HomeMy WebLinkAbout0378 PLUM STREET 3'7 g -Plu44^ S4-6
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UPC 12543 v
HASTINGS. MN
Town of Barnstable Building
Post This Card SoJhat it is Visible From the Street=Approved Plans Must be Retained on Job and this Card Must be Kept
BARNWASM
MAS& Posted.Until'Final Inspection Has Been Made. Permit1639.
e Where a Certificate of.Occupancy is Required,such Building'shall Not be Occupied until a`Final Inspection has been made.
Permit No. B-19-272 Applicant Name: TIMOTHY P JOHNSON Approvals
Date Issued: 01/29/2019 Current Use: Structure
j permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/29/2019 Foundation:
Location: 378 PLUM STREET,WEST BARNSTABLE Map/Lot: 196 015 _ Zoning District: RF Sheathing:
Owner on Record: JOHNSON;TIMOTHY P Contractor Name:`,,,TIMOTHY P JOHNSON Framing: 1
Address: 378 PLUM STREET Contractor License: CS-101696 2
WEST BARNSTABLE, MA 02668 ' `�� Est. Project Cost: $30,000.00 Chimney:
Description: BUILD A 14X20 KITCHEN ADDITION WITH FULL BASE MENT;ATTACH �i Permit Fee: $203.00
i Insulation:
&6X20 DECK TO LENGTH OF ADDITION.
Fee Paid:.! $203.00
Project Review Req: project must comply with 2015 IECC and AWC Deck Date: �f 1/29/2019 Final:
construction manual � �`
Plumbing/Gas
. Rough Plumbing:
Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after`issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas:
work until the completion of the same. t
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection-� Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior-to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection)
Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
_ Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
1 ,
®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Roof Header1RB02
Dry 1 span No cantilevers 1 0/12 slope October 3,2018 10:36:11
BC CALC®Design Report
Build 6536 File Name: T Johnson—Plum St
Job Name: Johnson Description:Window Header
Address: Plum St Specifier: jlm
City, State,Zip:West Barnstable, MA Designer:
Customer: Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
Connection Diagram Disclosure
i b I r.—d Completeness and accuracy of input must
be verified by anyone who would rely on
a output as evidence of suitability for
• • • particular application.Output here based
on building code-accepted design
properties and analysis methods.
• �—• • Installation of Boise Cascade engineered
wood products must be in accordance with
e current Installation Guide and applicable
building codes.To obtain Installation Guide
or ask questions,please call
a minimum=2" c=3-1/4" (800)232-0788 before installation.
b minimum=4" d=24"
e minimum= 1" BC CALC®,BC FRAMER®,AJST
ALLJOISTO,BC RIM BOARD-,BCI®,
Connection design assumes point load is top-loaded. For connection design of side-loaded BOISE GLULAM^" SIMPLE FRAMING
point loads, please consult a technical representative or professional of Record. SYSTEM®,VERSA-LAM®,VERSA-RIM
PLUS®,VERSA-RIM®,
All FastenMaster screws may be installed from one side of multiply Versa-Lam beams. VERSA-STRAND®,VERSA-STUD@ are
Member has no side loads. trademarks of Boise Cascade wood
Connectors are: FMTSL338 Products L.L.C.
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KITCHEN TOWN OFBABNSIAOLL
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Low-E Argon Gas Filled
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(2) 29.5"x 31"
(3) 2S,5" x 49"
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(1) 36"x 80"
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Application Number... ... .. .. ... ..........
BAFINSTA
* MASS. ,E,� Permit Fee........... •.1.......... ..Other Fee..... .....i„r.......
039.
RFD Irw' Total Fee Paid......................... ��.,/.. . ........ ......
e-
TOWN OF BARNSTABLE Permit Approval by..&k.�).................On. .� .J.—.1. .
BUILDING PERMIT Map....... .1.q ................Parcel................ ...4` . .............
APPLICATION
Section 1 — Owner's Information and Project Location
' I !
Project Address o \UN1 Village
Owners Name
Owners Legal Address 3 S
City . State M� Zip CO CO 0
Owners Cell# Ll 43�i/ CJM E-mail
Section 2 —Use of Structure
Use Group BUILDINGPF mmercial Structure over 35,000 cubic feet
JAN 24 9 Commercial Structure under 35,000 cubic feet
TOWN C)F P-AB.�,vrSinglef /Two Family Dwelling
Section 3 — Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) ` ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm
[ebuild El Deck Apartment El Sprinkler System
Addition ❑ Retaining wall ❑ . Solar
1
❑ Renovation ❑ , Pool ❑ Insulation
,r Other—Specify
Section 4 - Work Description
-¢ Last updated. 11/15/2018
i
Application Number.....................................................
Section 5—Detail
Cost of Proposed Construction ' Square Footage of Project DO'
Age,of Structure l 4S 1 Dig Safe Number INV
., i ,
#Of Bedrooms Existing L'` Total# Of Bedrooms (proposed) SciAm
110 MPH Wind Zone Compliance Method b/MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
Ed/Wiring ❑ Oil Tank Storage Smoke Detectors
❑'Plumbing �as ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
i
Water Supply ❑ Public Private
P
Sewage Dis osal ❑ Munici al 701d
ite
P
Historic District ❑ Hyannis Historic District Kings Highway
Debris Disposal Facility: k13-A0l 17 '1 I am using a crane ❑ Yes IJINo
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ElNo L
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this properly had relief from the Zoning Board in the past? ❑ Yes No
Last updated: 11/152018
®Boise cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Roof Header1RB02
Dry 1 span I No cantilevers 1 0/12 slope October 3,2018 10:36:11
BC CALL®Design Report
Build 6536 File Name: T Johnson—Plum St
Job Name: Johnson Description:Window Header
Address: Plum St Specifier: jlm
City, State,Zip:West Barnstable, MA Designer:
Customer: " Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
'_�o
12
i l � j l i l l l i i i l i i i i ► i l i i l l ' l r i l i l l l l l l i i
0SOCr00
BO B1
Total Horizontal Product Length=05-06-00
Reaction Summary(Down/Uplift) (Ibs)
Bearing Live Dead Snow Wind Roof Live
BO, 3-1/2" 722/0 1,249/0
B1, 3-1/2" 605/0 1,043/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 Standard Load Unf.Area(lb/ft^2) L 00-00-00 05-06-00 15 30 01-04-00
2 Reaction from Desi... Conc. Pt. (Ibs) L 02-06-00 02-06-00 1,176 2,072 n/a
Controls Summary Value %Allowable Duration Case Location
Pos. Moment 4,264 ft-Ibs 44.3% 115% 4 02-06-00
End Shear 1,910 Ibs 34.4% 115% 4 00-10-12
Total Load Defl. U999(0.071") n/a n/a 4 02-08-04
Live Load Defl. U999(0.045") n/a n/a 5 02-08-04
Max Defl. 0.071" n/a n/a 4 02-08-04
Span/Depth 8.3 n/a n/a 0 00-00-00
%Allow %Allow
Bearing Supports Dim.(L x W) Value Support Member Material
BO Post 3-1/2"x 3-1/2" 1,970 Ibs n/a 21.4% Unspecified
B1 Post 3-1/2"x 3-1/2" 1,648 Ibs n/a 17.9% Unspecified
Cautions
For roof members with slope(1/4)/12 or less final design must ensure that ponding instability
will not occur.
