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HomeMy WebLinkAbout0196 CHURCH STREET 'j i 0 RECYCLED, ® Uzi IIII UPC 12543 No. 53LOR OtpOC7,��ti5J HASTINGS, MN 4 KE Town of Barnstable Building •'RARN$GBLE. Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept j Posted Until Final Inspection Has Been Made. Permit'�ForAn'° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. _ Permit NO. B-17-4130 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals - Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location:- 196 CHURCH STREET,WEST BARNSTABLE Map/Lot: 153-006 Zoning District: RF Sheathing: Owner on Record: RITZMAN,JANE F Contractor Name: BRIAN D DENNISON Framing: 1 Address: 196 CHURCH ST Contractor License: CS-095707 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $ 11,256.00 Chimney: Description: REPLACE 8 WINDOWS .29 U-VALUE Permit Fee: $57.41 Insulation: Project Review Req: Fee Paid: $57.41 Date: 11/30/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to'Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r r Town of Barnstable *Permit# �-�� — y 13 0 P .1, Expires 6 motulrs froin isstte date Regulatory Services Fee NAM srner s v 1 .0�p Richard V.Sca6,Director iDlEo nta't t: Building Division Tom Perry,CBO,Building Commissioner 200 Main Street.Hyannis,MA 02601 www.town-bamstable.ma.us Office: 508-862-4038 Fax: 503-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTS ONLY _ Not Valid without Red X-Press Imprint Ntap/parcel dumber A5 S Property Address /9� 1!h01-d ��t< 1^� - [Residential Value of Work S 4/. Z S F, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 71,n e (�lT 15jo n L M A Contractor's Narriesfy��Jy? ALE 'Avt.1 - AP,27/1 ( //r sp/( Telephone Number �(o 1 2. Rome Improvement Contractor License#(if applicable) .1 '3 2 �/ J5- Email: Construction Supervisor's License#(if applicable) Oq �; 7 O 7 calworkman's Compensation Insurance Check one: ❑ I am a sole proprietor QX m the Homeowner I have Worker's Compensation Insurance Insurance Company Name Rr amc n.5 Tnsur-a-,cp Workman's Comp_Policy# W C A 3/ S 8 7 2 9 — 2— Copy of Insurance Compliance Certificate must accompany each permit. .P Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side _ S Replacement Windows/doors/sliders.U-Value . Z (maximum 32)#of windows of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: issuance of this permit does not c..-cmpt compliance with other town department regulations,i.e.Historic,Conservation,etc. y ***Note: Pcoperty caner must sign Property Owner Letter of Permission. A copy cAthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\DecollikWppData\LocaNWicrosoR\Windows\Temporary Internet Files\Content.0utlook\2P10I DHR\EXPRESS.doc Revised 04Q215 Rentwal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England Y 81 Jane Ferguson Legal Name:Southern New England Windows,LLC 196 Church Street RI#36079, MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 w1Mo0w NE uCEMEM1 10 Reservoir Rd I Smithfield,RI 02917 H:5083629533 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Jane Ferguson Contract Date: 11/11/17 Buyer(s)Street Address: 196 Church Street, West Barnstable, MA 02668 Primary Telephone Number: 5083629533 Secondary Telephone Number: Primary Email: mamaferg@hotmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $11,256 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $0 Balance Due: $11,256 Estimated Start: Estimated Completion: Amount Financed: $0 8-10 weeks 8-10 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Cash/Check the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 1/3 DEP 1/3 ON START OF JOB 1/3 ON COMPLETION. Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/15/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Eric Woods Jane Ferguson Print Name of Sales Person Print Name Print Name UPDATED: 11/11/17 Page 2 / 12 Massachusetts Department of Public Safety 'oil Board of Building Regulations and Standards License: CS-095707 Construction Supervisor ; BRIAN D DENNISON 7 LAMBS POND CIRCLEE, Mn,, CHARLTON MA 01507V; = Expiration: Commissioner 09/08/2018 .�� 07.1 (251 ¢2� Office of Consumer Affairs And Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improver e' : Contractor Registration Repistration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WIND,OV:V_S iI= BRIAN DENNISON ,Iy 26 ALBION RD LINCOLN,RI 02865 Update Address and return card Mark reason for change. scn:a 20w4W ❑Address [i Renewal I-Employment ❑Lost Card o�,0AI Ladd,..,. V ifrx oI Coasnmer Atrairs&Business Regulation Registration valid for individual use only before the expiration date If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Regisuation;. j3245 Type: 10 Park Plaza-Suite 5170 ExplrgM: %78rP2018; Supplement Card Boston.MA 02116 SOUTHERN NEW ENI&AND;WWDOWS LLC. RENEWAL BY ANDEE_1SONi;r BRIAN DENNISON 26 ALBION RD LINCOLN,RI 02865 t„pyae rtr=y Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorsiElectricians/Plumbers. TO BE FILED WITH THE]PERMITTING AUTHORITY. Applicant Information G Please Print Le 'bl`! Name. (Business!Organization/Individual): e LQ L �tUs Address: ,,& IQQ City/State/Zip: LtjtjjP Phone 4: Are you an employer?Cbeck the appropriate box: Type of project(required): 1..l am a emplover with ZO femployees(full and/or pan-time).' ?. New construction 2.❑I am a sole proprietor or pam- ership and have no employees working for me it; S. Remodeling any capacity.[No workers'comp.insurance required] 0. ❑Demolition :.�]am a homeewne;doing all work myself rl%to workers'comp.insurance required.: 0 Building addition 4. I am a homeowner and will be hiring contractors to conduct all work or:my property. I Aril) ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietors with nc employees. 12_QPllunbine repairs or additions ` 1 am a general contractor and]have hired the sub-contractors listed or the attached sheet. 1= These sub-contractors have employees and have worker'comp.insurancE .Roof repairs= Q / e We are a co�oretior and i_officers have exercised their right of exemption:per MGL c. 14.�Other_ /�YI el trr. 15L,f i,(4),and we have ne employees.[?vo workers'comp.insurance required.! I 2ololQ ni! � S 'Any applicant that checks box rir•t.must also fill out the section below showing their workers'compensmior policy information. Homeowners who submit this affidavit indicating they are doing all work:and Cher.hire outside contactors must submit a new affiidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitiu have employees. Lithe sub-contractor`have employees,they must provide their workers'comp.policy number. I am an emplover that is providing worAers'compensation insurance for my emplovees. Below is the po&cl•and job site information Insurance Company Dame: lire me S Policy#or Self-ins.Lic.4: W z g - Z- Expiration Date: 1 O Job Site Address: l9( (--A("-C_I- City/State/Zip:ry• A Attach a copy of the workers compensation policy declaration page(showing the police number and expiration date)• Failure to secure coverage as required under MGL c. 152,E25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment_as well as civil penalties.in the form of a STOP WORM ORDER and a fine of up to$250.00 a day against the violator.A copy ofthis statement may be_forwarded to the Office oflnvestigations ofthe DIA for insurance coverage verification. I do hereby M:ZIE penalties of perjury that the information provided above,is true and correct Si mature: Date: /- -/ Phone#: I(w Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License g Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4_Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone..*: ESLERCO-01 SANDERSO l DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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. 77-7 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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). COMTEACT PRODUCER CoBiz Insurance,Inc.