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0240 WEST WIND CIRCLE
cab 9 -ll-t 7 ~' TOWN OF BARNSTABLE BUILDINGLPmMIT APPLICATION e— PVA Map 1141 Parcel P 05 2017 Application # 7_C? ' � Health Division � � ate Issued 408 Conservation Division SEP 052017 Application Fee Planning Dept. TQWAJ ��B Permit Fee ' q Date Definitive Plan Approved by Planning Board Tq LE Historic - OKH _ Preservation/Hyannis . Project Street Address � .eTT C Village Owner S' y�S� L �� �' s Address Telephone Permit Request Ref 4 2 iS Al c Square feet: 1 st.floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l�6a 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 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: .❑Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:.❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 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 V l VW 1e1_ /�'`il�-C A�_/, Telephone Number �mm>3 6G--S®s—f Address 4;Ui`Z/0r' License i Home Improvement Contractor# Email 4 04 Worker's Compensation # ,C�{JCL ��� i ALL CONSTRU TION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUR DATE �� s j FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. I, ADDRESS VILLAGE OWNER DATE OF INSPECTION: 8 FOUNDATION FRAME c, INSULATION a J FIREPLACE r r ELECTRICAL: ROUGH FINAL +. PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL . ,*FINAL BUILDING �."/. ' �? F, fy A F 'DATE CLOSED OUT ASSOCIATION PLAN NO. The Cownw7weaM F �� &V W� �MA#2� MMMdw' APPU=mt Please Print .Nmm Z Are an eo:Iayer?. eckytfie bax: Type of project L am a v h (/ / `. ❑I ma a ge�rrd coact m and I (required): �Pl * eve biredthe 6. ❑New omsftm ifln ��(fall andor�t-hm* a we aroma I El�deling I Elgs I am a sole upaebor orgartuer- ship and have no empk5,am 7hne smb--c .hWM s. �]I7emnlifioa forme is any capacity. � bare w'�s 9. ❑Suil aadiiifla INO�'�- l 5. ❑ We ase a ompazafioa.and its 1b.❑Ekzhic;i repairs or adicfioions 3.❑ I am a.l=wvmer doing all vmFk officers have exwned their 11-❑Ph=biagrepaim or aac&iion$ ight of MM y � c.M g1{ we hwe no[No ❑flllier �` comp.msurar= ] AIIf fi]ILC�box--I=mAd=fRo=f��bPfim�iv A &&W . Mot; parkyi aIImPDWa�S�105Qbm3kYb3btdEd2le &eyiEdaizoYg affirm anewsffida-edIDdlf9d mch =C®��$7tl��fib���1TE,'��'.ffi 9dtid,�S�TC��IDg�eL�OEfbP ,,7:.. ffit151�eS�SO[IIOY'�GSE��` .I�Sbe5➢b-C�' �"�SIWOC�Iti'rf J ffiSC�ES��Y'��.•�)41�EZ lam Sel`ow is the paltry arrd joh site �or�afraa � /fJ P*Rcy 9 or Self-irns.Iia&--L 6,�3 �9/ ' fat <17i Job Tifemdre=AA Aftach a aepy of'the workers'camp Percy declaration p2p(shawmg to paUcy number and expiration date). Fag&=to sew coverage as req=edunderSection 25A of hMM m 152 can lead to the imposilioa of cAmmal penalties of a fine up to SUOD oa afldfar one-yesrimp isox==A as well as civil penakies m ibe fn=of a STOP WORK OBDER and a fime of up to$250M a clap against ffie violator. Se andsed tint a copy of tins statemat maybe£onFmded is 1 B Office of Iavestgalions ofIhe DIA for coverage vedfkabnm Fdo keralay fheP , and thattfra i farg�fiaaprmfdadabot is tressand correct Sim PhMe Orwidnsaaanl�. 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IrI •.It .••r :O O■ a■• ■.• I •• l .■■ •l i..•n �■' �.:1 ■n�■ :•u Rti r :+r t tu1' tale 1-.0. ■urn 115 �7p �' i l • 'Cap= = ■ alli i• 70-1 ►i Is �• I r1.� •'r • rlY r AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)` Q Check Compliance 1.1 SCOPE WindSpeed(3-sec.gust)..................................................................................................................110 mph WindExposure Category.................................................................. .............................................................B 1.2..APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch ..........................................................................(Fig 2)............,.............................. 512:12 MeanRoof Height ..............................................................(Fig 2)................................................._ft 5 33' Building Width,W...............................................................(Fig 3)................................................ _ft 5 80, BuildingLength,L ...............................................................(Fig 3)............................... ' Building Aspect Ratio(LNV) ...............................................(Fig 4)................................................. 5 3:1 Nominal Height of Tallest Openin? ...................................(Fig 4). ...................... ................. s 618' 1.3 FRAMING CONNECTIONS General compliance with framing connections..............:.....(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION','_-- 5/8'Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing-general................................. ........(fable 4). ............................................. in. Bolt Spacing from endfjoint of plate ............................(Fig 5)..................................... in.:5 6'-12' Bolt Embedment-concrete.......................................:(Fig 5)................................................._in.a 7' Bolt Embedment-masonry.........................................(Fig 5)............................................ in.z 15' PlateWasher...............................................................(Fig 5)...............................................Z 3'x 3'x'/.' 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension....:..............................