For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow
surcharge load.
Notes
Design meets Code minimum(L/180)Total load deflection criteria.
Design meets Code minimum(U240)Live load deflection criteria.
Design meets arbitrary(1")Maximum Total load deflection criteria.
Calculations assume member is fully braced.
BC CALC®analysis is based on IBC 2009.
Design based on Dry Service Condition.
Fastener Manufacturer:FastenMaster(tm)
Page 1 of 2
i
®Boise Cascade Double 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP Roof Beam1111301
Dry 11 span I No cantilevers 1 0/12 slope October 3,2018 10:36:11
BC CALC®Design Report
Build 6536 File Name: T Johnson—Plum St
Job Name: Johnson Description: Ridge
Address: Plum St Specifier: jlm
City, State,Zip:West Barnstable, MA Designer:
Customer: Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
Connection Diagram Disclosure
b -. I► d—.{ Completeness and accuracy of input must
f I I I I be verified by anyone who would rely on
a I output as evidence of suitability for
• . particular application.Output here based
on building code-accepted design
properties and analysis methods.
• • • Installation of Boise Cascade engineered
wood products must be in accordance with
current Installation Guide and applicable
building codes.To obtain Installation Guide
or ask questions,please call
a minimum=2" C= 10" (800)232-0788 before installation.
b minimum=4" d=24"
e minimum= 1" BC CALC®,BC FRAMER®,AJSTm
ALLJOISTO,BC RIM BOARD-,BCI®,
All FastenMaster screws may be installed from one side of multiply Versa-Lam beams. BOISE GLULAMTM SIMPLE FRAMING
Member has no side loads. SYSTEM®,VERSA-LAM®,VERSA-RIM
Connectors are: FMTSL338 PLUS®,VERSA-RIM®,
VERSA-STRANDS,VERSA-STUD®are
trademarks of Boise Cascade Wood
Products L.L.C.
®Boise Cascade Double 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP Roof Beam\RB01
Dry 11 span I No cantilevers 1 0/12 slope October 3,2018 10:36:11
BC CALC®Design Report
Build 6536 File Name: T Johnson—Plum St
Job Name: Johnson Description: Ridge
Address: Plum St Specifier: jlm
City, State,Zip:West Bamstable, MA Designer:
Customer: Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
�o
12
1&OS-12
BO 1311
Total Horizontal Product Length=19-08-12
Reaction Summary(Down/Uplift) (lbs)
Bearing Live Dead Snow Wind Roof Live
BO, 3-1/2" 1,176/0 2,072/0
B1,3-1/2" 1,176/0 2,072/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 Standard Load Unf.Area(lb/ft^2) L 00-00-00 19-08-12 15 30 07-00-00
Controls Summary Value %Allowable Duration Case Location
Pos. Moment 15,281 ft-Ibs 45.8% 115% 4 09-10-06
End Shear 2,767 Ibs 25.8% 115% 4 01-05-08
Total Load Defl. U362(0.638") 49.7% n/a 4 09-10-06
Live Load Defl. U568(0.407") 42.3% n/a 5 09-10-06
Max Defl. 0.638" 63.8% n/a 4 09-10-06
Span/Depth 16.5 n/a n/a 0 00-00-00
%Allow %Allow
Bearing Supports Dim.(L x W) Value Support Member Material
BO Post 3-1/2"x 3-1/2". 3,247 Ibs n/a 35.3% Unspecified
B1 Post 3-1/2"x 3-1/2" 3,247 Ibs n/a 35.3% Unspecified
Cautions
For roof members with slope(1/4)/12 or less final design must ensure that ponding instability
will not occur.
For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow
surcharge load.
Notes
Design meets Code minimum(L/180)Total load deflection criteria.
Design meets Code minimum(L/240)Live load deflection criteria.
Design meets arbitrary(1")Maximum Total load deflection criteria.
Calculations assume member is fully braced.
BC CALC®analysis is based on IBC 2009...
Design based on Dry Service Condition.
Fastener Manufacturer:FastenMaster(tm)
Page 1 of 2
®Boise Cascade Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1171301
Dry 1 span I No cantilevers 1 0/12 slope October 3,2018 10:35:59
BC CALC@ Design Report
Build 6536 File Name: T Johnson Plum St
Job Name: Johnson Description: Existign Wall Header
Address: Plum St Specifier: jlm
City, State,Zip:West Barnstable, MA Designer:
Customer: Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
Connection Diagram Disclosure
b �- —d—•-J, Completeness and accuracy of input must
f I I I be verified by anyone who would rely on
a I output as evidence of suitability for
• • • particular application.Output here based
IF- on building code-accepted design
properties and analysis methods.
• • • Installation of Boise Cascade engineered
wood products must be in accordance with
-� a current Installation Guide and applicable
building codes.To obtain Installation Guide
or ask questions,please call
a minimum=2" c=7-7/8" (800)232-0788 before installation.
b minimum=4" d=24"
e minimum= 1" BC CALC®,BC FRAMER@,AJST"'
ALLJOISTO,BC RIM BOARD-,BCI@,
Connection design assumes point load is top-loaded. For connection design of side-loaded BOISE GLULAM'*' SIMPLE FRAMING
point loads, please consult a technical representative or professional of Record. SYSTEM®,VERSA-LAM@,VERSA-RIM
PLUS@,VERSA-RIM@,
All FastenMaster screws may be installed from one side of multiply Versa-Lam beams. VERSA-STRAND@,VERSA-STUD@ are
Member has no side loads. trademarks of Boise Cascade Wood
Connectors are: FMTSL005 Products L.L.C.
