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0042 PACKET LANDING WAY
o I I Oxford NO. 1.52 ORA ESSELT'E 10°iA 1 0 0 A.CTI-VE i Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/8/16 �y Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 16-2925 Dear Mr. Perry This affidavit is to certify that all work completed for 42 Packet Landing Way,W.rBarnstable has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. Lia � All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q_— tm fl°t 1 9 TO'vv'N OF BARNSTABLE Map � Parcel Application # Health Division 1. ib �' Sri t' Date Issued Conservation Division Application Fee Planning Dept. InvIS101111 Permit Fee s Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address W i Village e Dafri&6[P/ Owner �-� e-.� ; S Address Cunt-. Telephone - 6 a f Permit Request R ' 3S ,Ce � Se �'o '4-r1e, ce I� �o --t q �; o Z. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Lk 5 00 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 0 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 1 i Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i Commercial ❑Yes 1KNo If yes, site plan review# Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t Ilt 1^ a+f o Telephone Number at 39B 0319 Address I1+JQr.-'ab License # *iL-C t o a•R6 ra►rma Home Improvement Contractor# 1��r Email Worker's Compensation # VC&,�S -7-00 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � e SIGNATURE DATE L 0 3 6 FOR OFFICIAL USE ONLY APPLICATION # - DATE ISSUED i t MAP/ PARCEL NO. ADDRESS f VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r ` FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL-BUILDING DATE CLOSED OUT ASSOCIATION.PLAN NO. } DATE(MM/)DIYYYY) A`oR0 CERTIFICATE OF LIABILITY INSURANCE 4/12/2016 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 pollcy(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 CONE:TACT Risk Strategies Company NAM Risk Strategies Company PAHIC0 N E : (781)986-4400 1 FAX No:(781)963-4420 15 Pacella Park Drive E-MAIL randol hcldQrisk-strat ies.com ADDRESS: P eg Suite 240 INSURER(S)AFFORDING COVERAGE NAIC t Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURER El Allmerica Financial Alliance Ins Cc 10212 Cape Save, Inc INSURERC:Star Insurance Cc 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211375 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. �S TYPE OF INSURANCE POLICY NUMBER MFM/ICY EFF P OLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMSMADE XD OCCUR PREMISES Ee occurrence) $ 100,000 X 01994480 10/16/2015 MEDEXP oneperson) $ 10,000 PERSONAL d ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JPECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ BINED SINGLE AUTOMOBILE LIABILITY EON.",m LIMIT $ 1,000,000 B ANY AUTO BODILY IN.IURY(Per person) $ AUTO ALLM �OEDULED AWBA46796600 11/6/2015 11/6/2016 BODILYINJURY(Peraccident) $ X HIREDAUTOS AUTOS � Pe ec�cidentDAMAGE $ IPROP $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAS CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ HIL 1 181994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION ,. Officers Included for - X STATIfTE OTTH- AND EMPLOYERS'LIABILITY _ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN coverage E.L.EACH ACCIDENT $ 500,000 OFFICEtoryin EXCLUDED? a NIA C (MendatorylnNH)H) , e . r WC085540700 4/9/2016 6/9/2017 E.L.DISEASE=FA EMPLOYEE $ 500,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remadrs Schedule,may be attached If more apace Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of named insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 West Main Street - AUTHORIZED REPRESENTATIVE Hyannis, lei 02601 Michael Christian/CLC '� 01999-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) / The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ww».massgov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 15 employees(full and/or part-time).* 7. New construction In I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.] ❑ 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Insulation 152,§1(4),and we have no 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: Star Insurance Co. i Policy#or Self-ins.Lic.#: WC085540700 Expiration Date: 4/9/2017 ! Job Site Address: 42 Packet Landing Way City/State/Zip:West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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_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 th pains and penalties ofperjury that the information provided above is true and correct Signature: Date: 3/ 6 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#: - Office of Consumer Affairs and Business Regulation i - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2018 Tr# 419291 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 Lost Card SCA 1 % 2OM-05/11 e�Pa�n„ca�rcoeu(l/e oPU(��casaa/r•u efid License or registration valid for individul use onl Office of Consumer Affairs&Busihess Regulation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,:%'171380 Type: Office of Consumer Affairs and Business Regulation ExpIratlom 3/14/2018 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY' 7-D HUNTINGTON AVENUE'__' SOUTH YARMOUTH,MA 02664 Undersecretary Not valid i signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards q- ' ----1-t 1-11sL1tr -111L1111�1111C1 Y1.1111 JtICIIAIIY .J[-:�. License: CSSL-102776 W II.LIAM J MC U 37 NAUSET ROAD West Yarmouth 1VIA Expiration Commissioner 06/28/2017 *(Do s.tobk NO Vt iLaflms' aoo.'a�oi � , U. . _ c i3S�J6 Town of Barnstable ' Regulatory Services BARNSTABLE. 7 MASS t639 �0 g Buildin Division '°'Fo Mn+• 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 I Inspection Correction Notice Type of Inspections Location L ���K�7 4-N,6/t,� Permit Number Z O l T 7 774 �L 1 W Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: Al � y Please call: 508-862-4038 for re-inspection. Inspected by Date 139 Queen Anne Road Harwich, MA 02645 Office: 774-237-0410 Frontier Energy Solutions, Inc. Web: frontierenergysolutionsinc.com Certificate of Insulation Work Job Site Address: Crew Members on Site: lsz $ Description of Work Location: Square Feet: Material: R-Value: R-Values per inch:Cellulose,loose:3.7,Cellulose,Dense Packed:3.2,Fiberglass:3.0,Poly-iso board:7,Closed Cell foam:6.5 Air Sealing Completed: Attic Access Treated: Blower Door Results: ❑ Attic ❑ Pull Down Stairs Pre-Work Test: ❑ Basement ❑ Hatches Post-W9Ac Test: Oil('Living Space ❑ Doors OY No Blower Door Test ❑ None Notes: certify that the address listed above was insulated as described on this certificate, and that all work was performed and installed in accordance with state and locaj b 'I • g codes. For�man..'_-- Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1r Map Parcel ©O Application # " Health Division '�SJ Date Issued Conservation Division I9' . Application Fee Planning Dept. Permit Fee. Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 7, AC, ,<-E-�-T-G' L-A fJ Village VAE1_� � V $ '� t7 � �j � - 1 A-c Owner Address S '� Telephone vE3 Q 8 3 g 0 -2-74 0 Permit Request 15�a t-'� N E �� , 9 X 4 AWD 1'< {T'E, "_Gl! Q {� CS 7_ `D Square feet: 1 st floor: existing proposed ` 1�2nd floor: existing p posed Total new Zoning Districtt Flood Plain Groundwater Overlay Project Valuation .Q 1 Q t�l Q Construction Type P4,� C 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:><bs ❑ 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: '-1 existing new Total Room Count (not including baths): existing ---, new First Floor Room Count Heat Type and Fuel: 0 Gas �il ❑ Electric (3 Other Central Air: ❑Yes '�"o Fireplaces: Existing 'flew Existing wood/coal stove: ❑Yes Y" Deta ara n B new size_Pool: ❑ existing 0 new size _ Barn: ❑ existing ❑ new size_ 'Attached garage.*isting ❑ new size _Shed: ❑ existing ❑ new size _ Other: J Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ^lo- If yes, site plan review# Current Use ( r-) la N � Proposed Use �� APPLICANT INFORMATION z (BUILDER OR HOMEOWNER) ^7 Name L �' Cb�N � X �TTeI phone Number t �� 1 Addres s"I77- ( 9 License # G � � 4 Z,Z,44,0 0 57-0(2- 'V 1:L-4,C: Home Improvement Contractor# �� Cl 3 *JG65b so 5-44.2-'26 I BA- Email r�-� Worker's Compensation;# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE KIIJ V Z 0 1 FOR.OFFICIAL USE ONLY APPLICATION# DATE ISSUED e MAP/PARCEL N0. - ADDRESS VILLAGE "OWNER , P DATE OF INSPECTION: FOUNDATION yp FRAME lip s- 13FRM s ilduALA&q-- ' f' r INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH- FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �t Town of Barnstable Regulatory Services ` $" E MASS. Thomas F. Geiler,Director Mass. 039. Building Division i 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 7o /S o 7 7.' Owner: Fy/i9 s Map/Parcel: / 71 - 00 `k Project Address_f/l/a lah ��W y Builder: & The following items were noted on reviewing: flD &4.x L� ��C�GClIZEllt�it/t'' a� ?N� t/i�SC/?/P'�fIL� �g�� �EC� �oNst�2a�t/pr/ �sc.I�y�E l�xS�c�� z Vo 9n I I Reviewed by: Date: 0 f Q:Forms:Plnrvw Town of Barnstable Regulatory Services BAMSrABLE.� Thomas F. Geiler,Director 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 Zo /.S o -) 7 7-P Owner: EL/0-5 Map/Parcel: / 7 00 Project Address 317 Builder: JCr � The following items were noted on reviewing: AD4 G/X l%ONSz'A-MGTI teSr- &arvT A:-�-OGC (I�eseeI wc's l emsmCWT-1.A1- G lmh 6s I oc ✓vim Sec c,� 7`P� Reviewed by: Date: e� la f f Q:Forms:Plnrvw AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone• Massachusetts Checklist for Compliance(ego CMR 5301.i.1.1)' dWEngineering & Design Co., Inc. 42 Packet Landing Project No.2015-340 Barnstable,MA 02668 November 3,2015 Q Check Compliance 1.1 SCOPE WindSpeed(3-sec. gust).................................................................. .................................................110 mph Q WindExposure Category.................................................................. .............................................................B Q 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) ......... 1 story 5 2 stories Q RoofPitch ..........................................................................(Fig 2) ...............................................3:12 5 12-12 Q Mean Roof Height ..............................................................(Fig 2)...............................................9 ft 6 in<_33' Q BuildingWidth,W...............................................................(Fig 3)......................................................8 ft 5 80' Q BuildingLength, L ..............................................................(Fig 3)....................................................14 ft<_80' Q Building Aspect Ratio(L/W) ...............................................(Fig 4)................................................... 1.75 S 3:1 Q Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................. 6'8"5 6'8" Q 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)................................................................ Q 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete .............................................................................................................................. Q 2.2 ANCHORAGE TO FOUNDATION1.3 5/8"Anchor Bolts imbedded or 5/8" Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general ..........................................(Table 4)...................................................... 48 in. Q Bolt Spacing from end/joint of plate ............................(Fig 5)...........................................12 in.5 6"—12" Q Bolt Embedment—concrete.........................................(Fig 5).....................................................7 in.z 7" Q Plate Washer...............................................................(Fig 5)......................... 3"x 3"x%" a 3"x 3"x W Q 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Q Maximum Floor Opening Dimension...................................(Fig 6)................................................... N/A. 5 12' Q Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Q Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).......................................9-1/4"Allowed 5 d Q Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).......................................9-1/4"Allowed 5 d Q Floor Bracing at Endwalls...................................................