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HomeMy WebLinkAbout0388 PLUM STREET y� IT luin e UPC 12543 No. 53LOR ►ASTINGS, MN e -,..,..,�.. .;. :� r--,. r .� �. �,- _.-...,;x �,r. -,�:4;a.;.^"^$►�.y+� {_.�t:s txrr+r.,� e•a..�.,, v_ - � ��:-t�rrs;,s�$yi�� ,,a;�,�.:,. ,�-.v�.�'!�'�^ - a"a Town of Barnstable , Building �.vsreus. Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept "AM Posted Until Final Inspection Has Been Made. Permit t63P �e 3 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1688 Applicant Name: JEFFREY STEELE Approvals Date Issued: 07/10/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/10/2021 Foundation: Location: 388 PLUM STREET,WEST BARNSTABLE Map/Lot: 196-018 Zoning District: RF Sheathing: Owner on Record: PALUCK, DAVID A SR&PAMELA M Contractor Name: L&P Boston Operating Inc Framing: 1 757 Contractor License: 194 2 Address: 388 PLUM STREET � WEST BARNSTABLE, MA 02668 Est. Project Cost: $ 1,395.00 Chimney: Description: INSTALL( 2) REPLACEMENT WINDOWS N�STRUCTURAL Permit Fee: $35.00 35 Insulation: .00 Project Review Req: GLAZING REPLACED IN HAZARDOUS LOCATIONS AS DEFINED Fee Paid: $ 10/2 IN 780 CMR MUST BE TEMPERED OR EC1UAL. Date: 7/ 0/2020 Final: Plumbing/Gas Rough Plumbing: Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after�ssuance. All work authorized by this permit shall conform to the approved application and the approved construction docum�nts 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 a�,d shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.The Minimum of Five Call Inspections Required for All Construction Work: 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 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: p� p Application numb 00 �q Date Issued.... .6) ............................t.. MAM 2639. `0�' ;, N ?0`3 Building Inspectors Initials... I OWN`J° 6AHNSTABLMap/parcel..............1....�.....�... TOWN OF BARNSTABLE � EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY FORMATION Address of Project: �)29 (I vM S� r-n S-4a to I Q_ -� NUMBS STREET VILLAGE Owner's Name: l� '� (IJa i v c.K Phone Number q kD Z 74 - �>'l 7 > Email Address: Cell Phone Number Project cost$ 3 7 3 I -' Check one Residential ✓ Commercial OWNEW S.AUTRORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: wee \44cf14 Ca �-� Date: TYPE OF WORK ❑ Siding U� Windows (no header change)# 8 ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CJWShe CONTRACTOWS INFORMATION r/ Contractor's name J,-�' �'Ieete — (,,k\&,J r (rQ �' '6oSfon Home Improvement Contractors Registration(if applicable)# L6 b O S (attach copy) Construction Supervisor's License# Oz 7 7 7 Z- (attach copy) Email of Contractor w ee , (.Car-► Phone number 7 '1 - ALL PROPERTIES THAT HAVE STRUCTURES OOER 75 YEARS OLD OR,IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Onl vx Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval xWOOD/COAL/PE LET STOVES ES Y Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOIEOWNEIVS LICENSE EXENTTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 Clot 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 LICL-11N1L9S3IcCNATURE _ Date /L-2- Signature —1 All perms a 'ons are subject to a building official's approval prior to issuance. • Window World of Boston MA HIC Registration Offices & Showrooms Number: O 15A Cummings Park O 295 Old Oak Street 166025 Wobum,MA 01801 Pembroke,MA 02359 Federal ID# (781) 932-4805 (781) 826-6281 82-4898432 www WindowWorldofBOSton.COm Customer: ke� Install Address: c38g %Ar Phone(h) Phone(w) (.cam � „c City: I State:MA Zip E-mail WINDOW WORLD F�4000 eries Single-hung AlVWeld $199 GLASS OPTIONS ries DH All-Weld so Elite-Dual Pane $119_ Q� ries DH All-Weld $215 Triple Pane/Krypton $240 _ -> $369�j_ - 6000 Series DH All-Weld $260 (*Series 60M Only) 2 Lite Slider $374 WINDOW OPTIONS 3 Lite Slider t,r�,,� ,/,I t,/,,�,/41 $575 Glass Breakage Warranty Picture/Fixed Lite (0-83 UI) (�00/6000) $15 INCLUDED Picture/Fixed Lite (84-130 UI) $45 1/2 Screens $g INCL EUD D Awning Foam Insulation on Jambs and Head $11 INCLUDED $310 Double Strength Glass(4000/6000) $15 INCLUDED Casement Plus$49(DH Sash Rail)$330 Double Locks(>26.) 2 Lite Casement $595 $5 INCLUDED 3 Lfte Casement Full Screens $25 �'�'�''� n/a•,/z,/Qi $910 _,R_Colonial Grids t ure Flat Basement Hopper $� ��/ ) $650 Bay Window-Soffit Mount/INS Seat $2660 Prairie Grids $75 Bow Window-Soffit Mount/INS Seat$2785 Simulated Divided Lite $182 Garden Window $2040 Tempered DH Sash(BSO)(TSO) $75— Bay,Bow,Garden Oversize (+109 UI) $975 Obscure Glass(BSO) (TSO) $75~- Beige/Almond $40 Oriel Style(40/60 or 60/40) $75 Wood Grain Interior(Series 4000/6000 only)$100 Foam Enhanced Frame (Light Oak/bark Oak/Che $35 ny/ Fox Wood PRE 1978 BUILT HOMES(EPA LEAP SAFE RENOVATION) Rich Maple) Brown Exterior(Arch.Bronze/American Terra)$100 —�-Lead Safe Practices Required $30 2�/D Designer Color Exterior MY HOME WAS BUILT IN THE YEAR /9�� Initia$175 Ale Speciality Window $_ MISCELLANEOUS Window Color w�--'tom / .� Custom Exterior Aluminum Cladding wo-Bend) r ❑Textured$90 O G-8 Smooth$90 $ Inside ourslde Facing Color NON CUSTOM DOORS Metal Window Removal $75 Vinyl Rolling Patio Door 5%or Eft. $t 095 —New Construction Vinyl Removal Vinyl Rolling Patio Door 8ft. $175 $1195 Multi-Bend Cladding $20 Add to base price for Custom Rolling Patio Door$1250 ull to Form Multi Unit French Rail Sliding Patio Door 5ft.or eft. $30 French Rail Slidingp $1395 Install Interio/Exterior Stops $50 So atio Door Eft $1495 Install Interior Casing Starts At $95 French Rail Sliding Patio Door 9ft. $1595 Custom Exterior Cladding Insulate Weight Boxes $20 SolarZone Elite or ETC Glass $30U Roof for Bay/Bow Windows $305 $500 Grids Patio Door Existing New Const,Ext.Retro Fri $15 Woodgrain Interiors $210 Removal of Existing Bay/Bow $ 95 $250 Exterior Designer Colors $595 Repair Sill,Jamb or replace sill nosing !$75— Interior Casing 21n 31n ' $275 Full Sub-Sill(Single)replacement $175 Handleset Options $ Mullion Removal �— $ Bay/Bow Conversion Ext.Retro Fit Door Color $50 (New Siding Will Not Match) $450 / inside v ROUND-UP FOR WINDOW WORD C/1RE5 . St Jude Children's Research Hospital $ PREPARING FOR YOUR NEW WINDOW AND D RS Congratulations on your decision to increase the comfort level,value and appearance of your home.To maximize i Investment and Tenable the installation to take place as smoothly as possible,we have created this handout to acquaint you with what to expect when our installers arrive. 1.Expected Delivery Time.All of our windows are custom made at one of our manufacturing plants located around the country and shipped to any of our over 200 Window World locations.The time between when your order is placed and when the windows are ready to be installed, though not guaranteed is typically 6 to 8 weeks.At that point we will call you to set an installation date.If for some reason you need to delay your installation for�more than a couple of weeks after notification that we are ready to install your order we will be happy to work with you.we will need to collect the remaining balance before installation if the delay you request is more than three weeks. 