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HomeMy WebLinkAbout0038 WILLIMANTIC DRIVE n *w _ � .. �. VE Town of Barnstable *Permit#"— � F " , �•� Regulatory Services Fee 6monthsjro^missuedate 3ARN51Q 2�• / I � utAss. � Richard V.Scali,Director ✓ ✓/x- �p 039. �0 Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I Not Valid without Red X-Press Imprint Map/parcel Number JJ Property Address 3S c.J(� t r�Ly►TC�C (-- residential Value of Work$ 6] 100 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address PtiM AQ,ems Contractor's Name �C44A S",A(ILOr� Telephone Number // Home Improvement Contractor License#(if applicable) o Email: R l' o 0-0¢� Coin CGC 3,/1Q�7— Cons ction Supervisor's License#(if applicable) LO'3 d,6 5 orkman's Co m ensation Insurance Check o : ❑ I a sole proprietor am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re q st eck box) e-roof(hurricane nailed)( tripping old shin All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:MPFILESTORMS\building permit forms\EXPRESS.doc 01/25/17 i 1 ' 27w Conzrrt'ornvealth of Massadiusetts Department of rariashiatAcci&7ds �► OfTce of lm.wftgafions. I' 606 Wasiiurgtozz Street Boston,MA 02111 fvum-, tass_gov1dia -- Workers'_ -. - - - �npensidica Ins�i ce-Affida,,; ~Brd FrJC" it:r ctorslEI�ccfr�iansP bers - A ppfirant Information Please Priaf<E,e�lly N ;, g 1/— - ems Address: City/S WZi1 .e.t-LA E . ©ka Z Phone iur-- Are n an employer?.Checkthe appropriate box: T of project r 1. I am a employer veitlr 4 ❑I am a general contractor and I � e i egnired}: employees(fish and/or partrme j* /true hired the sub-coahzactors 6_ ldetiv ctiori 2.❑ I am a sole pmpdetorr or partner- listed on the attached sheet. 7- ❑Remodeling. ship and have no employees These sub-cantractors have g_ ❑Demolition wadzing for mein any capacity employees and have workers 9_.❑B•uildiag addition ,Na U-a�P. ,comp.insure comp_rn¢vtrarr I - difimns reT ired] 5. ❑ �41.e are a corporation and its 16-❑Electrical repairs ax a d 3.❑ I aura homeowner doing all work of have exEmised their 1L❑Flumbingrepairs or additions myself[No yuork='gip- riot of exemption per MGL 12-❑Roofrgmirs inm anre required_]i c.132,§In andwe have no employees.[No war]cems 13-❑Other comp_inm=noe required-] ',3.ay appliczatthat r3edsboa�1 mast else fillout:the settoaheTowshatsing ilea svor?sexs'compensatianpo&cp infa�suoaL E�omeaaraets who submit dais s±Ed=uuUcztimg they axe damp all wad[end dim hire outside co=ctors mast submit a new affidzvst indic�ne sarfi Icaadzacias*ecbeckthisbinsxaustaitarT, asadditiaaals*ashowing the mmwofthesob-cmrtxsctas and staMwhetherarnot those entitiesb.nm employees.Ifthesub-cont3rtomhtve employeas,tfieynML5tpms0dtthe1r wadmw comp.policy aunher- I am an entpLayer that ivorkers'compertsadion hman ice for my earpFayees Beloty is thePVHCY=d job rde information. Insurance Company Name: 'Policy-,'*L or Self-ins-Lic_ k ExpirationDate: Job Sit�Addm= CitylStatd2ip: Attach a-copy of the workers'compensationpolicg declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MC L c�M can lead to the imposition of criminal penalties of a fine up to$1,50d 00 and/or arie-y&irimpEisonmeut,as well as civil penalties m the fomt of a STOP WORK ORDER and a fine of up to$250-00 a day abtaiast the violaiur_ Be addsed'that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA for ms»ce coverage ti�frca3i n- I do[wraby aanY tder dhepaurts psnaI s o!Cpedury tlrattlra utformafiorsprm &d abm�e is true and carrect Siomtore: Dale: Phone 17 Of'kind am curly. Do rat writs in this areas,to be campTeted by city arton-7t ojoiciaL City or Town: PermitlLieense; Issuing Authority(tacle one): L Board of Health r.Buckling Department 3.Citylrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: -- -— - --- - - 6 f formation and Instructions M&sechosetfs Geteaal Laws chapter 152 regaires all employers to provide woIkeas'compensation fW their MoPloy=- parsuantln ffijs Sb3t3te,as esrploy is defined as. -event'personm the