HomeMy WebLinkAbout0021 AMANDA COURT �l �J rya n cJ �. L off►'-�=�
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SAW Town of Barnstable Building
t Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept
M BAMSrABLK
*'"S• Posted Until Final, Inspection Has Been Made.
tasv �� Permit
µ Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.
Permit No. B-19-1422 Applicant Name: MICHAEL DELUGA DBA VILLAGE CRAFT BUILDING & Approvals
REMODELING
Structure
Date Issued: 05/20/2019 Current Use: Foundation:
Permit Type: Building-Addition/Alteration - Residential Expiration Date: 11/20/2019
Sheathing:
Location: 21 AMANDA COURT,COTUIT Map/Lot: 055-031 —---Zoning District: RF
Framing: 1 ;
Owner on Record: RONDINONE, RALPH J 1R& MELISSA W TRS Contractor Name: MICHAEL DELUGA
2
Address: 104 BEAMAN ROAD __ Contractor License: CS-050234
Chimney:
STERLING, MA 01564 Est. Project Cost: $40,000.00
Description: BUILD A 9'X40'COVERED PORCH AND REBUILD REAR SUNDECK ri Permit Fee: $314.00 Insulation:
20X20
Fee Paid: $314.00 Final:
Project Review Req: Date:` 5/20/2019
—� Plumbing/Gas
Rough Plumbing:
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months aftePR RHO iCia
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same. l f'
!I I Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: f' Service:
1.Foundation or Footing
2.Sheathing Inspection -�r Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Building plans are to be available on site Fire Department
Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Applicafionxber... .............
i
• BAPZ&TAM= Pe=t Fee.................. ......O6er Fee........................
NASEL
03
TotalFcx Paid................................................._................
- TOWN OF BARNSTABLE Pew Approval by..................._...........
.on........................_
BUILDING PERMIT /
Map........4 ..........
.............. . Pm�xl. /�
.......t.d. 3�[.....................
i APPLICATION
Section 1= Owner's Information and Project Location
Project Address h Village li
J a
i
Owners Name
Owners Legal Address'
City S7�,eW& State 9 zip
vg/
f Owners Cell# Ismail
Section 2—Use of Structure -
Use Gro ❑ Commercial Structure over 35,000 cubic feet
Group.
❑ Commercial Structure under 35,000 cubic feet
❑ Single/Two Family Dwelling
Section 3 —Type of Permit
Nay Construction ❑ Move/Relocate ❑ Accessory Structure ❑ hange of
Demo/ entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑
El
Rebwl• d ❑ Deck Apartment ❑ SprWerlptemk®,
❑ Addition ❑ Retaining wall ❑ Solar
❑ Pool ❑ Insulation
El Renovation I
Other—Specify
Section 4 -'Work Desc 'ption
b
r
T act nndqtm&-2J9=1 9
Application Nurn.ber....................................................