-CO PHONE 303 988-0446 jaC,No):(303)988-0804 1401 Lawrence St,Ste.1200 E- IL Ext):( ) E-MAIL Denver,CO 80202 ADDR CoMail@cobizinsurance.com ESS: INSURERS AFFORDING COVERAGE NAIC Y INsuRERA:Aradia Insurance Company 1131325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 i Southern New England Windows,LLC.dba Renewal by INSURER C:Liberty Surplus Insurance 10725 Andersen of Southern New England I 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE INSUNCE THE INSURED ED INDICATED. NOTWITHSTANDING ANYCIES REOUOIREMENTT,, TERM LISTED OR ISSUED BELOW RAVE BEEN O CONDITION OF CONTRACT OR OTHER DOCUMENT ABOVE POLICY ENT 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 I ADDL SUBR POLICY NUMBER MIDWUDU EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD INVD 1 QpQ,QQQI A I X COMMERCIAL GENERAL LIABILITY YYYI EACH OCCURRENCE S CLAIMS-MADE OCCUR CPA3158728 01/0112017 01/01/2018 DAMAGE TO RENTED 3OQ,000� PREMI E Ee ocamen� 5,000� MED EXF An one erson 1:000,000 l PERSONAL d ADV INJURY 2,000,OOOI G^E''L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE X I POLICY PRGQ ❑LOC PRODUCTS-COMP/OFAGG I5 2,000,000I u JET EBL AGGREGATE 5 2,000,000j OTHER: COMBINED SINGLE LIMIT 5 1,000,0001 A I AUTOMOBILE uABILnY Ea accidentI I I�ANy AUTO CPA3158728 01101/2017 01/01/2018 BODILY INJURY Per erson 5 OWNED SCHEDULED BODILY INJURY Per accident 5 AUTOS ONLY AUTOS PROPERTY DAMAGE i H: ,,LJTOS HIRED NON-OWNEC (Pe ONLY AUTOS ONLY S 1,000,0001 A X UMBRELLA UAB X OCCUR EACH OCCURRENCE CPA3158728 01/0112017 01/01/2018 AGGREGATE 5 EXCESS LIAR CLAIMS-MADEI Aggre a 15 1,000,0001 DED X RETENTION 5 01PER X STATUTE I ERH I B WORKERS COMPENSATION 1,000,000I AND EMPLOYERS LIABILITY Y 1 N CA3158729-20 01/0112017 01/0112018 :5 ANY PROPRIETOR/PARTNERIEXECUTIVE F i E.L EA ACCIDENT FICERIMEMBER EXCLUDED) ` I NIA EL DISEASE-EA EMPLO I S 1,000,000 (Mandatory in NH) 1,000,000 11 yes.describe under E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below 1,000,000 B Workers Compensatio CA3158730-20 01/01/2017 01/01/2018 117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION Worers OPERATIONS I LOCATIONS Includes-A I states except,ND OH,l Remarks WV WY ule,may be ached if more spare is required) I CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I{ ACCORDANCE WITH THE POI.IE'r PROVISIONS. AUTHORIZED REPRESENTATIVE I IF OR I n IP r ACORD 25(2016103) ©1988-2015 ACORD CORPORATION- All rights reserved. The ACORD name and logo are registered marks of ACORD AGRI BALANCEO 00. ® [I s V o 0 : b U 4 Company Name CAPE COD INSULATION Phone Number 1-800-696-6611 Jose Espinol Installation Date 04-25-2016 Jobsite Address 196 Church Street,West Barnstable A-Side Lot# s PA86001524 Permit Number B-Side Lot #'s 360492 Walls 5 Y2 R-24 230 square feet 9" R-40 240 square feet Attic Plates and Runners C 111 111 1 la�g4 I I NI 1 11%*moo 4 I iii I www.Demilec.com ; flZ •tj t-I'd Gut MUG DEMI*LEC �.. .. .. 7 _ ,...•_! Ha rir v.). r • .♦ `!:`�i'r r:`{. 9 .._. f _ s..f.S • _ .. _ ` v -. Town of Barnstable Q • Regulatory Services BARNSTABLE. MASS 0 Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location I y,6 (Hu-9Ck( ST 410 Permit Number 13- z0/S- !V 933 7 Owner A 7-a fit.AAA) Builder ��SC One notice to remain on job site,one notice on file in Building Department. The following items need correcting: " r vF T � � Lis iN T� fi �tl fl :. S F coy E leg s 77�can k� Q r , —fA?( l/6.�J S .�t� T��11� Oa- 7 Ja ore /V/?d C[L'-b• Please call: 508-862-4tM fsr x Inspected by Date b ZA /, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel Application # rzU Health Division Date Issued `I Conservation Division Application Fee Planning Dept. 00* F �.�V v Date Definitive Plan Approved by Planning Board R Historic - OKH Preservation/ Hyannis DEC 17 2015 Project Street Address / 6 C`Z oea- A Village Owner Fla vu-- lax vy Address Telephone Permit Request - �r• AA i l /2-X17 .Suyi Adal- , A 0A Square feet: 1 st floor: existing N" proposed V b 2nd floor: existing proposed Total new Zoning District 124F= Flood Plain X Groundwater Overlay x Project Valuation 304 CrOO Construction Type- Lot Size LK.S Grandfathered: ❑Yes **NA No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 5 Historic House: ❑Yes g g S No On Old King's Highway: ❑Yes 4 No Basement Type: gull kcrawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (s>q.ft) Number of Baths: Full: existing new Half: existing / new Number of Bedrooms: existing —new Total Room Count (not including baths): existing Y new First Floor Room Count s Heat Type and Fuel: I Gas ❑Oil ❑ Electric ❑ Other \\,, Central Air: . ❑Yes �No Fireplaces: Existing/New ?� Existing wood/coal stove: El Yes ® No Detached garage: 1 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 6n Telephone Number Address l� ►'► `a✓1,c� License # mar nSS`.c M 026-(of' Home Improvement Contractor# 1 T O 3 I Email 4 cl < < w Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO --2_ SIGNATURE DATE !t'/�A r FOR OFFICIAL USE ONLY � APPLICATION # -.. . DATE ISSUED MAP/ PARCEL NO. n ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ,t FIREPLACE + ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT s ASSOCIATION PLAN NO. r �V Town of Barnstable Regulatory Services MASS.M Thomas F. Geiler,Director .i639 �0 'OlF1639 Building Division t Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW o/So V s Owner: Rjl�'�C-Az Map/Parcel: Project Address 196 4akoellC . IVB Builder: A)Ey The following items were noted on reviewing: 0 Ze /Po40t `s tud 0. Ao y,d AJ e-S 7' 7:;.'=- �cQuif2F� `l/i,U,d �� ,�?l�1fiG«rs' /rJa r SAoSy r/. Ire, SdPIVO$ r Zn cfP /3-C-.A-rA- ��e� A4r—rE-OZS �i�i'yt�• Ar�iD&IF "N,6 e kr3' I-V 0604 017Wt - R V" Dr -r A* - V*r7 h�tw— 7eAma2 H.6 ® w��t/.Dcrz�d �i2o YK'Tra� �Zp`GI�L� /rlhArAl Reviewed by: Date: Q:Forms:Plnrvw ��Ctcd'�a�G •�c-s�> i °F r Town of Barnstable Regulatory Services r • a ■ 9S"M IE� Thomas F. Geiler,Director �A s6s9� �0 lE0.19.. Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW o/so V 3 s Owner: Map/Parcel: Project Address 86 CINatCA(Cr... AUB Builder: The following items were noted on reviewing: O a,v C--h Ir- �L'(ks 7- 4&WZAr;46 41,6ZI b �Tl 1f�Zs Ivor �t ASS 7;; e kr'�' iti '�Aq*6z"e- -!5'VA ® �t/6�J�OZ� /�2o ZE�^��o�✓ �zp�!i2C-� �!2ri�{�iV . / ��� of - ���,� /� G��,�-�• Reviewed by: Date:_ Q:Forms:Plnrvw the Conurrorrivealth of?4lassacliusetts Department of lndmtrial Accidents - - Office of fm�estigations 600 Washington Street Boston,?4IA 02111 wovttt rnasmgov/din 'Workers' Compensation Insurance Affidavit:Builders/Cant-actors/Flectricians/Piu nbers Applicant Infaiznation Please Print Le gib Name(Busmesslbiganizationmohidual): Aa�n,oy\!l Address: �' °—� Q4ICSA — o City/Sta&Zip,:W. Go,(y,,;66L 02-66� Phone:, ZO 0410 p hf t-L Are you an employer?Check the appropriate�bo Type of project(required): 1.❑ I am a employer with 4. [ i am a general contractor and I employees(full and/or yart-time). s have lured the sub-contractors 6. ❑New en tction. 2.El am a sole proprietor or partner listed on the attached sheet: 7. ❑Remodlilig ship and have no employees. These sub-contractors have g. n Demolition wo lino for mein any capacity: employees andhave workers' ,L�J/ [No workers'comp.insurance comp.insurance,1 9. Building addition required.] 5. ❑ We are a corporation and its M❑Electrical repairs or additions 3.❑ I am a homeowner doing all work offceas have exercised their I L❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12.[:1 Roof repairs insurance required.]T c. 152,§1(4X and we have no employees.[No workers' 13.❑Other comp-insurance required-]' "Any applicrat:that checks box Al maul also fill out the section below shavring their workers'compensation policy information. I Homeowners who submit this affidatrit iardic z they are doing all weak and then hits outside contractors nmst submit anew affidavit indicating such. :Ccnttactors that choir this boar must attached an additioml sheet shooring tha name of the sub-comnacb m and state whether or uat Those endtie-s have employees. Ifthe sub-contractors have employees,they must-provide their workers'comp.policy number. I attt•art eittployer tliat is prot.,fding workers'conrpettsagon insurance for ttty eniplo}-ees. Beioty is the policy and job site information. (Tllarei- �Ls Insurance Company Name: n Policy#or Self-ins.Lic.fi 1 Z 2 Q L-- (6 4 ZZ'7/� z) Expiration Die: � 1 Job Site City/State/Zip:W, pf j'��-�O� ,j�� Ivi o Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,50Q00 and for one-pear. smmemt,as well as civil pen alties.in the form of a STOP WORK;ORDER and a fine of up to$250-00 a day against the Nffiator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of1he DFA for iuWIce coverage verification. I do hereby certify under t 'is and penal es ofpeduty that the information prmaded abm�e is'true and correct Sitmature: Date: Phone Ofj`tcial use only. Do not write in this urea,to be camplded by city ortbim official. City or Torn: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions " . Massachusetts General Laws cliaptPr 152 regnh=all employers to provide workers'compensation for their employees. pursuant to this state,an owployee is defined as."_.