®Boisecascaee Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301
Dry 11 span I No cantilevers 1 0/12 slope October 3,2018 10:35:59
BC CALC®Design Report
Build 6536 File Name: T Johnson—Plum St
Job Name: Johnson Description: Existign Wall Header
Address: Plum St Specifier: jlm
City,State, Zip:West Barnstable, MA Designer:
Customer: Tim Johnson Company: Shepley Wood Products
Code reports: ESR-1040 Misc:
3
2 i
l l l t l l i ! l i l i ! i i i i l J 1 l l i l i i i i l i l 1 1 1 1 1
BO 14-00-00 81
Total Horizontal Product Length=14-00-00
Reaction Summary(Down/Uplift) (lbs
Bearing Live Dead Snow Wind Roof Live
BO, 3-1/2" 1,960/0 2,595/0 3,818/0
B1, 3-1/2" 1,960/0 2,596/0 3,818/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 Standard Load Unf.Area(lb/ft^2) L 00-00-00 14-00-00 40 10 07-00-00
2 Unf.Area(lb/ft^2) L 00-00-00 14-00-00 15 30 13-03-00
3 Reaction from Desi... Conc. Pt. (Ibs) L 07-00-00 07-00-00 1,176 2,072 n/a
Controls Summary Value %Allowable Duration Case Location
Pos. Moment 27,463 ft-Ibs 74.8% 115% 3 07-00-00
End Shear 5,911 Ibs 43.4% 115% 3 01-03-06
Total Load Defl. U282(0.577") 85.2% n/a 3 07-00-00
Live Load Defl. U455(0.357") 79.1% n/a 6 07-00-00
Max Defl. 0.577" 57.7% n/a 3 07-00-00
Span/Depth 13.7 n/a n/a 0 00-00-00
%Allow %Allow
Bearing Supports Dim.(L x A0 Value Support Member Material
BO Post 3-1/2"x 3-1/2" 6,929 Ibs n/a 75.4% Unspecified
B1 Post 3-1/2"x 3-1/2" 6,929 Ibs n/a 75.4% Unspecified
Cautions
Member is not fully supported at post BO. A connector is required at this bearing.
Member is not fully supported at post B1. A connector is required at this bearing.
Notes
Design meets Code minimum(U240)Total load deflection criteria.
Design meets Code minimum(U360)Live load deflection criteria.
Design meets arbitrary(1")Maximum Total load deflection criteria.
Calculations assume member is fully braced.
BC CALC®analysis is based on IBC 2009..
Design based on Dry Service Condition.
Fastener Manufacturer:FastenMaster(tm)
Page 1 of 2
AC 0" JOHN-10
OP In-
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO18
N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDOERO HIS
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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsemen s.
PRODUCER 508-775-6060 CA - Bryden&Sullivan Insurance
Bryden&Sullivan Ins Agency
88 Falmouth Road PHONE 508-775-6060 FAx
H ac N Ext: 508-790-1414
Hyannis,MA 02601 E a Arc No
Bryden&Sullivan Insurance
INSURERS ORDI G COVERAGE NAIC#
INsuRERA:NGM Insurance Company 14788
INSURED Johnson Home Building,LLC Citation 378 Plum St INSURER B: 40274
West Barnstable,MA 02668 INSURER c:Associated Employers Insurance
INSURER D:
INSURER E:
INSURER F:
C CERTIFICATE
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,
rINSRADDL SUB
PE OF INSURANCEAM POLICY NUMBER POLICY EFF POCIAL GENERAL LIABILITY LIMITS
MS•MADE �OCCUR EACH OCCURRENCE 2,000,000
FR.
MPT7064K 11/10/2018 11/10/2019 DAMAGE TO RENTED 600,000
ss Owners
MED EXP An one rson 10,ERSONAL&ADVINJURY $ 2,000,000
ATE LIMIT APPLIES PER: 4,000,000
EL LOC GENERAL AGGREGATE E
PRODUCTS-COMP/OP AGG $ 4,000,000
B AUTOMOBILE LIABILITY $
COMBINED SINGLE LIMIT 1,000$ ,000
ANY AUTO BCLRYL
AUWTOS ONLY X SCHEDULED 04/26/2018 04/28/2019 BODILY INJURY(Per arson $
�RE� AUTOS
AUTOS ONLY q(1TOS ONLY B DILY INJURY Per accident
ftOPERTY AMAGE
Far accident
UMBRELLA LIAB OCCUR
EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $
DED RETENTION AGGREGATE
C WORKERS COMPENSATION PER p7H
AND EMPLOYERS'LIABILITY yy�/NN
OFFYICEWMEIMgE XCLUDEwD CUTIVE (� N/A CC-500-$0114$6'2016 11/02/2018 11/02/2019 100.000
(Mandatory In NH) u E.L EACH ACCIDENT
If es,d;rbe under E.L DISEASE-EA EMPLOYE $ 100,000
to 0 oP s low E.L,DISEASE-POLIC 600,000
M
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached Ifmore space Is required)
Contractor-Certificate issued for insurance verification
ccRTIFICATE HOLDER CANCELLATION
BARNS-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept
200 Main Street AUTHORIZED REPRESENTATIVjt: -,;.;+,;j j x ,!!, t CI f�x1n
Hyannis,MA 02601 Bryden&Sullivan Insurahce_I V.
P;
ACORD 25(2016103)
m 1988-201t'ACOhO_ iP itq 1Oq^All Yibhts reserved.
The ACORD name and logo are registered marks of ACORD -
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/OrganizationMdividual): � C"�� 7 ag�,�AQQ
�\���1� l�.0
ldAddress:
City/State/Zip: Phone#: � 7 L O
V`�C �4�
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with f 4. I am a general contractor and I
employees(full and/or part-time).' have hired the sub-contractors 6. New construction
2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. insurance comp.insurance.f Building addition
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.
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:_A <_f . 1 t
Policy#or Self-ins. Lic.#: W Cc S,-)Z--) 5()1 1 H .Xp -31 Expiration Date:
Job Site Address: �� L' M 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$1,500.0 nd/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 da against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of IA for insurance coverage verification.
I do hereby certi u der the pains and penalties of perjury that the information provid}e^^above is true and correct.
Signature: Date:
Phone#: �-� ' 1 9�5/ U b S y
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#:
AWC Guide to Wood Const &ion in High WindA rem 110 rrph Wind Zane
Massachusetts Checklist for Compliance(780CMR 5301.21.1)l
0 Check
Compliance
1.1 SCOPE
WindSpeed(3-sec. gust).....................................................................................................................110 mph 1
WindExposure Category.................................................................................................................................B
1.2 APPLICABILITY ✓
Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) Q stor' s <_2 stories
RoofPitch ...........................................................................(Fig 2) ........................................... / <<12:12
Mean Roof Height ...............................................................(Fig 2).................................................. ft <33'
BuildingWidth,W ................................................................(Fig 3).................................................I ft s 80'
Building Length, L ...............................................................(Fig 3)............................................... 0ZL ft s 80'
Building Aspect Ratio(L/W) ................................................(Fig 4)......................................./,? 1 s 3:1
Nominal Height of Tallest Opening2 ....................................(Fig 4)................................................ s 6'8"
1.3 FRAMING CONNECTIONS
General compliance with framing connections....................(Table 2).................................................................
2.1 FOUNDATION It
Foundation Walls meeting requirements of 780 CMR 5404.1
Concrete..............................................................................................................................
ConcreteMasonry ........................................:............................................................................................
2.2 ANCHORAGE TO FOUNDATION1.3
5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete onlyr~.
Bolt Spacing—general ..........................................(Table 4)................................................ in.
Bolt Spacing from end/joint of plate .............................(Fig 5)..................................... ' in.<6"—12"
Bolt Embedment—concrete.........................................(Fig 5)..................................................-`in.>7,.