(Fig 9).................................(First 2 Bays 4ft O.C.) Q Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)...................T&G WSP Q Floor Sheathing Thickness .................................................(per 780 CMR Chapter 55).........................3/4"in. Q Floor Sheathing Fastening .................................................(Table 2).............8d nails at 6 in edge/12 in field Q i AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone, Massachusetts Checklist for Compliance(780 CMx 5301'2.1.1)1 AW'Design Engineering & Co., Inc. 4.1 WALLS Wall Height Loadbearing walls.............................................. (Fig 10 and Table 5)...................... 7 ft.0 in.15,10' Q Non-Loadbearing walls................................................(Fig 10 and Table 5)...................... 8 ft. 3 in.5 20' Q Wall Stud Spacing ........................................................(Fig 10 and Table 5).....................16 in.:5 24"o.c. Q Wall Story Offsets ........................................................(Figs 7&8).....................................1ft or less 5 d Q 4.2 EXTERIOR WALLS3 Wood Studs Loadbearingwalls........................................................(Table 5)........................................... 2x6-7 ft 0 in. Q Non-Loadbearing walls................................................(fable 5)........................................... 2x6-8 ft 3 in. Q Gable End Wall Bracing' Full Height Endwall Studs............................................(Fig 10).................................................................. Q Gypsum Ceiling Length(if WSP not used)...........................(Fig 11).........................Fully Sheetrocked z 0.9W Q 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays Q Double Top Plate Splice Length ........................................................(Fig 13 and Table 6)..........................................4ft Q Splice Connection (no. of 16d common nails)..............(Table 6)..............................................................6 Q Loadbearing Wall Connections Lateral(no. of 16d common nails)................................(Tables 7)............................................ 3 Per Stud Q Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)................................(Table 8).............................................. 3 Per Stud Q Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9)......................................... 3 ft 6 in. 5 11' Q Sill Plate Spans ........................................................(Table 9)..........................................3 ft 6 in.5 11' Q Full Height Studs (no. of studs)...................................(Table 9)..............................................................2 Q Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9)..........................................3 ft 6 in. 15 12' Q Sill Plate Spans...........................................................(Table 9)......................................... 3 ft 6 in.5 12" Q Full Height Studs(no. of studs)....................................(Table 9)..............................................................2 Q Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously° Minimum Building Dimension,W Nominal Height of Tallest Opening ....................................................................... 6'8"5 6'8" Q Sheathing Type..............................................(note 4)...............................................CDX/WSP Q Edge Nail Spacing.........................................(Table 10 or note 4 if less)..............................6 in. Q Field Nail Spacing..........................................(Table 10).....................................................12 in. Q Shear Connection(no. of 16d common nails)(Table 10).............................................3 Per Foot Q Percent Full-Height Sheathing... Rear................. (Table 10)..(51% Required)(100%Available) Q AWE'Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone, Massachusetts Checklist for Compliance (780 CMR 530I.iI.1)1 AW'Design Engineering & Co., Inc. Maximum Building Dimension, L Nominal Height of Tallest Opening2.................................................................. 6'8"s 6'8" Q SheathingType..............................................(note 4)...............................................CDX/WSP Q Edge Nail Spacing.........................................(Table 11 or note 4 if less)..............................6 in. Q Field Nail Spacing..........................................(fable 11).....................................................12 in. Q Shear Connection (no.of 16d common nails)(Table 11).............................................3 Per Foot Q Percent Full-Height Sheathing......Side(Table 11).................. (20% Required)(75%Available) Q Wall Cladding Ratedfor Wind Speed?.............................................................. .................................................11 O MPH Q 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Q Roof Overhang ................................................... (Figure 19)......1ft or Less s smaller of 2'or U3 Q Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)..............................................U=187 plf Q Lateral.............................................(Table 12)...............................................L=176 plf Q Shear...............................................(Table 12)................................................S=77 plf Q Ridge Strap Connections, if collar ties not used per page 21... (Table 13).................................T=206 plf Q Gable Rake Outlooker......................................... (Figure 20)......1 ft or Lesss smaller of 2'or U2 Q Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14).............................................U=417 lb. Q Lateral(no. of 16d common nails)...(Table 14)....................................... L= 162 lb. Q Roof Sheathing Type......................(per 780 CMR Chapters 58 and 59) ........................ CDX/WSP Q Roof Sheathing Thickness........................................... .............................................7/16 in.z 7/16"WSP Q Roof Sheathing Fastening ...........................................(Table 2)...............................8d(6"Edge 6"Field) Q i AWC Guide to Wood Construction in Aigh Wind Areas: 110 mph Wind Zone, Massachusetts Checklist for Compliance(780 CMR 5301:2.1.1)1 d ,�9 Engineering & j4Design Co., Inc. Notes: The compliance checklist is typically used for the prescriptive design method for high wind construction for structures located within exposure B.When a structure is located in exposure zone C,the checklist is used as reference guide to help determine the areas of a structure that need further structural evaluation.The forces that have been provided on this checklist have been calculated for this particular structure located within exposure zone B. 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. 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. 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height 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 '-WHEI+I THE EDGE RESfS ON RRAMING USE&I NAU AT6'oc 3 +� 11 11 I M Z O d2: 1 11 ,1 II 1 1 1 11 tr r M 1•I 1 r 1 1 J 11 11 t 1 ru II Il 1 1 m , t I o n 1; FRAMING MEMBERS ®a t l I ' 1 1 i ; m EdEDGE M0WEDIATE —"r it a u ,r iy 1 ; t 1 11 m h It y I r r r it O '; 11 1 i to 1 ; 1 r q 1 1 $"MIN. au ;; ' ---- ---t-- ------ - - ----a- -1--- ' is ;i i STAGGERED 3"Mil r r _i i NA1L PATTERN PANEL 1 - -tea _.•'Jt.� �.r. PANMEDGE DOUBLE NAIL EDGE SPACING DETAL OOUSLECDGE --- t� MAILSPACM ; + 1 PAtiEt_ d - Detail Vertical and Horizontal Nailing See Detail on Next Page for Panel Attachment Vertical and Horizontal Nailing for Panel Attachment I Barnstable Old Kings Highway Historic:District Committee z UR,Sr,S i 200 Main Street,Hyannis,MA 02601,TEL: 508-8624787 Fax 508-862-4784 s6yq. � 'rF°M�• APPI.,ICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and;on plans,drawings,or photographs accompanying this application for: heck aU categories that apply, ; 1. Building construction: ElNew ddition El Alteration' 2. Type of Building: XHouse ❑ Garage/barn ❑ Shed. 0 Commercial ❑ Other_ 3. Exterior Paintin roof new roof ❑ color/material change,of trim,:siding,window,door N/�t' 4. i , �. . ./ ❑ New Sign Existing Sign ❑ Repainting Existing Sign 5• r� ' Cry ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall- ❑ Tennis court ❑ Other 6 00 ❑ Swimming ❑ Other man-made pool ❑ .Solar panels ❑ Other Type or Print Legibly: Date �'� CI I NOTE AM applications must be signed by the current owner SLAW a L 1 A '5 Sa:g 38 0-. !,I Owner(print): Telephone#: • Address of Proposed Work: N—' IIt_T LAt_a�4 til fr Villagef�jyW/ ' '$L-E Map Lot# Mailing Address(if different) Owner's Signature .. Description of Proposed Work: Give particulars of ork to be done: 1 O 1-1 O O►=f-f0uSc "bV I t,y %-,j©0(7 pEe—IZ, -REIAJ , Or— t• OU5C Agent or Contractor(print):7l" "EA U' t e TZ- Telephone#: SDS 77.6 32-O 7, Address:-77,Z f-i A I N 1 S�=R1/1 LL E Contractor/Agent'signature: For com ease e� ertificate'.4s h by APPROVED DENIED D e bens si tures14 RECEMD ED PROV AP Oct v; Town of Barnstable ISomds and Commissions101d K" s Hi IOKH haationslOK11 Z011 Cert A ro riateness.doc Old Kings committee 1 Q. mg Sal APP PP P CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copies Foundation Type:(Max. 12'exposed)(material-bric cemen other) Siding Type: Clapboard_ shingle- other I Material: red cedar white cedar ✓ other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof 7/12:s Pitch minimum ( ) ( ) (specify on plans for:new buildings, major additions) Window and door trim material: wood other material,specify Size of cornerboards size of casings((=4min-)� color Rakes Ist member 2nd member Depth of overhang Window: (make/model) lJ material h► Color (Provide window schedule on plan for new buildings, major additions) Window grills(please check all that apply . true divided lights_ exterior glued grills— grills between glass removable interior_ None Door style and make: � �LI materialG�-� : :: Color: Wi Garage Door,Style �"'-' Size of opening Material'. Color Shutter Type/Style/Material: Color: Gutter Type/Material: rL� Color: VA Deck material: wood other material,.specify Color: n" Skylight,type/make/model/: LUX material Col-.. . Size: Sign size: Type/Materials: Color: Fence Type(max 6')Style material: Color: Retaining wall: Material: Lighting,freestanding �Z on building illuminating sign OTHER INFORMATION: : GROWTH MANAGEMENT TBE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows;doors,garage door,fences,lamp posts etc Signed: (Plan re arer Prmt Name:-Dh�,J APPROVE® Q.18oards and ConwiLuions101d Kings HiglnvaylOKHApplicationslOKH rt2O11 Ce Appropriateness.doc 2 OCT 8442015 Town of Barnstable Old King's Highway Committee Town of Barnstable Geographic Information System October 6, 2015 i 179016 062 i APP1T'I � I 17900100a #976 I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179013 179004 � #55 #42 PG 4 179014 #41 179003 #26 0 12 Feet DISCLAIMERS:This map is for planning purposes ardy. it is not adequate for legal Map:179 Parcel:004 Q boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner.ELIAS,STANLEY&EILEEN TRS Total Assessed Value:$324000 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map - E - are only graphic representations of Assessors tax parcels: They are not true property Co-Owner ELIAS FAMILY REVOCABLE Acreage:0.36 acres Abutters bountlades and do not represent accurate relationships to physical features on the map Location:42 PACKET LANDING WAY r + such as building locations. Buffer' i tL o r Town of Barnstable 0 E Regulatory Services R i sxetaw�r.eRro o` ichard V.Scali,Director MAIM _659 16 BuR�7n�"-'-`ice Division ED pAA'� . TomPerry,Buildma Commissioner 200 Main Street;Hyaums,MA 02601 www.town banutable ma_us Office: 508-862-4'03 8 Fax: 508-790-6230 Property Owner Must Complete and Sign Tbis Section If Using A.Builder as Owner of the subject property hereby audio&p �C M4 ko A HQ-• to act on my bdmlf, in all matters relative towo authorized bythis bw7ding permit application for. (Address of Job) "Pool fences and alarm are the responsibilityof the applicant Pools are not to be filled or tT i Pd before fence is installed and all final inspections_are performed and accepted. esjoffture of Owner Signature of Applicant Phut Name Print Name Dare . Q:F0RMS:0wrM?TERIMSI0Ie0DM i The eormmornwealth of Massadirfsetts �e,�r��erit a,�'�r�r�friaf�cciderrts -- Bantam,M 02111 . _y tvrvxfrrftcrs�govfdirs Workers' Campensat anIns"-m-anczAff idavit Bmilder-JCan{ract-or&MecfdcianslPlumhers Applicanflufq=atian Please Friut Leeffil Mate(13us�ess�0�rganiza'�ionlfn " rtz} (z �Q , k-C Add.