2.Access to the Windows and Doors.We will need approximately 2 feet in front of each window,inside your home,so we can place our drop Goths and tools necessary to perform our work.When the old windows are removed,gusts of wind typically flow through your home.It is advisable to gather together important papers,and other small items that can be disturbed by the wind and relocate them.Comother electronic egdipment should be covered or relocated temporarily.Please move aside any furnishings that are in the way of urtwork.f any furniture items are too heavy to move easily,we will gladly assist you. 3.Window Coverings.To gain access to the interior of the windows,we need all mini blinds,vertical blinds,roll-up shades,shutters, and any other window covering removed prior to our installation.We are not responsible for removing or reinstallation of these items and are not responsible for damage resulting In the removal and reinstallation.We also are not responsible for any window covering alterations that may be required to reinstall them. 4.Plants and Bushes.Occasionally we need to work in planters and other landscaped areas of your home that are adjacent to the windows ' and doors.Please survey your yard prior to us arriving and look for potential problems.Some trees and vigorous bushes need to be pruned back to give us access to your windows.Delicate plants and shrubs In areas right below a window should be temporarily relocated if they cannot survive being stepped on and you want to preserve them.We strive to be careful when working around vegetation,but our priorities are b focus d our work,your windows and our safety while working on your property.We are not responsible for any damage to plants,shrubs or landscaped areas. 5.Arrival and Departure Times.We will advise you bf the expected arrival time for our crew at the time we set u the i you.We generally stay till the job is done,unless it will be a 2 or 3-day job,in which case we may work as long as there is daylti ight!t Is our policy that our installers get a sign-off form and collect the outstanding balance at the completion of the job.We ask that you be available to approve the job and make final payment at the time of completion. 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OM Vt•J1X3 ON u!sag uua Bu 1 DI 4 united uolsog jo�!3 lenaddy lalgslU auGAIN'lenotddV uo;;erxossV opuo3 to pue tamxoawo i>r d !PflnB laawoaat/laauuOasrA walsl(S wtelV'6uluielS'6u!Wled:i�et;uoa Si i.ql!M uolloauuoa u!BurMo a t a suodsat sr law n 00'SZS to ssaaxa q un1 qi of O( r cls 3 31N1 Sit] Commonwealth of Massachusetts Division of Protessional Licensure Board of Building Regulations and Standards Construction Supervisor CS-072772 Expires: 04107/2020 JEFF C STEELE - `> 24 SHERWOOD AVE ' DANVERS MA 01923 4 V Commissioner i \ Office of Consumer Affalm&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC ReoistraHotn Expiration 166M 04111/2020 WINDOW WORLD OF BOSTON,LLC. JEFF C.STEELE �C —— 15A CUMMINGS PARK WOBURN,MA 01801 Undersecretary ` The Commonwealth of Massachusetts t Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, K4 02114-201' www.mass.gov/dia Workers Compensation Insurance Affidavit:Builders,rContractors;'Electricians,Tiumbers. TO BE FILED V►iTB T7HE PERMITTING AL'THOR?TI. Applicant Information // Please Print Lehibly ?'ame (BusinesslOrganizationMdividual): 14z. da,J Address: 15-H Cirn:•Sta,e/zip: lk)0 n u Phone r: �g ► — �i S 2- rig c 5 fire You an employer?Cbeck the appropriate box: Type of project(required): , l. am 2 employer with 0 mpitrvee (ful)and/or par-time).' 7. New construction j �.❑i am a sole proprietor or parmership and have no employees working for me in l ! S. n Remodeling capacrrv.Ne workers soap inmrance reouired.l I I 1 Demolition F am a homeowner doing a':work rnA,se1f- ?vc workers`coma insurance recutre&- ! ` i - ;i' L RuildiL•r aAdhkm, 4.O'arr.a homeowner and wili be hiring contractors to conduct all work or.m) property. ensure that all corm'ector<either have workers'compensation insurance or a-e sole � I l.❑Electrical repairs or additions j l proprietors will:no employees. ! 1 i.C Plum bin€repairs or additions i ari a genera]comnctor and 1 have hies:the sub contacton lister or.the attaches sheet. ! nR.00_f repairs These sub-contmaors have employees ane have wo}_e*s comF insurmice.- i V. %•.7 h vF are c-ortioation ant.i!-officer have exerrmeC Jrelr nghi o;a ernpbor pe" i u!52,E l<<j,anC we h2ve no empiovees. ?ve -s s•arr worke. 'comp.insce reciwred'. rr(I,a j � l 'Any appiicani that checks box f l must also fill our the section:below showing their workers'compensatior policy information. t Homeowners who submit this afnti2vit indicating they are doing all work and,Cher,hire outside contractors musi submit a new a5d2vi:indicating such =Contractors that check this box must attached an additions sheet showing the name of the sub-contractors and state whether or no:those entities have emplovees. r the sub-contractors have employees,they must provide their workers'comp.polim,number. 1 am an empiei:er tha;irc providing work e.*s'�ompensnto), :rsurancc or m-, emp:ovees. �eleN is sr.:polio, cr:d int sire information Insurance Company Name: t{ �_� < i Expiration Date: Z 7— /5 Folicy€ or Se._-ins.Lic.�: LpZ 11+/� e L—� 1 P / ot, Site Address: �o ?�yM S'1 Cit 'State—ip: l f � Attach z copy'of the workers' compensation policy declaration page isbowing the policx°number and erpirarin date.:. Failure to secure coverage as required under MGL C. 152_ §25A is a criminal violanot punishable by a fine up to 5h500A0 and/or one-year imprisotunent as well as civil penalties ir,the form of a STOP U`ORK ORDER and a fine of up to 5250.00 day against the violator.A copy of this tement may be forwarded to the Office of lnvesrigations of the DLa for insurance coverage verrfi tion. 1 do)terebr cer under a psi eriun That the infarmatior.prov;dEd above is true and carrec� �i amre: Date: Z Phone t: 3 L- es l 7 a use only. Do not write ir this area. to be complered by sin;or town official Ciry or Town: Permit:License Issuing Authority(circle one): 1.Board of Eealtb 2.Building Department 3.City/ToRrn Clerk 4.Electrical Inspector 5.Plumbing Inspector i i 6. Otber Contact Person: Pbope : '4�D6 CERTIFICATE OF LIABILITY INSURANCE DATEt9IDD.ly,1! THIS CERTIFICATE IS ISSUED AS A PdAT7ER OF INFORMATIOAI ON; s/2912Ma Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT} OR ALTER THE COVERAGE AFFO"ED BY THE POLICIES BELOW. THIS C1=127IFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AtrTHORMM REP;ZMENTATJVE OR PRODUCER,AND THE CERTIFICATE MOLDER• IMPORTANT; 11 tte Certificate holder is an ADDITIONAL 5 URE;3,the policy(es)most have ADDI710NA1.INSURED prevlsior>ti of he endorsetJ If SUBROGATION 1S WAWED,subjerl to the terms and ConrJ Ons-of•the policy,certain policies may renuire an endorsement A statement or: this certificate does not confer rights to the certificate Bolder in(ieU of such erldorse�rretdjs). PRODUCET. CO. ACT ' Marsh&McLennan Agency L LC I PHONE C:Wl Wtcher,CI..,CISR.CBJA �5 Jv. om St. I A c t10 I:336 5a5 s850 a r o:2',2-607-651C ' GI9Onsboro?SEC 27455 E•tdAl!. An Fss_ Carli.1AJ tche. marshm.T7a.co7T7 1 INSURER(S)AFFORDING CDITERACE I INS lNmmt:Atmerica Financial Beneti ?,334 I t:ra]o VA%Jndow World Cl$Ostom LLC 3'r"w;tm a:_Kerlford Fire Insurance Company 1-06a2 I 18 Shaver Sh2ef I INSURER C-MCISSacbusefts Bay Insurance Compam, 2230E i Nort-,Milkesborc NC 23659 lr saga r: 1 I"_`S7JRER E: I - !NsuRcr: COVERAGES CERTIFICATE NIUFJR3ER:10160 ici72 REVISION NUMBER- THIS I.:C CERTIFY THAT THE PD',iCIES OF 1NSURANCE115TED•BELbu 9'IAVE r BEEP.'ISSUED 70 THE DISURES NAMED ABOVE FOR THE POiICI PE?2;OP INDICATED- N071N,`fHST•ANDLNG AP:Y P.EQJIP.EMENT,7ERM OR CONDITJOt OF ARTY COT TRACT OP,OTi'IER.1>000MERr;VOTE PIESPECT 70 IA41CH THIS j CO;7IFICATE MAY BE ISSUED OR PN.Y PET ABJ,THE DISURANGE AFFORDEL EY THE,POUCIE,S DESCRIBED Hc'Ttt-1PI IS SU&JECT TO ALL?HE-E%AS- j EXCLUSIONS AND CONDITION-It OF SUCL'POLICIES.LIM7':SHOIIUI MAY HAVE SEEN REDUCED BY PAID CLAIMS. IADDL'SMaR -TR + '.'YPEOFDMRANCE .