Bolt Embedment—masonry.........................................(Fig 5)............................................min.>_15"
PlateWasher................................................................(Fig 5)...............................................>3"x 3"x 1/4„
3.1 FLOORS
Floor framing member spans checked ................................(per 780 CMR Chapter 55)....................................
Maximum Floor Opening Dimension....................................(Fig 6)...................................................e ft<—12'
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6).......................................
Maximum Floor Joist Setbacks
Supporting Loadbearing Walls or Shearwall.................(Fig 7).................................................... 22ft _<d
Maximum Cantilevered Floor Joists
Supporting Loadbearing Walls or Shearwall.................(Fig 8).................................................... ft <_d
Floor Bracing at Endwalls............................... (Fig 9)....................................................................
Floor Sheathing Type .........................................................(per 780 CMR Chapter 55)....................................
Floor Sheathing Thickness..................................................(per 780 CMR Chapter 55)..................... - in.
Floor Sheathing Fastening...................................................(Table 2)..._'?-d nails at Tin edge/C, in field
4.1 WALLS
Wall Height
Loadbearing walls.........................................................(Fig 10 and Table 5)............................ ft s 10' ✓
Non-Loadbearing walls.................................................(Fig 10 and Table 5)........................ ... ft <—20'
Wall Stud Spacing .........................................................(Fig 10 and Table 5).................... in.<_24"o.c.
Wall Story Offsets .........................................................(Figs 7&8)............................................ / ft s d
4.2 EXTERIOR WALLS3
Wood Studs
Loadbearing walls.........................................................(Table 5)...............................2x_V_-2 ft L-1 in.
Non-Loadbearing walls.......:.........................................(Table 5)...............................2x__!j-L-_ft 1 in.
Gable End Wall Bracing 1
Full Height Endwall Studs.............................................(Fig 10)..................................................................
WSP Attic Floor Length.................................................(Fig 11)..............................................,��4 j ft>_W/3
Gypsum Ceiling Length(if WSP not used)...................(Fig 11).............................................1"/ ft>_0.9W
and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11)..............................................................
or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joistor truss bays
Double Top Plate
Splice Length .........................................................(Fig 13 and Table 6)...................................... ft V
Splice Connection(no.of 16d common nails)..............(Table 6)........................................................... L� ✓
7
AWC Guide to Wood Constniction in High WindAreas 110 rWh Wind Zone
Massachusetts Checklist for Compliance(780CMR 5301.21.1)'
Loadbearing Wall Connections
Lateral(no.of 16d common nails)................................(Tables 7).......................................................
Non-Loadbearing Wall Connections
Lateral(no.of 16d common nails)................................(Table 8).........................................................
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans .........................................................(Table 9)................................... ft Jain.<_11'
Sill Plate Spans .........................................................(Table 9)..................................._ft_in.<_11'
Full Height Studs (no.of studs)....................................(Table 9)......................................................... f
Non-Load Bearing Wall Openings(record largest opening but check all openings for complce to Table 9)
Header Spans..............................................................(Table 9)................................... ft ° in.512'
Sill Plate Spans............................................................(Table 9)...................................__? ft in.512"
Full Height Studs(no. of studs)....................................(Table 9)....................................... .............
Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously'
Minimum Building Dimension,W ;
Nominal Height of Tallest Opening2 ............................................................................... 6'8"
Sheathing Type...............................................(note 4)......................................................
17n-
Edge Nail Spacing..........................................(fable 10 or note 4 if less)........................` in.
Field Nail Spacing..........................................(Table 10).................................................._&in.
Shear Connection(no. of 16d common nails)(Table 10)...................................................... _/o Percent Full-Height Sheathing.......................(Table 10).....................................................
0
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).....................
Maximum Building Dimension, L "I
Nominal Height of Tallest Openingz.........................................................................59 5 6'8"
Sheathing Type...............................................(note 4)...................................................... /
An-
Edge Nail Spacing..........................................(Table 11 or note 4 if less)......................... in.
Field Nail Spacing..........................................(Table 11).................................................. in.
Shear Connection(no.of 16d common nails)(Table 11)....................................................�
Percent Full-Height Sheathing.......................(fable 11)................................................... 5%
5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).....................
Wall Cladding /
Ratedfor Wind Speed?...............................................................................................................................
5.1 ROOFS /
Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) v
Roof Overhang ...................................................(Figure 19)..............�v ft 5 smaller of 2'or U3
Truss or Rafter Connections at Loadbearing Walls
Proprietary Connectors /
Uplift.................................................(Table 12).............................................U= plf ►�/
Lateral..............................................(Table 12)..............................................L=/ plf
Shear...............................................(Table 12).............................................S=7 plf
Ridge Strap Connections,if collar ties not used per page 21... (Table 13)................................T= IJ_ plf
Gable Rake Outlooker..........................................(Figure 20 —' ft 5 smaller of 2'or U2
Truss or Rafter Connections at Non-Loadbearing Walls
Proprietary Connectors
Uplift.................................................(Table 14).............................................U 117 lb.
Lateral(no.of 16d common nails)...(Table 14).......................................L MIb.
Roof Sheathing Type....................................................(per 780 CMR Chapters 58 an 59) ............
Roof Sheathing Thickness........................................................................................51L in.>_7/16"WSP
Roof Sheathing Fastening............................................(Table 2)...........................................................
Notes:
1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of
780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not
required per the WFCM 110 mph Guide:
a. Steel Straps per Figure 5
b. 20 Gage Straps per Figure 11
c. Uplift Straps per Figure 14
d. All Straps per Figure 17
e. Corner Stud Hold Downs per Figure 18a and Figure 18b
2 Exception: Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height sheathing
requirements shown in Tables 10 and 11.
3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade.
Application Number...........................................
Section 9- Construction Supervisor
Name S Telephone Number 17 nZ F
Address M SA- City U 47 ��5� State M< Zip nQ.(k
License Number 1014ACo License Type Expiration Date a3
Q
Contractors Email'-�' 'n� Cell# 77LY
U�
I understand my re o ibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massach a State Building Code. I understand the construction inspection procedures,specific inspections and
'A
documentation re by 780 CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date 1
Section 10—Home Improvement Contractor
Name � �� 7c J TelTZ
Number
Address 1� City State 1< Zip =( (Pt
Registration Number 119 Expiration Date �-;I/op/a,,
I understand my resp ibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massach State Building Code. I understand the construction inspection procedures,specific inspections and
documentation re d by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
T
1
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
Signature Date
Print Name M Telephone Number 77q o
E-mail permit to: <'�Sjs� ,`�; 11 , (o
Last updated: 11/152018
I
......... .... . ..