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defnaed as"an individnA partnership,association,corporation or Other legal entity,or any two or more of the foregoing engaged in a Joint enterprise,and including the Iegal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do mafiit ance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employes." MGL chapter 152, §25C(6)also sues that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any, applicant who has not produced acceptable evidence of compliance with the insurance.coverage required_" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of ifs political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance:.. r meats of this chapter have been presented to the contracting aulhozity." e�„tee , Applicants Please fill out the workers'compensation affidavit completely,by checking hue boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificates) of ec am -a„ce. Limited LiabMty Companies(LLC)or Limite Liabfiity-Parfnerships(LLP)withno employees other than the members or partners,are not mqu aed to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurancecoverage. Also be sure to sign and date the affidavit The affidavit should be retimied to ffie city or town that the application fir the permit or license is being requested,not the Department of hidustrial A ccide:nts. Should You have any questions regarding the Iaw or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listrrd below. Self-insured companies should enter their self-Tn so:rance license number 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 in fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fM in the pennit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applications in any given year,need only submit cue affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant shoed,write"all locations is (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for Bit re permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.'a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would ae to thank you in advaaca for your cooperation and should you have any questions, please do not hesitate to give us a call- The Department's address,telephone and fax number: Tho Camnmweala of Masachusetts Depa rtcamt of h dlIstzal Accidents Office of ftvestigatio= 600 Washington Stet Boston,MA 02111 - Te 4 61'-'27-4900 ci t 4€16 c.r 1-�77-MASSAFE Fax 617-727-7M Revised 424-07 w w .ma.s�;_govjdia o� Tof� Town of Barnstable Regulatory Services .yob WA5M Richard P.ScaI4 Director '��► 16 BII.ilding Division Tom Perry,,Emlding;Commissioner 200 Maim Street Hyana*MA 02601 www.towibarnstable ran-us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ina A Builder as Owner of the roe subject J P P rty herebyauthorize #044LII e— to act on mybehA in all matters relative to work authorized by-this bmlding permit application for. (Address of job) o6�B g` ' Pool fences and alarms are the responsibilityof the applicant. Pools are not to be filled or uili ed before fence is installed and all final ' inspections_are performed and accepted. S' of Owner Signature of Applicant 73a2g e- .Fe-(-- LL s� . Print Name Print Name Dare . QFORIvrs:O W MERFERI+MMI e00L4 f. Town of Barnstable Regulatory Service Richard V.Scalt Director RuMi ng bivmon w t sas:+��T2T4 Tom Perry,Building Commissioner 200 Main StW4 Hyannis,MA 0260I wwwtown-barnstable.ma us - Office: 50 8-862-403 8 Fag: 508-790-623 0 HOMEOTRa R LICEM EXXAI?TTON ' -Plr�se Print DATE: JOB LOCATIC3TL sit vmag= "HONlFAWLgA: . name - bon=phoac# w0i3c phone# . 7 CURRENT MAZLLIDIGADDRESS: city/ftn- stafr rip code The current exemption for"homeowners"was extended to include owner-occed dweliinas of six units or Less and to allow homeowners to engage an nadividval for hirewho does not possess a license,provided that the owner acts as supervisor_ DEFUMON OR HOMEOWNER persons)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 strictures accessory to such use and/or farm structures. A person who contracts more than one home in a two-year period shall not be considered a homeowner. Such ahomeownee'shall submitto the Budding Official on a form acceptable to the Building Official,that he/she shall be pe Ronsihle for all such work performed under the building permit (Section 109.1.1) The undesigued`.`homeowner"assumes responsinility for compliance withthe State Building Code and other applicable codes, bylaws,rules and regulations_ - The undersigned`homeowner"cmttifies that he/she understands the Town ofBmmstable Bolding Depart nentmmimmn inspection procedures and requirements andthat he/she will comply with said procedures and reqairemeuts. sigpata=ofHomcowncr - Appraval ofBm7d"mgO&cial None: Three-family dwellings conforming 35,000 cubic feet or larger wMbe reqmied to comply with the Stafe BmIdiug Code Section f27.0 Construction Control- HoKowNEgIs FUKnzezTON 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-U-Liceuiskg of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such Mork,that such Homeowner shall act as supervisor." Many homeowners who use this:exemption are unaware that they are assuoniag 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 eususe that the homeowner is fuIIy 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 of this issue is a form currently used by several towns- Yon may care t amend and adopt such a formleerfifiration for use in your community. - Q.FIPFILFSTORIAS\bmZcrmg pc=dtfimaslEXPRFSS doe Revised 061313 r CAPECOD-27 KLIGETT ACORO" CERTIFICATE OF LIABILITY INSURANCE [7��311712015 "' 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 pol'icy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT NAME. ROgers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 ac N A►c No:(8 816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A,Peerless Insurance Company-see LIBERTY MUTUAL INSURED INsuRERB:SAFETY INSURANCE COMPANY 39454 Cape Cod Insulation Inc INSURERc:Endurance American Specialty Ins.Co. 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1�TR D TYPE OF INSURANCE R -POLICY NUMBER PrMMO OLICY YM EFF POLICY D EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. CLAIMS-MADE N OCCUR CBP8263063 04/01/2015 04101/2016 DAMAGE 0 PREMISES Ea 7N I LU rxe $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X LOC PRODUCTS $ Z,000,OO PoucY❑JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaacddert $_ 1,000,00 B ANY AUTO TBD 04101/2015 04101/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY accident)AUTOS AUTOS t1 g X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS acdderd $ X UMBRELLA LIAB rd OCCUR EACH OCCURRENCE $ 2,0P0,00 C EXCESS LIAR CLAIMS EXC10006635000 04/0112015 04101/2016 AGGREGATE $ DED W1 RETENmONS 10,000 Aggregate $ 2,000,00 WORKERS COMPENSATION STATE ER AND EMPLOYERS'I'ABILITY D ANY PROPRIETOR/PARTNERnD(Ecunvr- Y/N CE00431900 06/30/2014 06/30/2015 EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? FN /A (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 1,000,00 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remaft Schedule,may be attached N mom space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement With the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sandy Neck Builders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 84 Minton Lane ACCORDANCE WITH THE POLICYPROVISIONS, West Barnstable,MA 02668 AUTHORGEED REPRESENTATIVE 01988-2014 ACORD-CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ACC> CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DDIYYYY) 1 12/02/2015 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 NAME: Deborah Corcoran CLEARY INSURANCE INC. ipZ N E:t: (617)723-0700 FAX ONE No: E-MAIL ADDRESS: dcorcoran@clearyinsurance.com 226 CAUSEWAY ST. INSURE S AFFORDING COVERAGE NAIC q BOSTON MA 02114 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: SANDY NECK BUILDING AND REMODELING LLC INSURERC: INSURER D: 84 MINTON LANE INSURERE: WEST BARNSTABLE MA 02668 INSURER F: COVERAGES CERTIFICATE NUMBER: 15724 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO S(RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ER" AND EMPLOYERS'LIABILITY Y I N A OFF CER/MEM ERPEXC UDED?ECUl1VE NIA NIA N/A R2WC642290 08/14/2015 08/14/2016 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue-date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification -Search tool at www.mass.govfwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 06010 C Daniel M.Coo ley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i DANIJPE-01 CNELSON MDMM CERTIFICATE OF LIABILITY INSURANCE °A'�`°5/2812014/2014 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 endorsements. PRODUCER CONTACT NAME Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 1AIC.N Ext: AfC No)*(877)816-2156 South Dennis MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NATIONAL GRANGE-MAIN STREET AMERICA INSURED INSURER a:Main Street America Assurance Co. Daniel J.Peckham INsuRmc:Associated