Expiration Date: 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 S250.00 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 ptVay that the lnformadon provided above is true and coned SiQrtatttro: Dat Opietal use only. Do not write In this area, to be completed by city or town oJJklaL ZZIMMEMEM City or Town: Permit/License 0 issuing Authority (circle one): 1. Board of Health 1. Building Department 3. C1ty/1'own Clerk 4. Electrical inspector S. Plumbing inspector 6.Other Contact Person: Phone* ' + Information and Instructions Maumbwettt (leaner! Lave dropout 132 requdta ell empbyda In pro" worloaa' oompem&tba for their UVWI"& Punuaa b thk stau" m swpbyw is dctinod a "».aray paws In the saris of soother under any contract of M capcaa of ing" oral of written." An e„jfipw it detimd r "era iodirid 4 pwxtaMd* usociadall corpaadas at other kpl eadty, or nay two or Mors of tba btepin� eapOed id a Joint anwrpies. and kachu ft the kpl repasat&drea ota deassod eaploy1w err tin rocdvor or trastes otaa Warltml. prmeship oloodoli m a other kpl entity. capkoyky =Vloyea. Hawewt the owner of s dweUhy how& bonny we anon then chose epartrnsaw and who now" tbaeik or the oaupwat otthe dwelWy bouw otanAw wbo eapbys paws& to do mddmaaa, coo&tcacdom a repair work an such dwoMM ham or oa the pound& at buiNfol opparwoom therein ubdl we becawe of suck empkrymnt be deemed lobs d empioyoc" M(iI. cheplor 132.123gq eke stain the "nrwry stare w local Heawliog &Pan1 AM "UMM Lk WUM of gown nil do amerce w psrook W operates beaino err to aaotrad bodMialls In do COM MwawnW Aar MW appticad wino boa not predsood aenptahk erI d l etesatpetanse widtt the laaerasn ceverap requi W AddWanDy.b6CILchopiwl52.12MsMw"NsidwtbocoozmmvnftzmuiyathopoMcdaAdividAd cow law my coaaad tint the pabsussum ofpablio work oudl ocuphble srideace otcougH whin tins boaranos mpkwnd& of thk chepw haw best p &mood oo the cootcactfauthority." APPVCSMW Please fill ore the worbn' couepon"os a®d&dt completely, by check&& the boxes that apply layout siamdos nod. It iasMoea L�d LWiitity C=WSWN (LLC)daLbLbWbd LleWWky Pa�MMW r ((LLP)) *4 W � s)of OdW rhea rho rnrmbae at parawlr toe ant mpked to Carry werkem' compeoudos hnumoor. If &n LLC at Lip des hew eaployssr` a po8ay is t - ,' - '. Be adviud diet We afi%kvk my be submitted to the Depubnoat of h dmkW AccWanb bt coadtmedom of loa:aoa Covaap. Abe be some w dp &ad dare do atiMdaViL The a[IIdarit should be noan&d o do city er been tint do opplicedos the dr pamk a Ikeawe k behas cwgo" see tins Dspmment of GndneotW Accidanm. 3b=M You bare any quadone x*Ir .1 the lawn at if you to rogohW to obtain a w - ion I coapos adorn policy, plow Call the Deporwmumt at the comber Weed below. Sdpitnmed compwda ubanM most their soMlosuteove Ileeaso member a lbw appoomfofe Has, C1 y w Town OMcM Pleas be nn that dw &®davit Is compka and p h*d Icsft. Tins Depsttmmd haw porWed i sprees ad the botm of doe a®dnk far you w till oat lee the overt the Ofto otlavadpdam ba to caawd you ropidiop the sppHead. Please be ON oo till In the pardt/Ban&s number wbkb will be used as a mfom a nmobeG Is &dditiot; = &ppBcawt that mot submit too file pamWBaaws appikadoow in my Sim yay good only suborn now dWWvit hedlcatLy cueaed policy Idamedon (ituscemmy) and unkur "lob WN Adhove the &ppik&ot d=U writs "a8 bcadoos ts_,(eity of town)." A copy of the atfi &vk da here been omdaBy utmpsd of norbd by the city or town any be povWW to the appBad m pod&d n ra1W &®d&A Isom Mohr !boas psrmh& or lieeoss. A now umdartt now be tiWd out ere► year. Whas a hams owner or dtiaa Is oboddrs a Mount or permit net reWW ID my bueioo ® of coacid veae aa (Le. a do{ Boone Booe or pardt to ban leave etL) said person Is rsgdeed to cour W . , able atBdariR Thw Otlloe of k radpdoaw would lib to thank you is advson An your cooperodom ad sbould you have say gmdiw% pleas dome besitaee is =ire ue a all. rho Depwaor 's address. Colophons aid ter: nmaba The Commonwealth! of Massachusetts Oepartmunt of Industrial Accidents Ot1lee of Investlptloas 600 Washington street Boston, MA 02111 Tel. 0 617-7214900 va 406 or I-W-MA39AFB Revised 11.224)6 Fax # 617-727-7749 www.mmaQov/des For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to. any pr&existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Saua'� B/ Est. Cost `qb Address of Work pl. Owner Name: Pc. A r. C , Date of Permit Application: It &t/ 14 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that:. OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Saa fK l Se Dad Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name . • � OF,Y'��4 J o� �y PLEASE DATE: JOB LOCATION: "HOMEOWNER" PRESENT MAILING TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, AIA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION STREET ADDRESS SECTION OF TOWN HOME PHONE WORK PHONE CITY OR TOWN STATE ZIP CODE The current exemption for 'Hom o er' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to enga a an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (Sta Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which e be, a one or two family attached or detached s constructs more than one home in a two-year peri submit to the building official, on a form acceptd such work performed under the building_ permit. / she resides or intends to reside, on which there is or is intended to :cure assessory to such use and / or farm structures. A person who shall not be considered a homeowner; such "homeowner" shall 51 to the building official, that he / she shall be responsible for all (Scktion 108.3.5.1) The undersigned 'homeowner' assumes responsibility or compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she unders nds the Town of Yarmouth Building Department minimum inspection procedures and requirements and that e / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, w Ch.142. Yes No If you have checked yes, please indicate the type coverage by checking the A liability insurance policy . Other type of indemnity meets the requirements of MGL T OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insur, Chapter 142 of the Mass. General Laws and that my signature on this permit application Signature of Owner or Owner's Agent h1omeowarlicexemp Check one: Owner Agent coverage required by. (es this requirement. TOWN OF YARMOUTH C BUILDING DEPARTMENT o y 1146 Route 28, South Yarmouth, MA 02664 �c�,';� ,s•� 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted Work Address Is to be disposed of at the following location: .C�.Ms }��.-,-� Q Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ignatur of Appt cation Permit No. / l ate k .. t %V ' Y The Co» lntonwealth of /Massachusetts Department of luduslrial Accidents Office r f Investigations I Congress Street, Suite 100 Boston, AM 02114-2017 wvvrvtnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Llcctricians/Plumbers Annlicant Information Please Print Lceibly Name (Business/Orgmiration/Individual): SolarCity Corporation Address: 3055 Clearview Way 0011 ,V,awV , vn I rlwl rnunc tr: --- --- — •-- Are you an employer? Check the appropriate box: 1.0 I am a employer with 3000 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the subcontractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurancc.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, ¢ 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑■ Other Solar / PV 'My applicant that checks box N 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit ntis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCauractors that check this box must attached an additional sheet showing the name of the sub-conuactors and state whether or not those entities have employees. If the sub-conuactors 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 Infortnatlon. Insurance Company Name: liberty Mutual Insurance Company Policy k or Self -ins. Lic. #: WA766DO66265023 Expiration Date: 09/01/2014 Job Site Address: All Locations City/State/Zip:i(� Attach a copy of the workers' compensation policy declaration page (showing the policy number aid expiration d e). 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 bereby cerl jy under the pales and penalties ofllrjp that ti Infonnallon provided above is true and correct 82152359 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License N Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• J � � ACC)RU' CERTIFICATE OF LIABILITY INSURANCE D0ATE 8/2 MNDY3 Oe/21/201 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 pollcy(les) must 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 Neu of such endorsements . IRooucla 0 26293 1-�15-Sa6-9 00 Arthur J. Gallagher i Co Insurance Brokers of California, Ina., License 10726293 1255 Battery Street /450 NAME -Brendan Quinlan _ PNON! TAR:• No•Eatl: 115-536-e020 _ IIuc,'N1; _ E-MAIL brendan Snlanla com AODREaa _ --- 9"_ _ -ajq. _ .___— San Lrrancisc0, CA 94111 _ INSURER(II) AFFORDING COVERAGE _-_ MAC ey INSURER A: LIBERTY NOT rIRE INS CO 23035 INSURED _ INSURER a: LIBERTY INS CORP 42404 SolarCity Corporation -- INSURER C• INSURER DI 3055 Clearview Nay _ INSURER EI San Mateo , CA 94402 INSURER F: COVERAGES CERTIFICATE NUMBER: 35272277 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. MSR LTR TYPE OF INSURANCE AD elk im POLICY NUMBER POLICY EFF PAMVOrfYYYI POLICY EXP (MM,DDJYYYYlLIMITS A GENERAL LIABILITY TB2661066265053 09/01/1 09/01/14 EACH OCCURRENCE f 1,000,000 X COMMERCIAL GENERAL LIABILITY O-RFNTE LM�E§ifLt.4��nce f 100,000 CLAIMS -LADE X OCCUR MED EXP (Any" S 10,000 X Deductible: f25,000 PERSONAL a ADv avURr f 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT. AGGREGATE LIMIT APPLIES PER PRODUCTS• COMPIOP AGO f 2,000,000 X POLICY PRO - _CT Loc I Ff A AUTOMOeIIUABRm )LB2661066285043 09/01/1., 09/01/14 COMBINED SINGLEI I E! Ecsba^I 1,000,000 X f ANY AUTO BODILY INJURY (Par Par ) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Pw auMard) f "ON -OWNED PROPERTY LAMA-�, S HIRED AUTOS UT"ON-OWNEDAUTOS My sockitno f UMBRELLA LIAR OCCUR EACH OCCURRENCE f f EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION f B WORKERS COMPENSATION NC7661066265033 (NI Retr ) 09/01/1 09/01/14 x WC STATu• OTW LIMITS FR ANDEM►LOYERS'LIABRJIY YIN E.L. EACH ACCIDENT S 1,000,000 B ANY PROPRIETORRARTNER)EXECUTNE IM766DO66265023 (Ded) 09/01/1 09/01/14 OFFICERIMEMBER EXCLUDED? N� NIA E.L. DISEASE. rA EMPLOYE f 1J0oo,000 (Manesrory In NH) N yea daaolbe unar DESCRIPTION OF OPFRATIONSbO" I I _.__.___ __ —. E.L. DISEASE• POLICY IIMIT -__ . __ f 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMICLES (AMach ACORO IDI. AddK$onal Rama*s acheddM,11 n apace M r"W,•d) Proof Of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance Only - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a...�e ACORD 25 (2010105) satyasan 35272277 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD , e?��/! O((U/��/Il(�/II(����1��� C�/((((JJCIf�IIJC�I�J = ffice o Consumer Affairs and Business Regulation �.� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration SOLARCITY CORPORATION JASON QUINLAN 24 ST. MARTIN STREET BLD 2 UNIT 11 MARLBOROUGH, MA 01752 SG1 1 0 2UM-0,11 Registration: 168572 Type: Supplement Card Expiration: 31=015 Update Address and return card. hilark reason for change. [] Address Renewal 0 Employment E] Lost Card �Office of Consamer Affairs & Business Regulation License or registration valid for individul use only r�iOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I�s�`Re Registration: Office of Consumer Affairs and Business Regulation # �, 9 • 168572 Type 10 Park Plaza - Suite 5170 `" �_•'� Expiration: 302015 Supplement 'ard Boston, lllA 02116 SOLARCITY CORPORATION JASON QUINLAN 24 ST MARTIN STREET BLD 2UNI�� AAALBOROUGH, MA 01752 Uoderaecretary Not valid without signature 1111111 Massachusetts • Department of Pubhs. Saloly Board of Building Regulations and Slandards I,.n.0 u• rn,n%up. I% 1..., Llcomo CS-095884 7) JASON R QUINLAN 190WALLS17 BRIIX;EWATER DIA^ 2 J 1- 1&14W- Laplratlun C/w1a1>tasu.ne, 1=2I2014 Office of Consumer Affairs end Business Velgiulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration SOLARCITY CORPORATION ALEC MEYERS 24 ST. MARTIN STREET BLD 2 UNIT 11 MARLBOROUGH, MA 01752 SCA1 a 2oMavtt I/ ffirictof r1/ I:III/III'/I//YY/111i ConsumerARaln& BusinessRcgnlatioa MEIMPROVEMENTCONTRACTOR egistration: 168572 Type: Expiration: 3/8/2015 ' . Supplement Card SOLARCITY CORPORATION ALEC MEYERS 24 ST MARTIN STREET BLD 2UNI ��-�--— LBOROUGH, MA 01752 Undersecretary Registration: 168572 Type: Supplement Card Expiration: 3182015 Update Address and return card. Mark reason for change. ❑ Address Renewal Employment ❑ Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 oe �f Not lid J; = ut si nature o• TOWN OF YARMOUTH Building Department Town Hall 0 Yarmouth, MA 02664 (508)398-2231 9XL1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: _ T-14-301 Applicant Name: SolarCity Corp. Applicant Phone: 9782152358 Building Location: 0021 PAWNEE RD Owner's Name: GODIN, PAULA Owner's Addres 0021 PAWNEE RD West Yarmouth MA 02673 Owner's Telephone: (508) 862-0659 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $150.00 Deposit Rec: $150.00 Payment Type: Check ChkNo.: 762380 Net Owed: $0.00 Application Date: 3/4/2014 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: -Map/Lot: 024.89 Install solar electric panels on roof DATE: DATE: DATE: DATE: DATE: DATE: WA: WA: WA: WA: WA: WA: DATE: Date Printed: 3/10/2014 :SolarCity. iW' Ch:er,ie• N IYJi. San fGaleo. CA 41402 Y (,;,HISG1-C.IIYr(GSu)56u-(i4hOSOtAkUIIY.cofl SUMMARY Humea•+ncr Name and Addiess 1'.0-Cian_•r ki ne (II Any) Paula J Godin Eugene Godin 21 Pawnee Rd West Yarmouth, MA 02673 Estimated Solar Energy Production First Year Annual Production: Initial Term Total Production: Payment Terms Amount Due at Contract Signing: Amount Due when Installation Begins: Amount Due following Bldg. Inspection: Estimated Price per kWh First Year: Annual Increase First Year Monthly SolarCity Bill: Lease Term SolarCity's Promises to You: • SolarCity will insure, maintain, and repair the System (including the inverter) at no additional cost to you as specified in the agreement. • SolarCity will provide 24R web -enabled monitoring at no additional cost to you, as specified in the agreement • SolarCity will provide a money -back production guarantee, as specified in the agreement. • SolarCity will warranty your roof against leaks and restore your roof at the end of the agreement as specified in the agreement. Your Prepayment and Transfer Choices During the Term: .I Iau or.. u,;mn I, lauenrry IYII 1011 iAI'C%:1 (A Cln,I I.q,,I I I.,,.1,d,d 11 In131rn as 1,1Id'(li4 hrstallaLon loraF.an 21 Pawnee Rd West Yarmouth, MA 02673 5,788 kWh 110,430 kWh $0 $0.00 $0.00 $0.1424 0.0 % $68.70 20 Years SolarLease Date: Luntnctar lucnse MA HIC 168572 • If you move, you may transfer this agreement to the purchaser of your Home, as specified in the agreement, • If you move, you may prepay the remaining payments (if any) at a discount. Your Choices at the End of the Initial Term: • SolarCity will remove the System at no additional cost to you. • You can upgrade to a new System with the latest solar technology under a new contract. • You may renew your agreement for up to ten (10) years in two (2) five (5) year increments. • Otherwise, the agreement will automatically renew for an additional one (1) year term at 10% less than the then -current average rate charged by your local utility 22. PUBLICITY SolarCity will not publicly use or display any images of the System unless you initial the space below. if you initial the space below, you give SolarCity permission to take pictures of the System as installed on your Home to show to other customers or display on our website. Homeowners Inittals 23. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS LEASE AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE YOU SIGN THIS LEASE. SEE EXHIBIT 1, THE ATTACHED NOTICE OF CANCELLATION FORM, FOR AN EXPLANATION OF THIS RIGHT. 24. ADDITIONAL RIGHTS TO CANCEL IN ADDITION TO ANY RIGHTS YOU MAY HAVE TO CANCEL THIS LEASE UNDER SECTIONS 6 AND 23. YOU MAY ALSO CANCEL THIS LEASE AT NO COST AT ANY TIME PRIOR TO 5 P.M. OF THE 14th CALENDAR DAY AFTER YOU SIGN THIS LEASE I have read this Lease and the Exhibits in their entirety and 1 acknowledge that 1 have received a complete copy of this Lease. Owner's Name: Paula J Godin Signature: C C►zZ< Date: Co -Owner's Name (if any): Eugene Godin Signature: L A� 4 Date: �,,SolarCity. SolarLease SOLARCITY APPROVED Signature: LYNDON RIVE. CEO Dale- 1/24/14 SolarLease ,:I1.t -YSDIarCity. 711"!vV - .ruI,m. S I lIII h llIII "Pi'(.: [FA CnnipLanl .0A.SolarCity. 3055 Cloamlew Way, San Mateo, CA 94402 (888)-SOL-CITY (765-2489) 1 www.solarcity.com February 28, 2014 Project/Job # 026208 RE: Project: To Whom It May Concern, CERTIFICATION LETTER Godin Residence 21 Pawnee Rd West Yarmouth, MA 02673 Version *31.3 A jobsite survey of the existing framing system was performed by a site survey team from SolarCity. Structural review was based on site observations and the design criteria listed below: Design Criteria: - Applicable Codes = MA Res. Code, Sth Edition, ASCE 7-05, and 2005 NDS - Risk Category = II - Wind Speed = 110 mph, Exposure Category C - Ground Snow Load = 25 psf - MP1: Roof DL =7 psf, Roof LL/SL= 19 psf Note: Per IBC 1613.1; Seismic analysis is not required because Ss = 0 < 0.49 . Note: Roof live/snow loads are reduced per applicable codes referenced above. Y00 JIN No. Digitally Igni:'d�y Yoo Jin Kim Date: 2 14.02.2813:17:19 -08,00' On the above referenced project, the structural roof framing has been reviewed for loading from the PV assembly on the roof. The structural review only applies to the section(s) of the roof that directly supports the PV system and its supporting elements. After this review It was determined that the existing structure is adequate to carry the PV system loading. I certify that the structural roof framing and the new attachments that directly support the gravity loading from PV modules have been reviewed and determined to meet or exceed requirements of the MA Res. Code, 8th Edition. Please contact me with any questions or concerns regarding this project. Sincerely, Yoo ]in IOm, P.E. Civil Engineer, Main: 888.765.2489, x5743 email: ykim@solarcity.com 3055 Clearview Way San Mateo, CA 94402 T (650) 638-1028 (888) SOL-CITY F (650) 638.1029 solarcity.com A-HIv'il I rl"C`_•,a l:,, 1'14, L')[( w,: JI I..I-,fir.. '11[,(-I11,. 711, 14:41.,,LI 10'.111;14v.)IIiCT:fr7ll. MA H:C I I A'r: ki" M"" 1:.1,46. 1111 II.u11(,1++... (,,IC.-H Iw4+:.,('r:i% 1141. 14 T, LH(17�r"Y,AI.:'-L SSA A,',�'11?J' L. 1,13,,. 411.4, AII � '+,� rl� \ �.�, • % w'r � 4 ", r i�1 tiLx�� a1�f�� • ' v q' !tr %�'• ..?,T �alr,q,�jt:+� � `� V ;rlok AMP �� • rs RYA � , , /• 'i.�, '.- 7i Gj � ;`fit :� ?,LA" Y' .,•tl ,. ,v � 14, '�i,.-: . �� `•{••�' � t� s•1 �..a�yy �,"a , ���+i ��, 'h:. red;� • �{f ib'� - ' + x :; 6:._,� 6 Kr elf V, If M �• QJ' �' I?. '`t ,f 7F �w � fu JcO dot • ,max/ Of I aiGi�LerlVla sIS. Commonwealth of assachusetts.EOEA: USDA LOAD ITEMIZATION - MP1 PV System Load PV Module Weight (psf) Hardware Assembly Weight s 2.5 psf 0.5 psf PV System Weightt 3.0 Psf Roof Dead Load Material Roof Category Description MPI. Roofing Type - -- .. _. _ ,.:_ _.__ :....._. _ ...._., . _:.. Comp Roof . (l l ayers )... ._ ._ _2.5 psf. Re -Roof to 1 Layer of Comp? No Undedayment .._..... _ ....:. • .. - Roofing Paper_... _.0-5 psf.._ ._. . Plywood Sheathing Yes 1.5 psf Board Sheathing.., . .. __.: ,..,...... - _... None... Rafter Size and Spacing 2 x 6 @ 19 In. O.C. 1.4 psf Vaulted Ceiling.....,. Miscellaneous Miscellaneous Items 1.1 sf Total Roof Dead Load 7 psf MP3 7.0 sf Reduced Ground Roof Live/now Loads Code Ground Snow Load py 25.0 psf ASCE Table 7-1 Snow Load ReducdonsAllovved?_._._, __. Effective Roof Slope 210 Horiz. Distance from Eve to Ridge _.: ,_W._ ._. __- . _ . 13.4 ft Snow Importance Factor I, 1.0 Table 1.5-2 _ Snow Exposure Factor Cc Partially Exposed 10 Table 7-2 Snow Thermal Factor 4 All structures except as Indicated otherwise Table 7-3 Minimum Flat Roof Snow Load (w/ pr 17.5 psf 7.3.4 & 7.10 Rain -on -Snow Surcharge) . .... _. -• .,...__.,.. .. _......... .._ ._.. _..._. Flat Roof Snow Load pr = 0.7 (C,) (Ct) (I) pg; pr t pf-min Eq: 7.3-1 17.5 psf 70% ASCE Design Sloped Roof Snow Load Over Surroun rn Roo Surface Condition of Surrounding q-Ma All Other Surfaces Figure 7-2 Roof 1.0 Design Roof Snow Load Over P"Od = (C&'*a) Pr ASCE Eq: 7.4-1 Surroundingrroor Roof p 70% 17.5 psf ASCE Desr n Sloped Roof Snow Load Over PV Modules Surface Condition of PV Modules CS -PV Unobstructed Slii0ppery Surfaces 1. Figure 7-2 Design Snow Load Over PV Modules p"9 p = ( ) Pf ASCE Eq: 7.4-1 70% 17.5 psf ". 