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department j❑ - LL '�.;
Conservation t
For commercial work,please take your plans directly to the fire department for approval,
Section 13 — Owner's Authorization
as Owner of the subject property hereby `
authorize J to act on my behalf, in all
ma relative to work a orized by this building permit plication fo'r:
37 � Cis
(Address of j ob)
L -
Signature of Owner dat
Print Name 1
I
r�
a
` Last updated: 11/15/2018
AP
P ROv E®
- k
fi
ACT Town of BarnshWay LEGEND
4 2 old Km9 s Hig \
Committee /� 98-- EXISTING CONTOUR h� RpOTF N
APN 196-014 r x 100.98 EXISTING SPOT GRADE 6q
G E,DEVELOPM NT '
�' �+ O EXISTING WELL
9 165.51
g ' + ,
�.' S�� I / TEST PIT o,
��'� ��'' + j BENCHMARK
CB/dh .1 1 / r Q7
C5 cPdO
m9 \ / i' S/ Church St
�` ` -Jam/ / ..4 % r N
LOCUS
LOCUS MAP
APN 196-024 WELL 98 � i NOT TO SCALE
rN
--------5�-------------- ---------------------- � �/
- GS
98a23 99.43 GENERAL NOTES:
+
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
1) LOCAL REGULATION: 150' SETBACK REQUIREMENT-WELL TO S.A.S.
Ben�hmork get - 98/67 � ---------------------------\ _ A 50' variance, private well (subject site) to proposed S.A.S.,
Oufsidcl cor. conc.��apron / 0 for a 100' setback.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
EL.=1 0.22 (Assu/ned) ; i l \\ ( O TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
O
DESIGN ENGINEER.
PORCH
7 / GARAGE 00 `�\ I I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
N EN6 VEER BE ORM THOSE �WCONSTR�CTIONACONTENUESORTED TO THE DESIGN
EXISTING / ; o
HOUSE(#378) \ ' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
• • • .. . / I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
l 100.2 100.1 � T.O.F.=102.09f•/ `�\ /r 0) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
O'ol'�'f' 99,23 �\ ,1 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
` �1 EXISTING OUTLET 109� 7. WATER SUPPLY PROVIDED BY PRIVATE WELL.
INV..=100.1t 01
�_ 9 .84 ` 1 -�I Q 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S.
eO9e of c(e 7.32 L +' \� `�D -�- ��- ° 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
• ,g,� F $*F P-2 �C -- -� / d4 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
\ C j j�l I �- j\ -1 99 7` 100,29 100.62 1 � 00.73 101,37 �F DIRECTED BY THE APPROVING AUTHORITIES.
�WQr 4 W \\ �\ Dc GRAVED L� \\ ��P��� MASS9C� 10 THE LOCATIIONIT SHALL BE THE OF ALLPONSIBILITY OF THE CONTRACTOR UNDERGRO ND UTILITIES, PRIOR TOO VERIFY
BEGINNING
I I .F \ --� DRIVEWAY" , o PETER T. Gr CONSTRUCTION.
97�Q9�- J 1 S r 100.52 t
i}-• �I 1 W o MCENTEE 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
M 11••10_I 1 Z
cp ��•� 99.6 100.19 o CIVIL IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
No. 35109
�-� � � + 9.5 -2 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
�\ e R61 o ff\ 99,4 LAMP Q�-_ �� ° /Pf6/STER�`� �C� 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
�• 27,500t f'S.F. N 'pOF IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
+ 98,80` . _ '-1 p0, q ` 101.28 AL
\\ _ 8.95 Mop , 96 � 13. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH
- _- EXISTING CESSPOOLS PERMIT FROM THE LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING
a O RECORD LOCATION-APPRZ9 Parcel i 15 �� Z12-(o I lU PERFORMED.
_ +98.15 <� 985 TO BE PUMPED, FILLED wl b 'o1 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
PROPOSED , SAND AND ABANDONED. ;
� ,SEPTIC TANK
N.
_ 1=00' 378 PLUM STREET, WEST BARNSTABLE, MA
22.46' - -
I n Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
� v CB/dh
o r' �� CB dh RIGHT.OF WAY �� (,
APN 1961 018 'C TO PLUM STREET OWNER OF RECORD Engineering by: SCALE DRAWN JOB. N0.
<v r 9 .74 APN 196�Q19 I EDWARD F. JOHNSON 1"=20' P.T.M. 108-10
4' \ 1378 PLUM STREET Engineering Works, Inc.
PLUMS EET 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
z Oo !WEST BARNS-TABLE, MA 02668 (508) 477-5313 2/26/10 P.T.M. 1 of 2
Commonwealth of Massachusetts
lugDivision of Professional Licensure
Board of Building Regulations and Standards
Const` Nbpj rvisor
.r
CS-101696 ,� G? E�pir es:08123/2020
TIMOTHY P JOHNSONN ,•
378 PLUM ST O
WEST BARNST/A$LE,MA,0266W5
1161
Commissioner v
12/1212018 Office of Consumer Affairs&Business Regulation-Mass.Gov
0-tt" Mass.gov
U' ff ice Of U" LA fz5ul ell#"
&I Pox 0
aly-ild
&..4
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R ul I ca%ti, 0 n ( BR;
HIC Registration Complaints
Registration 179608
Registrant Timothy P Johnson
Name TIMOTHY JOHNSON
Address 378 Plum St
City, State West Barnstable, MA 02668
Zip
Expiration 08/20/2020
Date
Complaints Details
https://services.oca.state.ma.us/hic/llcdetalls.aspx?txtSearchLN=179e08 1/2
I
"TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application.# 3 l
Health Division Date Issued k-17 AC ��
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board.
Historic - OKH _ Preservation / Hyannis
Project Street Address Jim
Village FG(,v14 �C
Owner V V Address
Telephone - 2
Permit Request (.
ug� IV L �01,etpaff h61,07
11
C �� 1�WA�J a I Af
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 2a0 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: 0 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: _` c
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes �No If yes, site plan review#
Current Use Proposed Use
zy �
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name (� Telephone Number 31 15-�(
Address ( License# U 0
V Yr Home Improvement Contractor# J ✓�
Email Worker's Compensation # W Mob
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT ILL BE TAKEN TO
SIGNATURE DATE IL
FOR OFFICIAL USE ONLY
APPLICATION # '
DATE ISSUED
r MAP/ PARCEL NO.
,ADDRESS VILLAGE
OWNER
r� DATE OF INSPECTION:
FOUNDATION t
FRAME
INSULATION '
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS- ROUGH FINAL
FINAL BUILDING
k
I, DATE CLOSED OUT
'I' ASSOCIATION PLAN NO.
--- R i Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: 08•100968
Construction Supervisor. d ,
HENRY E CASSIDY.
8 SHED ROW n. I�r wdc
WEST YARMOU-TH
.lam— Expiration:
Commissioner 1111112017
r ' 1
I Office of Consumer Affairs and Business Regulation
10 Park Plaza . Suite 5170
Boston, Massachusetts 02116
h. Home Improvement Cb. t.raetor Registration
Registration: 1$3567
Type: Private Corporation
Expiration: 12/15/2016 Tr# 259188
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE
30. YARMOUTH, MA 02664
: ..-'Updata,Address and return card, Mark reason for chringe.