Section 5—Detail
Cost of Proposed Contraction ,9 A Square Footage of Project 6�
Age of Structure 12 Dig Safe Number
# Of Bedrooms Existing Total#Of Bedrooms(proposed)
110 NIPIrVEd Zone Compliance Method 0 IYU Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
Wince ❑ Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
Water Supply Public ❑ Private
Sewage Disposal ❑ Municipal Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
j A
Debris Disposal Facility: 6I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone
Flood Zone:Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq.Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last undated:2J92019
®Boise Cascade Triple 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP PASSED
FB01 (Floor Beam)
BC CALL®Member Report Dry 12 spans I No cant. May 20,2019 08:38:13
Build 7192
Job name: Rondinone Residence File name: F601
Address: 21 Amanda Ct Description:Porch Beam
City, State, Zip: Cotuit,MA Specifier:
Builder: Designer: William Campbell
Code reports: ESR-1040 Company:
2
1
0
09-00-00 12-06-00
B1 B2 B3
Total Horizontal Product Length=21-06-00
Reaction Summary (Down / Uplift) (lbs)
Bearing Live Dead Snow Wind Roof Live
B1, 2-3/4" 618/180 392/0
B2, 5-1/2" 2002/0 1794/0
B3, 5-1/2" 761 /51 644/0
Load Summary Live Dead Snow Wind Roof Tributary
Live
Tag Description Load Type Ref.. Start End Loc. 100% 90%_ 115% 160% 126%
0 Self-Weight Unf. Lin. (lb/ft) L 00-00-00 21-06-00 Top 14 00-00-00
1 Ceiling Unf. Area(Ib/ft2) L 00-00-00 21-00-00 Top 0 10 04-06-00
2 Roof Unf. Area(lb/ft2) L 00-00-00 21-00-00 Top 30 15 05-00-00
Controls Summary Value % Allowable Duration Case Location
Pos. Moment 3579 ft-Ibs 17.1% 100% 3 16-01-02
Neg. Moment -4182 ft-Ibs 20.0% 100% 1 09-00-00
End Shear 1387 Ibs 14.6% 100% 3 20-03-00
Cont. Shear 1776 Ibs 18.7% 100% 1 10-00-04
Total Load Deflection U999(0.109") n\a n\a 3 15-07-06
Live Load Deflection U999(0.063") n\a n\a 6 15-05-07
Total Neg. Defl. U999(-0.018") n\a n\a 3 06-01-09
Max Defl. 0.1091, n\a n\a 3 15-07-06
Span/Depth 15.3
% Allow % Allow
Bearing,SuppOrtS Dim..(Lxw) _ Value Support Member Material
B1 Column 2-3/4"x 5-114" 1010 Ibs n\a 9.3% Unspecified
B2 Column 5-1/2"x 5-1/4" 3196 Ibs n\a 17.5% Unspecified
B3 Column 5-1/2"x 5-1/4" 1405 Ibs n\a 6.5% Unspecified
Notes
Design meets Code minimum(U240)Total load deflection criteria.
Design meets Code minimum(U360)Live load deflection criteria.
Design meets arbitrary(1")Maximum Total load deflection criteria.
Calculations assume member is fully braced.
BC CALC®analysis is based on IBC 2009.
Design based on Dry Service Condition.
Install screws from both sides, staggering screws by half of the spacing to avoid splitting.
Member has no side loads.
Page 1 of 2
®Boise cascade Triple 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Pl4$SED
FB01 (Floor Beam)
BC CALL®Member Report Dry 12 spans I No cant. May 20,2019 08:38:13
Build 7192
Job name: File name:
Address: Description:
City, State, Zip: Specifier:
Builder: Designer: William Campbell
Code reports: ESR-1040 Company:
Connection Diagram: Full_Length of Member . ._
a
c
e
a minimum= 1-1/2" c=3-1/4"
b minimum= 4" d = 12"
e minimum= 1"
Install screws from both sides, staggering screws by half of the spacing to avoid splitting.
Member has no side loads.
Connectors are: SDS 1/4 x 3-1/2
Disclosure
Use of the Boise Cascade Software is
subject to the terms of the End User
License Agreement(EULA).
Completeness and accuracy of input
must be reviewed and verified by a
qualified engineer or other appropriate
expert to assure its adequacy,prior to
anyone relying on such output as
evidence of suitability for a particular
application.The output here is based on
building code-accepted design
properties and analysis methods.
Installation of Boise Cascade
engineered wood products must be in
accordance with current Installation
Guide and applicable building codes.To
obtain Installation Guide or ask
questions,please call(800)232-0788
before installation.
