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0146 SADDLER LANE
P/6 �,SQdd/er Lctr,�C—1 /// q =S�gE�:.tiieOrpLm UPC 12543 No. °05?•CONSJe HASTINGS,MN i Town.-of Barnstable Biildlil i Post This Card So That�it .1'%isible.Fcom Ltie Street-Appco"ved Plans IVlust:Tie Retained on.Jobrand this>Card MusLrbe Kept essse;" Posted UnfilFinal Inspection Has Been,Mad'e. 9 . Where�a{ertificate'of Occupancy is'Regwrecl,such,Building shall Not�bexOccupied until a�Fiiial�lnspe�ttion�:has"been'made.` Permit Permit No. 8-17-1381 Applicant Name: LEARY,STEPHEN J&DEBORAH Approvals Date Issued: 05/17/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration;Date: • 11/17/2017 Foundation: Residential . Map/Lot: 151-075 Zoning District: RF Sheathing: Location: '146 SADDLER LANE;WEST.-BARNSTABLE Contracio�Name: Framing: 1 �. Owner on Record: LEARY,STEPHEN J&DEBORAH- • T Con 01 tractorZ-L1cense 2 - Address: 146 SADDLER.LANE fix,k $39,500.00 cto : Chimney: WEST BARNSTABLE,MA'f02668 Permit Fee: $:251.45 Insulation: Description: Obtain permitting requires for kitchen remodel entailsAreposition of a Fee Raid 5 251.45 i load bearing.walls gate 5/17/2017 Final: Project Review Req: Obtain'permitting requires for kitchen remodel entails .h - �,� � t .vl�.,. Plumbing/Gas .reposition of aload bearmgwalls ' "• �- : :�- .�� � � ry. �..:. . .........,. iRough:Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by'this.permit is to within six'"' m,rafter issuance. � _�. Rough Gas: All work authorized by this permit shall conform to the approved applicatidn aOR&pproved construction documen or�v ch t�h�s permit has been granted. All construction,alterations and changes of use of any building and structures,shall be m compliance with the local zoning',, •laws and codes. Final.Gas:This permit shall bepdisplayed in alocation dear) visible from access street or road'abd shall.be maintained open for ublic,1ns ection for the entire duration of the PY P P P I work until the completion of the same. � 1 Electrical The Certificate of Occupancy will.not be issued until-all applicable signature's bythe Building and Fire Officials are'provided-on`thisipermit. Service: ' Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing " " , •� Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed .. Final: &4.Wiring Plumbing Inspections to be completed prior to Frame'Inspection S.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 forElectrical,Plumbing,and Mechanical Installations., Health Work shall not proceed until the Inspector has approved the various stages of construction. Tinak "Persons contracting With".unregistered contractors do not have'access to the guaranty fund"(as set forth in IVIGL c.142A). _ Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J' Parcel 0715 Application #� Health Division Date Issued , Conservation Division Q11VG DEp-- Application Fee Planning Dept. MAY I o Permit Fee Date Definitive Plan Approved by Planning Board TOI&A, 2017 Historic - OKH Preservation/ Hyannis e�C lip ject.Str-eet Address `MCP Sc�d /er L t'1 (.U2 s�- 6Arr15�4h/f na0[o Village OW er:5 ix— 0 L-e ac / Address I'LI(n Sac�c�le r L n Telephone D Permit Request 0e;WI ta VZm lr�lN,6, „\t-6V3 V l VLD ��t�i L S �e�s►`c't�J j �b a �A Q ����C� ��0 LL , � , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District g Flood Plain Groundwater Overlay Project Valuation 2A sc�•�J 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: ❑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) C18P�Z�e Tel p oh ne Number - 5 a03 —4Zb -O Sb' Address) u tto ' )Dtb Lf1\_ L0 0 C License # 6A� ®`Lbbg Home Improvement Contractor# Email_M A R-►--U\171 �:ePWD . Cj t Worker's Compensation # M�� ___ AL0JJN_�-- --�STRUGTION-DEBRIS_RESULTING FROM THIS PROJECT WILL BETAKEN-TO^ PoSrJ 'SIGNATURE' 54 k/-- DATE—,, j FOR OFFICIAL USE ONLY Y APPLICATION # DATE ISSUED t ' MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME za rw INSULATION `u FIREPLACE ti . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s` DATE CLOSED OUT , _ ASSOCIATION PLAN NO. ' Client#:41389 2EMERALDCi r ACORD,. CERTIFICATE OF LIABILITY INSURANCE DAT 4/2s/206/20D/YYYI) 17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME;NTACT Dowling&O'Neil Dowling&O'Neil Insurance Agency PHONE 508 7T5-1620 973 lyannough Rd,PO Box 1990 Er AID Exe: A/c No: 508T781218 ADDRESS: COi@doins.COm Hyannis, 02601 INSURERS AFFORDING COVERAGE NAIC 0 508 775.1620 INSURER A:NGM Insurance Company 14788 INSURED Emerald City LLC INSURER B: INSURER C 2307 State Road Plymouth,MA 02360 INSURER D: INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �� TYPE OF INSURANCE INSR SWVO UB POLICY NUMBER POLICY YY POLICY D(P LIMITS A GENERALLIABILITY BPT0090S 4/14/2017 04/14/2018 DEAACCH��OECCCURRRRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oN D roe $5OO OOO CLAIMS-MADE F]OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY JE 0. LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ISCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PROP $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS L IAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION W1J7290M 4/14/2017 04/14/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIE'rOR/PARTNERIEKECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 If es,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $5OO O00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Steve Leary SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 146 Saddler Lane ACCORDANCE WITH THE POLICY PROVISIONS. West Barnstable,MA 02668 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of-ACORD #S190101/M190100 CBD i 77z-e Comm.artiveaitis of 1 assrrclrusetGs Deparhnait of In ustrid Acdderds Q,fie a,fIntwtzgatiamrs . . 600 Washington,street Gastrin,ALA 02111 'Wor•leers' CGmpensai an Insurance Affidavit BuilderslContracfursMec dcians!Plumbers ApplicantInfwmafran Please Print lily Name(B Oigania4ionfln�ival� g��u� l��CL� Address: 1 LQ0 S4 0b L62 Are you an employer?Check.the appropriate bb=: ' T of project r I am a general contractor and I Yl� l?r J ( e�uu ed}: L❑ I am a employer with b 6. ❑Items construction employees(ftz11 andfor part-ime)-* have lvredthe sub-contractors 2.