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HomeMy WebLinkAbout0023 PARRISH WAY n ti> r a �111 71 11/I UPC 12543 No.5.530.. HASTINGS,UN ^'.'r..:,_ _ _.-�... .,. �-,.,,•,..: .F. __. :.�.:'M." ... —.tea+-.+-`.r...-�. - ---�'^+,�'►y;.�r-�.+*.�.^`^'!�.i"s"":.�""` "�- "'^`�.:�?�".."^'..•ti,�"`�T!�^'�' -,:it_ �_cc� _ _ _-::sail - .,�=� _,_._. �:-..:.._,. .n`�""r...G',""':.P.';u'�•"""'e::?.`.."�-_ ..y.a:�.a.i�„d..�'��c.�a.'.rs:b:;aa�.-.vt�.t�...t......�,_,,.�ia..._..titch�.a:su-e:3 - •_�.__.a�.-_��� - Wit...._ ....o�..._�u�.— ���W�-.z:•nw_,,.., ....z .,..._ -•.._�.,_ -- � - Application to Y e Old Kin 's Highway Regional Historic District tj te �g g g g g g 00 3 in the Town of Barnstable for a 'AA .7y Pig CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate bf 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 CATEGORIES THAT APPLY: 1. Exterior Building Construction New Building ❑ Addition ❑ Alteration Indicate type of building: �ouse Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE !2 -16 JP ADDRESS OF PROPOSED WORK &&509; %ASSESSORS MAP NO. OWNER 3�NN F�=l2 ��I UGM L 5 ASSESSORS LOT NO. HOME ADDRESS 50 Sk-A-nN6- PANV-- Vt N,/AA/Nfs 94oz_,!�ol TEL. NO. $01; -7-7 -5Z2 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent pr2Lmrty owpers across any public street or way. (Attach additional sheet if necessary). �7$�C/rC• /`Z7�_4 I/ 0416 ��NN 6, /lyRPkZ 2N g&&,5' ,01A/ TA/I, b2dd //tom ogg Ulj&&IAA4 -7 �ZS L/d�I�D�TI'�f 20 Gc�-7y T� )//L►1:� yZ 63 Z AGENT OR CONTRACTOR �/fILL TEL. NO.�O -77: W?3 ADDRESS R OZ63Z-. DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). n U11 o w- 0 �} ...- ^ _ �A '*-ff Z, Signed kk, caner-Contractor-A Space below line for Committee use. -Received-by•H:D:E: i I.2 Date+ the er fic a is hereby ate ` Time - _ i10_....__:,.1 Approved ❑ IMPORTA PUCertificite is a proved, approval is sub+ ct to the 10 day appeal period provided in the Act. Disaonroved r l Town of Barnstable • �'` Old King's Highway Historic District Committee SPEC SHEET AL-L FOUNDATION /y0 �- $ X GN ./LrYC.J>rT7"(r. u-�!�f,QG L/ X B"/I o.0 /�cv�G Fi-;r- F2oNT : KE-0CEDA(L CL-APPOAKU Yz."X y _,.__ LANCAS-r X. ij1-j17-r k, 5;4 HL-17y 510 5 BACK'. 0141rr C t►�A.Z 5 H 1 N C-LF _._...___.... N a.-r 2�.>~ (6047XMIN ht 6o0) SIDING TYPE COLOR CHIMNEY TYPE -6r tc COLOR gag y TzlTf��C SGr1r' T-/<Q ROOF MATERIAL A$ COLOR PITCH WINDOWS SEE L-15 r A COLOR w ti SIZE 5 C..Z.-l.• 1 iT Pc ca5 ' S� A6 OF 01?AW1NC-' -rv2 P6-7/1/L OF VVIND040CAPS �oGf/7� �Ol1NC��134�� AND 4;7vr-/-AMc�-" - ALSO 1.2 14.A5 A: bP-Aw/NG- T� WAT1--R-.THY5L-E7 — ALL WrN D0,,jT2_i eA 1 X 5 DOORS;: 5 L 1 ST' A COLORS NEW I-ONIDON 309- -vND y I7C-,61 J"110-AM�"2-l�1 MAS�-7z �E�r ;Ne��tan/�S u2Cr 4A15CV PANC?— L7c:NT�/�lil�/ llocle-'r- SHUTTERS/Y:X 6/J' f /y`X 5/" COLORSA/Ck) LoNDON Bu,eUuNv y Y6 61 GUTTERS 5 ©. G, XLUI-411yaM (�-&777� Z-COLORS I✓/-// /F- Lan,r I�oA►i3.�H , B(LPL 1<- /OXS + iDX 6 a--e iZ.EU 13iZtL UL/NClL/Ti+lrr. " 51-J RML ,. DECKS : MATERIALS 27� !� 1 w/ /XN IVIAHOe-AAl/ -�MCi� w( !x k•���ie �c::C t. r S 7— B6NrTAMI M l�+�C•:. GARAGE DOORS COLORS-NEW I-W,100N v yrLiJ/ H441 SKYLIGHTS / v A SIZE COLORS SIGNS r Y� COLORS FENCE COLOR E , . • aA A-L NOTES. Pill out completely, including meaeuroments and materialm/oolore to be used. Four copies of this form are required for submittal of an application, along with Pour copies of the plot plan, landscape Elan and elevation plans, when applicable. SPECSIt'i Revised 11/98 NO 6-N 6 5 23 PA►KP-15 �-� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ffi 0q< ?On # Map Parcel pp Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board / Historic - OKH _ Preservation/ Hyannis Project S eet