[Zss_ ( lOUA - CiE I tel �� Phone �� a 4 n q Q Arl�fayees; n employer?Cfieckthe appropriate bma ' Type of praiect(regmd ed)c I_ a eaiployzr uit11�_ ❑I afa a geuerai contractorand 1 6- ❑New consfractiog (K-a an-Mar fi ne)_* I vehiredthe soli co3kEacfots st`d on the attached sheet. 7- ❑Remodeling 7-0 I•am a sole proprietor arpartner- These sob-canhractors have ship and have no employees. 8_'Q I7emaliCioa ern{rloyees aaclhareo*kers' wow far 7 e in any cpacity 9 uildm sddztiarE L"a iL't3P'_MM, cov1p_iasurmce We comp- a-coart�$ required - �. � Tie are a corporation and its 1�❑ ectacal repairs or ad�ns 3_❑ I arm a homeovner doing all u�oric of cers have exercised their LLQ Fiumbingrepairs or additions tight of exempfion per I� 43L 11 El Roof _ 'insum r[Ne ]i P- C,152,§1(4),anawe have no ❑O� � employees.[No wo&ers' comp-insurance required_Z °A'YRD`PEEthstchec3sTiox0:lmast also n7louEthasectoab Ioxs�accin�s ¢zunxTcets'eompexsafiaapoIiep*imarma'aa� ��mxmrnarc to sata�i[$iS rsda«Las stingy t!1P]f iLdff3 egt�ca a tbea7sie omside coarmr*+s�si mBmjranemmmd�-i&bdi sorb tCa> aatosf�tch�Tcui;bract emrlu�aasdcl �s1$trn2 Shet�stLen of sub-co=zdtnr=and ststeRkehec arnet�ese entitbshac� esm°lo7R�.Tff�sn5tantradeEs3>x�ee�pla�me�amstPms�de'�r R'°�s'�p•Pot�a�be� - • I am an e workers'comipensrdivrt irzsriranca fbr m}T entplvyees $Eio paficy eb spa irz,�ormrriion 1' ^ _i J --� ,Inswa ceCompanyYMCM: "Policy t or rims_Iic � S�S� +I W Q;W _5 P9 F�pi�atibaDate: �.3 jo Iob Site Addy 2' ?k_K��T' Aff2ch a copy of the Workene compeasalioapolicy-decIaration page(sh%wing the policy number and expiration date). Failure to secum.coverage as requiredunder Section 25A of MG1.c�-1572 can lead to the imposition of Trim;-M21 penalties of a tide-up to$UDU G andror one-year i sonmezit.as-¢eIl as civil penalties.in the fazm of a STOP WORK ORDFRand a ftae of up to$250-00 a day agar&a violator" Be advised that a copy of this statement maybe fiorpmded to the Office oi' Imves€cgations of i e DIA for ins coverage reclfrca#ioa Ida hereby csrf#y' au�r tkg s artdpsrna) s g fhatf3rs fr f brmatiau proud ahm e i s bars and correct sib Phone; a• 021rid uss"Ey Do not write to this area,to be calupTeted by city arfrrten a YkifiL City orTanu: PermzitUcensea Issuing A,50 itty(t-irje one): L Board of He9t h I Burfda,-,,Dt partmcnt 3.CiiTttova Qerk 4.Electrical bmpectnc 5. Fnspecter 6.Other Contact Pierson: Phone•#-. f - Client#: 16665 2MEAGHERCO ACORM CERTIFICATE OF LIABILITY INSURANCE 1 1012ATE 12015 ' 10/29/2015 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: Dowling&O'Neil Insurance Ag PHONE 508 775-1620 FAX 9731yannough Rd, PO Box 1990 -Mn Lo,Ext: ac,No): 5087781218 Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC n INSURER A:National Grange Mutual Insuranc INSURED Meagher Construction Inc. INSURER B:Associated Employers Insurance INSURER C: Timothy Meagher INSURER D 776 Main Street Osterville,MA 02655 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT RR TYPE OF INSURANCE NSR SWVD POLICY NUMBER MIIWDUBR IDY EFF I MIDDY EXP LIMITS A GENERAL LIABILITY MPT1250G 10/16/2015 10/16/2016 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea: D nce $500 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC5050054422015A 6/23/2015 06/23/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? FNI N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S160266/M158764 JM1 License or registration valid for individul use only V/e �;e before the expiration date.•If found return to: - �panenaa�uaea�l�o�C�/t�at;tcrc%rmeG�d � Office of Consumer Affairs&Business Regulation Office of Consumer Affairs and Business Reg4lation OME IMPROVEMENT CONTRACTOR 10 Park Plaza-S e 5170 egistration: '162938 Type: Boston MA 02 Jxpiration:.: 4/27/20.17t DBA MEAGHER BROTHERS CONSTRUCTION I `MICHAEL MEAGHER JR "; - 97 EMERALD LN :` Yot v w� out signature ; 7 ' 's- .,:��-� , MARSTONSMILL,MA 02648 ' Undersecretary Unrestricted-Buildings of any use group which contain less tan h 35,000 cubic feet(991m)of Massachusetts -Department of Public Safety enclosed sp e. Board of Building Regulations and Standards Construction Supervisor License: CS-102260 / MICHAEL S MEt tB1E ' 97 EMERALD Lt�TE Failure to possess a current edition of the Massachusetts Matstons Mills MA 8, State Building Code is cause for revocation of this license. ForDPs licensing information visit: www-Mass.Gov/DPS 914— )"W Expiration Commissioner 11I05/2016 "�y.-� "I LI AS The ELIAS I �, c h e n R e n ovation Kitchen, Bathroom, , Deck Renovation 42 Packet Landing s West Barnstable,MA NOTES: -� ,� � Ilia �f�� ��� I � �� j„ � .�� .✓ .-Q ,.� GRAPHIC SYMBOLS DRAWING SYMBOLS ABBREVIATIONS SITE PLAN swear uw m.cer..bUav: faf Im.a fnm, I \ \\MAP 479 _ COLUMN GRID r.�(m) I- '.n C (m) N6 E: Tm°`�°'m P'«<m w ro.N a Pa... 779 \ 62 7{ PM pwnOk C m...d .>r 476 °'6e:Q'. cRAvn core. nL DEwLs D..R Nrm A6aRENOgNS: iPn `mom ) ���Pw�s�PEw Pb.U.bm (r NM ROD/LEDGE ` NT °cwWlicd av n10 I M ibn In Uwle4 SECTION s..wn Nrwej.— &T a°e"'I„e°� 0 ® 0...n0 Sn.m On AEUu aum'.wn GA9•W 9•Wa .eI coNtmETE Ib �BG 'm a° rxv pw.m'um rt6 I - no�.c:°(a'> I 1 h(°'P 4 97 c�0 vrm. .�°M. r,m�. s 42 ® ` WALL TYPES , GIP 0V*nn RN �anl °e•..."vw / SE Kb. / I 3 o.lw Nrmm SET ar HIRwR nwam.. eucc �+ ^••� RTctl10 CONCRETE Mool DOOR NUMBER G°°.Nrnbv®sTm �V mTMn BC LO G0-O .1.S— WINDOW TYPE °.m.WlraNp.'u l.y(M Noa IroaxaSucam mA sSFaC a..ac,l.xwn l. \\ \\ �P Z O W—Tra ncac °m.. v05ir w L(a). GINI A .IurWs..Ted COILING HEIGHTS C.T'Eb..u.rr OR sm •.n(rm) swe .ro \ I. D..,el Tme:DH191FD rOOD all cm(m•e) KO x.mmm NOTATIONS Cal rcnenn ROua.GOD ❑1 � „O„•�„,�^°7• �I°ir).r).(xb)OWB w �.IdT �„•„ CODE COMPLIANCE ® w"" DEAL AREA m I—moo.:tbP.n... PERMIT °�M O.W WeR uCOrlf , I. Ro .�NI TAG W R1°�•� CTR cdmM Lcc l.°E teal.°<°ppv TOS by.I.brJ Tor CWM FE DERR-1.STAT I1-D CUxRRCODE REOoWmG s EOUIPMENT, TRIO UwIM GW$ARD ORpNANCEi D TN PLY1°OOD O Epripmvni Rtiv.nca NumOer 0NG °I•V•.Wl IW. m®mnn°Pi°Mi0 1Tpc.I CO1.o'l1ANDAGE C-MS ME VERSIONS OR THE Pa1DWmG- l°rq.Scab IM Gandn uECM nWnn¢RI °1f� CODES ANO AGENCJES ARE REODUOD: $111pY Scae OR Limcnabn uED m.f OUMO ° ro1N°iM.W NORTH ARROW °o n m°voa. Immi 1°°mnx,,,n ee emn., mac-xmnataw RmHrtlr eMMMf� �°O`"k EvELOPMENT ��� Trv.N.M oI.R m°.v um VNR P mw Y°an.tlmOEnOnpedm9fm. NTIIR E 9wRD OrC °.a.i.p 6C ^'°� wa rv7l mmpvMim Ub IMC.xxmnbd ups olcmnmxnGm• Clrck°aM IS wl la. �O "1vun1(m) Mr .mih x rm Rc-xu�mavm�Fl..faa. Scm.: ass \�Ai/ occ w.°l.Ic(m) �T AS NOTED ®ERN•Scdv ENC .cUk My c°.Ie NOu wN .°! T°D CNR•rA Amvdrsux°r IBG sma scd. REVISIONS Eatty n.°Y°m> me na x mnwa re .mo m°.I .GUR-.0 e°v...um.�a.amlrm °mr. 1027/TS Ola .m.,r. rlTs I.rtaN 'w s.CMa•M4.c....xrH.w . EO .'�OVI°eO..:d.nie° 52.CMR-W p°° i.pM+lb° DwTN�mdQ OY'PSVu IiO.RD . E...Gr, l ar� .:�.. IXG uL.p OPG .pminq CIIUSETTS a IXf ert 00 °6.m.le 'r0 .iUml STATE OF MASS. ING CODE EA EDI ION AEUNIHW G °w°D BARM3TIBlE COUNTY ANO TOWN OF NARWIGN ON T1 .1 weNr.° �MELIAS °.� Kitchen, Bathroom, —- r -—-— Deck Renovation BOLT E1dBED0®r sBPs/o-d I 42 Packet Landing "AB�R BP West Barnstable,MA oc o I I b � � o Q I I mum m u10 r5 DOw1 a r5Y —IN F L r MO MALL AlIO BET M EPOAT. LT PLl.@ M/ ALL POUR , 1 Foundation Plan Del. ��Roof Framing Plan Det. E..Hdrr,; 0" FRAMING TIMBER CONSTRUCTION NOTES: 1.TIMBER CONSTRUCTION SHALL CONFORM TO IBC-INTERNATIONAL BUILDING CODE,UK EDITION COMMONWEALTH OF NOTES 'MASSACHUSETTS BUILDING CODE,'BUILDING 2.FRMIING SNAIL HAVE A I IW PSI ALLOWABLE BENDING STRESS.THE MODULUS OF ELASTICITY SHALL BE A MINIMUM TABLE REFERS TO WOOD FRAME CONSTRUCTION MANUAL(WFCM)110 MPH EXPOSURE B OF 1,400,000 PSL (1)CORROSION RESISTANT 11 CAGE ROOFING NAILS ARE PERMITTED.CHECK IBC FOR A LAMINATED VENEER LUMBER BEAMS SHALL HAVE A MINIMUM ALLOWABLE BENDING STRESS OF 2300 PSI AND A MINIMUM ADDITIONAL REQUIREMENTS. MODULUS OF ELASTICITY OF 1,900,001)PSI UNLESS NOTED OTHERWISE rQ�111ST FLOOR PALIE BOLT TO SILL WI 121 1Adt11?BITS @�2A•O.C.STAGGERED NOTE IF !.TIMBER FOR STRUCTURAL USE SNM.L HAVE A MOISTURE CONTENT OF 15%. 5415 NOT THRU BOLTED USE THIS SDS®20'O.C.STAGGERED TOP PUTS TO BOTTOM.2ND FLOOR SHOE TO RW 101sf(1)16D EACH BAY(16'O.C.) 5.TIMBER SHALL BE SO HANDLED AND COVERED AS TO PREVENT MARRING,AND MOISTURE ABSORPTION FROM SNOW OR RAIN. (0)SEE GARAGE EVE DETAIL St.O FOR PLYWOOD LAYOUT B SPECIAL NAILING 6.JOISTS SPANNING OVER V MUST HAVE CROSS BRIDGING AT NO MORE THAN e'O.C. NABS.UNLESS OTHERWISE STATED,SIZES GIVEN FOR NABS ARE COMMON WIRE SIZES. BOX AND PNEUMATIC NAILS OF EQUIVALENT DIAMETER AND EOUAL OR T.WOOD FRAME CONSTRUCTION MANUAL,2 E0.110 MPH W WDS-EXPOSURE B. GREATER LENGTH OT THE SPECIFIED COMMON NABS MAY BE SUBSTITUTED UNLESS OTHERWISE PROHIBITED. PERMIT TABLE 2. GENERAL NAILING SCHEDULE: JOINT DESCRIPTION NUMBER OF NUMBER OF ROOF FRAMING COMMON NAILS BOX NABS NAIL SPACING PT LD9 d BLOCKING TO RAFTER(TOE-NAILED) 2d 2-10d EACHRIM BOARD END WALL FRAMING:SEE�R(O�Y/DNAILED) 2-16d 116 EACH END 51ieel lMe: PT Om B TOP PLATES AT INTERSECTIONS(FACEfNAILED) Ft6d S160 AT JOINTS STUD TO STUD(FACEIiWLFD) 2-t60 2-160 2.'O.C. HEADER TO HEADER(FACE-NAILED) l6d l6d 1S•O.C.ALONG EDGES FLOM FRAMING FRAMING JOIST TO SILL TOP PLATE OR GIRDER(TOENABED)(FIGURE 141 {-BE -0d PER JOIST A0 Md EACH END h I �0 16 O I BLOCKING TO JOIST nOE-NAILED) 2 PLANS &DETAIL Y BLOCKING TO SILL OR TOP PLATE(TOE-NAILED) ?'w 4CW EACH BLOCK I I I LEDGER STRIP TO BEAM OR GIRDER(FACE-WALED) d-IM -Sd EACH JOIST JOIST ON LEDGER TO BEAM(TOE- ED) 3 S 3-IM PER JOIST BAND JOIST TO JOIST(ENONAILED)(FIGURE 14) 0.16d 416d PER JOIST SAND JOIST TO SILL OR TOP PLATE(TOE-WAILED)(FIGURE 14) 2-IM 116d PER FOOT PT m2) ROOF SHEATHING — I — WOOD STRUCTURAL PANELS RAFTERS OR TRUSSES SPACED UP TO IV O.C. B4 tOd 8'EDGFjg-FIELD RT'� 4a RAFTERS OR TRUSSES SPACED OVER 16.O.C, 8d 10d V EDGEJJ'FIELD LLRAKE 01O"^1K b. GABLE ENDWA RAKE OR RAK E TRUSS WITHOUT GABLE OVERHANG u TOd VEDGEJ6-FIELD S, GABLE ENDwALL RAKE OR RAKE TRUSS WTlH STRUCTURAL OUTLOOKERS w 10d V.EDGE/ FIELD Im—I I ar• „a GABLE ENDWALL RAKE OR RAKE TRUSS WITH LOOKOUT BLOCKS Bd 10d. I'EDGEN'FIELD CEILING SHEATHING kOM AS NOTED GYPSUM WALLBOARD SIT COOLERS - r EDG&Hr FIELD WALL SHEATHING WOOD STRUCURAL PANELS Dofc STUDS SPACED UP TO 24'O.C. 8d IOd W EDGEMr FIELD r,•AND %-FIBERBOARD PANELS ' WIT 7 EDGW FIELD sn..Nu Mr Y.'GYPSUM WALLBOARD50 COOLERS - r EDGEAfO'FIELD ■ BOLT R11BCro® FLOOR$HEATHWwowDeck Fraa11►ng w0 STRUCTURAL PANELS '1 I.ORLESS BITIm WEDGEIIrFIELD L Scale:1/4"=1',011 ..GREATER THAN 1 1Dd 16d S.EDGE w FAD - ELIAS Kitchen, Bathroom, Deck Renovation 4. In 42 Packet Landing m 40 8 1 West Barnstable,MA •T �• r�T>.Win_ ��T�n�. -T-T�T m � 1 Existing Conditions Plan Proposed Overall arsnnron L un� I • • I I I /\ I L--------3 II II rn —� f————I I F— --L- i0 L --I F J b I I I 3 0• I I I II I I PERMIT I vI EVELOPMENT AS NOTED 9/27/15 TPlan Detail Kitchen 41 Plan Detail New 1/2 Bath 1 . Scale:1/2" Scale:1/2".