Employers Insurance Co. 11104 dba D J Electric 87 Audrey's Lane INSURERD. Marstons Mills,MA 02648 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M1DDIYYYY1 (MMfODIYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS-MADE a OCCUR MPT0400H 01/22I2014 01/22@015 DAMAGE TO RENTED PREMISES occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,00 POLICY ElJEC LOC PRODUCTS-COMP/OPAGG S 4,000,00 OTHER $ AUTOMOBILE LIABILITY COMBIN d.SINGLE LIMB $ B ANY Auto MlTO400H 04/28/2014 04/28/2015 BODILY INJURY(Per person) $ ALL SCHEDULED AUTOS N� X AUTOS BODILY INJURY(Per accident) $ 1,000,00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS er aaideid $ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A CLAIMS-MADE CUT0400H 04/28/2014 01/22/2015 AGGREGATE $ 1,000,00 HExEcE RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C. ANY PROPRIETOR/PARTNERIEXECUTIVE YIN CC5005008152014A 04/08/2014 04/08/2015 F1,EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 It yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101.Additional Remarks Schedule,maybe attached H more space Is required) —DANIEL PECKHAM IS INCLUDED UNDER WORKERS COMPENSATION"' CERTIFICATE HOLDER IS ADDITIONAL INSURED(FOR COMMERCIAL GENERAL LIABILITY,PER WRITTEN CONTRACT IN PLACE) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sandy Neck Builders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 84 Minton Way ACCORDANCE WITH THE POLICY PROVISIONS. West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD OSHA36-004930868 { } • i This card acknowledges that the recipient has successfully completed a 10-hour Occupational Safety and Health Training Course in t Construction Safety and Health E Anthony Nese (Peter Rice 66873 8/6/2014 (Trainer name—print or type) (Course end date) r Commonwealth of Massachusetts Department of Public Safety Iloisting Engineer License: HE-128057 ANTHONY M NLSE 84 MINTON IN._ 11M s West Barnstable,ZA� , Expiration: Commissioner 11/09/2016 --'-_�e�nvuitterrtrzfetcll/o�P/lll/J1Cec�use/,ld _ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR - _ egistration: 178731 Type: xpiration: 5/13/2016 Corporation �- SANDY NECK BUILDING&RtMODELING LLC ANTHONY NESE 84 MINTON LANE <c>. r W.BARNSTABLE,MA 02668 Undersecretary y Massa chusetts -De artment of Public Safety P Board of Building Regulations and Standards Construction Supervisor License: CS-090335 t `� IA.' ANTHONY M NE3* 84 MINTON LN ' F West Barnstable IOTA I66-8 . Expiration Commissioner 11/09/2016 ie.sv.... \ NEW WELL yy 0� \ y OLD WELLHSE \ O \ C \ m X i \ EXISTING POOL I k Dcr✓k 1 X . GAS i METER EXISTING EXISTING GARAGE DWELLING TOP FOUNDATION ELEV. = 51X I c-) Ir 1 I l / I EXI T. S.TANK / fj�s• CAoTION: GASLIN \ / TH 2 Sf C 0�--, III - �_ PAVE / DRIVE TH J G. MAPLE 48 : v 1 1 o I so / DIRT i \ NEW WELL \ OLD=WELLHSE \ D \ X D �x\k \ C g k \X m EMSTIN1cJ� G \ - POOL - -- - lJoa✓ � xl 4 I } �G�l.:. / GAS i METER DUSTING EXISTING GARAGE DWELLING TOP FOUNDATION ELEV. = 51.4' i EXI T. S.TANK i CAOTION: GASLI ,\/ .PAVE TH MAPLE 1� 48 49 DIRT 50 ! fl I ! s 1 ml — • I III! - \\ \ E t IIII wi # to # ! E I I I It X 0 � M C/) - � OR III, III: mo C ! # ! 0o o III; m (� rx I — I [E � X m IIIICID =O 0 — 0 — F O O I 1 � - 0 i I I Ij i V #n E #III # t III; III: Cn ITI [ f IIIE I OITI cn III; III' 0 # III I Illj { 1 # # ? H 1111 I a t I Ills m p L._ IIII IIII \� N NJ m z X ci co A I Ofl OII A f_Olf D .} Y 121-011 101-01 0 Z 0 O m r O rn0 -n0 o � m � ; > r< � nZ � D - zm cnv m0 X00 00 z � 0r no n m wD0 v9 < X < 0 = < COOO y --10 zm r� 0M CQ � � z zOX m m Ow0 o0 � o Iv 00 40 Dm v 0� Om > 00 mmr25 X CD Ccn 0 m -v z z0 c Oz 0Cz z — WM 0 X � _ � z oITI � o z Am Mn �00m " xC0 0 CO OC z � � Dmn@ono m 0 m -n �m F. = O Gz Omr- 0 O � mx �n� O O 0 O ' z mp � x x0 0,i � z W m Om � �Xm cf) ' z 0 :° > Oz F in z ao OM ) 0 C z m M Omm m O �0 � NEW CONSTRUCTION FOR: X = m K- ;0 .. m < • • 831 Main Street -0 JANE FERGUSON mA archr�e As inc Dennis,MA 0pho8 196 CHURCH STREET ' S08.694.7887 phone D 1 Residential Commercial Net Zero —.a3architeminc.com Z WEST BARNSTABLE MA 02668 N A Oo N N NHISDMWMOOTICE OF COPYRHOHT: O T E THE PROPERTY OF THE AR-1LCr HAS BEEN PREPARED SPECICALLY FOR THE OWNER FOR THE PROJECT AT THE SITE AND E NOT _ Ul Ln TO BE USED W HNOUT WRITTEN CONSENT OF THE ARCHfTECr 0 Al ARCHITECTS"HNC 201S ARCHITECTURAL ASPHALT SHINGLES, MATCH EXISTING - `"- W.C. SHINGLES, 5"T.W., NATURAL,TYP. ko k 1X4 TRIM WITH 2"SILL, o -- --'-- PAINTED AT ALL DOORS AND Q WINDOWS,TYP. z uj NEW ANDERSEN DH O Z ol� In WINDOWS v O I- co W U 1X6 CORNER BOARDS ZO LL = m U w U171 w NEW IPE DECKING, NATURAL Z � � TITLE: - - - - - - - - ELEVATIONS, s o e I I I . < I I I d o c_ I I I ' r EXISTING HOUSE 1274"SUNROOM I 10'-0" DECK I I a N d 10 < 1 EAST ELEVATION -j q2 1/4•-I-0• L----J FIELD VERIFY EXT'G FOUNDATION - co IS VIABLE PRIOR TO INSTALLING co° s LEDGER `V^ 0 9 i L � ARCHITECTURAL ASPHALT SHINGLES, MATCH EXISTING . c Z _ e W.C. SHINGLES, 5"T.W., g —lG NATURAL,TYP. i 1X4 TRIM WITH 2"SILL, . . E t PAINTED AT ALL DOORS AND WINDOWS, TYP. NEW ANDERSEN DH co °� WINDOWS AND FRENCH �4-0 WOOD HINGED DOORSo= 1X6 CORNER BOARDS 4) / \ z�oc NEW IPE DECKING, NATURAL Date: OKH REVIEW 11.18.2015 PERMIT: 11.24.2015 T.O. EXT'G FLR ~ T.O. SUNROOM — _ t X%13 A EXISTING HOUSE 18'-0"SUNROOM WITH DECK EXISTING HOUSE 2 NORTH ELEVATION BACK A, 14.��.-0. N X � N O X D � 0 -0 0 r N n T 0 y zZ -0 -0 -0 0 -0 Z m0 0 -< y w Z 0 M (n r m o N z 0 C r 2�r1 m X � 0 v O m n D O m00O o O � mD rX DDO � = DO 0Onn r- Dn r.- -—i � � � zxn � Ocn 0 Dz ornr:� � � � � � 9- _ z x � O � � OZ --{ cn0 -0M 2Dm2DD � N � 0D r-0 C � m � � zr � �Ammmc ; m — m rvz � � G) 0 zooX 2n 0 m � 0 mcn0nc� (n — = r0 � c = � D -� G) -i 2 � 0 N m p r D 0m rw90 C Z CO rr — m � 0 0 ZCZ -5 � W �� � m�nmcn � z co TiAN z0Mr- N � p Z N Zcwi+ rjXKOw x w.OD �' G) 0 0 0 Co r? � . o G)`. oo (n �i cn 0 N N X 0 m 0 X 0 OG5 m -0 0 0m ' m m ;0 Z D 8'-1y" J'-► mT0 N � cn000 En 0 -0 O O r- G) � C cn m O Z z -1 � XO. ;I ci 00 6o 6� • - i m 0 d � NEW CONSTRUCTION FOR: ;0 D 831 Main Street n m JANE FERGUSON POarchitects inc Dennis,MA 02 508.694.7887 phone ne � 196 CHURCH STREET Residential Commercial Net Zero —.a3architectsinc.com Z WEST BARNSTABLE MA 02668 N A QD 90 N N NOTICE OF COPYRIGHT: O O THIS DRAWING 6 THE PROPERTY OF THE ARCHITECT HAS BEEN PREPARED SPECIFICALLY FOR THE OWNER FOR TH6 PROJECT AT THIS SITE AND 6 NOT L" 01 TOM USED WITHOUT WRITTEN CONSENT OF THE ARCHITECT IL O N ARCHITECTS.INC NITS 4 i u; G �'. ca D sae � cn co rn 101 c+k f " W, AWC Guide to Wood Construction in'High Wind Areas:.110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2. .1)1 0 Check Compliance 1.1 SCOPE WindSpeed(3-sec.gust).....................................................:........... .................................................110 mph WindExposure Category..............................:................................... .............................................................B 1.2 APPLICABIUTY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories s 2 stories RoofPitch .........................................................................(Fig 2)...........................................m'1_512:12 MeanRoof Height .:............................................................(Fig 2)................................................t 'ft 5 33' �L BuildingWidth,W.............................................::................(Fig 3).........................................I...... 42L ft s 80, aL BuildingLength,L ..............................................................(Fig 3).................................................it ft 5 80' - Building Aspect Ratio(L/W) ...............................................(Fig 4).................................................Z;. 5 3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................ 6'9' - - 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting-requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. Concrete Masonry..................................................:................. .................................................................. I 2.2 ANCHORAGE TO FOUNDATION1,3 5/89 Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in con to ly Bolt Spacing i P 9-general................................. ........(fable 4)............. T- A ..... ... m. tk Bolt Spacing from endfjoint of plate ............................(Fig 5)................I _in.5 6'-12" Bolt Embedment-concrete........................................(Fig 5)................................................. in.z 7" Bolt Embedment=mason T ry.........................................