❑ I am a sale proprietor orpartner- fisted ou.the.attached sheet. I- ❑Remodeling slip and have:no employees These=b-contractors hake 8.,❑Demolition. woddng for a21P in any capacity. employees andhave woikers' 4. ❑Building addition INo tpdbem' comp.insu a„re comp.msu=M1 ed. 5. ❑ We are a corpomfion and its 14❑Electrical repairs or ad�ons re quired-]mr o$cess have exErcised their 3.❑ I am.a hameawner doing all worlG 1 LEI Plumbing repairs or additions. myself.[No woikecs'oamp. riglit of eaempfion per MGL 13.❑Roof repairs insurance required-I E c.152,§1(4k andwe hawe no employees.[No workiers' a❑Other comp.insurance mViired_I *Any Wffcustdmtche 3box#1—stalsoffiautthesecdcmbelowshmt gtbekwcaeecompeasatinapeRUiafocrosuom #&ameowners uho submit this afiidavu in dusting they see�aiag slI wad and tfi�bite outside t ontmctars nmst submit a new affida1ft b,,itv6ne sack TCaatractosIMst thecitfhi5 bat must attached toe adriifinnal sheet sIwtuiag thenane of the sub caatxstfioa•and state whether arnot fbnse entitieshare employees.If the sub-contmctombive anployees,they pmtide their warken'rrmp.policy,number. I am an empLapr that is prm idirra workers'compensate insurance for my employees Relow is thapolicy and job site informatiom Insurance Company Name: Policy 4+or Self-ins..Ec.O RkpitationDate: Job Site Address: Cityf5tatelfsp: Attach s copy of the w&rkere coxmpensationpolicydeclaration page(showing the policy member and expiration date). Failure to secure coverage as required under Se-etion 25A of MGL c 1572 can lead to the imposit of rdminai penalties of a fine up to$LSOD.00 an&or one-yearimprisonment,as will as civil penalties in the form of a STOP WORK 01ZDERand 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 hwest gations of the DFA for insurance coverage yred5cation_ 'I d'o hemby cmrdfjt rzatder tlrs pains alldpenatties ofger urp t7ratflle irzforrsca#iQrr prooirTed abors ig i}ars aced correct $i2nature, V,,— Date' - S OPhone iF Ojo&i b use anly:, Do not write in fFds area,€rt be campleted by city artown officiat City or,own: PermitUcense# Issuing_Ufl rArity(circle one): L Board of Health 2.Building Department S.GtydTo rwn Clerk 4.Electrical Inspector S.Plumbmg Inspector 6.Other Contact Person: Phone#: ormation and last'uc ious M car]rzceffs Geheaal Laws duptr-r 152 req�es all empIoyeas Yo provide wormers'compensation for their emghIoyees. Pmso-fat-t o this sue,an er7q7Iayee is de-fhaed as.';e=y persdn in.tie smvice of another under any contract of hue, express err inrpliaA oral or writhm- defined as"an individual,paxfnership,association,corporation or other legal entity,or anY two or more Au Moyer is of the foregoing engaged ina Joint cntr-p ,and including the,Iegal=prese�afi a deceased employer,or the receiver or tmstee of an individual;pmtam-hip,association or other legal entity,employing employees. However the owner of a dweIIinghouse having-not morethan tluMapadmeuis and.-who resides therein,or the occupant ofthe- dw di-ing house of another who employs persom to do mahtenmce,construction.or repair work on snch dweIling house or ou the grounds or bmldmg appmt=zzt thereto shall not because of sash employment be deemed to be au employer." MGL chapter 152,§25C(6)also states that'every stat-,or local Rcea�a agency shaII withhold tie issuance err 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 compl'ran.cewith the insurance.coverage required" AdcfitLonally,M([,chaptra 152,§25C(7)states¢Neither the commonwealth nor hay ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of complimcewith the fimn-mce.. rents of this chapt r Dave been P==ted to the contacting authority_" Applicants Please fill out the workers'compensation affidavit completely,by checking dhe boxes that apply to your siination and,if necessary,supply sub-contractors)nane(s), addresses)and Phonenumbe(s)alongw"htheir certificates)of ms�ance. Limited Liability Companies(LLC)or Limited Liabr7ity-Partnerships(LLP)withno�Ioyees other than the members or parEaeas,are not xtgaied to carry wotrers'compensation insaranm If an LLC or LLP does haTe employees,a.policy is rminired. B e advised that this a$da-?tmaybe submitted to the Department of Indus ial Accidents for confirmation of insurance coverage. Also be sure to sign and date t affidavit The affidavit should beretumed to$e city or town that the application for the peunit or license is being requested,not the Department of Lrizrstrial Accidents. Should you have any questions regarding the law or if you are reqoi-red to obtain a workers' compensationpolicy,pleasecaatheDepmtmeatatthen=bedlistedbelow: Self-insured companies shouldentertheir self-insurmce license number on the appropriate line. City or Town G:EdaLs Please be srn e that the affidavit is completo andpriirted.Iegibly- The Departmeathas provided a space of the bottom of the affidavit for you in fh710 in the event the Office of Investigations has to coact you regarding the applicant Pleas e b e sure to th71 in the peu iltllicense number which will be used as a reference number. In addition,an appli�t�nt that must submit multiple pennitMcm sa applications in any given pear,need only submit one affidavit iodic. tng p olicy baf6=ation(if necessary)and under"Job Site Address"the applicant shou.Id write"a]I locations in (may or town)."A copy of thczffidavk that has been officially stamped or marked by the city or town maybe provided to the . applicant as proofthat a valid affidavit is on fle for fdm pem is or licenses. Anew affidavitmust be filled Olt each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial vennna (i.e.a dog license or permit to buns leaves etc.)said person is NOT reqaimd to complet-,this affidavit The Office of Inves6.gatians wound 15m to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Departmenfs,address,telephone and fax rrmnber: Thu Cn-MmDaWmItbE of Massachus! t s , I)eagajtm=t of lndustzal Accidents Boston�MA 0�111 Tel.if 617- -4 �t 4€6 or 14P :� Fax#617-727 774 1Zevised424-07 a .ga Idia. Town of Barnstable Regulatory Services '. drrIKE b "Richard V.Scali, Director Building Division ERL%M Paul Roma,Building Commissioner KAM � s �m� 200 Main Street, Hyannis,MA 02601 pTEn www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION .. `� `--� Please Print DATE: p . JOB LOCATION: I L((O numb�er1i / street village "HOMEOWNEIU': name 1 home phon�e�# work phone# CURRENT MAILING ADDRESS: L4 6& goi-- g 019 L6 MA , D Zkob6 cityltown state zip code The current exemption for"homeowners"was extended to include owner-ocMied 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 hermit. (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 Htmeowner 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 shall 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,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed•person as it would with a licensed Supervisor.. The 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 to amend and adopt such a form/certification for use in your community. • �1ME?