Address -.I- Village , Owner J Address a yc Telephone -o ^ 9 4 Permit Request aU 2=6k ` S' a �fth 0 1 � C'rR�in //DIA 4 ' T� � r�Q� �d P'oa�M DD Square feet: 1 st floor: existing proposed,-,-' 2nd floor: existin proposed Total newq Zoning District Flood Plain Groundwater Overlay Project-Valuation: _ Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family (# units) Age of Existing Structure �- V' Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: d Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor W-00m Couri Heat Type and Fuel: 3-Gas ❑ Oil ❑ Electric ❑ Other Central Air: d'Y'es ❑ No Fireplaces: Existing New Existing wood coal stove: Q s 0 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ xisting '13 nev m size_ Attached garage: 2 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 NameSkl'0-4;4-124-S;(,c4 iTelephone-Number­­-: q A,dr �-£� — c� �� l`�:b�}.�- cerise## _ - ` s � Home Improvement-Contractor#_ -Z Worker's'Coffio- nsation#, ""'� ALL CONSTRUCTION DEBRIS R SULTING FROM THIS PROJECT WILL BE TAKEN TO GNi4TU.RE z DATE I f FOR OFFICIAL USE ONLY APPLICATION# ow DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE . OWNER �I r t z s DATE OF INSPECTION: t - 3 ; J QUNDArTION+ FRAMEf E E OJ C dNSULATION.:w 3 �— ,r FIREPLACE ELECTRICAL:. . ,ROUGH FINAL ' ' PLUMBING: ROUGH FINAL j GAS` ROUGH FINAL FINAL BUILDING:. DATE CLOSED OUT ASSOCIATION PLAN NO. �. 7— - r 1 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 Lepibly Name(Business/Organization/Individual): SU Address: 425-0 A4: 2"0a— / D-5-37 G City/State/Zip: &. ' c-Q-� 6�Phone `7 Are y an employer?Check-the he appropriatUPIXa:m Type of project(required): 1. I am a employer with 4. a general contractor and I employees(full and/or part-time).* have-hired the sub-contractors 6. ❑New construction 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 �'• 9. ❑Building addition [No workers'comp.insurance comp. incmanceJ required.] 5. ❑ We are a corporation and its 10.El 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.❑offer 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: �CG� Policy#or Self-ins.Lic.#: to 1, U 9 f6:HJ *7 Expiration Date: v t Job Site Address:' ��,�tis� �" City/State/Zip: lam. ¢ ,r tf v yGGB Attach a copy of the workers' compensa ' policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1;500.00 and/or one-year imprisonment,as-well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy under the pains an penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone it: -7-7 L 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#: p_ r 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6`also states 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 members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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-MASS AFE Revised 4-24-07 Fax#617-727-7749 - www.mass_gov/dia Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 160037 Type: DBA Expiration: 6/19/2014 Tr# 226520 SUNRISE RESTORATION COMPANY WILLAIM FEDER P.O. BOX 802 E. SANDWICH, MA 02537 — Update Address and return card.Mark reason for change. SCA 1 Ca 20M-05/11 Address ❑ Renewal Employment Lost Card (i7l-ie'Fam toy,wealel,olb-1147.uaclarettr Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 160037 Type: Office of Consumer Affairs and Business Regulation xpiration: 6/19/2014 DBA 10 Park Plaza-Suite 5170 Boston,MA 02 SUNRISE RESTORATION COMPANY WILLAIM FEDER 480 RT.6A P.O.BOX 802 E.SANDWICH,MA 02537 a Undersecretary Not valid without signature r Dep:u•t lilt:rt lot 1'uhlic 'Safctj 9 &i;ud of Builtlin�, Rc�,ul:uinn, :uul St.11 and o Construction Supervisor License License: CS 105323 WILLIAM FEDER 24 PARRiSH WAY r WEST BARNSTABLE, MA 02668 Expiration: 3/14/2014 t mwi..i nvr Tr#: 105323 r, Town of Barnstable °t Regulatory Services • uxxsr.