$CA 1 <'+ 20M..05. l [] Address Q Renewal Employment U Lost C91•cl
/co anc�rcaactuea.(G/c o�'O/G�uaJa.�ttJoGl'J
a •ornl c of.Consnmcr Arrnlrs& Duslnoss Regulnllon License or registrmlon vRIld for Indlvldul use only
OME IMPROVEMENT;°CONTRACTOR before the expirntlon dRte.Arfound return to:
eglstrallon; -.4.0507 Type: Cf(lce of Consumer Affairs Rnd Business Regulntlon
xplrallon: Private Corporation 10 PRrk PIRzR •Suite$170
CAPE COD wSULAtii'QN:;:INC'' `' Roston,MA 02116
HENRY CASSIDY
18 REARDON CIRCLE' .
$0. YARMOUTH,MA 02604 Undersecretary N valltl wl ut sign
i
I
I
The Commoriwerchlt OfM usrcchusetts
' ! Deprcrlm.enl oflnrlccstrtrclAcctrlents
1 Congress Street, Suite 100
Boston, MA 02114.2017
• fvww,May.goiv/rllrc VYw—kers' Compensation Insurance A"davlt; Builders/Contractors/BlectrlclnnsfFlum
To BE FILED WITH THE PERMITTING AUTHORITY, hers,
Ilcant Informs Ion
Name(Business/OrgenizatioNlndividual)' l Please Print Le ibty
Address.
City/State/Zip � 2�
Phone #: y
FA you n �ployer? eck the appropriate box;
am a employer with__1�L^employeos(full and/o(part-time).' Type of protect (required)
~
i
2.�I am a sole proprlelor or partnership and have no omployees working for mo in
any capacity.(No workers'comp, insurance required.) 7• Q New Remodeling
).�I am e homeowner doing all work m self. 8•"Q Remodeling
Y (No workers'comp, inswanco required.)r a �I am a homeowner and will be hiring contractors to conduct all work on m 9' CD Demolition
Iha1 all contractors either have workers'compensation insurance or arorsolo Y l will 10 Q Building addition
proprietors with no employoes.
�Q Electrical S.Q 1 am a general contractor and I have hired the sub 11 Eleical repairs or addition••.,
contractors listed on the attached sheet,
Theca sub•contreclorsthavo employees and have workers'comp, insurmco.i 12'Q Plumbing repairs or additiuw,-
13,Q Roof repairs
6 Q W
Oorporation and its officers hevo oxercisod their right of exempllon per MGL o,
15 and we have no employees (No workers'comp, insurance roquirod.j 14, Other '
'Any applicant That chockbox NI must also fill out the section below showing Iheir workers'compensellon
' Homeowne,s who submifihis aFfidavlt indicating they are doing all work and Then hire outsfdo contractor
lContraclors►hat check this box must attached an additional Sheol showing the name of Iha subcontract policy information. ' - -
-_ anployecs. If Uic subcontractors have employoes,they must provide their workers'comp.policy number s must submit a now effldavit indicoting such.
ant nn employer!list!s pro vlrllirg workers'corm ensa ors end state whether or not Ihoso entities liavc
• .• inforrnatlon, p tton Insurance for rrry e/nployees, B
elow/s t/re policy arrr(/vb sc�A
• . Insurance Company Name• f, �_-
Policy a or Self-ins, Lic. N:
Job Site Add d 1 o h Bxpiration Date: � /
less: L�j,,..!
Attach a copy of the workers' compr.nsntlon policy declaration page (showing f4k�
6allure to secure coverage as required under MOL c. 15e §25A is a criminal violation th
and/or one-year imprisonment, as�vCll as civil penalties i g the policy number.and expiration dntci.
day agatrisl the violator. A copy d'f,tdII statement al n the form of a STOP WO punishable by a fine up to 31,500 00
_ coverage verification. Y be forwarded to the Office of IInnvo tga ons of the DIA foR and a fine of up r ?Sfi Vii
l r(o 11e 6 Ce .' tnSurance
y rt(/y rr�rrler!lre parrs airrl peitnitler ojper/)cry Mal lire 11Vorrructlon provlrled
r bove is true and correct
lion !l. D Q
OfTclal use only, Do;/rot )vrlte ll1 Mls area, to be completed by city or(own o
j,/lcla4
City or Town: tl
Permit/License pfssuing Authority ( rI, Board of Henp 2Building Departroeat6, Other CI /Zo�va '�---- �I
Clerk 4, Electrical Inspector S- Plumbing Inspector it
Contact Person;
Phone p; ;�
i
CAPECOD-27 CLEDDUKE
ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE 7/1111/IDDIYYYY)
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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In Ileu of such endorsements,
PRODUCER NAMTA T Barbara DeLawrence
Rogers&Gray Insurance Agency,Inc. PHONE
434 Rte 134 Ale No):
South Dennis,MA 02880 ADDRESS:bdolawronce@rogersgray.com
INSURERS AFFORDING COVERAGE NAIC N
INSURER A:Peerless Insurance Company
INSURED INSURER B:Safety Insurance Company 39454
Cape Cod Insuletlon,Inc,. INSURER C:Endurance American Specialty Insurance Company 41718
18 Reardo..:Cl?cie INSURER 0:Atlantic Charter Insurance Comp an 44326
South Yarmouth,MA:02984..' INSURER E
INSURER F:
COVERAGES CF.'71FIC. )" MMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POL.P.ES OF;INSURANCE';LI.$TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTAN •DING ANY REQUIKEMENT,":*. Yl
CERTIFICATE MAY BE ISSUED OR MAY:;p812'TAIN, THF::�NSlli@AN,, AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUC.WP.OL•ICIES.LIMI7'S'SHOWN•MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE :: OLICY'NIJ BER MMIDDIYYYY MMIDD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE a OCCUR CBP8283,063 04/01/2016 04/01/2017 PREMISES Eeoccurrenee $ 100,000
MED EXP(Any one person) $ 51000
PERSONAL&ADV INJURY $ 11000,000
GEN'L AGGREGATE LIMp[..T,•'A.;PRGI 'PER: GENERAL AGGREGATE $ 2,000,000
X POLICY�:JCT OC
. PRODUCTS•COMP/OP AGO $ 2,000,000
OTHER:
$
AUTOMOBILE LIABILITY m " ' ' EeaBINED SINGLE LIMIT $ 1,000,000
B ANY AUTO • ; 8232T07 COM 01'' .' 0.4�01/2016 "041,0:112017 BODILY INJURY(Per person) $
ALLOWNED". SCHEDULED
AUTOS X .,AV.TNNOS BODILY INJURY(Per eccldenl) $
X HIRED AUTOS x. gIJIOSWNED $
Pere Ident
X UMBRELLALIAB X OCCUR•.; ;`:•', i• •9ACFIiO.000RRENCE $ 2,000,000
C. EXCESS LIAR CLAIMS:M`AOE EX6'1.0006636001 04101'2G16 04/0112Q1'7,-___ 8t3'ATE $
:. ..:
DED I X I RETENTION$ V,600 :: • ""'•
<Aggre6 9•.• $ 2,000,000
WORKERS COMPENSATIONVim-
:.
