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HomeMy WebLinkAbout0235 HIGH STREET N S M EAD No. 53LOR UPC 12543 smead.com • Made in USA �afcvc(�c0 f 71 a ' RNR US®N iMS PROdKT lNE M � SFI ERTIRED C ISOURCM MRMMLSSPROGRAWOM Town of Barnstable Building r AMM ; Post his Card So That,it is Visible From the'Street-Approved Plans Must be Retained on Job and this Card Must be Kept 6� �$ Posted Until Final Inspection Has Been Made. ` ". Permit A. Where a Certificate of Occupancy is'Required,such Building shall Not be Occupied until a.Final Inspection has been made. Permit No. B-18-1846 Applicant Name: todd leduc Approvals Date Issued: 07/05/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/05/2019 Foundation: Location: 235 HIGH STREET,WEST BARNSTABLE Map/Lot:_ 111-019 -. Zoning District: RF Sheathing: Owner on Record: Janice Gannon I Contractor Name:'-,TODD LEDUC Framing: 1 Address: 235 High Street Contractor License: CSSL-106019 2 West Barnstable, MA 02668 ' '� Est. Project Cost: $7,000.00 Chimney: Description: Air sealing and insulation of attic flat and basement sills. Permit Fee: $85.70 € Insulation: Fee Paid:` $85.70 Project Review Req: Date: 7/5/2018 Final: , Plumbing/Gas �i 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 th Fs 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. L_ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.The Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 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. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "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 v r,L ,_ Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r.�►�a-� S E..-,c . ►,� Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept M^B& Posted Until Final Inspection Has Been Made.163 bs Permit � ¢ e Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-1774 Applicant Name: Richard J Tavano Approvals Date Issued: 07/02/2018 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 01/02/2019 Foundation: Location: 235 HIGH STREET,WEST BARNSTABLE Map/Lot: 111-019 Zoning District: RF Sheathing: Owner on Record: MACFARLANE, KAREN Contractor Name: Richard 1 Tavano Framing: 1 Address: P O BOX 868 Contractor License: 6653 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $5,000.00 Chimney: Description: New Duct System in Basement, 2 Zones Hot Air Furnance,Gas with Permit Fee: $85.00 A/C. Insulation: Fee Paid: $85.00 Project Review Req: Needs Dud test results to close Date: 7/2/2018 Final: b-Cr� — 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: Rough: 1.Foundation or Footing 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 Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT /7) 1 b �_aAw Commonwealth of Massachusetts " OF tew .t � � • Permit# Date: JUN p 4 2018 Estimated Job Cost: $ Db A h �R�J JJSI ABL, Permit Fee: $ ' Plans Submitted: YES NO S\ Plans Reviewed: YES— NO Business License#. �J Applicant License# D (J Business Information: Property Owner/Job Location Information: Name\ C�t1'1Cl (A—, L� Name:, Street: S 5 City/Town:\,�� ��cA n 5- �10�L City/Town: (� Telephone:��� ' ?�� �� Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES ✓ NO staff tial J-1 -7=estricted license - J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family ✓ Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. V-1" over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes I�o❑ If you have checked Yes, indicate the ty a of coverage by checking the appropriate box below: A liability insurance policy Other type of ind emnity demnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner �� Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my"knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments FType of License: eY - Zmes-ter Title ❑Master-Restricted City/Town ❑Joumeyperson Permit# Signature*of Licensee.. ❑Journeyperson-Restricted Fee$ License Number.( Check at www.mass.aov/dpl Inspector Signature of Permit Approval I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lehibly Name (Business/Organization4ndividual):AirSmart, LLC Address:1065 Service Road City/State/Zip:508-280-0024 Phone#: 508-280-0024 Are you an employer?Check the appropriate box: Type of project(required): 1.52 I am a employer with 7 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q'gemodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I 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 employees. [No workers' 13.0 Other 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. tContractors 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:Merchants Insurance Policy#or Self-ins.Lic.#:WCA19099895 (� Expiration Date:02/12/201 Job Site Address: 3,� �1 CA S-+ W , !` `�� City/State/Zip: (.e 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 ai s d nalties�of p}erjury that the information provided abo/ve is true and correct JK Signature: k � cam- `� Date: ! } Phone#: � • a�y "-O0, 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#: I Date Prepared: 01 /11/18 DIRECT BILL WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE POLICY MERCHANTS PREFERRED INSURANCE COMPANY BUFFALO, NY 14202 NCCI COMPANY NUMBER: 33942 INFORMATION PAGE POLICY NUMBER: WCA9099895 TRANSACTION TYPE: RENEWAL AGENCY/BROKER: SOUTHEASTERN INSURANCE AGCY RENEWAL OF NUMBER: WCA9099895 AGENT CODE: 66814/NER06/033 BUSINESS TYPE: LLC 1. THE AIRSMART LLC INTERSTATE/INTRASTATE RISK ID: INSURED 1065 SERVICE ROAD BOARD FILE NUMBER: MAILING WEST BARNSTABLE, MA 02668-1849 FEDERAL EMPLOYER ADDRESS IDENTIFICATION NUMBER: 811180983 OTHER WORKPLACES NOT SHOWN ABOVE: (ADDRESS,CITY, STATE,ZIP CODE) 2. POLICY PERIOD is from 02/12/18 to 02/12/19 12:01 AM standard time at the insured's mailing address. 3. A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $1 ,000,000 each accident Bodily Injury by Disease $1 ,000,000 policy limit Bodily Injury by Disease $1 ,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: D. This policy includes these endorsements and schedules: MS IU 05 11 99 MU 06 3J 10 14 WC 00 00 00 C WC 00 00 01 A WC 00 03 10 WC 00 04 20 WC 00 04 21 C WC 00 04 22 B WC 20 03 01 WC 20 03 02 A WC 20 03 03 D WC 20 04 01 WC 20 04 03 WC 20 04 04 WC 20 06 01 A 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Rates Per Estimated Annual Classifications No. Total Estimated Annual $100 of Premium Remuneration Remuneration SEE EXTENSION OF INFORMATION PAGE MINIMUM PREMIUM $ 460 DEPOSIT PREMIUM $ 4,515 TOTAL ESTIMATED ANNUAL PREMIUM $ 4,515 Interim adjustments of premiums shall be made: ANNUAL Countersigned by: �. Authoriz4WrepresentativJ Date COPYRIGHT 1987 NATIONAL COUNCIL ON COMPENSATION INSURANCE WC 00 00 01 A AGENT .COPY OOM OI�f�NEALTH:OF NISHIfSQT�S' Commonwealth of Massachusetts • • ' ' • • pepartmen t of Fire Services SHEET WORM,S • . ' "+ BU-317891'4---- • ' . z ISSUESTI��:FOLLOWINC� umer ia—perrt�{cateI t Technic BUSINESS% $! �`' oi►B 4 k RIC ARD J TAVA &� x RICHARD J TAVANo �106SMART LL:C: 1065 SERVICERD• MA 5 SE. WEST BARNSTABL�E . 'WEST�' ►RISTABL �?; 02668 E ation Da _ < 3 xpir to Marshal _" ✓ 1112612019 �; 41 State Fire M 769f102/2019' 2821 t1 • •. COM _ t s DRI1f6RS1LICENS Y s`,'P a X•`:.fit K� SA NONE �rJVZ7 EP 1HVAE:Te niclan Cert�cation' , m-----r 3 608 A jea"a AifSection 608--; ° ts`sEx-M _i �,1a9���ertiGc2tion Dale January 26;7994�;:_� � E;- ��_ T RICM.JRD�VAN(i-K f 'L ' 126K96 ©21fi<r28286M � 1� � J z tin4 W E°RUA D , nt7ry065.SEi 4 BARNSTABL E,MA 02/6687849 } an ._.5 W%Z1 mn 8e.m.ISae F>id� Fold,Then Detach Along All Perforations . ... ................................................................................................ .. ................ _ . ..._.... OMMONWEATHj:OF=1IA;ECS� T > O. SHEEpAVIEL WORKERS`, r ISSUES THE FOLLOWIPCEr�LMENSE Y f WAS tJNRWT. RICTEEi I I GHARD J TAVAN0 � �1065 SERVICE RD , y F lag U. y « >f 665a', .111281201 , 230842 y i �o� tH>: ropy Town of Barnstable �P Regulatory Services BARNSTABLE, + Richard V. Scali,Director 4 y MASS. �p 1639. ,,mom Building Division p� ArEa p't a• . a, • _ Paul Roma ' Building Commissioner' 206 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must r, Complete and Sign This Section If Using A Builder , Janice Gannon as Owner of the subject property. hereby authorize 5 Yv-)6o(i- to act on my behalf, in all matters relative to work authorized by-this building permit application for: " 235 High Street West Barnstable, MA 02668 f ` (Address of Job) Si tune of Owner 0I Aate E Print e. If Property Owner is applying for permit,,please complete the Homeowners License Exemption Form.' C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content..utlook\L'7U69LF2\EXPRESS(2).doc 01/25/17 GUARANTEES: All materials are guaranteed-by the contractor to be as specified. All work to be completed ,r in a workmanlike manner according to standard practice. Any alteration or deviation from specifications f � . - on contract involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents; or delay beyond our control. In the event that work cannot be completed due to unforeseen existing condition.1, the work will not proceed and a written,agreement will be executed for the deduction of this work from the specifications on the contract. Customers to carry fire, tornado, and other necessary insurance. Our workers are fully covered by Workman's'Compensation Insurance. Any defect in materials, manufacture, • 4 design, or installation found within one (1) year from date of the installation shall be remedied withou charge,and11 _within a reasonable period of time. z SCHEDULING: Work will begin based upon sub-contractor availability and permissible weather conditions. ; We will contact you to set a date and time. NOTICE TO MASSACHUSETTS CUSTOMERS: The Commonwealth of Massachusetts, Board of Building Regulation and Standards requires that you be notified of the following: "All home improvement contractors,and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed,to: Director, Home Improvement Contractor Registration . . .. . One Ashburton Place, Room ,1301 Boston, MA 02108 Phone' (617) 727-8598- Any and all necessary construction,related permits are included in this contract. It shall be the obligation of the contractor to obtain�such permits`as the customer's agent. Customers who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund." r NOTICE TO BUYER: 1. You are entitled to a copy of this agreement at the time you sign it. j 2. The seller has no right to enter unlawfully your premises or commit any breach of the peace to repossess goods purchased under this agreement. 3. You may cancel this agreement if it has not been signed at the Main Office or a Branch Office of the Seller provided you notify the Seller at his Main Office or Branch Office shown in the agreement by registered or certified mail, which shall be posted not later than midnight of the third calendar day after the day on which the Buyer signs the agreement, excluding Sunday and any Holiday on which regular mail deliveries are not made. 4. No lien or security interest is placed on the property as a consequence of this contract if payment:is made in accordance with.contract terms. , . Printed:05/08/2018 2:16:04 PM of Barnstable w 14 W. Building ? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card'Must be Kept M". jPosted Until Final Inspection Has Been Made. { Permit 36sa � . raa�° ,Where a Certificate of Occupancy is Required,such,Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-1378 Applicant Name: MACFARLANE, KAREN Approvals Date Issued: 05/08/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/08/2018 Foundation: Location: 235 HIGH STREET,WEST BARNSTABLE Map/Lot: 111--019 Zoning District: RF Sheathing: Owner on Record: MACFARLANE, KAREN Contractor Name:' Framing: 1 Address: P O BOX 868 Contractor License: 2 Es t. Project Cost: $8 00,000. MARSTONS MILLS, MA 02648 �.� � Chimney: Description: Replace Windows, Doors and siding ; Permit Fee: $40.80 I Insulation: Fee Paid:` $40.80 Project Review Req: f Date: K' 5/8/2018 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. _ _ - r Electrical j 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 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: W)iere applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "P,.iersons 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 ptr Application number................................................ Date Issued.................................. ............... N Building Inspectors Initials I 1� 163 MAY 04 2018 Map/Parcel................................................................. .. ........ ... ...... TOWN % TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY NFORMATION Address of Project: DZ5 V\-k C.,\(\ S�T-e� NUMBER 6TREET VILLAGE Owner's Name: 'SoArA-.CX C-Tcky%,y\o-n Phone Number Email Address: Phone Number Project cost $ 19 o No Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature:. Date: TYPE OF WORK EB"VSl ing 5J Windows (no header change)#_LD _ED Insulation/Weatherization D"Doors (no header change) # Commercial Doors require an inspector's review R60-f(not-applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT-HAVE STRUCTURES OVER.75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER . *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach1loor plan with exits marked) Dimensions of each Tent X X 3 X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: QfMA Yy ,CJ n Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Tow, of Barnstable. Date S ..L' ignature APPLICANT'S SIGNATURE Signature Date All permit appli ations are subject to a building official's approval prior to issuance. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston,MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information \ ( Please Print Legib1Y_ Name(Business/Organization/Individual): - )Qw1lG� `7C-• Y�0" Address: az tJ "aA City/State/Zip: S ` Phone Are you an empIoyer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [] I am a general contractor and I • employees(full and/or part-time).* have hired the soli-contractors 6. ❑New construction listed on the attached sheet 7. �Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.# required..] 5. We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself,[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 isproviding workers'compensation insurance for my employees. Below is the polrcy artd job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 inchhrance coverage verification. I do hereby c TP under the and penalties of perjury that the information provided above is true and correct Q Signature: Date: t' O Phone#: O Official use only. Do not write in this area,to be completed by city or town official City or Town: Peraiit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Phone#: Contact Person: r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiowbdividual): ­SGJv�\ce c ( s,�V\O Address: '4Z)!) k \kg� 1 C__ATSaA_ City/State/Zip: W A V �ovcy�S�fA ei Phone#: 'Sd%"3�Lt Are.youan employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp•insurance. t 9. ❑Building addition required.] 5. ❑ We are a corporation and its UP Electrical repairs or additions 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 employees. [No workers' 13.[1 Other 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. tContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 c;IW�AtA nder the p d penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone _3( 1Lt---I 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person id the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a 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 maintenance;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 employer." MGL chapter 152, §25C(6):also`states thatt,,`every state or local 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 its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pemrittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future 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 (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance 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: , The Commonwealth of Massachusetts Department of Industrial Accidents Office of luvestigatims 600 Washington Street Roston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable ` �. Building e Post This Card So That it is Visible From theStreet Approve'dPlansMustbe Retained onaJob and thisFCard�Mustbe#Keptµ w Posted Until Final Inspection,HasBeen<Made.. � .. Permit � '�� Where a Certificate of°Occupancy Is�Required,.such Building shall�Not be�Occupied untiFa F.inal�lns`pection has�been made. � . Permit No.` B-18 1239 Applicant Name: MACFARLANE,KAREN Approvals xr Date Issued: 04/26/2018 Current Use: Structure - Permit Type: Building-Alteration INTERIOR Work Only Expiration Date: 10/26/2018 Foundation: Residential Map/Lot: 111-019 Zoning District: . RF , Sheathing: Location: 235 HIGH STREET,WEST BARNSTABLE- . Contractor�Name Framing: 1 , Owner on Record: MACFARLANE,KAREN ' ContractorUcense Address: . P O BOX 868Project Cost: $10,000.00 Chimney: MARSTONS MILLS,`MA 02648 Pemit�Fee 101.00 Insulation: Description: open wall between kitchn&living room 12 o,pe in g with 3 1/2 on Fee Paid: $101.00 each side(2)9 1/4 x 13/4 versa lam .remodelbathroomzchange r ti Date , 4/26/2018 Final: wall location rotate basement stairs s g Project Review Req: � Buildin� .G g Official Plumbing/Gas Rough Plumbing: r5—mol� This permit shall be deemed abandoned and invalid unless the work author ed by�his-peemit"is-commenced4ith%ixtmonths after issuance. Final Plumbing: All work authorized by this permit shall conformad the approved applpication=and thetapproved construction documerits for whighthis permit has been granted.. . ^4'dw�Y4r`� Jmt,, j All construction,alterations and changes of use of any building and structures,shallxbe m compliance with the local zoning, y lawrand codes. Rough Gas: - This permit shall be displayed in a location clearly visible from access st- t ad and shall be maintained open for public mnsp act on for the entire duration of the e y work until the completion of the same. " ` Mel. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures bya. Building and Fire Officials are,p�rov ded on this•pe.md. Electricals Minimum of Five Call inspections Required for All Construction Work 1.Foundation or Footing _ "` Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue limngii installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame.lnspection 5.Prior to Covering Structural Members{Frame Inspection)• Final: , A Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final:- Work shall not proceed until the Inspector has approved the various stages of construction: ,Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth•in MGL c.142A). Final:. . Building plans'are to be available on site Fire Department. - All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT _- - -Final: Application Number........ 0 PeI. ............Oth.er Fee........................ ........ KAS& 03 16 Total Fee Paid........................ .... . AW ... TOWN OF BARNSTABLE Pemit Approval by...49........... ............. .pm=l............................................ MELDING PERMIT MIT............................. APPLICATION Section 1 owner's information and Project Location . I'll, 110 Fillage Project Address Addre§s ---state UYN-�k , ()YY) Mail Section 2—Use of S\4uctu-r Use Group---. F, Commercial Structure over 35,000 cubic feet El commercial Structure under 35,000 cubic feet El single/Two Family Dwelling erection3--T-y-pe-ofYeFWt- New construction ❑ Move/Relocate El Accessory Structure El Change Of use F1 'Finish Basement [I Family/AmnestY 91%)e Alarm ❑ Demo/(entire structure) D S %-rer System Apartment p Rebuild F1 Deck 4)0)p e F1 Addition F, Retaining wall El Solar 04//V op Renovation ❑ Pool El Insulation Other-Spec' Section- yy-� V -3\b! ILWA ify-- E� —�-4,-�W�ik�l T A.qf Tmdaft-d!2/9/2018 Application Number.................................................... Section 5-Detail ' [Cost-of Proposed-Construction to o r7 Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Egi_sting Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ' 0 Smoke Detectors ❑ Plumbing [] Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I an using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section S—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated:2 2018 Application Number........................................... Section 9— Construction Supervisor Name Telephone Number Address City State zip License Number License Type Expiration Date Contractors Email Cell# I understand my responsibilities under the riles and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and.the Town of Barnstable.Attach a copy of your license. Signature Date Section.10 —Home Improvement Contractor Name Telephone Number Address City State Tip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your HIC... Signature Date Sectio me-Owner-s:L- cease Exemption-= Home Owners Name: Telephone Number Cell or Work Number So`�—� t.� -7 I understand my responsibilities tinder the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date �-i a•�1 1� Print Name ��� �., oY� Telephone Number LQ `� b =1 )L-1 7 y E-mail permit to: (""A C vr1 r� ae7.nrnnnjo Section 12—Department Sign-Offs l Health Department ® Zoning Board(if required) ❑ ' Historic District ❑ Site Plan Review(if required) Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire departm nt for approval Section 13—Owner's Authorization I' as Owner of the-subject property hereby ' to act on my behalf, in all authorize matters relative to work authorized by this building Permit application for: (Address of job) date Signature of Owner Print Name Last undated:2192018 Boise Cascade Double 1-3/4" x 9-1/4"VERSA-LAM® 2.0 3100 SP Floor Beam\FB01 r Dry 1 span No cantilevers 1 0/12 slope April 23, 2018 08:56:44 3C CALCO Design Report j 3uild 6536 File Name: BC CALC Project Job Name: Gannon Residence Description: Designs\FBO1 \ddress: 235 High St Specifier: :ity, State, Zip: West Barnstable , MA Designer: BC :ustomer: Frank Bridges Company: Shepley :ode reports: ESR-1040 Misc: i 1. l i I I I i i l l l 1111 l i l l l l i t +t�E-�W ��., .A:`- y 5.�+ij• � seyr�it.,.ra � M. -..