�acs, • BLwss g Thomas F.Geiler,Director ;9. , '�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,ktebaud � Z—Z. ��-/C , as Owner of the subject property herize_ S(A,n!%k S'c to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final ins ectio s are erformed and accepted. Signs e o &igmtureApplicant • IV I �T! Print Name Print Name ate QFORM&OWNERPERIMSIONPOOL•S 62012 Town of Barnstable Regulatory Services e R�RN!.TA 3 Thomas F.Geiler,Director ��; •``� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street age "HOMSOWNER": name ` home phone# / work phone# CURRENT MAELING ADDRESS: city/town state/ ap code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for,hire who does not possess a license,provided that the owner acts as supervisor. DEFD MON OF HOMEOWNER Person(s)who owns a parcel of land on ch he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such/use and/or farm structures. A person who constructs more than one % 01 home in a two-year period shall not be considered a homeownW Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit•(Section 109.1.1) The undersigned"homeowner"assumes responsibility or compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 7 Signature o�i om 7 Approval of Building Official Note: Three-family dwe}lings containing 35,000 cubic feet r larger will be required to comply with the State Building Code Section 127.0 Construction Control. / HOMEOWNER'S NIMON The Code states that: "Any homeowner performing work fo which a building permit is required shall be exempt from the provisions of this/Section(Section 109.1.1-Licensing of consction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall`act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The hommeowner acting as Supervisor is ultimately responsible. \ To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilitieAf a Supervisor. On the last page of this issue isa-form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\d=Uik\AppData\LoceAM m-osoft\Wmdows\Temporary Internet Files\ContuitOutlook\QRF,6ZUBN\):)aRESS.doc Revised 053012 r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T1 Q%4M. IFICATE 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.AN THE CERTIFICATE HOL ER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NAME: THE INS AGCY OF CAPE COD PHONE FAX P O BOX 960 (A/C,No,Ext): (A/C,No): E-MAIL EAST SANDWICH,MA 02537 ADDRESS: 77GBG INSURER(S)AFFORDING COVERAGE NAIC q INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY SUNRISE RESTORATION COMPANY INC INSURER B: INSURER C: INSURER D: P O BOX 802 INSURER E: EAST SANDWICH,MA 02537 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IN IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD)CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MMMD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE E]OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGd, �uATE _ Q POLICY F]PROJECT LOC RODUCTS-CGiIWP/OP AGG -� AUTOMOBILE LIABILITY COMBINED SINGL ANY AUTO LIMIT(Ea accide'r )l _ ALL OWNED AUTOS BODILY INJURY- SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMfi<GE C,7 (Per accident) r rn UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TAAWORKER'S COMPENSATION AND x I we sTATuToRY i oTHER EMPLOYER'S LIABILITY Y/N UB-4956P477-13 11/29/2013 11/29/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. PROJECT LOCATION:23 PARISH WAY WEST BARNSTABLE MA ---------------- CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED BLDG DEPT IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN ST �. AUTHORIZED REPR HYANNIS,MA 02601 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1989-'2010 ACORD CORPORATION. All rights reserved. Rightfax N1-2 1/29/2014 6: 49: 51 AM PAGE 2/002 Fax Server " r DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T. IFICATE 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. ND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT NAME: THE INS AGCY OF CAPE COD PHONE FAX P O BOX 960 (A/C,No,Ext): (A/C,No): E-MAIL EAST SANDWICH,MA 02537 ADDRESS: 77GBG INSURER(S)AFFORDING COVERAGE NAIC a INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY SUNRISE RESTORATION COMPANY INC INSURER B: INSURER C: INSURER D: P O BOX 802 INSURER E: EAST SANDWICH,MA 02537 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD)CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MMMD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE a OCCUR. PREMISES(Ea occurrence) ED EXP(Anyone person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGC ATE 1 POLICY [—]PROJECT a LOC DRODUCTS-C-CiM /OP AGG 5--4 AUTOMOBILE LIABILITY COMBINED SINGL ANY AUTO LIMIT(Ea accident) —n ALL OWNED AUTOS BODILY INJURY— $) SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY CJ7 NON-OWNED AUTOS (Per accident) PROPERTY DAM (Per accident) C" ri r-- rn UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X I WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-4956P477-13 11/29/2013 11/29/2014 LIMITS ANY P ROPE RITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 10 N/A E.L.EACH ACCIDENT $ 100,000 (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 OPERA'IONS/LOCA'nONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. PROJECT LOCATION:23 PARISH WAY WEST BARNSTABLE MA CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE'THEREOF,NOTICE WILL BE DELIVERED BLDG DEPT IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN ST AUTHORIZED REPR HYANNIS,MA 02601 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988=2010 ACORD CORPORATION. All rights reserved. 01/30/2014 THU 14: 15 FAX 508 947 6844 GAMMONS INSURANCE 2001/001 ACaR©® CERTIFICATE OF LIABILITY INSURANCE 771/30/14 /DD/YYW) 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: Gammons Insurance Agency PHONE FAX (508) 947-6844 328 Bedford Street E-MAIL E (508) 947-3460 No: PO Box 1235 ADDRESS: info@ ammonsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC* Lakeville, MA 02347 INSURER A:Patrons Mutual Ins Co. of CT INSURED INSURER B:National Grange Mutual Ins Co Da Rosa Construction INSURER C: 95 Ashley Boulevard INSURER D: New Bedford, MA 02746 1NSURERE: i INSURER F: COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POU CY EXP INSR VWD POLICY NUMBER M1DD1Y MMIDWYYY LIMITS A GENERAL LIABILITY BOP2700753 8/23/13 8/23/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LUBILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS-MADE Fx_1 OCCUR MED EXP(Arryone person) $ 10,000 PERSONAL&PDVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE L[MIT APPLIES PE R: PRODUCTS-COMPIOPAGG $ 11000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMB[NE SINGLE L[MIT $ ANYAUTO BODILY INJURY(Per person) $ ALL O WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eracadent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION B VMKERSCOMPENSATION WCB9268S 2/9/14 2/9/15 WCSTATU- OTH- AND EMPLOYERS'LIABILITY EfL ANY PROPRIETORrPARTNER/EXECUTNE YIN E.L.EACH ACCICENI 100,000 OFFICER/MEMBFR EXCLUDED? N I A pNandaeory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLimrr I s 500,000 CESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is regrf red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jeff Sollaws ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 802 480 Rte 6A Suite 2 AUTHORIZED REPRESENTATIVE East Sandwich, MA 02537 Robyn McCarthy O 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: (508) 833-8911 E-Mail: r �✓6 � 0 L Y,4 DIVES:Cti _ a r i W .