(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).................................................._a_ft 512' Full Height Wall Studs at Floor Openings less than 2'from ExteriorWall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7)........................:............................_Oft 5 d f Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)....................................................-aft 5 d FloorBracing at Endwalls...................................................(Fig 9).................................................................... 9 Type (per 780 CMR Chapter 55)............:...............4..q.1W Floor Sheathing T e ....................................................... Floor Sheathing Thickness ................................................(per 780 CMR Chapter 55).......................3�in. Floor Sheathing Fastening......................................:...........(fable 2)..._!�_d nails at bin edge/ in field 4.1 WALLS Wall Height r iD„ Loadbearing walls...............:........................................(Fig 10 and Table 5)....................`$+ 1. ft s 10' Non-Loadbearing walls................................................(Fig 10 and Table 5)..................`:)2�-3 r ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)...................�in.5 24"o.c. Wall Story Offsets ........................................................(Figs 7 8 8)..........:................................. . It 5 d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls........................................................(fable 5)..............................2x h - !& ft in. Non-Loadbearing walls..................................................(fable 5)..............................2x,:-11 ft:L in. Gable End Wall Bracing Full Height Endwall Studs............................................(Fig 10).............:.................................................... WSP Attic Floor Length........:........I..............................(Fig 11)..........:................................... It 20/3 Gypsum Ceiling Length(if WSP not used)..................(Fig 11)...............................:.........:.. >_0.9W f„ 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 ...........................6............................(Fig 13 and Table 6)....:................................ ft Splice Connection(no.of 16d common nails).............(Table.6)...........................................................110 AWC Guide to Wood Construction in High Wbid Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301..2.1.1)t Loadbearing Wall Connections Lateral no.of 16d.common nails ............................. ( ) ..(Tables 7).............................................................. Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Table 8)........................................................ 2 Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans .........................................................(Table 9)................................... ft gL in.s 11' Y SillPlate Spans ......................:.................................(Table 9)................ .. a ft in.5.11' Full Height Studs-(no.of studs).....:.............................(Table 9)........................................................ 0 Non-Load Bearing.Wall Openings(record largest opening but check all openings for'compliance to Table 9) HeaderSpans.............................................................(Table 9).................................. . A in._s 12' Sill Plate Spans............................................................(Table 9)..............7...............y1..4r%L'ft_in.512" 77 Full Height Studs(no.of studs)....................................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously, Minimum Building Dimension,W tZ--�tI Nominal Height of Tallest Opening2 .............................................................................4 s 6'8" Sheathing Type.... note 4 'rWSIP 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........................(fable 10).......................................................�fQ.A 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest Opening2..................................................................... s 6'8" SheathingType.............................................(note 4)...................................................... WSP Edge Nail Spacing.................:.......................(Table 11 or note 4 if less)....................... in. Field Nail Spacing.........................................(Table 11)................................................. I? in. Shear Connection(no.of 16d common nails)(fable 11).......................................................; � V_ 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 s smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary-Connectors Uplift................................................(Table 12)............................................U= Pff �L Lateral.............................................(Table 12).............................................L=_Q6 plf Shear.:............................................(Table 12).............................................S=�pif Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T=_.plf �L Gable Rake Outlooker.........................................(Figure 20).........:...�ft s smaller of 2'or U2 -A/- Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U=`t/7 lb. ✓ Lateral(no.of 16d common nails)...(Table 14).......................................L.==Ib. ,Z Roof Sheathing Type ...........................:...............(per 780 CMR Chapters 58 and 59).......WSp ' I Roof Sheathing Thickness....................................................................:..................7 0 in.z 7116"WSP V Roof Sheathing Fastening...........................................(fable 2)...................................W-COX1tr'►Q74 Notes: nbE 2�'Fi,b"`E 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. AII.Straps per Figure 17 . e. Corner 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. i AWC Guide to Wood Construction in High Wind Areas: .1.10 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)t 4. a. From Tables 16 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent FulkHeight Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i.. Panels shall be installed with strength axis parallel to studs. ii. All Horizontal joints shall occur over and be nailed to framing. iii. 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 '-MOI T is�IREM ON rigaallo u5E6i NA S ATbbc. _- - - e-----=rr== -- 11 n 1 u n 11 n 1 n u 11 I t u n ' 11 11 n I u it n n41 � Q u rp 11. 1 b 1 allI Q 1 11 ILL U 11 ii~W 11 ; 11 � 11 II 11 1 11 11 N I1, 11 • 11 T_ 11 11 IT MARSPACM > See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in.Nigh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7so C19.R 5301.2.1.1)1 1 i 1 1 1 1 , 1 1 1 1 I Il 1 � 1 lit 1 - � 1 1.__ S�AO KOK PATTERN PAMM PANEL EDQ DOU MLF NW®CE SPACKC DEFAL Detali Vertical and Horizontal Nailing for Panel Attachment t 'Barnstable.Old Kings Highway.Historic District Committee 200 Main Street,Hyannis,MA.0260 1,TEL 508-862.4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS. Applicati6h is hereby made,with four(4)complete sets,for the:issuance of a Certificate:of Appropriateness tinder Section 6'of Chapter. 470,Acts and Resolves of Massachusetts,1973,for proposed work'as described below and on plains*j drawings,or photographs accompanying this application for,, Check all categories that apply, 1. Building construction: El New Addition 11-Alteration 2. Type of.Building: House ❑ Gara2elbarn El."Sbed, Elrornmerciai El Other 3. Exterior Painting, ng,roof. 11.new roof El Color/material-change, of trim;sidin* g,window,door, 4. Si.p_n' El :new Sign El Existing Sign ❑ Rep ainting Existing Sign 5. Structure: OFence 0 Wall El Flagpole 0 ReUdni:ng wall E3 Tennis court. E]. Other .6. -Pool ❑ Swimming ❑ Other rnan-made pool. ❑ Solar panels El Other Type or Print Legibly: Date 10 Iv, Izo 'VQTE AR applications must-be'signed by the current owner Owner(print): - J� Telephone.4f; Address of Proposed Work: 1! & Village 146T66gjst�' ap Lot# Marling Address(if different) .Owner's Signature r:' , -f� I (�•�r,� - Description of Proposed Work: Give particWars of work to be done: SAX 19-02 M Or—F 1W Ez f?I'VC—K— VY ttA idj-W 0 Agent or Contractor(print):- l(NIMTel fione#, . qp Address: 2638 Contractor/Agent" signature: UM For committee.use only. This Certificate is hereby APPROVED/DENIED. Date 'Q1 f- Members-sipnatures. ItECEVED 0c, 2 1 2015 %FNT APrr '0)NT11 MAt4 able Town of Barnst waY old Kn e Q.A8oardv and C-e;"?dssi'onA01d Kings Highiva NOK14 ApplicatW s\OKH DRAFT 2011 Gorr Approprialenesf DRA.FT.doc I 1 � CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit s COpieS Foundation Type: (Max. 12".exposed)(material-.bnck/cement,other). Siding Type:. 'Clapboard— shingle�. other , Material: red cedar white cedar other, Color. Chimney Material: OV 71� Color: Roof'Material: (make&style) I't, Color: MA$,�4A O6 Roof Pitch(s): (7/1.2minimum) 7112. ;(spec.ifir ora plans for new buildings.,major additions), Windblly and floor trim ingterisal: wood other niatenal,specify .Size of corn,0boards � ,, size ofcasings(I X a min.) . 1)(4 color VA-k11-F Ra)es. Istrriember �2"`�nIe:mber_ �X 3 Depih of o�rEi hang /ED Window: (make/model) V material QV k UPA• color VAAh V (,Pt rrntctc ti+=Enclo�,r scliedtile on plan fO netiir builriiitgs,nauj6r.ttdditious) NOV .l g 2015 Nvindow. Town of Barnstable Old King's Highway tru.e.divided lights_ exterior Bitted grills grills between:glass._removable interior_: None r&o rnittee Door style and make: '- mat CA".". AU M Color: . � Garage Door,Style, Size(Yf opening Material Color Shutter Type/Style/Material: Color: , A (;utterType/Material: O+J M )AWM - - Color: Deck-.tnaterial: wood ✓ �ftfer rnaterial,.specify Color: . 9AM . Skylight,typ0make%model%: material Color: Size: Sign size` . Type/Materials, Color: nErETV D Pine Type(Max 6' )Style material,: . Color: ., Retainingwall:;Material: GROWTH MANAGEMENT Lighting,freestanding on building: illuminating sign. OTHER VNI FORM,AXION: THE ATTACHED-CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide sainples:of paint colors,manufacturers brochure of windows,doors,garage door,fences,.lanip posts etc ` Signed .tplart.preparei) - Pnrtt IVazne. QA8oards:arul Conurussioml0td Kinds Hi$!hway\OKl1 Rpplicat orulOKfl DRAFT 2011 Cert Appropriateness DRAT dnr. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : , * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town of Barnstable Geographic Information System October 27,2015 11300112' 4213S 164003002- 02130 164004 164002 1 020 00 164007002 0 60 177001 040 00 154006 0108 164007. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 072, 130010 " 4 % ;4: ; . t i ; . : . . z % z . : . -. " % % . ; ; ; . t : i #29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 163007001 163004002 0240. *#45 AS40D70011 153018 0122 163033 153006 2 163008 163004004 Ito led #196 • #S9 vRiC 153022. -vr t216 IS3021 0230 163008 163004003 153003 163007 #282 #47 00 '0 260 1* IS3009001 40, 163032 15300400 1 #181 0302 163009002 021 0324- IS3028 0215 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11i6008 Ilk. 0 0 163012002 163002 Oro 20 163020 09 M 163012001 0286 153010 4011 0339 0263 0219039 ! 4 t 163031* 163012003 106301111 1 ft 107607 I53 14 060 Ilkis 0249 176006 163026 00 IS3024 0134 163015 15301t3 176001003 1051 #90 -1238 /0246 065- DISCLAIMERS:This map Is for planning purposes only.It Is not adequate for legal Map:153 Parcel:006 boundary determinationtion or regulatory Interpretation. Enlargements beyond a scale of Owner.RITZMAN,JAN.E F Total Assessed Value:$401000 Selected Parcel 1*-IW may not meet established map accuracy standards.The parcel Ines an this map are arty graphic representations of Assessors tax parcels.They are not true property Co-owner. Acreage.,2.00 acres Abutters W E boundaries and do not represent accurate relationships to physical features on the map Location:196 CHURCH STREET such as building locations. Buffer • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town of Barnstable Geographiclnformation System October.20, 2015 RECEIVED T 2'12015 ®WITH MANAGEMENT r a F i k 0 23 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:153' Parcel:006 - O ( - Selected Parcel- boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:RITZMAN,JANE F Total Assessed Value:$401000 1'=100'may not meet established map accuracy standards:The parcel lines on this map W E _ are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner. Acreage:2.00 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:196 CHURCH STREET t� such as building locations. Buffer :.T 'S�c �M1`� � —. �• �' r _ a�..x,.Za„� . Y om ltl-1 q+ `•n z. "ice. '•� ,� •t ,.�1 �,i °' i � � �i. '¢''1 � _ ,y v. '.'s' a"Jsi�:K `}L ..�°7.�•� �" J.. � vim,� w y�� ''��Sdf�:�gY' a<�i's�c8-'- Y.'�� ,d .iF���Z,'� '�'o°�2c �''dR•v W ^ • �y �� ��,Q�•< efig',. d' i'-'3'>��f�.'�st,,,.dta�'. �� �-. 9.••.�{�<{'v5�-s..�,�.A '''• k�•." �`� wr�f� �,t'` �y !{�•'3'Y'b :'s;�„� �•'r,: •.y. :, Lb -=����.Isy°i¢+'� ��,3 � 47 e •J:.'L'Y,,'. .SSY tiY"S! F" � � ti f 7 _ ',^h k. e'tre..r,� '�F �ieA -;� - M: .. �--•�. ter. :�=._:� 5,-- � � -�<'- d 92L i r 9. IRS •�r �—�*' ��-13,,�a� r t 9'.1`r�1f� ' <lP.��L F �''}�. 1 t�v v '�.�.,.��' g-_ �■ '�7�HY � 3 1 ter: ,•a3 ,rW :�: .may.. 'G. ::s.:. •t.�f3.a�yc.' :=r fit" ritoM SMEN 't►� _ - ¢'�=\ �y..1%•4 � i>��'�Y��'[`P.� 3�:...�t��` Z- � 'S S�1 d S+ A •-a�� 4 .o i RW— vv-,M-" Y17�.t aV, � � a7��1` yL ,. L,F��r S S "= il 4a � «� i r`�A z.`�•��`c tea._ „�"• t `� � .^'u.,-r i 1 � '�� r �5.���' °✓x':.'.- Ai bt -,�..c�' �,.;Y raT L.i Zak• y i' - 4 h .Y'' ` .� Y' .."��e ry 1.� I � ` 3 .. d ��. I 1�t7 � � -. � _�• .rat I, h L t f•'4'Y 7'xl��i` � �, I 5 � y✓ '�'`� �y/B'�r'' a .ta _ •;r 'dy4' may. .i- .I 1 �S¢ 'a ,"t•.- x �r'Ls� -.� -�,�'•�' `tires' :v+�ti f: t. . ��` ire ,•s "��, n',�'PSpw.,' � � '75 •y} ���"�,� d78 ,�' �_-k F Il i1i•�t.� � 4 :F r_Jy{`� •UJr� S` � C,taR�3aagtrm ® � � � �.� 4� "•( -05 ..,a,Q�._ 'w`� : •,�tr, `=+mod �: ^•,�,- et,;nc=>: *c`Ja"�n.+�fC •F�.�+?wr- { r�rt"s�vr�-rrzu� rt Rw > '+� t -c r•.r"'�_�.t I.t A.� � " �L����>.c�.r'�4��nr �_��i sr ARCHITECTURAL ASPHALT SHINGLES, MATCH EXISTING -- — W.C. SHINGLES, 5"T.W., 00 — -- - NATURAL,TYP. kD " -- - 1X4 TRIM WITH 2"SILL,. o — `— - -'- PAINTED AT ALL DOORS AND p Q WINDOWS, TYP. z t Lu Lu NEW ANDERSEN DH 0z W ca WINDOWS ? O H U 1X6 CORNER BOARDS ZO Lp = m U W V Z �o U.,NEW IPE DECKING, NATURAL FFn Z � -1 3: ' i TITLE: - - - - - - - - - ELEVATIONS s V n I i j I co c N EXISTING HOUSE 12'-0" SUNROOM I 10'-0" DECK I o a 1 I L < / N Q 0 L 1 EAST ELEVATION aMoav�i g. ARCHITECTURAL ASPHALT RECEIVED SHINGLES, MATCH EXISTING ^++ ACT 21 Z015 zci W.C. SHINGLES,•5"T.W., --16 NATURAL, TYP. GROWTH MANAGEMENT L 1X4 TRIM WITH 2"SILL, 09 PAINTED AT ALL DOORS AND S Eo WINDOWS,TYP. ® V U F NEW ANDERSEN DH V S.. 68 WINDOWS AND FRENCH ®�® (�+, o � WOOD HINGED DOORS ®�` � g`s' \ IONS M / \ Si 3W 1X6 CORNER BOARDS a �o��of s Hag nea Otd KGo�m� \ NEW IPE DECKING, NATURAL Date: OKH REVIEW 11.18.2015 \ / T.O. EXT'G FLR \ / i :x 7 ~ r` T.O. SUNROOM a, C tX Ln A-2 6 . EXISTING HOUSE 18'-0" SUNROOM WITH DECK EX 10 2 NORTH ELEVATION BACK A2 J , NV cn = 0 K � 0° C , ► ~o � rn0 i � noo 0�—Z 0 - = me � 1I1 t1 °o° y X rn X n ONO orn (n1 0 z= 00 44 - 1 I I ` N O f i i I I 1 i zX D D 0 ao 12'-0" 7 10'-0" --7 (n Z ` TImTID C: Cnz rnz ;u j = (n rn — rn - p rXrr Z � cm m — Xm O � cmz — o (zi� � 00 O - I G) 0Mz � � = D � � �,,, Z � pZ = * zCn 000z 0 X �, 2 — rn � �`' 0 (0i� m � Op XZnrn z 006 � mp � " N . . . C/) a' G) = � D Z � z � m p �I, C7rn � ao � mz Cn = � p � U n X C: 0 � m m � Z Oroo p ((nn p Lrl = = m rn z y '0 0,01 gd ��•6s GP ,1 3 Z.S � 9 N 0 �`°� CP a y .� v+ tv L�7 00 NEW CONSTRUCTION FOR: < 831 Main Street JANE FERGUSON "' architects inc Dennis,MA 0pho8 196 CHURCH STREET ' S08.694.7887 phone D Residential Commercial Net Zero www.a3architeminc.com Z WEST BARNSTABLE MA 02668 90 N NOTICE OF COPYRIGHT: THIS ORAwMG 6 THE PROPERTY OF THE ARCHITECT HAS REEN PREPARED SPEOHCALLY FOR THE OWNER FOR THIS PROJECT AT THIS SITE AND 6 NOT , TO RE USED WITHOUT WRITTEN COMENT OF THE ARCHITECT 0 A3 ARCHITEM INC 20IS Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 11/10/2014 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 196 Church Street(#201308479) has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCloskey NOiSIAIG h V Wd % f AUf; 117s: 979VISUVO JO NJV-Oi TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map G Parcel O Application #_Q O: 3° ? Health Division Date Issued a Conservation Division Application Fee Planning Dept. Permit Feet Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis iM Project Street dress 6 C u e Village S Q l Owner Address s ti i as abovV Telephone Permit ReT,(est 1 �/1 eX at-, o /,s. &Aa ie IPtS K Q r`01 To l y 4 S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation` s OU — 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 woPd coal sto cue: ❑%s ❑ No 9- Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: xisting `.