1.. w 1 r CALCULATION OF DESIGN WIND LOADS - MPi Mounting Pane Information Roofing Material Comp Roof PV System Type _ ._..__ ...,._.. ... _ __ ....._ _ ...-SolarCity SleekMount'" Spanning Vents No Standoff Atachment Hardware)- —C&nli Mount T e C-' " Roof Slope 210 Rafter Spacing' 19" O.C. E-W Puriin S acin E-W Installs Only I NA Tile Reveal .., Tile Roofs Only. I NA Tile Attachment System Tile Roofs Only I NA Standincl Seam Spacing SM Seam Only NA Wind Design Criteria Wind Design Code ASCE 7-05 Wind Design Method ` . - . - Partially/Fully Enclosed Method - Basic Wind Speed V 110 mph Fig. 6-1 ExposureICategory' C Secdon 6.5.6.3 Roof Style Gable Roof y Fig. 6-11B/C/D-14A/B Meari Roof Hei ht _ .. _ , _...._ .. _w, .-. h .. _...... - - 15 ft' Section 6.2 Wind Pressure Calculation Coefficients Wind Pressure Exposure K= 0.85 Table 6-3 Topographic Factor ,. , ,- _ _ ... . , . _ 'Kt 1.00 _.. _ _. _ ._ . Section 6.5.7 Wind Directionality Factor Kd 0.85 Table 6-4 Im rtance Factor ... ........ ,.. _. .,-, .. I _ 1.0" .. - . -Table 6-1_ . . Velocity Pressure qh qh = 0.00256 (Kz) (Kzt) (Kd) (VA2) (I) Equation 6-15 22.4 psf Wind PrPcuirn Ext. Pressure Coefficient U G -0.88 Fig.6-11B/qD-14A/B Ext. Pressure Coefficient Down G 0.45 Fig. 6-1113X(D-14A/B Design Wind Pressure p p = qh G ) Equation 6-22 Wind Pressure U -19.6 psf Wind Pressure Down 10.1 P5f ALLOWABLE STANDOFF SPACINGS X-Direction Y-Direction Max Allowable Standoff Spacing landscape 57" 39" Max Allowable Cantilever landscape ....... _ ... _ _ - . ,., 24" NA Standoff Configuration Landscape Staggered Max Standoff Tributary Area Trib 15 sf PV Assembly Dead Load W-PV 3 psf Net Wind Uplift at Standoff T-actual- _ -276 Ibs ..... _ .. . Uplift Capacity of Standoff T-allow 500 Ibs Sa' ndoff Demand Ca acl_ , .. DCR _ ... - 55.2%...... X-Direction Y-Direction Max Allowable Standoff Spacing Portrait 57' 65" Max Allowable Cantilever - Portrait . 19" - _ _ . NA Standoff Configuration Portrait Staggered Max Standoff Tributary Area Trib 26 sf PV Assembly Dead Load W-PV 3 psf Net Wind Uplift at Standoff Tactual -460 Ibs _ ...... Uplift Capacity of T-allow Soo lbs S aDemand/Candciff. DCR 92.0% ABBREVIATIONS ELECTRICAL NOTES JURISDICTION NOTES A AMPERE 1. WHERE ALL TERMINALS OF THE DISCONNECTING AC ALTERNATING CURRENT MEANS MAY BE ENERGIZED IN THE OPEN POSITION, BLDG BUILDING A SIGN WILL BE PROVIDED WARNING OF THE CONC CONCRETE HAZARDS PER ART. 690.17. DC DIRECT CURRENT 2. EACH UNGROUNDED CONDUCTOR OF THE EGC EQUIPMENT GROUNDING CONDUCTOR MULTIWIRE BRANCH CIRCUIT WILL BE IDENTIFIED BY (E) EXISTING PHASE AND SYSTEM PER ART. 210.5. EMT ELECTRICAL METALLIC TUBING 3. A NATIONALLY —RECOGNIZED TESTING GALV GALVANIZED LABORATORY SHALL LIST ALL EQUIPMENT IN GEC GROUNDING ELECTRODE CONDUCTOR COMPLIANCE WITH ART. 110.3. GND GROUND 4. CIRCUITS OVER 250V TO GROUND SHALL HDG HOT DIPPED GALVANIZED COMPLY WITH ART. 250.97, 250.92(B) I CURRENT 5. DC CONDUCTORS EITHER DO NOT ENTER Imp CURRENT AT MAX POWER BUILDING OR ARE RUN IN METALLIC RACEWAYS OR Isc SHORT CIRCUIT CURRENT ENCLOSURES TO THE FIRST ACCESSIBLE DC kVA KILOVOLT AMPERE DISCONNECTING MEANS PER ART. 690.31(E). kW KILOWATT 6. ALL WIRES SHALL BE PROVIDED WITH STRAIN LBW LOAD BEARING WALL RELIEF AT ALL ENTRY INTO BOXES AS REQUIRED BY MIN MINIMUM UL LISTING. (N) NEW 7. MODULE FRAMES SHALL BE GROUNDED AT THE NEUT NEUTRAL UL—LISTED LOCATION PROVIDED BY THE TOWNYs juts��� NTS NOT TO SCALE MANUFACTURER USING UL LISTED GROUNDING R-MEl' M FOR R'DIMN"3 AND ZONING GODE'C OC ON CENTER PL PROPERTY LINE HARDWARE. B. MODULE FRAMES, RAIL, AND POSTS SHALL BE ANCE, ERRORS OR OM111fi5 ONS DO NOT RELIE% POI POINT OF INTERCONNECTION BONDED WITH EQUIPMENT GROUND CONDUCTORS AND APPLICANT FROM THE R115P©N&SILI1Y OF 'AS E� PV PHOTOVOLTAIC GROUNDED AT THE MAIN ELECTRIC PANEL - COMPLIANCE. SCH SCHEDULE 9. THE DC GROUNDING ELECTRODE CONDUCTOR DATE; SS STAINLESS STEEL SHALL BE SIZED ACCORDING TO ART. 250.166(B) do STC STANDARD TESTING CONDITIONS 690.47. --=- "- TYP TYPICAL UPS UNINTERRUPTIBLE POWER SUPPLY BUILDING OFFICIAL, FILE COPY V VOLT Vmp VOLTAGE AT MAX POWER VICINITY MAP INDEX VOLTAGE AT OPEN CIRCUIT W WATT 3R NEMA A RAINTIGHT PV1 COVER SHEET PV2 SITE PLAN PV3 STRUCTURAL VIEWS PV4 UPLIFT CALCULATIONS p`• r PV5 THREE LINE DIAGRAM `'� LICENSE GENERAL NOTESr • � PV6 ELECTRICAL CALCULATIONS X ,'' 143f` Cutsheets Attached j `� .. GEN #168572 1. THIS SYSTEM IS GRID—INTERTIED VIA A ELEC 1136 MR UL—LISTED POWER —CONDITIONING INVERTER. 2. THIS SYSTEM HAS NO BATTERIES, NO UPS. ; `" :, ," •, 3. SOLAR MOUNTING FRAMES ARE TO BE _ ,. . `•` ,Y GROUNDED. 4. ALL WORK TO BE DONE TO THE 8TH EDITION + , �� ; , ,'` MODULE GROUNDING METHOD: ZEP SOLAR OF THE MA STATE BUILDING CODE. 5. ALL ELECTRICAL WORK SHALL COMPLY WITH • ",�• N. � y ... COMMENTS AHJ Yarmouth THE 2014 NATIONAL ELECTRIC CODE INCLUDING � ,K � ,�•. REV A NAME G4TE COFMS MM MASSACHUSETTS AMENDMENTS. UTILITY: NSTAR Electric (Cambridge Electric Light) CONFIDENTIAL - THE WOMATION HERON CONTAINEDE17 O %IJAUANYONE NOT BE USED FOR THE TMINC. sIWi ATB N mam J B-0 2 6 2 0 8 00 PRM a•NER DexWTwN GODIN, PAULA J GODIN RESIDENCE 21 PAWNEE RD DMN; Spencer Branch 3SolarCity. '�i� 'Com SMou NOR � DISCLOSED IN Comp Mount Type C 4.25 KW PV Array y PART To OTI EM OUTSIDE THE REaPIEN1Y WEST YARMOUTH, MA 02673 MooUIEr 14 St Haft Drk% BuMog 4. Unk 11 MA ORGANIZATION. EXCEPT N CONNECTION PATH THE SANE AND USE OF THE RESPECTIVE 17 YINGLI # YL250P-29b Oar. REV. oATE• OEARa STY EQUIPMENT, WITHOUT THE VRTTEN PEA OF man E: PACE W. 5088620659 COVER SHEET PV 1 2/28/2014 T: (esaj ax`�`wou s017 apt-Tort pme)-Sa.-aTY pas-s489) . ..MaraRxawn Ntw nk SOLAREDGE SE380OA—US—ZB—U A 2 .1 21 Pawnee Rd PITCH: 21 ARRAY PITCH:21 MPl A71MUTH:150 ARRAY AZIMUTH:150 MATERIAL- Como Shinale STORY: 1 SI LEGEND 1 (E) UTILITY METER & WARNING LABEL INVERTER W/ INTEGRATED DC DISCO & WARNING LABELS p DC DISCONNECT & WARNING LABELS AC AC DISCONNECT & WARNING LABELS Q DC JUNCTION/COMBINER BOX & LABELS O DISTRIBUTION PANEL & LABELS 0 0 � LOAD CENTER &WARNING LABELS ❑O 1 O DEDICATED PV SYSTEM METER A Q STANDOFF LOCATIONS — CONDUIT RUN ON EXTERIOR --- CONDUIT RUN ON INTERIOR GATE/FENCE Q HEAT PRODUCING VENTS ARE RED r,' INTERIOR EQUIPMENT IS DASHED L :�J SITE PLAN N Sole: 1/8" = 1' 01' 8' 16' F Ain S CONTDEND1u-THE USED ATION CONTAINED 9Ut1 N^' . OSEO FOR THE NOR ST OF ANYONE � n sN WRan INC. Ax416max JB-026208 00 GODIN, PAULA J GODIN RESIDENCE oSSpencer Branch �.�}, \\, SolarCit MDom NOR SI+ui IT BE p�..EO N WHOLE OR N Mount Comp Mount Type C 21 PAWNEE RD 4.25 KW PV Array '��i� y. PART To OTHERS OUTSIDE THE Karon WEST YARMOUTH, MA 02673 MOOUIE4 24 SL Ma1N DrM, BuWFIV.oiq7 2, U"N 11 52 OWNIZATON, EXCEPT N CONNECTION WITH THE SUE AND USE OF THE RESPECTIVE 17 YINGU # YL250P-29b DALE: SOEARCITY EQUIPMENT. WITHOUT THE WRITTEN PERMISSXN or SO ARCITY NC. 5088620659 P/ Nam' SITE PLAN ' PV 2 2/28/2014 T: (660) 6 OM N (650) 635-1029 (am SOL-CITY (7e5-2469) .. Admft)L� NNRTER SOLAREDGE SE380OA—US—ZB—U R n SIDE VIEW OF MP1 NTS MPJ X-SPACING X-CANTILEVER Y-SPACING Y-CANTILEVER NOTES LANDSCAPE 57" 24" STAGGERED PORTRAIT 57" 19" RAFTER: 2x6 @ 19" OC CJ.: 2X6 @19" OC ROOF AZI 150 PITCH 21 STORIES: 1 ARRAY AZI 150 PITCH 21 Comp Shingle PV MODULE 5/16" BOLT WITH LOCK & FENDER WASHERS ZEP LEVELING FOOT ZEP ARRAY SKIRT ZEP COMP MOUNT C ZEP FLASHING C (E) COMP. SHINGLE (E) ROOF DECKING 5/16" DIA LAG BOLT WITH SEALING WASHER (2-1/2" EMBED, MIN) (E) RAFTER CONFIDENTIAL - THE DFOWA71ON HEREIN CONTAINED SHALL NOT BE USED FOR THE BENEFIT OF At-- EXCEPT SMARCITY INC.. NOR SHALL IT O}' SCLOSED IN MCLE OR N PART TO OTHLg=� TSDE THE REaPENTS ORGANIZATION. EXCEPT IN CONNECTION VATH THE SALE AND USE OF THE RESPECTIAE SOLARCITY EMWMENT. MAHOUT THE MTITIEN PERMISSDN OF SOIARCITY INC. (6) (4) LOWEST MODULE SUBSEQUENT MODULES STANDOFF `71 Scale: 1 1/2" = 1' mom JB-026208 00 MOmim Sym ComD Mount T►De C maim YL250P-29b INSTALLATION ORDER (1) LOCATE RAFTER, MARK HOLE LOCATION, AND DRILL PILOT HOLE. (2) SEAL PILOT HOLE WITH POLYURETHANE SEALANT. (3) INSERT FLASHING. (4) PLACE MOUNT. (5) INSTALL LAG BOLT WITH (6) INSTALL LEVELING FOOT WITH BOLT & WASHERS. GODIN, PAULA J 21 PAWNEE RD WEST YARMOUTH, MA 02673 5088620659 GODIN RESIDENCE 4.25 KW PV Array PALE KALE: STRUCTURAL VIEWS Spencer Branch ;,,SolarCity �. 24 SL Nath ft% BuIIYp 2. um 11 1: AC1E DAZE: 752 T.,(650) 676-102a F A(650) 676-102D PV 3 2/28/2014 (US)-SOL-CITY (265-2489) . sdar lty� UPLIFT CALCULATIONS SEE SEPARATE PACKET FOR STRUCTURAL CALCULATIONS. CONFIDENTIAL — THE DFDRIIATION HEREN CONTANm SHALL NOT BE L m rm THE BENEnT Or FTANaSIN TwY%E DUPT SMARCITY INC.. NOR SHALL BE MOSED aEE OR IN PART TO OTHERS ouM THE RECIPIENTS OFMANZATON, CUPT N Cm"CTICN WTH THE SALE AND USE or THE RESPECTnEE SOEARCITY EOWPYENT. WHOMTHE NRTU P° SSM Or SEAARaTY N` im N..11RER — GODIN, PAULA J GODIN RESIDENCE 21 PAWNEE RD 4.25 KW PV Array WEST YARMOUTH, MA 02673 PACE WE 5088620659 UPLIFT CALCULATIONS Spencer Branch i'v� 1,, SolarCit YDONTNO SISTat Comp Mount Type C woo= 17 MW YL250P-29b 24 SL Yanb DdN% Bud z unit n T. (63°) mt 02Eh �� 06-1029 (88*SM-Cm (76'r24N) ....wlwcey� SHM. REM DATE PV 4 2/28/2014 �� SOLAREDGE SE3800A—US—ZB—U GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) f8 GEC TO TWO (N) GROUND and Number. GE Inv 1: DC Ungrounded INV I -(1)SOLAREDGE !! SE380OA-US-ZB-U LABEL:- A -(17)YINGLI / YL25OP-29b GEN p68572 RODS AT PANEL WITH IRREVERSIBLE CRIMP Meter Number. 2305521 Inverter, 38OOW, 24OV, 97.57: w/Unifed Disco and ZB, AFCI PV Module; 250W, 226.2W PIG H4, 46mm, YGE-Z 60, Black Frame, ZEP Enabled ELEC 1136 MR INV 2 Voc: 37.6 VpmaX: 29.8 INV 3 Isc AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER E 125A MAIN SERVICE PANEL E 100A/2P MAIN CIRCUIT BREAKER D Inverter 1 (E) WIRINGGU CUTLER -HAMMER METER 100A/2P Disconnect 3 SOLAREDGE SE3800A-US-ZB-U (E) LOADS B C 1 71av SdorCity L1 L] A 20A/2P N EGfJLaC. 2 1 DC• A -_ GW ---_-__--____—_-_---__-__ GEC pp DC • 1 Streq(s) of 17 On NP 1 B ' ' __ EGG-__---___----_------------- -- 1-_-_ _- ECL-__ -_-------_ 1 y 1 N 1 EGCK,EC z 1 1 ' 1 ' 1 �_ GECT—i To 1zo/z4ov ' ' 1 1 SINGLE PHASE � � UTW1Y SERNCE 1 1 1 1 1 1 1 1 1 1 Voc* = MAX VOC AT MIN TEMP 01 (t )cE iHQ212o 20A / 2P BREAxtR 0roaker, 2OA/2P, 2 Spaces B (1)CUILER-HA1alER t DG221UR8 Dixamoct, 30A,/24OVoc. Non -Fusible, NEYA 3R ^ C A (1)SdarCil 4 STRNG JUNc,ION eox �C „ 2r2 S1YR�GS, UNFUSED, GROUNDED -(2)dound Rock 'S/B• a g, Copper -(1) Oaild%Nau'4d Cmerd -(I 1UP I W Ict, 30/k Duty (DG) Bopl96-0:2C (PKG B] C SdorCuord Monitoring System `' P V r» 4 meal= A300AW powers" H4. DC to DC 2EP nd ( 1) AMC 6% Solid Bare Copper -( 1) daud Rod; 5/r x IY, Capper (N) ARRAY GROUND PER 690.47(D). NOTE PER EXCEPTION NO. 2, ADDITIONAL Og1 AMC /l0. THAN-2, Black (1)AWG #10. THAN-2, Red 1 AMC 1106 1HIkN-2, Block Voc' 500 VDC be 15 ADC (1)AWC NO. THAN-2, Rd Vmp •350 VDC Imp.7.76 ADC O El ODE_IAAY-IOI-BE-REQUIRED XPFNDING-*LIXAnM -O"E) FI ECTROD (2)AWG /10, PV ORE, Block Voc* • 500 VDC Tx • 15 ADC O (1)AWG J6, Solid Bore Capper EGC Vmp a350 VDC Imp-7.76 ADC LLL (1) AWG /10. THAN-2. We NEUTRALEEE.11l. Vmp 240 VAC Imp 15.83 AAC (I) .AwG /14 THYN-Z deco.. EGG .....- (1)Canduil, Kit'. 3/.4 PYC� ?ch 10.... ............................................................... . q;.-(1)Canduit,%.3/4 EMT.......... M N CONTAINED � N� J B-026208 00 SE P`ODIN, � °��` �` SHALL LbNERT O ANYONE NOT BET SO FOR THE T BE USED IFOR T BENEFIT OF ANYONE EXCEPT 50tARCln INC. GODIN PAULA J GODIN RESIDENCE Spencer Branch '01. j =;: SolarCity. IKARITNc STS1Ett NOR SHALL IT BE DISCLOSED W WiOLE OR N Comp Mount Type C 21 PAWNEE RD 4.25 KW PV Array tr;� . PART To OTHERS OUTSIDE THE RECIPIENTS ORGANIZATION, EXCEPT WEST YARMOUTH, MA 02673 IEOIAEs 24 St Martin Drive, INAding Z Unit 11 N CONNECTION WTH THE SALE AND USE Or THE RESPECTIVE 17 YINGLI # YL250P-29b BEET: REV. DATE PV 5 2/28/2014 SOLAROTY EQUIPMENT, AITHOUT THE WaTTEN PUMSSION OF SOLARan INQ PACE TINE 1 5088620659 THREE LINE DIAGRAM 52 T. (6S0) We Moftwo7A f:A(617 36- 6f02Y 1 (Bee)-SOL-OTY (765-2489) ...,daranyaae N"Im SOLAREDGE # SE380OA—US—ZB—U ELECTRICAL CALCULATIONS Hardware O Model Voltage Drop Calculations Module: 17 Yin 11 YL25OP-29b YGE-Z 60 Vdrop= (Imp) (2'Length) • (Resistance) I (Vmp) DC Converter. 17 SolarEd a OP300-MV Inv Power DC W PTC DC W STC InverterA Im (A) Max. Len th (ft Wire Inverter A. 1 SolarEd a 3800 AFCI 38M 3768.49 4250 Input: 8.39 45 AWG_10 Inverter B: Vdrop= ( 8.39 •90 •0.00124 Ohms) 466.1733 0.19 3800 3768.49 4250 InverterA Imp A Max. Length ft Wire Output: Vdrop= Comb. Drop 756 (7.76 Im A 501 AWG-10 • 100 1 •0.00124 Ohms) 1 Max. Len ft Wire 466.17334 0.21 Inverter A Stringing Inverter B Stringing String 1: 17 Modules Stang 1: Modules 7.76 20I AWG 10 Stang 2: Modules String 2: Modules Vdrop= ( 7.76 ' 40 •0.0012 Ohms) hms 0.1552 1 0 Voltage Drop Calculations -F 'C Photovoltaic Module ElectricalSpecifications: Photovoltaic Source Orcuft Modules to PowerBox Yln II YL25OP-29b YGE-Z 60 Voc at Min Temp= 42.53 V Record Low Temp: 3 1 -16 Power (STC)= 250 W Voc= 37.6 V Max Average High Temp: 80 27 Power (PTC)= 226.2 W Vmp= 37.6 V Voc= 37.6 V Vmp at Max Temp= 27.42 V Vmp= 29.8 V Isc= 8.92 A Isc= 8.92 A Imp= 8.39 A Imp= 8.39 A Icont= 11.15 A Tvoc= -0.12032 V/deg C Tvmp= -0.12516 V/deg C AWG 12 Table 310.15(B)(16) Tisc= 4.46 mA/deg C Ampacity= 30 > 1 13.94 A Corrected Ampacity= 17.40 A > 11.15 A Temperature Derate= 0.58 Conduit Fill Derate= 1 DC Converter Electrical Specifications: Inverter A Input Circuit (PowerBox to Inverter) Unused SolarEd a OP300-MV Powe- 3DO W string 1 Vmax= Soo V Wire Length F 45 Vmax= 500 V Wire Length 50 Efficiency Facto- 0.987 Vmp= 350 V Vmp= 350 V Vmin_input= 5 V [max= 15 A Imax= 15 A Vmax_input= 60 V Imp= 7.76 A Imp= 7.76 A Imax_Input= 10 A Vmax output= Soo V AWG 10 90 °C:Table 310.15rNA 90 C: Table 310.16 Imax_output= 15 A Ampacity= 40 >A Ampacity= >#1A A Corrected Ampacity 23.20 A > Corrected Ampac(ly A > Temperature Derate= 0.58 Temperature Derate= Conduit Fill Derate= 1 Conduit Fill Derate= OCP= 20 A OCP= A DC Converter Electrical Specifications: SolarEdge 3800 AFCI Inverter A Output Circuit Service Voltage = 240 V Combined Inverter Output Clrcult Service Voltage = 240 V Power- 3800 W Icont = 15 A Wire Length 20 Icont = A Wire Leng h Vmp_Input= 350 V Vmax Input= 500 V AWG 10 90'C:Table 310.15(B)(16) 90 C: Table 310.16 Imax_input= 12.664 A Ampacity= 40 > 18.75 A Ampacty- > A Vmax_output= 240 V =Service Voltage Corrected Ampacity= 36.4 A > 15 A Corrected Ampacity= A >FEI A Imax_output= 15.83 A =lcont Temperature Derate= 0.91 Temperature Derate= Conduit Fill Derate= 1 Conduit Fill Derate= OCP= 20 A OCP= A CNFIDDITIAL - TIE DFMATION HUM CONTAINED SHALL NOT BE USED FOR 11E BMT OF ANYOK DWT SaaRCITY INC. NOR SHALL IT BE Ixs M IN tL W OR IN PART TO OTHERS OUTSIDE THE RECIPENTS OMWZAIION, DWI IN 6c"cnON W THE SALE AND USE OF THE RESPECTM SOLARCITY EQUIPMENT, NAM, IHE NPoM Pl[R°SS10N 0i 50LARCITr - JOB NNBM JB-026208 00 MUM&UM" VIL51"lut I GODIN RESIDENCE 21 PAWNEE RD 4.25 KW PV Array WEST YARMOUTH, MA 02673 PAGE NAIE: 5088620659 ELECTRICAL CALCULATIONS VLSM Spencer Branch \�\\% .d� 'o-ii " SolarCity. NOLINTIND smLx CompMount Type C NODuiIM, 17 YINGU # M50P-29b 24 St. NvtYh W,% Bu1&q Z UnR n NO T: (6S0)D]6- F. (om) fiJE-1029 (a88)-sOL-aTY(765-2482) ..sdwdty� StEEf REY. DATE PV 6 2/28/2014 KARTlR SOLAREDGE # SE380OA-US-ZB-U k _ 4 fib SolarCity SleekMountTM - Comp The SolarCity SleekMount hardware solution is optimized to achieve superior strength and aesthetics while minimizing roof disruption and labor. The elimination of visible rail ends and mounting clamps, combined with the addition of array trim and a lower profile all contribute to a more visually appealing system. SleekMount utilizes Zep CompatibleTM modules with strengthened frames that attach directly to Zep Solar standoffs, effectively eliminating the need for rail and reducing the number of standoffs required. In addition, composition shingles are not required to be cut for this system, allowing for minimal roof disturbance. MEIN • Utilizes Zep Solar hardware and UL 1703 listed Zep Compatible'" modules • Interlock and grounding devices in system UL listed to UL 2703 • Interlock and Ground Zep ETL listed to UL 1703 as "Grounding and Bonding System" • Ground Zep UL and ETL listed to UL 467 as grounding device • Painted galvanized waterproof flashing • Anodized components for corrosion resistance • Applicable for vent spanning functions Components (� 5/16" Machine Screw (j Leveling Foot U Lag Screw UD Comp Mount (9) Comp Mount Flashing SolarCity SleekMountT"" - Comp SolarCityary. Janu 20,3O� ® �� SolarCity �,..of , January 2013 Installation Instructions u f Drill Pilot Hole of Proper Diameter for Fastener Size Per NDS Section 1.1.3.2 Seal pilot hole with roofing sealant ( Insert Comp Mount flashing under upper layer of shingle Place Comp Mount centered upon Flashing Install lag pursuant to NDS Section 11.1.3 with sealing washer. (� Secure Leveling Foot to the Comp Mount using machine Screw Q) Place module 4, 1 .d solar- o SolarEdge Power Optimizer Module Add -On For North America P300 / P350 / P400 PV power optimization at the module -level - Up to 25%more energy - Superior efficiency (99.5%) - Mitigates all types of module mismatch losses, from manufacturing tolerance to partial shading Flexible system design for maximum space utilization — Fast Installation with a single bolt Next generation maintenance with module -level monitoring Module -level witage shutdown for Installer and firefighter safety USA - GERMANY - ITALY - FRANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us I solar ' o e a SolarEdge Power Optimizer Module Add -On for North America P300 / P350 / P400 ►300 ►350 ►400 (Far 6o<en ry (far nacre w (far 96a1 ry ntedules) module+) meduln) INPUT ------------ -- Rated Input DC Powerie ----------- 300 _ 350 IOD ---- W Absolute Maximum Input Valtage (Voc M lowest temperature) 48 60 so Vdc NIPPY OpentingKorea 3.48 8-60 8-80 - We Maximum Short Circuit Current Jim) 10 Adc Maximum DC Input Curren 12.S Adc Maximum Efficiency 99.5 5s Weighted Efficiency 933 Is Maeimum Ou1pN Carteret Maximum Output eft", _OUTPUT DURING STANDRY (POW Safety Output VonaR! per Power Opnm EMC Safety Roks _INSTALLATION SPECIFICATIONS Maximum Allowed System Voltage Dimension (W a L It HI Weight (Including cables) Input Connector Output wbe Type / Comertm Output Win Length Operating Temperature Range Protection Raring Relative Humidity -raemn.�+e.,.aw rrrxiyr.wr�xr..er-a PV SYSTEM DESIGN USING A SOLAREDGE INVERTER Minimum Stang Length (Power Optimi,m) Maximum String Length (Power Optimizers) Maximum Power per Sting Parallel Stings of Different Lengths or Crentatiom Adc Vdc R_ DISCONNECTED FROM INVERTER OR INVERTER OFF 1 IEC62109-1(class R whey), UL1741 141_x212 a40.5/ 5.SS x 814a 1 S9 - -- - 950/2.1 er/Ib - MC4/Amphe1e1/Tyco. Daubh Insulated; Amphenol 0.95/30 I 1.2/3.9 m/R 40-a115/40-a1115. 'C/'F IP65 / NFMA4 0.100 56 SINGLE PHASE THREEPHASE THREEPHASE zoev 480V g 10 14 2S 2S 50 5250 6000 12750 W Yee Maw �.a•� V_ b A YG" Z 6 ® YL255P-29b (/� YL255P-29b CELL SERIES YL255P-29b YL245P-296 YL240P-29b • Ideal for residential and commercial applications where cost•savings, installation time, and aesthetics matter most. ► Lower balance -of -system costs with Zep Compatible" frame. ► Reduce on -roof labor costs by more than 25%. ► Leverage the built-in grounding system - if it's mounted, it's grounded. ► Decrease your parts count -eliminate screws, rails, mounting dips, and grounding hardware. ► Minimize roof penetrations while maintaining the system's structural integrity. ► Invest in an attractive solar array that includes a black frame, low mounting profile, and aesthetic array skirt. ► Increase energy output with flexible module layouts (portrait or landscape). ► Trust in the reliability and theft -resistance of the Zep Compatible- system. AC SOLUTION OPTION The YGE-Z Series is now available as an Enphase Energized- AC Solution. This solution delivers optimum performance and integrated intelligence. enpha5e The Enphase M21 S-Z Zep Compatible )1 ' Microinverter is designed to connect directly into the Z Series module groove, eliminating the need for tools or fasteners - all with one easy step. ll��ae%s61 w4 Intelligent real-time w,:_ • monitoring at the system and module level with Enlighten. I1 YINGLI SOLAR I'Y`l 9 U.S. Soccer Powered by Yingli Solar Leading limited power warranty ensures 91.2% of rated power for 10 years, and 80.7% of rated power for2S years. 