>`!SD! 1 '^'lfJ61B!-T POLICY£�F PO:.1C"-:7 C �( C'OmmrRMALGENERA-LiAOf I'7V 1 1t$=DD Tm 4jALjj7DFVV 1 7J.'-0'TS I J Ot7c,�CtPu c,/�tF 9�2DT° I EACHOCCJ?RcNCE i —!CLAPIS-NED° =CUR i I: MC BDF L APE 7C RErv?�7 i T'RE!:11SE` L�eccLM j --- t tE EtG(Am`mr;ltmon: 1 r E•00E i PERSC;dALE qD\rIP1JU3`;' S?,ODD,C•lh t G_N'LAGGPX--GATE J rr APPLES PER: POLICY i I J L LOC I I G'c _LAG'C-T_CN E _ 42.CW.C^C i FRO^UCTS-Ccmcmc AGG I'LWe Cut OTHER: t f i +- AUTOMOBILE IJABJ..n'7' i ? IA4UiB757G}c- Gmmam,- E.y`r�.E ` X .ATdYACTC+ t t i i nt OWNEC Sr4=-]U_cC ! i oOD!LY1•Wd"r,!'lPe-ceracn; ' __ A3;Of ON•�i AJi05 I ! F'0-i`-V m.113Y •HMEL •,MM:-01NNtZ' R 4t DAP,7A�r .I +lie-ecctia�m, i C r. U!BRFiLA L7AE !x ''. tr� ; J1CHOCCUR J"f'URRE1C�EXCESSLIAB CLAWS-PAD= I f.�.tli1C.LC i I I I I AGGREGATE ;LDDD.BCC RE ENTICNF t I r+ORKMS COPAPENSATION ' ;'Y�L?�i•:-Si c ( 7J2720?F 7;27J"C'IS �R i OTh- .IAl7D ELIPLDYERE'itABrLtTY ?4 1/LNYF.?OPRIE.,OFJPARTNcRrcdEC!--iVc IT JOFFICEPJP.7EiAEEREXCLUD--S !:r:i:.I 1 ELEAViAOCIDEW, !SPCwIP.Y •(mnaatoty in NH; `U; !I`Ye$.desclibeundo: E.L DISEASE-Ef.E}TLCVEE,55DD.DDO ; ?D6ct.RIP7?ON OF OPERATIONS Dr)aa j 1 EL CISEASE-FDLIC7 iJh17 i:E=.DDC iESCflIPT10�;OF OP�710Nt fLOCp71DN5:VESICF,ES (ACORu'9II1_Addir!enal Ren7arlt;SeitegDk;arrd he otlached i`mom spas-is reryuirod; I :ERTIFICA7E HOLDER, CANCELLATION SHOULD ANY OF THE ABOVE-J)ESCRIBED POLICIES BE CANCF-LED B3=FOM T.it EXPIRATION DATE i1EREOF, NOTICE WILL 8E DE IVEPLD IN I ! -ACCORDANCE IAHTF THE POLICY PRObISJONS. I 1 AMHORMIED-REPRFSENTAIME I C 1988-2015ACORD CORPORA TIDN- Al!rights reset-rec. CORD 2E{2016/0:) The ACO}ZC rtanne and loge.am registered marks of ACORD CAPE COD INSULATION Ii � ® plq ® 11 SS 11q>110>M SUS M�TTI OUFTIgf IN1UlAT10N C1ItI.0s 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village `4�44N"t jk"UMQ AU P/&,n 67 4J� 47VSI'4� Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ( ) ( ) Slopes ( ) ( ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ( ) ( 43 ) ( 9 ( ) ,6 v,erej 6VOr Sincerely 2ryHE ssi r, President Ins ation, Inc. i a 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - �j rO'WN OF BARNSTABLE . Ma ���D ParcelApplication d, Health Division f'`i %� ) Date Issued Conservation Division Application F` � Planning Dept. L� ' �'� Permit Fee - Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address 2,ff X - Village �, ✓� ��0����,3�F OwnerZL2 ;0/vCk Address Telephone 39 Z4i Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation / �r Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family /111� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ANo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes .❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name <L �L� �e� /f��d�/�/i�.� Telephone Number 937 ,?/, Address /�/2�f1�c'�¢� �� License # /D v OlJ/GL Home Improvement Contractor# 43 Y y Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO av � SIGNATURE DATE 41-h ���� FOR OFFICIAL USE ONLY ` APPLICATION# DATE ISSUED ' MAP/PARCEL NO. w ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH- FINAL FINAL BUILDING DATE CLOSED.OUT y K ASSOCIATION PLAN NO. F,Y 4 is 1 rro'n of Barnstable Regulatory Services Richard V.ScA Director Iaui3ding Division Tom Perry,Building Commissioner 200 Main Street,Hyannis.-'MA 02601 www.to w n.b a rns tab!e.ma.us Office: 508-862-4038 Fax: 508-700-6230 Property Owner Must Conmpletie and Sign T'lizs Section - If Usine ABuilder �i4 v c ,as Owner.of the:subject pxoperq herebyauthpHze AS 4 to act on in,beb.9, in all matters relative to work authorized by this building permit application for -746 (Address d jo .)- ,-"Pbol fences and alarms are the resp0nsMit)'.0f`the-applicant. Pools are n6vtd be:filled or utiked•before•fence is iastalle&M' a}lfinal inspections are performed and accepted- . � . � Signanue of Owner Sipatum of Appbcwt Print Name Print Nacre c - _ D Daze JUN 2 2 2015 QTORMSSOWNMEWSStONPOOLS Massachusetts -Department-of Public Safety :.Board of Building Regulations and Standards Construction SuperviN61, License: CS-100988., HENRY E CASSI ,+ ' 8 SHED ROW WEST YARMOUTrH + B Expiration Commissioner 11/11/2015 4 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement CAtrdetor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. A 1 +.i 2OM•05n1 Address Renewal Employment Lost Card &Xe fQanwitew?,tuece-N, �/CD/,1/�,,,jjac/z[FJef Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: '1:53567 Type: Office of Consumer Affairs and Business Regulation xpiration: :;::1211./201.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 4PE COD INSULATI'QN-INC:°:``'. ENRY CASSIDY 3 REARDON CIRCLE J.YARMOUTH,MA 02664 Undersecretary qNyv Wi 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/Plumbel-s Applicant Information Please Print I e ibly Name (Business/Organizadon/Individual): Address: 16 Favdm, Go& City/State/Zi LAVAbak, 1v Phone #: �� ' 1 ' I21 - - Are you an employer? Chek he appropriate box: `-`-- -� 1. I am a employer with 4. ❑ I am a general contractor and I Type of project (required): 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 working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insuranceJ 9• ❑ 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12• Roof repairs I j 3a.❑ I am a homeowner acting as a employees. [No workers' 13. Other general contractor(refer to#4) —--�- --- comp. insurance required.]. 'Any applicant that checks box#1 must also fill out the section below showingtheir workers co saticd li -- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside connt actors must submio a new affidavit indicating such, tContractan that check this box7must 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 mast provide their workers'comp,policy number. I am an employer that is providing workers''C t compensation insurance for my employees. Below is the policy and job.site �-- information. (� Ldsurance Company Name: �,(,�,N � �w (W,)(jntoc-e� Policy#or Self-ins. Lic. #: W(i56614:-3 1 _1 ()d Expiration Date: (� Job Site Address: . l /h1 19,41 City/State/Zip:_ {W Z4 �� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fails rd 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 ORDF,R and a fine of up to$250:00 a day against the viglator. 