(Fig 6)........:........................................._ft 512' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7). . ... .......................................... _ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... ft 5 d FloorBracing at Endwalls...................................................(Fig 9).................................................................... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55).................................... Floor Sheathing Thickness ..............:.................................(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fastening..................................................(Table 2)..._d nails at in edge/_in field 4.1 WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)..........................._ft 510' Non-Loadbearing walls.................................................(Fig 10 and Table 5)..........................._ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)..................._in.. 24'o.c. WallStory Offsets ........................................................(Figs 7&8)........................................... ft 5 d 4.2 EXTERIOR WALLS' Wood Studs Loadbearing walls.........................................................(Table 5). ............................2x -_ft_in. Non-Loadbearing walls................................. . ..........(fable 5). ............................2x -_ft_in. Gable End Wall Bracing' Full Height Endwall Studs............................................(Fig 10)..........................:....................................... WSP Attic Floor Length...............................................(Fig 11).............................................. ft 2:W/3 Gypsum Ceiling Length(if WSP not used)..................(Fig 11)............................................_ft Z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c.. (Fig 11). ........................... ............................... or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length .........................................................(Fig 13 and Table 6)......................................—ft Splice Connection(no.of 16d common nails) ....:.......(Table 6). ................................................ . AWC Guide to Wood Construction in High Wind Areas:110 mph lend Zone Massachusetts Checklist for Compliance(780 CYIR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Tables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9).................................._ft_in.s 11' Sill Plate Spans ........................................................(Table 9).................................._ft_in.511, Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(fable 9).................................._ft_in.512' Sill Plate Spans...........................................................(Table 9)..................................—ft— Full in.512' HeightStuds(no.of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist.Upli t and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 .............................................................................._5 6'8' SheathingType..............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)....................... in. Field Nail Spacing ........ .. ..........................(Table 10).............................................. in. Shear Connection(no.of 16d common nails)(Table 10)..................................................... _ Percent Full-Height Sheathing able 10 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest Opening2 _5 6'8' . ......................................................................... SheathingType.............................................(note 4)...................................................... Edge Nail Spacing..........................................(Table 11 or note 4 if less)....................... in. Field Nail Spacing.........................................(Table 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................— Percent Full-Height Sheathing (Table 11)..................................... ............_% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?............................ . ............................................................................................ 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............._ft 5 smaller of 2'or u3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U= plf Lateral.............................................(Table 12). ................................. . .....L= plf Shear..............................................(Table 12). ................ .......................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13) = pif Gable Rake Outlooker.........................................(Figure 20)............._ft 5 smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(Table 14).......................................L= lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)............ Roof Sheathing Thickness........................................... .............................................. in.Z 7/16'WSP Roof Sheathing Fastening...........................................(Table 2)........................................................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal.straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMxs301.2.1.1)i 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height, Sheathing and Nall Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16'and be installed as follows: 1. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. ill. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -MEN the EDGE REM ON R3AMWG WEsd NALS At6'oa 11 u n u 1 u It I u M i ' 1 11 11 11 1/ 11 11 • 11 11 II 1 11 I l N l g If fl A 1If IF 1 II 4 F b I I 0 �Jy7 l m fl j'j Z 1 I 4] II 11 it •ii� 1 I u IL U tt I4lti 1 u 1 ^' If I i n Ts I If WJLSPACM PAN t II tl 1 1 •- M tll - �Ir See Detall on Next Page Vertical and Horizontal Mailing for Panel Attachment I i AWC Guide to Wood Construction in Sigh WindAreas:110 mph Wind Zone Massachusetts Checklist for Compliance (7so Cmx 5301.2.1.1)` ' ' 9 . t vs 1 IRAMM MEs ESE ER3iAED0.T£ I , aw --s_-i�---------�-- -----i- -;--- - -- ---i ST Wt at?ATi�iN PANG PA1VEi.AGE DOUBLE NAIL EDGE SPACING DMAL Detail Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7s0 Cmx 5301.2.1.1)1 FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a 110 mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM 1 oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category (B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if fd11 height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. ��►,�, Town of Barnstable Building Department Services n'""'�'• Brian Florence,CBO D ��� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - f If Using A Builder as Owner of the subject property hereby authorize VT/1Y71/ /(` � /�-� ��� 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 specttons are performed and accepted. ignature of er S' ture of Applicant ya/hV Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOIS Rev:09/16/17 Town of Barnstable . Building Department Services -Brian Florence,CBO. ' qp Building Commissioner 200 Main Street, Hyannis,•MA 02601 sw,80terw SM KAM www.town.barnstable.maus: 059. Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE.EXE PI°ION Please Print. DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: s city1town• state yip code t' The current exemption for"homeowners"was extended to include owner-occupied dwelling 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:\WPFUM- \FORMS\building permit forms\EXPRESS.doc 08/16/17 r FILE NO.: 14 3 96Z ,. lyIORTGAGE INSPECTION PLAN N EGISTERED LAND DEED BOOK:13920 — PAGE.318 A ADDRESS: 40 T ORG T 2 5040 PLAN BOOK: 290 PAGE:55 LOT(S):� ATTORNEY: W 01 FIC ON PLAN NUMBER: OF ��: N M MORTGAC COR REGISTERED LAND k F. A f Off,R N EL TAY A AN KIS AppUCANT: PH & SCALD '•c30, REGISTRATION BOOK: PAGE: DATE: 5 3 CERTIFICATE OF TITLE: PLAN NUMBER ,FLOOD HAZARD INFORMATION .� FLOOD MAP COMmL,.%JTY NO.' ,5091- ZONE: c ASSESSORS MAP , DATED: 08/19/1985 MAP: BLOCK: PARCEL.,_ R � PANE: 0015C IVY N/F OSTERVILLE WOODS LTD. 100.00' `p - LOT 52 ! 15,000 S.F.t " �' .. �0; os�� DECK �-vs% LOT 51 $ LOT 53 9 150 Y N t 2 Y ri .SVIV WEST WIND CIRCLE d MORTGAGE LENDER USE ONLY THIS 15 THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT �c4. OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE D�t7j ij�T>Cp[� � •�p�si tLt.[47 INSURANCE COMPANY AND.ABOVE WR A y y AND�LENOER.:,, e � + TFA NC THERE ARE NO DEEDED EASEMENTS IN 'THE ABOVE REFERENCED 'a KENWOOp PROLE, f,UITE 8, FRANKUN, MA 02038 .. a DEED OR ENCROACHMENTS'WITH RESPECT TO BUILDING$ SITUATED TEL•(800)287-8800 FAX:(508)528-4blI.,, ON THIS LOT EXCEPT AS SHOWN. ;? + '?I THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN ' A SPECIAL MOO1Sll ZONE. �R y BISSONN THE LOCATION OF THE DWELLING AS SHOWN HEREON EITH)R 40. 31300 WAS IN COMPLIANCE WITH THE LOCAL ZONING BY-LAWS IN Y.. ,p� t EFFECT WHEN CONSTRUCTED WITH RESPECT TO STRII� �, .� • 5'' SETBACK 1EEOUIREMENTS ONLY),`OR IS EXEMFT,F'ROV VW A CeO ' LA'S 1 ENFORCWENT ACTION UNDER W SS,-G.L. TRL�041. CtJtPTT f' 44A, y t , w SECTION'.?. „ . �,` ,'� � � t_ � � •` ■ :� � ��■ n ' � ■ �Q��� ���� �_ ■ ■ ■ �� � �� ■ • •, �'�_ ■ . � �.� .� a� . � . . � . . � � ■ � �� N � ■ �� ■ \ � a .� ■ ■ ■ 1 •�� � ■ ■ � ■ �� un p A 7 k --I ---------- -....- - - - - -- - -- ti _ t Age 10 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 240 w sf- wj nrl -�rcle Ost_Pryi 1 1 r. Maac_ j i Owner �`hael Taylcsr l Date of Inspection: 4130103- SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system Including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public Vter supply enters the building. 4 r vt � ' 5'© u1i' s?r w r,vd C � R c 10 �. AC R CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDdYYYY) 9/19/16 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. 1 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 NAME: United Insurance Agency, Inc. PHONE 508 759-6595 F^X Na; (508) 759-3822 199 Main Street auIAIL , P.O. Box 1013 ADDRESS: Buzzards Bay. MA 02532 E INSURE S AFFORDING COVERAGE NAICN INSURERA:Atlan is Casualty INSURED I John Mackenzie INSURERB:Trave erS+ Indemnit ,I 248 Camp Street I NSU R ER C: • L 1 INSURERD ) INSURER E: West Yarmouth, MA 02673 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 REDUCED BY PAID CLAIMS. IN RI ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MM/DDVYYYY LIMITS A GENERAL LIABILITY L117002318 9/23/16 9/23/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ` DAMAGETORENFED c $ ZOO OOO CLAIMSaNADE }{ OCCUR ocrrenME EXP(Anyone person) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2 000,000 GEN'LAGGREGATE LIMITAPPLIES PER t : '•PRO- PRODUCTS-COMPlOPAGG $ 2 OOO O00 POLICY LCC a AUTOMOBILE LIABILITY INEDSINGLEI I Ea accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWN�D SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPE DAMAGE AUTOS er a RTYcc dent $ "M k UMBRELLA LIAB OCCUR $ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - B WORKERS COMPENSATIONS $ AND EMPLOYERS'LIABILITY 6HUB0632289116 9/24/16 9/24/17 X WCSTATU- I 1OTH- ANY PROPRIETORIPARTNERIEXECUTIVE Y I N OFFICERIMEMBEREXCLLOED7 