BC CALCO, BC FRAMER®,AJS-,
ALLJOIST®, BC RIM BOARD-,BCI®,
BOISE GLULAMTM, BC FloorValue®,
VERSA-LAM®,VERSA-RIM PLUS®,
Page 2 of 2
Carter, Jeff
From: Carter,Jeff
Sent: Tuesday, May 14, 2019 4:29 PM
To: Ivillagecraftbuilders@comcast.net'
Subject: Permit/Application:TB-19-1422 at 21 AMANDA COURT, COTUIT for Building -
Addition/Alteration - Residential
Please be advise that we are currently reviewing your permit request for 21 Amanda Court, Cotuit. At this time we have
to deny your request until we receive additional information for review. Plans as submitted do not meet span
requirements(farmers porch perimeter beam), beam is not directly supported by posts. Please provide the following
information:
1) Provide a stamped plan for a registered design profession shown plan as submitted meets the requirements of
current code or
2) New plan that decreases spans to allowable limits and show a prescriptive method to directly support beam
with post and
3) Provide specs for LVL's as shown on plan.
And, if aggrieved by this notice and order; to show cause as to why you should not be required abate the violation in this
notice, you may file a Notice of Appeal (specifying the grounds thereof) with the State Building Code Appeals Board
within (45) days of the receipt of this order and in accordance with MGL c. 143 § 100.
Feel free to contact me with any questions regarding these requests.
Thank you,
Jeff Carter
Local Inspector
Building Department
Town of Barnstable
200 Main Street
Hyannis, MA 02601
508 862-4035
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1 PIC_ tJ5UD TO De Tet'Al�►lt= LOT' Lt;-l`S Ilpru CA,"-r
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers, Compensation Insurance Affidavit:.Buflders/Contractors/Electricians/Plmnbers
Applicant Information Please Print Legibly-
Name(Business/orpnizahon/Individ*:
e, :"/.) ��
Address: pil V -
V� �/
C' /State/Zip: Phone#: �0- - 1,4 ;i7�
Are aan;,(loyer?Check the appropriate box: Type of project(required):
1. I.am a yeswrth , 4. ❑ I am a general contractor and I 6. ❑New construction
employees(fall and/or part-time).* have hired the sob-confractors
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or Partner-
These sub-contractors have S. ❑Demolition
ship and have no employees
working for me in any capacity. employees and have workers' 9. ❑Bolding addition
[NO workers'comp.insurance comp.insurance,t
5. El We are a corporation and rts 10•❑ repairs or mans
r �]3.El I am a homeowner doing all work officers have exercised their l 1.❑Plumbing repairs or additions
myself[No workers' comp. right of exemption per MGL 12.❑goof repairs
insurance required.]t c.152, §1(4),and we have no 13.❑Other
employees.[No workers'
comp.insurance required.]
*Any applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy information l
t Homeowners who submit this affidavit indicating they are doing all w
work and then hire outside contractors must submit a new affidavit indicating such
Contractors that check this box must attached an additional sheet showing fbo name of the sob-contractors and state Whether or Dot 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. A*'
Instaance Company Name: ��• " '
�(l->�1l Expiration Date: Z /�
Policy#or Self-ins.Lic.#: U
Job Site Address: zi
AM,M, cWstawzip
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation 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 imprisomnent,as well as civil penalties in the foffi of a STOP WORK ORDER and a tine
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 ko rance coverage verification.
I do hereby certify under pains and Pe f perjury that the infornudion provided above is and rred
S e: Date:
Phone#
offckd use only. Do not write in this area,to be completed by city or town official
City or Town: PermitUcense#
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#:
.. .. ...........................