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 Gerd un the pains and penalties of perjury that the information provided above is true and correct ~ Si a Date: Pbon #: i O ftcial use only. Do not write in this area, to be completed by city or town offliciaL - - -� I City or Town: Permit/License # Issuing Authority (circle one): �- 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#• i From)'Rogers&Gray InsuraFax: To:+15087785735 Fa::: +15087785735 Page 2 of 2 03130/2015 10:04 AM CAPECOD-27 BDELAWREN_CE •�� �V DATE 0 DIYYYY)� CERTIFICATE OF LIABILITY INSURANCE 3130/212015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIFIICIES 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 endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 877 816-2156 434 Rte 134 A/c No Ext: A/C No): ( ) South Dennis, MA 02660 E-MAIL -- ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY 39454 Cape Cod Insulation,Inc. INSURERC:Endurance American Specialty Ins. Co. 18 Reardon Circle INSURER o:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SRPOLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/OD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C CLAIMS-MADE M OCCUR CBP8263063 04/01/2015 04/01/2016 PREMISES Ea Occurrence $ 100,00d. MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a PEC LOC PRODUCTS-COMP/OPAGG $ 2,000,000I OTHER: $ AUTOMOBILE LIABILITY EO MBINED SINGLE LIMIT $ 1,000,0013 B ANY AUTO TBD 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Peracddent AUTOS AUTOS ( ) X X NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000' C. EXCESS LIAR CLAIMS-MADE EXC10006635000 04/01/2015 04/01/2016 AGGREGATE $ _ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000, WORKERS COMPENSATION PER IT AND EMPLOYERS'LIABILITY Y/N STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431900 06/30/2014 06/30/2015 E.L.EACH AC 1,000.00 OFFICER/MEMBER EXCLUDED? N❑ NIA ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000I If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under thh General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS. —� South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION J � Map Parcel �0 0/ 0Application # o Health Division Date Issued 3 Conservation Division ,Application Fee Planning Dept. Permit Fee ID n Date Definitive Plan Approved by Planning Board 1G Historic - OKH _ Preservation/ Hyannis Project Street Address J i U1 Village e. 6, t� Owner } D,Y'1 0` v, Add r ss Telephone I L4 — G Permit Request 0-11 T o, i r Square feet: 1 st floor: existingq)ILroposed 2nd floor: existing 2'proposed Total n Zoning District Flood Plain Groundwater Overlay Project Valuation d U Construction Type Lot Size , Grandfathered: ❑Yes o If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family units) Age of Existing StYull re Historic House: ❑Yes LI o On Old Kin ' 9 9 d g s Highway: /Yes ❑ No Basement Type: rawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 1,31 71, Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing I-new Total Room Count (not in ding baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes /No Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attac rage ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Aut rization ❑ Appeal # Recorded ❑ 44 w .:� a Commercial ❑Yes alNo If yes, site plan review# `' VFJ Current Use Proposed Use C =3,• APPLICANT INFORMATION .(BUILDER OR HOMEOWNER) Name G Telephone Number Address ZL/ `' f-'�°' Y' �''S �'� License # 9 Home Improvement Contractor# / -e o Email �ic+s� b �, (d/�= c o.,0 1, CGY'') Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ,T l U pp- ~ FOWOFFICIAL USE ONLY �s APPLICATION# DATE ISSUED MAP/PARCEL N0. a ADDRESS VILLAGE OWNER DATE OF INSPECTION: Y ` FOUNDATION _ FRAME } =' INSULATION �3LAJs o �l�xB�ifw � �+ FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. f j a The Corrmwnwealth ofMassachusetty Deprfinent oflndustrW Accsdenls Office of InveytigadOUS 600 Wash Tton Street Boston,MA 02111 www.imass go v1k a Workers' Compensation Insurance Affidavit:•Biulders/Contractors/Electricians/Plmnbers Applicant Information p Please Print Le "b ' Name(Bar/ ) / S C _ Address: c,, s C I rc,lit, City/StatelZip: Q1LC) Phone#: C1 `6 7-71— F-i-7-7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ a employer with 4. I am a general contractor and I employees(fall 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 8. VBuil olidon working for me in any capacity. employees and have workers' 9 addition [No workers'comp.insurance comp.in uranceJ �) 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repass or additions myself [No workers'comp. right of exemption per MGL 12 0 Roof repairs insurance requuEd_J t c. 152, §1(4),and we have no employees. [No workers' 13.0 offer comp.insurance required.] *Any applicant that ehxla box 41 must also fill out the section below showing their worker'compensation policy infnrmziiort t Homeowners who submit this affidavit indicating they are doing all wo&and then hits outside contractors must submit a new affidavit indicating such. 'Contractors&at check this box must attached an additional sheet showing the name of the m&contradnrs and state whether or not those ctities have employers If the sub-contractors have eaoployc s,they mast provide their workers'comp.policy number, lam an employer that is praviding workers'compewation insurance for my employees Below is the pony and job site information. Insurance Company Name: Policy#or SeLf-ins.Lic.#: 4 C Z 3/S 3/-7 Z•/ 1 G q V Expirtion Date: Job Site Address: 3 `(� �/. vl r"I City/StaWZip_/�C,e0 b Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). FaLlure 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 fb=of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under ae pains Penafdzc ofPmjw.Y that the informatioic provided above is true and correct Si Z D�:c: •7 �� Phone#: 50 �r 7 -7 '3 -1 7 � Official use only. Do not write in this area,to be completed by city or town offzciaL City or Town: Permit/License# Issuing Authority(circle one):_.. .._.....__......_ . 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#; • , f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pmmmutto 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 is 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 Ioca.l 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 ofpublic 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 wormers' 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 fur 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 lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the perms t license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications is 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 maybe provided to the applicant as proof that a valid affidavit is on file for finTure permits or licenses_ A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture. (i_e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax number. The Cozy Qnwu-alth of Massachusetts Department of Ind-Ustnal Acudents Office of jvestigatio= 6�Q�asbingtQn Street Bastin,MA G2111 Ttl,#617'27-4900 ext 4-06 or 1--377-MASSAF`E Fax##617-727-7749 Revised 4-24-07 - v,w wmaz.govf dia 1.1 SCOPE WindSpeed(3-sec. gust)........................................w........................................................................ 110 mph 7, Number of StDries(a roof which exceeds 8 ln.12 slope shall be considered a story) stories :5 2 stories 1.3 FRAMING CONNECTIONS 2.1 FOUNDATION 2.2 ANCHOR.AbE TO FOUNDATION" 5/8*Anchor Bolts,imbedded or 5/8"Proprietary Mechanicil Anchors as an alternative in concrete only 3.1 FLOORS Full Mel s Maximum Floor Joist Setbacks Maximum Cantilevered Floor Joists 4.1 WALLS Wall Height Wood Studs Gable End Wall Bracing' /V.............................................._--oau.9vx � and2o4 Continuous Lateral Bra6»@O ft.o.c.