10-year limited product warranty. ' In compliance with our warranty terns and conditions. YGE-Z 60CELL SERIES ELECTRICAL PERFORMANCE Module type 1 ! ' YL260P-29b YL25SP-29b YL25W29b YL245P-29b ` YL24OP29b Power output ± P_ I W 260 25S 250 245 i 240 Power output toloramoss AP.w % _ L / e3 Modvoltagle e • tlffiJsnq -y.__ - _. _-__- w % 15.9 15.6 V I, 70.7 70.0 15.7 29.6 15.0 i 14.7 29.6 P 29.7 current at P+ Ope"mult veltoge 6.0 Vw " A 37.7 Ill1.39 V 37.7-27.6 -� _ - 8.28 _ 8.16 - 773 - 373 Short- Ircult cumM 6 A 9.09 9.01 8.92 _ 8.83 I 8.75 STC 10W W/mr Fradence, 25'C cell lompwatun. AM I.Sg spectrum according to EN 609W-3 Avwsgs relative o8mciwcy raducbon of 3.3%at 20OW/mr occomdrg W EN 609041 Power output ' P+ w 1 189.7 166.0 182A 178.7 voltage at Is- m Vwo ` V 27A 27A 27.2 27.0 current at P_ 6" I A 'I 6.67 6.79 6.71 _ 6.62 opendreeit voltsgo i V. f V ! 34.4 34.8 34.7 34.6 Short-circuit current 6 i A 7.35 7.28 7.21 --- 7.14 WXT.. opomcocut module opwation temperature M 800W/m' indann. MY ambient THERMAL CHARACTERISTICS temperature, Im/a wind sped �1'11a. F)r 7. i7r�' 3r.±? , 11---- -;1 UL 1703 and ULC 1703, CEC, FSEC, ISO 9001:2008, ISO 140012004, BS OHSAS 18001:2007. SA8000 C @Bf 11 you Cry bum YvVh /monks. Ym91i A. acts as the inponer and mmpkx wnh.0 LISTED IST EE reran appl.bl. was Customers can bey from Yvgll Amwncn wnh no worry cat they will be kablo for 4400 any ^mPo"MnOs. YINGLISOLAR.COM/US I Yingli Americas Nominal operating cell temperature Noct M Temperature ro.(ftd.m of P- { r - %rr _-- -- - _.0.42__- Temperature coaeWent of Vw I Fw . %rc .0.32 i Temperature eoofBdonl of 6 ppp9 aw ; IVY � 0.05 Temperature coefficient of V.w,ll Pm.or' 16M -0A2 Powered by YINGU GENERAL CHARACTERISTICS Dimensions 0./W/W 64.96.(165Dmni/369en M13mm)/ 1.61nfaunni Weight 45.21he (20.Skg) PACKAGING SPECIFICATIONS Number of modules par pallet 1 22 Number of pallets par 4W container 26 Pamiaging boa dimenYon, "W/Fe 67in V710wt0/45am 0145rm) 461n (I178mr0 Box weight . 1067be (4841,g) 2s 6 Units: inch (men) 6.54 -- 7.07 OPERATING CONDITIONS Max. system voltage 6WVoc or 1000Vnc Max. wits fuse rating 1 SA Whiting reverse current - ---- 1SA Operating temperature range r Max. static bad a0 to 185-F 1-40 to 75'Q _-___--24001'a_____.-__.. __---_-- Max. hailstone bWn(diameter /velocity) ----25mxn/23m/s CONSTRUCTION MATERIALS Front cover (material / thickness) bwton tampered glass / 32mn Oa (quantity / material / dimensions / ---- number of busbars) Enupwlant (materia8-------- --- - 60/ multiaystalmo silicon / 1S6mm x 1 S6mmt / 2 or 3 -- -- othyle , vinyl sc,bte (EVA) Fran (material / color / edge waling) ------------ ------------------- anodird aluminum alloy / black / silicon, or lap• ------------------- Junction boa (ingnss protection rating) a W6S Cable (length / oos,4ectional area) 1100mm / 4mm' connector (type / Ingress protection rating) MC4 or Amphorwl H4 / a IP67 3.91000) L Warning: Read the Installation and Usor Manual In its entirely 7 before handling. Installing, and operating Yingli modules. Our Partners The specifications in this datasheet are not guaranteed and are subject to change without prior notice. This datashoot complies with EN 50380.2003 requirements. Yingli Green Energy Americas, Inc. Tel:+1i(888) 86-8820 Tel: +1 (888) 686-8820 7 r� YINC�I SOLAR YINGLISOLAR.COM/US I NYSE.YGE O Yngli Green Ensgy Holding Co. Ltd. I YGEZ60C.II5erwQ013EN_20I309-V0I U.S. Soccer Powered by Yingli Solar S. 04 - solar,Zoffo SolarEdge Single Phase Inverters For North America SE3000A-US / SE380OA-US / SE5000A-US/ SE6000A-US / SE760OA-US / SE10000A-US / SE1140OA-US I The best choice for SolarEdge enabled systems — Integrated arc fault protection (Type 1) for NEC 2011690.11 compliance (part numbers ending in a-U') - Superior efficiency (98%) — Small, lightweight and easy to Install on provided bracket — Built-in module -level monitoring — Internet connection through Ethernet or Wireless — Outdoor and Indoor installation — Fixed voltage inverter, DC/AC conversion only - Pre -assembled AC/DC Safety Switch for faster installation USA - GERMANY - ITALY - ERANCE - JAPAN - CHINA - ISRAEL - AUSTRALIA www.solaredge.us so I a r o EaT Single Phase Inverters for worth America SE3000A-US/SE3800A-US/SE5000A-US/SE6000A-US/ SE1600A-USISE10000A-US/SE11400A-US SE3000A-US SE380DA-US I SE5000A-US I SE60DOA-U5 SE7600A-US SE200DOA-US SE11400Ai15 OUTPUT Nominal AC Power Output 3300 3940 5200 @ 208V 6D00 7680 9980 @ 208V 11520 VA 5520 @240V 20080 @240V Max. AC Power Output 3650 4150 56M to 208V 6000 8350 10800 IS 2DBV 120DO VA 6000 @240V 10950 @240V AC Output Voltage Min: Nom: Max.•- 283.208.229 Vac AC Output Voltage Min: Nom: Max.- J J ! ! ! J J 211- 240 - 264 Vac AC Frequency Min: Nom: Max.• 59.3.60.60.S (with HI country setting 57. 60. 60.5) Ha Max. Continuous Output Current 14 I 16 I 2S @ 208V I 25 32 I 48 @ 201 V I 48 A 23 @ 240V 42 @ 240V . GFDI 1 - A . Utility Monitoring, Islanding Protection, Country Configurable Yes Recommended Max. DC Power— 4100 I 4800 I 6500 I 75M I 9600 I 12400 I 14400 W (s7q Transformer -less, Ungrounded Yes Max. Input Voltage Soo Vdc Nom. DC Input Voltage 325 @ 208V / 350 @ 240V Vdc Max. Input Current'-- 11 13 17 @ 20 18 23.5 I I 33 @ 208V I 35 Ade 17 @ 2406V V I 30.5 @ 240V Max. Input Short Circuit Current 30 45 Adc ' Reverse Polarity Protection Yes GroundFaultIsolation Detection 600ko Sensitivity Maximum Inverter Efficiency 97.7 98.2 98.3 98.3 98 98 98 % CEC Weighted Efficiency 97.5 98 S @ 208V 97.97.5 97.5 97 @ 208V 97.5 % - 98 @ 240V - 97.5 @ 240V Nighttime Power Consumption <2.S <4 W _ADDITIONAL FEATURES Supported Communication Interfaces RS485, RS232, Ethernet, 7igBee loptional) STANDARD COMPLIANCE Safety UL1741, UL16995 (Part numbers ending In'-U•), U1.3998, CSA 22.2 . Grid Connection Standards IEEEIS47 Emissions FCC pants class B INSTALLATION SPECIFICATIONS AC output conduit size/AWG range 3/4' minimum / 24-6 AWG 3/4. minimum/8-3 AWG DC Input conduit size/4 of strings/ 3/4. minimum/1-2 strings /24-6 AWG 3/4" minimum / 1.2 strings/14-6 AWG AWG range . Dimensions with AC/DC Safety 30.5 x 12.5 x 7/ 30.5 x 12.5 x 7.5/ 30.5 x 12.5 x 10.5/ 775 x 315 x 260 Switch (HxWxD) 775 x 315 x 172 I 775 x 31S x 191 Weight with AC/DC Safety Switch S1.2/23.2 54.7/24.7 88.4/40.1 i Cooling Natural convection Fans(user replaceable) i Nolse 42S <51 Min. -Max. Operating Temperature -13 to •140 /-25 to a60 (CAN version ...-.40 to •60) Range _ - Protection Rating NEMA 3R . •rareMerrtak+W reMl r ple. mean sdreear ugprrr •• lFnxN b list b louear. Mart enrrMy axaraP aya lmxxerwvr Y d-aa T•f/tSKaMis IISx b bnUam Men x Y helm 1nznsK r-MxW a<amuxr4 nM1r ar l •••aM4l�«mlwn wwv,nry lr•W;en.-.ner.a smemine<evnn elN rNw om4. •••• GII rnh M.ly�a. b IM Oi<anr rR rN mbvrR I�xrRK SFIlaW4USUlMI rel i .•.l-.i-.. w., .pr .4. '.. ... r1 ..' ` r '• i'`1 `i rr�i: e1 L+ S<neweie te-rww,,-+. +,•.+, awe r. (.1i. .1k nr J ,w 5..: _ 27X4-1t... TOWN OF YARMOUTH Building Department (508) 398-2231 ext.261 PERMIT NO FB-09-1052 ISSUE DATE .. ..949 .: PROI ........ .....� APPLICANT .GaryGustafson BUILDING sI " PERMIT ' JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 10021PAWNEE RD ZONING DISTRICT R•25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1024.89 BUILDING IS TO BE: CONST TYPE 5-8 USE GROUP R-3 LOT SIZE remodel wdsting bathroom, add pocket door as per plans dated 04/24109. REMARKS AREA (SO FT) EST COST ($) $7,300.00 PERMIT FEE ($) $100.00 OWNER GODIN, EUGENE R BUILDING DEPT BY ADDRESS 10021 PAWNEE RD West Yarmouth I MA 102673 INSPECTION RECORD Date �� Note Progress - Corrections and Remark CONTRACTOR LICENSE 74640 Gustafson, Gary 1645 Newtown Road Cotuft MA 02635 5084289518 PHONE 5088620659 FIELD COPY r os 1 TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 '- PERMIT NO B-11-170 - PROPOSED USE PERMIT ISSUE DATE ;- 8/11/2010 . ; ;_ _ _ . _ ... APPLICANT _GaryGustatson---- ....... JOB WEATHER CARD _ __ A -VA PERMIT TO Alterations AT (LOCATION) 10021PAWNEE RD NING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE one replacement slider, 7.5 squares siding REMARKS BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 AREA (SO FT) EST COST ($ $8,500.00 PERMIT FEE ($) $75.00 OWNER IGODIN, EUGENE R BUILDING DEPT BY ADDRESS 0021 PAWNEE RD West Yarmouth MA 02673 CONTRACTOR LICENSE 74640 Gustafson, Gary 1645 Newtown Road. Cotuit MA 02635 5084289518 _ PHONE 15088620659 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector l *..00--maw. r TOWN OF YARMOUTH Building Department B U I L D I N G , , , , , (508) 398-2231 ext.261 � PERMIT NO ', ,B-07-422 , - PERMIT M ISSUE DATE 9(29/20Q¢ , : PROPOSED USE APPLICANT Thomascapizzl • ' ' ' ' ' ' • ' ' ' • • ' ' • JOB WEATHER CARD .............................. PERMIT TO Repair AT (LOCATION) 100021PAWNEERD ZONING DISTRICT R•25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1024.89 BUILDING IS TO BE: CONST TYPE 5-A USE GROUP R 4 LOT SIZE II strip and reroof, 19 squares, paper and vent to code REMARKS AREA (SO FT) EST COST ($ $7,500.00 PERMIT FEE ($) $25.00 OWNER EUGENE R GODIN BUILDING DEPr BY ADDRESS 100021PAWNEERD W est Yanra m MA 02673 INSPECTION RECORD CONTRACTOR LICENSE CS057032 Capizzi, Thomas Jr. 1645 Newtown Road Cotuit MA 02365 5084289518 PHONE 15088=659 FIELD COPY Date I _ Note Progress - Corrections and Remark I inspector SEP 2 9 2006 BUILDING DEPT. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth BuNdins Department 1146 Route 28 South Yarmouth, MA 02664 (508) 3M2231 Ext. 261 AssFss S urFO MATMN: r wpio den. (-Pa-0CPSC, 'EL N %RaidatW 0 Commomw Pit Cat dCom�on > � 1 a o -I L4o Cm bucbm pa.i.orl is . 05-1 ova wafine's Compeosbm hau moos: (check me) 0 1 m the 0 1 am the sale poprift 0 1 bm waba's compmssfice lieso ww �} bsmmw Camp my N=w '7___ 1 �(7 1'7 �YiL(1,2 wcdes Comps MicyN 0 wo�c m ss 0 Tert (Fke ltrdmteCa1i6aM esecied) rsMBMZD Dmadan wood ft" adrd L] tbd� N d'sa..e. • O Rpdeos�t wadowe: N 0 ��doon: N ,00c Nor l_Oiol� StONQ / \ old dlinow\• () sus om lgwm orwilligg rod rlt,. d.r,l..,df M of . I deden wndr paleiee ofpeq�r mt 1!e Mete twni oodeied M ame M d QwNd le11 bet afsy kmmkdp and bdkt I vdwd wd de dry §bs Ww=(r) wilt be jot ce Ear nroatiw of my bast vd Earp oKod w � r &LG.L a NeoGew 1. Apptioer e L7 tc _ a G1(17 v OwwweBipron(or ) OrIK App ed odicBr7dfebUmoel (or dedOne) Z 3iog Di*k tfitm ul DWrict 0 Yea aII ,o Water Raomoe Rooecpou i strict✓ 0 Yes I!r`f Food Plow z0fW0 os 0 )k Widdn R afWcdaWr Tes 0 No 7A1 t Date, 6/13/2006 Time, 8140 AH Tot 8 9,1,5084281547 it i, i' AEC Ins. A4CY• Pagel 035 rAmunu Cllent#.47298 - -- ACO M CERTIFICATE OF LIABILITY INSURANCE 0s113106 PRODUCER Rogers 8 Gray Ins. Agency, Inc 434 Route 134 P. 0. Box 1601 South Dennis, MA 02660-1601 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 0 INSURED Capizzi Home Improvement, Inc. Capizzi Enterprises, Inc. 1645 Newtown Road Cotult, MA 026M INSURER A: National Grange Mutual Ins. Co. INSURER B: GUARD Insurance Group INSURER C: INSURERD: INSURER E: GUVtRAGta THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING I ANY REOUIREMENT. 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS. EXCLUSIONS AND CONDITIONS OF SUCH j POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER P0LlCY EF VE POLICY EXPI ON DATE LINKS p I GENERALLIAeILITY ER X COMMERCIAL GENERAL LIABILITY CLANS MADE a OCQAi MP010707 MOM 0610=7 EACH OCCURRENCE s1000000 DAMAGE TO-E =ffNTED $500000 MED EXP (M we pawn $10 000 PERSONAL I ADV INJURY $1 000 000 I GENERAL AGGREGATE s2 000 000 i GENLAGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOPAGG f2000000 POLICY FlPJECT RO- LOC A AUTOMOBILE LIABILITY M101070T 06108106 0610810T �p LIMIT $500,000 � AtIY A/AUTOCOMBD ALL OWNED AUTOS SCHEDULED AUTOS BODILY NJ RY � s X X HIRED AUTOS Na+-wMt+m AUTOS BODILY s X X Drive Other Car IPPROPE�gAMAGE i E LIABILITY AUTO OILY -EA ACCIDENT s OTHER TWIN EA ACC AUTO ONLY: AGO f i AN 171 $ A,i BILITY LIABILITY CLAIMS MADEXERENENTN ❑110000 CU010707 06/08106 EACH OCCURRENCE 0000000 $ss5 AGGREGATE $SOOOOOO . iI1 DEDl1CT x wcsrATv- on+ I B I WORKERsCOMPENSATION AND EMPLOYERS'UANUTY CAWC702365 12/25/05 12/25/06 E.L.EACH ACCIDENT $500000 E.L DISEASE - EA EMPLOYEE $500,000 ANY PROPRIETOR PARTTERAD(ECUTNE CTFICERIMEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT 11500000 ' EymCAevbundr SPECIAL PROVISIONS Wm i pESCWPibN OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS � I I � i Town of Wellfleet 300 Main Street Weliflest, MA 0266T ACORD 25 (2001108)1 of 2 #M22681 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL in DAYSWRITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1 lljln [' < f Irrr'c,�li�aliur�e f i .;ushirr;;lurr ,SYr[ul • �•..iw, )�'larrt� nr.rrss:;;o)/din '��►'[�riEtcrs' CoTllllcalsaij011I SO )C.CAffidavit:)3WIders)C:onirariarsll+;lCcia'jCiaTas/P11lIn).)Cr's nD?ic•.arT! lni'orrllaiic�rl I'lc�au l'rini l.ct�il�Iy �7)�c, <i;v �cs�or ni�atta»nna�viaUal): Capizzi Home impruament Inc. —1:4tx-NB nt gn Rn nd 9dress: ;' Colult, MA 02635 Tel M951811800-262.5060 -- (y/SiaielZi�: 3'0u an emploper? Chccl; ilic•appropriaie box: I am a e,xr,Nloycr bvitb_ 4. am a grareral eontrmiorand 1. employees (Rib and/orpaii--Zme).* • have hired The sulrcomraaors i am a soldp'roprietor of partner- lisicd'on the attacbed dices. t . sbip'andlavetoo t Wployees Tbcsesub-contractorshave Working for me in any capacity. [No WOTkOtl CO3VP••bqiu2nce worke rs' comp. insuiance 5. We are a corporation and its • . required] officers have eaercisa their Iamahommvmerdoinbali•groA, rizLiofexemptionperMca, myself jI.to woricis' comp.. "•� c.152, §1(4), and vre1me,no insurance zcquircci] t employees. [No vrofl=, Type of project (required): . G.' ❑ New const wfion 7. E] Remodeling S. ❑ Demolition 9. L] Birildn¢g addilior;' . 10.0 B1e6tacal repairs or addition s lLEI Plnmbmg repair or additions 3.2E3 Roofrepaas ' 33.[] Ohre: �nlic`ni laic =1- bo�L gl anut$lso 10 =tb15 scWOXLbelow siiowjur-iheirwaa=ce; ori' li ' miomieiion ov,mcasWbosntanitasaE5davi loMce4Lgffi z=p,;;�� c1' clog +�.gt r.�ec1$iisboz 1171LS1 ry "`•+•+� aIl wor]:end S3cnl>ae 01d.9aE0®1i9LLorS miisl.6nbIIDi a �w nffidaviimd-iC51TIIg such � m addiiiona] s7uxisiwwing $ie7osme ofike sub mni�actors xnd pieirwo' a®. policy information.-' . ernnloyerYlzaLis prat>�dvW stroTkers' cnr t rAY eur taz`ioir_ nperrsra`ion irssurtvacc or p Fees. �8e7nr' is tiilie}' andjv$ site ' ace Compan}Namc G ()Lrk or•Self-ins.lic.W. CA"C7Oa 6 5Earn-ationDatc: e Address _. ' �..�... _ City/StafdZsp: �. a copy of #Le yrorkers' conipensatxott police deelaxaiion page (sly wixt; i.l e poiic5' number a)ad expiuxiio:a date)_ : to sceru a coverage as required undcx Section 25A of MGL a 132 cmlead to tine imposition of criminal penalties -of a to $1,500.00 and/or ono -year iu risoniaml, 23 well as chrgprma�-,yin the form of a STOP WORK ORDER and a one $250.OD a day aD mrr t31C, ��n ge advised that a copy ofiius sia(c a=i-play be forwarded to the Owe of nations oftixe DIA for insurance oovemge veri£catipn. r4bj74 told.tmu7p Pe-7U)] Weir!fvmlion,plgvide�d'ubffisXr=J3Udrvnect .L . 7S1 X eitrl tsse on1}r rUo :ror rNrite ix: This ateq #v be compXeted by cite or>inart nffuiaL r or •ToNsu: '�rniiill tcense #� tag Authority (circle obe): 1oar iher .d of J6Lealtb z. Building Dtnneparent 3. Ciiyl 071 Clerk 4. Ilectrical bnpector a rlumbing Lrspector .act Per son: 'hUAC t Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement.Contractor Registration Registration: 100740 Type: Private Corporation Expiration: ti/ WO08 CAPIZZI HOME IMPROVEMENT,.INC.-:-.* Thomas Capizzi, jr. 1645 Newton Rd. Cotuit, MA 02635 . Update Address and return card. Mark reason for change. ors -CAI A 50M-D Po PC8698 Address Renewal Q Employment 0 Lost Card Board of Building Regulations and Standards j t=- HOME IMPROVEMENT CONTRACTOR Registration: 100740 Expiration;- 6/23/2008 .Type: Private Corporation CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi,jr.. 1645 Newton Rd. Coluit, MA 02635 Deputy Administrator License or registration valid for indi-vidul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ala. 02108 . Not valid Without signature ! _ � •c✓%.s :Powr9no� j�f �/�iaaearl~i'" BOARD O s �� P Bt11LDING REGUL;4TTONS License NSTRUCTION S! �-;— Numb'" 0570.i2 t Birthd a i�9/3fi1dj4�63 y'` =i •Ex' ties: g17,bD7 :. � � . THOMAS X Reciea�f 1�s;r' ! • CAP =� _ . �-`-r 1645 NEWrOWNiR COTUIT, 1.1A 0265�.31' __ CQF rnlssrorier Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, rn r' m c s, ('!:�o CD I n OWN THE PROPERTY LOCATED AT 21 PAWNEE ROAD IN WEST YARMOUTH MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO • LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. _ SIGNATURE OF OWNER(S): OWNER'S ADDRESS: OWNER'S TELEPHONE LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: APPLICANT'S TELEPHONE: RESPONSIBLE OFFICER: 21 Pawnee Rd., W. Yarmouth, MA 02673 508-862-0659 1645 508 428-9518 RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Rd., Cotuit, MA 02635 C� LOT SIZE remove bad bearing wall to open area between livingroan and kitchen as per plan submitted 09/06/06. REMARKS AREA (SO FT) EST COST ($ $700.00 PERMIT FEE ($) $75.00 OWNER EUGENE R GODIN BUILDING DEPT BY ADDRESS 100021 PAWNEERD WastYamauth MA 02673 INSPECTION RECORD CONTRACTOR LICENSE CS057032 Capiui, Thomas Jr. 1645 Newtown Road Cotuit MA 02365 5084289518 PHONE 1508862OW9 FIELD COPY Date Note Progres - Corrections and Flemark Inspector 5 //-Olo % 01 oF'YgR,� ONE & TWO FAMILY ONLY - BUILDING PERMIT 3� C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING p y Town of Yarmouth Building Department '...,C.9 f 1146 Route 28 • Yarmouth, NIA 02664-1492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Information: Permit No. Date 4tv Type M �rS� Endorsement Date a L Permit Fee $ j Recording Date New Deposit Rec'd. $ Date Plan No. 1.4 Property Dimensions: Net Due $ Other Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Perrni Date Issued: Signature: ^�� Certificate Is of Occupancy R ' Is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 2 I nieP_ i21� 1.2 Zoning Information: 925 Zoning District Proposed Use V . \4 Q2m 0 U-1- 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L c. 40. S 54) Public Private 1.5 Flood Zone Information: Zone: BFE: Comments: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: /� Po i Y11 rS (fu C. tg:' VOOI �� �1W11Q Q N e ( rint) Mai��liinyng��Addddress `JIJ U ign urc Telephone 2.2 �,r� ,^�7 '1 f� -Utcr`�dlAeitA u`-r1T J QIpcor �7t�1 L Na (pri t) t , Mailin A dress 1J'l� O gna a Telephone Fax M SEP 0 6 2 76 Section 3 - Construction Services 3.1 censed Construction Supervisor: z Ncx�nP zmpiZuL>� �n�+�} 'oYAp icable B License Number C)5� 0 � 2- `"U�AO wl1 �V `1 V Address - Sze) y29 - q s I ExjZiration Dat Z x —4 U g r Telephone 3.2 Registered Home Improvement Contractor: Cop�pany Name 2 I ��Ur.Q_ J.n�p rQU 2 iYlQ.11� Not Applicable Ell �ceqsUna 1 r Q ,�i� Ad ress yy Q ((��I �0 (�•`I 2 ?P S 18 ig a r Telephone Expira ion at ti r 1of2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 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 .......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: o\Dtn (z' 102 La0.rz) i3ecLr cL _—t G t U C. 0 P rQ m s6-u Costs rPOS}S Mr) sk_Ck-k1ep n LOG�Al %C SUp Estimated Cost (Dollars) to be Check Below completed by permit applicant ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) •' Lo To be Completed When for Building Permit Section 6 - Estimated Construction Item 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & eddMons) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies 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. - �- 4 Cx Signature of Owner Date Section 7b - Owner/Authorized Agent DeclarationI, I\'I S1� 110 ) o 2-i 1—T , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Eignatqjr KOwner/Agent Date r 0 For+ - 9. 