•ia"$- 12-07-00 B 1 BO Total Horizontal Product Length=12-07-00 Reaction Summary (Down / Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,636/0 877/0 B1, 3-1/2" 1,636/0 877/0 Live Dead Snow Wind Roof Live Trib Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area (lb/ft^2) L 00-00-00 12-07-00 20 10 13-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 7,339 ft-Ibs 55.3% 100% 1 06-03-08 End Shear 2,088 Ibs 34% 100% 1 01-00-12 Total Load Defl. L/346 (0.421") 69.4% n/a 1 06-03-08 j Live Load Defl. U531 (0.274") 67.8% n/a 2 06-03-08 Max Defl. 0.421 42.1% n/a 1 06-03-08 Span/Depth 15.7 n/a n/a 0 '00-00-00 %Allow %Allow ` Bearing Supports Dim (L x W) Value Support Member Material BO Post 3-1/2".x 3-1/2" 2,513 Ibs n/a 27.3% Unspecified B1 Post 3-1/2"x 3-1/2" 2,513 Ibs n/a 27.3% Unspecified Notes Design meets Code minimum (1_1240)Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum Total load deflection criteria. Calculations assume member is fully braced. BC CALCO analysis is based on IBC 2009. Design based on Dry Service Condition. Fastener M an ufacturer:Simpson Strong-Tie, Inc. - 4 Boise Cascade Double 1-3/4" x 9-1/4" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 1 span I No cantilevers 1 0/12 slope April 23, 2018 08:56:44 3C CALC®Design Report ,__ 3uild 6536 File Name: BC CALC Project Job Name: Gannon Residence Description: Designs\FB01 4ddress: 235 High St Specifier: City, State, Zip:West Barnstable , MA Designer: BC Customer: Frank Bridges Company: Shepley Code reports: ESR-1040 Misc: Connection Diagram Disclosure Completeness and accuracy of input must b a be verified by anyone who would rely on a output as evidence of suitability for particula application.Output here based on building code-accepted design properties and i analysis methods.Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions, a minimum = 1-1/2"c=6-1/4" please call(800)232-0788 before b minimum =6" d = 12" installation. - e minimum = 1" BC CALC®,BC FRAMER®,AJS-, Install Screws with screw heads in the loaded ply. ALLJOIST®,BC RIM BOARDT-'BCI®, Member has no side loads. BOISE GLULAM- SIMPLE FRAMING Connectors are: SDW22338 SYSTEM®,VERSA-LAM@),VERSA-RIM PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Cascade Wood Products L.L.C. I Parcel Detail Page 1 of 4 of �o (J ff .MASS, 0o rr fi ., -5�""'��",.�+�a. Logged In As: Parcel Detail Tuesday,April 24 2018 Parcel Lookup Parcel Info Parcel ID 111-019 f Developer Lot Location 235 HIGH STREET Pri Frontage 1155 Sec Road I sec Frontage I I Village West Barnstable I Fire Distrlct JW BARNSTABLE ---1 Town sewer exists at this address NO Road Index 0702 ... I Asbuilt Septic Scan: 111019 1 interactive trap y `, Owner Info owner MACFARLANE, KAREN I owner /oGANNON,JANICE E streets P O BOX 868 �__ 1 street2 I city IMARSTOWS MILLS ( state MA I zip 102648 country I Land Info _.........._..............._..__...._._._.._.....-----................................................_..........................................................................._............_........._._......................................................................................._....._._.._....._..__........._....__._.._._.....__..._._....._.._..._.........._...._..._.._..._..................__._...................................._._.... Acres 1.11 �,... )use Isingle Fam MDL-01 Zoning RF _. �.__...._1 Nghbd 0107 � Topography Level ( Road Paved utilities JSeptic,We11,GaT7771 Location I. ....�^� - Construction Info Building 1 of 1 Built 1969 svuct Gable/Hip wall Wood Shingle Cluing Roof 1118 over As h/F GIs/Cm "c Area Cover p None p Type . WD� Style Ranch au Drywall Rooms ed 2 BedroomsTO Model lResidential IntFloor Hardwood � � Rooms Bath 1 Fu11-0 Half Grade Average �) Type Hot Water Roo me 5 Rooms stories 1 StoryHeat P arson F0°"d" Fuel Poured Conc. 14.Gross 3244 Area "w Permit History Issue Date Purpose Permit# Amount Insp Date Comments Visit History Date Who Purpose 5/15/2013 12:00:00 AM Nancy Finch Cycl Insp Comp http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6374 4/24/2018 { 33' 33' V� 41' 36' 48' 62' 139Y2' 41r 76' 30' iS4' N Cr _ � � 36• I 60' za• �, 3' ----------- i ----------- �24' ------------------------------------------------ ---------- 132V2' 113E 212)j' 135h' 121�' f v� 7 `NY-,.C-e G �v\YNvl-N �\ ` i-e.e-,1 A I , 1 r l i 1 i + 1 e 1 i 1 I ( � t d � ( t t I i d I I I I .. N 10 it I it 4 , 1 f j ? 33" 3 41" 54" { 36" 48" 68 48" 30" 3 33" 60" 24" 3 35" 11 i I {f 24" i r 'f t S � f t ' 1 _ � r t , - t t I' • t � t � � Ik 1 i 1 t