- (Fig11).---.--------_-.—'_.—.�,.— or1c3caU�g�ningsbips�� 1G^opoc�gm�.v�b2x4b�ck�g��4fLmpac� �ginand�u� orh000bays�____ | � Double Top Plate Splice Length .................:......................................(Fig 13 and Table G)....................................___ft � . Splice Connection(nuof1Gd common nails)..............(Table G)........................................................._�_ ____ AIVC Gi de to f•Vood ConStructiotl ht High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (7s0 CMR5301.2.1.1)' Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Tables.')..................................................... 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) HeaderSpans ........................................................(Table 9).................................._ft—in.15 11' SillPlate Spans ........................................................(Table 9).................................._ft in.:5 11' Full Height Studs (no.of studs)....................................(fable 9)............................................... .... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9).................................._ft_in.:5 12' SillPlate Spans...........................................................(fable 9).................................._ft_in.5 12" Full Height Studs(no.of studs)....................................(Table 9).............................................. Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest OpeningZ ............................................................................... 5 6`6' SheathingType..............................................(note 4).:::::................................................ Edge Nail Spacing................:...............I.........(Table 10 or note 4 if less)........................ in. FeldNail Spacing...........................................(fable 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)......................................................._ Percent Full-Height Sheathing........:..........:...(Table 10)...................................................._% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest OpeningZ :5 SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. FeldNail Spacing...........................................(fable 11).........................................,....... in. Shear Connection(no. of 16d common nails)(Table 11)........................................:.............. _ Percent Full-Height Sheathing........................(Table 11).............................................:....... % 5%Additional Sheathing for Wall with'Opening>6'8'(Design Concepts).............. .. Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... 5.1 ROOFS Roof framing member spans checked?...........:............(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19) ............. ft 5 smaller of 2'•or L13 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift ...(Table 12)............................................. = p lf Lateral.............................................(Table 12).............................................L= plf Shear............................:..................(Table 12)............................................S= plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Out)ooker..........................................(Figure 20) ............._ft s smaller of 2'or L/2 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift.......................:........................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(fable 14).......................................L= . lb. Roof Sheathing Type................:................... (per 780 CMR Chapters 58 and 59) . . ............... ............ Roof Sheathing Thickness..................:..................:..... ............................................. in._>7/16'WSP RoofSheathing Fastening............................................(Table 2).................................. ..................._ Notes: -1. This checklist shall be met in its entirety, excluding the speck 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. Comer Stud Hold Downs per Figure 1 Ba and Figure 18b 2. Exception:Opening heights of up io 8%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. Parcel Lookup Page 1 of 1 OR 7HE rQ r.. 10, BAAR'STARM --''- NIASS, . az Logged In As: Parcel Lookup Thursday, March 12 2015 Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options , Search By Street Street# 388 J Scree PLUMName I Village I All Villages 'Search` ` <Prev Next> Page 1 of 1 Rows/Page: 10 (k Parcel Location Owner Village Index Map 196-018 388 PLUM STREET PALUCK, DAVID A SR& PAMELA M WB 1284 196018 http://issgl2/intranet/propdata/lookup.aspx 3/12/2015 ie�Eomvnaaruuet��l/ ' ��JJacxcwem License or registration valid for individul use only Ofliceyof Consumer Affairs&Busi ess Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Type r'egi Office of Consumer Affairs and Business Regulation stration : .168588 10 Park Plaza-Suite 5170 piration: 211.1/20.1.6_ Partnership Boston,MA 02116 ILDING SYSTEMS. �- ,. BOBOLA" ^: RNCIS CIRCLE MA 02601 Undersecretary Not valid without signature "Assachusefts Ve -O� ,ment of Qbarol=Bt�N gf ''ul tta P �f Safer a 9 �s n y, gns chonSu ,rtimed �. P. or ice `se -0589$7 ` ,STEPHEN E _BOB94,A c, 24 ST _ ,r - I� HYA"s MA 02601 .. Expirationry Commissioner 02�04/2016 , _ i AGE CERTIFICATE OF LIABILITY INSURANCE DA,EcMMIDDty"Y, 6/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- If the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER BRYDEN&SULLIVAN INS NA E: T 88 FALMOUTH RD PHONE AIC No HYANNIS, MA 02601 E4'AA1L ADDRESS: INSURERS AFFORDING COVERAGE NAIC# NSURERA: Liberty Mutual Fire Insurance 23035 INSURED INSURER a: MASS BUILDING SYSTEMS LLC 24 ST FRANCIS CIRCLE NSURERC: HYANNIS MA 02601 NSURERD: INSURER E: M12PRER COVERAGES CERTIFICATE NUMBER: 20737496 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAID) SUBR POLICY EFF P Y EXP LTR INSD D POLICY NUMBER NNWIMNUDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR MISES Me occurrence) A rEl5 $ MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY❑JPERLOO- LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Par accident) $ AUTOS AUTOS NON-OWNED PROPS DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LaB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION WC2-31 S-317211-044 6/7/2014 6/7/2015 IN ✓ PER -� ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE.L.E Y�N 1 A E EACH ACCIDENT $ 500000 OFFICEFLMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,descdha under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) Workers compensation insurance coverage applies only to the workers compensation laws of the slate of MA. This certificate cancels and supersedes all previously issued Certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE ,A� �4't* UcbJoyc. Liberty Mutual Fire Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20737496 CLIENT CoOE: 1611184 Didi Dangas 6/30/2014 2:49:17 ?Pt (EDT) Page I of 1 'r AWC Grade to Wood Construction in High 1),7nd Areas: 110 inph Wixrd Zone Massachusetts Checklist for Compliance (790 CNIR 5301.2.1:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a) new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte. 28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. 