=I'-0" 1. ■ 'WAS �\ q Kitchen, Bathroom, .tea Deck Renovation 42 Packet Landing West Barnstable,MA MOi6:. ' L01JER UB LOVER CAa Kim Elevation Kitchen Elevation i Scale: =1'.0" e..wo.s aASED sorest i r � f wDDD O E $T6 w MALL �• D/V DM � ' OVFJ� l—E)OgtG UB� S�aal ae.: qKitchen Elevation n Kitchen Elevation seale:lrz"=r-o^ ' scale:.lrz^=r-a' ELEVATIONS GSDG CneckvaK ASNOTED 1027/15 u»ei Mwmea Kitchen Island Elevation . AMScale:lrz"=1'-0 � " ' Town of Barnstable Geographic Information System October 6,2015 ` 179016 #52 - '1 15111- J 179001002 #976 179013 #55 179004 #42 PA 0` QP 179014 #41 179003 - - #26 -0 12 Feet W^ _ DISCLAIMERS:This map is for planning purposes ordy. tt Is not adequate for legal Map:179 Parcel:004 Selected Parcel a boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:ELIAS,STANLEY&EILEEN TRS Total Assessed Value:$324000 -1•=100'may not meet estatostned map aecurecy standards. The parcel Ones on this map ,Owner ELIAS FAMILY REVOCABLE Acreage:0.36 acres Abutters D W E r are ory graphic representations Assessor's tax parcels. They are not properly boundaries arid do not represent accurate relationships to physical features on the map Location:42 PACKET LANDING WAY such as building locations. Buffer // r ,r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division Q Date Issued Conservation Division C S. g���b/ Fee �/l �. Tax Collector e/oz/c) f Treasurer -l-e c� �IZ�ZOvI �.> S ST mi U'111.17ALLEWN COMPLIANCE Planning Dept. WITH TITLE 6 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address �(cC/,y-,e,i= Village I atfj , /0/�_ Owner _ ��a.�V f Zi�eelz Z-11�.S Address srCIW Telephone ' Permit Request Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type (� Lot Size Grandfathbred: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family ,Two Family ❑ Multi-Family(#units) Age of Existing Structur Historic Houser es ❑No On Old King's Highway:_(es ❑ No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) A/W l7 Number of Baths: Full: existing CZ new Half: existing new r Number of Bedrooms: existing 4 ' new Total Room Count(not including baths): existing D new First Floor Room Count Heat Type and Fuel: ❑Gas 410il ElElectric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 490 Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage-AYexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Jtwle4ml, ifes. Proposed Use FFi e_ BUILDER INFORMATION � v Name Telephone Number ���� 4//r1 7 _5r3� Ad;q,Ave_e_ 02 License# 06S(O�11 Home Improvement Contractor# Worker's Compensation/# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUR DATE Ar • FOR OFFICIAL USE ONLY . ' .PERMIT NO. DATE ISSUED MAP/PARCEL NO.. ` r _ ADDRESS* _- VILLAGE OWNER � f �� , - •. DATE OF INSPECTION:c FOUNDATION FRAME _ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ; GAS: ROUGH FINAL FINAL BUILDING,_ 1q-f1c, DATE CLOSED OUT' i ASSOCIATION PLAN NO. $ Regulatory Services Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner • 367.Main Strcet.Hyannis MA 02601 Office: 508-862-403.8 Fax:, 508-790-6230 Permit no. Date 3e AFFIDAVIT HOME ZWROV VM4T CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c- 142A requires that the"reconstruction,alterations:=ovation.repairg modnmi=don.conversion. improvement,removal,demolition.or constm rion of an addition to any pre-existing ow w-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors.wtth certain exceptions.along with other requirements. Mary Cost D Type of Work: of Work 444e� Z4 V r /2i10 Address �-- y�— Owner's Name: ,4pj 4 -� ,AeAlC �S Date of Application: D D I hereby certify that: Registration is not required for.the following reason(s): OWork excluded,by law []Job Under$1.000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING�O RK DO NO�� CONTRACTORS FOUR APPLICABLE HOMEARBITRATION PROGRAM�FUND UNDER MGL c.14ZA. ACCESS TO THE SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit 13the agent of the owner. //�Ud D 1 - D Contractor,We Registration No. OR Dace Owner's Name q:famis:Affidav via CommonweaLth of Massachusers -' -- 'al Accidents Department of7ndrrsrn -� 011fea Otis rpstlgzffgzs --a 600 Washington Street -;� Boston,Mam 02111 Woricers' Comnensatioa Inmu=ce davit // r//r��;fir;/�/�rr•.<� nrsr.-• , la�on- yhvne a city ❑ I=a homeowner pn* miag all wmk=MIE I am a sole mQczietor aad bave no a=wmie a is aa9 ®ea�tm aa�aag as thu job. I aza as emalav�piovidiaJ;wad .•,.,�°y� :..: . .......... ..... ......... ...n.......... ,. ..wY...,:.. .ox,..n ...... •r.fiay..n......tK••:: •;t �.`::.::•. > :• .fi.r...::...,.awn.+«-.:.::::-;.,,n;:';;:.:•. ...:•..........:•......t:•.............................n,•:•.ax .. t r.... . .2T{22 o-:•o-. ;.avt ......,.,.x.�w .fiVh'...;... .•: .......+T.....•.wn..,tw..nwt.w.n.... 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Inmraaa-' p�sae tosss�s eos�ate es:eeoasd tinder Seetlot<ZSA ofMGL=emisad to tha iaepe of s�eai of Bas ap to S1 M awy�,��saswazz the pmaitlssiatheformcfaffm ��a�ofSio0.00atli►stactm& Itmdr�ss co7 of this statemmtmsy be forwarded to tba Once of I=esdgxdm of the nufor core rate vedna"M I h�by cattjy ut:de t ojper�ary the slsr injornratioa prtrvrded abav+e it sr�@rd corrcd D� amre (' Si� ,�. . . ��-3 Print name /I//�1 (!e/ 60d Pfit�# ofndsi use only do not write is this area to be ssmgietrd br citY or town omdsl eeaseft Ogtdillin;Devi' cftY or to"* Phu ❑Ilerasmx Boas scicc=cn's O Q c}serYitI=edJ&w response is required _ ❑Hnith DcaSrV _ether Information ancL. I.Mrructions M:ss=:,.•. S = G=-.-=1 Laws cha= 152 section 25 =jai=all esnniovers to provide woriters' iot•rs. As guard fr=the "Iaw",an g rnplv_vee is cia".- t:.-d as et cry p an is for sertzcr of aaotize �c.�: r, or mr--, --==s or i=lied, oral or writrta. :fin errrolaver is ae 'as an individual, Par=- w associatiairL caraoraaa�a -- ' ��• �•tR•o c: by rorr_oinP ==�is a oim ^�, or oth.. Ie� , or an d �etprise, pad lnciudiag the legal zr.:zr � of a -��, en ,niova. or.;'. �- trust_-: of as individual,pa=cr associat cm or 13d=r legal eMMy, ®ioyiag®1131.=. Flowet=tIL CV; c= dwdlinc house haviig not more thaw three aparaa=aid who z`s_th.--r3a, ortb.-cceuaaar ofth.- aR=iiac .r anath.—who ®ioys p==tocansttttcttaa or zrtgaa vicda on sic dwelling house or on t�z _--= burldmg apgur tlL--eto shall not be�se of such be d.,,.. Cd to be an employer. MGLch== 152sccdon25a1sa states that every state or.IocalTueasing agency shall withhold the issuance ar r: of a license or permit to operate a business or to contra bnBxtags in the commonwealth for any applicant we ,•not produced acceptable evidence of co=rhazyce with thehmmraaee coverage ram, ArM111Y,n-;.;- =any or Its pohtZ�1 Sal7divLS�S Shall==into sa3r Coo==for TL-p of public walk .�^',�,l.'d�,le..�VtC..-'I."r of r�mfl- �t_�"�vi&the Ofl=S CIZ3pLQ have b pZlS=ed to ter 3IIrhIIIIty .. �gpli�au 'trse in th.-weds' i'111pait ', Ch.._ g?he boz:that applies Zo yoar ,. . MVMg ft,at an afizdrhm may be mated to the DeparmzCat of aiArr�dratrrM Oft.=VcmgL Also be sere to sign an: the zMdaviL The=Edavitsb= be zetmm=dto the City or to fbatth,•-agpncati=forth C pc= orB - =is. car z-.. d,notthe Degas _421Accidms. Shoa3d poabave pap 4a=d=rzgaraaagthe `haw"or if z t to of a wQt s' _ porICy,P =Rthe D at below cy,or Towns x be sme thatch.-amd mis az ml and pzh=dlegibly. Zhe D bas providgd'a spate pith.-boz`am or fer you to fill=imthz- the 0fr=ofT C===Ym regarding th-aapli . P=....se :zo r to n"II inthe p- . nortwnir�wMbe assdas az====� - er. Th..amdavits may.b.......�. D.-pztu by mazl or FAX aalrss other hm br��ade. 0!E= of— 1s would M=to thank you is advance foryou=UP===and should you hava=y ou.,-•• cos. s- do no:h tr:to give us a call. _j'+***==1s -Iff �,m:.-Paaa.-and faxzainiler: The Commonweaith Of Massachusetts Department oflndustrial Accidents oQtco of t�ttestlQattQnz 600 Washington Stz-erz Boston,Ma. 02111 fax*: (617) 727_77 49 ESTIMATED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) 2 square feet X$96/sq. foot= 2 a -� (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X.$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value I i i i ' -' +' �` ✓1re i�om�xo�uuea�i,o��aaaac�urae!!d - . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR • Numbg (�S 065651 Bhli ai3a•=05J071973 Fj'frei 05/07/2002 . Tr.no: 23890 Restricted To: ,T 9-N9 MICHAEL D CR011VE-F `' 75 CAYUGA AVE MASHPEE, MA 02649, Administrator .,; t5~ • _..a.:.._ ! t,i 1 i_.:..•''�_.. '��'_s a .:�........ ..� .. � T a,.� la�g�•/la6aaEua®Q2 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Repicn�_119388 i6J30/2003 CROWE BUILDINGUR MICHAEL CROWE;� 75 CAYUGA AVE 4 MASHPEE,MA-02649 -Administrator &CORDrwesjERTI{FICfATEOiF�LIBILT " pq• ni � � `'t 4 Q adl NUR ATE.r-._ .:. :�..:- �• .•g=_. . ..T dtt`+. '., i*.'<fri'Yz,F.: E,3 , M .� _ 5/30/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Nolan Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 938 HOLDER. THIS CERTIFICATE-DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 728 State Road Manomet, MA 02345 COMPANIES AFFORDING COVERAGE - COMPANY A ZURICH INSURANCE INSURED COMPANY James P Parkhurst B AIM MUTUAL INSURANCE CO 1 River Farm Rd COMPANY Plymouth, MA 02360 C COMPANY D _ ,. ;CO,VERAGES 'z � ,> THIS IS TO CERTIFY THAT THE POLICIES OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED,NOTWITHSTA THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISS OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS UED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION _ _. - " LTR POLICY NUMBER DATE(MMIDDIYY) DATE(MM/DDfYY) i LIMITS GENERAL LIABILITY - GENERAL AGGREGATE $ 2,000,000 A, X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG $ 2,000,000 Q 'r CLAIMS MADE a OCCUR SCP 32423692 1/06/01 1/06/02 PERSONAL&ADV INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 110001000 FIRE DAMAGE(Any one fire) $ 0 :._........_... .- - ....._-—,._-:, . .-...._..-. ........ MED EXP(Any one person) $ 10,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ ' SCHEDULED AUTOS (Per person) HIRED AUTOS O Q BODILY INJURY NON-OWNED AUTOS O (Per accident) $ . P PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $1 ANY AUTO OTHER THAN AUTO ONLY•, r• � .' ` EACH ACCIDENT $ AGGREGATE $ fi EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY X TORY LIMITS ER EL EACH ACCIDENT $ ZOO 000 PARTNERS/EXECU7IVE B THEPROPRIETOR/ INCL AWC 7006150012000 8/10/00 8/10/01 EL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: RX EXCL - EL DISEASE-EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS ' - LPG INCLUDED ,CERTTIFICATE HOLDER � z }� i, .CANGEE0CTI O N z�i ��� `� �� .a.aw a»� t5 ; xa o t3 ..,.. w SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CROWEBULIDING AND REMOLDING EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 75 CA� GA AVE MASHPEE, MA 02649 10 .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ` OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / i WIT.T..TAM P Nt7T.AM -i-r l A. CORD„ CERTIFICATE OF LIABILITY INSURANCE 07/21/2000 PRODUCER 508-790-1030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MCSHEA INSURANCE, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 320 WEST MAIN STREET INSURERS AFFORDING COVERAGE INSURED INSURER A: NATIONAL GRANGE MUTUAL GALLAGHER PLASTERING INSURERS: PO BOX 387 INSURER C: WEST YARMOUTH, MA 02673 INSURER D: INSURER E COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRUJIL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE is 300,000 A COMMERCIAL GENERAL LIABILITY MPK31247 3/31/00 3/31/01 FIRE DAMAGE(Any one fire) $ 500,000 CLAIMS MADE FX I OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY. $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600,000 POLICY "COT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS 0 (Per person) $ HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTYDAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMBS ER EMPLOYERS LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATION SILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN CROWE BUILDING&REMODELING NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 75 CAYUGA AVENUE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE,INSURER,ITS AGENTS OR MASHPEE,MA 02649 REPRESENTATIVES. AUTHORRE R RESENTATIVE �i- ACORD 25-S(7197) ®ACORD CORPORATION 1988 ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/VY) 2-1 ^ PRoouce f_� a THIS CERTIFICATE IS ISSUED AS- A MATTER OF INFORMATION Edward A, Grazul Insurance A enc I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 y r n - HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 267 Cotuit Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich, MA 02563 INSURERS AFFORDING COVERAGE INSURED INSURERA: Assurance •Co. of America Aaron Strom INSURERS: PO Box 2 7 n 3 wsuarr I Mashpee, MA 02649 INSURERD__ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNSR�E OF INSURANCE POLICY NUMBER POLICY EFFE TIVE POLICY EXPIRATION LIMITS ?