- _;.• a:. .it -. 3EtGUD.getY.IShL.._. ----=-1--.... � - 1 ��-b��.. :•', � .. .. 'i : iY" •r SMOKE; J9,rECTOI� FtE IEWED BARNSTABLE BUILDING DEPT. DATE _I FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING • � gyp.p' Y- a; _ .I- �MNlIY�lN►� Y fAYIG�t - d pi ' o p 1 ANEW 'eta . . . --- • . - •� . =-t_..._._ ! j L ir\j • , er�i q•ro�•rt_T.r, t • � .tW� Y Tom} },,,_ "°� '} • w t 1 r � Y ` • 1 [1 0' r 1 •� 61 i 1 I i TOWN;OF ARNSTABLE - BUILDINq PERMIT PARCEL ID 110 045 GEOBASE ID 37057 ADDRESS 23 PARRISH WAY PHONE W BARNSTABLE ZIP - LOT 22 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT ' 41888 DESCRIPTION SINGLE FAMILY DWELLING (PERMIT 036335) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY. CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Ox CONSTRUCTION COSTS $.00 4y�' �T 753 MISC. NOT .CODED ELSEWHERE 1 .PRIVATE PIi.* E f * BARNSI'ABLE. • MASS. i 339- FD Mp►l A BUILDING ITV O B DATE ISSUED 10/21/1999 EXPIRATION DATE 'TO-O,. - er- BARNSTABLE r BUILDING PERMIT PARCEL ID 110 045 GEOBASE ID 37057 ADDRESS 23 PARRISH WAY PHONE W BARNSTABLE ZIP - I LOT 22 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 36335 DESCRIPTION 2ST%HIP ROOF COLONIAL/2CAR/3BR/2BA(SEW#99-50 PERMIT TYPE BUILD - TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS: PHILIP J. NUC ES REMODELING Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $489.09 ptr BOND $.00 CONSTRUCTION COSTS $157,770.00 101 '`� SINGLE FAM HOME DETACHED 1 PRIVATE R 49 B--►RlvsrABLF, MA83. \ 1639. ` BUILDI 'SIO BY IATE ISSUED 02/08/1999 EXPIRATION DATE t, BUTLD1,;.C' 131 4 4 1 T I,A:ICE I, I) 110 045 GFOSASH 10 37 UI,7 ".3 "' 1114 iH :'1Y V B*,XSTA.31A YIP .'11' 22, �3LrJCiC WT SIL+ I�2IA DXVLf PML'NT DISTRICT '11i '1;R ;IT 3633t, DESCRIPTION 2.t,T/141P ROOM OF1:411T TYPE BUfIUD TITL:8 Nblvi RKuIDP: 4TIAL BLDC PM" CONTRAgTOR',-',: P411 L.I P J. N[Jr',N1.=: R1 MODS W ING Department of Health, Safety A RCH?TECTS): and Environmental Services i I.OTAL fteS: $489.02 1 CONSTRUCTION _COSTS $157 ,7,70.00 1.0] S T NCB LL YAM HONE DFTAC I-1120 1 PRIVATE P *i ,grABUF. *' j MA83. �► I 1639. �0 Ep�Cl A BUILDI . 9I�. BY I I►W V. I r,33URD 09./08/1999 iek?t RAT i ON DA' I i THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUI DING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �2cuil2 02 9G G� 1 �OJ�I 61 Ow 2 j 2 r 2 c: 1 HEATING INSPECTION APPROVALS INTERING EPARTME T 2 P BOAR&OF HEALT if OTHER: SITE PLAN REVIEW APPROVAL W R SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS UTH SPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY RIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. I � a f. L r, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 1) Permit# >4Kealth Division l 69_ _�f_ /U/r Date Is ued +_'C" onservation Division Fee q s 9 , 0 7 �ax Collector �Gay..2 SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE /Tr surer �. WITH TITLE 5 ENVIRONMENTAL CODE AND Planning Dept. ��U �REG� Aj vNS 64 Date Definitive Plan Approved by Planning Board storic-OKH Preservation/Hyannis Project Street Address �A+��t S i�r.J+�U (AJ. 13 Ig t_N S-f A- 6 LG Village �� LC-_ _ Owner �-7'� N/ F02— /Y U G—/l/L� �L / Addre SO 51�l�T�lq,�— %Zr�i K ; Telephone 60 7 7/ e, 582 t/.A//S Permit Request _51 N 1-,1_c= F�.t, _v Square feet: 1 st floor: existing_ proposed 2nd floor: existing propose Total new Estimated Project Cost _ `SZ&ng District F Flood Plain Groundwater Overlay Construction Type Lot