service of another under any contad ofhae, express or implied,oral or writtcm" An eupTaye-is defined as"an mdrvidual,partnership,associaiicm;corporation or oilier Iegal efitt',or arty two or more of the foregoing engaged is a joint ,and]nc1D Iegal represemiatives of a deceased employer,or the receiver or trastee of an mdividnal,partaersbnp,association or other Iegal entity,�P1oY �pmY Howevez the owner of a.dweIIing hone having not more than three aparimemis and who resides therein,or the occupant of the - dweIImg house of another who employs persons to do maintenancc,consfraction or repair wo&an such dwelling house or on.the grounds or butldmg apput-[r-nant thereto shall not becanse of such employment be deemed to be an effiplOYCr-" MOL caaptea 152,§25C(6)also states that"every state or local licensing agency,sIL2H withhoId the issuance or renewal of a ficen a or permit to operate a business or to construct buiidings in the commonwealth for any applicant Who has not produced acceptable evidence of compliance,wrh the insurance coverage required_" Additionally,MCrL chapter 152, §25C(7)stair's-Neither the commonwealth nor nay of its Political subdivisions shall enter into any contract for the perlin:mance ofpublic wo>3cuu�I acceptable evidence of compIianceFvif$the msarance._ rcTlim rien s of this chapter have Been presented to the contracting aothoi*-- Applicants PIease fill out the wont='compensation affidavit completely,by chec the boxes thatapply to your sitnaiion and,if necessary,supply sob-contractor(s)name(s), addresses)and phone numbers) along with their certificates) of insurnce_ Limited.Liabflity Companies(LLC)or Lmzited LiabnZi tyPmtoeuhips(LIP)withno employees other than tine members or partners,are not regrmed to cant'workers'compensation insarmce. If an LLC or LLP does have employees,apolicy is required. Be advisedthatthis afddayitmaybe sabmitisdto the Department of Industrial Accidents for conformation of insurance coverage. Also be sure to sign and date the aftidayit The affidavit should be retrmned to the city or town that the application for the permit or license is being regaeshA not the Department of ; Lndastial Accidents. Should you have any questions regarding the law or if yon are required to obtain a workers' compensation policy,please call the Department at the m=ber lfi( d beloFv. Self-insured companies should en:bL-r their s,If-insurance license nomber on the appropride,line. City or Town Officials Please be sore that the affidavit is complete and printed legibly- The Department has provided a space at the bottom of the affidavit for you to f.Il out in the event the,Office oflnvestigaiions has to contactyouregarding the applicant. Please be sure to fill,in the peonit/Iicense number which will be used as a reference nuunber. In-addition,an applicant that must sobm>L mu�Ie,pe�itJlicense applitaiions in any given year,need only submit one affidavit iodic, cuuEnt policy information('if necessary)and under'Job Site Address"the applicant should write"all locations in (citY or. town)-"A copy of the-affidavit that has been officially stamped or mm iced by the city or town may be provided to the applicant as-proof that a valid affidavit is on file for future peonies or licenses Anew affidavit must be filled Dirt each year.Where a home owner or citizen is obtaining a license or petit not relatEd to any busiacm or commercial ve�e tie_ EL dog license or permit to bum leaves etc.)said person is NOT rimed to complete this affidavit The Office of Investigati=would igm to thank you in advance for your cooperation and should you have any questions, please do not hesifab:to give us a ea1L The Dej ffiti enfs address,telephone and fax number: CG=MMWWItbE of M&I s , Deparimmt of Iudastdak Accident a �c�of 7rr� fio� - t�4 Bus au,MA OiI I Tc,-L 4 617' -4900 uxt 406 cx 1-M MASSAFE Fax 9 61 7`27 7M Revised 424-07 AWE Town of Barnstable Regulatory Services MAS& Richard V. Scali,Director s6,39. Building Division. °lam Paul Roma,Building Commissioner -200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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 of Job) ' **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date QYORM&OWNERPERMISSIONPOOLS Town of Barnstable , Regulatory Services °@tom Richard V.Scali,Director Building Division ' UMNSTA13M Paul Roma,Building Commissioner MASS 039. �m 200 Main Street, Hyannis,MA 02601 CFO 1 u� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER 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 two- 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. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomu\EXPRESS.doc 06/20/16 Client#:44947 2ALLSTI ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/1812016 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 Dowling&O'Neil Dowling&O'Neil Insurance Agency o" A No5087781218alc oEXt:508 775-1620 973 lyannough Rd,PO Box 1990 E-MAIL ADDRESS: COI DOINS.COM Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# 508 775-1620 INSURER A:Acadia Insurance INSURED All Star Renovations, LLC INSURER B:Associated Employers Insurance P.O.BOX 775 INSURER C: Sagamore,MA 02561 INSURER D: 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I S WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY BOA507775913. 1/02/2016 01/02/2017 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PAEMRSES EaENTEnT p nce $50 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COM Ea aBcciINdentED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050116252016A 1/02/2016 01/02/2017 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? F-N] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Cape Ability Construction LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p Ty THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 13 Fort Hill Road ACCORDANCE WITH THE POLICY PROVISIONS. East Sandwich,MA 02537 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S178495/M163283 CBD I &Xc tpanrnnararue��t�o�C/ iaaac���oe _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR — Reg istration:,'.:164857 Type: Expiration:�;-1.1119/2017 DBA ALL STAR RENOVATIONS,w t.�;,�s9<•:fit:"_=:a' 1>� moo.:, RICHARD SULLIVAN. t,qt, j 14 POWDERHORN CENTERVILLE,MA 02632`' Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards i License: CS-103265 Construction Supervisor RICHARD P SULLIVAN 14 POWDERHORN WAY i CENTERVILLE MA 02632 - t' �yi1 0 r'-j-^K l— Expiration: Commissioner 08/31/2017 i AV v_'..OF B�1111111111F�V A Name- Pam vergetis Job address- 38 Willimantic rd Date- 02/26/17 marstins mills MA 02648 Phone- 781-724-9633 Home address- Cell- the anne spalaris ten year trust Email- P.O. box- Office All material and work is guaranteed to be as specified and all work will be completed in a substantial workmanlike manner for a total sum of $7,100.00 with payments made as outlined. deposit $2,000.00 Remainder.due immediately upon completion! Please make check payable to All Star Renovations If paying by credit card please note that there will be an additional cost of 2.75% in addition to any APR that you may already be incurring. If you would like different payment options please ask. All workmanship is guaranteed. Factory warranties apply to all materials used and we Stand by the products we use and also our customers. In the event of a problem with any product used we Pledge to stand behind our customers to resolve the issue. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. This proposal may be withdrawn by us if not accepted within 30 days. Any issue of mold in the building will not be our responsibility during or after the project. Signature Date of acceptance �' a Acceptance of proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. I as the owner of the property hereby authorize you to do the work as specified. Payments will be made as outlined above. Home Improvement Contractor registration#164857 Call the office at: 781-217-8123 Construction Supervisor License#103265 ALL- Name- Pam vergetis Job address- 38 Willimantic rd Date- 02/26/17 marstins mills MA 02648 Phone- 781-724-9633 Home address- Cell- the anne spalaris ten year trust Email- P.O. box- Job description: new roof (will be stripping off old roof) (main house) (1 layer rip) 20 We hereby propose to perform the following services in a neat professional manner in accordance with manufacturers specifications and local building code. 1.Supply and install Certainteed brand/Landmark (limited lifetime warranty ten year surestart protection 10 year warranty algea resistance 130 MPH wind resistance warranty) These shingles are heavy weight self sealing multi-layered fiberglass reinforced architectural style shingles featering copper-ceramic stones. 2.Supply and install Certainteed Winterguard ice and water shield at all eves walls roof vents skylites valleys and roof penatrations 3.Supply and install try-flex premium under-layment to entire roof deck 4.Supply and install new stink pipe flashings 5.Supply and install 8"white drip edge along all fascias 6.Supply and install vent along the ridge In addition to the above work we will also clean and remove debris from the work area daily, re-Hail roof deck as needed, and clean all gutters. supply/install 2" hole vents every 16" O.C. Thru out the soffits block off/remove gable louvered vents (replaced with ridge vent) Home Improvement Contractor registration#164857 Call the office at: 781-217-8123 Construction Supervisor License#103265 i En Dept. (3rd floor) Map /d C? Parcel 0 6-& Permit# J z House# Qpff Date Issue 9-2-13 " 8 oard of Health(3rd floor)(8:15 -9:30/1:00-4-30) onservation Office(4th floor)(8:30-9:30/1:00--2:00) DO WSR4 ftMff6ff­g9e-pt. (1st floor/School Admin. Bldg.) MUST DE INSTAL PLIANCE De€init� proved by Planning Board 19 . �� 5 ' ENVIRO CODE AND TOWN OF BARNSTABLE TOWIN R LATIONS ,BJ,uilding Permit Application � Project Street Address wl I 1 �'�' `.L �� 1:56AS Village Ua�6+b&5 UAS E(JL��GIl�IJLtfi I Vt.(� Owner Address li, Telephone - oln Permit Request io X 11, t First Floor /square feet Second Floor square feet Construction Type b (o Ftoor.eI lid wp Is ?,Y O Q Estimated Project Cost $ A ODD Zoning District Y' Flood Plain ���U� Water Protection l0 t" Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p/ Two Family ❑ Multi-Family(#units) Age of Existing Struck 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 No. of Bedrooms: Existing c ' New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Zo El Oil El Electric ❑Other Central Air ❑Yes Fireplaces: Existing ✓/ New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) f/None ffShed(size) ? IQ X o ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name ywis Telephone Number 4�a -394 Address License# Home Improvement Contractor# 1 21 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4WO JJA SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOW NG REASON(S) a 3�- z7 �Y' - FOR OFFICIAL USE ONLY t Q RMIT NO. �'•/•' - _ DATE ISSUED MAP/-PARCEL NO. ADDRESS VILLAGE' , OWNER _ ti DATE OF INSPECTION: FOUNDATION - e FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH} . FINAL '.FINAL BUILDING DATE,CLOSED OUT 0 ASSOCIATION PLANLLNO. ca 0 ti r . . ✓/LG,V/dIYUht(J7Z6IJC�I�/L a�V(/LQSCLCILCL(IP(iLU ! . DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Expires: Restricted T.o_;; 00 ANGElO KAIDIS _ BITTERSYEEI V HARHICH, MA 02645 The Commonwealth of Massacl:use= Department of Industrial Accidents >d ___ , �'�� OlBcl'aflmres�l�atloos 600 Washington Street ' Boston,Mass. 02111 Workers' Compensation Insurance Afridavit , name: Weto U S ocation- K.- W-KPk c( ✓� city4t" " one it ❑�.am a hom eowner performing all work myself. ❑'i am a sole Prometor and have no one worldng in any c acity ❑ I am an employer providing workers compensation for my employees woridng on this job. comannv name• -T? address: • . .. dty phone insurance CO. RnIICV a ❑ I am sole proprieto general contractor, or homeowner(circle one)and have hired the contractors listed below who have • the following workers' compensation polices: . tom anv name! i AA ` � "� address-. ... .�:.'�. .�:. dty �"�" &M VV>WvM�..... ... .�.:. insarnnee cn. eomnanv name- address- dt%- "hone d: . ..�,, -•,<•. :...;.:�.: :K:{ ::tea.. 8ev i! ... .:.,. nsuranceco. ,era i• :�.. .,... ... ::,.. Fare to saasse eorerete ae required under Section 25A of**1GL 152 an lead to the fmposidon of criminal panitles of a One up to SL500.00 and/or ooa years'tmprfaottmmt as well as drll penattler in the form of a STOP WORK ORDER a"a floe of 3100.00 a day sgaime nuL I tmdenmd that a copy of thh atatsmeat may be forwarded to the Oma of Invesdgxdona of the DIA for co a ate rerMcu m I do hereby certify raider the pains aad pens t* of perjury that the irejormartioa provided abovr is trw and corree� Si, rte ( Dam — _ C Wd-Ls' Printname - - :C3rh-4r me only do not write to dds area to be completed by city or town ofndal own: persawnewe N �BuOding Department CLtcensin=Board i ltfatmedLta reaporw 1s eegoieed ❑Sdeeatrm's 0r0se (]Health Department person• phone i!: Mother — ,man:9195 P1Al Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers 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 ally cant-- of hire, express or implied oral or written. , Anemployer is defined as an individuaL partnership, association, corporation or other legal entity, or any two or more of tie foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the re=-er. trustee of an individual, partnership, association or other legal entity, employing employees. However the owns of 3 dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of ...�.s.... lr;�pesos to do maintenance , construction or repair work on such dwelling house or on the grounds o: building appurtenant thereto shah not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,nerthtrthe commomvealth nor any of its political subdivisions shall enter into any contract for the perfonnance of public work until the insurance requirements of this chapter have been presented to the acceptable evidence of compliance with co�ctzrL authority. Applicants Please fill in the workers' compensation affidavit completely, by checidng the box that applies to yours and supplving company names, address and phone numbers along with a certificate of insurance 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 Waw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. i City or Towns Please be sure that the affidavit is complete and printed legibly. The Depar meat has provided a space at the bottom of the affidavit for you to fill out in the event the Office of has to contact you regarding the applicant:. Please be sure to fill in the permi Nicene number which will be used as a refcz=number. The affidavits may be rct u ed 1n the Department by mail or FAX unless other arraagemeats have bees made. Time Office of Investigations would lice to thank you in advance for you cooperation and should you have any questions. please-in not hesitate to give us a call. /% The Depr.nae='s address,telephone dad fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Imtesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat 406, 409 or 375 MCUR Ate! • `. Tab1e.LLZ2b(eoatlaaed) Prnesfpd►e Packages for One and Two-family Residential Boadlap Hated with Food Fuels MAXIMUM MINIMUM 01ozin Wall Floor Baremeat Slab Hestimg/Coolimg Area''(%) U R valuk:� R valuo'- R.valkkcl Wall Paimm Equipment EMaeucy' Package R.value' R.value' 3701 to 6500 Heattow Degree Days' Q IV% _ 0.40 38 1 13 1 19 !0 6 Normal OM 12% 0. 30 19 19 .10 6 Normal S12% Q50 38 13 19 10 6 85 AFUE T15% 0.36 38 13 25 WA WA Normal U5% 0.46 38 19 19 10 6 Normal V39A 0.4-1 38 13 23 WA WA 83 AFUE W om 30 19 19 10 6 15 AFUE X 18% 0.32 38 13 23 WA WA Normal Yr1r/, 8% 0.42 38 19 23 WA WA Normal Z8% 0.42 38 13 19 10 6 90 AFUE AA OSO 30 19 19 10 6 90AnM 1. ADDRESS OF PROPERTY. III CJ C� . l�l.��s �Li ►is i'��--�2� . 