15-99 2 of 2 _• � pF AkAr r .or PLEASE PRINT: job Location: _ TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM 2I +-�WrW,4eIZ.D W-\JAILK-�0cAA4 Number Owner of Property: i f)-Ir Street Village Construction SupervisorT o 1-15 CAQ177-1 05-� o3Z 8-�Z.a'g5l Q� Name License No. Phone No. Address: It -f 4s- ►'l..wfouut'1 92o Cow (+ M A Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which lie is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 Tile license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 0 No ❑ If you have checked M, please indicate the type coverage by checking the appropriate box. A liability insurance policy -[:a Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ig a of Owner or owner's Agent owner ❑ Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: A--L"Tm A—f 1gi`j Est. Cost---k 2m 0u Address of Work 2 I ?Auj ► -e-- '2Q Owner Name: tU CA42,n-e- %- I po,, Date of Permit Application: V 2 L/ 0 U I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: o s (}n n cz�! C rl-� ,� - a o� � luiii�— V C6ntractor Name Registration No. NA Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial accidents emce811aresdonfoss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit c4tN phone p oc::)--C(-p ❑ I am a homeowner performing all work myself. 0 I am a sole proprietor and haNa no one working in any capacity -{, I am an employer pro%idine workers' compensation for my employees working on this job. address n Y�i 7✓ �M �% 'rnk-AA� Y I I� nhoneq: ���� 74 ❑ I am a sole proprietor.:eneral contractor. or homeowner (circle one) and have hired the contractors listed below who ha,.e the following workers' compensation polices: company names address• f1D phone N• r�nce co policy. N Failure tore coverage as required under Section 25A of MGL 152 can lead to the imposition of crislaal penalties of a Ilse sp to S1.S00 40 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER sod a Ifni of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do hereby eery gr1hrpains and penalties ojperjury that the information provided above is true and correct Signature ateyI/ Print nameLa hone 0 oRcial use oniv do not write in this area to be completed by city or town official city or town: YARMODT11 ❑ check if immediate response is required permitAicense 0 nBuilding Department ❑Llcensiog Board 261 ❑Selectmea's Office ❑Health Department (508) 398 2231 t phone 0: _ __ _ _ ex r7lOthcr contact person: us.,sed 3.95 PW Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entploNees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrplot•er 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 o%%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d%%ellina 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 emplo%er. %lG1. chapter I section 25 also states that even 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 vho has not produced acceptable evidence of compliance with the insurance coverage required. applicant % Additionalh. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public %%ork until acceptable evidence of compliance with the insurance requirements of this chapter hae been presented to the contracting authority. .applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying= company names. address and phone numbers as all affidavits 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. City or Towns 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. The aff davits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Accidenis MCC 81 111reSU120123 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 4069 409 or 375 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET "HOMEOWNER" NAME HOME PRESENT MAILING ADDRESS SECTION OF TOWN WORK PHONE CITY OR TOWN STATE ZIP CODE The current ju(2 ption for `Homeowner' was extende to include owner— occupied dwellings of one or two units and to allow homeowners to engage an individ for hire who does not possess a license, provided that such homeowner .11 act as supervisor. (State Build' , Code Section 108.3.5.1) Person(s) who owns a arcel of land on whit he / she resides or intends to reside, on which there is or is intended to be, a one or two famil ttached or detac ed structure assessory to such use and / or farm structures. A person who constructs more than one me in a t o-year period shall not be considered a homeowner; such "homeowner" shall submit to the building ollic' a f rm acceptable to the building official, that he / she shall be respnsible forfor all such work rformed under the bui ermit. (Section 108.3.5.1) The undersigned `homeowner' applicable codes, by-laws, rules for compliance with the State Building Code and other The undersigned `homeowner' c rtifies that he / she understands Town of Yarmouth Building Department minimum inspection procedure& and requirements and that he / she 1 comply with said procedures and requirements. HOMEOWNER"S SIGNA APPROVAL OF BUILDING OFFICIAL INSURANCE COVyesplease : I have a current liabilance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ❑ No If you have checked 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 the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ h:homoowndiccump TOWN OF YARMOUTH 1146ROUTE28 SOUTH YARMOUTH NIASSACHUSLTTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 22 PAL, n0 (AJ ' �L6-j nC)U* H Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. A Unlk) 0111-L+� Signature of Applicant Permit No. &LQvd�cp Date Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT 21 PAWNEE ROAD IN WEST YARMOUTH MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. 1, A SIGNATURE OF OWNER(S): OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: APPLICANT'S TELEPHONE: RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: 21 Pawnee Rd., W. Yarmouth, MA 02673 508-862-0659 1645 Newtown Rd., Cotuit, MA 02635 RESPONSIBLE OFFICER TELEPHONE: " O' 'Orj� i 7 Of I ,Vf, ,,ter ,, W°M k02 r stal 0/la/1000 T1IDeI BIYU AM To, Y Y,1,b9V42V1b47 YLO J.DS. ACCY• Yagal UU1 Client#• 4 298 CAPIHOM .ACCRD. CERTIFICATE OF LIABILITY INSURANCE 06113/06 PRODUCER Rogers & Gray Ins. Agency, Inc 434 Route 134 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THS CERTIFICATE DOES NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 1601 South Dennis, MA 0266D-1601 INSURERS AFFORDING COVERAGE NAIC M INSURED wsuRERA: National Grange Mutual Ins. Co. Caplzzi Home Improvement, Inc. INSURER a: GUARD Insurance Group CapivJ Enterprises, Inc. 1645 Newtown Road Cotult, MA 02635 NSRx:Ea C: INSURER D: NSIATLR E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE 14SURANCE AFFORDED BY THE POLICIES DESCRIBED HMEIN IS SUBJECTTO ALLTHE TEEMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS TYPE OF INSURANCE POLICY NUMBER DATE ( MMj)DlYYIEFFECTIVE DATE M D Yn LIMITS A GENERAL.UABIUTY MP010707 06108/06 06/08/07 EACH OCCURRENCE 51000000 DAMAGE TO RENTED iSOOOOO X COMMERCIAL GENERAL LIABILITY MED EXP (Any me person) S10 000 CLAIMS MADE ❑X OCCUR PERSONAL i ACV INJURY it 000 00D GENERAL AGGREGATE iz 000 000 GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS -coMPIOPAGG i2000000 PaLwY PRo Roc jEcT A AUTOMOBILE UABIUTY ANYALJTD M1010707 . 06/08/O6 06/08/07 COMBINED SINGLE LIMB (EsH) SSO0,000 BODILY INJURY (Perpem) ls S ALL OWNED AUTOS X SCHIDULEDAUTOS BODILY INJURY (Pa acdaenq S X HIREDAUTOS X NqY-WyL�D AUTOS PROPERTYDAMAGE (Peracddenq i X Drive Other Car GARAGEUABLITY AUTOONLY-EAACCIDENT i OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG A EXCESSAIMBRELLA LNeR1TY CUDID707 06/08/06 D610810T EACH OCCURRENCE S5 000 000 AGGREGATE iS 000 000 X OCCUR CLAIMS MADE S S RDEDUCTIBLE S X RETENTION i 1000D B WORKERS COMPENSATION AND CAWC702365 12I25105 12J25/06 TH- X WCSTA7U- OFR E.L. EACH ACCIDENT :SOD 000 EMPLOYERS LIABIUTY ANY PROF'RIETOfR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED7 E.L. DISEASE• EA EMPLOYEE S500000 8 yes, desalbe abler SPECIAL PROVISIONS below E.LDISEASE • POLICY LIMB 00000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIDNS L) ANY OF IRE ABOVE DESCR83ED POLICIES BE CANCELLED BEFORE THE D71 RATION THEREOF, 79E ISSUING INSURER WILL ENDEAVOR TO MAL , In DAYS WRITTEN X TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SE NO OBUGATION OR UABILTTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AGUHU Za (ZUU7UUu)1 of 2 #MZ2681 Mtt1 W AoUnU wnrUrwl "Iv Te00 • •L f!l��!! (� Y� �111'l•JJJ�;pi10JJ8 ta'���la : nrrrs�.,� of/die .,�'+'c�r;lscr,5'�n�J��aisal�urxl�u�araa�u:��'fida�'ii:l3uildcrslC:ont�~actorsll,Icc�xici�nslPi���nlacrs .: n lic-.an� 3nforri�aiir�x7 7'lc.►sc� 7'rini 1.c ►ilrl � • • an�c:<13nsi„css/o,�ar,;,a�;oJ,�„�,�,,a���: • CapInl Home ImprinI ment I:ic. 6t;5-NmW nihm�nscl 9dress: CdVI MA 02635 e • 4299518 11•soo z62 A60 -- ly/Siaie/Zzp: ��+au an employer?CL""DJc•approp)-iaLebo= i ant a Jloyer vvzilJ 9. El l am a gcm aal conicacbmad I _ �3��3'�s (foil and/orpai-L-Vie)."' iJaue haed 9Jo s�1J-cor�rar;�ozs Y am a soldjrioprietarotpartnea- sb p'andhavgho emlJloyees Iisied on fk attached d=L Z . WorlCiUg for MC, m any capacity. Udsesub-mnImctonhave vro&=' comp, ice [N4 -uroxke "cotijp_ IIISMn Ce $- '9Je are a cozporMIS aad idS - regnzred ] I -TM a lt3omeocvnadoingaIl officras inve exercised J'beu iiiiofcar�lionpcahlCrl groric myself [Nowarkeas'comp.. a c 152,§z(9),andvreiaveno iusuranceza7uiicci] 3 4np%yccs. jNo ivo&Ue co - Sc�nimste3�ec;sbo�xSianucslsota3Joiu73�escb;oabelo �OA4Z.;IJUUCa_I ape of project (required): . G.' New constmn on 9. ❑ Remodeling B. D=aliiion 9. E] Bm�.dingadditioa° tD.❑ i31 xepausoradditioLa 1 LE] i'Inmbing r0pnim or additions 12_E3 Rooficpain 33.fl•Oiber • ocameswlwsa�nuih�saSeaviimaicatm�Yi��y� w wmgYiieacror]¢desai�on�o7iq?�ormeiion CwxSozmust811or3ie3yo:YOS�rBIIdi�3CSi�IICD37i9dCLY]nir•rtq� su6unia ye$adaviimcTicsim�each a aadWonsl siuxishortiRg ibe7oa�e oiff�e s� coairacicvs aid iJ r. awi�xa' «moo. potter mfor�^=on sz em;�loyea z7icr� is proJ'idirzg x'oTkers? co ' �`ioiz r mpcvrsatrorzsrzsxJ!'.ruzce,�vrJuyezaploj�g�c.iBrJnr�iS>fiie�aiict�and,�vLsire . . pr s .LAG : CAWC7 0all, 7[rapirationDaic: J �(p •+ � Addrq`ss _ . J. a Copy Hof tLc rorlteas' co you policy declaJ i+o>a page (6aWmo i e poiicy number mad expiration date)- : I. to secure colrcaagc as squired thdw Section 25 A of MGL c,152 canlead i ' ih0 osition of c:iminnl to $1,500.do andlor ono- 1 pCaaltits of a o $230-00 a dayyear is�Jxzsonmmdi as wcU as hr p eaaltitsin. the fozm� of a STOP WORK ORDER and a fine aa'amst fire vIainr_ Be advised iiaat a to oftiiis statranpai nlay be fozv to O of . ❑n c ofthe DIEb for uJsurance coverage ye3ficaf oil �•�j'r-��'�e1.�7le�ruinsrnadpcsvf,Pel�3'J�irrltJze,gzforuur�ioA,p,gvided`rr�AvaysXistemsdrorreci ,,,., Ire: Date: czai rrse oxJIiz .t)o not tvlite u: Y7us,¢�-,� ¢o ba,c,�>�X(�,�j, �, artmi�x� o•�',ciaL - - . . > or xopc�a• ��cJmiilLi�ccnse�l "ag Auttlt 44 (circle wae): eardafBCealtli Z""'RdutgbepariJmexd 3-Cit.1'rrO'VinClerk 4.D=iAi.c:dbaspecior &rl.umbingLaspecior ,art rex-SOA: 1'Lnne}: t 677-7 Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100740 Type: Private Corporation Expiration: 6232008 CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi, jr. 1645 Newton Rd. Cotuit, MA 02635 OPS-CAI 0 5oM-04N5-PCams ,p\ Ole &wwwm4,aa& o�.��aeso�u�eeld �il\� Board of Building Regulations and Standards License or registration valid for indiv3dul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Registration: 100740 Board of Building Regulations and Standards Expiration: 6/23/2008 One Ashburton Place Rm 1301 Typo: Private Corporation Boston, Ma. 02108 - CAPIZZI HOME IMPROVEMENT, INC. Thomas Capizzi, Jr. 1645 Newton Rd. Cotuit, MA 02635 Deputy Administrator Not valid without signature j�. $Of1Ftb OF 13Li1LDING FtEG_ULXTT* a Llcense:'CCONSTR— MoN Ste: h� Numbed 057032 i :4 R. C $itthdate�b9/26Y17Q53 [� c1 07 s Update Address and return Card. Mark reason for change. Address Renewal Q Employment 0 Lost Card THOMAs X 164.5 NEWT( COTUIT, MA 0 Daniel F. Braman. RE �E{.� �E5lprclJGt. 189 Harbor Point U Cummaquid MA 02 637- 0361 lz ens. Z �0G----- �ol,+ C�I.PcZz� i-�cl-tE �+-tP0.o�Et-l.E1-�T G..S LC, t4 o V CE I L. t &-A Gt 1,V L - tAAt%S S7Ar7a f!> &L QcNcft C=�v� TRtFs, LQ cr w O.L. s LA..-� T.L. c. 1 C""" U •'4 l ( C) �Q . L( 3.4.4 �z L.V.L. 14 C%I{tiL� Cim�-4, 61 1=2."5 4tl r d� h.QYt..1 o-ris d. * -0 M c►-6de.t m OF DAM jplj-} .�.�_ ! .�. _� .1.. � � .t �._..:. _ `• I .� .�� I 1 t t( •mot 1 cV t t t t .t.... I �• !- . r__r 11 • t , 1 Li Aof cco � � , • �.r/...-w�i• t t . w..-r _.• �-..r_ •! r.n w. _-..1.._..1.___���-��.J.�.F.i ' t � i i ••i • � 1• • j 1 /•�_�n• � ' t f ' • i t � �, t ' : 1 In 4-4 O • • ' .i � • .• ri • � i wt i • ••,•—� � _ • ; •ir _:. .i 1 ., • , .• • : • •_. T • � •.._�.-1... .: • ' • _.1• •t _•-r ! , F ;_• ' i+ .! ... 1 i .�..._- _ •'• • t '___..__ • .� _ , •,.. ,• 1. i. .i i.... �...�.. _:_ I i...' _ � , ... /'ty� A 1 .,.. I- �—Il-'_. j .. I �-.1 .. !. { .� �. .1 J... • .-'7- i i "1• ' =�,5-w�'y-""'^ ',_..a loa i , ,J,N,"cz-n( 3,-2jp// APPLICATION FOR PERMIT TO DO GASFITTING u r� -----_' (OFFICE USE ONLY) ��f NAL- RMOUH By 4C ;i 2003 Fee: $N1 ��5 ,k 9 C-0 PERMIT NO. Building Owner, AT Location /�y i�Q- an' a Name :Rg U� 6 � l /Q l-n. • V A )CAn a.r to Type of Occupancy New ❑ Renovation AI Replacement ❑ Plans Submitted Yes'K No* WO Y Z Q Q F- Q n J Z ch Z m W W I- I` W Q} W O Z a O W W Q y LL=1 W W W z a= ¢ 2 W ¢ W O IyO�--j f• � Cf •� QW Q W n Q m W W 4 cc W> x 0 a x Z M 3 0>c Q g 0 0 o O O u. c t7 V cc > a f- SUB-BSMT. BASEMENT 1ST FLOOR I 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name .1 c) Address "I T rits :RA Business Telephone ZWA Name of Licensed Plumber or Gasfitter Check One, ❑ Corp. ❑ Partnership K Firm/Company _ D.u, ,i c'4c - Pests rl FLAP-C- cop erc... INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes 'IA No ❑ If you have checked yes, please indioaty the type of coverage by checking the appropriate box. A liability insurance policy R1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: ,owner ❑ Agent O Signature of Owner or Owner's Agent 1 hereby certify that all of the details and Information 1 have ' bmitted (or entered) In above application are true and accurate to th best of my knowledge and that all plumbing work and Installations p rmed under Permit Issued for this application will be in compllance with 1 pertinent provisions of the Massachusetts State Plumbing Code an Chapter 142 of the General Laws. of Licensed or Gasfitter License Number TYPE LICENSE: Plumber 0 Gasfitter ❑ Master Ajourneyman r T ROI Ido 1$ TV: C «j A--r [Z O F TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO 8-04232 . PERMIT ISSUE DATE 8/21J03 . _ ; PROPOSED USE _ _ _ _ _ _ _ APPLICANT •James Ringer JOB WEATHER CARD PERMITTO Addition AT (LOCATION) 100021PAWNEE RD ZONING DISTRIC R-25 Bldg. Type: Reskientlal SUBDIVISION MAP LOT BLOC 1024.89 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE O remove existing deck and replace with 12 x 14 three season room over new 12 x 19 deck as per REMARK plans submitted 07/22/03. AREA (SO FT) EST COST ($ OWNER JEUGENE R GODIN ADDRESS 00021 PAWNEE RD West Yarmouth I MA 102673 PERMIT FEE ($) $150.00 BUILDING DEPT BY INSPECTION RECORD CONTRACTOR LICENSE 078016 Ringer. James -71 78 Turnpike Road Westboro MA 01581 5088701900 FIELD COPY Date Note Progress - Corrections and Remarks Inspector d� 0 ��✓ . r vF YAR tr MATTACM[[f ro ONE St TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 02664-4492 •- Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Off, ce Use Only Permlt No. Date 'Pe rmit Fee / .,. 'posit Rec'd...� lte Net Due ow Planning Board Information - Plan Type Endorsement Date Recording Date n No Other Assessors Department Informa ion:': Map -_ iot _ old New 1.4 Property Dimensions:: Lot Area (st) Frontage (ft) ' :, Lot Coverage,'• =.-This Section for Office Use Only. BuildingPe Number• _% Date Issued....; = Signature' ' Certificate of Occupancy is is not requved Building Official - Date Sectional..= Site Information Use Group: R-4 Type: 5-B 1.1 Property Address: lam► \I 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided iS. - y 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone In ahon Comments - ' Zonec;'' BFE. Section 2= Property'Ownership/Authorized Agent 2.1 Owner of Record: (s x Name (pri Mailing Address' - -:K 6 a - C) Signature Telephone 2 2 Authorized Agent: 4dA-, T %at N me (print) Mailing Add ss Signature Telephone HA o$I Seetion'3-Construction Services` 3.1 Licensed Construction Supervisor: Not Applicable ❑ �T y License Numb r \\gp Address N1 �-1� dca'_ $ O _ v v _VSAatur Expiration ate Telephone 3.2 Registered Home Improvement Contractor.' Company Name NotApplic bile ❑ Licens Nu bar Addr s Q tJ��X — I ature Telephone t7. Expira on Data 9- 15-00 1 of 2 OVER Sect,on 4'-'Workers' Compensation Insurance"A fidavit (M.GL"c."l52 S 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 ... .•... No .......... Section 5''=. Description of Proposed,Work.(check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ 1 Repair(s) ❑ Alterations ❑ 1 Addition ❑ Accessory Bldg. ❑ Type Demolition Other Sped Brief Description of Proposed Work: cy— fly oc- `o Costs Section 6:`Estimated Construction Item Estimated Cost (Dollars) to be Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) completed by permit applicant 1. Building p 6C:5� • 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 4AA 7. Total Square Ft. (new houses & additions) VocF Section 7a - Owner Authorization - To be Completed W en Owne s Agent or Contractor Applies for Bulding Permit G;-odY\(1 , as owner of the subject property hereby authorize � `�����'� ��S to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b --,Owner/Authorized Agent Declaration as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name ()A.,, LAE!—_ Signs of Owner/Agent f Date 9-15-99 . 2of2 r e TOWN OF 'YARMOUTH r�"a�►,L s BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF ApplicantSa�s-% PM62- Building Permit No.: Address:!Ig "'Vv.TU • WW�N'6zMaTel. NoS'g'- g'13-190�'Date Filed: (- rl-03 Bldg. Site Location: -�V Map No.: Lot No.: The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATERDEPARTAIENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION CObB U,SSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: A"T- r : 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. CODi111ENTS: 8/99 Applicant Signature 4&WIdc-2 ��YLc✓� Date f TOWN OF YARMOUTH or pf .Mkir 3� o 0 y PLEASE PRINT: Job Location: _ BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Number Street Village Owner of Property: caz A \ 1.4 Construction Address: Licensed Designee: (If other than Supervisor) Name Name 2.15 Responsibility of each license holder: :)rl g p\ to -V-:O�-Wqb - License No. License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shallwillfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 121 No ❑ If you have checked yo, please inndte the type coverage by checking the appropriate box. A liability Insurance Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. neral Laws, and that my signature on this permit application waives this requirement. Check one: Signat of Owner or Owner's Age Owner ❑ Agent Signature: Building Official Approval: or For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Pcrmit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: AAS�k;(Sy\ Est. Cost Address of Work a.) Owner Name: Date of Permit Application: 43 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: at�; Contractor No �� Registration No. ca OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents Omceo11nestlpstloss 600 ff ashington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit . r 1 i t 1 t r l 9 7ti1►tlM.. r,r city' l�`tS,C. v\ . — j \ nhone aIT1,0:;z— V►OJ9 I am a homeowner performing all work myself. C3 I am a sole proprietor and have no one ttorkine in any capacity �1 1 am an employer pro%iding workers' compensation for my employees working on this job. company name: address: [j[r: W1L$�C `\ ��5 b phone a: insurance co. ��� `RtJ��� porgy a 35 \zzGr Z—T 9353 I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following "orkers' compensation polices: company name: address* city: phone a• inu�rance co. policy q Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erimisal penalties of a Got up to 51,500.00 aadlor one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Boe of 5100.00 a day against me. 1 oadetstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify u der the pains andpenalties of perjury that the information provided above Is true and correct SignatureA�-ate 4-00 Print name `r—c PhoneA_"Qy-�� t70— 19(57� official use only do not w rite in this area to be completed by city or town official city or town: YARHOOTIJ ❑ check if immediate response is required contact person: permitAicense 0 r3Building Department ❑Licensing Board 261 ❑Selcetmen's Of lce phone a; _ (508} 398-2❑Health Department231 eat. nOthcr Ire.ned ].VS P)A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrplover is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoin_ 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 %%ho 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. %lGL chapter 15=section =5 