Size 33, 08 3 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. I Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: O Yes ❑No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) N't4 Basement Unfinished Area(sq.ft) 16793 Number of Baths: Full:existing new Half: existing new I Number of Bedrooms: existing new 3 - Total Room Count(not including baths): existing new First Floor Room Count 4 Heat Type and Fuel: b�Qas ❑Oil ❑ Electric ❑Other Central Air: PYes ❑No Fireplaces: Existing New 6-A-1_-.,, Existing wood/coal stove: ❑Yes AN Detached garage:O existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing 9 iew size3Ox'U Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes XNo If yes,site plan review# r Current Use Proposed Use BUILDER INFORMATION Name 21i 1 L—I R 1 10 6—N Es Telephone Number r�0 9 '7 _75 75 71 Address�00 PH( N c-�y S License# G S 00 5 6 5 - ('�O,►'l-fo oryl Ile i HA Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 71 DATE / oZ5J 1 FOR OFFICIAL USE ONLY S / PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE Ta OWNER- DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE c ELECTRICAL: ROUGH FINAL PLUMBING: ROUG ..,, FINAL GAS: ROUGH X FINAL FINAL BUILDING =a DATE CLOSED OUT a ASSOCIATION-PLAN NO. S 69 S�•o�q lgs ool �o 4) LOT 22 44 S' 33,063 sq.ft. O � N O (v o� 0 N ' N SA Al#50" 99.35! 4S,S. 2 N vZ�J R 55.00� L 47.00 PARISH 266.E 9' WAY GRAPHIC SCALE 80 0 30 60 120 240 ( IN FEET ) 1 inch = 80 it. I CERTIFY THAT THE STRUCTURES ARE SHOWN ON THE PLAN AS THEY EXIST ON THE GROUND DATE PROFESSIONAL L ND SU PLOT PLAN �� RFGISIERf� �Cy STEPHEN �+ a J. � PEPARED FOR: M. NUGNES " DOYLE LOCATON: LOT 22, PARISH WAY No. 37559P P�' DATE: MARCH 9, 1999 Ess' o� SCALE: 1" = 60' lq�p Sole FLOOD PLAIN—DATA: LOCUS DOES NOT LIE IN A FLOOD HAZARD ZONE — ZONE PREPARED BY: STEPHEN J. DOYLE AND ASSOCIATES 42 CANTERBURY LANE, EAST FALMOUTH, MA. TELEPHONE: 508/540—2534 - .ems- . _ IRgtaLt! . . .1NQt'.tiMaq]1tL(ala —=—r 77 • I A:�:OA.mri• �1.7`as»tral•- '�• :I'. 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CENRAL CONSTRUCTWN NOTES nc.w ry vcrz:w e:c.'ern..ov.ar.•..ry .. r.Lla•omwvr•alp wr(mµg WML tolrow ro o.r.v.Ira a rllt tueswAa Or90'.4 PSrra/e • .. pr .. }..r une OR.�1�IMr OKII T—Y u NWL ft.KIISSrOa[' ��lw}— .c vs a a2Y o•a ���:•I.� . y na.a,r wa P rws�auor ter r.Kr ..mcos.rlOiTa AOIIXt Nornrr ra[fK trOKS P rpryr Q.nr. :.{1 LCn a•. 1 41 em-mr P OR SarafAal S,SR/r OWl H t,IV.aI[P Ei-„I. . • rr:uroale r IOAoarC ugia M,AR urP]a m,aAw>D _.�Sa-r-- - ��.�I' —�--- `',,�, S II'E:' PLAN O F LAND . P tta,as m o+awn t.•»aaoan wAu a rnm loorw m'rm. �•a.v_ o aY.P nwKsavere wcas roan. roacw_sAt..�.,' •� ,el.r :a__- WEST 'HARNSTAH L£. MA . a ns txc.rrm/ec.In.cln suaL Kan a aauoa,P Au •u u . NIL UR VU oaal t*A-VXAMaoc, uu�tram_ - .w•_,c.:. ...lam- _• cou"O m Idrrom wct soot,aL r»>mtac ao rLc IAe AT am ao>ti.. :._—t= •-� _ / Fi�•, W LT r-1N ES RE S I D E N C E • a.Ir,.,\Psr lean uae W abn cow"lo U Aoc raTwco r aua. -_ ]elr u wow nW.o•.amr IL rase ' 1 Mgr W:IfIL 9a1{l'NAK A YrrJY anr[P GW RLT rP rOnf. . ..•.MO at(yyWp1(.p�t•4'1.waY6 drwraaRM1 at6L L - - Table J31 I (eonrianed) . prescriptive Packages for One and Twe•Famitlr Reddmtlal Botidlnp Seaoed with Fond Fuels , MAXIMUM MINIMUM Gtaziag Ghzing Wing Wall flow Baste Slab HeatinWCooling Am'(%) U-value= R valuer R valuo'- Rrvaluej Wall Fbim= Eqwpm= Efd=yl IpAdcage R.Vwuo !-valuer I t H Dayi? Q 12% 0.40 38 13 19 10 6 Normal R 12% 032 10 6 Normal S 121A 030 3E 13 19 10 6 iS AFUE T I P A 0.36 3E 13 2S WA WA Normal U 13% 0.46 3E 19 19 10 6 Normal V 13% 0." 