� nevi size_ a Attached garage: El existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 03 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ co CIO Commercial ❑Yes ❑ No If yes, site plan review # rn — Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q 2 p Name w'►'� /gc(kSke /L/,"?JeJQ Ve <, Telephone Number �i Address (evt �� License # J6 Home Improvement Contractor# o 139 0 Worker's Compensation #TUX3af-3 7 E ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO fQ l�A4(��l SIGNATURE DATE /e! 3 FOR OFFICIAL USE ONLY 4 APPLICATION# PATEISSUED MAP/PARCEL NO. ,l ADDRESS VILLAGE t OWNER DATE OF INSPECTION: ` - FRAME , f' INS,ULATION.,.•+, i FIREPLACE ELECTRICAL:. ROUGH FINAL .. x, PLUMBING: ROUGH FINAL X t GAS: ROUGH FINAL ' FINAL BUILDING.' _ a DATE CLOSED OUT ASSOCIATION PLAN NO. I . , z I j runt rorr►r-�,�i� _ The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers bl A hcant Information Name (Business/Organization/[ndividual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer?Check the appropriate box: r6. pe of project(required): 1.0 I am a employer with 7 4. ❑ I am a general contractor and I ❑New construction employees(full and/or part-time). have hired the sub-contractorslisted on the attached sheet. ❑ Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12•❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no 13.0 Other Insulation employees. [No workers' comp. insurance required-] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Technology Insurance Company TWC 3353968 Expiration Date: 04/09/2014 Policy#or Self-ins.Lic.#: � &VM��Job Site Address: CC� 'G� City/State/Zip1� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties o er ury t/at the information provided abovI is true and correct Signature: _- - Phone#: 508-398-0398 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: r� �1 Ae6Ra DATE(MMIODM-M CERTIFICATE OF LIABILITY INSURANCE 10/22/2013 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 policypes)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 Ileu of such endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk strategies Company PHONE (781)986-4400 FAIL No:(781)963-4420 15 Pacella Park Drive Spite 240 INSURERS AFFORDING COVERAGE NAIC f Randolph lea 02368 INSURERA:Selective Ins. of America INSURED iNsuRERB:Safety Insurance company 3618 Cape Save, Inc iNsuFtERc:Technology Insurance company 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth NA 02664 IrSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE9- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR S1994480 0/16/2023 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO X LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE Ea accident L 1 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 208200 1/6/2013 1/6/2014 AUTOS XN AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAR IN OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION H11 S1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for X WCSTATU- OTH- AND EMPLOYERS LIABILITYTS ANY PROPRIErORIPARTNERIDCU ETIVE YIN overage E.L.EACH ACCIDENT $ 500,000 OFFICERWEMBER EXCLUDED? L N I A (Mandatory In NH) 3353968 /9/2013 /9/2014 E.L.DISEASE-EA EMPLOYEEI$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael Christian/CLC ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD -. � . . a� � .. ;� . . - — _y .. . . ....; _ � .� - , . .. , .�_... _ � ._ .� 1 .... I I , � , � . I � R t r � r i ,. .. .+ i � -�, - 1 Massachuse-s -Depar rnent of Public Safe'%, Board of Building Regula?ions and Standards Construction Supervkor Specialty icense: CSSL402776 WII.LIAM J MC CLUSIKEY ' 37 NAUSET ROAD West Yarmouth MA 02673 commissioner 06/28/2015 m glie le � r Office of Consumer Affairs and eusness Regulation 10 Park Plaza - Suite 5170 == Boston, Massachusetts 02116 Home Improvement Contractor Registration! -__- Registration: 171380 Type: Corporation - -=- Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. - WILLIAM McCLUSKEY = -= 7-D HUNTINGTON AVENUE - =- SOUTH YARMOUTH, MA 02664 -- _ _ _ ..- Update Address and return card.Mark reason for change. Address Renewal Employment i�I Lost Card OPS-CA1'O 50M-04/04-G1012166 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only n HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business R lation .__ a Registration: _:.171380 Type: egu y � Expiration: -3114/2014 Corporation 10 Park Plaza-Suite 5170 ..7 J' ;°: Boston,MA 02116 CAPE SAVE INC: WILLIAM McCLUSKEY-_.,-;,e�...:.- : 7-D HUNTINGTON AVENUE:_:.' \ SOUTH YARMOUTH.MA'026g4 Undersecretary Not valid wit o signs Building Permit Authorization I, Jane:Ferguson: as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 196 Church St West Barnstable, MA 02668 SignedG- sz �J2_ Date Czj 3 U , Z-6)1 3 .. (-cp •IC SYSTEM MUST BE Assessor's 'office (1st floor): �1, :;STALLED IN C �gCE Assessor's map and lot number &.:.4-` -13....�J.��?...... f Board of Health '(3rd floor): WITH T o Sewage Permit number .. .... �....!..�K. .....:'—���. L :i.6pi ®�9ME�9T B Engineering Department (3rd floor): TOWN R 1"639• House number ••• 0M Ar- j APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE RUILDIHG INSPECTOR APPLICATION FOR PERMIT TO ......6 vl� ....... /.! .1.!Vr tq......40 L........................................... TYPE OF CONSTRUCTION .......5 �`r �..: `' .:..1/t .Y. ............................ ................................................ r ' ..................... ....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to he following information: Location ....../`7..�....... N.ITV .'1......5t...................lf ...... 17.1�.Ef............................................................................ Proposed Use .....I.. ..3.�..f. .��t!. .1'��V./1/ s. !.H1..t�(/!/.........QG. ... . ................................ r Zoning District !` ...................Fire District ..................... . ... .............. .......................... Nome of Owner ..0AV(...... t./..2.1!�.(9.�...................Address ....lq(......�!G— !.....�.......... ....boa m- .s Nome of Builder ... ......46.v�,<......................Address ..�'?` ......P ).41.... .................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ... 0..!! .G.Y..f' ................................................. Exterior ......5..(..r. K..............................................................Roofing ...................../.............................................................. Floors ......................................................................................Interior ....... lw.. ................................................ ............ Heating - g Fireplace ..................................................................................Approximate Cost ......-.0004.......................... Definitive Plan Approved by Planning Board _______________________________19________ . Area 410 7!..... . ...................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH + S2ey ` ' 3 /,76 do�v i f .5 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 . 40-04.1...... .. ` ........... Construction Supervisor's License ............ ........... �- RITZMAN, PAUL V Swimmin Pool No �.�..�,Q.Q. Permit for ............... .............. Location ...7..9.6...Cb.uxc.Y}..,Street ...................... J ;r ..................W......Barnat.abI.e........................... Owner ..... . 0 ...Ritzman c ............................... Type of Construction ..GuXli. ........................ . ................................................................................ Plot ............................ Lot ................................ '7 Permit Granted August 19 , 19 87 Date of Inspection ............. ...19 F � .� Date Completed ........., .. .........................19 v f l , i Application to `'LPN'O PEA NP E�DS�' Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATION OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings,or photo- graphs accompanying this application. TYPE OR PRINT LEGIBLY rG1 a DATE ADDRESS OF PROPOSED WORK /c7& "D1 uv S f (✓AP-V!