1MHENTHIS EDGERESTSoN FRAMING USESd NAILS ATB-o c • 11 11 1 11 11 - • 1 u IJ 1 11 11 1 jg] 11 11 I yj ti 1 11 tl 1 1 Apo 1 i•i N 1• f.CN e 1 1 11 11 M 1 1 1 1 1 1d 11 m 11•I Il 1 x I 1 '� / . ito W Ii ii$ i 4 i i tl Q fl ti �L MMIING MEMBERS EDGE WERIJEDIATE Q 1 t • 1 .� 11 �f P.1 1 1 ( - L3/91 1 _j 11 11 Q 1 1 I :1 H \ 1 1 1 1 fl t 1 SWTA -1t_ �IJt. 3•MMd DOUBLE — i`, PATTERN IirSPkJ AGG t U41L NAIL P GERED NA ATTEriN PANEL I okNd el t � PAWL EDGE DOUBLE NAIL EDGE SPACNC DEUL See Detail on Next Page Vertical and Horizontal Nailing Detall • for Panel Attachment Vertical and Horizontal Nailing for Panel Attachment I -.r- Town of Barnstable Regulatory Services Richard V.Scali,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 as Owner of the subject property hereby authorize �LL C to act on my behalf, in all matters relative to work authorized by this building permit application for. (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 inspections are performed and accepted. Signature of Owner - Signature of Applicant h �bei 1.y Print Name Print Name Date Q:FORMS:O VtWERPERMISSIONPOOLS Town of Barnstable . Regulatory Services �oF Me rolryy Richard V.ScaIi,Director Building Division w SST M ` Tom Perry,Building Commissioner 19-- ��� 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 village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town 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. DEFINITION 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 he/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 Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature 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 performing work for which a building permit is required shaH be exempt from the provisions of this section(Section 109.1.1-Licensing 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 exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To 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 form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomu\EXPRESS.doc Revised 061313 �oF,HEt Barnstable Old Kings Highway Historic District Committee MANSTABLE 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 MA6A a 9�a 1639. rfOMA� APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: all categories that apply; 1. Building construction: El New Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting, roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other . Type or Print Legibly: Date NOTE All applications must be signed by the current owner Owner(print): �c,..c _ �� L LA C `'� Telephone#: - ZG $ — 7 Address of Proposed Work: 3 $S, Village 16.E 13 a 6 Map Lot# Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be done: Agent or Contractor(print): d -�Y L, � ��. Telephone#: Z 'Address: ► Ce r G�e /� a n s1.,17 0-7-6 Contractor/Agent' signature: For committee use only. This Certificate is her y APPRO ENIED PECENED Date 49114'_ Members signatures i 1 c prrl 0 Z015 1 1 MANAGEMENT � GROWTHNIA i . APPROVED FEB 2 5 2015 Town of Barnstable 1 Q:IBoards and Commissions101d Kings Highway0KHApplicalionslOKH2011.Cert Apprb r1Renesstd2,.0lWay Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copies Foundation Type: (Max. 12"exposed)(ma rial-brick/cement,other) /�/,q Siding Type: Clapboard_ shingle other Material: red cedar white cedar other Color: a Chimney Material: s y 1 A Color: Roof Material: (make&style) A spz A k Color: f q LNA-r-6 U I o Q L (tl oJc Roof Pitch(s): (7/12 minimum) (sped on plans for new buildings, major additions) Window and door trim material: wood other material, specify Size of cornerboards 9 Inc S size of casings (1 X 4 min.) color �'� (/rt g,�Cz h Rakes Ist member 2°d member l X3 Depth of overhang Window: (make/model) /4R r v�Y C/`smaterial color 7 4- . (Provide window schedule on plan for new buildings, major additions) Window grills (please-check all that apply_: / true divided lights_ exterior glued grills_ grills between glass �f removable interior_ None D�qrr style and make: A A material Color: G�age Door, Style IV IA Size of opening Material Color Slitter Type/Style/Material: AJ 1A Color: Gutter Type/Material: j 7,, „,,�w +, Color: D ck material: wood Mother material, specify Color: Xn ght,type/make/modeY: / A material Color: Size: size: Type/Materials: Color: RECEIVED Fe ce Type(max 6' ) Style material: Color: . Retai ing wall: Material: 2015 Ligbfing, freestanding on building MANAGEMENT OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,g ge door,fences, la posts etc �hQ Signed: (plan preparer) Print Name FEB o r ,,,,,� v i Town of Barnstable Old King's Highway 2 Q:Boards and Commissions101dKingsHighwaylOKHApplicationsIOKH2011 Cert Appropriateness.doc Committee o , , l � E 1 � i (JD kA Town of Barnstable Geographic Information System February 9, 2015 197040 • A 197028 197029 00 #1549 197020 197021 #59 #73 #1678 '#1588 197003 197006 ♦ , 197027 00 #34 #121 197001002 197001003 197002 #43 197031 #126 #86 #58 ' 197004 197005 • v #44 197032# 197001001 #18 #4 197023 It #1684 197037 #96 #1610 197024 197035 #1760 197022 01630 #1700 ppRKFJt/rD #1596 ♦ $197025� 1 #1638 97047 197036 177005002 197044 • #26 #1736 P 01'#150 197)404 #1595 197026 B 197042 #25 197043 .9 #76 . #1611 97033 Mp 197045 A ft,#IO #'1781 E #424 197039 #1633 197038 01646 L196016 #1781F #404 916 196007001 196040 i86024 196008 N #1721 #69 .196017 #1613 #1685 1111111041111111, #390 = 196012 1 vPs 196018 #1615 196011 • A • 0388 #1666 196010 14 196#00 2 0 #1663 i196009 196019 #187W 198005 196015 #36� #374 #378 1 s6007004 • 196026 #50 196003 0 . 196013 198004 � 196014 #1675 #115 #161s �96028 -- #355 #1617 #0 1 -- e 196026* 196020001 —#.1673_ #350 196007005 196002 114 #317 . 196006 186#020002 196TI 324 #310 196029 lid 196039 #25 #278 0 142 Feet 196032 196033 21601 3 027 #271 #110 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:196 Parcel:018 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:PALUCK,DAVID A SR 8 PAMELA M Total Assessed Value:$327200 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map W � are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.51 acres Abutters :::::; boundaries and do not represent accurate relationships to physical features on the map Location:388 PLUM STREET / ✓! such as building locations. Buffer} i Town of Barnstable Permit# Expires 6months from issue date Regulatory Services Fee ♦ a a • SARNSTABI�, • 63 i639 • Thomas F.Geiler,Director . ♦� Building Division PV Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 . EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number �r1 c G Property Address f rh��Z I(t ff Residential Value of Work$ 3, 1/0 a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name ��►«I ��,��4.,.,o h Telephone Number Fit-C g 7 Home Improvement Contractor License#(if applicable) j 3 3 3 G Email: Construction Supervisor's License#(if applicable) 1 S fl PERM ❑Workman's Compensation Insurance IT Check one:❑ AUG - 5 2013 I am a sole proprietor ❑ Lam the Homeowner I.have Worker's Compensation Insurance Insurance Company Name /,,; , 2 a ��/ TOWN OF BARNSTABLE Workman's Comp.Policy# �,o a L=575 G i Z G It Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque c eck box) . LtT Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �e, DeL hf z ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WHILESTORMS\building permit fonms\EXPRESS.doc Revised 060513 VA The Comnyonweakh ofMassachusetts Dteparftnent of ludastrral Accidents O ke of MW-stigat lons, 600 T3'ashington Street Boston,MA 02111 wit'w.mass gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Flectricians/Mumbers Applicant Infarmation Please Print Legibly Name ITA 4,h.