38 13 23 WA WA iS AFUE W 15% 0.32 30 19 19 10 6 SS AFUE x 18% 0.32 38 13 25 WA WA Norma! Y 19% 0.42 39 19 25 WA WA Normal Z 190% 0.42 38 13, 19 , 10 6 90 AFUE AA IE'/. OSO 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 'Z 3 P—(Z l S H /j l�_" STIR 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 2 CO 3. SQUARE FOOTAGE OF ALL GLAZING: 3(G 4. %GLAZING AREA(#3 DIVIDED BY#2): Z O/0 S. SELECT PACKAGE(Q—AA-see chart above): 4" NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-Corms-080303a 7R6 Footnotes to Table J5.11b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer iII accdrdance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R 19'requirement could be met EITHER by R 19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. . `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with ,the other glazing. Basement doors must meet the door U-value requirement described in Note b: 'The R-value requirements-are for unheated slabs.Add an additional R-2 for heated slabs. 'If the building utilizes electric itsistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.Ia ROTES: a)Glazing areas and U-values are•maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do norinclude structural components. b)Opaque doors in the building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 035). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or mom areas with different insulation levels, the component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). 43 gi ne commonweaun oj massachuseas ' Department of Industrial Accidents � ofl/ceol/�es�/pat/oas ; - ! 600 Washington Street - Boston,Mass. 02111 r Workers' Co m ensation Insurance Affidavit name: .ICE E i i iP I�I ��G—d`(L 5 ,�? / Z—/y location 2 YAe=2 i S P4 :f 1 9A y city phone# -7-7:s ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no'one working in act 00:1 ❑ I am as employer providing workers'compensation for my employees working on this job. - ::>::>:::::: i� Q... '.a..................;.. phase i!. ....... :.}........... nsa a is cif ' > <>>'?>'•.`':' '':<»>' >< i<< '<? > >'>? 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J...r{O}L:a:{n......•::•.iQ............. :;.:avvv.v::::.... !n:}:{.}}}:{.:{;.5}:•}}ii:a;{•i}:::;•;::::•i}}}i}J:a:!•iiii}:{;??::::::::5•:si;w:::n:v...:.....:::;:n•.::.......... ::::::::::::::::.:.. >.L::}.. .. .. .:.J:.v;}..-v..... ....:. nmran Pailme to 5,eeare coverage as required under Section 2SA of MGL 152 can lead to the imposition of csfmtnd pem Su itiea of a e up to 514500.00 as Uor one years'tmprisomaeat as wen as dva penalties in the form of a STOP WORK ORDER and a line of 3100.00 a day n=aind ne. I undcmtmd chat a copy of this statement may be forwarded to the Ounce of Investigations of the DIA for coverage veriftad . I do hereby certify the pants p t of perJury that the information provided above it tnu,and coned signature Date �/�/U Plintname � Phame#S'G�'—'17 9973 offidai nap only do not write in this arc to be completed by city or town official city or town: p�i�se# ���g Deparhent OLicensing Board ❑chedcif immediate response Is required ❑Sdeednea's OIDee (]Health Deparhnent contact person: phone#; ��QOther @oviNd 9/95 PW t _ _ , 7 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any come= 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 receive- trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe 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. r., r/� City or Towns 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 permit4kense number which will be used as a reference number. The affidavits may be ict<uned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Imresugadons 600 Washington street Boston'Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 eat 406, 409 or 375