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 %vho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the common"calth 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 ha% e been presented to the contracting_ authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. City or Towns 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. The afUdavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 fttice of lareSU13111812 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 exL 406, 409 or 375 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARNIOUTH MASSACHUSEYrS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resuniti1ng from the proposed work/demolition to be conducted at Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature fApplicant Permit No. %a/03 Date TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/0R COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ..................................................................................................................................................... REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: DATE. N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whito copy - Buddmg DcpL - Pink copy - Wata DWL - Ye low Copy - HmM DTL - Pioh Copy - Fmginmkg Dcpt - Goldwrod - Fire DcptACoomwatim 03/16/03 TAE 12:37 FAX 734 487 6922 Personal & Confidential, 10003 ACORD„ 3/181 CERTIFICATE OF LIABILITY INSURANCE MDDIY)T 03l18/2003 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Joseph McKeone HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR JP McKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 INSURERS AFFORDING COVERAGE Ann Arbor, MI 48106-0333 _ -• --- -- INSURED patio Rooms Of America INSURER K. Liajtfprd _ JohnEslar 78 Turnpike Rd INSURER C: Westboro MA 01581 INsuFIER D: — , • _•. ._ __ __.. INSURER E: COVERAGE5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSTIr— —•"—' ••--POLICY NUMBER P AT �. F.FEGTWE PpDCTrCX� RAtIZiIII DDMI TYPE OPNEUAANCE LIMITS 1 , GENERAI.WBtu)Y 35 SBW KM5352 11101/2001 11/01/20173 EACHOCWRRENCE f 2,OD0,000 A COMMGRCIALGEN:AAL LIABRJTY OCCURvyyy ix:�c ►IRE DAMAGE (Any W9 (uRl f 100,DODCLAM.SMADG IgallY PERSONAL f ADV INJUNY _•l flpO,D 3ENERALAGGREGATE. Is _ zS2Uw- . PROOVGTS • COMPIDI AGG 2,000 ODO GENT AGGREGATE LIMIT APPLIES FER: - -' POtIGY r0• N,IOC B AUTOMOBR.EUAWUTY 179957400001 12,15120111 12I15/2003 i OM�ORINEEDioenl'INGLFLIMIT s 1,000,000 ALL OINNGO AUTOS BODILY INJURY IPW PArLan{ f SCHEOVI C•D AUTOS — • • •• - "—"• •' NSiED AUTOS � l .BODILY INJURY (PR Feyonnl) f X X NON•OYMED AUTOS I — • -- --• —� " PROPEPTY DAMAGE i OARAGC LIABILITY AUTO AUTO ONLY :SA ACCIDENT f IANYAUTO I OTK-zn THAN SAACC AU70ONLr. AGG i f A ocesswmuTv 3556WKM6352 I11N1/2003 EACH OCCURRENCE f 2,000.0oJ •• OCCUR L � CLAIMS MADr. I11lO1l2001 I AGGREGATE —^- ' --- "—i' L "— � •- jE - MZ—O ..ODD I (DEDUCTIBLE . rCTt"ON f 4 I VC StAIV• OTH- A WORKERSCOMPENSATIONAND 35 WBQ JJ9353 09/01/2002 ITQRYLIAAITS, E ;�-- EMPLOYSRt'LIAWLM I01101=03 EL EACH ACCIDENT f t0000D As required by the laws E.L. DISEASE • EA EMPLOYEE f 10o 000 of the State of New York E.L. DISEASE • POLICY LIMIT f 500,000 OTNGR DESCFUPTION OF OPERATtONVLOCAnONSNENICLGSIEXCLUSIONS ADOSD BY ENDORSEMENTISPfCIAL PROVISIONS INSURED COPY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE IXMRAT30N DATE TNEREOF, THE ISSUING INSURER RILL ENDEAVOR TO MAIL _ DAYS WRITTEN Not" TO THE CERTIFICATE NOLOER NAMED TO THE LEFT. BUT FNLURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON ME INSURER. ITS AGENTS OR a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: _138971 Exp f ra two n: _6/2/2005 Type:: Supplement Card PATIO ROOMS 'OF AMERICA- JAMES RINGER`';, F ram' 78 TURNPIKE RD. WESTBOROUGH, MA 01581 Adminlstrator License or registration valid for Individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ala. 02108 Not valid witho signature 72a-epmnw..Zae o�'✓C{aalac%uieQ� BOARD OF BUILDING REGULATIONS Lleense:.CONSTRUCTION SUPERVISOR Number. CS 078016 Blrthdate 1t/08/2000 A Expires al1%0=004 Tr. no: 78016 fr • Restricted To;; =00s JAMES F RING 44 CANDICE STREET':-.•}; CLINTON. MA 01510 Administrator In accordance with Axticla 1 Sectio,n 114.1.3 of the . Masszcusatts State. Building Code, i certify that all debris resulting fro= wort_ associated with Parmi.t will be properly disgo5e3 of at EL, 9,61WEV SahlS , I licensed solid oasts' disposal as defined by MG-i, C11. SisoA. o^ ature as permits Plicz*it E.1.HARVEYEMS ix `� �sS• `'�c� x 8$ HOPK I11TOH RD Print Name of Applit.-P=t �cS70Gt;0, MAY F_—�tL�ly1.VC, P � +?t`_'��15— cRrE try) 1Sal Fr NTeae (if eny) ,% N Effecti� a Se�te«-u' ar '12, 1391 the DePaXtrnent of 3eeltn/Code . r t he 1_a35 acting under CaaPte: ? �a=title 13 oy 1^IOrC OSi c� [.eJ sad Cr.�ricnce rB:1:li+E."+ "-Q'Jf OE disy'�.OS?1 7i.. ?ea�15 gen6r8ted cats a Iesulz of th1S P'---Mlt. he Proof small be at dated end signed receipt from the licensed disposal facility comtaiaing tha following irifo�+==ion. A - ascription of the d ris, tiaa waight, and volume od the d�bris --"Cl the location of- the disposal facility. The receipt. Must also have a signature of the own ex/o?=_razor or the diz:posals faci.li-'y. 7 failure to cc:rply with the revairem_nts of Chis o:3inance will' rerzlt is --for-- ament action by the City. TOTAL P.02 Y ' Addendum "B" ALARM & PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI REQUIRED INSPECTION SCHEDULE: , BOARD OF HEALTH REQUIRES R.d CADILLAC1. 'ALARM TO BE WIRED BY ELECTRICIAN ON TO INSPECT OR LAYOUT, AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP I. 9'-9' FRONDED FROM IEACIaN(: IN P,,.rl PLEASE GIVE R. J. CADILLAC 48 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDED IN Iv.1I ADVANCE NOTICE: WIRING INSPECTOR. 2. NO RESERVE AREA SHOWN. 310CMR I••; V 1. STAKE LOCATION OF PROPOSED WAIL. 3. ALARM TO BE LOCATED IN HOUSE. 3. VARY LEACHING TO PROPERTY {RIF nr t INSPECT WHILE FOOTING PC(IRED, VARY 5 15.211 (I). 4. PUMP TO BE CAPABLE Of PASSING 1. VARY 5' ALL AROUND REMOVAI, Its NI 4 INSPECT WHILE WALI. POURED. 1-1/4' SOLIDS AND INSTALLED UI STRICT AND FOR BASE Of REMOVAL TO Id Ir'•, 2. INSPECT AFTER 5' REMOVAL EXCAVATED CONFORMANCE WITH MANUFACIURER'S MINE WALL FOOTING SIOI•MR 151'•'• ('•) 3. INSPECT PRIOR TO N4l TO CHECK SPECIFICATIONS. SYSTEM INVERTS AND 5. PROPOSED LEACH AREA IS 83't, AHII IA'I- LOLOCATION 5. USE MEYER MW50. 1/2 TIP PUMP, OR TOP OF COASTAL DANK, EOUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIEP Rr t . 310CMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED III FLOOD ZONE V15. BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR / / SHOREY H-10 1000 CAI. TO 3/31/95, AND THERE IS NO EXPANSION Of HABITAD�E/ MAKE WATER 110111 SPACE, BENCH MARK --FOP Or CONC. / �O / / Invert 6.17 _ -,� _ \7• BOUND-696 ASSIGNED-� � 4'1 5, - 1.11)" OFF II 0, u ,r�4 a 5 Bottom 1 0.' t E . 6� 0.� _ vnw n tit %V C` \ .• I, r Nor CIL \ It r.-_ •. t ...M. !{�'. N,.t, '... A' r4Lt. l�'�AOK1N 'M•. •.-I'jt\ �' BWO NCH MARK --TOP Or OD � � d• STAKE-7.14 ASSIGNED i '1 0. N/F BILSKII \ / /P\T OUOYANCY CALCULATIONS 1500 GAL. H-10 WEIGHT OF EMPTY SEPYIC TANK AND IS- OF COVER TANK- 5.74 TON (PER SHOREY) IB' COVER-1.5' X 5.67' X 10.5 X .055 IOII/CU. FT.r 18' COVER-4.91 TON TOTAL- 5.74 TON + 4.91 TON - 10.65 TON WEIGHT OF WATER --HIGH GROUNDWATER DOWN (3.0 -2.08) X 5.67' X 105' X 0.0312 10H/CU F1, WEIGHT WATER- 3.19 TON / TANK AND 18'COVER ARE HEAVIER BY 7 4 TON BunYANCY CALCS-I,DQO GAI. H-10 PUMP CHAMBER WEIGHT OF EMPTY CHAMBER AND 9" OF COVER CHAMBER- 4.12 TON (PER SIIOREY) 9' COVER-.75' X 4.63' X 8.5' X 0.055 ToN/CU, FT. 9' COVEA-1.69 TON TOTAL- 412 TON + 1.69 ION - 5.81 ION WEIGHT OF WATER --HIGH GROUNDWATER DOWN (38-1.67)X 4.83- X BY X 00312 I0N/CU F1 WEIGHT WATER- 2.73 ION :? ` GOr� eUQ°oj ea9aTOWN OF YARMOUTI I I • TOP SALT MARSH ., 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIAT.' FOR SITE PLAN, SEPTIC DESIGN ig 0 TANK AND 9• COVER ARE HEAVIER BY 3 ION C3, r\-i� 1_�(x\9. •SL ■ I N �C�z�1\4C`i,\"S _r1A • l 1 lr<T FlrltF I(r1•ATION, NUMDfR s�\ "l 1% ISI/ � lq�, WATER LINE PER WATER DEPT. uE CARD 7� EXISTING HYDRANT MARKINGS (IF SHOWN) __.Gl GAS LINE {BARKS POINT) EXISTING k PROPOSED ELEVATIONS ('%' jj.O EXISTING CONTOUR PROPOSED CONTOUR m EXISTING SEPTIC COVER HEALTH AGENT APPROVAL ' Addendum "A" II ALARM do PUMP NOTES MAXIMUM FEASIDLE COMPLIANCE APPROVAI REQUIRED INSPECTION SCHEDULE: , BOARD OF HEALTH REQUIRES R.J. CADILLAC 1. ALARM TO BE WIRED BY ELECTRICIAN ON I VA ` i0 INSPECT OR HEALTH PEO, AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP 1. 9'-9' PROVIDED FROM LEACHING IU I PLEASE GIVE R. J. CADILLAC 18 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDED NI Iv.l i ADVANCE NOTICE: WIRING INSPECTOR, 2. NO RESERVE AREA SHOWN. 310CMA Ia ; V 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO BE LOCATED IN HOUSE. 310C3. VARY R 15.211 10 PROPERTY IINf Iri INSPECT WHILE FOOTING POURED. VARY 5 15.L11 (1). INSPECT WHILE WALL POURED. �• PUMP TO SOLIDS CAPABLE TA PASSING 4. VARY 5' ALL AROUNDOVALREMOVAL 1„ IK 1-I/�" SOLro$ AND INSTALLED IN STRICT AND FOR BASE Of Rf.MOval W Ut jr,.. 7. INSPECT AFTER 5• REMOVAL EXCAVATED. CONFORMANCE WITH MANUFACTURER'S MINE WALL FOOTING 310CMR 1571'• (`•) SYSTEM I 3. INSPECT PRIOR TO I TO OI CHECK SPECIFICATIONS. 5. PROPOSED LEACH AREA IS 83'1, ANTI IA-1- IJVERIS AND NO LOCATION S. USE MEYER MWSU. I/2 TIP PUMP, OR TOP OF COASTAL BATIK. EOUIVALENT. 6. VARY DISTA14CE 10 GROUNDEWAIER Dr I i i II 310CMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED 114 FLOOD ZONE V15. % DOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR % '' SHOREY H-10 1000 GAI . TO 3/31/95. AND THERE IS NO EXPANSION OF HABITAIEI,V MAKE WATER TICHI SPACE, �� O O I�." i 61 BENCH MARK --TOP OF CONC. / / invlrl 1i.17_.,�n�,ARM - ty' BOUND-6.96 ASSIGNED / % % '' ly'' - % 0 OFF Bottom In VAIII IT J I OENCH MARK --TOP OF moo S1AKE-7.11 ASSIGNED I. N/F BILSKII 1'�°���9,�p •F' `• � ' .4• //yip`'' •• `, I F \\ \ Cori �. - •. q� �, ,".I..• •.+.YIIII?V. " .'` Q•V /+III` 91R7��`a(}" `(JV+•rR•w 1� "" • � '� Lr I 41 " Q •I •" ISO. Q ? / I ' Addendum "B" ALARM do PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAL REQUIRED INSPECTION SCHEDULE: , BOARD OF HEALTH REQUIRES R.J. CADILLAC 1. 4'-9' PROVIDED FROM LEACHING lu 1. ALARM TO BE WIRED BY ELECTRICIAN ON TO INSPECT OR LAYOUT. AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP ' P�•a PLEASE GIVE R. J. CADILLAC +B HOURS 2• ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDEN RI IV.11 ADVANCE NOTICE: PARING INSPECTOR. I. NO RESERVE AREA SHOWN. 310CMR Ir, 4- 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO DE LOCATED IN HOUSE. 3. VARY LEACHING 10 PROPERTY 1111f 111 1 INSPECT W1nLE FOOTING POURED. VARY310C5 15.211 (I), INSPECT VAIILE WALL POURED. �• PUMP TO BE CAPABLE INSTA PASSING �. VARY O ALL AROUND OVAL I. In lI + 7. INSPECT AFTER 5' REMOVAL EXCAVATED CONFORMANCE MONIES WITH MANUFACTLEDURER'S III STRICT MHO FOR BASE IN REMOVAL TLI U1 IF'•. 3. INSPECT PRIOR 10 11ACNFILL TO CHECK CONFORMANCE WITH MANUFACTURER'S MINE WALL FOODNG 310IS 't ?Al (`Q SYSTEM 114ARIS AND•LOCATION SPECIFICATIONS. 5. PROPOSED LEACH AREA IS 8S'L, A111, In'I• 5. USE MEYER MWSU. I/2 HP PUMP, OR TOP Of COASTAL DANK. EQUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIER OV 1 , 310CMR I5.$17. NOTE: ALL OF LOT 107 IS LOCATED 114 FLOOD ZONE V15. / BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR " SHOREY H-10 1000 CAI. TO 3/31/95. AIJD THERE IS NO EXPANSION OF IIABITABlE/ MAKE WATER TIGHT SPACE, / BENCfI MARK --TOP OF CONC. / QO / • Invert 6.17/ALARM- 17" DOVND-6.96 ASSGNED •' \ / / �'' ON •- !•H � 1'S OFF I(l'II II p, .... . . U r /, id � •�\ , Bollonl 167— --�,s STI)Nl' 111:+ CL V4 III If T LO 4 N I W J ` .oR ON n 7,o�, \ L \ I t\ J tt r \ . � -ps�� ro c , BENCN MARK --TOP OF WOOD r._,. ...� Y. ...n..p, Mrt+^V .: 0�4Y(1<' ` ��!/,tlKrol '+•t•. ,. r,'qj'\ j STAKE-7.11 ASSIGNED Qi Ott CO. N/F BILSKII \pTP / •I . C NEW 6' DOOR - FROM PORCH (NCN0MN 115 VEW) EM C VIGA Ir G I YI/1M ra L FROP05EV 5 5fA5ON PORCH 12' X 14' (APPIM 5ILVIO 5W ENO.O5LM 3" EP5 + H ROOF 5Y51EM (12' SPPN) NEW 6' DOORS FROM PORCH (Nor 5H041M N 1F 5 VEW) 5fM 8 RAL 56" Hlai RAL II" fR(',N7 7-V 4" 05E 4" BAU.ISIER 5F)Ia FWFO%D NEW PECK 12'X19' (APPRM 1. 20 PrfEW a 1611 Of- 2. LWaR 001 lW 1/ 2")(5" LAGS 31" of - !I. J05f H Naz c LEDGER 4. 22 Pf 1RIPLE MAM 5. In SIDE J016 5 7.3/ k" f8G PLY OVERi.AY B. 6X6 1`055 9.5fAR5 10.5/4" X6" PfDEMK 4 11. PM J05f Q "c' WAu O B eProyct;60PIN Scale:l/8"'I'-0" Drawnµ tterliving SIn�NC� SUN A M ROAD ROOMS 21 P A YARM0U%MA026" "IlTum(gos)s;ioisao (soei o'um DaLm. 6124105 5 A I of I IWQ V AYOUT PLANS EXI5TING BUILDING ��� S . n ' �? O a -1E s d C. >'`0 r - m o \ d u R .III arx6ow. alxow UI B - WALL 14•-z" 5TUDIO FLOOR PLWI (NOT TO SC Qq ` ,� 0® 5 � 4��4,1," Q 0 SRN -ARE LIVE LOAD TABLE FOR 13 FT. PANFI WALL SECTIONS 25 PSF 30 P5F 35 P5F 40 P5F 1 45 P5F 5&Jr5F 55 P5F 60 P5F H 3"HC I 3"HC I 3"HC+H I 3"HC+H I 45"HC .-kt 45"HC+H 45"HC+N HI 3"EP5+H I 3"EP5+H I 3"EP5+11 I 45"EP5+H j 4.5"EP5+H I 4.VEP5+H I 45"EP5+H I 6"EP5+H 1. ALLONA15LE LOADS, THE LESSOR OF THE OR THE LOAD AT SP/ 2. HC/EP5 REFER5 TO PANELS VATH ALUMI HONEYCOMB/P Y6 AND 6" IN 1� MI 3. PIEXP(Ir CONN 4. DE-4V * ANE 5. POt ANDOW I 6. WIDTH OF B-WALL DOOR / WINDOW LA 7. PANELS MAY ONU AND WALLS OF ON CONSTRUCTION: TY TYPE VI (FOR 55C) O, NOTES NDEPTO (i'VINYL CLEATS OK He. SIGN WIND SPEED, DEAD LOAD = 5 P5F. )CATIONS/SIZE5 ARE �Y YAKY PER UT UPTO 24F E USED IN R( TORY 13UILDI VB (FOR IBG D TYPE Mimi z CONSTRUCTION 8. PANELS MAY 014LY BE USED 114 ROOF5 AND WALLS VA,ERE CLA55 B OR CLA5511 INTERIOR FINISHES ARE PERMITTE 0 BY CODE. 9. HORIZONTAL JOINT5 BETWEEN THE ENDS OF PANEL NOT PERMITTED. ��((��''�� 10. CONTRACTOR TO PROVIDE FALL FLOOR E[r�,L C� FOR SUNROOMS WITH A FlNISHED FLOOR L o OOO OR GREATER ABOVE AN EXTERIOR 5U Aq`"q� q 11. STRUCTURAL FRAMING AND CONN V BQ.IN5TALLE PER C13M SPECS. 12. CONTRACTOR TO INSPECT ALL EMS 4DfTION5 AND AS NECF55AVY REPAIR AND/OR ALL m e (MAX)�N® <rS Q —LE LL 0 STUDIO SIDE WALL Q ASSEMBLY DETAILS SEE ALLOWABLE LOAD L TABLE FOR PANEL SIZES I \ ({r MINIMUM SLOPE 1:12 S� "4 P 1 Ca GUTTER FA5C1 \ _ �A �` I H fVIZT BEAM SLIPI14G DOOR ttXOPTIONAL) OR WINDOW N ` TEMPEREDGLA55� Q � FLOOR CHANNEL I '9BKEVIAT101J5: 1 " 3y00R CBM=CRAFT-GILT MANUFACTURING PSF = POUNDS / Sa FOOT - TYPICAL STUDIO 5 3 MULLION O W = WINDOW FT - FEET BC = BUILDING CODE NOT TO EW _ HC = HONEYCOMB PANELS IBC = INTERNATIONAL BC INN O i, EP5 =POLYSTYRENE PANELS UDC = UNIFORM BC H = THERMALLY -BROKEN ALUMINUM H-5TIFFENER P = PANEL NBC = NATIONAL BC 5BC= STANDARD BC MFG = MANUFACTURER @� ��0,0 9- t MPH = MILES PER HOUR SPECS - SPECIFICATIONS MAX - MAXIMUM AATERIALS AS REQUIRED TO RENDER EM STRUCTURALLY ! SOUND AND COMPLETE �a ff AUTHORIZED FOR BETTERLMNG DEALEK/MATERW9 U5E ONLY. ip�'' a CnNa.L Joss PROJECT: CONTRACTOR GODIN BETTERLMNG D05T01 21 PAWJEE RD. 78 TURNPIKE ROAD 6VE5T YAKMOUTH, MA 02673 WESTBORO. MA 01581 DRAWN BY: CJJ DWG NO.: cm50-12x14-gcdin 5CALE: T" = 75" DATE: 625/2003 11'-11" x W-2" STUDIO ENCL05UKE GENEKA� A T . . l 2-2"x8" TIMBER JOI5T5 2"x8" LEDGER WITH J015T NAILED 024" WITH 12d NAILS HANGERS SECURED TO STRUCTURAL STUDS IN HOUSE 6' EXISTING © A WITH x1 WITH DOOR Ca- WASHERER 0 S 16oc EXISTING."oc f,�_]514"Xr3"PT0ECKJNG 3/4" T&G PLY OVERLAY FF 1 11 d0t5l DECKING WITH VAPOR BARRIER Q 'II II II II 11 II II II iN' NAILED TODECKINGALONG TOPEDGE `I E, 19'-2" W DECK FRAMING PLAN NOTES: 1. TIMBER DESIGN STRESS' ASSUMES: SPECIES: SOUTHERN PINE NO.2 2" x 8" BENDING STRESS Fb: 17N751 COMP. PERP. TO GRAIN: 565 P51 COMP. PARALLEL TO GRAIN: 1,550 PSI SHEAR PARALLEL TO GRAIN: 90 P51 MODULUS OF ELASTICITY: 1,600,QC EXTERIOR LUMBER SHALL BE PRESSURE T ,M: 6"x6" TIMBER (TYPICAL) GRADE (TYMC 2-2`A5" TIMBER JOISTS NAILED 024" WITH 12d NAILS TIMBER JOISTS 024" WITH 12d NAILS CONCRETE FOOTINGS (SEE NOTES 4 6 5) TIMBER BAND - 3/8" x 5" LAGS " 51MP50N CBA66 (TYPICAL) - 5/8" x 4 3/4' ANCHOR BOLT 'J 0 TYPICAL POST DETAIL 0__ AA 5 �Q DESIGN ASSUMES: OTIN 1<170TING5 SHALL EXTEND BELOW FR05T LINE 0 CONCRETE IS TO HAVE A MINIMUM COMPRESSIVE t�2 STRENGTH OF 3,000 P51 AT 28 DAYS. Q 6. FOR DECKS WITH A FINISHED FLOOR LEVEL OF 30" OR P PUBLISHED IN 1991 ND5 "DESIGN V LUE 'K WOOD CONSTRUCTION" 2. DESIGN LOADS: PATIO DECK LIVE LOAD = 40 P5F DEAD D =10 P5F PATIO ROOF: GROUND SNOW LOAD = 30 P5F DEAD LOAD = 5 P5F OPEN DECK LIVE LOAD = 60 P5F DEAD LOAD =10 P5F 3. AUTHORIZED FOR 15ETTEFLPANG DEALER USE ONLY. 4. REQUIRED FOOTING DIAMETER: 12" DIAMETER FOOTING FOR 4,000 P5F 501L BEARING. "STRUCTURA'L' PROJECT: GOOIN 21 PAWNEE RD. WESTYARMOUTH, MA mNTQAnTn2- zvl "% 78 GREATER ABOVE AN EXTERIOR SURFACE. CONTRACTOR TO PROVIDE NECESSARY KNEE BRACING AT ALL VERTICAL POSTS TO RESIST LATERAL LOADS AND FALL PROTECTION PER LOCAL CODE 7. CONTRACTOT TO PROVIDE MIDSPAN BLOCKING FOR ALL JOISTS HAVING DEPTH-TO-THICKNE55 RATIO EXCEEDING 6:1. 8. CONTRACTOR TO PROVIDE NECESSARY STRAPPING & TIE DOWNS TO FE515T WIND UPLIFT. 9. DRAWING SHOWS MINIMUM STRUCTURAL REQUIREMENTS FOR DESIGN VALUES SHOWN. 10. CONTRACTOR TO INSPECT ALL EXISTING CONDITIONS AND AS NECESSARY REPAIR AND/OR REPLACE ALL MATERIAL9)A5 REQUIRED TO RENDER THEM STRUCTURALLY 50UND COMPLETE 1©STAI IGH RAIL ��.7- /4" RISE S 4" BALUSTER SPACE 11'-11"x19'-2" DECK N,.. a��Ricxia-gaam FLAMING FLAN SCALE V4" =1'-O" IR FOR STUDIO ENCLOSURE DATE 6/25/03 PROPOSED 3 %A50N PORCH 12' X 14, (APPROX) 5nw SM.E uaO5 J(E 3" EPS + N ROOF 562M (12' SPM) NEW 6' DOOR NEW 6' DOORS FROM PORCH FROM PORCH (NOf 510VuN N (NOf 9IpydJ N 1W5 VIEW) 115 VEW) 101 B etterliving SUNROOMS 78 Tumppike Read Westboro, MA 01581 %lone (508) 8701900 Fax (508) 670 57% � " Hai WL5rA1R��8/�R�AL /V II" TREAt7 7.3/ 4" Ra 4" DALL1,629 SPACE Protect• 60PIN I�T51PMN 2 PAWNEE ROAD YARMOIAK MA02615 PR0P05E17 NEW DECK 12'XI9' (APPROX) 1. 20 PfFKNIT a 16" OL. 2. L PaR POMP]/ 2"X5" LACE 52" O.C. 3. J05f F10,1 5 a LEDLFR 4. M Pf fMX SEAM 5. WL SIDE J05f5 6.(5) 12"0 X 45" DEEP F65 W/ AJ4CH015 9. 5/ 4" f86 PLY OVERLAY 5. 6X6 P055 9.5m 10. 5/ 4" X 6" Pf PtaJ G 11. Da- JoSf a " C" WA-L J O .CdG: 1/ 8"'11,0 " 1rrawwq A-1 Date: 6/ 24/ 05 1 Sheet I of I OR }i Addendum "It" I m ALARM & PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI REQUIRED INSPECTION SCHEDULE: , BOARD OF HEALTHREQUIRE$ R.J. CADILLAC I. ALARM TO DE WIRED BY ELECTRICIAN ON TO INSPECT OR LAYOUT, AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP 1. 9'-9' PROVIDED FROM LEACHING In • I'+•a• PLEASE GIVE R. J. CADILLAC 48 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL rROV10f.n III Iv.H i ADVANCE NOTICE: WIRING INSPECTOR. 2. NO RESERVE AREA SHOWN. 310CMR 14 .1V _ 1. STAKE LOCATION Or PROPOSED WALL. 3. ALARM TO BE LOCATED IN HOUSE. 3. 310CVARY LEACHING TO PROPERTY lWf ITT L INSPECT WHILE FOOTING POURED. VARY S 15.211 (1). 4. rulJr TO BE CAPABLE OF PASSING A. VARY 5' ALL AROUND REMOvnI hI lu 4 INSPECT v4RLE WALL. POURED. 1-1/4" SOLIDS AND INSTALLED 117 STRICT AND FOR BASE Of REMOVAL ILI III IF•.. 2. INSPECT AFTER 5' REMOVAL EXCAVATED CONFORMANCE WITH MANUFACTURER'S 3 INSPECT PRIOR 10 RACKf ILL TO CHECK MINE WALL FOOTING 31 DIS 157'•'• ('•) SYSTEM INVERIS AND LOCATION SPECIFICATIONS. 5. TOP OF PROPOSED LEACH AREA BANK, I$ 8!'L, AIIII IA•I S USE MEYER MWSO. 1/2 HP PUMP, OR TOP Of COASTAL BANK. EOUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIEP Rr I 310CUR 15.212. NOTE: ALL OF LOT 107 IS LOCATED IN FLOOD ZONE V15. BOTH HOUSE AND SEPTIC VA4ERE IN EXISTENCE PRIOR �� '` SHOREY H-10 1000 GAI. TO 3/31/95, AND THERE IS NO EXPANSION OF HABITABLE- MAKE WATER TICIII SPACE, O ®' •" r 6 1 -{- BENCH MARK--fOP IV CLwC. / QO , � 4• ' Invert 6.17 ALARM _ \� BOUND-696 ASVONf.O \ _ / 1-5' ON "0' I I 0. OFF H ' Bottom 167-,_��')'-STtN;r L1I�- ry �" cS Q. T 2 J \ cam^ \ \ BENCH MARK --TOP OF WOOD r +' "•�• .+'*"I STAKE"7.14 ASSIGNED 40 • . 1 N/F BILSKII BUOYANCY CALCULATIONS IND GAL H-ID WEIGHT OF EMPTY SEPYIC TANK AND 18' OF COVER TANK- 5.74 TON (PER SH6REY) 18: COVER-1.5' X 5.67' X 10.5' X .055 TON/CU. FT. ti 18COVER"4.91 TON TOTAL- 5.74 TON ♦ 4.91 TON - 10.65 TON WEIGHT OF WATER --HIGH GROUNDWATER DOWN (3.8 -2.08) X 5.67' X 105' X 0.0312 TOTI/CU FT. WEIGHT WATER" 3.19 TON / TANK AND 18-'COVER ARE HEAVIER BY 7.4 TOTI RUQYANCY CALCS-I000 GAL H-10 PUMP CHAMP WEIGHT OF EMPTY CHAMBER AND 9' OF COVER CHAMBER. 