TOWN OF BARNSTABLE
SARNSTAHM ? BUILDING DEPARTMENT
MASS
APPLICATION FOR CERTIFICATE,OF OCCUPANCY
Date
Building permit application number map/par
Address of structure
Area of structure C.O.will be issued to
Name of Tenant
Edition of Building Code
Use and Occupancy Classification
Type of Construction
Design Occupant Load
Is the facility licensed by a State agency Yes ❑ No
if yes
If yes, name of agency
Relevant Code of MA Regulations(CMR)that apply
Automatic Sprinkler System
Sprinklers provided? Yes ❑ No ❑
Sprinklers required? Yes ❑ No ❑
Building Department Use only
Special Conditions:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 40959
POLICY NO. WCC-500-5006114-2018A
PRIOR NO. WCC-500-5006114-2017A
ITEM
1. The Insured: Michael Deluga
DBA: Village Craft Building& Remodeling
Mailing address: 568 Santuit Road FEIN:**-***2146
Cotuit, MA 02635
Legal Entity Type: Sole Proprietor
Other workplaces not shown above:
2. The policy period is from 12/23/2018 to 12/23/2019 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to'the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. ,This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 000355380
INTER SEE CLASS CODE SCHEDU E
Minimum Premium $500 Total-Estimated Annual Premium $3,474
MGOq Deposit Premium $899
State Assessments/Surcharges
$3,122.00 x 3.8300%.- $120
This policy;';ineluding all endorsements, is hereby countersigned by 11/26/2018
Authorized Signature Date
Service Office: Malcolm &Parsons Insurance Agency Inc
54:.Third Avenue P 0 Box 527
Burlington MA 01803 Stoughton, MA 02072
rui F;oi= il,.
WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.
Commonwealth of Massachusetts
®l Division of Professional Licensure
tt Board of Building Regulations and Standards
i Constructdri'tupervisor
C3-050234 Ezpires: 07/09/2020
e
MICHAEL DELUGA. 7
668 SANTUIT Rp
COTUIT MA f1263t
Commissioner
Office of Consumer Affairs 8,Business Reguiation
HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
' RPais� t+'ation 07/1�6J
2020
105548-
MICHAEL DELUGA. ..
DIB/A VILLAGE GRAFT BPLDING&REMODELING .
MICHAEL DELUGA
s68 SANTUIT RD. Undersecretary .
COTUIT,MA 02635
Registration valld,for individual use only
before the expiration date. if found return to:
office of Consumer Affairs and Business Regulation
F One Ashburton Place-Suite 1301
-•-Boston,MA 02108
d
I - <
Not valid without signature
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Application Number...........................................
Section 9—.Construction Supervisor
Name J aj Telephone Number
Address 5 P City , (6+v S Zip
License Number 6 License Type OA.Vas 0 iration Date Z
Contractors Email �R c i�. j JS Ell
I understand my responsbilities under the rules and regulations for Licensed Construction Supervisor is accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 and the of Barnstable.Attach a copy of your license.
Signature Date
Section-10—Home Improvement Contractor
Name AIV Telephone Number.--
Address
i Stafe Z� 0 3
Registration Number d �� Expiradon Date L�
I understand my responsbilides under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State uilding Code I the construction inspection procedures,specific inspections and
documentation regmred by CMR and of Barnstable.Attach a copy of your IUC...
Signature Date
Section 11—Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation regaired by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
Of
Signature Date / 1�
f� 1 G�
Print Name -e {�/ I f> e ' 7
T lephone Number � �/��
E-mail permit to:
T e..r.....i-. A.nlnnnlo
I
Section 12—Department Sign-Offs
Health Department ® Zoning Board Cif required) El
i
Historic District ❑ Site Plan Review Cif required) ❑
Fire Department ❑ ,
Conservation
Y P
For commercial work,please take our lass directly to the fire deparEment for aPP rovab
'
Section 13—Owner's Authorization
I, , 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 for:
(Address ofjob)
j
Signature of Owner date
Print Name
r
Last uwdatmh 2/92018
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application #
Health Division Date Issued L
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis p�'
Project Street Address
Village
Owner ?�"CNNOV 1�1��rGf Address
Telephone
Permit Request ( P� �\ Q,\\L&\0_X Al-, Ctn A2n
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 00,Ob Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new r�
Total Room Count (not including baths): existing new First Floor Room Count %� c`>�
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/co. I stove: 'O Yesp.O No
j Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑=new =z e_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
co
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name L Telephone Number `tS33'�S3$`�
Address Sty\ �, "` License # 6 a S
JUT G&C S3-`5 Home Improvement Contractor# o
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE ` L�-�1 ' 12
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED -
MAP/PARCEL NO.
ADDRESS VILLAGE
_ OWNER .
` DATE OF INSPECTION: `.