AND EMPLOYERS'LIABILITY YI•N: _• .' STATUTE' ER
D ANY PROPRIETORIPARTNER/EXECUTIVE WCEOp431'802 06/30/2016: '06130/2017 "8;:;;E'cHACCIDENT:;; $ 11000,000
OFFICERIMEMBER EXCLUDED? N I A
(Mandatory In NH) E.L.DISEASE•EA•6MpLO.E $ 1,000,000
II Yyes descAbe under
OESG�RIPTION OF OPERATIONS below E.L.DISEA,&,:p LICY LIMIT:: 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICL0 (ACORD 101,Additional Remarks 9chedule,.mey bo:at(a6.ffAd:1(°toots space Is required)
Workers Compensation Includes Officers or Proprietors. ..:::
Additional Insured status Is provided under the General Liability and Auto Li 1.4tylvVhen required by written contract or ag1`edMiRtsw6'the Certificate Holder,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
VaZ11.gr.Hfg$ UeRB J dyers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
94A Co rtferce Park SOLtt�h ACCORDANCE WITH THE POLICY PROVISIONS.
Sou hatham,MA 0266 `+,".,
AUTHORIZED REPRESENTATIVE
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
row
Parcel Detail Pagel of 3
F THE r017
ats
Ey
. . YtAFMS^.fAt71E. >
1
C1 -39
6 /
Logged In As: Parcel Detail Thursday,November 10 2016
Parcel Lookup
Parcel Info
Parcel ID 196-015 _ I Developer Lot U N N U M LOT
Location 1378 PLUM STREET Pri Frontage
Sec Road I Sec Frontage
Village West Bamstable I Fire District W BARNSTABLE
Town sewer exists at this address RO ) Road Index 11284
Asbuilt Septic Scan: _�. i
Interactive Map
196015_1 sz Y •Pff
Owner Info
owner co-
WIRTANEN, KAREN&JI owes %JOHNSON,TIMOTHY
streets 1378 PLUM STREET I Street2
clry WEST BARNSTABLE _I state MA (zip 102668 r�I country
Land Info
...................................._.._....._...................,....................._.....................__..._................................._............--...._......................................._.._._..._.._._..........................................................................................,............................................_....................................................._........................__............
..__..._..
Acres 0 MDL-01^ �I
.63 Use Single Fam Zoning RF _I Nghbd 0108 �I
Topography Level �I Road
utilities Septic,Well,All Public I Location
Construction Info
Building 1 of 1
Beni Mvecc ai 1951 s GableHip Wl Wood Shingle
LivingArea 1138 Roof As h/F GIs/Cm "C
Area - I Cover p p ( Type None
Style Cape Cod Bed
wall Prywall Rooms 4 Bedrooms
Model lResidential � ) Int Hardwood Bath 2 Full-0 Half
Floor Rooms
Grade Average ( ype Hot Water Total�_I Rooms 7 Rooms I
Found-
stories 1 Story Feel Oil ��� anon Conc. Block _._.
Gross 2832
Area
Permit History
Issue Date Purpose Permit# Amount Insp Date Comments
3/5/2009 New Roof 200900899 $3,950 STRP OLD
Visit History
Date Who Purpose
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=14190 11/10/2016
to Town of Barnstable
Regulatory Sereices .
Richard`V.Scab,Director
a6jA '♦�
Tom Perry,DuRding.Commissioner
200 Maia Street,.Hyamis,MA 02601
whh w.town.barnstablema.us
Office: 508-862-4038 Fax: 5Q8-790.-6230
'Property Owner Must
Complett:and'5.i n T'his Section.
Yf.Us n- AABuilder
x I, � `� 'as Ownet6fitlie.st6j&t property
hereby authorize_ k C,OD 0-S d L A-( kN to act on my behalf,
in all matters relative to work authorized by this binding permit application for.
' 7� t'lc 1a� S r b Pour rAv� U (�
(-,Achess'<ofj6b)-
"Foal fences and alarms are the respons bil Ly.of-the-apphcant. Po6lfi
ar aot.to be.filled or utilizedefore'fezt e is installeii anti all final
ections are perfotmed and.accepted.
X
Signature of Owner Signature of-Applicant
Print Name J Print Name
x
Date
QTORMS:O\VIQF.RPERMISSIONPOOTS
FIKE Town of Barnstable *Permit
o �
Expires 6 onths from iss date
-�BAmmtNsTABLE, Regulatory Services Fe
v nsass•i639• 0�aq mas F. Geiler,Director
a� p � � 9
'F0 N10'` /T ZQ v Building Division
w/V op q Tom Perry, Building Commissioner
RNSrgeC20 0 Main Street, Hyannis,MA 02601
Office: 508-862-4038 I-
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address
D Residential Value of Work /�6
Owner's Name&Address �c
Contractor's Name ,/ee.71 </U'/1I rc I^ Telephone Number 57�Gf ), 7 30
Home Improvement Contractor License#(if applicable) �6v�___2,F&
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance.
Che ne:
[�] aim a sole proprietor
❑ I am the Homeowner
❑ I have Worker's CompensationInsurance
Insurance Company Name
Workman's Comp.Policy#
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
Re-roof(not stripping. Going over / existing layers of roof) �C sf��� �f/`P /0"/?
El"Re-side RC C 7 1,2 1i� e
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: erty/0 er sign Property Owner Letter of Permission.
Signature ,
Q:Forms:expmtrg
Revised121901
The Commonwealth of Massachusetts
-- = _- Department of Industrial Accidents
_ = Office olloyestlgat/oos
_ 600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance davit
location: 3 3 30
phone#f�L
cC I am a homeowner performing all work myself.
gi I am a so rorietor and have no one worlan in capacity
/ G%%%/
%%
co ensation r
for my employees working oa this job.kers
ovidin wo mp
am an e � •.€r.
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enalttes of a tine to S1,500.00 aad/n
Faibu•e to secure coverage as required under Section 25A o[MGL 152 can lead to the i,R and
fine
of$100-p e.
one yes",imprisonment as well as civil penalties in the form of a STOP WORK ORDER atnd a Hoe o[S100.00 a day against ma I mtderstand Man
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify thep d penalties ofpenuy that the information provided above is tru<and correct
Date
Signature `v"-`'
Phone#
Print name
official use only do not write in this area to be completed by city or town official
peradt/liceme# ❑Building Department
city or town: ❑Liceawng Board
❑Selechnea's Office
❑check if immediate response is required ❑Health Department
j phone#; _ ❑Other
contact person:
0tvised 9/95 PIA)
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 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 section 25 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,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 �I
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
iL 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.