4.12 TON (PER SHOREY) 9' COVER-.75' X 483' X 8.5' X 0055 TON/CU. FT. 9' COVER"1.69 TON TOTAL- 4 12 TON ♦ 1.69 TON " 5.81 TON WEIGHT OF WATER --THIGH GROUNDWATER DOWN (38 -1.67) X 4.83' X 85' X 00312 TON/C"U FT WEICJIT WATER" 2.73 TON i / tT'/f ' •' I _ •r��9 \NC• • 1' PA lit I I I f NI W ,r J ARON ��V\0� Ol • LJO Es,�j ,6qe TOWN OF YARMOU•f 11 \Ot H • �� TOP SALT MARSH ., 3 7 LAND SURVEYOR'S STAMP FOR SITE PLAN. 1/ iI 1 a�X )`j a a TANK AND 9' COVER ARE HEAVIER BY 3 TON 'Z�'o' rtza� )a:xwI ' I FC;FNn a '1CD TEST HOI_F. LOCATION, NUMDER-�'6_-w�,i\% arz_�Y -W- WATER LINE PER WATER DEPT. IIE CARD V. EXISTING HYDRANT -G- CAS LINE MARKINGS (IF SHOWN) .11.0 EXISTING k PROPOSED ELEVATIONS ('X' MARKS POINT) -8, EXISTING CONTOUR -_-_.8--- PROPOSED CONTOUR m EXISTING SEPTIC COVER SANITARIAN'S SIAI.• SEPTIC DEIGN GO 01,ON-- HEALTH AGENT APPROVAL 6 Addenduct I'll" REQUIRED INSPECTION SCHEDULE: ALARM & PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI BOARD OF HEALTH REOUIRCS R.J. CADILLAC I• ALARM TO BE WIRED BY ELECIRICIAK ON TO INSPECT EA LAYOUT, RE NOTED BELOW. SEPARATE CIRCIUT FROM PUMP 1. 9'-9' PROVIOED FROM LEACHINC. It) • r+tl• TO INS LIVE R. J. OUT,CADIS 4e D BELOW 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDED RI Tv., I URS ADVANCE NOTICE: TARING INSPECTOR. 2. NO RESERVE AREA SHOWN. 310CMR I, ! I- 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO BE LOCATED IN HOUSE. 3. VARY LEACHING TO PROPERTY Ultf Il, INSPECT WHILE FOOTING POURED. 15.211 (1). ♦. PUMP To BE CAPABLE OF PASSING 4. VARY VARY 5 5' ALL AROUND P.EMOVAI, III (II 4 INSPECT WHILE WALL. POURED. 1-1/4- SOLIDS AND INSTALLED RI STRICT AND FOR BASE OF REMOVAL 1L1 (1( IF•.. 2. INSPECT AFTER 5' REMOVAL EXCAVATED. CONFORMANCE WITH MANUFACTURER'S MINE WALL FOOTING 310CMR IS7!.-• (`•) 3. INSPECT PRIDR TO ILACI�Fgt TO CHECK SPECIFICATIONS. SYSTEM INVERIS AND LOCATION 5. PROPOSED LEACH AREA IS 83'1, Anh IA-1- 5. USE LIFTER MW30. 1/2 TIP PUMP, OR TOP OF COASTAL DAIIH, EOUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIER OY I 1I 310CMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED IN FLOOD ZONE V15. ' BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR SHOREY H-10 1000 CAI. TO 3/31/95, AND THERE IS NO EXPANSION OF HABITABIV MAKE WATER 71CIIT SPACE, / - _ f. BENCH MARK --TOP IX CCWC. ' Q / Invert 6.17_�/J�LARM- \7" BOUND-6.90 Ass cNr.D \ ` �' �`' ' ON •.0 (I I I OFF o, s Bottom 167 �_�-� STUNT' nr;+ /�/�q°� /\� p.� VAIIrltl Li T 13 \' 4. /'D) NI tv \ �" \\ �D' .I, :0.4 �,,;.r 0. NI F MARON 0� ? .\ i c1 pit\ to \ 1 0 \ BENCH MARK --TOP DF W000 Ttl`:.A'�`�•` fix\ STAKE-7.14 ASSIGNED ,`.� 1 ' N/F BILSKII \ / T 7� BUOYANCY CALCULATIONS 1500 GAL. H-10 WEIGHT OF EMPTY SEPTIC TANK AND 18' OF COVER ' TANK- 5.74 TON (PER SIIISREY) IS* COVER-INX 5.67' X 10.5 X .055 TON/CU. FT. IS' COVER-4.91 TON TOTAL- 5.74 TON + 4.91 TON - 10.65 TON WE1C4iT OF WATER--II11011 GROUNDWATER DOWN (3.8 -2.08) X 5.67' X TO 5' X 0.0312 I0H/CU FT. WEIGHT WATER- 3.19 TON / TANK AND 18"COVER ARE HEAVIER BY 7A TON 17 WEIGHT OF EMPTY CHAMBER AND 9' OF COVER CHAMBER- 4.12 TON (PER SHOREY) 9' COVER-.75' X 4.83' x 8.5'.X 0.055 TON/CU. FT. 9' COVER-1.69 TON TOTAL- 4 12 TUN + 1.69 TON - 5.81 TON WEIGHT OF WATER --HIGH GROUNDWATER DOWN (38 -1.67) X 4.83' X 85' X 00312 TON/CU FT WEIGHT WATER- 2.13 TON �- Gar/ c\\o^a of • I.ro cd9ej.6AeTOWN OF YARMOU111 I • VO TOP SALT MARSH - 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIAE- JFOR CITr PI AN SFPTIF nFSIrN x ►•`f TANK AND 9- COVER ARE HEAVIER BY 3 ION 4ZTKo- ry�� 1zk:x`1,1 40- TH 1 TEST HOLE LOCATION, NUMBEn i I -W- WATER LINE PER WATER DEPT. 11E CARD - 7,L EXISTING HYDRANT --C^ CAS LINE MARKINGS (IF SHOWN) .11.0 EXISTING & PROPOSED ELEVATIONS ('XMARKS POINT) EXISTING CONTOUR �.8-- PROPOSED CONTOUR m EXISTING SEPTIC COVER N HEALTH AGENT APPROVAL Addendw "8" 111 N REQUIRED INSPECTION SCHEDULE: ALARM do PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI BOARD OF HCAIRI PEOUIRES R.J. CADILLAC 1. ALARM TO BE WIRED BY ELECIRICIAN ON • ' TO INSPECT OR LAYOUT, AS NOTED BEIOw. SEPARATE CIRCIUT FROM PUMP 1. 9'-9' PROVIDED FROM LEACHING IH 1 +•.� PLEASE GIVE R. J. CADILLAC 46 HO BEL 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDED IN IV.II ADVANCE NONCE: WIRING INSPECTOR. 2. NO RESERVE AREA SHOWN. 31OCUR In ; r 1. STAKE LOCATION Of PROPOSED WALL. 3. ALARM TO BE LOCATED IN TIOUSE. 310C3. VARY LEACHING TO PROPERTY IINf III l INSPECT 1NIILE FOOTING POURED. VARY S 15.211 (I). INSPECT WlalE WALE PL$IRED. 4. PUMP TO SOLIDS CAPABLE TA PASSING 4. VARY 5' ALL AROUND OVAL I. HI NI � 1-1/4` $DUDS AND INSTALLED 1N STRICT AND FOR BASE Of REMOVAL It) U( If'.. 2. INSPECT AFTER 5' REMOVAL EXCAVATED. CONFORMANCE WITH MANUFACTURER'S MINE WALL FOOLING 31pCMR 152.'•'• ('•) 3. INSPECT PRIOR TO RACKfItL TO CHECK SPECIFICATIONS. SYSTEM INVERTS AND,LOCATION 5. PROPOSED LEACH AREA IS 83'1, Milt IA•1. 5. USE MEYER MW50. 1/2 TIP PUMP, OR TOP OF COASTAL BANK. EQUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIER OY I 310CMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED 114 FLOOD ZONE V15. / / BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR / SHOREY H-10 1000 CAI. TO 3/31/95. AND THERE IS NO EXPANSION OF HABITAEI�E/ MAKE WATER TICIIT SPACE,- i BENCH MARK-- IOP OF CCNC. / / \ l O / / / Invert 6.17 _ `,,<L �AR M _ \2•. 1 BOUND-6.95 ASSIGNED ON OFF _Ift Bottom 1 67- _,-/(t STlxtl' Ins N \ / IN I.If IA g o I �� va lit I I tJ r. < a t11 1V J �`• BENCH MARK --TOP Of WOOD STAKE-7.11 ASSIGNED � N/F BILSKII HLIOY I Y CAICLILATIONS 1500 GAL H-IQ WEIGHT OF EMPTY SEPYIC TANK AND 18- OF COVER TANK- 5.74 TON (PER SIIOREY) 18' COVER-1.5' X 5.67' X 10.5 X .055 TON/CU. FT\ 18" COVER-4.91 TON TOTAL- 5.74 TON + 4.91 TON - 10.65 TON WEICJTT OF WATER --NIGH CROUNDWAIER DOWN (3.0 -2,00) X 5.67' X 10 5' X 0.0312 10t1/CU FT. WEIGHT WATER- 3.19 TON / TANK AND IS- COVER ARE HEAVIER BY 7A ION BUOYANCY -A .S-1000 GAT H-10 PUMP CHAR= WEIGHT OF EMPTY CHAMBER AtID 9- OF COVER CHAMBER- 4.12 TON (PER SLIOREY) 9' COVER-35' X 4.83' X 8.5' X 0.055 TON/CU, FT. 9' COVER-1.69 TON TOTAL- 4 12 TON + 1.69 TON - 5.81 ION WEIGHT OF WATER --HIGH GROUNDWATER 0OtN1 (38 -1.67) X 4.83' X 85' X 00312 TON/(:U FT It WEIMIT WATER- 2.73 TON :?. -.1 i . . 9.4 _n 0356. 'I3S'r0 �•, oc" f? D ,I tP NI F MAIROr) 'o • 0 47 \\ GOr� "\\*06 of r too 110\" .e9" TOWN OF YARMOUT I I �P\off L 1 •; TOP SALT MARSH -, 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIAT.- FOR SITE PLAN. SEPTIC DESIGN Filth ( TANK AND 9 COVER ARE HEAVIER BY 3 ION C3-60- rrix� If(x\1,1 '�`Dt �}'M 1 TEST 14O E LOCATION, NUMBERR -W- WATER LINE PER WATER DEPT. HE CARD V EXISTING HYDRANT -G-- GAS LINE MARKINGS (IF SHOWN) .11.0 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) --8, EXISTING CONTOUR - 8^- PROPOSED CONTOUR. m EXISTING SEPTIC COVER I HEALTH AGENT APPROVAL G G 'LAYOUT PLANS EXISTING BUILDING a o Q S X D 00 a t' 10 - X d M d 8l"x6aw 81"xoaw u 11.a7 B-WALL STUDIO FLOOR PL , Q (NOT TO SC6 I, 81 (MAX) I— . WALL SECTIONS e� 5 " STUDIO FRONT WALL (f� N 0 ( � X s ; 0 WARE LIVE LOAD TABLE FOR 13 FT. PANEL (WITH 12 FT. OR LE,50,�& 'lt �e 00 >2 M 25 PSF 30 P5F 35 P5F 40 P5F 1 45 P5F 'FxE, F 55 P5F I 60 P5F $- 311HC 311HC 3 HC+H 3 HC+H 4.5 HC \, . tH 4.5 HC+H I 4.5 HG+H ' P'S+H 3"EP5+H I3"EPS+H 3"EPS+H 4.5"EP5+H I 4.5"EP5+H I 4 EP5+H I 4.5"EP5+H I 6"EP5+H ga NOTES 1. ALLOWABLE LOADS ARE 13A5E9 U THE LESSOR OF THE ULTIMA OR THE LOAD AT SPAN/ ©�+, Ca 2. HC/EP5 REFERS TO CB ` �i7 L DID CONSTRUCTION PANEL5 WITH ALUMINA ONDED TO HONEYCOMB/P LY ►I��I� RE5 (3", 4'6z" AND 6" IN THlC�3�D`JACENT PANEL5 ARE CONN IN INYL CLEATS OR He. 3. EIGF�,(�j If i19E51GN WIND SPEED, 4. DESIu .� F`PANEL DEAD LOAD = 5 P5F. 5. POO) NDOW LOCATIONS/SIZES ARE INTEP,tgXfGEABLE PER MFG'S 5PEC5. 6. WIDTH OF 13-WALL MAY VARY PER DOOR / WINDOW LAYOUT UPTO 24FT. 7. PANEL5 MAY ONLY BE USED IN ROOFS AND WALLS OF ONE STORY BUILDING CONSTRUCTION: TYPE VB (FOR IBC/ , S TYPE VI (FOR 5BC) AND TYPE F� s �A _ Cr 8. PANELS MAY ONLY BE USED IN ROOFS AND WALLS WHERE �®NATIONS: CLA55 B OR CLA55 If INTERIOR FIN15HE5 ARE PERMITTE �v pOOR BY CODE.Kll��60--MULLION 9. HORIZONTAL JOINTS BETWEEN THE ENDS OF PANELS O W = WINDOW NOT PERMITTED. O HC = HONEYCOMB PANELS, 10. CONTRACTOR TO PROVIDE FALL PROTECTION Et nPES, EP5 = POLYSTYRENE PANELS FOR SUNROOMS WITH A FINISHED FLOOR LQ H = THERMALLY -BROKEN OR GREATER ABOVE AN EXTERIOR 5U A ALUMINUM H-STIFFENER 11. 5TRUCTURAL FRAMING AND CONN ;?-INSTALLED P = PANEL PER CBM 5PEC5. T Q MPH = MILES PER HOUR 12. CONTRACTOR TO INSPECT ALL EX15TI PO DITIONS AND A5 NECE55ARY REPAIR AND/OR GE ALL MATERIALS A5 REQUIRED TO RENDER TT1EM STRUCTURALLY 5OUND AND COMPLETE. OF Mt 13. AUTHORIZED FOR BETTERLIVING DEALER/MATERIALS U5E ONLY. <� CRAIG J. a Joss n millm. I lol- WL I Q<"V CA O O 4 STUDIO 51DE WALL (C .� A55EMI3LY DETAIL5 SEE ALLOWABLE LOAD TABLE FOR PANEL 51ZE5 MINIMUM SLOPE 1:1 GUTTER FASCIA — SLIDING DOOR OR WINDOW TEMPERED GLA55 FLOOR CHANNEL — CBM=CRAFT-GILT MANUFACTURING P5F = POUNDS / 50. FOOT FT = FEET BC = BUILDING CODE IBC = INTERNATIONAL BC UBC = UNIFORM BC NBC = NATIONAL BC 5BC = STANDARD BC MFG = MANUFACTURER SPECS = SPECIFICATIONS MAX = MAXIMUM H FORT BEAM TYPICAL STUDIO NOT TO 96P PROJECT: CONTRACTOR: \X GODIN BETTERLIVING 13O5T0. 21 PAWNEE RD. 78 TURNPIKE ROAD WEST YARMOUTH, MA 02673 WESTBORO, MA 01581 DRAWN BY: CJJ 5CALE:1" = 75" DWG NO.: em50-12x14-godin DATE: 6/25/2003 m V-11" x W-2" 5TUD10 ENCL05URE GENERA& U%, T J AR 21-10 22'x8"TIMBERJOISTS� NAILED ®24" WITH 12d NA G' EXI5TING pJ ®� 5 DOORE>aSTIN{1:�, �. 0 0 19'-2" DECK FRAMING PLAN_ NOTES: p 1. TIMBER PE51GN 5TRE55' ASSUMES: Q SPECIES: SOUTHERN PINE NO.2 2" x 8" BENDING 5TRE55 Fb 1'.f6L COMP. PERP. TO GRAIN: 565 PSI C•� E1 ��J Q. COMP. PARALLEL TO GRAIN: 1.550 P51 0 SHEAR PARALLEL TO GRAIN: 90 PSI ( MODULUS OF ELASTICITY: 1.600.000 1% ` EXTERIOR LUMBER SHALL BE PRE55 R liz Q' PUBLISHED IN 1991 NOS "DE51GN V Liu FO Q WOOD CONSTRUCTION" °1 2. DESIGN LOADS: \ PATIO DECK: LIVE LOAD = 40 P5F DEAD D =10 P5F PATIO ROOF: GROUND SNOW LOAD = 30 P5F DEAD LOAD = 5 P5F OPEN DECK: LIVE LOAD = 60 P5F DEAD LOAD =10 P5F 3. AUTHORIZED FOR BETTEKLMNG DEALER USE ONLY. 4. REQUIRED FOOTING DIAMETER: 12" DIAMETER FOOTING FOR 4.000 P5F 501L BEARING. `M OF MaS PROJECT: �G GODIN CRAIG J. 21 PAWNEE RD. JOSS WEST YARMOUTH. MA STRUCTURAL y CONTRACTOR:/' 40024 78 TURNPIKE 6"x6" TIMBER (TYPICAL) GRADE (TYPI( P LEDGER WITH JOIST iER5 SECURED TO CTUKAL 5TUD51N HOUSE 1/2" x 5" LAGS WITH 1ER5 016"oc 5/4'7(6" PT DECKING 3/4" T&G PLY OVERLAY DECKING WITH VAPOR BARRIER 2"x8" TIMBER JOISTS 016"oc NAILED TO DECKING ALONG TOP EDGE 2-2"x8" TIMBER J015T5 NAILED 024" WITH 12d NAILS 3-2"x8" TIMBER JOISTS NAILED 024" WITH 12d NAIL5 CONCRETE FOOTINGS (SEE NOTES 4 6 5) 2-2'k8" TIMBER BAND - 3/8" x 5" LAGS 1/2" x 51/2" SIMP50N ONNECTOK CBAGG (TYPICAL) - 5/8" x 4 3/4" ANCHOR BOLT TYPICAL P05T DETAIL 0 94� G DE51GN ASSUMES: OTING5 SHALL EXTEND BELOW FK05T LINE. Q CONCRETE 15 TO HAVE A MINIMUM COMPRE551VE STRENGTH OF 3,000 PSI AT 28 DAYS. 6. FOR DECKS WITH A FINISHED FLOOR LEVEL OF 30' OR GREATER ABOVE AN EXTERIOR SURFACE, CONTRACTOR TO PROVIDE NECE55ARY KNEE BRACING AT ALL VERTICAL POSTS TO PE515T LATERAL LOADS AND FALL PROTECTION PER LOCAL CODE 7. CONTRACTOT TO PROVIDE MIDSPAN BLOCKING FOR ALL JOISTS HAVING DEPTH-TO-THICKNE55 RATIO EXCEEDING 6.1. 8. CONTRACTOR TO PROVIDE NECE55ARY STRAPPING & TIE DOWNS TO RESIST WIND UPLIFT. 9. DRAWING SHOWS MINIMUM STRUCTURAL REQUIREMENTS FOR DESIGN VALUES SHOWN. 10. CONTRACTOR TO INSPECT ALL EXISTING CONDITIONS AND A5 NECE55ARY REPAIR AND/OR REPLACE ALL MATERIAL�PA5 REQUIRED TO RENDER THEM STRUCTURALLY SOUND COMPLETE. 11.5TAI IGH RAIL p EAD ��.- /4" RISE Cj 4" BALUSTER SPACE 11'-1111x19'-2" DECK FRAMING PLAN SCALE:1/4" =1' 0" Q FOR 5TUD10 ENCL05URE DATE: 6/25/03 Property Owner Must Complete and Sian This Section If Using A Builder I, Itz tJ CI�NC 19. GODMI , as Owner of the subject property hereby authorize Betterliving Patio Rooms (d.b.a. — Patio Rooms of America) to act on my behalf, in all matters relative to work authorized by this building permit application for (address ofjob) Signature Owner Date Owner or Builder (as Agent of Owner) Must Complete and Sign This Section I, _ :Y—O'M4 s --s���I Agent hereby declare that th (address of job) '.1 , as Owner/Authorized :nts and information on the foregoing application for 0145-li" R t�__ are true and accurate, to the best of my lmowledge and belief. Signed under the pains and penalties of perjury. Print Name 4 ature of Owner/Age 7 1.411a3 Date KC0NS.UIIIE}2NE0RB110N.EOR11i ;_.SUNROOhiS.a.�� Massachusetts SiatcBuildtna CodeS7S0 CI1R A en ixJ;_Sectio a 1:1:23 ,ram The Massachusetts State Building Code (780 CiflZ) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a "sunroom" addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to -uncontrolled solar Bain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of "sunrooms", inoluded below is a non -required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a "sunroom". It is recommended that consumers carefully review these- options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. RODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" • Solar Orientation and Natural ShadiIIg • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame seaiiIIe and ;2skctinv materials/ seal durability and/or weather tightness of the sunroom Adequate ventilation - Operable windows and fans • Applied Shading Systems • Insulation level in floors, walls, and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Coolinb Methods: Efficiency, Zoning and Controls Homeowner AcluiowIedgment The Massachusetts State Building Code, Section J1.1?.3.1, requires that the actual Property owner (not the owner's agent or representative) acknowledge r eceipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. Signatur of Actual Building Owner Date 2. G o Print Na>} e Owner Address (if different than project location) Address of Permitted Project 150W_ a- 0b59 O•.ner's telephone number SUNROOMS 78 Tumpike Rd. Westboro, MA 01581 508-870-1900 fax 508-870-5756 The enclosed permit package is for the proposed building of a three -season sunroom on a new wood deck. Included in this Permit package: • Plot Plan and septic diagram if applicable. • Deck Framing Plan • Plans for the sunroom • Homeowners Permission to represent them in securing this permit • Signed consumer information form for Sunrooms T i and me R==dellr_R Licensee - Prca. of N::pe Esc.., ce....e ..� Ea .._�_.. a F Proof of Workers Compensation Coverage Debris Removal Plan Tartk you to advance A)r your f?SS't5t i7Ce. PleasecAli with :aay add;ttiinai information !ation you need. Best Regards, Rose King :508-870-1900 ext. 223 Property Location: 21 PAWNEE RD AL1P ID: 24/ 89/ / / Vision ID: 2705 Otker ID: 20/ R107/ / / Bldg #: 1 Card 1 of 1 Print Data 08/0S/200311 CURRENT OWNER TOPO. UTILITIES STRTIROAD LOCAITON 4SSESSAfENT DIN, EUGENE R & PAULA J SM CENTRAL ST 442 LEONIINMT14 MA 014S3 Description Code lArvraisedValue Assessed Value d15 YARMOUTHI, RESLAND RESIDNTL 1010 1010 169,100 I0I,S00 169,100 HUM SUPPLEAIENTA DATA Account # 0263500 Subdivision 120 Ward isM. "SIC Total 270,9W 270,900 RECORD OF OWNERSHIP B&VOL/PAGE SALEDATC & 41 SALEPRICE VC PREWOUSASSESSMEN ISTOR DIN, EUGENE R do PAULA J 1PSON HENRY S 07I30i1996 Q 1 137,000 0 Yr. Code Assessed Value Yr. Code Assessed Value Y►. Code Assessed: 2003 003 1010 1010 77.000 tOO2 63,200 tOO2 1010 1010 77,000 LODI 63,200 001 1010 1010 oral• 140,200 Tof 140,200 Torok MMAfPTIONS 07TWHERASSESSAfENTS This signature acknowledges a sisit by a Data CoUedor orA.n Year nvelDescription Amount Code Descrivition Number Amount Comm.Int. APPRAISED VALUESU.40LIRY Appraised Bldg. Value (Card) Appraised.NF (B) Value (Value(BBldg) A Land Value (Bldg)g) Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: CostlmarketIV oto NOTES 0120 et Total Appraised Parcel Value BUILDING PERMIT RECORD HSITICIIANGE HISTORY Permit ID Issue Date 71re Description Amount Insp. Date %Comp. Date Comp, Comments Date ID Cd. Purpose/Res 00-630 3/10/2000 RS entlal 9.942 100 1=001 REPLACE WINDOWS 8I1611995 DH 00 essur+Llsted LAND LINE VALUATION SECTION B# Use Code Descri non Zone D lFrontare I Death Units UnBPrice L Factor I S.1 I C. Factor Nbad I AdY. Notes- AdjlSpeclal Prfcinz Land Vt 1 1010 SINGLEFAM 10,M.00 SF 7.64 1.65 6 11S 0060 1.00 ism Total Card= Uniu 1 10, MOO I SFj Pared Total Land Area: 10,890 SF r Toed Land V Property Location: 21 PAWNER RD 31AP ID: 24/ 89/ / / Virion ID: 1705 OtherID: 20/ R107/ 11 Bldg #: 1 Card 1 of 1 Print Date 08/05/200311 terries Story - 1 all Dftcfior Wall 1 4 woad Shingle %Common Wall 2 Nall Height Stnidure ahle/111p Zoof Cover UphIF Gh lC mp CONDOMOBILEHOMEDATA hterior Wall 1 2 5 PiNFIA WD ent 5excription Fe, lez bletior Floor 1 4 2 2 Adj itLocation Jnit eating Fuel easing Type 5 of Water amber of Units C Type 1 one umber of Level A Ownership 3odkmooms Bedrooms COS T/. MRKET VALUATION 5 1 Badmus Base Rate ize Adj. Factor 100.00 1.115" Dial Roomer s omsJna4 Ty 2 rfodern (Q) Index 097 Kitchen style )2 ern .. Base Rate 10830 Idg Value New 137.199 ear Built 1960 Year Built 1975 mil Physcl Dep 27 Obs� ped� Coda 0 MIXED USE 1010 SINGLE FAM 100 l G emu %Cood. 73 Bldg Value 100.200 OB-0UTBUILDING &YARD ITEbfS,2 I XF-BUILDING EXTRA FEATURES Code Descritnion LIB Units I UnitPrtce Yr. D Rt I %Cnd A FPLI FMEPLACE 1 ST B 1 2,200.00 1975 1 100 EOS Encl Oats Shwr B 1 0.00 1975 1 100 BUILDING SUBAREA SUMfARYSECTIO E .Area I Unit Cost Und Code Description Ltvin Area Gross Area HAS list Floor 1,038 1,038 1,038 108.20 FGR ge 0 SM 203 43.24 FOP orch, Open. Finished 0 50 10 21.64 WDK Wood 0 168 17 10.95 r r y.,,vr� r+y, e.rT r•..=+- r •�rrl�l� «.�w.wn+•�r�...►�+.+.w .r +rw.r �-bye TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Detenanines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Steams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: 2. ENGINEERING DEPARTMENT: 3. 4. N/A: S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Whdc copy - BafWmg DepL - Pwk a)py - W&W DepL - Yellow Copy - Hedth DNL - Piak Copy - En8mocring Dcpt - GoWwW - Fire DcpUCanscvuiw e ' Addendum -e- I REQUIRED INSPECTION SCHEDULE: ALARM be PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI BOARD Of HEALTH REQUIRES R.J. CADILLAC1. ALARM TO BE WIRED BY ELECTRICIAK ON TO INSPECT OR LAYOUT, AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP I. 9'-9' PROVIDED FROM LCACHIN(: III ' I++:,• PLEASE GIVE R. J. CADILLAC 48 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIOEO III IVAI ADVANCE NOTICE: WRING INSPECTOR. 2. NO RESERVE AREA SHOWN. 31OCMR 11, 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO DE LOCATED IN HOUSE. 310C3. VARY LEACHING TO PROPERTY 111 if II, I INSPECT WHILE FOOTING POURED. VARY 5 15.211 (1). INSPECT WHOLE WALI. POURED. 4. PUMP i0 BE CAPABLE TA PASSING 4. VARY 5' ALL AROUND ROVAL I. h1 (IT + 2. INSPECT AFTER V REMOVAL EXCAVATED. 1-I/4' SOLIDS AND INSTALLED IN STRICT MINEBASE WALL FOORNG JIpEMR 1-, 2!.,. ('• J. INSPECT PRIOR 10 IUCI fRL TO CHECK SPECIFICATIONS. SYSTEM INVERTS AND LOCATION 5. PROPOSED LEACH/ AREA IS 83'1, AIR1 IA-1- 5. USE MEYER MW30. 1/2 TIP PUMP, OR TOP OF COASTAL BANK. EOUIVALENT. 6. VARY DISTANCE TO GROUNOEWAfEP nY I JIOCMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED IN FLOOD ZONE V15. ! ! BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR SHOREY H-10 1000 GAI . TO 3/31/95, A14D THERE IS NO EXPANSION OF HABITAB�V MAKE WATER TICIII SPACE, !! O ®' .' i 6 1 BENCH LURK --FOP LY CONC. '! �O �!' Invert 6.17_- ARM- {7" I} VOUND-6.96 ASSIONED ! �' ON _ .,f1. 1-5 OFF - IFtII'11 O. .;i . . u ! � f1, � �, Bottom 1 67-� _ STUN(' 1n P! o I IJ tit (v 1 i , Lp Y\ \ lo 0. OVA c"I Co BENCH MARK --TOP OF w000 r•_.. ...,,,•'Xlr:ny,� .:' Qrt,�r;Ri4 1 t ./.%rot ..,�.. .. r''Ir\ ! STAKE-7.14 ASSIGNED CO y• �A a'r1' /! I 11cl0. N/F SILSKII \ '6 BUOYANCY CALCULATIONS IS00 GAL 11-10 WEIGHT OF EMPTY SEPYIC TANK AND 18- OF COVER TANK 5.74 ION (PER SI OREY) 18' COVER -IS X 5.67' X 10.5 X .055 TON/CU. FT. i 18' COVER-4.91 TON TOTAL- 5.74 TON + 4.91 TON - 10.65 TON WEICJIT OF WATER --HIGH GROUNDWATER DOWN (3.0 -2.00) X 5.67' X 10 5' X 0.0312 TOH/CV FT. WEIGHT WATER- 3.19-TON / TANK AND 18"COVER ARE HEAVIER BY 7,4 TON nUOYANC�Y CALCS-10Q0 CAL. 13-10 PUMP CH AM= WEIGHT OF EMPTY CHAMBER AND 9- OF COVER CHAMBER- 4.12 TON (PER SIIOREY) 9' COVER-.75' X 4.83' X 8.5'.X 0.055 TOIL/CU, FT. 9' COVER-1.69 TON TOTAL- 412 TON + 1.69 TON - 5.81 TON WEIC14T OF WATER --HIGH GROUNDWATER DOWN (3 8 -1.67) X 4.83' X 8 5' X 0 0312 TON/CU FT WEIGIIT WATER- 2.73 TON :? °� �W, TOWN OF YARMOU•II I ea9 ` 1 ' TOP SALT MARSH ., 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIAF' FOR SITE PLAN. SEPTIC DESIGN �1 � c J n a �•4 �k)`� s f1�JlNH .I \(^• TANK AND 9 COVER ARE HEAVIER BY 3 ION 0760. rr_c� }a:x•41• TT1 1 LELFM ate; - a TEST HOLE LOCATION, NUMDER -W- WATER LINE PER WATER DEPT. TIE CARD Y�X EXISTING HYDRANT -G^- GAS LINE MARKINGS (IF SHOWN) .11.0 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) EXISTING CONTOUR PROPOSED CONTOUR m EXISTING SEPTIC COVER If 5118A6 HEALTH AGENT APPROVAL J FROP05E7 S 5EA50N PM PROF05EP NEW DECX 12'X19' (APP= I. Z;(8 F'rFEW a 16" O.L. 2. LEDGER PaTW 1/ 2")5" LAGS 52" O.C. 9. J05f HANGERS Q LEDGER 4. 