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING. 4. %GLAZING AREA(#3 DIVIDED BY#2): 5: SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1 b: , Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,.skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness-over the exterior walls without compression, R 30'insulation may be substituted for R-3 8 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-flame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements•are for unheated slabs.Add an additional R-2 for heated stabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J51.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more area with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I °FINE lam_ The Town of Barnstable • BABxsrABM • MAS& �0�' Department of Health Safety and Environmental Services 59. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,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 to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 1[�� ��M �o UV Estimated Cost (4, UA- Address of Work: y W 16l( 6 ✓�i :S �lA �S U 1 � Owner's Name: - SOG� l Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 2- Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav Aut GAn 5 3 5ro VL5 ai 1(s l 4O r ict 1 n /!/1/l/1 AAM fl n iC I it f/aff 2. . v of v A-Tl D Al ��LLr ' .; g G1�l�illl' r-L.66R <I T 4lI Ck dlt 2- The" ; own of Barnstable FRAM I NG SECTION - - - - - - ALL DIMENSION LUMBER SHALL i BE KID SPF NO.2 OR BETTER. x COLLAR TIE I . 2 x RAFTER @ " O.G. 1' SHINGLE 2 x CEILING JOIST @ " O.0 W/15 L8. FELT 1 1 � Ix PINE FACIA R-30 KRAFT FACED FG Mrs R- UNFACED FG BATTS —r SOFFIT VENT W/G•MIL POLY VAPOR BARRIER (1 st 2ND FLOOR) PINE SOFFIT , I , I 1 2x FLOOR JOIST @ '"O.G. (isr 4 2Nc FLOOR) - ti 1 . 1 1 I I r. SILL SEAL ve- AN(-NOR BOLT @ 6,-O" O.G. o. ~CONCRETE °.'° FOUNDATION WALL Roo`' PLY G • �_______, Cl-G J 0675 � IL PI)RASA M �xisriNG Cl-6 , -TOTS--r �----i� Ll It NE�9D�R5 (T YF' ) w41-L s W17- XI$T1N ( la�laC C ro BE REMOVED— S E4T —FL° o/ P. T. SILL vy r S/N RS R2 0 7 8 0 RIGHT J SHORT FORM File name: BLANKFHW.RSR Job#: Htg Clg For Outside db 0 88 Inside db 75 75 �.F.l.Ji NSLvw 145T�P- 1# -7 DesignTD 75 13 Daily Range - M CORP Cet}ifrcc fe GPI-ere y(ol4'S Inside Humid. - 50 By: E. F. WINSLOW PLUMBING & HEATING Grains Water - 23 8 REARDON CIRCLE Method Simplified SOUTH YARMOUTH MA 02664 Const.glty Average 508-394-7778 Fireplaces 1 DATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a Efficiency n/a Efficiency n/a Heating Input 0 Btuh Sensible Cooling 0 Btuh Heating Output 0 Btuh Latent Cooling 0 Btuh Low Output Basebrd 580 Btuh/Ft Total Cooling 0 Btuh Total Low Basebrd 11 Feet Actual Cooling Fan 146 CFM High Output Basebrd 825 Btuh/Ft Clg Air Flow Factor 0.053 CFMBtuh Total High Basebrd 8 Feet Spy Therrnostat Load Sensible Heat Ratio 88 ROOM NAME AREA HTG CLG BSBRD FT CLG SQ.FT. BTUH BTUH LOW HIGH CFM BATH ROOM 147 6538 2724 11 8 146 Entire House 147 6538 2724 11 8 146 Ventilation Air . 0 0 Equip.@ 0.93 RSM 2533 Latent Cooling 384 TOTALS 147 6538 2916 11 8 146 MANUAL J:7th Ed. Right-Suite:V4.0.05 /98� - �,�� ; �� � ��� J � � I v'o?nniont�iea 0 —8 ARTMBRT OF'PUBLIC 9AFBTY CONST0,61 N SUP$RVISOR LICENSE = ll---. ° Bxpires: 0 ;Restrrzted TOE 0 KALDIS a° 3'BITTBRSiBBP LR _ �:MARMICM, MA 01645 ;.HOME IMPROVEMENT CONTRACTOR Registration 122982 TYPE OBA Ezpirati6n 1Y/14/98 _ a;. ,.i. - :fir.. ✓ .. ANGELO'S AGELO KALOIS: �" BITTERSWEET LANE ADMINISTRATOR .HARWICH,MA 0264S { I °F THE The Town of Barnstable • EARNSPABLF. - 9� 16 9. ,0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cross en Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: _ ���c�, �LJ Map/Parcel: Project Address: �j Q Builder: The following items were noted on reviewing: t-Y 1?�<G n-A) Please call 508 862-4038 for re-inspection. Reviewed by: Date: U l q:building:forms:review _ t 61 wo rL - SCALE TF ID j ' 508.43$-�! E o evi i n o eS 1 n' fo -e copyright C) All R rght Reserved r 01 I 041 c i Y? � s