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 permrt/Ilcense number which will be used as a reference number. The affidavits maybe retarhR 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
0111ce of investlgatlons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
nhone#: (617) 727-4900 ext. 406, 409 or 375
T
troti Town of Barnstable
Regulatory Services
9EELA MAS& 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
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, ZEd CJ c-( c 1)�✓►J'O L.-\ , as Owner of the-subject property
hereby authorize �e r- �, J�� 0 So to act on my behalf,
in all matters relative to work authorized by this building permit application for:
.(Address of Job)
Signature of Ownee Date
Idwcx f-d F I m fcL,
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:OWNERPERMISSION
Town of Barnstable
�n'P�O4 SHE 4L
Regulatory Services
Thomas F. Geiler,Director
BAEt�STABr.E. .
ALAM
Building Division
rFD Tom Perry,Building Commissioner
_.__.... ..... ....-.---.........200 Mairi:Street;Hya�is;-MA 02601 _.-___......._.... ..... __ ..._.._.. .. .. _._.__.......... ..:
vt'ww.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
r
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAMING ADDRESS:
cityhown state zip 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.
DEFINMON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to-
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that be/she shall be
responsible for all such work performed under the building permit_ (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned."homeowner"certifies that-he/she understands the.Town of P.- .able,Bui. ..g.Dtpartment
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signatirt•e of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner perfomming work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Lccensmg of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemptirat 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 personm to this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a fomi/certification.for use in your community.
Q:forrris:homccxempt
�: � ;/pie -(panvnwouuP,al� a�.%�aoaac/u�oe� � •
Board of Building Regulations and Si.iiidards i License or registration valid for individul use only i
HOME IMPROVEMENT CONTRACTOR before the expiration date. -If found rturn to:
lug Board of.Building Regulations and St1ttdards
Registration: 102785 Oiie AsljUu'ton Place Rtrr 1301;
.,Ex ira•don_7/2/2010 Tr1E 270242 Boston,Ma'02108 .
k. <Type:—Individual
PETER EDWARG JOHNSON
Peter Johnson
7 PENELOPE LANE--, w __ No valid wtthok signature
COTUIT,MA 02635 Adiiunistrator
Board of Building Regule ans an ds y'I
1 Con§t_ruction Supervisor License
License: CS -62830
\ .
Expirato 8%/2009 Tr# 15827 t �W
PETER E JOHNS-
7 PENELOPE LN
I COTUIT, MA 02635 4 4 ------------
COrninlssjioner
. I
n
I
I r _ �. ^ . ,.. � ' i t >. � � r=* i � yam.• - '� • �
c.
Assessors map and lot number .... ........... .....................-...... c THE c
/
Sewage Permit number ....!�... �c:7��v................... ................ d
339HHST4DLE, �i
House number ......... .. . .x... ....,:. / ............ ....:............ 90
MABa
! i 039.a�0�
MP
TOWN . OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ................. .:........................................................
TYPE OF CONSTRUCTION .......:..... G Q. ..... � A r..........................................................................
I
................. /7..........19.97#
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to
the following information: t
Location ........ %i/. 47r ......i . ?'.................................
Proposed Use ........ f ��. , " i�e :^a l'"'.................................................................................................
..
Zoning District .............Fire District
Name of Owner l!`/ 1G(7_,r°� // tr���l,�...Address .:3.7: ... :�-�. ...... ...... .. .,
Name of Builder :�....a65.11 s Address 7 1./..:."..).. .....M a
......................................S ...Name of Architect ..................................................................Address ....................................................................................
Number of Rooms ..................................................................Foundation L�
.................. ..........................................................
Exterior . ' ...........f ''.� --^
Floors ..................................... .. f .�.:..............................Interior ....................................................................................
iHeating ..................................................................................Plumbing ..................................................................................
Fireplace .....................................................................Approximate Cost ........ ........!".•t1 .....................................
Definitive Plan Approved b Planning Board -__------_-__-__-___--- �'.>�................
pp Y 9 ------19-------. Area /..........,..............
Diagram of Lot and Building with Dimensions Fee / �'
SUBJECT O' APPROVAL OF BOARD OF HEALTH
M R 4 M��� ����� � ��s�e-ArWA
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ....
Construction Supervisor's License ....................................
JOHNSON, VELMA & E. F. A=196-015
No26087 Permit for BUILD..ADDITION....
........... ..................
Garage & Storage
...............................................................................
1-6cation .....3................78 Plum...............Street............................West Barnstable
...............................................................................
dwner ....Velma. E. F. Johnson
.......... ................................................
Of
Type of Construction ......Frame
....................................
................................................................................
Plot ............................ Lot ..............................
Permit Granted Xebz-.vATY'..,17.............19 84
Date of Inspection ...!................................19
Date Completed ......................................19 01
:/3' 3
Assessor's map and lot numb r ....�. ..!.....�. . . . . . ..... I CF THE t0
Sewage Permit number ....0. . .. . /. .... .: .... .. ........ ....
S HASd9TADLE. i
........, aa ...I.. rang
ouse number ..7.D.. ....���..... .. ...........:.... v
�p �639. \0�
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .............. ...&.-,ba.t........................................................
TYPE OF CONSTRUCTION ............ ..........................................................................
................. kiV..1..7............19.$�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ........ h .400...4.M..... ...... s..............
ProposedUse ......,.,S7"Q�►�.. ..... . . ......�AIRA.6,z.................................................................................................
t 2.
ZoningDistrict ................ ...... �...............................Fire District ..............................................................................
Name of Owner ✓IFA A':tt4- (; 40#A".00V...Address G44 �
Name of Builder s,.�J.� Ns44-I 0-k/4W- —/.F..Address ..3.7.5 / & J T .8
........M...................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ..................................................................Foundation ......... .�G�' .................................................
Exterior .........WOOD....SWIA.V..C44S..................Roofing ............A.84,41.d...................................................
FloorsQl ...C�1.F" ............................Interior ....................................................................................
Heating ..................................................................................Plumbing ........................��.........................................................
Fireplace ..................................................................................Approximate Cost ........�.f..Oaac.a..; ............................
Definitive Plan Approved by Planning Board ---------------_—-----------19_______. Area ..../a.r.X...............
..
Diagram of Lot and Building with Dimensions Fee 0`...........................................
SUBJECT ff APP OVAL OF BOARD OF HEALTH
M R+Ai Rs- �VRR Mrs 3 r/�7 1 rwo oil
OCCUPAN PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. ,
Name �c� �...`.. :!
Construction Supervisor's License ....................................
JOHNSON, VELMA & E. F.
No 26087 Permit for , BUILD ADDITION
..... xage..&..Storage...............
Location ..37.$..Pa,W..Street............................. `
............................... 'A
Owner _.F. Johnson
...............................
Type_ of Construction ........Fri.......................
Plot ..................... Lot ................................
Permit Granted .....February` 17, 19 84
Date of Inspection .....................................19
Date .Completed ...................19