2X8 Pr fRIU 6EAM 5. DBL 51DE .Mf5 6.0) I2"0 X 45" DEEP FIC6 W/h4CH R5 1. V 4" U6 FLY OVE11M B. 6X6 F055 9. 5fAR5 10.5/ 4" X 6" Pf DECXNG 11.Da.J05fe"c'WAI 6' DOOR d PORCH NEW 6' D FROM P01 (Wr9t IH5 VEW, i' O 5fAIR 8 RA1. 56" Hai M II" TW 9-V 4" M 4" DALLL69R5PACE O B eFrokct;GO5eak:l/8"-I'-O" Draxrx� tterl ivi ng nIN �5119 NCB SUNROwe21PANUPDW g TumDike Road 0 OL581 YMMOUR MA 026" Phase c508> gm Fax 508) 870 Y156 Date: 6/ 24/ 05 56A I of I NRQ AYOUT PLANS EXI5TING BUILDING 0 s +p �00 d c O ; 3 � � r � a t M d Vv . arrow . areow -—Bt- )I.WALL r— IF STUDIO FLOORVV��ff (MAX) (NOT TO 5CF�1.. fk Ci 5TUDIO FRONTWALL �N +iVi ppvvL y�/ABLE LIVE LOAD TABLE FOR 13 FT. PANEL (WITH 12 FT. nR I Fsa WALL SECTIONS (bil 1 9 1 ®k 0 0$ o �r R O STUDIO 51DE WALL (Cl. P1 Q ASSEMBLY DETAILS SEE ALLOWABLE LOAD I TABLE FOR PANEL SIZES I \ A- SF 25 P5F 30 P5F 35 P5F 40 P5F 45 P5F t-C F 55 P5F 60 P5F "H4 S.KV41i2+H 3"HC 3"EPS+H 3"HC I 3"EPS+H 3"HC+H I 3"EPS+H 3'TiC+H I 45"EP5+H 4.5"HC O�HI 45"EPS+H 5+H 45"HC+H I 45"EP5+H I 45"HC+H I 6"EPS+H NOTE5 FO UD 1. ALLOWABLE LOADS ARE 6A5Ep THE LE550R OF THE ULTIMA OR THE LOAD AT SIP' 9 �S 2 HC/EPS REFERS TO CB L OND PANELS WITH ALUMIN ED TO HONEYCOMB/P LFES (3", 4 %. AND 6"IN ,{� D9ACENTPANELS ARE CONN U INCYVINYL CLEATS OR Ha. 3. El G I�A1F�1 f�E51GN WIND SPEED, EXP U BB 4. DE R F ANEL DEAD LOAD = 5 P5F. 5. D00 , NDOW LOCATION5/51ZE5 ARE INTER GEA5LE PER MFGS SPECS. 6. WIDTH OF 5-WALL MAY VARY PER DOOR / WINDOW LAYOUT UPTO 24FT. 7. PANELS MAY ONLY BE USED IN ROOFS AND WALLS OF ONE STORY BUILDING CONSTRUCTION: TYPE VB (FOR I TYPE VI (FOR 56G) AND TYPE VVI CON5TRUCTION 8. PANELS MAY ONLY BE USED IN ROOFS AND V CLASS B OR CLA5511 INTERIOR FINISHES ARE BY CODE 9. HORIZONTAL JOINTS BETWEEN THE ENDS OF NOT PERMITTED. 10. CONTRACTOR TO PROADE FALL PROTECTION FOR SUNROOM5 WITH A FINISHED FLOOR LM OR GREATER ABOVE AN EXTERIOR MUAI,ItSTRUCTURAL FRAMING AND CONNPER CBM SPECS. 12 CONTRACTOR TO INSPECT ALL EASTT b 1w MINIMUM SLOPE 1:12 GUTTER FASCIA—�J�� — ''it��$.S HE/�,, 'f;{�UN ROT BEAM I SLIDING DOOR �i7V-� OR WINDOW it Q TEMPEKEPOLA55 > FLOOR CHANNEL 0139EVIATION5: CBM=CRAFT-GILT MANUFACTURING 3,fl00R P5F = POUNDS / 5Q. FOOT TYPICAL STUDIO 5 41`= MULLION O W = WINDOW FT - FEET BC = BUILDING CODE NOT TO Ffw HC = HONEYCOMB PANELS i, IBC = INTERNATIONAL BC O H = THEFMALLLY-1-BRO N ALUMINUM H-STIFFENER I NBC = NA TONAL BC 5BC = STANDARD BC � �O 9- P = PANEL MFG =MANUFACTURER MPH = MILES PER HOUR SPECS = SPECIFICATIONS p-� MAX =MAXIMUM 6\lira Q AND A5 NECE55ARY REPAIR AND/OR PEACE ALL MATERIALS AS REQUIRED TO RENDER EM STRUCTURALLY +� SOUND AND COMPLETE .a uv M� 13. AUTHORIZED FOR BETTERLIVING DEALER/MATER W.5 USE ONLY. u cn��w t .Iosa PROJECT: GODIN 21 PAWNEE R.D. WEST YARMOUTH, MA DRAWN BY: CJJ 5CALE:1" = 75" CONTRACTOR: 13ETTERLPANG BOSTON 78 TURNPIKE ROAD WE5TBOR0, MA 01581 DWG NO-. em50-12xM-godin DATE: 6/25/2003 W-11" x K-2" 5TUD10 ENCLO51 GENERAL LAO 2-2"x8" TIMBER JOISTS' NAILED 024" WITH 12d NAILS 6' EX15MG © � 5 DOOR EXI511N, a Dr Q CO O 10 1' 4'4" 5' DECK FRAMING PLAN Vr NOTES: 1.171VIBER DE51GN STRE55' ASSUME5: SPECIES: SOUTHERN PINE NO.2 2" x 8" BENDING 5TRE55 Fb: 1'.2=51 COMP. PERP. TO GRAIN: 565 P51 COMP. PARALLEL TO GRAIN: 1.550 PSI SHEAR PARALLEL TO GRAIN: 90 PSI MODULUS OF ELASTICITY: 1,600 Q0 EXTERIOR LUMBER SHALL BE PRE55 TR PUBLISHED IN 1991 ND5 "DESIGN Y LUG WOOD CONSTRUCTION' 2. DESIGN LOA05: PATIO DECK: LIVE LOAD = 40 P5F DEAD PATIO ROOF: GROUND SNOW LOAD = 30 P5F OPEN DECK: LIVE LOAD = 60 P5F DEAD L0, 6"xG" TIMBER (TYPICAL) GRADE (TYrIC O 5 2'Sc8" LEDGER WITH J0157 HANGERS SECURED TO STRUCTURAL STUDS IN HOUSE WITH 1/2" x 5" LAGS WITH WASHERS 016'oc 5/476" PT DECKING 3/4" T&G PLY OVERLAY DECKING WITH VAPOR BARRIER 2"x8" TIMBER JOISTS 016"oc NAILED TO DECKING ALONG TOP EDGE 2-2'k8" TIMBER J015T5 NAILED 024" WITH 12d NAILS 3-2"x8" TIMBER JOISTS NAILED 024" WITH 12d NAILS CONCRETE FOOIINC75 (SEE NOTES 4 & 5) 2-2"x8" TIMBER BAND - 3/6" x 5" LAG5 " SIMP50N CBA66 (TYPICAL) 1- 5/8" x 4 3/4" ANCHOR BOLT TYPICAL P05T DETAIL N. G DESIGN A55UME5: OTING5 SHALL EXPEND BELOW FK05T LINE 0 CONCRETE 15 TO HAVE A MINIMUM COMPRESSIVE e lq- STRENGTH OF 3,000 P51 AT 28 DAYS. Q 6. FOR DECKS WITH A FINISHED FLOOR LEVEL OF 30" OR =10 PSF EAD LOAD = 5 P5F =10P5F 3. AUTHORRED FOR 13ETTEKLMNG DEALER USE ONLY. 4. REQUIRED FOOTING DIAMETER: 12" DIAMETER FOOTING FOR 4,000 P5F SOIL BEARING. `tN OF Mqs PROJECT: s9c GODIN CRAIG J. �G 21 PAWNEE RD. JOSS WEST YARMOUTH, MA STRUCTURAL H CONTRACTOR .r '\ 40324 Ll GREATER ABOVE AN EXTERIOR SURFACE. CONTRACTOR TO PROVIDE NECESSARY KNEE BRACING AT ALL VERTICAL POSTS TO RE515T LATERAL LOADS AND FALL PROTECTION PER LOCAL CODE. 7. CONTRACTOT TO PROVIDE MI05PAN BLOCKING FOR ALL JOISTS HAVING DEPTH -TO -THICKNESS RATIO EXCEEDING 6:1. 8. CONTRACTOR TO PROVIDE NECESSARY STRAPPING d, TIE DOWNS TO RESIST WIND UPLIFT. 9. DRAWING SHOWS MINIMUM STRUCTURAL REQUIREMENTS FOR DESIGN VALUES SHOWN. 10. CONTRACTOR TO INSPECT ALL EXISTING CONDITIONS AND A5 NECE55AKY REPAIR AND/OR REPLACE ALL MATERIAL-9)A5 REQUIRED TO RENDER THEM STRUCTURALLY SOUND. COMPLETE 11. 5TA1 IGH RAIL © EAD ,�-7- /4" RISE ) 4" BALUSTER SPACE ° 11'-1111x19'-211 DECK TIJ-(�UGlfl FRAMING PLAN 1/4" =1'-0" FOR STUDIO ENCL05URE DATE 6/25/03 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTLAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler System, Etc. ..................................................................................................................................................... REVIEWED BY: 1. WATER DEPARTMENT- DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: N/A: [ -- uIA. _. -- --._- ---- - 4. HEALTH DEPARTMENT DATE: N/A: 3. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR. DATE:. N/A: 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: WhMOW-BuAdgffDept• - PWkaW -WSW Dept - YdbMCow -HMMDcM - PMkCopy •F.o®oo 4Dcpt - Gddm:od-FkcDg4 Ca=mtw ' AddendleA "B" is- REQUIRED INSPECTION SCHEDULE: ALARM do PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI BOARD OF HEALTH REOUIRES R.J. CADILLAC 1. ALARM TO BE WIRED BY ELECTRICIAN ON ' TO INSPECT OR LAYOUT, AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP 1. 9'-9' PROVIDED FROM LEACI+IN(: TO • 1•+::• PLEASE GIVE R. A CADILLAC 48 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIDED RI Intl ADVANCE NOTICE: WIRING INSPECTOR. 2. 140 RESERVE AREA SHOWN. 310CUR In jv 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO BE LOCATED IN HOUSE. 3. VARY LEACHING TO PROPERLY UNF Il, INSPECT V411LE FOOTING POURED. 15.2t1 (1). 1. PUMP TO BE CAPABLE fN PASSING 4. VARY VARY 5 5' ALL AROUND REMOVAL. lu tll + INSPECI WIULE WALL POURED. 1-1/4' SOLIDS AND INSTALLED 114 STRICT AND FOR BASE OF REMOVAL I0 (R IF•.. 2. INSPECT AFTER 5' REMOVAL EXCAVATED. CONFORMANCE WITH MANUFACIURER'S MINE WALL FOOTING 31OCMR 1-, 2!.-. ('•) 3. INSPECT PRIOR TO LO (L fO CHECK SPECIFICATIONS. SYSTEM INVERTS ANDND lo(:A ROJJ 5. PROPOSED LEACH AREA K 83'1, AIRI IA-1- 5 . USE MEYER MW50. 1/2 IIP PUMP, OR TOP OF COASTAL DAIIK, EOUIVALENT. 6. VARY DISTANCE 10 GROUNDEWAIER Or I - i i I 310CMR 15.212. NOTE: ALL OF LOT 107 IS LOCATED IN FLOOD ZONE V15. r r BOTH HOUSE AND SEPTIC WI4ERE III EXISTENCE PRIOR r ' SHOREY H-10 1000 GAI . TO 3/31/95. AND THERE IS NO EXPANSION OF HABITABSV MAKE WATER TIGHT SPACE, r ®I 3 O r BENCH MARK --TOP IX CCVJC. Invert 6.17__-'<LAnM- N7" OOUND-6.96 ASSIGNED ON - ,.0- I I OFF !� Bottom 1 67- _��"•�'STUNt' nrr• PI 5 P° � r' /Q•���9 �`.. Q��p.ry vAnrlll4. tit 1114 1p �� �\ v`�,` I," .9.4 �' r ''q `so. N/F MA12UN (D•II� m c \ \1 .' .••M. +a•Y. FI^V �4 f ppl�,, QXIOI 'M••.. r.'-!ir\ BENCH MARK --TOP OF WOOD - OI..:'..• .. _•F+. •I'�• r S7AKE-7.14 ASSIGNED �� Q' ' •' ' N/F BILSKII \ '6 /P�- 7 / BUOYANCY CALfULATIOUS INN CLH_ID WEIGHT OF EMPTY SEPYIC TANK AND IS- OF COVER TANK- 5.74 TON (PER SHOREY) t8• COVER-1.5' X 5.67' X 10.5 X .055 TOIL/CU. FT. 18' COVER-4.91 TON TOTAL. 5.74 TON + 4.91 TON - 10.65 TON WEICMT OF WATER--HICII GROUNDWATER DOWN (3.0 -2.08) X 5,67' X 10 5' X 0.0312 10H/CU FT. WEIGHT WATER- 3.19 TON / TANK AND I6"COVER ARE HEAVIER BY 7.4 ICIN ausyllm III I t WEIGHT OF EMPTY CHAMBER AND 9" OF COVER CHAMBER- 4.12 TON (PER SIIOREY) 9' COVER-,75' X 4.83' X 8 5' X 0.055 TON/CU. FT. 9' COVER-1.69 TON TOTAL- 4 12 TON + 1.69 ION - 5.81 ION WEIGHT OF WATER--tIIGH GROUNDWATER DOWN ` (38 -1.67) x 4.83' x a5' x 00312 70tJ/rU FT \ WEICJIT WATER- 2.73 TON :a �jea96TOWN OF YARMOU•fII cp9> �o6 [ I • vV TOP SALT MARSH ., 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIA[.' JFOR SITE PLAN. Q SEPTIC DESIGN TANK AND 9' COVER ARE HEAVIER BY 3 ION, c7Ic�0. r\ecr� lt(XV! LEGEND TH 1 TEST NOTE LOCATION, NUMBER 1 N -W- WATER LINE PER WATER DEPT. TIE CARD 7X EXISTING HYDRANT -0 - CAS LINE MARKINCS (IF SHOWN) • .11.0 EXISTING h PROPOSED ELEVATIONS ('X' MARKS POINT) _8, EXISTING CONTOUR ...._.gam- PROPOSED CONTOUR m EXISTING SEPTIC COVER If HEALTH AGENT APPROVAL i t ?80 Tas- Commonwealth of Massachusetts Official use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �UV Rev. 11199] leave blank � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00. (l'LE1SE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9/29R005 city or Town of YARMOUTH To the Inspector of Wires: `y this application the undersign gives notice o is or her intention to perform the electrical work described below. pM �I �aocsiZVStreet & Number) N )(PAWNEE ROAD, WEST YARMOUTH �+ 0 O"er r Tenant PAULA GODIN Telephone Na 508-862-0659 O"ert ) Address SAME 13 this permit is conjunction with a building permit? Yes ❑ No .S (Check Appropriate Box) Purptose of Building RESIDENCE Utility Authorization Na \FW fisting Service Amps Volts Overhead ® Undgrd ❑ Na of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ Na of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: HVAC WIRING Comoletlon ofthe followine table may be waived by the Immctor of Wires. Na of Recessed Fixtures Na of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA Na of Lighting Outlets Na of Hot Tubs Generators KVA Na of Lighting Fixtures Swimming Pool Above ❑ I ❑ rod rod a o Units ey g ting Bette Units Na of Receptacle Outlets Na of Oil Burners FIRE ALARMS No of Zoucs Na of Switches Na of Gas Burners Na o Detection and Initiating Devices Na of Ranges Na of Air Cond. Tonal No. of Alerting Devices Na of Waste Disposers IieatPump Totals: Number Tons W a I ntained o Detection/Alertin Devices Na of Dishwashers Space/Area Heating KW Local ❑ htun 'pal ❑ Other Connection Na of Dryers Heating Appliances KW Security Systems: Na of Devices or Equivalent Na of Water KW Heaters Na of - Na of Signs Ballasts Data Wiring: Na of Devices or Equivalent Na Ilydromassage Bathtubs Na of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER: Attach additional detail Vdesired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCES BOND ❑ OTHER ❑ (Specify:) GENERAL COMP. UADILITY 02/19/2006 (Expiration Daze) Estimated Value of Electrical Wor(When required by municipal policy.) k: Work to Start: 9/30/05 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cerfyy, under th a pains an dpen es of perjury, that the Information on this aNflcadon is true and complete. FIRM NAME: . -' LIC. No.: A17137 Licensee: Edward L Merry Signature WC. NO.: 35745F, atzpplicable, enter "erempt"in the license number line.) Bus. Tel. No.: 508-394-7778 Address: 8 REARDON CIRCLE SOUrH YARMOUTH, MA 02664 AIL Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabili urance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent. OwuSignature Cent Telephone Na PEMIITFEE. f L� P 0 .. .. ,-I *I.' i Building Site Location: Proposed Improvement: Gn 1 V TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET �4= Map No: Lot No: Address: U �Ii -J,4 l� . 4 , t` �. s'� ,' �� r ._ �-rtr Te1No.: 7 / /�G _. Date Filed: 2ALZ43 The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Ddcrmines Compliance to State and Town Requirements for Personal Safety, Property Protection- i.e., Smoke Detectors, Sprinkler Systems, Eta ................................................ ..... z....................................................................... REVIEWED BY: 1. WATER DEPAR N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS, S. WIRING INSPECTOR DATE: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: f77i5I.�l5i:i�� SIGNATURE OF APPLICANT: DATE: White copy - BuWmg Dept - Piot cM - Water Dept - Yc low COPY - HaM DTL - PvA Copy - E%inc r Dept Goldwod- Fire DepWo minim . r Addendlm "B" II REQUIRED INSPECTION SCHEDULE: ALARM do PUMP NOTES MAXIMUM FEASIBLE COMPLIANCE APPROVAI BOARD OF HEALTH PEOUIRCS R.J. CADILLAC I. ALARM TO BE WIRED BY ELECIRICIAN ON ' TO INSPECT OR LAYOUT. AS NOTED BELOW. SEPARATE CIRCIUT FROM PUMP 1. 9'-9" PROVIDED FROM LEACHwG HN • I>+•.� PLEASE GIVE R. J. CADILLAC 45 HOURS 2. ELECTRICAL WORK TO BE INSPECTED BY SEWAGE RETAINING WALL PROVIOED III Iv.11 ADVANCE NOTICE: WIRING INSPECTOR. 2. NO RESERVE AREA SHOWN. 310CUR I', J1- 1. STAKE LOCATION OF PROPOSED WALL. 3. ALARM TO DE LOCATED IN HOUSE. 310C3. VARY LEACHING 10 PROPERTY (II If IFt t INSPECT WIALE FOOTING POURED. VARY 5 15.211 (1). INSPECT v4KLE WALI. POURED. 4. PUMP TO SOLIDS CAPABLE TA PASSING 4. VARY O ALL AROUND OVAL AI. H1 III + 2. INSPECT AFTER 5' REMOVAL EXCAVATED. CONFORMANCE SOLIDS AND INSTALLED R STRICT AND FOR BASE Of REMOVAL It, (I( If'.. CONFOICA TION WITH MAN(1FACIURER'S MINE WALL FOOLING 310CUR IS 7"• (•• 3. INSPECT PRIOR TO ND LOCATION in CHECK SPECIFICATIONS. 5. PROPOSED LEACH AREA IS 83'I, ADII IA-1- 5. USE MEYER 11,10150. 1/2 TIP PUMP, OR TOP OF COASTAL BATIK. EQUIVALENT. 6. VARY DISTANCE TO GROUNDEWAIEP Pr I , 310CUR 15.212. NOTE: ALL OF LOT 107 IS LOCATED IN FLOOD ZONE V15. BOTH HOUSE AND SEPTIC WHERE IN EXISTENCE PRIOR " SHOREY H-10 1000 GAI . TO 3/31/95, AND THERE IS NO EXPANSION OF HABITAB�V MAKE WATER TIGHT SPACE, le O ®r•, 6 I ol r• .1 ^ BENCH MARK--11x+ LX CONC. `l O �Invert 6.17-�,/ L' A7• POUND-6.96 ASSIGNED � ON -^ .'•Ill .l. OFF o� Bottom i 67-,_/ STUNG n1:• BENCH MARK --TOP OF WOOD STAKE-7.14 ASSIGNED N/F BILSKII o r � 14 e 9 OJc�E. vnlit `II1 tit IV a'0. N/F MARow �r v \\ r• - t ...,..• .;itl••i+n,V . ,wi►q 11RIIh,'!,,'jIY.'(?°;1WYI ' J o0. q, X-- BUOYANCY CALCUI ATIONS INN GAL 11=10 WEIGHT OF EMPTY SEPYIC TANK AND 18* OF COVER TANK- 5.74 TON (PER S16REY) 18" COVER-1.5' X 5.67' X 10.5 X .055 TON/CU. FT. i 18' COVER-4.91 TON TOTAL- 5.74 TON a 4.91 TON - 10.65 1014 WEIGHT Of WATER --HIGH GROUNDWATER DOWN (3.6 -2.08) X 5.67' X 10 5' X 0.0312 ION/CU F1. WEIGHT WATER- 3.19 TON / TANK AND 18"COVER ARE HEAVIER BY 7.4 TON BUOYANCY -CAI CS=1000 C 1 _ H-10 PUMP CHAMBER WEIGHT OF EMPTY C14AMBER AND 9" OF COVER CHAMBER- 4.12 TON (PER STOREY) 9' COVER-.75' X 4.83' X 8.5'.X 0.055 TON/CU, FT. 9' COVER-1.69 TON TOTAL- 412 TON a 1.69 ION - 5.81 TON WEIGHT OF WATER --HIGH GROUNDWATER DOWN (38 -1.67) X 4.83' X 85' X 00312 T0N/CU FT It WEIGHT WATER- 2.73 ION - e�\°oa of l,To cagej,dgeTOWN OF YARMOU•III /• vVVOP I ' TOP SALT MARSH -• 3 7 LAND SURVEYOR'S STAMP SANITARIAN'S SIAT.' FOR SITE PLAN, SEPTIC DESIGN JAJ //.Os.imcf, . III, TANK AND 9 COVER ARE HEAVIER BY 3 ION • a<4 o- r\ � 1 L'1 x \ T j ND TTl 1 TEST HOLE LOCATION. NUMBER -W- WATER LINE PER WAFER DEPT. TIE CARD 7x EXISTING HYDRANT -C- GAS LINE MARKINGS (IF SHOWN) .11.0 EXISTING k PROPOSED ELEVATIONS ('X' MARKS POINT) ^g-- EXISTING CONTOUR PROPOSED CONTOUR m EXISTING SEPTIC COVER I 5118A(, HEALTH AGENT APPROVAL R •` TOWN OF YARMOUTH Building Department Town Hall ,, Yarmouth, MA 02664 (508) 398-2231 exL261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-058 (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 14081 Net Owed: ($25.00) Application Date: 7/22/03 Issue Date: Expiration Date Applicant Name: James Ringer Comments: ? Location: 00021 PAWNEE RD remove existing deck and replace with 12 x 14 three season room over new 12 x 19 deck Owner's Name: EUGENE R GODIN Owner's Addres 00021 PAWNEE RD West Yarmout MA 02673 Owner's Telephone: (508) 862-0659 ZONING APPROVED jo_�o, 63 This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. NOTICE An as built plan must be submitted to this depaltm Uon prior tofoundation �rgon. � or any 70 Date Printed: 8/4/03 qwr " FIELD COPY MOM �3-00-636 -0 � 3-�05. 1 PERMIT v . DATE Z'm1 10. 2000 19 PERMIT NO.� APPLICANT - PAM MACD02iALD T OPRESS 18 L�fA2I ST_ SUIT H-1 �' ' 067195 (N0.) �BFEIJ, alp. 01581 (CONT R'S LICENSE) MBER OF PERMIT TO RFr-Pi.ACR 14 WINDOWS (_) STORY ll/l2itW:I l�tE DWEELLLIING UNITS (TYPE 0/ IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) 21 PAM= ROAD WFq YARMOi11iL MASS_ 02673 A-2 DISTRICT 5 . (N0.) •(STREET) , S BETWEEN AND oai I (CROSS STREET) - (CROSS STREET) - 24JA9 LOT 20 m SUBDIVISION LOT=R_In BLtVAP SIZE p BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION ,0 Z'TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) U. REPLACE U. 14 IMOWS �L ' REMARK57 AREA OR P VOLUME ESTIMATED COST $ 9,942.00 FEEMIT $ . 35.00 (CUBIC/SQUARE FEET) OWNER I-MGENE r.ODTN - BUILDING DEPT. ADDRESS 556 CEWMA1. ST_ 442 L F02•fINSTERB 1SASS. 02453 BY �•`�<! INSPECTION RECORD DATE NOTE PROGRESS CORRECTIONS AND REMARKS INSPECTOR • w r- • . LSD -_- C OV , s o� �0 M•r.wcn[[*5 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 02664-4492 TO: (508) 398-2231 x261 • Fax: (508) 398-2365 Off c-A Use Only Permit.No. Date A. b—" a, Permit Fee b.rV Deposit Rec'd. $ /0 66 to Net Due $ Planning Board Information Planrype Endorsement Date ording Date ePlan No. Assessors Department Information: t Map Lot Map Lot Old f New 1.4 Property Dimensions: Lot Area (so Frontage(ft) Lot Coverage Other This Section for Office Use Only Building Permit Number: Date Issued: ";_ Signature: Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property ass: W 1.2 ation: Zoning District Proposed Use 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required . Provided 1.4 Water Supply (M.G.L c. 40. S 54) Public Private 1.5 Flood Zone Inffo% n: Comments: ZoneBFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Re ^ r e, Pn c y�e, (} O q vt SS4 ►Ql(>(i 'y — P ' Name((print) Mailing Address .l O Signature Telephone 2.2 A orized Agent: �L- [[nrN i[ Sid r Ks u t aja C Db L-�� - N Mail/iing''Addres / F00 Signature Telephone Section 3 - Construction Services 3.1 d Construction Supervisor: f o„ / 1;1,oe D ana Id Not Applicable ❑ e, s o6, / S' /� S 12i! jgaf eo r — GG��ir� /� iG / 7 License Number G / resrN 8 QO -,:23.2 _ Expiration Ilate Signature Telephone 3.4istered me Improvement Contractor: C ; NotA plicable aLicense Number O / 4� — Q Z Ad p p 6O "730! --? P 3,1 Signature Telephone Expiration Date /0S-3 9- 15-99 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6) 1 1 , I 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 w.-.-.".�.. No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repalr(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: - n n .f r Gprtinn A - FstimntPd Construction Cristsi R q Z�--2 Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1 +2+3+4+5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner's Agt I, or Contractor Applies for Bu led When Permit Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , 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. Signature of Owner Date Section �7bb-- Owner/Authorized Agent Declaration I, L�; ice//�Ii%C��G��1rLd ' ►JrL' ew 1410M�4a� , sOwner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of 9.15.99 2of2 v ate TOWN OF YARMOUTH 1146ROUTE28 SOUTH YARNIOUTH DIASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ft-o/ X W ny &, Pc1- Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. & jg 013 IdFld6 Signature of Applicant Da Permit No. TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. : J 0 Job Location: Number Owner of Property. Cf ±, I 70h� Construction Supervisor:���' Address: Licensed Designee: (If other than Supervisor) Name r 2.15 Responsibility of each license holder: License No. Village License No. No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes � No ❑ If you have checked =, 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 Cha o a . Ge eral L ws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner wner's Agent Owner Agent , Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents Wed 011"affaaFirs 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Applicant information PieasePRiN'i'TedGhTa name location- cit%- phone N 0 1 am a homeowner performing all work myself. O 1 am a sole proprietor =ad have no one working in any capacity 0 1 am an employer pro%iding workers' compensation for my employees working on this job. O 1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below w ho haN e the following %%orkers' compensation polices: company name, address• cJD': phone a: insurance co. policy N Failure to secure coverage as required under Section 25A of&IGL 152 cam lead to the imposi000 of criminal penalties Ora One up to 514N.W Radial one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Out ofS100.00 a day against me. I aadentaad that s copy of this statement may be forwarded to the Oflice of Investigations of tht DIA for coverage verification. l do hereby r the paj and -A nalties ojperjury that the injormadon provided above is true and eorrem Sign 1/ ��� Date 0�3 / � 6 T Print name S. ✓Y% r /7/1/� /G� Phone 0 /roff If -,7& Official use only do not write in this arts to be completed by city or town official city or town: YARMODT13 _ O check if immediate response is required contact person: permitAlecuse 0 nBufldfag Department 1.1censiog Board 261 OSeleetmen's OOlee (508) 398-2231 eat. �Ht Department phone M; _ nOtherer Ironed 3,95 PJAI , - , Suprsted Affidavit for Home Improvement Contractor Permit Application For Omce Use only NAME OF CITY/TOWN Permit No Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc.142Areeutrcsthat the 'reconstruction. aIIeration. rrnovation. repair. modemtratton. ennversIon . m^rrn•ement. remnval. demr uonn. nrconstrucunn or an addition to anverecastm oWnerrucumed huddtn containing at least one but not more roan inur awrihce onus -.rr In structures Winch me amacent to sucn rtstaenee nr mmldtne be done ov rccuterca Contractors. wort Certain exceptions. along won gaper requirements. .. // f r r�� S Est. Type of Work:d��i�P/?���G f%t t L9- Address Owner Date of Permit Application: O I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law _Job under SI.000 _Building not owncr-occupied Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREUISTERED CONTRACTORS FOR APPLICABLE HOME IMPRO%,T.MENTWORK DO NOTHAVE ACCESS TO THE ARBITRATION PROGRAM OR G(:ARANTY FUND UNDER ,MGL c. 1.12A. Sicncd under penalties of perjury: I hcrcbv apply for a permit as the agent of the owner. (13 0 o 0r �- A( 4t4 ��0 66 Dat � tractor Namctj Rcgtstrauon No. OR: Notwithstanding the above notice. I hcrcbv apply for a permit as the owncr of the above property: Darc Owner Name cm /OVA-ccu-Weld`. HIGH PERFORMANCE WINDOW 6 DOOR SYSTEMS LaN FRC A An Arch Amen company "Equal Sight Line" Vinyl Double Hung National Fenestration ARGON FILL LAW E Rating Council wifti:V91M W, Mko WA I o jmr savings will depend on your specific climate, house and lifestyle re Information, call 1-800-782-6347 or visit NFRC's web site at frc.orgSolar Neat WinIsibletightragor a31041 Tr e.43 .31 Al 1 45 Marufact rer stipulates that these ratings corform to applicable IERC procedures for determining whole paxW energy performance. NFRC ratings are detearMed for a fixed set of emiro medal conditions and specific product sizes ✓�re SwAnananu�w.all� ..i'm BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 067195 Birthdate: 08/16/1952 Expires: 08/162001 Tr. no: 6529 91 Restricted To: 00 PAULS MACDONALD 25 MASON RD �.%... �i✓ DUDLEY, MA 01571 Administrator <L HOME IMPROVEMENT CONTRACTOR Nislriti0a: 120456 Eltpiritioo: 01/02/2002 Type: • Privile Corporitic BIL-RAY ALUM. SIDING CORP A L MACDONALD aoM STRATM �� ELMONi RD EIMDNT MY 11003 MAR- 6-00 MON 1:33 PM BIiRAYGROUP 0 i FAX NO. 4019431825 i P, 2 ACORD, CERTIFICATE OF LIABILITY INSURANCE 77.; rfLaou�R d ON YC� G,M=-r-=.7-M ISY NO EUGH SSUM —AS ,3 PION,TF UC= COUN'i'Rs ILviY INSDR.2vCE ?GEZ�CF, �1 7 2MRRICX ROAD HOL�1E-i. 7Hls c�ACATc oaE NOT AMME D, E ALTER THE CCIVE-UGE AFFORDED fly THE POUCIE SIIrTE 212 p�_r.—LTySLLE , NY 11701 NSURERS AF-rdRDiNG COVERAGE B=—R.a-s LUHIM SIDI;TG COEZD . 13 L-10 ATL.a.NTIC AVEYLrE R_CEF-OND HILL, NEiv' YORK 11419 COVERAGES INStti>r IL-CI� 'INSLt�1NCE . COI+p�,Ny' - IN=*=c'PLM'4IW I3iSD'RAT7E Caig-�uiy �---- 0 I.,_-• —_. ......�,-....,..�.,,,,.nauvouncuru'4xcyA60Yt-OHItitPOUCYPE■ZOOWOICATE0.NTTw pr{Y RECuQRE•viE'!T• Tahf OR CONDI770N OF /NY CONTRACT OR OTH01 DQcL'Ms T wrni RF--FEc • TO V441C I THIS C� CArc MAy 8E 1 aaue AC.-; ,AT-c L2XTSSHOWN MAY RAVE a�u aarMu O�G�Dn n�i. c5 ��E� TO '�L THE 7FFhF8 c�cC�Orrs :NO C OxomON: . _. _. .. i'Y%Gp q+�u•Gt ., __- _ ►al1C7 HU1.•CCS ... .... AUtT �.e-•I7VL ..r J•aOaY•D.79LAT1aM LDArrm r�JJ.ZJJ. U.L.a.1TT •_ _. _.. _.. G1L_Y occwuLPlJca ! 1 0 g COMSIE9G�i•GZ'IL lL L1ARC[iY AOG ® CJPI CJJMS MC- --••�.�•,• p•••• IGL0068S6 ::_._-... _.. ..___ •, ..05/14/99.:.05/14/00.P�aRJJ.LaavaLJURY •• •• h/0 R.P u••r r•• ".•L a •. a1.00 _ GEWULAacnerA-M a2 00 I POLJCf I 1 rim laG iR00UC4. ©LIP•CPJVGSI .. r OO '. ..'.._ _. '• ,•. .. ♦LrTOP.l.n, r LLAs6ZT... AUTO -.... •S:'+r .,' ' CMMo 9MGU uhar .LLL CIYPIPJ IufT03• SGYOL!•.�' _ _ _ ._. ______ zaaa.Y aut1RY ! - Mtks=.L JT03 ..... . Mo.-CwWfII .�i:iaC' .. _ •. i .. -- • •+ eaaarMJTJ" a 0%1wJ..1 1 PROPEM aAhu= ! ?v •ml.•d i I i' LJJ.CiLtTY JWY I.LTO - AIM a -f. aL SC QLT e arMel l7VM G�CC a / LLCa Mr. �aa i Lac^-_s tuaurr Cc'= Q W X•-Z MAC ucv ocuruxc 1 73' , 0 0 A=eurE s3 , 0 0 ( B BINDER 05/14/99: 105/14/00 I t cloucniy-s CII51697 l a M6r•MT1cP4 ! C WOFM'-0 curAND H'P"�L1i°m HINDER r 05/1 4/99 I 05/14/001 b "'t�ypu LL El=1. nZM ssoo-f C u..a_+ea-eALyM=al l500 , ( CII51498 • [L L1ISF.LS-PC= umrr I a5 00 , ( a iS/C. DID=ST�T_'1'= H3%7ER z ' I Oo/01/98ILZ7rIL=L Ci251499 Ca:.,TCFL-D .a�...'..=3PL7CHGaPs,•L..—ax���:TAv�dc�1��'�a;L,tic•.Esr'�^^"-==:r.7�.�1Lr.CYttnlc: , TE HG CA.NC�? :71074 W)0 if- 5-7-1 oS W OF �q9 V oar 'yo W1TKw�5� Oy„s O M APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) TOWN OF YARMO T, I. By o 0� Fee: $ PERMIT NO. �'OU—DI2 Date I T,3 19 L to _ Building Owner's AT. Location Name EJ �E Gor -) \ICY ry, , EM . oZb�3 Type of Occupancy��F New, Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ Cn S �� W fA Y U Z X ¢ N ` W W 0: O V m� y . y ..t-.+.a .. .. Z .� Q: ' Z O r= n , `. -}sX :-. vr• Tip .-.� r:.; u) cc ict Wm O Z. 0 OZ LU ~ r A C3 WFdr W r cc WQO M II— Lu>U) Z F- W '4 Q� fW" > rN, m Z LL O Z W O N= _ 'o a= 3 0 g °' ¢> o a o uu.. SUB-BSMT. BASEMENT,)t )� 1ST FLOOR . 2ND FLO R 7� 3RD FLOO n . � Vi ,� ,- (PRINT OR TYPE) K •heck One: Installing QCo�mppanny� Name F F:Wjm W �irY,��](,(7 �- rhr ..❑ CorY.p; i��r rd rtrr Address t MI >G OS Partnership — cTll \i_ ii ;%(` i�2(�(- f r-irbVCompany Business TelephoneeT—� u . -] -7 % - !j Name of Licensed Plumber or Gasfitter F L 1110�l]Wl) .11L INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ .,No If you have checked yes, please indicate the type of coverage by checking the appr�p iaie box. A liability insurance policy ❑ Other type of Indemnity ❑- r 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. Check One: jOwner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Licensed Plumber or Gasfitter •, —, rr a r, License Number TYPE LICENSE: 0 Plumber ❑ Gasfitter Amaster ❑ Joumeyman r�fv*'Y,I ONE & TWO FAMILY ONLY - BUILDING PERMIT 1j rC� APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING p� r' I`y frncu oflatuuuth Building Ucpartmcttt 3 1 /� 1 13(i Ruuu _'8 1'aruttrutlt, \1:111`Lliti 3!14 ;,C,,: ;ti '1•rl: (50S) :198-2231 x261 • Pax: (508) 398-0836 Otf U — my 1lanninq Board Information Assessors Department Information: / o Permit No. �/ e � �� a "ra Lot �,\><\�_��)//� Permit Fee S%(�( - ors me Date D ��l Recor mq Date New Deposit Rec'd. $ A-N V Dat Plan No.1.4 Property Dimensions: M Net Due $ Other Lot Area (sq frontage lift) Lot Coverage This Section for Office Use Only Building Permi ber. T Date Issued: - Z 9 Certificate of Occupancy Signature: Is is not required Building Official Date Section 1 - Silo Information I Use Group: R•4 Type: 5•B 1.1 Prc=rtv Address: 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards _ _ Rear Yard MM Required V Provided Required Provided Provided 1.4 Water Supply (M.G.L. c. 40. S 54) i 1.5 Flood Zone Information: Comments: Public Private zone: BFE: APR 2.9 ZOO RuILDINGIDEPT Section 2 - Property Ownership/Authorized Agent 1 Owner of``��,eco''r.`d:- By ' Mailing Address Na/� �rirtt) [% , /' Signature Telephone Au orii ge t• 1 — _ Name prinC _ D Ltd s� tc�0 Z43� atur Telephone Fax , — —^— r �) Section 3 - Construction Services _ l� •� Licensed stru tto :pervisor: JW+ � Not A plicablo Q License Number Addr r Expir to lure Telephone �M 3.2 Registered Home Improvement Contractor: Company Flar a Not Applicable License Number rAdJre \� Expiration qate'� y lure �% Telephone 16 1 uvtH Sect(an�t=Workeis'Co tton^ftfisuPanct3Atfldavirfdf3L.`c?�:5275fX( 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 ... V.. No .......... Stictlo : ��.D .:. h oE:Fm aesflfifo ',(check�e►tL : ate . New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ - Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed or r d :Section&.-Estimated:Cortstn�ctlor fiats; Item Estimated Cost (Dollars) to be Check Below completed by permit applicant 1. Building ❑ Conservation -Commission Filing 2. Electrical (if applicabl9) 3. Plumbing / Gas 4. Mechanical (HVAC) ❑ Old Kings Highway & Historical 5. Fire Protection Commission approval B. Total a (1 + 2 + 3 + 4 + 5) (d applicable) 7. Total Square Ft. (new bmw a edM=) wfw y, Oewnec s ll"'en arltrectar Aglresfo BufdIng, it g; as owner of the subject property hereby authorize to act on my behalf, In all matters relative td work authorized by this building permit application. Signature of Owner Date Section7b-t :Owner/A(Ahoitreit.A enttfecfaietion as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Q� Print name / a S1*0 of nerV date 9- r5-99 2 of 2 .1 1. ., ... 3r TOWN OF YARMOUTH Wispy BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT; Job Location: Owner of Pro Construction Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.5 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.5 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a ent liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yz, please indicate the type coverage by checking the appropriate box. A liability Insurance policy^ Un Other type of indemnity ❑ Bond ❑ OWNER'S INPRANCE WAI R: I am aware that the licensee does not have the Insurance coverage required by Chapter 15 f the Ma : G Laws, and that my signature on this permit application waives this requirement. G. Check one - Age (r/y Sin f ra f nwna r n s °ant Owner ❑nst' i Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pro -existing owner-oocupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Cyr Address of Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties ofpedury: I hereby apply for a I Ddt e OR: as the agent of the owner: ICP gistration No. ) Dori q() Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name BUILDING TOWN OF Y A R M O U T H ELEGrRICAI GAS 1146ROUTE28 SOLMiYARMOUTH . MASSACHUSEM02664.4451 PLUMBING Telephone (508) 898-2251, Ext. 261 — Fax (508) 898-2865 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and'780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at \ ° ) 0 0 tL., Work Address is to be disposed of at the following location. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Permit No. Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT /� nn it 0-%-S ( a- ! Lev � p C� f,.0- oe�( OWN THE PROPERTY LOCATED AT IN Loc,�v,--JL , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: APPLICANT'S TELEPHONE: RESPONSIBLE OFFICER: 1645 Newtown Rd., Cotuit, MA 02635 508428-9518 RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: The Commonwealth of Massachusetts Departinei.it of Industrial Accidents Office of Investigations 600 Washiiigton Street Boston, BiA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers City/State/Zip Phone.#: �<��-ya�•gs�� . e on an employer? Check the appropriate box: 1I am a employer withCK4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insurance.$ required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and its' officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No -workers'-. comp. insurance reguired.l Type of project (required):. 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I LEI Plumbing repairs or additions 12.❑ Roof repairs __ 13.❑ Other_ - •Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infomtution. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 Policy # or Self -ins. Lic. #:KM,�� (vQ C-) Expiration Date: Job Site Address&L�- aV Wwn A. City/State/Zip. • Attach a copy of the workers' compensation policy declaration page (showing the policy nu mbe and expiration date). Failure. to sectue coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ' fine up to S 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 30olator. Be advised that a copy of this statement may be forwarded to the Office of use City or Town: area, or town official. Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person:- Phone #• SgLL :all .Inurn.iumu. t OLOUBMLL :u iitrJ�JY3 �rsr,� r/ b E99Z0 W 'HOIMONb S AVM lUGHS 9 NOS:MIS69 AWD y 00 '01 PaPulsaU . Ob9trL SO:asua313 . asuaol-j toslAjadns uogonilsuo0 �liar.pnrl� pill. cun!1r!nl,i21 Vu!p!mfj •lo paroS — - ilajrS ),,glad jar 1tt?ttil inn -- ainpu94�, 0411 !l0A N J01ttj1slulwpy S£9Z0VW'llmn '; \\ 'PU u01M9N S99L �rr gVisno AUdp - 5c 3W0H IZZIdvo 60[ZO'VW 'uolsog FueOluawal�[ t0£t W-d astt!d uolingysy au0 NOU£Z 9 sub sp.tupuulS Puu suolluln22u 2ulpllna jo piuofl OVLOOL 't�o!7� lsteea ...„-..,:.,,.,,:.,...:olu�nlarPunoJJl `a1uP•uo1ln�jdxaayla�01aq.... u..„...U0l0VU1N001N3W3A0LIdWl3W0H�:.. (lvo esn !npintpul joj p!luA u0pttJls!2a.1 Jo asu2313 spisparls putt s00!tttin23g 2ulp!!nII j0 pig El 0 0 v 0 r •' ACORN- CERTIFICATE OF LIABILITY INSURANCE DDNYYY) PRODUCER Rogers & Gray Insurance Agency /30/M/ 12/30/OS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED CapHome Improvement, Inc. INsuRERA: NGM Insurance Company Capful Enterprises, Inc. INSURERB: American Home Assurance 1645 Newtown Road INSURER C: Cotuit, MA 02635 1INSIRERO` WSURERE COVFRAGFS THE POLICIES OF INSURANCE USED BELOW MY = BEEN ISSUED TO THE NAMED ABOVE FOR THE POLICY PERIOD INDICATED. ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER (NSURED DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY BE IS USUEED OR DWG MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS.SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A N R TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OOCCUR POLICY NUMBER MPB1075H POLICY EFFEATE OCTIVE 06/08/08 POLrfn AICY EXPIRATION XTE IRATION DtM 06/08/09 LIMBS EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREmisE MED EXP (Any one Person fSO OOO 15000 PERSONAL S ADV INJURY f1 000 000 UENERAL AGGREGATE $2000000 ' GENL AGGREGATE LIMIT APPLIES PER: POLICY PRO. LOC JECT PRODUCTS . COMP/OP AGG $2 OOO O00 A AUTOMOBILE LIABILITY A'NYAUTO M1 M28044 06/08/08 06/08/09 COMBINED SINGLE LIMIT (Ea accident) $500,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (P" P—) f X HIRED AUTOS ..._...,. __.__ _. _ .. .. ... ..,....,.... _._... _.. .. X NON-0WNEDAUTOS BO ILa YINJURY(Pw f X Drive Other Car PROPERTYDAMAGE (PW acddw t) f GARAGE LIABILITY ANYAUTO _ _ _ _..... _ . . AUro ONLY- EA ACCIDENT f A EXCESSIUMaRELLA LIABILITY X OCCUR CLAIMS MADE CUB1076H 96/08/08 06/08/09 OTHER THAN EA ACC AUTO ONLY: AGO EACH OCCURRENCE f f $5 000 000 AGGREGATE fS 000 000 f DEDUCTIBLE X RETENTION f 10000 Sf B WORKERS COMPENSATION AND EMPLOYERS! LIABILITY WC6957000 12/25/08 12/25109 X IOC STATU OTM E.L. EACH ACCIDENT $500000 ANY PROPRIETORIPARTNERIEXECUTNE IAI OFFICEREMBER EXCLUDED) E.L. DISEASE. EA EMPLOYEE f5000OO V yea, deaa3e under PE CIAL PROVISIONS bebw OTHER E.L DISEASE • POLICY LIMB IS500.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry CFRTIFICATF WnI r1FR Town of Yarmouth 1146 Main Street, Route 28 South Yarmouth, MA 02664 ACORD 25 (2001108)1 of 2 #S40671/M40647 ) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1EREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SD SHALL NO 0SUGATION OR LIABILITY OF ANY KIND UPON THE W SURER, ITS AGENTS OR KIN o ACORD CORPORATION 1988 w TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 e4261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: Applicant Name: Applicant Phone: Building Location: T-09-310 Gary Gustafson 5084289518 0021 PAWNEE RD Owner's Name: GODIN, EUGENE R Owner's Addres 0021 PAWNEE RD West Yarmouth MA 02673 Owner's Telephone: (508) 862-0659 REVIEWED BY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 1187 Net Owed: ($25.00) Application Date: 4/7/2009 Issue Date: Expiration Date Comments: Map/Lot: 024.89 remodel existing bathroom, add pocket door 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 4/8/2009 TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF To be completed by Applicant: ,, ` Building Site Location: 2 1cr--»ue- � 14J� �►�. ��.r.�,�.. Map No.:, 1219@1 E0 APR n 2 2009 Proposed Improvement: &1-( e_I , 70 CIL6-f - AyOr Gu Address: IC445' 6-cQ ('t,+.., . + **Ifyou would like e-mail notification of sign off; please provide e-mail address: Owner N DEPT. Lot No.: Tel. No.: S ° w Date Filed: Arai a- Z " Owner Address:_ ?-I (�c," Y` L'• cam-. .i' Owner Tel. No.: SO8 Fr6 2-a:5(.7 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; L��2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: DATE: r tz I r rw/ /0 C K- r,.,. - S��w. �' gAlvy' t'' - j jERA Ia11L,'A&V AI oT ; ID I 2- �X�f �/E#•L1Eij•ni _ . r I _ +' TOtORi ARMOU i H t - 1 ZONINGCCD�CANCE. ERRONS DO NOT RELIEVE THE APPLICANT FMM THE RESPONSIBILITY OF 'AS BUILT' jf!' .. r / - - ? _ COMPLIANCE 10 A FILE C fj ,�•'",.�f I BUILDING OFFICIAL i iView— ���-- �ivc c;000e� G -A e7ve � oo` 7 Qx ,s•F-� �� 1 4.1 .1 6 d� 4a r repIl2ei^g ek sf-5 d)cur OF y / TOWN OF YARMOUTH � l MAY 2 7 2009 BUILDING DEPT APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ pyV PERMIT NO. Date 6— —,27- 20� Building 1 4 Owner's !�� 9z/Iw v �o4/n AT: Location 2/ l�Gy�%�—P ��/ Name New ❑ Plans Submitted Renovation 9 Yes ❑ No ❑ Type of Occupancy Replacement LZd z N p Y Fa- ur U) J U) U Q Z � (7 y x 0: I// zl to W fA N 2 0 U W Y 9 a LL Z O. Z - j U Z W Q N Q N W ? 0 Q N Z Q 4 a 0 U. 717,310 9 W x Q= 3 3 0 Z x 3 Y a o t' Q Y W U. Y W a°Oa 3x yr gaoa0-1a 3 0 3 0 Q.Q. x N U. O o Q x m SUB•BSMT. BASEMENT 1ST FLOOR I I I 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name �_/�.�is �.a42r ❑ Corp. Address ❑ Partnership ® Firm/Company Business Telephone Name of Licensed Plumber ZZ, e"-4 6.¢Gw INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes IS- No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy C4 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature or Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ irli+ r`- ;/ - Signature of Liccwd Plumber License Number Type: Master ® Journeyman 0 Ce' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING \, (Print or Type) �.� W Af � 101 �f r I ,Mass. Date_[Zj 30 20 10 Permit N Building Location 2•(.BAWN E�� PD14rD Owner's Name �E t�tJD( IJ __Owner TeIH .XJV' �2• �� ~' Type of Occupancy ❑ Renovation ,..., _ ..- .. ._;� _.' i p - Replacement . Plan Submitted. Yes ❑ No ❑ FIXTURES . . Business Telephone #� ;11 z v Y / 7 746 Name of Licensed Plumber or Gas Fitter Check one: Certificate "eOrporation ❑ Partnership 13 INSURANCE COVERAGE: I have a curr`e liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes. please icate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity 0 Bond D 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. Agent D Signature of Owner or Owner's Agent hereby certify that all of the details and Information I have submitted (or entered) I above appli on are we an ccu to to nowledge and that all plumbing work and installations performed under the permit ad for application will phan ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene I s. By Type of Ucense: • -Plumber Signature of Ucensed Plumber or Gas Fitter Title -Gas fitter -4Aasler Ucense Number Cltyrrown • -Journeyman APPROVED (OFFICE USE ONLY) my 4116MIS SlipGen- Portal Home P.:1116VA Town of Yarmouth V=92 Template [Building Dept] ■ Slipsheet Identifier [sg239631 Document Category Building Permits Map -Block Number 024.89 Street Number 0021 Street Name PAWNEE RD Department Building Parcel ID 2705 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-04-16 - 09:38 tMJAasedche12GlpGuV 1/1