FOUNDATION ~� -
' FRAME
INSULATION
FIREPLACE
k ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
3
GAS: ROUGH FINAL i
1 FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.- '
y _
The Commonwealth of Massachusetts PrinCfoitn;`�
r Department of Industrial Accidents
Office of'Investigations -
1 Congress Street, Suite 160
Boston,MA 02114-2017;
If www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name(Business/Organization/Individual):CONSERVE ENERGY INC. d.b.a CONSERVISION ENERGY
Address: 376 ROUTE 130, SUITE C
City/State/Zip:SANDWICH, MA 02563 Phone#: 508-833-8384
Are you an employer?Check the appropriate dox: Type of project(required):
1.® 1 am a employer with 6 4. ['1 am a general contractor and 1
employees(full and/or part-time).° 'have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- l listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. (] Building addition
[No workers'comp.insurance comp. insurance.:
required.] 5. ❑+We are a corporation and its 10.❑ Electrical repairs or additions
]
3.❑ 1 am a homeowner doing all work officers have exercised theit I I,[]Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGIs
t 12.0 Roof repairs
insurance required.]t ,{i It
;4;c. 152,§1(4),and we have do EATHERIZATION
" �employees. [No workers' 13.®OthetW
comp. insurance required.];
•Any applicant that checks box ttl must also fill out the sectipp,below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are uq gig ull work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional shtet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they musthpr`tvide their workers'comp.policy number.
+ri'
I am an employer that is providing workers'eui pensad insu
information. rance fur my employees. Below is the policy and job site
I'
Insurance Company Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH
Policy#or Self-ins.Lic.#:WC7956539 '. Expiration Date:3/15/13
Job Site Address: Ciry/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 Seedon 25A of MGL e. 152 can lead to the imposition ot'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 adV.ised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
/do hereby certi under the urns and en Ities"Werjuty that the in ortnatiun provided above is true and correct.
Signature: Date 2LZ
Phone#:508-833-8384
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 1t4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Client#:68880 y CONSER
ATE(MMIODM
T ACORD. CERTIFICATE 'OF LIABILITY INSURANCE 003115/20112
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 !CONTACT
Rogers&Gray Insurance Agency,Inc. PHONE FA
IMC,No,EXt):508 398-7980 IA)C No
434 Route 134 E-MAIL
South Dennis,MA 02660 AOORESS:
INSURER(S)AFFORDING COVERAGE NMC tl
508 398-7980 _ INSURER:;Selective Ins.Co.of the South
INSURED Y
INSURER B':
Conserve Energy,Inc.
376 Route 130.STE C i INSURERc
Sandwich,MA 02563 INSURER Or;
INSURER E;
INSURER 6
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THEOPOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IMP DDL SuaR - POLICY EFF POLICY
LTR TYPE OF INSURANCE I POLICY NUMBER _ _ MMIDD MMJOD LIMITS
A GENERAL LIABILITY X ➢S2011299 01 141201210311412013 EACH
q�OCCURRENCE f 1 000 OOO
X COMMERCIAL GENERAL LIABILITY •PREMISES EaEo aED ce, 5100,000
i;
CLAIMS-MADEOCCUR ,MED EXP(Any one Person) .f 1 O OOO
_ rPERSONAL 8 ADV INJURY ;f 12000,000
GENERAL AGGREG ATE _ f 3 OOO OOO I >
GEN'L AGGREGATE LIMIT APPLIES PER: 1 1 PRODUCTS-COMP/OP AGG f 3,00000 000
PRO-
X POLICY JECTLOC $
AUTOMOBILE LIABILITY '1' - .YCOMBINED SINGLE LIMIT
:W (Ea accident) S
ANY AUTO :,j BODILY INJURY(Per peraw) f
ALL OWNED SCHEDULED
AUTOS '�AUTOS rr, BODILY INJURY(Per accioen)+f
° PROPERTY DAMAGE
HIREDAUTOS NON-OWNED
�$) f
AUTOS -', rMar accidertll
q UMBRELLA LAB X OCCUR iTXS2011299 3M412 01 2 1 0 311 4I201 EACH OCCURRENCE 1�000 000
)( EXCESS LOAD CLAIMS± E AGGREGATE _ f3 OOO OOO
OEO I X1 RETENTION 50 _ f
A WORKERS COMPENSATION sTATu OTH
(WC7956539 3f1412012 031141201 WC - I L "
AND EMPLOYERS'UABILn'Y ,X__EL RV LIMBS. .ER
ANY PROPRIETOR/PARTNERIEXECUTN Y J N
OFFICER/MEMSER EXCLUDED? a NIA r E E.L.EACH ACCIDENT ,S1 OO OOO
(Mandatory N NH) t; F E.L.DISEASE-EA EMPLOYEE f 1 OO 000
d yea,dexdbe under
OESCRIPTION OF OPERATIONS below 1 h 'E.L.DISEASE-POLICY LIMIT I f 500,000
t �
I
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ifmore space Is required)
Excluded officers under workers'comp-Conor and';Courtney McInerney. Blanket additonal insured coverage
applies under CGL.
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CERTIFICATE HOLDER + ; CANCELI:ATION
Thielsch En ineerin I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
g g, f1C. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
195 Francis Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Cranston,RI 02910
AUTHORIZED REPRESENTATIVE
I
®198 -2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S788991M78898 DDR
fi
Office �/ Lega
�oi6umer d'ays&'Bu<cm License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTIOR before the expiration date. If found return to:
"'RegisUation: 171251 Type: Office of Consumer Affairs and Business Regulation
Expiration: 3/1/2014 Partnership 10 Park Plaza-Suite 5170
Boston,MA 02116
CON=SERVE ENERGY
5
CONOR MCINERNEY i
376 ROUTE 130 SUITE C g� � �
SANDWICH,MA 02563 ---�CJ.�'W
Undersecretary Not valid without signature
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Mas-sh huw ..-Department of Public"aft:tl
4 BoardaM'Building Re-gulalions and�tantlar,
4 Constr iCtlon Supervtsor Specialty Licerse
License;;CS SL 102778
Restricted to ,IC
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CONOR MCINERNEY
39 SIASCOfV$ET DRIVE
,�
SAGAMORE BEACH, MA 02562
-•� l Expiration: 8/19/2012
nruuiic err TrR: 102778
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THE COMMONWEALTH OF MASSACHUSETTS
Department of Public Safety
One Ashburton Place, Room 1301
Boston, MA 02108-1618
APPLICATION FOR LICENSE RENEWAL
CONOR D MCiNERNEY
39 SIASCONSET DRIVE
SAGAMORE BEACH MA 02562
Please note changes to nailing address.
License Type: Construction Supervisor Specialty Restricted to:CSSL-IC-Insulation Contractor
License No: CSSL-102778
Expiration: 08/19/2012
Please refer to the Department of Public Safety website,www.mass.gov/dps for continuing education requirements.
Licenses not renewed by the expiration date shall become void,and shall after one year be reinstated only by a new
application and re-examination of the licensee if required.All future renewal notices will be sent by E-Mail.
Please specify the E-Mail address you want your renewal notice to be sent to: 1.;�C_ ,"anec4 Ci i Wit@
Please review information on your license on the DPS website at: www.mass.gov/dns
I hereby certify,under the pains and penalties of perjury,that I am unable to access e-mail notifications and therefore
request U.S. mail notifications of renewals. )
Signature of Applic nt Date
Please enclose a check or money order made payable to the Mail the completed renewal form with
Commonwealth of Massachusetts for the required non refundable payment to:
processing renewal fee of$100.00. Department of Public Safety
DO NOT MAIL CASH. CSL Renewal
P.O.Box 414376
Write the license number on the front of the check or money order. Boston MA 02241-4376
I AUTHORIZE DPS TO USE MY RMV PHOTO INFORMATION (Please check box on the left).
This option authorizes the Department of Public Safety to electronically access my photograph from the Massachusetts
Reeistry of Motor Vehicles database solely for use on this license/registration. If you do not authorize use of your MA RMV
photo or do not have a MA RMV license,please submit Photo Submission Form for License Renewal available at
www.mass.gov/dpss. Failure to follow DPS license photo procedure will result in your renewal status being changed to
"Incomplete"until a proper photo is received.
LANGUAGE ACCESS PLAN (Optional) Please check here if English is not your primary language AND your ability to
read,write,speak,or understand English is limited. Please indicate what your primary language is:
I hereby certify under the pains and penalties of perjury that to the best of my knowledge and belief the
information above is correct and that I have filed all state tax returns and paid all state taxes required by law and
complied with I laws of the Commonwealth relative to the withholding and payment of c ild support.
Signature of Applicant bate
Rev: 1000-3000 Amt: $100.00 RenID: 119741 Lic[D: 291686
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at
(Property Address)
Caf�,�f 1y OZ63-5-
(Property Address)
1
hereby authorize vis
,
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
O ees- Siedha-1:171,
(,T Q
Date
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ONE
BANK OF CAPE COO
ConserVision �A .�At 0176
]67tiltt]
e n e r g y
379 RaMe 130.Suit C
smwath,tN11025G! BfB/2II12 '
Pni 5004334 _
IPAY TO THE y
ORDER Of Dent of Pt hlie Saftay s iQO.Of]
One Hnndred and nn/1nn•^.................................................................................................. DOLLARS
Dept of Public Safety
CSL Renewal
P.O.Box 414376
II memoBoston,MA 02241
r`CI fl 1A077A SECUnITV FEATURES INCLUDED.DETAILS ON UACK. Q' J
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sses or's map and lot number ...., ..:.3 �:.k:'•...
_ SEPTA BYST k MUST 6E
"TAU ED IN COMP• � � � DANCE
-Sewage Permit number VATM TITLE 5
TOWN
N ENNIAONMTTjCrE AND .
TNE> 1 O ♦1 1 \ OF �BARI� ' � NS
Z BARNSTABLE,
"6 ,•� .. BUILDING , INSPECTOR
APPLICATION I 0w_S 7 ed—LIC TION FOR PERMIT TO .................. ................................,5.......................`�.........................��t............
�oG�
TYPEOF,CONSTRUCTION .....:........... ...................................................................................................................
.............�Q.. ..zS...............19.
y TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location �T*`t Au&^N �p�.r 0R + aA-t;&
............................................................................................................................................................................... '
ProposedUse 711 ......................................................................................................................................................................................................
Zoning District _.....................................Fire District �....
................................. . ..............................................................................
�L .Address �vx�vr ti Y 1,A Name of Owner ..... D!!N, ...... — . -¢...Y............... .o.... . .. ..................................
�l M0_1!%4t
Nome of Builder . ..OE..... 5. ..T.V.�.....Address
.. .....u.�......... e.`A.�. ....
Nameof Architect �.,...................��..............�................. ...........Address ..........................................-.........................................
Number of Rooms Foundation ......... pv�e� c�rc lY
.. . ..............................................................
cc
Exterior ... .ay .... J �.� C.............Roofing ...................... L�..............
..........� �.°C
Floors 1 r .
Cal 1. Interior ..............c��e C,Gl�► Ll�.x
.............................................. ..... ............ . ............... ................ ..........................
�' , ,q
Heating ...........'T'..:.wt..�.�....... .1. ..............................Plumbing . CY V.C.
Fireplace ..........................� ........................................Approximate Cost ......................
�.660..........�.......
Definitive Plan Approved by Planning Board --------------_--_---_- Z
------19-------. Area ....1..1../.� .' ............
Diagram of Lot and Building.with Dimensions Fee �'�20.............................................
SUBJECT TO APPROVAL F BOARD OF HEALTH'
I hereby agree to conform to all the Rules and Regulations t e To of Barnstable regarding the o e
construction.
Name ...................
`
Lot #3I 21 Amanda Court
Location ...............--_—.--.—.--------.
^ `
Cotoit
—~--.---~..---..—.~.--------.—
Owner _.Thomao..Kelll/_________.
~~ Frame
Type of Construction ..........................................
.
--.—.---------.-_.----,.-----
.
Plot --'---.---.. �» ----------..
. . ' ��",
�
,�'-
Permit p'vnne6 —..]�.Ql8eMb.er 9 80
�
Date of, -----� ..l���~�
� ~ ' r
Dote ^�.{�� l���� ^ `
�o /���n -------- ---..
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PERMIT REFUSEDFft
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----' '
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ed .... ----------..---. 19
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---------------^^^^^--^-----'
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� -------`------------........--
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Ass�--Aor's map and lot number
Sewage Permit number .............. ( .� '..:.>.. �J
T"E.T TOWN OF BARNSTABLE
Z SAJOSTAIME,KASIL
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t639-
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BUILDING INSPECTOR
� MAY
pt{S�VG'f� J/K�l.. 7 �rtll.� Clue (.
. APPLICATION FOR PERMIT TO ...............................................................................y
............................................
TYPEOF CONSTRUCTION r '� r .....`��{..................... ..................... ......................................:..............................................
............. ^.......Z ..............19. )
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location �� '� 1't'WA00A ec7u.rT OTvt "
...............................................................................................................................................................................
Proposed Use t-� �!` "°
ZoningDistrict ............................... .....................................Fire District ......... ���?.l.................................................
Name of Owner .. 1+ ! tll��.r, Of' l 11-t.......................Address �t_/�.IY�1R)K,� �... ..................:.... ......... ........................................
l {{ .� ff A ( }
Name of Builderl� P�tTS.. Ct" ;A :h �� U. ......AddressGi ,li�v�� C .tip S�fr.►
. ........... ............. ...... . ............
Nameof Architect .................................`................'..............Address ....................................................................................
Number of Rooms ''J Foundation ................ '!
............................................ �'.........
Exterior 01r 1.4 r t1 ... SV, �.R F r � E'�4-*► `.. t....��.� 1
.........................Roofing
Floors :-s lrc u.r� Interior ..............: ��.� Cr CA.-A . � t e
.. ............................................... .... .......`-............
/ /'�
t l ,.-,car *.' , 1 V
V
Heating g
Fireplace .......................... .� ..........................................Approximate Cost .......................��� .:.................................
Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ..........................................
Diagram of Lot and Building with Dimensions Fee " �
.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I hereby agree to conform to all the Rules and Regulations,of`the Town of Barnstable regarding the above
construction.
l ,
Name. L .. .. 1 ( a.f .. a... ..
1
KELLY, THOMAS/ �31
: 2.2638 One 1/2. Story
................. Permit for. ................:
Single Family Dwelling
.................. ..............................................
i
Location
Lot #31 21 Amanda Court
t
Cot...................
it ........ .................................
OwnerThomas. . , ...Ke...11.... .. ....... .. .. .. .. '..................................
i
Type of Construction ......F. ame.......................
4
....................
Plot ............................ at ................................
f Permit Granted ?Jov... r , 19 80
1 .. r ....... .....
Date of Inspection ......19
Date Completed ..............:......................19
j PERMIT REFUSED
't
' ............................................ ..... 19
t �. .... ..........
......................C ...:.............
Approved ..
1
...................... ............ ........................... ........
..................... .........................................................
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�„�•;` TOWN OF BARNSTABLE Permit No. 22';ii
1 Building Inspector
�,Un.n
.�A - Cash _--
OCCUPANCY PERMIT Bond
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Ti-aras Kell-N Address
s7A 1, ;'1 Ar,andn Certrt-- C'nt-i r
Wiring Inspector\ / cf j ' ction date
Plumbing Inspector '�.. **-x f' inspection date
Gas Inspector Inspection date
r Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS. n `
Building_!Inspector
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