— - DATE .MID ATE M/00/VY GENERAL LIABILITY EACH OCCURRENCE S 300 000 COMMERCIAL GENERAL LIABILITY - FIRE DAMAGE(Any one fire) S ————— CLAIMS MADE _XXOCCUR: I MED EXP(Any one person) 0 0 0 Q— --___ PERSONAL&ADV INJURY S 3 Q 0 ,99 0— �� i ! GENERAL AGGREGATE S 6 Q 0,QQQ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG I s 600 000 I PRO- : — CP 3589524 / POLICY: ! T .LOC - -- � / Q 7 J 0o 1 Q 1To 710 1 AUTOMOBILE LIABILITY I! COMBINED SINGLE LIMIT ANY AUTO '(Ea accident) S ALL OWNED AUTOS BODILY INJURY i S SCHEDULED AUTOS OP") (Per person) HIRED AUTOS I OBODILY INJURY Pr Is NON-OWNED AUTOS ( e aCCidertl) -- PROPERTY DAMAGE I -- - s (Peraccident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS LIABILITY_..__. I EACH OCCURRENCE I$ OCCUR CLAIMS MADE I AGGREGATE ����� is DEDUCTIBLE ' Is --— I RETENTION S s WORKERS.COMPENSATION AND I I WC STATU• OTH-; TORY LIMITS! ER EMPLOYERS'LIABILITY --- - ---- E.L.EACH ACCIDENT is _ I E.L.DISEASE-EA EMPLOYEE S _ E.L.DISEASE-POLICY LIMIT' S :OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER I ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Crowe .Building & Remodeling DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN 75 Cayuga Avenue NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL Mashpee, MA .0 2 6 4 9 WPM No OBLIGATION OR LIABILITY OF ANY KIND UPON THE USURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ZIL o - LL LU a c CIA LL Lu kv r � k k i j I S L - - -. - _o 144 - - - -- --- ---(,�•- _ �^-•_-_-ter �---_.._.;...__._._:�...__��'--_-:-___...._. --- -- . --- ------- *- �. - � Ji- k - : • N LU , a k .d. -_--�.-_T;_��:o��a��o�:-o�:_:car o�_..__-_�___-_�= •-=__:_-�•�:____.._�^:_T -: r- _.�; _.._ . .. - _•-- :- --------F-----�._ __.._-.-� _-----.--: .— ----- --t�=-- --_�-.__-_�--- - -- --.-'-cam: 3 • ff , �- i , , • S 1 i p� i x �.► C-i _ _ .. , I_ I . LAN. _ Z l _S ' _. _'S`!oZ.... . Prq c T. ..... /�.... - .I � ��1�/tlS�,� I i , ! ! 1 ; ..V E_7L bai W Nii _ .. ( .. .�. � b R : ...yy � X; ; .. v�ru!r/N i i + y� I : i I I i 0 8R401 ; ► 1 1 i WJIH = I I I . ( , R ; I i I ! i ! I t I ; i i � r r � I i •' � i + � ( � I � i ! i ! + � t I i 1 : : - i I , I I I � > �• I 1 ,. � 4 1 , i � , I I 1 i t,L PRrj L C7 APFROk. la'-4 fi/- FF0M L I S"nl fr HOUSE LOT 13 1 00 2- 1 _ -GAR_.- LOT 12 LOT sue. •� y i RES. .ZON ..• "RF This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only-- TOWN- MS- _:___- REGISTRY OWNER: AIZU IV_P._& STA.iYUY.ELI s _ DEED REF: _2178 . 5?__ _BUYER: _'MN.A1YQ ________-- __-- - --------- PLANDATE: _8f� /9 REF: 1_77L43 _ _ ____SCALE:1"= 30' FT. I HEREBY.CERTIFY TO �6LVI1 H1�H�Q=QR�'f�ATV��� V .� — -- __THAT THE BUILDING ;�DNA 0•' 4,43 �--' ss YANKEE SURVEY SHOWN;ON• THIS PLAN IS LOCATED ON THE GROUND AS ��` CONSULTANTS •./c�/ i�.nC; �yJ SHOWN°AND. THAT..ITS POSITION DOES ____ CONFORM j::( A. TO THE .ZONING LAW SETBACK REQUIREMENTS OF THE . .► j NIERiTF EIN Z 40B (SUITE 5) TOWN..:OF �__RARgsLIf f=-___________AND THAT h:) 3'098 INDUSTRY ROAD IT DOES NQT_ LIE WITHIN THE SPECIAL FLOOD HAZARD . MARSTONS MILLS. MA 0264E AREA AS. SHO�YN. ON THE H.U.D. MAP DATED_Z'/_Z/AR___ �'' ` = :Co uni -Panel 250001 0011 D '� TEL: 428-0055 FAX 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT 12286 DPG FAU A. '1` LS -- SURVEY. NOT TO BE USED FOR FENCES. ETC. Application to 2 001 , 1 2 2 01Ib .ing'ss biffbinap Regional Jbigtorit Miaritt Committee In the Town of Bamstable O Fly CERTIFICATE OF APPROPRIATENESS sa -; Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under'_Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plaAs, drawings, or photographs accompar;ying this application for: v� CHECK CATEGORIES THAT APPLY: —' w C,()� 1. Exterior building construction: ❑ New Addition ❑ Alteration ''u U) N Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑. 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: 1-1 Fence ❑ Wall El Flagpole ❑Other TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PRGPOSE`B 11•SOR!S (a ���ir�� ��i� .i_ ASSESSOR'S MAP NO.7 OWNER a- V �-ti leey aS� ASSESSOR'S LOT NO._ 4 HOME ADDRESS Ya ck:- Z&da;; 4 t4,(e', L t,Z,v, TELEPHONE NO. 36,'2 — Oo g &ate 111W. 1311 tAl 6fa&6 8 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR TELEPHONE NO..S08 y77 --5-7 ADDRESS 7Jr a v 1 2- DESCRIPTION OF PROPOSED,WORK.- Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. I e. +7TA-CPE� PL4JVS i9017i77o •,` Signed i IXe— Owner,Contractor-A 11 n C1Mn n For Committee Use Only L���1�UU d) B U V/ his Certificate is hereby U A Date b r. 3�( taps �D;�,i� MAY 2 4 2001 ommittee Members' Signatures: , TOWN OF BARNSTA LE OLD KING'S HIGHW Y i 2001 , 122 Town of Barnstable Old King's Highway Historic District Committee COPY SPEC SHEET FOUNDATION SIDING TYPE CQ694t.l�c COLOR CHIMNEY TYPE �- COLOR ROOF MATERIAL COLOR PITCH WINDOWS �Q��N COLOR W xf, SIZE TRIM COLOR fi✓f7�7 Q, DOORS Ajef(.VA1 COLORS SHUTTERS COLORS GUTTERS i1(/ C�40It,A(/j41 COLORS DECKS MATERIALS GARAGE DOORS COLORS �— no 1,° �� SKYLIGHTS VP fV k SIZE �X/ Cf COLORS ��Ou/i101 U0 SIGNS COLORS MAC NSTABLE FENCE COLOR NfN OF 'S"lG�Vu�Y NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 2001 . 122 ? o � f -Vino LOT 13 ++ s 0 - LOT LOT TOWN OF BARNST OLD KINGS HIGH AY RES. ZONE. "RF" This* MORTGAGE. INSPECTION Plan is or FLOOD ZONE,- "C" Bank 'Use Oniv TOti1'N: f'FS -la4j&l L -_ REGISTRY OWNER. E_ll._EEN_A. _& STAWY ELKS DEED REF: _2'1?B5?______�_-F3UYER: __-_------------------ DATE: _8 � /99 ----___--- PLAN REF: _177�43 ----------SC.ALE:1" FT. I HEREBY CERTIFY TO 4SAa n'L EQ=QEF49ATJ-VE& -- - ---THAT THE BUILDING \s� YANKEE SURVEY' SHOWN ON THIS PLAN IS: LOCATED QN THE GROUND AS ` ' F- 0L I . SHOWN'AND THAT .ITS POSITION DOES- ____ CONFORM `�; CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE !�`f 1�E�THEW 4 40B SUITE 5 0-4 �-- N i LXISTING POMC i _ r I N i El - - - - - -M-5-F1NG DWI NCB - -- -� - - , APDX, /X7 WNIT PiJt- 9bS CT M. E. �. r�r-are =i�=��a�i�� CAL�� �� OA/� r-o®r �IAY 22 �o/j/ I , a i �`1-iA1v I 1,'�:5 i. ..,. 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T , ra i 7 ` r liJ6 Lgiri"S !V d c � ?I? ePl:,l�l"a thgt 110sos and �f`>�s,:.��+�s�.,rax,, ,.�t�la.a' ..lc.iidia3�. ,r.�e �'{S3 �:..�i:�, dT �f�TLyt` addj% lls i" v . 2e2.11�'�y �'�ie:A�LIG �+� 'j,..1t3 m 4S191e 1 NFORMA'1ON FORM :'s to ho. tiles 1' Patt Qf the hair ding ; rM=t �� , ����, �, �dix�r', � b►i�Ir���'��:zaw�<bcYr or homeowner, P: �I;► { i Fg�S 6i ire t"� } .� !7 �+!"..;9ai 5 Jslli�y 5ta1,,ks t0 utilize. 3 ;:vr 4-a � w. ig% n ir;g�a hit grit ,}n ► fiil�, re.. ,.. is •. 730 C'.VM 7:e`� �i'�.1Edr:1Ti1. ',�; Al ::�r.�.za';y �. i* r ;w 1�.z. U., j);�,vw`� 11 r l�ax�eczw�:zet * m selecting a �.; 4 � l' y{ rk� a:,a �,P �titlda.t--t.�C1.� \7! y .�}yA�.�'y, C1Z1.���i�f.f�A.i.�J�a. b+yL`�,l.tui.Wg��,,�q ( ��l�y q�`"1va�.:S�'rt.�Zp'v f�t l.l'.. lw��P,(���41 'v,,�-��.gv-.L'nrey,�y6F�L,I�t�y/. 'y�'�;�y'/�q,s o y .a,�, > T �.l`f .Pil'�t&n 4e 0.A �.I.11d 4k'1..11.,� 51 L�1h� C1, ' �'� �,aui4CuM.:..`I'164EV� ONWw- t'PS+at�(� 1•CJ E '. ifh'Ta U t'A 'g 1LI Yv:{. la . ' irawiw'e in. :leak- uw s .,;t ti: .� ar►.�iM,i� IEaf aaa Asx " u.Vwr;s Yxaa i rsgsr:�:lXal�ra+t Wud C7fYt3 �anra:.�1�1�;:1r, �s�.k� c�1te tta �;Y:;1xc:.�yj1�. sc'i�r a �:-' aYMtil�,l�ur;�3h',r,d ►`�cil�±l��s +��''B�aS�'�(g -if the train house, to -ended list ��� yLj '.tJhl and '- � 0� +",� �1:4.tor� r�;{��c����:� �l�r�da��. ��:�trk�v � � a�r� i�, }� l , x iiim,tio� ".fA.w Q 8 l K.,.c�a.�►i'Alt:w u•+&y 1'�Ji e ''. ,Fr U:i i `'a ASt IM+"t1191 4+0 , :�afat ..71rfi:'.ti1��9 .,' ,v E`�1 .: - options with �t; is, t' =1�C.�9�1"i:� gald1or house or VI tr-W , zst ..cad be hind !V�4a 1;,�'4F1 to 6' Tyrw of GILT ng, , �+ BAR War bt,�t g;iwi,e lt :ae lt 'ral aad , Applied 5hviftng Syvt,eua.. V I1tSWSl.'ilan Af.-v! 1ln Owtv.: 7Y'"AF; lb 1a;^ oqj Yaaoloevaa fray the Ta �l rY ,°iu Reams mad +C'ooilmg Meth,-ti r E.M encY, ,a.,tffAv1 ylra�,, ...w.rziD�Ae.:.:7i.�W+xU,3f.161iMiuiY'li/i•�.e917IH� ,. .z , S vaio n .�';.i . _:3.?, J1.11t±C.!"y. F 4� „ i a `1- . 't �L�'Ill'r(not the � + � • I'R�1�T; r �ad.L,rl�., ,,'ly N...!'.•+t.A0"N FORM prior to 'r'. _ ;'c}c l-1 r rtl' a �,.r F+:brl;:�1ti �T'j bi a:L'p+;4'S'd"!��::�. a:1�►t,,, drF i . T'f,`sidt"a1w," ^ I' "' :�11it ;��'1w, has r1Cii� '?d is1�+� Fs2 z� a"T Ci c� F:n e. a .1 , 5 ��8 e 4-- 3(12Z- I � 1 �TIE 'Town of Barnstable *Permit# Regulatory Services6mo f,from issuedutFeee B".NSTABLE, Thomas F.Geiler, DirectorNAM Expires � � Buildin Division -PRESS aio"m t; 0, Building Commissioner . 200 Main Street, Hyannis,MA 02601 JUN 13 2008 www.town.barnstable.ma.us /* Office: 508-862- Z Fax: 508-790-6230 EXWF SIRq�'E� I1L•ICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address `7 � G� �� _44A,12),WZL �IV4 I/ (,J Residential Value of Work 7 V I , Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S T�✓V lG y yl- ����� U�S Contractor's Name ����� � � 5�/y Telephone Number Home Improvement Contractor License#(if applicable) Z) ;7 ®Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance n n Insurance Company Name d�� S 4/<jV Workman's Comp.Policy# 7 h Ll Copy of Insurance Compliance Certificate must be on rile. Permit Request(check box) ,(J� 1� [ Re-roof(stripping old shingles) All construction debris will be taken to :5, i`') �G17 �✓U� �L,L ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders:U-Value (maximum .44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. 1 SIGNATURE: — 6ir �./ Q:Forms:bu ildingpermits/express Revised 123107 J ..j Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT AOf) /,Oru'!� OWN THE PROPERTY LOCATED AT 4 L IN tk-)' 'ti , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORD E WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER:. OWNER'S ADDRESS: i4L -e OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: 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 j Affic�$iT 4 e ��� �j��slElectricians/Plumbers Applicant Information 1_6 4a WAAFl Please Print Leeibly Name(Business/Organization individual): Cotl.lit, MA 02635 Tel. 18/ 1.800.262-5060 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): IS 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 8. Demolition workingfor the in an capacity. employees and have workers' Y P tY• = 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.❑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 subcontractors and state whether or not those entities have employees. If the subcontractors 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? information. Insurance Company Name: Policy#or Self-ins. Lic.#: 7' ! �� 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 S 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 an erry that the information provided above is true and correct e: -Date: Si atu Phone#: 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 —�_ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: t Registration: 100740 Board of Building Regulations and Standards Expiration: 6/23/2008 One Ashburton Place Rm 1301 Type: Supplement Card Boston,Ma.02108 CAPIZZI HOME IMPROVEMENT, I U RY GUSTAFSON 1645 Newton Rd. �� Cotuit, MA 02635 Administrator t valid with t Sig ture Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor.Registration Registration: 100740 Type: Supplement Card Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT, INC.: . GARY GUSTAFSON 1645 Newton Rd. Cotuit, MA 02635 Update Address'and return card.Mark reason for change. �� -• p ❑ Address Renewal Employment Lost Card ✓/ze Taa�r�maru uea,�� o`����c�ariciu�,lld Board of Building Regulations and Standards Construction Supervisor License License: CS 74640 Birthdate: 11/29/1975 Expiration: 11/2k008 Tr# 6430 ° Y Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH, MA 02563 Commissioner Client#:47298 CAPIHOM ACORD.M CERTIFICATE OF LIABILITY INSURANCE DATE(MWODm'") PRODUCER 2007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURERA; NGM Insurance Company Capiui Home Improvement, Inc. INSURER B: American Home Assurance Capiui Enterprises,Inc. 1645 Newtown Road INSURER C: Cotult,MA 02635 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTTI E POLICY DAT MM/DDIYYON LIMITS A GENERAL LIABILITY POLICY 06/08/07 O6/08/08 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DDAMAM SESO RE NTED $500 000 CLAIMS MADE OCCUR PREMED EXP(Any one person) $1 O 00O PERSONAL&ADV INJURY $1 00O 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 00O000 POLICY f7PRO- PRODUCTS-COMP/OP AGG s2,000,000 JECT 7 LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND WC1764953 12/25/07 12/25/08 WC STATU- OTH- EMPLOYERS'LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Corporate officers are included in Workers Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ n DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 1 of 2 #S33206/M33205 KW 0 ACORD CORPORATION 1988 ��pFlHElp�p Barnstable Old Kings Highway Historic District Committee M 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 BARNSTABLE, 9vA 16 39- IFOM APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building constriction: ❑ New ❑ Addition Alteration ° o 2. Type of Buildins;: House M' Garagelbarn ❑ Shed ❑ Commercial ❑ Other s 3. Exterior Painting roo new roof color/material change, of trim, siding, window, c*or 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sig`fi' �00 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall Elt tennis cour Other-1 6. Pool ❑ swimming ❑ Other man-made pool o M Type or Print Legibly: Date: /��C%` Address of proposed work: House#.