� ASSESSORS MAP NO. OWNER vl ;A ASSESSORS LOT NO. Au�•�ti s'i' kj A4ev!5 �� �-9� 33 C HOME ADDRESS I / TEL. NO. AGENT OR CONTRACTOR f7 WC� U1/ 00 �S E v KJ PI A�i N3 L-loor v Leo v wl7 Rd ADDRESS TEL. NO, T is application is for exemption of proposed exterior construction on the ground that: (1) It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) ` • PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot,and, if an additlon is involved, show•. ing location of existing building. < C ! pc�t � ' "�?0`hid .fi N r *V1 Poo Oltr �'�J✓a i ( S� �J C P(JWI pN� WA Av' vv PLACC. A SIGNED. Owner•Contraet r-Agent Space below line for Committee use. Received by H.D.C. The Certificate is herebyVV ` Date dam=— • Time By Date Approved ❑ - -- -- _ _ The categories of work,entitled to exemption are listed on Disapproved Elthe back of this form. EXTLRIOR`ARCHITECTURAL FEATURES SUITABLE FOR CERTIFICATES OF EXEMPTION FOR RESIDENTIAL USE ONLY FENCES: 1. Post and rail, split, half round or round; natural finish 2. Square rail;white or natural finish �. Stockade;natural or gray stain finish;not forward of face of main building 4. Picket;white only (Maximum height of all fences,4 feet) HEDGES: natural, not to exceed four feet in height DECKS: constructed of wood, on single family dwellings, built after 1900, at first floor level, at the rear only, railings not to exceed 30 inches in height, not over 50%to be visible from a way;natural finish or color 73-e compatible with building involved BREEZEWAYS: enclosure of existing breezeways,consistent with style, material and color of house, excluding sliding glass doors facing street,way or public place FLAGPOLES: on residential property, not over 24 feet high, not less than 20 feet from way, constructed of wood, with natural finish or painted white, or of aluminum,or of fiberglas or metal painted white ARBORS AND TRELLISES: of lightweight,wooden construction, not over nine feet high ROOFS: natural cedar shingles,or asphalt shingles per approved color samples;not over five inches exposure to weather SIDING: natural cedar shingles,or wooden clapboards-natural or approved color;not over five inches exposure • to weather STORM SASH,STORM DOORS,WINDOW SCREENS, SCREEN DOORS,GUTTERS AND LEADERS: permissible if consistent with style, material and color of building LIGHT POST: permissible if consistent with style, material and color of building AIR CONDITIONERS: portable,window units at side or rear of building -n STONE WALLS: construction of field or split stone, not exceeding 30 inches in height NOTE 1..All prior bulletins hereby superseded. 2. Conditions contained in certificates of appropriateness shall be binding regardless of any exemptions contained herein. Assessor's office' (1St floor): nnpF'r E ro Assessor's map and lot number &01.../S13 0.6. Board of Health (3rd floor): -) l3C'�YcU�M v Sewage Permit number BABBSTOBLE, i Engineering Department (3rd floor): so Saes p 1639• `00 House number ........................................................................ E` o YPY a• 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 ...... <<:...... (................................................................. TYPE OF CONSTRUCTION .......S......r G/ ........................................... ............................... - n ...................... Z...........19 /. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......I-C7 ...... N.// .<... ......5t......................................................... ...b.................................................................... Proposed Use ..... . 3. r {v'G Y U V N� S Zoning District ........................ ..... ....Fire District � Name of Owner ... ti ........ !. ?-.. ?. Address ..... ...... h v vc�l �cJ �C��I Vil1� ................................................. ......... Name of Builder ...t4.A. �C�✓ 740.P 5 5...................... ..6"?'.!6 G ,. ,4�5'v l UU.t/J1�.... .................. c �.............. Nameof Architect ..................................................................Address ............../. ...................................................................... Number of Rooms ..................................................................Foundation ...,C .. ,..'.: 7��................................................. Exterior .......��/..T.`P...............................................................Roofing .................................................................................... Floors Interior ...........f...... ..........................................::..:................: Heating ..................................................................................Plumbing .................................................................................. Fireplace ..............:...................................................................Approximate Cost QQ........ Definitive Plan Approved by Planning Board ________________________________19________ . Area .......1 .7 6...................... Diagram of Lot and Building with Dimensions Fee ......�.. .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH '170' .� ;X)A 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. 2 -1 Name !!/d'l .. ... . .:A•D.. ......... Construction Supervisor's License QD� 3 .................................... RITZMAN, PAUL. /A=15 3 '31100 Swimming Pool No ................. Permit for .................................... Accessory to Dwelling ..k.......... . . . . . . .... ... . ........................... Location .....1.9.6...C.hu.r.ch....S-t.r.e e.t................ .. .... .. .... .... ....... .. W.. Barnstable ................................................................................ Owner .Paul Ritzman ........................................................... Type of Construction ..........G.uni.te.................... .. .... ..... ................................................ ............................... Plot .............................. Lot ............ ................... Permit Granted ...... ..........1,9 87 Date of Inspection. ........... ........19 Date Completed .........................................19 LG. NEX H.O. BOOT P R F/LTE/Q PUMP MOrae 4¢ ALUM. COP/NG CLIP +' r ALUM. COP1NvG OO O I WEL O'(lam//\//S l M//T 1 G/AL.V�•I�OT�o� — — — — ——— . /-•-5GI.F Drc36.LI,JC. F-4•lT6Nm/L� A M CO/!T/N6 OYE.e N/EL OS /L SK/MMEIP-SU4T/ON j AL7/M. COP/N6r OO I CO/VLIPETE O.P I -16x/ L6. HEaC H0. BOLT, , wovp DECa (B/l (r HEX NY/T'.0(2),-ZAr WW5-,1E,PS 4//) S , 1 OTHE.PS) UP TO d M P �15-(z - O r CaP/N6 — ZON6 .57 .All K E, ._ UCr/A4/ Q10 I ~A FiPAME G-1 /2 qo. IF P V/N YL L/NER �^ FEAME BASE-O EL ALTERNATE A I � RIM LOCK COPING a� I , RET_Ule/\► / G P - STEEL PANEL - _ Cla q:.) pE PANEL STlfffVrR STEEL I � D . STAKE /✓ TYP/CAL .1 I F-PAME PLAN VIEW. OF POOL eASE " C .. p, /1./QUND W/TNC4NCR£TF Atrwr fte�t aar���ITw R.+� • <r TOA Z,*^wq of/W r Liss Ivor trsi nrAN / M�w�+r AFL � wa,00 a6u../F w�"sNwct K c,<a fr<„r w✓a.. .. Yf..a1y 1 TaMN / so.rf 7 v54 r A su w A>saAw�t� L.< d w. u•ru R t.r► .,rLy �— FZatV ,IWAY Cs�UMf. Ac 10 ' \\ fat Ss<,.... f.<. �-A.l,s •r .j YE?T/CAL /LLE,QLH G F tr —^i p r) I_ \ c.Ow" „ /8X t4SANO BOTTOM - TAMPtO T LONGITUDINAL SECTION SANO BEDFELWASHER (2) r uTOP GOR�E/PMATERIALS LIST EAe7-r/, elSE HOLES /NTEM /9 6 c O E f 6-/ 6.2 K L M D P Q R S T;- .U...../. ►+'.:-X 0 ,0,. P,9/VELW W 2 _ ���•` W \/✓ALL -SECTION. •A- FRAME POOL ry. Z Z . 2 : 2 . �. h W K J v v,t ; '@ = F w w y., _ G U.Q VEO S/ZE o2h' �v ' ~�' �'�ki� Q2 � 2 �'� IO och222�er2? F/LLE+2 � � � 2 dUO�+ J W"�� cL ?2v�, �h ; 1,- : cvoo "` o: ��' W 'C�"`.v�i �' Q� 'a� T,/a c...P.,E.,,s e/c P..t ...ac _ �� 2^ _ � �z: CORNER CONNECTION /2).?4 / 2 B 6 4 6 4 4 4 S6 145 .760114 S- 6 8 6 4 1016 I /6 r 14 / /O 6 6 6 4 4 4 6, 56 /4t J60/4S 6 e 6 4 /0 Nulr, tTc. I.: c. r<cr .••ry u<ni F. .t cn..tr< cr,..I /6 x 32 / /Z E B B 4 4 4 7 56 /70 4/S 170 6 8 6 4 /2 .. /8r36:. l /Z 8 8 B 4 4 4 8.. S6 /70 41.r/70 e 8 e 4 /4 iie s,e.L f,..'s�to "/ "'"r WELDS ON S/OE OF P.91VEL /�-/�•: 20 r 40 / 2 /4 /1 /Z /2 4 4 4 9 56 I/s 495 1/S 6 e /Z 4 /4 L oNa, W EL OEO TOP e B O T TCi/J ,.,. /6x34 / 8 4 8 8 B 4 4 4 7 Sb /70 4/S /70 6 d 6 4 /I ar a</� 'f `'d' /1Q Fr AS SIs/0w/v (WaLDS TO 95.E '�?A►TS 2Sx S0 / /2 C /+ /4 /4 4 4 4 9 68 1SS Se0?Ss 6 .8 /4 4 /b 3 ! W/TM "C•All-VA-•KIOTi� -fox 60 ! 2 /Z 6 /B /B /B 4 4 4 .4 68 310 710 3to 8 e /e 4 ZO +<t 2 8 I 1212 8 6 6 b 4 4 Co :Co rro 41S i7o b �p I �' � :• � + 1 `.. NCTtL:A PP12�,K. YOL WnrG �:I. •\\ '• . POOL DIMENSIONS POOL S l ZE A R C D C F G N K C M N P R 6,911 ON-5 "q /Zx24 /7=3' 74=3• 3'4' 6'-0' 6'0' &'0' E'-3" 4'-O' 4'•0" 4';3" a'-0' 5 � q-4' 77=7 9,0�0 7YPG 1;!170! R'•3' 24'-!" 3'•. " 7'0' 6b B'O" 6'•!'" 4`0' 40- 8'J" 4'0' o$'e 9-6_ IJtPc' i� 750 /✓0 D/YiNG BogRD - /6 r31 /6'•3" 37'3' 3=4" B'-o', 8'-6, /3�6' 6'-1" 4 -0' 4'"0' 8'-J 4'-0'• ,'_.;- ,A.,co"36"I4e' 19 -750 �i ' • • Heldor Industries /BxA /s'J" 3c'-t• 3'-4•' B'o' /0'•6', 1776" 1' a:G" 4--0 /0'•3" a'o' A- ia:io' 40%7- ?5 Soo TYPO ff 10f40 ' ' = = ' mr� � OL• 0/V/NG Morristown, Nrw JrrNy ID 3' 4u3 J=q" e0" /76" .di _ 50s ' I/ r. 1 / /br34 /G=J' 34'•J 3'•4" B'"0 /O'6" %�'-6"' 6'"1" 4-0' 4.0 e-1 4•o- i a• d. o" 7:/Oti po,gc� TYPICAL PANEL 4s °-"-a' +���.: RECTANGULAR so,6o 40. zJLs- LO'-3- �. B 6 za 0 ;;-o, IO.-9 4'•6" 4 ! 7/'-3' 4'6" F 2'� tc "s$ 6�'"IJ �� sso eaaR� z�►�r - STIFFENER DETAIL , Lam`_ POOLS OZ,.4.28 +d'-�• ta' a' 4. p.. i '- 3:d.. G'c" g'-o 2 0.. 4-0 �'_�, d=o� .� t:u'o ii �. 2. 1� quality S T-IFE �I POOL : -.AO Cnl— '—. uncommonu GOGr� Q 7 O -