>G~ Adress: 2 r" �2��� 4- City/State/Zip: 13 j G S M17 o Z 3�51 Phone#: 7 Are you wa employer?Check the appropriate box: T of ect r 4. I sin s contractor and I � l:�] ( ���� I-❑`I am a employer with_ ❑ 6- ❑New won employees(full andlor * havehiredthe sub-contcactms. 2-❑ I am a sole proprietor of partner- listed on the attached sheet: 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition wo>jcing forme in any capacity_ emP to�and have workers' 9_ ❑Building addition [No workers' comp-insurance comp-tnsuranc&1 reqcLirecL] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp- right,of exemption per MGL 12..❑Roof repairs instuaace dL]3 c.152,§1(4) and we have no employees_[No workers' 13.❑Other comp-insurance rely-] */lay WpUcmn that checks boa#1 t®st also ID1 out the section below showing their wo&ere eooVensation policy infarmatiffi_ T Homeowners crbo submit this affidavit in&cating they are doing all uok and then hire oxide contractors—st submit a new affidavit indu-ling mch- lConttactors that check this box mast attached as additional sheet sbaasing the name of Hie sub-conamctors and slate whether ornot those amities have emphrpees. If the sub-chat mctots bare employees,&L7 must provide their workers'camp.policy number. Taman employer that is prm�iding nrorkers'compe?Lmtion irsurance for rriy errrptayees. Below is the policy and job site information. Insurance Company Name: ►/04 1,ti . CU1 C t' Policy#or Self-im-Lic.#: (z,, 1-4 $ 0 i Z c !I Expiration Date: !./f ll-t Job Site Address: , A) n ty w, CitylState/Zip: f 3 i k ,44 Attach a dopy 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 S1,500.00 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 oppy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance:coverage venfication- I do hereby aerhfy render thepains and penalties ofpetjury that the information provided above is hue and correct Si tare: Date: r Phone#- OBICiai use only. Do not write in this area,to be completed by city or town ofj'iciaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Cleric 4.Electrical Inspector 5.Plumbing.Inspector 6.Other Contact Person: Phone th 6 Information and Instructions r 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the 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 applicanf 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 Gor amaawealth of Massachusetks Depaitmmt of Industrial Accidents Office of Investigations 600 WashiVon Street Boston,MA 02111 Tel.#617-727-4900 W 406 or 1-877 MASSAFE Fax#617-727-7749 Revised 4-24-07 w .massgov/dia I Ro® CERTIFICATE OF LIABILITY INSURANCE DATE YYYY) 01/19/2019/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(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 endorsement(s). PRODUCER 04740-00f NAME:CT Miller McCartin P)R.Nfio,Ex<: (508)775-1620 .No.: 973 lyannough Road �Sss: Hyannis,MA 02601 INSURERISI AFFORDING COVERAGE NAIC i INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED Michael Hutchinson Hutchinson Roofing INSURER C: P 0 Box 534 INSURERD: Brewster,MA 02631 INSURER r INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1tv TYPE OF INSURANCE 1118pkJ POLICY NUMBER Aw9m PMYSm LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAG O RENTED $ PREMISES Ee occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ EN1.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY RCTT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ' Ee eC.d.nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 'EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ MWI GIs€CW1% v,I� X T`Av`IPS 0EV_ A AONYIPROPRIEfORIPARTNER/EXECUTIVEMN NIA VWC-1 00-60 06 598-2 01 3A 1/15/2013 1/15/2014 E.L.EACH ACCIDENT $ 100,000 (((M�yFta@ndddQatoo�5/cryyIbnaMNNHH))REX,CLUDED7 U EL.DISEASE-EAEMPLOYEE $ 100,000 DES(:FtIPMNO UPERATIONSbelori E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is reclulred) Michael Hutchinson is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION T.G.Homes 6 Mallard Lane SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Harwich,MA 02645 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD r r i F Michael Hutchinson R PO Box 534 PROPOSAL Page No. i . M Brewster, MA 02631 of 1 Pages I 1 PROPOSAL SUBMITTED TO: PHONE (508)362-7835 DATE 07/30/13 NAME Cathy Kuria JOB NAME i i STREET 388 Plum St STREET CITY Barnstable CITY STATE STATE MA We hereby submit specifications and estimate for: Job consists of strip and reroof (21ayers) Supply& Install- Roofers Select felt on underlayment Supply& Install-Drip edge and vent boots Supply& Install- Landmark architectural shingle(Hurricane nailed) Clean & Remove-Debris from job site Total -$3,400 Hutchinson Roofing warranties all work done for 5 years(508)896-6375 Hutchinson Roofing is also a member of the BBB with an A+ rating Note-Tom Wilson for carpentry(508) 367-7035, please.call after 1;00 pm We hereby propose to furnish labor and materials-complete in accordance with the above specifications, for the sum of dollars($ )with payment to be made as follows: All material is guanuveed to he as specified. All work to be completed in a tvorkrrranlike manner according to standard practices. Any alteration or from above specifications involving extra costs, will be executed only upon written orders,and sill become an extra charge over and above the agreements contingent upon strikes, accident or delays beyond our control. This proposal subject to acceptance days and it is void thercaticr at the option of the undersigned. i Authorized Signature ' i ACCEPTANCE OF PROPOSAL. The above pricm specifications and conditions arc hereby accepted.You are authorized to do the work as specified.Payment will he made as outlined above. i ACCEPTED: G,• Signature -- �.."1 DATE - 07/30/13 Signature @E-Z Con=ors Fortes Fortn No.EZ 110 Vlie. ano��aaruuea -/99"'paacA 161 bf Consumer Affairs&Business Regulation {I _ ,MtIMPROVEMENT CONTRACTOR — egistration:- ,138330, Type:. '.__" DBA zpiration: r3126/2015", i 1, '-F HUTCHINSON ROOFI�V_G : rr{ Gj 1 1 � 1 . (' MICHAEL HUTCHINSQN , "z";::i 26 MAURY LANE � _ �.{ =���' � BREWSTER,MA 02631 UndeKseeretary License or registration valid for individul use only before the expiration date. If found return to:-, i Office of Consumer Affairs and Business.Regulation i 10 Park Plaza-Suite 5170- Boston,MA 02116 Not valid without signature Massachusetts- Depailinent of Public Safet Board of Building Re!4-ulations and Standards Construction Supervisor License License: CS 99258 MICHAEL HUTCHINSON PO-BOX 534 BREWSTER,-MA 02831 cam_ �y Expiration: .12/25/2013 ('ommisviuncr Tr#: 7285 . Assessor's map'and :.fit 'numb I Acl;' , �7_ �K _ 5 SEPTIC SYSTEM MUST BE IMP �P INSTALLED IN COMPLIANCE Sewage Permit ,number ..._ .. 14— WITH ARTICLE ,II STATE SANI tMET TOWN OF BAR o� l` owN i BABH9TODLE:' " 9. .� 6-1.1UtDING INSPECTOR Ct U rrs. Oct `0 APALICATION FOR 6PERMIT TO• ... ................. ............................................................................................ r; � TYPEOF !CONSTRUCTION ..... ......1�LZ. ................................................... .............................. .19. r+ 'TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......J. ...........��...L.(l11!1.........�.J...a................v...!....... /. .�........................................., ProposedUse ... 1.... / Tl! 'L........................................................................................................I......................... �sT �3L Zoning District ........�.. ..................................................Fire District ..✓ 5.... ��'.`..................... .....................,,.... Name of Owner ... m t�.S Ie��1�14.................Address " U ST /n1 ........... /..../.......... //.g�...qc....... ......................1...............`.... `.1.... Name of Builder !r �%PAW�!-.e.....4� ........Address ...kl..l..... Nameof Architect .............. ............................................Address ..................................................................,......,.......... Number of Rooms ...... .;.' ► D ...... 8$!. `.. oundation ............�:�.1..................................................... Exterior ......12 ?.... �J1 [S:) [ram.........Roofing �� �� ................................ ..... .. . . .. . Floors ......... .............................. ............ . .......Interior ................... �.......................................................... Heating ...... ....P-1.....................................................Plumbing .��:�'P.�-un�8 13�.T.. E Fireplace .............wjh.........................................................Approximate Cost .........Lf........................................,............. Definitive Plan Approved by Planning Board -----------___—__-----------19_______ . Area Ile.................................... a� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....- .C .`.."r'. - .. .......................... Ku * James ----' - 19244 � ^ remodel interior ' � No -----..' Permk{or .................................... -----------'--------~------' Location ................ ____..____..�eo±..B�?������lw_.___.. ' ' ^^ ^ Kurra � ' ' t" """c"u.. ---..f+A°= ................... �� �~ . - ----.----------------.----. . ' . -Plot � � ` y�@r 24 �7 � PermitGronmyd ----.—'------']9 . Dote .... ................................l9 Date Completed .......... -----l9 79 ' . . � .n PERMIT REFUSED ' . . . ~ � _.--.---..`..---.--------- 19 �� _--_--- -----------------� �...'..--'.—....-------.---------�—. [ ' ^ � � ....................................................... . , ^................... v � � Y.'-----''.-----'--^---' | Approved —.-----------'�—.. l� ^ '~ | �r ! ---------------'------~^---' � -------------------------... . � ' - - • z Assessor's 'map and lot number ............. .... .... = =7Sewage Permit number ...1!�.'..!:�!'.!4......:...�t'�...{!;:.� TOWN OF BARNSTABLE ?NE TO ' P fob O'w -{•y •� BJSBSTLELE, i t3 OyYa:��� RURDING INSPECTOR APPLICATION FOR PERMIT TO ... ....... . o..L TYPE OF CONSTRUCTION i1 f k NM r-- ..................................................................................................................................... . .... ......... /..j...r!................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location -` ( .. n`I (�'•• r�/ �• �//j L Proposed Use ....�:.r.: !/ f''} !� L Zoning District ` rv�l�NS/�7z15��"� .......................................................................Fire District ................. �^ G ............................................................. Name of Owner ... ~ �f) ......C.-....S...........>.�.....•.....! .. ..................Address ...a PZ I-lm,,�7, - zb, Ld,2NS f� ........................................................ .Name of Builder ?A `� �/✓�� ( �` • Address ...?.Z.... ? / / U�l� ,2dll T , / //.)/V/YU ............................ ..................................... .. ........................................................... /� Nameof Architect ......................�r........................................Address .................................................................................... Y Lr3�vDn�' •, Number of Rooms ...... ....µ.. : 1.'��- t......' tr �.t d.(.IK Foundation ................ .....:. // / / . .� ................................................ ........ Exterior '��- G�-=1Jr3�T C h//✓r, 1 fr 5 Roofing ..................I..:...!.� .r t ;,1, ./�Il, - ... ..y. ! Interior � � Floors � '� ............................................................ 'o ....................... .......................................................... .......................... Heating ..................................................................................Plumbing ........................................................leis.................... Fireplace .................................. ..............................................Approximate Cost ............t Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area 6'.................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r I , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. /' /....... .................................. Name ................................ P Kurra, James A=196-18 T 19244 remodel' interior No ................. Permit for .................................... ............................................................................... Location ........ 388*Pluni Street ........................................................ West Barnstable ................... Owner .............James...Kurr.a.......I........................ ........ ........ . Ty of Construction .......frame......................... P# ................................................................................ Plot ............. ........ Lot ................................ ...... Permit Granted ..........ay. 2.4..................19 77 Date of Inspection .......... .... 1.9 Date Completed .... .................................19 PERMIT.REFUSED ................. ............. . ............ ... 19 ....... ............ ... ...........U I... .... ................. ..... .. .. .... ..... ........... .... ...... ............................. .......................................... ...................................... ............................................ ................... ........... Approved .................. ............................ 19 ...................................................A� . ......................... ................ ...........................................................