�/ A Street: . PAC I<!5� / 1 4 /1••%i)/k Village�t ' 'hc'/��>% Assessors Map Lot# Description of Proposed Work: Give particulars of work to be done: ti`J7 44.,4_ 5 /A T"S , - Agent or Contractor(print): 4y?,K y � GII�Y/,�1� JG��! Telephone#: ��� (?c� `! "� el-:! Address: .0 10 Contractor/Agent' signature: .• — _ -- G NOTE All applications m¢ist be signed by jie c urent owner , Owner(print): ! V 7 �h' y- / �',� Telephone#: Owners mailing address: /'l/ 4 0 Owner's signature: > c m 3 N N N _ For committee use only. This Certificate is hereby APPROV /D�II wo) Dt� E W Date )A_f-/O Y Members signatures Q qYv MAY 88 2008 TOWN OF BARNSTABLE V &V)e HISTORIC PRESERVATION �iflofrova . 1 7,f,1t1.r;-nnncln&Kinvc f1ivhwnv1nK1-/NPw AnnIt7KHCP_Yt Annrnnriateness 07.dne Town of Barnstable Old King's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18" exposed) (material - brick/cement, other) Siding Type material: c �A� �f `��cJCjG � Color: LO Chimney Material: Color: Roof Material: (make & style) 064 Trim material Color: Roof Pitch: (7/12 minimum) Window: (make/model) material color I Size(s): Door style and make: material Color: Garage Door, Style Size Material Color Shutter Type/Material: Color: Gutter Type/Material: Color: Decks: material Size Color: Skylight, type/make/model/: material _Color: Si . Sign size: Type/Materials: Color: NN Fence Type(max 6' ) Style . material: Color: P1 O �O Retaining wall: Material: Lighting, freestanding on building illuminating si _ Please provide samples of paint colors and manufacturers brochure of style of windows, doors, g e ar, 3 O , N p1a�i fences, lamp posts etc ADDITIONAL INFORMATION: O °'° m R �'X 0 1L _ _0_ Signed: (plan preparer) print name tel.no. Location of application: Street no. Street Village 2 , .. .- ,,, .-__..__.,,��:_... u:.........anvuu,.,•, A....1/1VFJ�'nr e,.,,,•,,,,,-r,,,�.,� �n�.r.,,. 4. SIGNS Diagram of sign, showing graphics, size, design and height of post, color and materials. Spec sheet. Site Plan on a GIS map or mortgage survey, OR photographs OR to-scale sketch of building elevation showing location of proposed sign; and any tree to be removed near a freestanding sign. Fee according to schedule. 5. FOR LIST OF ABUTTERS; PLEASE SEE OKH STAFF SIGNED (plan preparer) � Print /�/�l� — ' �' ��Y�✓ IQ. . Date: r U U Tel. Phone no's: - NOTE The Old Kings Highway historic District Committee MAY DENY INCOt�IIPLE'I'E,.IPPI.,ICA'TIONS /I TTENDANCE AT MEETINGS: lj'ihe applicant or his/her representative is not present during the hearing is scheduled, the application may be either CONTINUED OR DENIED APPEAL PERIOD APPROVED PLANS------- PLAN PICK UP There is a fourteen (14) day appeal period for approved plans. This is necessary for each Certificate of Appropriateness and/or Certificate for Demolition issued by the Old King's Highway Committee. Plans approved by the Old King's Highway Regional Historic District Committee may be picked up at Growth Management,Regulatory Division, 200 Main Street, ITyannis, after expiration of the 14 day appeal period. if the 14"' day falls on a Saturday, your plans will be available the afternoon of the following business day. _ ----- DENIALS ----_— -- — Applications that are denied may be appealed to the Old Kings Highway Regional H' ri trict j, Commission within 10 days of the filing of the decision with the Town Clerk. For ora4on, Bulletin of the Old Kings Highway District Commission. , Q_. L�_— BUILDING PERMITS, OTHER AGENCY CONTACTS �O�O 5 _ In most instances, before commencing work, a Building Permit is required. The Building Div ' n will require a certified plot plan for new construction and/or demolition. Commercial work may re ae P§j Go approval. Demolitions: the applicant should check with the Building Division as to conforma wit�r' T_E co Zoning requirements. C-' o Y 0 Other Regulatory Agencies at 200 Main St, Hyannis MA 02601: Building Division 508-862-4 Q Conservation Division 508-862-4093 Health Division 508-862-4644 --� --� �-O QUESTIONS ABOUT YOUR ARPLICATION? PLEASE CALL THE BARNS ABLE OLD KINGS HIGHWAY OFFICE AT 508 862-4787 5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application l Health Division Date Issued S CA Conservation Division Application Fee � Planning Dept. Permit Fee ac? • �� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village L , Owner �'Ta�ry �' %�P.Gr,� �Lv�� Address yO� AC-471 Telephone Permit Request 16aA011949r" I&I0 -4,Z L7,,-1-e11, ,, �7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 9�6� 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 0 No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sqPT� Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new , 4 ZE NJ Total Room Count (not including baths): existing new First Floor Room Count o w Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No - Fireplaces: Existing New Existing wood/coal stove Yeg,❑ No Detached garage: 0 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 D /w vt�i� K�-f�fi' Telephone Number 0?9� —232S Address �� /00ir License # cJ 7 0,, 6? ' Home Improvement Contractor# 161/ /49 Worker's Compensation # WC 13163 70 4 3T010 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 0// ` � "' 0�rw FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED j MAP/PARCEL NO. ADDRESS — VILLAGE OWNER s. . DATE OF INSPECTION: q FOUNDATION is FRAME r INSULATION FIREPLACE -� ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH } FINAL — - GAS: ROUGH FINAL FINAL BUILDING A-14 S DATE CLOSED OUT ASSOCIATION PLAN NO. ' i 7C`OYM of Barnstable Regulatory 5ervices • : kL�FUl3TA�LE. '• Tho mas F. Geiler, Dixector ' Building ]�i ision to 91 ,0 Thomas Perry, CBO,Building Commissioner 200 Maim Street, Hy�s,MA-02601 WWW.town.banutable.ma.us Fzx: .508-790-6230 Officec 508-862-4038 PLAN R VEEW /Parcel: Owner: , �9 S Ma P �0 yGf 4 zME-111k Project Address � � T Buzlder: W� The following items were noted on reviewing: 77 6 7,Y o C FIA �n c w t r tfiA-) GtJ i nr&2t0- GCS f C— T�icc �oT' s-lfo coo) old Reviewed by: Date: The Commonwealth of Massachusetts ,Department of Industrial Accidents Office of Investigations fi 600 Washington Street Boston, MA 02I11 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I,e i blY. Name (Business/Organization/Individual): 44vA L Address: A City/State/Zip: Q/1/��� O16B� Phone #: %ZSv2_? Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 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' 9 ❑ Building addiirs or additit tion [No workers' comp. insurance comp. insurance. required.] 5. &r We are a corporation and its 10.❑ Electrical repairs q ] officers have exercised their I I.❑ Plumbing repairs or additit 3.ElI am a homeowner doing all work 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.�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 inscrance for my employees. Below is the policy and job site information. Insurance Company Name: eft Policy# or Self-ins, Lie,#: (%I3I.S~.� 7,66.�.f O�d Expiration Date: Job Site Address: 7 C 7 GR � City/State/Zip: Attach a copy of the workers' compensation polic 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 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 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. 1 do hereby certify and p is an penalties of perjury that the information provided above is true and correct. Date: may— ZO /'0 Si nature: p Phone# 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 S. Plumbing Inspector 6. Other Phone#: Contact Person: 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 in the service of another Linder 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, constriction 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 that"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-contractor(s)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 pen-nit 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 permit/license,number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town):"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicani 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 burn 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia I oF� r `a vn of Barnstable Regulatory Services 5AJ2NSrABLE v hues Thomas Ceiler, Director i639- Fo y Building bivision Torn Perry, Building Commissioner 200 Main Strcct, Hyannis,MA 02601 Ivwpv.tOwn.barnStable.ma.Us Office: 508-862-4038 Fax: 508 Property OwrierMust Comple'te and Sign This Section If Usin A wilder as Owner of the subject ro e hereby authorize ;GG - to act on MY behalf, is all a mtteis relative to work authorized by this bwddiag permit application for. (Address ofjo6 Signature of Ywner Date jee-,, Print Name if Property Owner is, applying for perm.1t please complete to Homeowners License Exemption-Form on 'the reverse side. I I BATHROOM I I I I OFFICE AREA I I I I I 1 I I I I i i I ' I I I BEDROOM i I I I I I I EXISTING SECOND PART PLAN ZII - 1 FT. i 1 SECOND FLOOR PART PLAN. DWG.NO.42PL 2010-1 MACKENZIE BETTY ASSOCIATES. 42 PACKET LANDING. WEST BARNSTABLE. MA ARCHITECTURE AND CUSTOM BUILDING SCALE §� = i FT.I 1:241 GATE BTH APR 201 0 aaee n+.�s..e.,,mc�c.n nc oaeao ..eoe aeo eacc REMOVE BASEBOARD EXISTING WALL AND 5' 16" HEATER AND INSTALL TRIM CLOSET REMOVED -WITH NEW BEAOBOARD WAINSCOTTING, REDIRECT [_NEW TILED FLOOR T 2 1 B° WIDE 2 DRAWER ( FILE CIRC PIPE BELOW FLOOR. MATCH EXISTING AND SINGLE DRAWER BASE _ UNITS AND GRANITE FLOWER BOX FLOWER BOX 2 FLOWER OX COUNTER TOP WITH WOODEN SURROUND 1� I I ERIC -i STANOAR NEW DESK ----- ---- O FLO W I S E IIAL i �' —— —'——''——— ———— LUSH CLOSET,.' NEW ELEC. E TING -I-•:� .� MAT BELOW T LTWITH NEW THERMOSTAT. N WALL LAWFOO I I NEW THRESHOLD, CARPET 3 NEW BATHROOM BATH I I `' NEW BACK TO SUIT DOWNLIGHTB ————— L L— ———�, �� BM ALLER ROOM. ———————— ————— — ———L —————_.———————'— OBA" 1�-RIOOM O NEW 2X4 WALL WITH I I GREEN BOARD AND NEW DOOR TO MATCH EXISTING 2 9HOWIE DOOR DOWNLIGHT - :DRESSING I I :AREA BO EXISTING BEADARD NEW SHOWER ENCLOSURE WAINSCOTTING EXTENDED RELOCAT�DI SHOWER WITH FULLY TILED WALLS AROUND ENLARGED I AND CEILING ON BATHROOM EXCLUDING VANITY I � FI— HARDIBOARD SUBSTRATE, SHOWER RAIN Q WITH SEAT AND GLASS I I -.HEAD: W " WALLS TO 2 SIDES N I I TWO STAINLESS STEEL T , HANDRAILS ICHE, HAND SHOWER WITH ADJUSTIBLE RAIL. I I FULL HEIGHT ADJUSTIBLE CLOSET THERMOSTAT CLOSET SHOWER HEAD WITH RAIL_�j FOR FLOOR CHIMNEY WITH VALVES AND — RELOCATED EXISTINGJ THERMOSTAT BELOW LIGHT FITTING ———————————— WALL AROUND CHIMNEY TO MOVED BACK AS FAR AS POSSIBLE. I I BEDROOM PROPOSED SECOND PART PLAN ZII _ T. 9 ECON 42 PACKET LANDING, WEST BARN STABLE, MA D11 FLOOR PART PLAN. DWG.NO.42PL 201 0-2A MACKENZIE BETTY ASSOCIATES, BCAIE 2�c 1 FT.I I:24) DATE 1 3TH APR 2O1 O ARCHITECTURE AND CUSTOM BUILDING ]aee Moir, T.e a 026J0 — i I i - T� ;°ate o�✓G��� ... ... . .... ..... . ..�,. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR �. before the expiration date.'If found return to: Office of Consumer Affairs and Business Regulation Registration64148 10 Park Plaza-Suite 5170 • Expiratiogct�-1L2011 Tr# 288409 Boston,:MA 02116 ` Type: P7iVate_Corporation . BELPORT BUDDING&:REMODELING, LLC. MAZHEIKA DZMiR_ - 262 SKUNKNET RP CENTERVILLE, MA�02632y e' Undersecre.tary. 1 of valid without signature --- ) -Tfie Vi anUnzaruue .o��ac�ucaell Board of Building Regulations and Standards a Construction Supervisor License Lice: CS 97029 11 i - Birthdate_t0/8/1982- ' S1 Expiratio /8%2010 Tr# 97029 estrictiich onni= g-- TT;R; 0_•`. i DZMITRY MAZHEIKA — f P.O. BOX 2881. HYANNIS,MA 02601 Commissioner Barnstable Kitchens, LLC 3282 Main St. W.Barnstable,MA (508)298-2523 (508)367-5900 Estimator: Keith Mackenzie Architect: Keith Mackenzie General Contractor: Dmitry Mazheika Proposal 04/18/2010 to: Stan and.Eileen Elias 42 Packet Landing West Barnstable, MA Proiect address: 42 Packet Landing West Barnstable, MA General to the Entire Project: 1. GC to carry both Liability and Worker's Compensation Insurance; 2. The Owner shall maintain their Homeowner's Insurance Policy throughout the duration of the work. 3. GC to pay the required.Town of Barnstable fees, as required; 4. All materials will be furnished by GC; 5. GC to use existing on-site electricity; 6. GC to provide for proper disposal of all construction and demolition debris, and pay all fees associated with same; 7. GC will provide cleanup on a continuing basis and all debris wilt be removed from site and nail.s extracted with magnets. We utilize magnets so as to minimize your exposure to personal injury and/or property damage from nails left behind at the job site. 8. Unaffected areas of the House (those areas where Construction will not take place) will be isolated from the Construction area during all phases of work; 9. Furniture in any affected area of construction will be moved to the unaffected area of construction by GC and covered for the duration of the construction. 10. All affected Construction areas will be cleaned to move-in condition at the end of construction. Furniture moved to affect construction will be returned to its proper place after complete cleaning. 1.1. Any fees or costs associated with NStar Electric,National Grid Gas, Water Dept.,Telephone Co., Alann Co., or any utility to be paid for by Owner. Work to be coordinated by GC; 12. If during any area of Construction(i.e. Demolition,Build Up,etc.)unforeseen evidence of rotting, critter damage, etc. is discovered,the Owner will be notified and an assessment made as to the cgrrective action and cost prior to proceeding; We hereby submit specifications and estimates to furnish and install as follows: Item 1: Demoft. n "d floor Bathroo Acce led b Date 4e d . This page is part of and in conformance with proposal# 42 Packet Landing pl of 4 - Dust protection all job - All demolition according proposed drawings/plans - Remove and save existing carpet (office) - Remove and save existing 30 closet doors for future reuse in new closets. - Remove entire shower walls including all finishes - Remove wallpaper(office room only) - Remove floor tiles entire bathroom - Remove wainscot wall paneling as needed - Remove and save all bathroom accessories - Remove and save existing toilet and vanity. Item 2: Frame tight - 2x4 stud 16"o.c. all interior walls as per drawings according proposed plans - Build three closets and work desk in new office room according designed drawings. - I" level bathroom wall repair(Rotting wood replacement) Item 3: Wall covering - '/2 Moisture resistant bard /Plaster - 1" level bathroom wal/epair LZ;4 Item 4: Ceiling cover - % Moisture resistant board/Plaster Item 5: Insulation - Walls: R-13 Faced fiberglass as required - Ceiling/floor: R-19 Faced fiberglass as required Item 6: Tile work -New cement pan - Waterproofing shower(walls/floor) - Bath main floor: 6x6 tiles to match with existing - Shower floor: white pebble tile - Walls: 4x4 (including tile inside the new niche) - Tile repair(Is' level shower) - New White Carrera marble"Threshold(I"Level Shower and New 2"d level shower) Item 7: Trims and finishes - All new trims (to match with existing) -New wainscot paneling with chair rail (to match with existing- bathroom only) - Reinstall saved bath accessories as towel bars, paper holders and etc. - Reinstall carpet (office room) - Painting all newly installed trims and mouldings - Painting walls/ceilings (bathroom, office) - Install New PVC Flower boxes @ 3 (2"d floor windows rear side only) A ep ted by Date f-/f-/O This page is part of and in conformance with proposal #42 Packet Landing p2 of 4 is Item 8: Shower doors and accessories: - '/2" glass frameless pivot shower door with satin nickel hardware (according designed drawings) - Install 36" stainless steel grab bar inside the shower. 1 - Install New 2/3 x 6/3/4 glass shower doors (]" level bath) (,�e,Am -��J- Item 9: Cabinetry 0 - Custom built on site work desk with Birch veneered 3/4 PLY (Allowance $1,500 not included in contract cost) - Install new oval mirror/med. Cabinet (Kohler K-CB-CLR-2031 OW) Item 10: Plumbing/heating - Plumbing work to code: Permit water supply & drains/vents. (According drawings) - Shower pan: Vinyl liner - Wall plumbing for claw foot tub. -All fixtures'`installation and hook-up (shower fixtures; reinstall existing toilet new location; existing vanity new location, install new claw foot tub.) - R&R existing baseboard with new larger unit. - Bath venting: tie-in to existing HVAC System. Item 11: Electrical - Bathroom: 1 bathroom GFI receptacles on one 20 amp circuit - Bathroom ceiling: 3 - 5" recessed light: white trim, incandescent bulb - 2 Single pole dimmer switch - Shower/vanity: 4 - 4" recessed light: white trim, incandescent bulb - Office room: 2 - 4"(slope ceiling above work desk) and 2 - 5" recessed Light(flat ceiling): white trim, incandescent bulb - Two Receptacles above work desk - 2 fluorescent lights in each closet on the switch/Poo2 iw;ld- - 3 Single pole switch(office room) - Electrical permit/ inspections - Install new warm floor system (2"d level bathroom only) Total project Labor& Materials allowance: $ 44,916 I� �� Payment will be made as such: > - 30%Deposit $13,475 CA.2O66 - 30%upon rough electrical / plumbing inspection completion $ 13,475 �S - 20% upon final electrical/plumbing inspection $ 8,983 - 20% upon Final building inspection $ 8,983 Alternative work : 1. Custom built on site work desk with Birch veneered 3/4 PLY Finish: natural with 4 coats of polyurethane on the counter. Allowance $1,500 2. Base cabinet with one draw (each) Allowance $ 350 Payment will be made as such: - 50%Deposit /'_e!21 Accepted by Date This page is part of and in conformance with proposal 4 42 Packet Landing p3 of 4 - Upon 100% completion If acceptable, initial here: Job is estimated to commence approximately 2-4 week after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately 4-6 weeks If acceptable, (both) initial here: WARRANTY All labor and materials by Barnstable Kitchens, LLC are guaranteed for a period of one [1] year upon completion, free from defects in workmanship and materials, under normal use and service. Any work above and beyond the specifications outlined in this proposal will be performed at $56.00 per man hour plus materials or priced on request. All additional work, including travel time and lumberyard runs will be subject to extra charge. In the event of rot repairs, roof repairs or any related work requiring immediate attention, we will proceed without customer approval (if repair not exceed more then$100). GC will provide cleanup on a continuing basis and all debris will be removed from site. All products installed by GC will be to manufacturer's specifications. All work will be performed by insured professionals. Owner not responsible for any accidents or injuries happen during construction project. All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and/or specifications submitted for above work and completed in a substantial workmanlike manner. Any alteration or deviation from above specifications involving extra costs will b ecuted only upon written orders and will become an extra charge over and above the esti This Contract not valid unless signed by Corporate Officer: Acceptance of Estimat The above prices, specifications and conditions are satisfactory and are hereby accepted. Barnstable Kitchens, LLC is authorized to do the work as specified. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Date: 0-// le - OW/0 Signatures: Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. Notes: Accepted by Date O'(/ `49 This page is part of and in conformance with proposal # 42 Packet Landing p4 of 4 E ` I Town of.Barnstable *Permit# Expires 6 r nth,iron ' re-date Regulkory Services Fee tsasxsrnat.E, Thomas F.Geiler,Director - y ntA3S. D 9.IN Building Division Tom Perry,CBO, Building Commissioner ^� 200 Main Street,Hyannis,MA 0260.1 VL1° www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ��� ply" � 191�/N4 Property Address XtResidential Value of Work; Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address_LhN 2�n� Contractor's Nam \ c �� . � �'`C1` - _Telephone Number�&is-4& Home Improvement Contractor License#cif Vplicabble))`� n L 6 ❑.Workman's Compensation Insurance m� a s Check one: ❑ I am a sole proprietor 304 ❑ I am the Homeowner R�STA��� I have Worker's Compensation Insurance -To w..0 gA Insurance Company Name Workman's Comp.Policy#� Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) c Re-roof(stripping old shingles) All construction debris will be taken t\�(�tn�, \ 1� �`1 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: 9-- Nvr 6D0 Q:Forms:buildingpermits/express .t/ s t• Revised 123107 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 Legibly Name(Business/Organization/Individual) S�-,_ Address:\Ll�h s )?=C\ City/State/Zip: (�` ('�►�t���S Phone.#: �lcF� Are you an employer? Check the appropriate box: Type of project(required):. XI am a employer with&2) — 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 workingfor me in an capacity. employees and have workers' Y P tY• $ . 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.❑ 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: 0 C,, 1M Policy#or Self-ins. Lic.#:� (JC� bt)(Oc�l Expiration Date: Job Site Address:\4--'\\ G\�2c�, 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of —Investigations of the IA for j6surance coverage verification. I-do-hereby-c-er-ti- , -nd6r-t p -c -and-penalties-ofpar-ju4--y-that-the-infor-mation-provided-above-is-txue-andreorr-ect. Signature: Date: — - Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: Client#:47298 CAPIHOM ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER 12/30/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers$Gray Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. O. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: NGM Insurance Company Capizzi Home Improvement,Inc.Capizzi Enterprises, Inc. INSURER B: American Home Assurance 1645 Newtown Road INSURERC: Cotuit, MA 02635 INSURER0: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $SO OOO CLAIMS MADE a OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 OOO OOO GENERAL AGGREGATE s2,000,0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000.000 POLICY JEd LOC A AUTOMOBILE LIABILITY M1 M28044 06/08/08 06/08/09 ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $500,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY 4AUTOONLY: ONLY-EA ACCIDENT $ ANY AUTO R THAN EA ACC $ AGG $ A EXCESS/UMBRELLALIABILITY CUB1076H O6/08/08 06/08/0 OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE AGGREGATE s5.000.000 RDEDUCTIBLE X RETENTION $10000 B WORKERS COMPENSATION AND WC6957000 12/25/08 12/25/09 . X WC LIMIT OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s500,000 OFFICERIMEMBER EXCLUDED? If yes,describe under- E.L.DISEASE-EA EMPLOYEE s500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATON, Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S40650/M40647 KW O ACORD CORPORATION 1988 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: . Board of Building Regulations and Standards Registrpt!P,b;,�100740 One Ashburton Place Rm 1301 p1ra:12n F 23/2010 Boston,Ma.02103 . _ �plement Card CAPIZZI HOME M py M Z bARY GUSTAFSOty--_ x. ,5i- / 1645 Newton Rd- �.FF Cotuit,MA 02635 Administrator No vali itho,t " nature ::>lasi:lcbu.Ai.ti. Uclfartnu:nt of Public safety -- -Board of 0(fildin'. Rendiltit+n .ind stlttsdards Construction Supervisor License License: CS 74640 Restricted.to: 00 GARY :GUSTAFSON 8 SHORT WAY SANDWICH, MA02563 1 1/291201 0 7r 7755 r Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, OWN THE PROPERTY LOCATED AT IN '� /Q'�u'� " , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN CORDANCE WITH 780 CMR, THE-MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: yG OWNER'S TELEPHONE: y 06 Z — �1,6 q LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 'RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: t i -7, ) °FtME TOwti Town of Barnstable *Permit# Expires 6 months from issue d to Regulatory Services Fee BARNSTABLE v� MASS. Thomas F. Geiler,.Director, '°lFn nary� Y" Building Division � �� �E IT O ,�1, Tom Perry, CBO, Building Commissi e VV 200 Main Street,Hyannis,MA 02601 APR 23 2010 ,,vwtiv.town.barnstab le.ma.us Office: 508-862-4038 TOWN OF BAR T o-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address esidential Value of Work 7 Minimum.fee of$25.00 for work under$6000.00 1 Owner's Name&Address M/u, lL%% tf:A LI w S t , Contractor's Name 6 S v (��� Telephone Number Home Improvement Contractor License# (if applicable) Construction Supervisor's License#(if applicable) El<orkman's Compensation Insurance Check one: ❑.I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 3iupOy th I&& Workman's Comp.Policy# W G/ 'y 3)S _ 3�7oZ<- Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to.5'-' &0��,y�"S ift roof(not stripping. Going over existing layers of roof) UB ne-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Proper y Owner Letter of Permission. A copy of the Home Impr e ent Contractors License & Construction Supervisors License is equired. SIGNATURE: n\WPFII.F.C\Fr1RN1R\huildine oermitformsEXPRESS.doc i "Al r ,f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 'a 600 YYashington Street Boston, MA 02111 s' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �T17��� l{�/l!/'jG1 L£� Address: //� 7,_ City/State/Zip: Phone 1y A;re 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 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.$ ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 5. 3.ElI am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself,.[No Workers_'_eo�t?p,......__.._............. .... right of exemption per MGL _..._ _ ._.r..12.❑.R repairs........... .......,. _ insurance required.] t e 15o ees. [ and we have no employees. [No workers' 13. Other C-- 200 comp. insurance required.] e-s *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: L I Policy#or Self-ins. Lic. #: G� - fS ` �� 3 0 9 Expiration Date: Job Site Address: ktj L AA/ City/State/Zip: Attach a copy of the workers' compensation policy d laration 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 verific lion. I do hereby certify under the pain and pen i o erjury that the information provided above is true and correct. signature: Date: - 1s- 0 Phone#: 5 ; �L-0 Official trse only. Do not write in this area, to be completer)by city or toivn 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#: ' V 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 in 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, constriction 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 that"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 mem bers or partners,are not required to carry workers compensation insurance.' If an LLC of iI P 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially 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 investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia 4/16/2010 7 :55:17 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15087906230 Page: 2 of 2 ® (MMIDD/YYY Y) CERTIFICATE OF LIABILITY INSURANCE DATE4/162010 9RODUCER ROGERS & GRAY INSURANCE AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 434 RTE 134 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOUTH DENNIS, MA 026601601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800 553-1801 508 258-2124 INSURERS AFFORDING COVERAGE NAIC# INSURED THOMAS F BUTKOWSKY INSURER A: Libecly MutualGroup PO BOX 1 167 INSURER B: WEST CHATHAM MA 02669 INSURERC: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR INSRn TYPE OF INSURANCE DATE(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ AMAGE ToCOMMERCIAL GENERAL LIABILITY PREM PREMISES Eaa occurrence $ CLAIMS MADE OCCUR MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC1'31 S-372834-019 5/$/2009 5/$/2010 ,/ WC STATU TORY LIMIT- OTH- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-FA EMPLOYE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ZE Workers Compensation Insurance: Part One of the policy applies only to the Workers'Compensation Laws of the State of MA THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR THOMAS F BUTKOWSKY 0- CERTIFICATE HOLDER CANCELLATION 2-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES A CANCELLED,5FORET d EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDE VOR TO MAILCC ))1 O 7�''YS WRITTEN TOWN OF BARNSTABLE to r-- ATTN: BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO ELEFT,BUT A�URE�Df�D0SOSHALL 200 MAIN STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BARNSTABLE MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge .,4 ���G5 ) ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT NO.: 7227316 CLLENT CODE: 1391365 Deb Corby 4/16/2010 7:52:16 AM Page 1 of 1 77 Sie �om �wouueci/�i �� ¢c�ucaelit6 Board of Building Rcg�l!tio sand Standards-. LiUnsc or registration valid for individul use only - re the ca iration.date: If found return to: HOME IMPROVEMENT CONTRACTOR t bclo P .,. Board ok Buildiog Regulations and.Standards - RegistrationY 161140 pl�e.Ashburton.Place Rm 1301 Expiration g/29/2010 Tr# 27556F.: (Boston,Ma..02108 Type Individual S, i i . THOMAS F BUTKOWSKY, THOMAS BUTKOWSKY y `— a 1054 MAIN ST �� o�� ,t sn-er Not nht'lrc CHATHAM,MA 02633. "� lclnunistrl�et ...1 '= 19assachusetts- Department of Public SafetN Board of Buildinl,, Rc!-,ulxtions�nd.Stand:r-ds- -Construction Supervisor License License: CS 59939 Restricted to: 00 THOMAS F BUTKOWSKY . 1054 MAIN St CHATHAM, MA U633 Expiration: 12/4/2010 ('u nun issi1O1' Tr##: 7698 I PROPOSAL_ r ,© �� ���(f �;L G, G ` q PROPOSAL NO. j30� � � y / v�A - ;driyo SHEET NO. UJI, c i 17f iM j' Ly 04-6 5`�4 a3� /(l DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: j NAM ADDRESS -761101W -711 IfT s� ADDRESS DATE OF PLANS PHONE NO. ARCHITECT ,��fs - aQ �Od We hereby propose to furnish the materials and perform the labor necessary for the completion of e 1362 ,sib e o,-s m At, i I) P d. L 1- Le C / 62aao - L 61� myb - _ 7� L ' 1 e y L All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications su mltted for above work, and completed in a substantial workmanlike manner for the sum of_ �//D t,1 D �fu_q kt moo- --- Dollars (9f i pZ,00 r with to be made as follows:. c., payments � �;d® dN� ems! IPA _. Respectfully submitted_7 Any alteration or deviation from above specifications involving extra costs will be executed only upon wri(len order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note - This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature '•. DSIIB i PROPOSAL M."', MADE_IN��eaco r PROPOSAL !J•y� 074-u w S 14 y ��] /S' �73 PROPOSAL NO. I < I d y / ►r`r7 Ilk T SHEET NO. DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME o ADDRESS G .4--L� ADDRESS DATE OF PLANS PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform.the labor necessary for the completion of w 21 SO. . ^' 3 5' k-b 14 tZ 0 0 cj:� N � , All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, an com leted in a s ibstantial workmanlike manner for the sum of �S � ���cJc� -� Dollars ($ with payments to be made as follows: j1oN p� 5 °.,tom `'`''1� P f-► -tL oc2 j Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon wrilten order, and will become.an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note - This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature __ DaiiB PROPOSAL .dams aa,\0i°IN n�ExiCO . 1 THE.T TOWN OF BAR.NSTABLE Z BAR33TADLE, i •"6 9 BUILDING INSPECTOR O am a' APPLICATION FOR PERMIT TO AJX. 7t < TYPE OF CONSTRUCTION `�� `�..................fir..c�..�-�..��..:s............:.,f...:.........,���''r9-a.....0 . ...... ............Ar r............,2. ..t9.7..�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit /according to-/the following information: Location ...................../.:.4�.�.�4:e ... .G� vaGf. ... .....U�ln.. .......................................................................................... \"I ProposedUse ............... �. .:i.:. P �;2.. ........................................................................................................:........... Zoning District ............. ... -..........................................Fire District ...XY. Seas r..►-�.� ! .�.�' Name of Owner ..... . I_` .,?...........Address ..f...Gl CIc.P.. h. c��. .We.s.. .�..1�1.,1:lFty'Nf�a-b�2 Name of Builder ......0� P_,_ �qf �. LJo�►��►s Cam` L_G4.Y'�...... .. .._..t�..l�.�-:5... 1� ....Address�c.,�C..�.�:� c......�... .............................�:hl•�_ Name of Architect °�— :..............................Address ..............n......................,...................................................... Number of Rooms ......6�N:e..�.............................................Foundation ......l..A..r.C. r..e`he .�'J� O.C/ ...................... Exierior ...0 S ( I / 1!`�... . ....... .. .�e:-:..............................Roofing ......... .5�((---.,,,. a.1:��Jn.1 l: Floors .................W-.0-04....................................................Interior ..........SM....Q...P-I-xv..k......................................... Heating �.� g � as. .rs..... bf/� G' a..............................Plumbin..... . .... ............. ............................... Fireplace e�....,3..o........ p ................................................................Approximate Cost ..'...........................................� Difinitive Plan Approved by Planning Board ---------------_---------------19________ . oq - Diagram of Lot and Building with Dimensions / S� "'scP e, Ln —� z O > A + z -< o � Ucn O N cn mc -in co 7j -� --I d _ . Z. O �-- Y o : � � > � oo 000 n r; r' G D Z 0522 r Lo Lo z �t _ > p '+1 m r �. - . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....`/- � ............... J James, William R. 311970 13019 No ...........'...... Permit for .............add....to..................single. .... family dwelling ............................................................................... Location Packet Landing Way W Barnstable ............... ..est..................:................................. 1� ' .... .. ... Owner William R. James - .................................. Type of Construction ' frame ..................... t ................................................................................ .^t� Plot ............................ Lot ................................ Permit Granted April..22.......:.....19 70 Date of Inspection �l...v of e .. f 1970 `Date Completed PERMIT REFUSED ................................................................ 19 ................................. ....................... .......... q fl .......................................................................... i Approved ........................................... 19 i ............................................................. ........... ir .................... ......................................................... rP - e _ -- Project ELIAS Kitchen, Bathroorr Deck Renovation 42 Packet Landing West Barnstable, MA NOTES: OCT 1 8,2015 Town of BaHighwaY Old Committee Revisions: I 1 Side Elevation Section Detail 'Scale: �1/4" = 1'- 0" Scale. 1/411 = 1 - 011 RECEIVED GROWTH Tvi:"�;�ACEMENT Sheet Title: DESIGN - � -- DEVELOPMENT PHASE 11 1 L—J r—I LJ L===�J I I I U I Drawn By: GSDG Checked By: Scale: AS NOTED (rGarden Elevation Date: 9/28/15 cale: 1/4" = V- Olt Sheet Number: