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BP-90746 Permit No. BP-90746 BUILDING PERMIT GIS#: 3296.00 Commonwealth of Massachusetts Map: 0066 TOWN OF DARTMOUTH Lot: 0002 400 Slocum Road,Dartmouth,MA 02747 Sub-Lot: 0082 Phone;(508)910-1820 • Fax:(508).910-1838 Category: SOLAR PANELS Project# JS-2019-001365 PER 4'IISSION IS IIFRE131 GRANTED TO Est.Cost: $32500.00 Contractor: License: Phone It: Fee: $75.00 RYAN M POTTER CS-092059 (774)992-4801 Const.Class: - YII-183476 Use Group: R3 Engineer' License''. Phone#; Lot Size(sq.ft.) 45124 Zoning: SRB Applicant Prone#:;' Aquifer Zone: N/A GREEN SEAL ENVIROMENTAL INC - (774)992-4801 Flood Zone: ZONE X OWNER: New Const.: N/A FERNANDES ALEXANDR": Alt.Const: N/A Date Typed: 11-27-2018 DATE ISSUED: - • TO PERFORM THE FOLLOWING WORK: Install a thirty five panel photovoltaic array on existing rooftop - 10.85 KW Approved/Issued By: Ear .,Ject Location: 3 GOLDFINCH DR DAVID BRUNETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 9'"Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion,final inspection is required. ir I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zonin ermi/ t. Signature of Owner/Agent: "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth ill MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: / Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET TOWN OF DARTMOUTH -,UILDING DEPARTMENT RECEIPT 9 07�1, - PHONE: 508• 1820 FAX: 508.910=1838 ' Name:)- ( td' k)Pzope IfyOwner: - of /L S i-, , Date; ( / ( 1C--b Job Location: ..J O.>: / + i ,( i, ' )r Map: /G'tO Lot: c� -„'3 G_ Description _General Ledger#'s Ref. # Amount Building & Building / 13NMD1 0 00-44105 fr- d` Electrical ?��010 -44106 Plumbing& Gas 07,®a 01 t:+0-44107 i. Trench Safety gd * 0-44129 NO Other Department Reven HinOlN o 000-42 BE ErIMENTS White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS RESIDENTIAL ❑ Phased Approval(R106.3.3) $25.00 APPLICATION FEE IS NON RE-FUNDABLE&NON-TRANSFERABLE DAT ��E'sIVED la`s°=v�c', DARTMOUTH BUILDING DEPARTMENT ,ola.x s, 400 Slocum Road, P.O. Box79399 `I I mitt Dartmouth, MA 02747 ,.!I_A r \ :it,,)- Phone: 508-910-1820 Fax: 508-910-1838 e6 I www.town.dartmouth.ma.us _-_. APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE R TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMIT NUMBS : 6 ///� DATE ISSUED: Q SIGNATURE: cL/1/�t Q `mil DATE: i%— ia(� Building Commissioner/Inspector of Buildings Zoning District: Sf Proposed Use: Zone: 131-0 B ❑A 0 V Aquifer Zone: THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: ❑Board of 0 Board of 0 Cons. 0 Demo 0 DPW 0 Elec. 0 Energy Report Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up* ❑Fire 0 Gas 0 Planning 0 Sewer Card 0 Water Card 0 Zoning 0 Other Chief Cut Off Board Cut Off Cut Off 'REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL i Board of Health: Signature: Date: Conservation Commission: Signature: Date: i Other: Signature: Date: Signature: Date: Signature: Date: Brief description of work being performed: /� _` SECTION 1 -SITE INFORMATION v v 1.1 Property Address: v 1 C.-R yn G I'1 D r 1.2 Assessorsap& Lot Number: Lot Area(sf.) Frontage Map Cot (o Lot a - g -- Required Provided Front Yard 1.3 Historical District 0 Yes 0 No Side Yard Rear Yard Year Built Y 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal 0 Private Well 0 Municipal 0 On Site Disposal System 0 Yes 0 No Date: c Revised 10/11 El CONSTRUCTION PLANS 0 SITE PLAN 0 ENERGY REPORT RESIDENTIAL SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner Record: xccndre L ernctno es 3 Go)cinoh 0%t. 01-7-119 iti-2-1F Name(print) Contact Address por.hiyi G, kk Phone Number 2.2 Authorized Agent: R ! Mick 1� hh �V1 .1/4/an c I�r Ma Col lK-E-+ 1 -77H-°192 4S-01 Name(print) Contact Address Phone Number SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor/Specialty License: Ryan eek4C.Ar License Number: C-S —C)C 2_(YJC:1 Company Name/Contractor Name:Green sect I Envi aU V1 rnrX1" Q Address:1 MC.i s. 'C) lienn 11 (_Yl M a't of fo\Se-`'i- MA— Expiration Date: ) 1/ I 1 /20 Signature: 1/z44M 'b Teiephone:q 4.Clg244r8-01 3.2 HomeownertExemptio -One&Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section;provides that if a Homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. For the purposes of this section only,a"Homeowner is defined as follows: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or Iwo family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who Constructs more than one home in a two-year period shall not be considered a Homeowner. If you are applying under this section sign below: Signature: SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152§25) Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure toprovide this afffdav twill result in the denial of the issuance of the building permit. Signed Affidavit Attached: IS4es 0 No SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable) ❑ Deck 0 Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace ❑ Woodstove/Pellet Stove ❑ New Construction' 0 Accessory Bldg. 0 Roofing/Siding tether (Energy report required) (Shed/Garage) (Specify below)� ❑Addition 0 Replacement window/door 0 Demolition (Energy report required) No. of windows Doors (Specify below) 'If new construction,please complete the following: Single Family: No. of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No.of Baths Unit 1 No of Bedrooms Unit 2 No. of Baths Unit 2 ❑ Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): 0 Air conditioning-(separate unit) ❑None of the above to be provided 0 Hot Water: Gas Electric Fuel Oil Other DocuSign Envelope ID:E2370A20-2408-4601-83B4-2AD3BD454A72 SECTION 6-ESTIMATED CONSTRUCTION COST Item Estimated Cost($)to be completed by permit applicant 1. Building ( 2. Electrical Si I , 000 3. Plumbing 4. Mechanical(HVAC) 5. Total=(1 +2+3+4) -4 :3'2. I 'iuV SECTION 7A-OWNER AUTHORIZATION (to be completed when owner's agent or contractor applies for building permit) (Plea 4ezarVdre L Fernandes ,as Owner of the subject property hereby authorize Ryan Potter/ GSE to act on my behalf,in all matters relative to work authorized by this building permit application. e—Docusigued by: &)aztV'_t, L' Ft/tutu-Ls 11/20/2018 11:16:55 AM EST SinratY PACci e... Date SECTION 7B-OWNER/AUTHORIZED AGENT DECLARATION I, Ni an c +-4cAr ,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 in the pains penalties f perjury. • r ure of Owner/ u orized Agent Date SECTION 8-OFFICE/INSPECTOR'S NOTES — -- Less Application Fee:$25.00 Remaining Balance: $ Total Permit Fee:$ 7 S Other$Amount$ Gross Area-New Construction total sq.8. Gross Area-Alteration total sq.ft. ,e jJ ,. Permit Issued to: 1�`Z��J 'L et,' 3 6 �/� �72X — ,Y/il'� )12-G., __ sSz/ rpZ /4 Ck/ SECTION 8-ADDITIONAL COMMENTS/SKETCHES IT" `11///�V Permit No. BP-90746 Project Location: 3 GOLDFINCH DR Commonwe � r. sachusetts TO v , d® ntl r r R i 4 UTH rt 0 i sei i"g er. �i • it i;-• lon : m : go 40k, • • _ r a g - Contra* t e. p� s° ",'one#: RYAN "� : R 059 '°- ;; .4)292-1136 s s� t. . 76 40) rl . a Architect + ea Phone#: € �s Applicant: ®,e� ��'a` Phone •#: GREEN SEAL r4P:O�IE 1jfiC sp+*. (774)992-4801 OWNER: m' i FERNANDESALEXA ' + ' DATE ISSUED: r TO PERFORM THE FOLLOWING WORK: Install a thirty five panel photovoltaic array on existing rooftop - 10.85 KW I- _DATE ( _�4G. .�l -- - _ --- --- TYRE OF-4^'S➢F�'TT.O!`! &-RE_vFARKS. _ r*!IT?Y2 1-- / e_ 3e,b 0/4,771 e. /t 4 ri 41D/7441 b /t- From:508 888 1506 77/27/2018 09:49 #005 P.007/001 ..--...... - .,_._. COMMONWEALTH OF ASSACHUSETTS .,.1°). ( q.(g5P4a1 e • POE t l ®: Commonwealth of Massachusetts f-•-.. OF -MAP ' Division of Professional L'censure ELECTRICIANS Board of Building Regulations an. tandards ISSUES THE FOLLOWING LICENSE AS A Const`,I,lcR6rltooervi.or REG JOURNEYMAN ELECTRICIAN 11l RYAN POTTER CS-092059 Fatytr 11/11/2020'\ 21 ACUSHNETR0 1 MATTAPOISETT,MA 02739.1561 RYAN M POT:kR ' 7 MELISSA Af�jgI LN " - MATTAPOISETT4�A 027`48 \lc- :. 12866 07g1Q019 ,�ZW� �.-y 89667 :/\l'.1:1, `. 11-iM.12'2.1`i'-_U'YFLR:1•gl4'._ a' -ifisl Commissioner CAL Fir /,`_\0ieee of Conwmer ARaiuA 11e9W�0on COM7JIONaitt • USE7TS HOME IMPROVEMENT R tr 1•'Tf:� :-feF l'1='�' a 8 �� 1�j?1;:�supple • �9 J f TMI PE.- Card .. ELECTRICIANS ` 183�7fi 0 10/19/2019 ISSUES THE FOLLWNWO LICEN9F AS A REGLgTERED MASTER ELECTRICIAN GREEN SEAL ENVIROME AL.MICA RYAN M POTTER RYAN POTTER /\ 21 ACUSHNET RD 114 STATE a BLDGACt4. B U ' MA7TAPOISETT•MA 0 2 7 38-16 81 SAOAMORE BEACH.MA 02502 undersecretary 2t647 07/31/2019 89562 =.: S'I'A'i'F()1 1tfiODE 1SI,AND The Commonwealth of Massachusetts �_ Department of Industrial Accidents 1 - ""r Office of Investigations ° N__- 1 Congress Street, Suite 100 -'0 Boston,MA 02114-2017 �, _- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Green Seal Environmental Address: 114 State Rd B City/State/Zip:Sagamore Beach, MA 02562 Phone#:508-888-6034 Are you an employer? Check the appropriate box: Type of project(required): 1.❑l I am a employer with 20 4. ❑ I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance) 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no SOLAR employees. [No workers' 13.❑■ Other comp. insurance required.] *My 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 then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Atlantic Charter Insurance Company Policy#or Self-ins. Lic. #:WCV01062905 Expiration Date:3/16/19 Job Site Address: 3 Goldfinch Dr City/State/Zip: Dartmouth, MA 02747 Attach a copy of the workers' cornia'ti Iiipo & ,Qectpt;ti n page(showing the policy number and expiration date). Failure to secure coverage as require rdcti 4 to �� L c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year enr, s e as evil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pai and penal 'es of perjury that the information provided above is true and correct Signature: ne �� Date: 11/16/18 Phon088886034 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC OR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 11/16/2018 • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00777-DD9 goiter Starkweather&Shepley Insurance Corp of MA r1/8.P1o.Ed): TMic.No.: PO Box 9 Providence,idence,RI 02901-0549 '�6kE$B, INSURERS)AFFORDING COVERAGE NAIC INSURER A: Atlantic Charter Insurance Company VDAC 44326 INSURED _INSURER B� Green Seal Environmental,Inc. ---- - !RORER C: 114 B State Road INaiLRER D Sagamore Beach,MA 02562 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDOLLD BYEE PAID CLAIMS. ILTR TYPE OF INSURANCE F Bp POLICY NUMBER (MM/DD/YYVYA (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MEDEXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GEM_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 7pOLICY f UECT yoc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY — ROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ S l'egfaRNIPCl$EA X I TV8RIaas A p I Rr ummearecunveIN/A WCV01062905 3/16/2018 3/16/2019 E.L EACH ACCIDENT S 1,000,000.00 I('Maentleataoscry�lpn�,N,,Nd)er Policy Coverage State: MA E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 DgSsCFIYI(ONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Project Location:3 Goldfinch Dr.,N.Dartmouth,MA 02747. CERTIFICATE HOLDER - CANCELLATION Town of Dartmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 400 Slocum Road BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Dartmouth,MA 02747 WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.jL//�I AUTHORIZED REPRESENTATIVE I�\���`/W"r 'r ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY n & anSOCZATESs =au 21 HIGHLAND AVENUE NEEDHAM, MA 02494 TEL: (781) 449-8200 E-MAIL: RICHARD@RAVASSOC.COM November 19, 2018 Tow of Dartmouth Building Department 400 Slocum Rd, North Dartmouth,MA 02747 Attn: Paul Murphy Director of Inspectional Services Re: Solar Energy Roof installation FILE' COPY 3 Goldftnch Drive, Dartmouth, Massachusetts Dear Mr. Murphy, Please be advised that I, Richard A. Volkin,a Registered Professional Engineer, Commonwealth of Massachusetts,made an analysis of the wood framed roof at 3 Goldfinch Drive,Dartmouth, Massachusetts for the structural capacity to install a roof- mounted solar energy system, including the minimum design loads set forth in ASCE 7- 10,taking in to account the existing dead loads, snow loads as prescribed by the 9`h addition of 780 CMR Massachusetts Building Code, live load, 139 MPH wind load and the proposed dead loads caused by the proposed installation of the Solar Modules and system. Based upon the evaluation, I hereby certified that the roof structure located at 3 Goldfinch Drive, Dartmouth, Massachusetts,with the solar load not exceed 3.5 pounds per square foot,will meet and exceed the design conditions of 780 CMR Massachusetts Building Code 9th edition, International Residential Code (IRC)with Amendments, International Existing Building Code(IEBC), and 780 CMR 7th edition,under the present earliest code requirements, we are required to consider given when the roof was constructed. Respectfully submitted, a>::QccV1 or'}" 1% RAV&ASSOCIATES 3,i. "'IA 7, ' o RICHARD g A. < o v / OI KIN co,. it '4 No.222$2�0 �4 I:.'l'P'7 C15 E� �$ s:° Richard A. 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