NIA E.L.EACH ACODENT $ ZOO 000 (Mandatory In NH) Ifyyesdescribeunder ,. E.L.DISEASE-EA EMPLOYE $ 100,000 DESG�RIPTION OF O RATIONS below S E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is regui red) Carpentry Workers Compensation policy does not include coverage for John Mackenzie CERTIFICATE HOLDER CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE John Mackenzie THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 248 Camp St I, r . .l L1 AUTHORIZED REPRESENTATIVE West -Yarmouth, MA 02673 ..P; f Kris Dexter 'f P ©1988-2010 ACORD CORPORATIONACO . All rights reserved. Phone: 25(2010/05) F '°. The"ACORD name and logo are registered marks of ACORD Phone: 1Fax: E-Mail: diion55@hotmail.com :y 4- t t ` 1 ' -161 '�+' ea,m,na�zcuecz/l1 a�cYl��uuc/zzare(la Massachusetts Department of Public Safety a Of.'C- ofCousumerAtfays&BusmessRlguljlhou ,;� Board of Building Regulations and Standards lug OMETIMPROVEMENT.CONTRA_CTOR - License: CS-085363 Registration: 183593� TYPe �.,, r. .' . + � ti �., Construction Supervisor 1 s ,., Expiration m'1D/28/2017 ,ijlndividual O N MACKENZIEy + u r t JOHN A MACKENZIE 248 CAMP ST.L-1 A T = WEST YARMOUTH MA JOHN".,MACKENZIE s .. " 248 CAMP.ST,,L.1 ' ' W:YARMOUTH,MA 02M�`'``s•,F• i -� s j�w % �: Undersecretary Expiration: f Commissioner 01/03/2019 Atsessor offioe (1st floor): // l Assessor's map and lot number ..�4(. f /./ ����.�(• `�x''��v'-f ��c ` `Q OF THE TOE 3 V�� AD1��7iauV �MV••.t Nc�'T ��? O� Board of Health (3rd floor): Sewage Permit number ..............................�?.�?.. 1. .re c Soso �`� 1 f} = B�9TnnLE, Engineering Department (3rd floor): n {�a"A Se )-t,c _ 'INhV v raea �,/ 6.J L � fps,1639• \0 House number .............................Ay...�•`0..... ............. ....• -Zoe 7 �o W� 0,1 �F�NOa- APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR ' APPLICATION FOR PERMIT TO /t!<' CI-sL- S,�IU. F.C'ref'.....�!`....�Q/J.... s.`�Cl.. (' .................... TYPE OF CONSTRUCTION .......6/'0.Jl1................................................................................................................ ' 19-- TO THE INSPECTOR OE; BUILDINGS: The undersigned hereby' applies for a-permit ,according to the following information: Location .... ....w4sr-•... /.% /0.....(.111ff'.G. ...............O.S'7.&ff'/��. ....................•.................................. �50,1ZJ-.....A'0-0 ...Proposed Use ...... 1'17........................................................................................................... ........................ Zoning �' ....Fire District .....................( • �•.��...../U.. g District ...................�:........................................... ........� l... Name of Owner /;V....:�a �C..l_: �.................................Address .e?':Q..... S ..�rt�l/dU2....G••% '.i... 5.�l�U/•LLL Name of Builder ..J..•.. .0 �. �. .!M. .�..!.!.I......Address ...�.T..`r... ��/��'....Po�U...!e� /�L S ........ . ....... ....... .�. .. Nameof Architect ..................................................................Address ..............................•.............................•....................... Numberof Rooms ...... .........................................................Foundatio4j, ..............................................•.......... 5L a�' Exterior .... ..............................Roofing ....:./.��. /�f✓!, L., ................................................ Floors ..../ .....T' '.J... l�G!Q?. p...:,Y�...t�•i9.•IS°1.ve,71.".....Interior ....../.9t y.....`S!YGCT f���/"..... !y.......................... Heating ..............................Plumbing ....... ........................... t� Fireplace ....../l/Wtiv.l= .'.�i�-, Jr ........ a :.......... . i :. Q Approximate;Cost �. . . ............... Definitive Plan Approved by Planning Board __________________________ ________ . Area ......... -r/,-�n....... Diagram of 'Cot and Building with Dimensions f` ( 9 g Fee ............. t........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS —7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..7? ..........................:................ Construction Supervisor's License .... .!...����S MR. KELLEY A=121-01,1-023 No -3.0-2.5.5.. Permit for ...Enclose ..Enclose...Pe.ck. .. .. . .. .. . .. .. .. .... & Add Deck/ Single Family Dwelling .......................................................................... Location ......240 West Wind Circle 'Osterville ............................................................................... Owner .......Mr. Kelley , ........................................................... Type of Construction ..........Frame........................ ....... ............................................................................... Plot ............................ Lot ................................ December- 8 , 86 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19, yo it l _ kseSsor'S offioe /Ust floor):, " ` ` Z rC_ THE Assessor's ,map and lot number ....... . . �j' ` ' 3 15R (� , AQA17toiN ,n^u5r NUT' Board of Health .(3rd floor): q v Sewage Permit_ number .......................I....... ... ...1. 6� ctosov �1^� 1afr Z B8Bd9ISDLE, i Engineering Department (3rd floor)-x , -F�a*ti S�t)4. T^� K, +o 2639 House number ......... J't•;..d.yo......1!!.0✓ �^s. o,s�+6}9. \0 APPLICATIONS PROCESSED 8:30 9:30•A.M. andi 1:00-:2:00 P.M. only N;;pT" YSTEM MUST BE T OWN 40 F "B,A R N S T XR, IN COMPLIANCTF BUILDING/ �iNSPECT44 o ®� E�T�� 5 CODE AR'T' RE APPLICATION FOR PERMIT TO y��l1-SL-. (lIU. E..('e('..... .... oleo....TOyp�t1.:G ONS. .. .................. TYPEOF CONSTRUCTION ....:.r!i11.0.0,Q......:......................................................................................................... ....................:.........................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....a3io.....War...4.11 z.....ane.4.c...............C./..S1..eX..V1KL,e......................:............................... p ProposedUse .... 11..4)...../,).l�om. . ..............................................................................:..................................................... Zoning District ................... ...............................................Fire District (/�................C. ..... ...... ......................... Name of Owner ,G..P'.........................:.........Address ?1/1 ......4/ksr.....1�/.�llO....C'✓�.i..�..5'1.C.�C�I.I�GC Name of Builder ..4, ft..Yl.......C.19.i Cr.Q�.....Address `�...f`O/U� �.��...!F�... , Nameof Architect ..................................................................Address ...................•................................................................. Number of Rooms ....../.........................................................Foundation ..9A.0.C.I.f'....................................... ................... Exterior ....I ..OQ,0..... ..............................Roofing ...., 4. ................................................. Floors .... �.... ..7 L. ..4,.O.04... Y.'.. F?Ccf".....Interior ...... zcT Heating .-..................................Plumbing .......I)IO.' e.................................... . ................. Fireplace ....../.1/ A:57 .....Approximate Cost ..�.,� �—OQ,00 r... ..........Q.../..................... . Definitive Plan Approved by Planning Board ________________________________19________ . . Area .......... ....�..,.�:. ......' Diagram of Lot and Building with Dimensions Fee ...............:-�..®................... SUBJECT TO APPROVAL OF BOARD OF HEALTH o /4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .. .... .._... ........... �................. Construction Supervisor's License ........... ........................ MR. KEIULEY 30255 /nclose Deck No ................. Permit for .................................... &. Add Deck/...Single ...Dwelling ..... ................... ..... .. ..... Location .......24.0 West Wind Circle .... .................................................. Osterville ............................................................................... Owner Mr. Kelley .. ..................... ................................. Type of Construction ......Frame .rm.e......................... .. .... .. ............................................................................ Plot ............................ Lot ................................ Permit GranIdd ... December 8 ..................I............ ......19 86 Date of Inspection/747Z7...................19 Date Completed ...... 7...............19 4 I HEREBY CERTIFY THAT S ,GOT IS NOT LOCATED /At FFp-me,,4k FI-00P HAZARD ZONE "AS SHOWN ON THE F£PERAL FLOOR INSURANCE RATE MAP FOR THE rOWJV_ OF F r` COMMUNITY PANEL NO. EFFECTIVE PATE] R0BER7 E. RAYMONP, R 4.%5 PATE NOTE: NORTH ARROW NOT*TO 0 BE USEP FOR 60449 RMvp SE3 y O Opy j .•1oo . 00 a LOT 52. 15000 SF L,OT Sk 0 0 o o Oe � y -S y 8 Foth.lD�TI 8 D 20.32 za 7e ,- 13.8 O 10o . 00 WEST WIND CIRCLE o. .THIS PLOT PLAN WAS NOT MADE FROM FOUNOAT/ON 4OCAT/ON .ioLAN AN INSMIWeNr SURVEY ANP /S FOR ME LOT 52 USE OF THE BANK ON4 Y. UNDER NO CIRCUMSTANCES ARE OFFSETS rO BE WEST WIND CIRCLE USED FOR FENCES, W,441.%5, HEDGES, BARNSTABLE MA ' OWNED BY. a - ��ZH OF s f,9 .4,ff)fO Y ENGINEERING INC. ROBERT60 EAST F.4�GAlOUTH HIGHWAY RAY,,E. E•�ST #cA4m0[/TH, A O.Z536 No.21 iEi3 SCALE:80 PA SHEE P PRAWN BY: CHEMPBY APP2 BY. PLAN NO. v7 ll� u // Assessor ap and lot number ... �• �.e�'�..�.�a,. Rat, �� SINE t0 Sewa je Permit number .............t!..:.1..... 1 V D ^, �jM r-U,,*XCS //�//y,� pye/ {� !NP11'- T17LE, v' t BAHH9TODLE, i House number �� ....4r f�� 7GF9�rV�bM"� 5lA u�d' � � ''- `;i� 9� NMa ................. ..... .. ... ............................ 039 TOWN M TOWN OF BARNSTABLE BUILDING::"; INSPECTOR APPLICATION FOR PERMIT TO .................I... .. .... ...................................................................... TYPE OF CONSTRUCTION ..........G!(,� .. .....r.. .�C°.........I�.(,11�C.:r.L `�,1��� ............ ...................../.0.'1........19. TO-.THE INSPECTOR OF BUILDINGS: ! The undersigned hereby applies fora permit according to the following information: Location .......° ........W... ..t.7..... ...... ....... .. .�%f�..✓.` �1 ProposedUse .........f ..9/1 ,.�.: , .,Rf..�p'....................................................................................................................... Zoning District l. .........................................Fire District (f.—.0 .... ... .................................................... Name of Owner ...D.0,A11V1j......f.7,69...C®Y!, .Address .... Name of Builder ......SPE--A<1.... t'/.° rd' /Y /jAddress ................. i. .l .r .Yf�(�..�.� ................ Name of Architect ..................................................................Address ...............t.....�.11 ..f ................. Number of Rooms 2...OR...... Foundation .....���°���.....G,��.lv�a.��.�..T..rF..... Exterior .... Roofing ....... ............... Floors : �� . .. 7�..�......................................Interior ......... .. y..... . ...rJ .. .............................. Heating 1'T..V... .. � �'rA....O.Y...r ..lT. ?...:.....Plumbing .........: ........13.171.-1ZI............................... Fireplace ........................I. �......................................Approximate. Cost 3. ... _f ............... . .... ........ ... ........................ Definitive Plan Approved by Planning Board ---------------____-----------19________. Area .......................................... Diagram of Lot.and Building with Dimensions Fee ........��/.................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH IA 40 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .... . ......... Construction Supervisor's License ........�f ..�° ,ai. DENNIS STAR CONSTRUCTION 28796 1 . ... Permit for On.e...Story .............. Single Family Dwelling ................................................. Location Lot 52, 240 West Wind Circle ................................................................ Osterville ............................................................................... Dennis Star Construction Owner .................................................................... Type of Construction ..................Frame........................ ................................................................................ Plot ............................ Lot ................................ Permit Granted .... ........19 85 Date of Inspection ......................................9 Date Completed ...... ....19 14,9 01-110:2-0 A TOWN OF BARNSTABLE . BUILDING* DEPARTMENT tkDARIST. TOWN OFFICE BUILDING OAS& 1639- HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for ,the building authorized by A Building Permit #........... 4. ............................................ issued to ...... ...........at-$11-174— Please release the performance bond.4W :'�"``<.°..+'.-�C,"'r'A rti; "zj�_ ,�. .< - �.')f'. :yr "�. :ter;"y.•:,,`���::f._.,.,q.a.� `W � .fir ::�krf"-.�'�Y.x . '.e... •e- �r.�.iu�5^,r:ter. �4j w o�TM� TOWN OF BARNSTABLE Permit No. __--_28796_ 4 Building Inspector Cash 1639. OCCUPANCY PERMIT. Bond _- - - 1� i Issued to. Dennis Star Construction Address Lot #52. 240 West Wind Circle. Osterville r� Wiring Inspector ° Inspection date Plumbing Inspector Inspection date ��� Gas Inspector }S 1�" a� no Inspection dated Engineering Department Inspection date Board of health \ 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 1152 � 5A A0, Building Inspector - Assessor's .map and lot number ......... ofINEto Seyvage-fermit number ...................................... .............. Z EARNSTAME, i House number .. pew 039. ♦� 't D Mix a\ TOWN OF BARNSTABLE BU�LDING INSPECTOR APPLICATION FOR PERMIT TO r ........................................................ TYPE OF -CONSTRUCTION ..........&.ttzi �rEa;1 .. ..... ��.r-�.��1.! ..........n.l.. . ............. ................... . ........19. ZK TO THE INSPECTOR OF BUILDINGS: The undersigned jhQereebby applies fora permit according to the following information: �/v W �..,f �1 Location ................... .....I....... .......... ......CJ :- ...........L✓..a1�,1�......(5... ...........f .......v.. ProposedUse .:...... ...,,1. !t�.A�...�—.�-;J..�../....c. .................... ..................................:: ............................................................ Zoning, District ............. ........................ .................Fire District ........................ Name of Owner ....J .+I NN/'r.... 7r� ...�1 /��:;(7Address 6-ow.. ..................... ./ .��.. ...... Name of Builder ..... )..��.t✓A.0....7ht�.w-'...O..y X.1.10.k, Address ................. ~ .. /.I (.,..(�.7, ................ Name of Architect ..................................................................Address ............. ...... .. .f/ �J v..T...................... Number of Rooms ...P�. .....1:..1.V.....n/,/��, �t /TFoundation �� (J G�N�. F...T F. . Exterior ....ln/...I-f:.LT.45...a. ��....Roofing ........ /�N.� .......... .............. k Floors ....... .....................................Interior .........h...Pl.y.....��. ... .............................. He"atin g-- �'- y�, 1.. .... .....�... :: ....... ...:.:-:Plumbing :.:....... b - Fireplace ...................... .C2 & .r.................... ...........Approximate. Cost .............. . .X-(�C'�..0 v................. Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .......................................... Diagram of Lot.and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH y. jy r , t 4o f 6 v OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ...... Construction Supervisor's License .........011-t DENNIS STAR CONSTRUCII"=121-11-23 No .18.79.6.... Permit for QnA..59Q.V.Y............... Single Family Dwelling ...........4t................................................................... Lot 52, 240 West Wind Circle Location ................................................................ Osterville ................................................................... Owner ...........P-Q-Uni-s...atar...Qms.ttuctictn.. Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ......December 23, 19 85 ........................ . Date of Inspection .....................................19 Date Completed .......................................19 Town of Barnstable *Permit 0 L� (�-- Erpires 6 months from Issue date �� eS Regulatory Services Fee 3 t qd S p�p Thomas-F.Geiler,Director M TD 4Y 31 ? �17 Building Division V/V 0 ��6 . Tom Perry,CBO, Building Commissioner BgRNsl 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint lap/parcel Number ra In roperty Address I esidential Value of Work �t�Dl'i Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address L A%Z AAZA,AC ` ✓ g 1p v v ` .ontractor's Name 0 ? v �w "l Telephone Number 439"^7 Jame Improvement Contractor License#(if applicable) L S�o D :onstruction S ervisor's License#(if applicable) n o A BE/ orkman's Compensation Insurance Check one: ❑ I am a sole proprietor' ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance assurance Company Name u� lam S Workman's Comp.Policy# ��U 1� " 7 .4 D A 7�— Copy of Insurance Compliance Certificate must be on file. Permit R=ing old shingles) All construction debris will be taken to S2 K ttT/j ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) '`Where requited: Issuance of this pertnit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Impro east Contractors License is required. e . SIGNATURE: Q:Forms:expmtrg Revise071405 LATZ Pro perties ' LLC Commercial & Investment Estate / Management &Real COREY Stephen Latzanakis/ Owner, Manager Office 781-369-1067 Mobile 617-721-4146 pi q C 770, 18 Cambridge St.,Winchester,MA 01890 va1111VUL11 kd. #115, Centerville, MA 02632 C. ERTA. 1', NTE E D LAND MmARK 3-Q -- AR ARCHRECTURA, L STYLE RE_-` : R_ 0. 0, F1NQ PROPQ $ A. L. May 27,2006 STEPHEN LATZANAKIS INSTALLATION ADDRESS: 18 CAMBRIDGE STREET 240 WEST WIND CIRCLE WINCHESTER, MA 01890 OSTERVILLE, MA Office: 1-781-729-1000 Cape: 1- 508-428-9176 Cell: 1-617-721-4146 FAX: 1-781-446-7539 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove And Haul Away All.Of The Old Asphalt Roofing Shingles. Any PLYWOOD SHEATHING Needing Replacement Is Included In This Proposal. Supply and Install CERTAINTEED LANDMARK AR 30: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, 245 POUND EXTRA HEAVY WEIGHT, SELF-SEALING, 70 MPH WIND WARRANTY, MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive COPPER/CERAMIC STONES with a FULL 10 YEAR WARRANTY AGAINST ALGAE CO TAMINENT COLOR: Supply and Install CERTAINTEED WINTER-GUARD (Ice& Water Shield )WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves,Valleys,Under the Step Flashing on the Skylight, Chimney and Gable Walls. Supply and Install HICK'S VENTILATED ALUMINUM DRIP EDGE on All Living.Area Main Eaves. Supply and Install 15# SATURATED BLACK FELT UNDERLAYMENT PAPER Supply and If Install AIR VENT.SHINGLE VENT H RIDGE VENT on All Four Main Ridges. Supply and Install ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL. � 9�►O 0.00 Payable immediately upon completion. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra at the Rate of$50.00 per Hour Plus Materials Plus 20% Overhead Mark-up on the Total Extras. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLESCOREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and then on a pro-rated basis for 30 Years Total if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a 70 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra charge,over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance upon the above work.. This proposal may be withdrawn by us if not accepted within thirty days. COREY & COREY carries Workman's Com ensati and Public Liability Insurance on the above work DATE OF ACCEPTANCE: V~ ACCEPTED BY: SUBMITTED BY: 4A $ nLES YHOMEOWNER C® RE i ;:.;isi>:;.>:.:�:.;>:.>i;;;:.:i:;-;:.ii:;.ii;:•;i;ii::::.::.;i::.:::::.:::::::::::::::::::::::::::::::::..:�:::::::.._:::::::::::.:......,:...:::::.::::.::.:::::::::::::::.......... :a�:`:::2;::::�::::::k:::;::::::::::::::::::::::>:�:i'::;:5;:;;:;.:::•:c::: DATE D —17-05 (Mono �r» :.:J.v:isJ::::ii:niiiiiiiii:ii}isi!•:^iiiiiiiii:vi:ii:4::::•i:•i:ii:•: PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GOLDMAN & ASSOC INS FIN HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 933 FALMOUTH RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RTE 28 HYANNIS MA 026012319 COMPANIES AFFORDING.COVERAGE COMPANY 28HPP A THE TRAVELERS INDEMNITY COMPANY INSURED COMPANY COREY, CHARLES DBA B COREY & COREY COMPANY 1694 FALMOUTH ROAD N115 C CENTERVILLE MA 02632 COMPANY D ...................................... ....................................... ... .............. THISIS TO CERTIFY::T.::::..............................................................:.................................................................................,,,.......,,...................................................................................... ..............................................:::•::::::::::....::.�:::::;::::::::::::::::::::::.:.:�::.,•::::::::::::::-::>:;:i:-;:-;:,:::�:ii:•;::,�:::.;;:-;:-;:::.i:iii:>:-:•ii::-:�;;:;-:-;:-:>:-;>:�:-:::ii::;•::i:i:;•:;i:.iis:;:•>:•»>s»:�»»:�i:z>:;>:a:>.r:�:<s»:: THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATIO LTFI TYPE OF INSURANCE POLICY NUMBER DATE(MW%DD\Y1) DATE(MMIDD%YY) OMITS GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. g CLAIMS MADE r OCCUR .PERSONAL&ADV.INJURY g OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE(Any one fire) g MED.EXPENSE(Any one person) S AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) S PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT g AGGREGATE g EXCESS LIABILITY EACH OCCURRENCE g UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-0868C61-1-05) 09-14-05 09-14-06 STATUTORY OMITS ................................. THE PRO _ EACH ACCIDENT _ 6 100.000 PRIETOR/ INCL PARTNERS%ECUTIVE —^� DISEASE—POLICY LIMIT S 500,000 OFFICERS ARE: X EXCL DISEASE—EACH EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTTONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. :ERT JIrAT�=:Ht���D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ;THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE SAMUEL DAY GALLERY 4039 MAIN ST LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CUMMAQU ID MA 02637 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. • I AUTHORIZED REPRESENAUTHORIZEDTATIVE I ' I L The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 v�UqF www.massgov/dia 0 ..C- Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumilbers Anpligant bformation Please Print Legibly Name pwsiaess/Organization/Individual);_ Address: 169 y 15 Z.--y4uy, City/State/Zip: Po k.r v �O hme#. Are you an employer? Check the•approprlateb -:. Type of project1,❑ I am a employerwith 4. m a general contractor and I 6 employees (fall and/or part-time).* have hired the sub-contractors El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors hays 8,. ❑ Demolition working for mein any capacity. workers' comp.insurance . g, ❑ Building addition [No workers' Comp.insurance. 5. ❑Ve are a corporation and its required,] officers have exercised their 10.❑ Electrical rcpafrs oz additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs off• additions myself,[No workers' comp: c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t , employees. [No workers' 13.❑ Other camp.insurance required.j . *Amy applicant that checlrs box#1•muat also fill out the section below showing their workers'oompensation-policyinformstion: t Homeowners wbo submit this affidavit indicating they ere doing all work emdthen hire outside contractors must submit a new affidavit cadicatmg such tCoatract m that tEecTc this box must attached an additional sheet showing The name of the sub-contractors and Their workers'comp,policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below Is the policy and job site Information. S Instu'ance CompanyName: 't--� 7�..Q �✓ .. Expiration Date: Job Site Address: r✓ City/State/zip:(I ST �?Q� Attach a copy of the workers' compensation policy declaration page(showing the policy number and eapiration date). Failure to securc•coverage.as required undd Section 25A of MGL a. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.40 and/or one-year imprisonment, as well as civil penalties in the form oi'a STOP WORK ORDER and a fine of up to S230.00 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. 1 do hereby eerti der the pains and penalties of perjury that the information provided above is true and correct; Si ature: Date: Phone#: it 09- Official use only. Do not write in this area,to be completed by city or town official. City or Toms: Permit/License# Issuing Authority (circle one): 1.B02.rd of Health 2.Building Department 3.City/Town Cie rk 4.Electrical inspector 5.PluutbinD Inspeztor 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, _ express or implied,.&al or written." An employer is defined as-"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the . receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwcftg house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto,shalIm'otbecause of such.employmentbe deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or logo 11censing,;R ncy sha]I withhold-lbe issuance or renewal of a license or permit to operate a business orto construct buildings.in the commonwealth for any applicant�who has not�produced acceptable evidence of compliance with the insurance,coverage required." Additionally,MGL chapter 152,§25C(7)skates'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requiremerds of this chapter have been presented to the contracting authority."_ Applicants Please fill out the workers'compensation affidavit completely,by checle mg the boxes that apply to yeas situation and,if, necessary,supply sub-contractors)name(s),address(es)and phone mmlber(s)along with their certificate(s)of ins mce, Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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,-nut the•Deparkaent of' . Industrial Accidents: Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please can the Department at the number listed below. .Sclf-insured compaii=- omr�d tinter .1heir self-insurance license member on-the appropriate lime. City or Town Officials . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space at the bottom. of the affidavit for you to:0 out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permiVlieense number which will be used as a reference numnber. In addition,an applicant that must submit nmlti'U permit/license applications in any given year;need only submit one`affidavit indicating current 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 stamrrped or marked by the city or town°may be'provided to the applicant as proof that•a valid affidavit is on file for future pemmits or licenses, A new affidavit must be filled out each ' year.Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance fox your cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone and fax rmmber: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.'#617-727-4900 ext 406 or 1-o77-MASSAFE ' Fax#t 617-727-7749 Revised 5-26-05 www.mass,gov/din . I i •' BOARD OF Bl11LDIN,G REGUI-ATIONS License: CONSTRUCTION SUPERVISOR ' 002881 { hila 1.943 Bi t, I 08 19666 i 14724 Tr.no: y 111' ReAtri d ._ CHARLES E COREY -=_ I 1694 FALMOUTH �= 32 mmissioner CENTRERVILLE, Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPT_OVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration�136066 g.Reg = - hie Asti rtori�Place Rm 1301 xprat drt;_6%6/2006 Boston,*a.02108 COREY&COREY i �1VIO EMENTS CHARLES CORE 1684 FALMOUTH RDa#1`15�./V CENTERVILLE,MA 02632 Administrator Not vall wit ature