� Town of Barnstable ti Regulatory Services BARNSTABM Richard V.Scah,Director �'OrE16,19. '`0� Building Division Paul Roma,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 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 Print Name Print Name Date Q:FORM&OVJNERPERMISSIONPOOLS �BoiseCadcade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 1 span I No cantilevers 1 O/12 slope April 26,2017 11:40:49 BC CALC®Design Report Build 5837 File Name: Enerald City_146 Sadler Job Name: Description: Designs\FB01 Address: 146 Sadler Lane Specifier: jim City, State, Zip:West Barnstable, MA Designer: Customer: Emerald City Company: Shepley Wood Products Code reports: ESR-1040 Misc: �_w__v—s__._ •___�„�� •v o w- •y 9 3 v - s X s Xw -V Xo 4 y . w-.. er.. +r..�,--..5-;.. ..fir s v o r v -v ' X AP p •y 12-00.00 BO B1 Total Horizontal Product Length=12-00-00 Reaction Summary(Down I Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 480/0 1,298/0 240/0 B1, 3-1/2" 480/0 1,298/0 240/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area (lb/ft^2) L 00-00-00 12-00-00 40 10 01-04-00 2 Unf.Area (lb/ft42) L 00-00-00 12-00-00 20 10 01-04-00 3 Unf. Lin. (lb/ft) L 00-00-00 12-00-00 160 n/a 4 Unf.Area (lb/ft42) L 00-00-00 12-00-00 15 -30 01-04-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 4,934 ft-Ibs 35.3% 100% 1 06-00-60 End Shear 1,457lbs 23.1% 100% 1 01-01-00 �,�ik0 F. Total Load Defl. U566 (0.245") 42.4% n/a 3 06-00-00 Live Load Defl. U999 (0.072") n/a n/a 6 06-00-00 or LAIC J, G Max Defl. 0.245" 24.5% n/a 3 06-00-00 ` CEDERHOLM m Span/Depth 14.6 n/a n/a 0 00-00-00 u MUCTURAL Squash Blocks Valid No 3890 %Allow %Allow ��` Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 1,838 Ibs n/a 20% Unspecified B1 Post 3-1/2"x 3-1/2" 1,838 Ibs n/a 20% Unspecified Notes Design meets Code minimum (U240)Total load deflection criteria. Design meets Code minimum (L/360) Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume member is fully braced. Design based on Dry Service Condition. Fastener Manufacturer:TrussLok(tm) Page 1 of 2 ®Bolsecascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor Beam1FB01 Dry 1 span No cantilevers 1 0/12 slope April 26, 2017 11:40:49 BC CALC®Design Report Build 5837 File Name: Enerald City_146 Sadler Job Name: Description: Designs\FB01 Address: 146 Sadler Lane Specifier: ilm City, State,Zip:West Barnstable, MA Designer: Customer: Emerald City Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure +� o r— d -- .- Completeness and accuracy of input must be verified by anyone who would rely on a I output as evidence of suitability for particular application.Output here based c on building code-accepted design properties and analysis methods. • Z • • Installation of Boise Cascade engineered i 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=5-1/2" (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALC®,BC FRAMER®,AJSTM ALLJOIST®,BC RIM BOARD-,BCI®, All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. BOISE GLULAMTM SIMPLE FRAMING All TrussLok screws may be installed from one side of multiply Versa-Lam beams. SYSTEM®,VERSA-LAM®,VERSA-RIM Member has no side loads. PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are Connectors are: FMTSL338 trademarks of Boise Cascade Wood Products L.L.C. /Z°il 2x14o Iuk - Mgylo � rowNopB 4?411 A��'i is e=�Arz. - r - I i i i i The Commonwealth.of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, ?t1A 02114-2017 ►vw»;»tass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apulicant Information l Please Print LeLribly ame(Business Oreanizat;outlndi�it+�ial j: !9l lr I�(�s e7 c lye ryk 1 -Foc, (.-t✓G Address: City/State/Zip:, tat: 14 KJ\11,62. Phone 4: 7 Are you an employer?Check the appropriate box: l LQ I .a employer with employes(full arxL'or pan-time).* Type of project(required): !. Q Ne»�Construction 2. I am a sole proprietor or partnership and have no employees working for rite in any capacity.(No workers*comp,insurance required.] S. Remodeling s.�I ant a homeowner doing all work myself(\o work-"_ ,cmrp.irsutartce required.)t 4• Q Demolition 4.[:][am a homeowner and%N ill be hirine contractors to conduct all work on my property. I will 10 Q Building addition, ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietor with no employees. 12.Q.Plumbing repairs or additions :.Q i am a general contractor and i have hired the subcontractors listed on the attached sheet. TL•ese s b-centractarn have employees and have workers'comp.inswmnce.; 13.[:]Roof repairs 6.a Nb'c arc a corporation and its officer have exercised their right of exemption per MGI_c. 14•QOther 152,§1(4),and we have no employees.(No workers'comp,insurance required.) Any applicant that checks box;4'I must also till out the section below showing their WoPrers'compensation policy information Homeowners who sub7rit his affidavit indicating they are doing all work and then hire outside contractors muss submit a near atftda%irindicating such. Contmaors that check this box must attached an additional sheet shoving the name of the scb caatr2ctors and mate whether or not those entities have employees. Ifthe sub-contmcups have employees.they taust provide their workers'comp.policy number. 1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy>=or Self--ins.Lic.=: .Expiration Date: Job Site.address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(shoeing the policy;number and expiration date). Failure to secure coverage as Nquired under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby ce •y under he pain a penalties ofperjury that the information pro tided ab�ovgis tr to and correct. Signature: Date: Phone.=`: `7 -7 - e-7 Official use onl}-. Do not Write in this area,to be completed bit cite-or town ofciaL 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#: .4 o rsg � g 8Z. 6S - - � -7 �t ` ` o y O Q f � Q CERTIFIED PLOT PLAN LO CAT 1ON/9V SN'11 VOTE' Th�t� P2oPGaftTy/�o�s No7 FAtt_..wiT�i�✓R /"�_ SCALE . . DATE .� 'l!/�'JJ LLi 7 dfl A 6L11/�� .Z�/✓E �7,Di1//.i��C��)X�S S�vw d i i: *.r+-n �1 . -T��- fN��O�i!ll�r! �i1/E.L if/a.�Z S"'C�o'/.- �����. o-��:�• �...�..,,;,:�;. .., .. . . _.._ .. _ .._ :.. .._... ,2isrrt y gas F .gx: ?o PG. 9 7 N OF CERTIFY TKAT THE ��'/ �J� Ak�EIG/N ; �_� �--•�+., - ':u; �{�5'i7.'gf. T.i't i.�i,F'��:t-`i.;i+lt'ii-'LY�.�4Ytt.'Wi�4:'d''.sw*.8�+cr6 =s.. -��,.3 g AS SHOWN HEREON o.17030 /.^TE �Q� DATE t - . :. ��yp SD�v�,� �• w�ST y�/yI0(fThlj/I9�-�• TITIONER: . . . . RED. PROFESSIONAL LAND SURVEYOR .y • 1� .i«♦..�` S7.\gin:.::�:-�o �.5:•: ,.,.�-\::-.It I�' 7•C..J'. ,,,.� •� i ,'J �I•:•• tom,•�;ne.�,'',.•�',, •T/, �r�. �S G'�.,:/•,.��t .l•, d. � �` � .I- .�!:, .w..il./ii 1.r::',s•i"•4'i..'; .ii: .1'.�j���� _CFY�..-• _ 4= _ � .n---...-� _ _� .�.:1 .a y;� �' -..1'•:.�... ..�:. "It'' '�•Z�� 1 ��1,',%ate.... ..):. - ,mw ;. `,i _"�.�..' .•c:_ - •in/{t�.�/y.,, !� •iG� ;II: ;;�; �C,.�^:camIlk, — :._�.`_r .`• :.__ - -- _— �'••• 54� ;,t: '�� 96 .x,�: :'�.:, .�'/.<r:Li v+i':��-. :.�,' ,S � _ _ _ _�� 1!-�' fir•' - 1ir�%•...�.,h'',,:�%.•' "i cy5ia:�.iAp ��.—�:.:.:..•. .tu. — li'':�.1'..:i-at _ -� -!�n•�.�..�=. /!'•�a��ll�'•f�,TI�•�: qj /////�1�L�It'111'��u���!!l�f�1 I i y l:� I!.: �:_::.:�.• -_ .r + _ � _ 'r I`,_�,_.'>!�� .//' 1�\��•1'1�� Jr.a �...:»: _� i I w ��..�\�� I ?_ �llfdi.i:l'•�.,. �, '^1>•► '=-A_i�+::. —=— ,,Clam ........ I• ,.• q pll` llll fll 1 LI .N`V f:� 7 - RV r t ' i L�■�J _a fI II _ �- r .g� Bedroom 12 X 15 i i Balcony IT6'X'17'6 Cathedral The Secretariat Second Floor evi Tb 0? oc &f)1I ' I f . I i 1 O GJ is _ co 0) Im �` ! I -r I CA) _ 1 - i i ° I ; S W 00 N v O cr i I Ut r 1 O 0) CD C{fV I i W v' OD i ! I 1 W . I I _ • 1 o i tjj- e 6 it e L l ---— - ------------ 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Nrap' �/ Parcel Permit# O �a Heai�h Division �� S — /�/ Date Issued OF qG Conservation Division Fe Tax Collector Treasurer ' Planning Dept. Checked in By - . EXISTING SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board App' oyl. _7 M�... Historic-OKH Preservation/Hyannis `Q Project Street Address Village 'l'`/ c Owner—S 1 -✓� �e a � Address �,— Telephone f Permit Request Square feet: 1st floor: existing_ proposed 2nd floor: existing proposed Total new Valuation Ulm Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family Ox Two Family ❑ Multi-Family(#units) Age of Existing Structure nP f S Y*'�istoric House: ❑Yes o On Old King's Highway: ❑Yes 4110 Basement Type: ull ❑Crawl O 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 O No Fireplaces: Existing New Existing wood/coal stove: O Yes', ❑ No.'-': , Detached garage:O existing ❑new size Pool:O existing ❑new size Barn:O existing O new, size Attached garage:O existing ❑new size Shed:O existing ❑new size Other: �I .. Y Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ r3 r-,y Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �� �'l Telephone Number 5AY-�-Y `7C1" 1� 5� — Address License# OjO—CFHome Improvement Contractor# (� 0y�3 Worker's Compensation# � - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ��� DATE FOR OFFICIAL USE ONLY Y PERK41T NO. ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r e _ DATE OF INSPECTION: FOUNDATION FRAME E7 INSULATION Lo FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH = FINAL GAS: ROUGH PO i6- FINAL - FINAL BUILDINGcl) , DATE'CLOSED OUT ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts Department of IndustrialAccidents Office.of Investigations 600 Washington Street y` Boston,MA 02111 ',N 5••' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly "� Name (Business/Or nization/Individual): Address: ` .Let- City/State/Zip: w-►, '"wsc}�i lv M'L Phone d 1 Are you an employer? Check the-appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.E dam a sole proprietor or partner- listed on the attached sheet. x 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. - 9. ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL II Plumbing repairs or additions myself.-[No workers' comp. c. 152, §1(4),and we have no 12.❑ R of repairs insurance required.] t employees. [No workers' comp. insurance required. 13. er ] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information I am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site information. - Insurance-Company Name: Policy#or Self-ins.Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500..00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and co rrecs: . S• ature:. Date:,. � Phone#: Official use only. Do not write in this area,to be completed by city.or town off8cw City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, au 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:"au mdMdual,.:partuership;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 workvn such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for:future permits.or licenses..A new affidavit.must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . Department of Industrial.Accidents Office of.Investigations .600 Washington Street- . . Boston, MA 02111. Tel. #617-7-27-4900 ext 406 or-1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia �F�HeTTown of Barnstable , . Regulatory Services s,►WgrABLE. ' 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 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. . (( /0 Type of Work: ^ S�'ea ram`v'`� Estimated Cost Address of Work: 7 l� C�' l Vf1 q rw � (/l22•� i�ZPo Owner's Name: Date of Application: D s I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK.DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby app permit as the agent of the owner: 617.0r; C _ • � a6ULI. Date actor N e Registration No. OR Date Owner's Name Q:farms:homeaffidav M CUR Appeadls J Table JSX[b(continued) p}escriptire Packages for One and Two-Family Resldentlal Buildings Heated with Fossil Fuel MAXfMUM ASIMMMYm1 alariag Glazing Ceiling wall Floor Bas==1 510 Heating/Cooling- Area!(•/.) 11•valusa R-valusJ R vala R-valu2 'Wall perimeter Equipment Etlideacy' Package R-values R vaiuo! 3/01 to 6300 Heating Degrse Da 12/• 0.40 38 13 19 10 6 Normal Q ' Normal R 12% 0.32 30 - 19 19 10 6 g 12% 0.30 38 13 19 10 6 8S�f11E ATIA Normal 13 ZS NIA 6_ --Normal- - ----- U..:. .. .:15% 0.46 38 19 T 19 10 N/A M AMIE :..:15% 0.44 � 38 13 2S N/A w IS•/. 0.32. 30 19 19 10 6 83 AFUE X 18% 0.32 38 19 25 NIA NIA Normal. y 18% 0.42 38 19 25 NIA NIA Normal Z ., . 19% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.30 30 19 19 10 6 90 AFUE I.-ADDRESS OF PROPERTY, S:. 2. SQUARE FOOTAGE OF ALL EXTERIOR WALL 3. SQUARE FOOTAGE.OF ALL GLAZING: ✓ 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q4orms-S80303a - - rA 780 CMR Appendix J Footnotes to Table J$.2.1b: lass doors, skylights, dad + Glazing area is the ratio of the area of the glazing assemblies (including sliding-g ows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall basement wind area,expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 fe of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3.a. U-values are for whole units: center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the-exterior walls without compression, R 30 insulation may be substituted for R 38 insulation snd R 38 insu7ahon may be subtuted`for R=49'-insulation: Ceiling R-valries=represent the sum•of.cavity— _... insulation plus insulating sheathing (if.used):For ventiIa d ceilings, insulating sheathing must..be.placedbotween . the conditioned space and the ventilated portion of the roof. ,.. 4 Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(If used). Do not include exterior siding, structural sheathing,.and interior drywall.For example,an R 19.requirennent could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Will requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any.individual basement wall with an average depth less than 50%below grade must meet the same R value requirement as above-grade walls. Windows and sliding glass •doors.of conditioned. basements must be included with the other glazing. Basement doors must meet.the door.U-value requirement described in Note b. The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes electric resistance heating use compliance approach 3;4, or 5.• If you plan to install more re than one piece of cooling equipment, the equipment with the lowest than one piece of heating equipment or mo efficiency must meet-or exceed the efficiency required by the selected package... For Heating Degree Day requirements of the closest city or town see Table J511a NOTES: -values ar a)Glazing areas and.U-value mare max mu and ep not include structural components. minimum acceptable-levels. R-value requirements are fotabl levels.Insulation R y b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,of crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component.Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 r -, °FtF1E, Town of Barnstable Regulatory Services � a s�xrrsre ' Thomas F.Geiler,Director 9 �. 0q 4'pf,� `e 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 ABuilder I, ea r as Owner of the subject property to act on m behalf, hereby authorize Y in all matters relative to work authorized bythis building permit application for. (Address of job) AUK$ Aoqos 11 2D05 Signature of Owner D i Print Name QTORMS:OW "ERMISSION xn t�';. �a,�:rya,�3 :/1ZC T009)�/!➢LO7LlI/� OL S��� , . x ' �,w:Bird of liui{anig l2ckulau�l/� �4i1 y�urTHtfcls�` , HOME IOVEMENh'CONTR15C7rOR' Regist4ttonN 10023 fi ?/2006 x �a;one GREGORY C. f GREGORY VAR i a 18 6AbDLER i_N WEST BARNSTABLE, A4A 02668 �: . i c• ' _`_`_ AUmiiiiTA(ptor BOARD OF BjllM?DN tfiEC;l�1LvAyTtdN,S{ 4.6,'c-- a OO IiSaTF2lJC�T®,I S jPFy, 'Vi O,R: ;r ` Alu MA, 'beiCi ©49;825 �' Bi date• 1/_31%A§1 - Ir 6 Tr.no: 15872 Re. GREGORY C VA r�lll : POBOX712 CE'NTERVILLE, MA © 3 Acting:o-o'miss ner .. e Y �.Y � ":' n` ��R+L"Prd of l3urtdiug 12�i�uIJUr�antl S�ih�{ � " HOME I VEMEIJl'CONTRI�(:7�OR` Re isttro� 10023. /2006' GREGORY C.- GREGORY VAR A "�8 SADDLER W WEST BARNSTABLE, NIA 02668 ✓ S o B ��RD�iO.F UI DIN �'�ULvA f'�N'S, �Lrc �CsO STRU�T,O Sly, VI,StiOOs� ?i � ) Rd m ©49,825 Bpi' •1 '6 Tr.no: 15872 y;. Re GREGORY C VA PQlip�@X 72 CENTERA'G6LLE, MA A�c`EiOg2 MOM miss."nee i - " a - I o 05C-tD LcxIST NCB Rcmr �-(r.1�� i pR P � 5 N�� Do�2r•ER � • i r (�La V4-TJ��tJ SPELT -IMPORTANT sH 1,, Cb -S TION THAT INCREASES LIVING SPACE 4 .VOND 1200 SQ. FT. PER LEVEL MAY REQUIREoTHE •STALLATION OF ADDITIONAL SMOKE DETECTORS. .OTE: A SEPARATE PERMIT IS REQUIRED FOR THE STLLATiON OF SMOKE DETECTORS-THE ELECTRICAL �-O =_RMIT DOES NOT SAi iSFY THIS REQUIREMENT. /� NDGRSc:rV 11 C-33 c-A5,c 9mr `� cam✓+-�' ���(�' �S , GAP- 67 C RADA i O v 1 I i\1 �. J l � ri O Zoo rj � G1 J i v rr4 011ie LA r' L7 io N � r.A A o �;a � 'S 11�.41 C_( ( U 6U LW - Gets-rr�l�-7 zxiZ r��,C ►3,ar� 5T/a �r L RE VCArr- o�oSL� SNLD �o,RMi z;�` 16,1 v.C, — E-�' drip dwL,Iec.cle�- dY�R ?AAA-6)G •rtn�o�.s -,C4f ;, �e�-�-- AO �( PA w4!.u> i Kt�'t°1ViG 2x 10 o-C . Zito .. t `,, o.t:. RAFT ax►o dcsv�Ie z � �(a,+-e. �� tN► 1 c z-14y IG o av e r�t;.ne ��✓ AilP�G� uoisw BC CALC®2003 DESIGN REPORT - US Thursday,September 22,2005 10:34 Double 1 3/4" x 11 7/8" VERSA-LAM® 3100 SP File Name: G Varjian_Leary.BCC: FB01 Job Name: Leary Description: Address: 146 Sadler Lane Specifier: City,State,Zip:West BArnstable, MA Designer: Joe Madera Customer: Greg Varjian Company: Shepley Wood Products Code reports: ICBO 5512, NER 629 Misc: 13 2 Standard Load-30 psf 110 psf Tributary 01-00-00 Ak "ilk BO B1 3360 Ibs LL 3360 Ibs LL 2147 Ibs DL 2147 Ibs DL Total Horizontal Length-14-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00-00-00 14-00-00 Live 30 psf 01-00-00 100% Member Type: Floor Beam Dead 10 psf 01-00-00 90%. Number of Spans: 1 1 Unf. Lin. Left 00-00-00 14-00-00 Live 0 plf n/a 90% Left Cantilever: No Dead 60 plf n/a 90% Right Cantilever: No 2 Unf.Area . Left 00-00-00 14-00-00 Live 30 psf 11-00-00 115% Dead 15 psf 11-00-00 90% Slope: 0/12 3 Unf.Area Left 00-00-00 14-00-00 Live 20 psf 06-00-00 100% Tributary: 01-00-00 Dead 10 psf 06-00-00 90% Controls Summary Control Type Value %Allowable Duration Load Case Span Location Live Load: 30 psf Moment 19274 ft-Ibs 78.8% 115% 3 1 -Internal Dead Load: - 10 psf Neg. Moment 0 ft-Ibs n/a 100% Partition Load: 0 psf End Shear 4728 Ibs 51.2% 115% 3 1 -Left Duration: 100 Total Load Defl. U241 (0.696") 99.4% 3 1 Live Load Defl. U396(0.425") 91.0% 3 1 Disclosure Max Defl. 0.696" 69.6% 3 1 The completeness and accuracy of the input must be verified by anyone Notes who would rely on the output as Design meets Code minimum(U240)Total load deflection criteria. evidence of suitability for a Design meets Code minimum(U360)Live load deflection criteria. particular application. The output Design meets arbitrary(1")Maximum load deflection criteria. above is based upon building Minimum bearing length for BO is 1-7/8". code-accepted design properties Minimum bearing length for 131 is 1-7/8". and analysis methods. Installation Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing of BOISE engineered wood products must be in accordance Connection Diagram with the current Installation Guide Consult project design professional of record or BOISE technical representative for connection design and the applicable building codes. Member has no side loads. To obtain an Installation Guide or if you have any questions,please call Connectors are: 16d Sinker Nails (800)232-0788 before beginning product installation. a=2" b ' d BC CALC®, BC FRAMER®, BCI®, b-3 BC RIM BOARD TM BC OSB RIM -4 a BOARD- BOISE GLULAM-, d= 12" -• —• - • • VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, C / VERSA-STRAND TM, � VERSA-STUD®,ALLJOISTO and AJSTm are trademarks of • - • Boise Cascade Corporation. Page 1 of 1 ' Assessors map and,lot number ...... / (�4 / THE .. �O Off` i P Sewage Permit number ........ .............. House number ........................... 2 BAHBSTADLB, .................. /. : ......................... q0 039. 69 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,U„l L...........................A S TCJR ............... ................. .... TYPE OF CONSTRUCTION ...................`AJX�rr4jQ..........7.-e1)M...r........................................................................ .TfJ �...... �.......19. 5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followi g information: Location �� `?��.......... Si9DOLCv! �69k�( ..............�l,�t.1.T.. .. T7!LL.......... ... �`l, /(ISTfi�Gl� ProposedUse ................a✓.(!u .......................................................................... ................................................... Zoning District .................... . ..............................................Fire District ...............C' G .............................. Name of Owner .....:S .S......Te(1... 7...............................Address ......./O.l.�......I? ...�.3 .....1.. �� !�UPS.......... Name of Builder .'...... ....?E! .... .....Address ....................................... A !/!ll.S............: Name of Architect .....1/!!2pT 1 s!or..... Q,/.G.�/..........Address ........1�TC'.. �"A..... 1/Nl�W1ou��l(}ale r _ 9 , / 1 Number of Rooms ........................5 ....................................Foundation ....'..... a.U.U?e V� C.Q C(��7 Exterior ................s� CS..................................... .......................................................Roofing r. Floors .................... LYyu! n •Interior Sk ee;PQC1� Heating . _. .:..:... Plumbing U ,11C.0.7f)inCR........ y Fireplace ................ ..E. ...............................'.':.?..................Approximate Cost d ......... Definitive Plan Approved by Planning Board _�___� � i ___19— . Area ........9COB...5.�5�...30�f o� Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH • r e OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS Qon I hereby agree to conform to all the Rules and Regulations of the, o4BA rnstobl egarding the above construction. - /F� Name ................ ..........:J................. .. n Construction Supervisor's License ... A S L S TRUST A=151-004 & 006 No ..28839... Permit for ....1 St.�..... or..o y............... Single Family Dwelling ............................................................................... Location Lot 57, 146 Saddler Lane West Barnstable ............................................................................... Owner S L S Trust ................................................................... .. Type of,Construction Frame ......................................................... Plot ............................ Lot .............................. `> -January 13,- 86 Permit Granted ........................................1.9 Date of Inspection ....................................19 Date Completed ~ d 1 �As a sessor' map:and .,lot 10 SN&tllflJ3d lot number ..... .................................. O*TM E T�� Sewage Permit number .......:. All , 'aNb.309�HM b 3 1 )" NJ Q�1SNI 2 BABa9TAXE, i House number �/ S!y.............. '39Mrl�d�� ..............................uc ...............:...... yo rasa a 3£11St1W W31SAS 'J11d3S ooYpY.a`�� r TOWN OF BARNSTABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO ............to L� ......../.a:........S..TDR ......................................................... � .. TYPE OF CONSTRUCTION ...................11 4W4..........,,�emir....................................................................... `R....... .......19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the follow' g in fa,mati Location .......... ....,?r�.........5 k9.OL .......f�.��Sl�........ . . T CS(�... . .!.�L . ......t�� Proposed Use p ............................................ .......................................:............ " .W... L{.N. 1. ............................. ZoningDistrict ................. .........................................Fire District ................ ................................................... ...... Name of Owner .....S .S.... gV.ST...............................Address ......✓.OI�j ®1- ...Z3 ..... , N�� S.. Name' of Builder .. >a. .... LIOf!! ....... -..Address ................7........1...z............. ..flN.1lllS................... Name of Architect .....AP,7-#5.AC......Pe--4/9.N.........Address ........ e 41ef'out— CI� G1 ,,Nvmber.of Rooms ........................ ........................................Foundation ..........PQQgCA cape !?2 Exterior .................`�.�.1. ........................................Roofing .................t0. ....................................................... Floors ...............:....P�-YW�-.........::...:..::.........:.:....:...:....Interior ..............S�e�T a. ........................................ .. .......... 2-- Heating .... ......Plumbing .......... �� �.. / C�:........... .. 5. y Fireplace �f..CE.S. .......Approximate. C st 20 Definitive Plan Approved by Planning Board _ _ -------19 Area .........(12 .......1?�sc... o�s r Diagram of Lot and Building with Dimensions Fee �L2 " SUBJECT TO APPROVAL OF BOARD OF HEALTH I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of th own arnstable regarding the above construction. Name . ... .... FiS ....... Construct on u rvisor's License ..g ../.. I S L S TRUST ,No ...28839 .�Permit for ..1. ...Story................. �...S.z . le. Family...Dwelling....................... Location ... �......146... ..Lajip...... .Fa West Barns.tlbl.2............................ Owner ........ L 5.....Trust Type of Construction ...ZXame............................ : R - Plot ............................ Lot ................................ Permit Granted January 13, . 86 ,a Date of Inspection ......19 Date Comp etgd ..c.7..... ......... 19,'&-, c ' Ul X, C, 13 L ter, 04 �z _ o• TOWN OF BARNSTABLE Permit No. ------28839 l � 4 Building Inspector cash 1639. °"' OCCUPANCY PERMIT Bond Issued to S L S Trust Address Lot 57, 146 Saddler Lane, hest Barnstable Wiring Inspector �'L Inspection date " Plumbing Inspector Ile Inspection date Gas Inspector C ../t.n* �. f _.cc Inspection date 14 Fe h XEngineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. �, . / lg .....c-f".� � .✓ lam_—�^• Q� Building Inspector • TOWN OF BARNSTABLE Permit No. ------28839___-______ sZ i Building Inspector Cash +e39. 7--f-L-. °B' OCCUPANCY PERMIT Bond __ X ��, Issued to S L S Trust Address Lot 57, 146 Saddler Lane, West Barnstable Wiring Inspector �' � Inspection date £� Plumbing Inspector'� Inspection date ��G Gas Inspectors �* .� Inspection date k Engineering Department f ,�/ / ` Inspection date Board of health rl Inspection date • r THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. _...., .�_ y.. . i Building Inspector +::. :'vs �.-.:-�:^,F. 'G.�... --.rw.;.►.R..., T•� y..�° �'::4j,r e ., a '� 'y'` '�N.tti,j�,,,, :� •.e1. 1�. ti� s Y» .-.i. r� TOWN OF BARNSTABLE BUILDING DEPARTMENT t D, S = TOWN OFFICE BUILDING rua i639' �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: ' An Occupancy Permit has been 'issued 'for the building authorized by BuildingPermit #........ P....3 ...._......................................................................................................»...... . ......_. »...._». issued to ...5r�.......... 1✓..� ..... 10'I.� ........ _ .................... Please release the performance bond. 1HE tp Town of Barnstable, Massachusetts � an Development 'Department of Planning d Dlo • RMNSTASM I Huss. m Office of The Planning Board 034. �0 !. TEDMA'lA 367 Main Street, Hyannis, Massachusetts 02601 (508) 775-1 120 ext. 190 August 29, 1989 r Aune Cahoon, Town Clerk Town of Barnstable k Town Hall 367 Main. Street Hyannis, MA 02601 . .. Re: Subdivision 547C, "Hunter Hill 11 " ; Amendment to Special Permit At a duly posted meeting of the, -Barnstable Planning Board held August 28, 1989, it was voted that .a p,ub:l,ic hearing would not be necessary and to APPROVE the AMENDMENT to the SPECIAL PERMIT pursuant to Section 3-1 .6 of the Town of Barnstable * Zoning By- law ( formerly Section T) , by granting the REDUCTION OF THE REAR YARD SETBACK for LOT 57 by 75% to 11 .25 feet. Subdivision #547C, Hunter Hill 11 . Respectfully, Jos p E. Bartell , Chairman stable Planning Board JEB:vm ATRM COPY ATnW ---a— Town C:erk Town Clerk BARNSTABLE QAR�lSTABL� 1 6 Z.. 6S qj-7 ' �o O ` O �'S►V EQ i 33�f v , Q o � q o 4 a 3 h - CERTIFIED PLOT PLAN' LOCATION/�s.'`}��:W W.gAn!+"�TA$l� NOTE:'.'TJlt�_P2oP�*JZTy,Do6-r/Vor FA-LC-"G��T�iti�4 SCALE . /��_ �p' . . DATE W//��9 $lGJ�+ i}Zi¢;rLd_7 �00� Zoi✓E ov:;:-G.��//Ssbtwx) �� . . . . PLAN REFERENCE . HUIL}I/LGIZ 7-7h=P-,2eY1SEA: !/GUsT'l-7 %9 B 8 I e .. C.E. �L.s. yrSL.Qi►�cvTlf,/rI�4.st s�C�.4ilws OF M, srrz y� s F .�ex. fz o PG. g 7 • . . . . . `� J tiN I CERTIFY THAT THE �K/ I�JF.I�k/EIL/N�•. . 2E LPL E SHOWN ON THIS PLAN IS LOCATED ON THE GROUND • C ON H AS SHOWN HEREON 17030 Mp SURGE' DATE . ./ ETITIONER: REG. PROFESSIONAL LAND SURVEYOR' ' .;,,- -?; . .. � SECTION -'SEWAGE 23 -SEPTIC TANK- 3 - "D"BOX - 3 -LEACH -TOP OF DN ' -- - - __-.-- - ---- -- - __.—. '► I ..'7s 5 1 --•- - - -- tDQ(MSW• "2"OF 118TO STONE IN* j OUT• IN•. OUT• iN• F = _ s za lh"l D SEPTIC - ! ELEV. TANK ,{ + t ELEV. ELEV. - £LEV. ELEV. ELEV. OF 3A WASHEO-STONE TEST HOLE LOG p 4(a32 C '� •i � tESTBy� a11` �•C�hln �B•c�. .� -- - f a +Y TEST DATE WITNESS 05 DESIGNBEDROOM HOUSE T.H: it 1 T.H. 2 . . r� ,5 ELEV. i{rCard ELEV. �,! 0 DISPOSER DISPOSER g ( 14, PERC RATE NO MIN/IN. (¢2 , FLOW RATE 3A (GAL/OAV) 33C� 5 SEPTIC TANK S? .°(�.5�= qs h AEO'DSEPTIC TANK SIZE `t �d 1 t�I'r1 LEACH FACILITY SIDE WALL eMo = t 50.a (2,S) 3"C'i.O G/D. 1 / I 0 moo:3 � � •�..�� � 4$ N BOTTOM �t f O TOTAL 01 . 1 S� _ �h C. 2 t / 0' 0 t 2 1�oQ USE: 1 o►�IE LEACHING P�'f M �►O�/ LdT-6� . 0 1 FF'v= •6 Fes. E 1-4 . .pT 714 F 4Ar WATER ENCOUNTERED .14 - NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL) TAKEN FROM t-50,0ZI QUADRANGLE MAP 2.MUNICIPAL WATER S nV ULABLE AH or \6 *Q451AeOUT 1 iGO 2' 3.PIPE PITCH:W^PER FOOT _ _ 6,� � J 4.DE E 'H. SIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- 1; `1 -44 b ARNE S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. v p� C OJALA .�• 6.PIPE JOINTS SHALLWATER BE MADE WATETIGHT , 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. _ CIVIL , PLAN -STATE ENVIRONMENTAL CODE TITLE S _ _ _ NO.30T8?\ SITE. 8. T�-i�b Pt �' r F oL Y��7D hl� O►_i�K a.ra� J�.� - _ _.- {� ` Lane— REG.►-JOT 6E +..tb6D r=a� �Szc?t'sL1�f l .`� �r�.r+vcs �'c ri '� /� �'�[` `.. LOCUS: 1.e1-- �j"(� S(1d�\{�t'� r E • �k EhG\h ____ " �C ' • .��E`M4s,� Grp. ��--r�-fit�1�\ . t.••�ld r - •PRO AL ENGINEER' y � •.y�, •- ARNE y REF: down cape engineering : �."� c PREPARED FOR: I-OL64PA S6 I QLA)6 - - CIVIL ENGINEERS BOARD OFHEALTI! LAND SURVEYORS CONTOURS (EXISTING)............. vwbuIASt, — -�� ��t i►w. •� - SCALE u' {O (PROPOSED)-O-O-O-O- APPROVED DATE MA Yr DATE.•. 8 Z l 6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel ,�) Tpu ,' c p z a Permit# 6 t�.3 Health Division a e Issued YZ90 t—? Conservation Division 4N3 APR 23 PH 12: ftlication Fee Tax Collector Permit Fee Treasurer 01 11510f Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 146 La hi e,o Village QV d1 4I Ayi Skabon Owner a4d, Zr-&6 L/_S(lyd Address Zahg Telephone J Q Permit Request e < � o jln� Ch -y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation %3,2 4,a?, Construction Type _10—b AaAjml�f Lot Size—N/A Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. c1 Dwelling Type: Single Family ak) Two Family ❑ Multi-Family(#units) Age of Existing Structure /� ��f' Historic House: ❑Yes t�f/lo On Old King's Highway: ❑Yes 44 Basement Type: 2/Full ❑trawl ❑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: W Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes W] o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:UYexisting ❑new size Shed:❑existing ❑new size Other: , Zoning Board of Appeals Authorization ❑ Appeal# Recorded Cl Commercial ❑Yes �No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ShATelephone Number Address S a dW er Long n License# (�►^ �QX_�_ ttr Home Improvement Contractor# Worker's Compensation# ALL'CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY • PERMIT NO. DATE ISSUED ' i MAP/PARCEL NO. v ADDRESS VILLAGE^ OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE i r ELECTRICAL: ROUGH --' FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT ASSOCIATION.PLAN NO. Page No. of Pages ya° �s�m P.O..Box 90 P�+® '2067 7 9' Sandwich,MA 02563 E 508-888-5114 PROPOSAL SUBMITTED TO PHONE DATE Mr. Steve Leary (508) 428-0563 03/01/03 TREET JOB NAME 46 Saddler Ln. Fireplace Relining w/Stainless Steel CITY,STATE AND ZJP COD JOB LOCATION W. Barnstable, MA 02668 wine ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Installation of approximately-2.1 ft, of 92"x9 I recfi gular, 304 series stainless steel FireplaceFlex flexible liner into fireplace chimney flue. Will include stainless. steel Fire- .placeFlex pipe, top supports, one stainless steel chimney/rain cap, one damper rotary control sweeping of fireplacechimney.flue prior to`installation and installation of same,. . All stainless steel liners installed by our company comply w/MA building codes- Any permits required for the use of a heating. appliance is the homeowners responsibility to acquire. NP 17roposie hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Ehree Thousaad Two Hundred Forty-two dollars and no cents Dollars($. 3,242.00 Payment to be made as follows: )epost of 2 down ($1 621 .00) and balance due on completion of installation y )f P-r—op9sal 111 material is guaranteed to be as Authofted 9 specified.All work to be completed in a workmanlike manner SI nature according to the standard practices.Any alteration or deviation from above specifications involving g Odra costs will be executed only upon written orders and will become an extra charge over and Dove the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note:This proposal mTte honer to carry fire,tomado and other necessary insurance.Our workers are fully covered by Vorkmen's Compensation Insurance. Withdrawn by us if not 31 days. captttnrr Of PrO11110 l—The above prices,specifications and additions are satisfactory and are hereby accepted.You are authorized to do the work Signature is specified.Payment will be mace as outlined above. /� 4e )ate of Acceptance_ 4 / �-/63 Signature ---- _-_---___ The Commonwealth of Massachusetts — _- Department of Industrial Accidents == _ ONCe o/%Yesmomffoos _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit �.. name: 6 • location phone city ❑ I am a homeowner performing all work myself. (:3 lam a sole rietor and have no one worlds in capacity I am an em Toyer raviding workers' compensation for my employees working on this job.:: ::::::::::::: 'company nam iticldre C ty' 2 ' .. ............................................................................. . ... . . %%4i?.«fi'. ' ` <a < nsuran �cv I am a sole proprietor,general contractor or homeowner le one)and have hired the contractors listed below who have the followingworkers' compensation polices; ::•::::•::::.;�;:•:.�:.:•:::.••:::.......�:::.:.. .::• ::•.•......;:• :.. :•:::,. :::w.:...... .. �iii:J:Liii::•vii?j:6:{•ii:v:::?: i is:. ..•:`;:..?:: �':is:::i�j"^:4ii :.!. }: {{•ii: i :... : .. :. :::::::.:::. ..............,. _. .::...:..:...::::........... ..:..:.....:.::................: ................:v::::.... ... ....................::::.�:..........................................................:•........................:•.v::::........{.......:x.v::v:.v::�•:x::::.::::......:::::.w:.v:.:v:n'.vw:•:v..x.: .. .::C ....... .. ....... .. ... �: >;;:;.;:;.i:.:;.:�::.:.;:.;:{.;;i::.;;::.>:;;:.:.:•;::.;:.;:.;;ii:.; •:::�%4:vi:•:i`+%''rT}iii:%iYiiii:i'�:•i:^'F;i±'r:;:y}�;:?}' '{Lin `�:�i4:;?:{}};tiSiii:i i;;{;;+;,••is4ii:'i:•i:•:{•>i:•i:�:ti�iy}rii:�:2?::�<};}}.i:•'i::�^i:;i:;i:i;:�::},i:{y:[i:.Isis"::4i::iii:i:LC;i:�i:tiL•ii:i iiA.. ::::w:::::w:n�:::•:::::i•i::v:::::n::•: .. .. .......X. �{:... ... .. ............. ..................................:w v:::::::.::.:::::.�.�::::.v.v:n�::.�:.�..�::::i:•::•::::::::•:::. .:Mv::.�:.'.:i::'.;.:.?:i;:.:;.•ii:tiC:•::^S:>:<::Ib:�iii::::::::i:iiii:{{v?ii::•:Y.•iiii::^:::?i::i:{!4:•i�::iji:i: wnraneeca :::;:;:.:;<.:.;:.:;::;:>::::>:.:.:.i;:<.;:.;;s.;:.:.:.>;:.:.;::.>:<;::.;:.;::.>::.::.;.::::::::.::,::::::::::::.::.::,:.:.:::.::.:::....... .. ... b�t� c sa .:. �•MUii:'wii::: • .�S•`i:ii:%.",'>,. ...:,.,...'<:j}:4 j :v::::::•.�.�::..........::::v::.�:.:�::::::::: :w:::::•.:................ .....{..:•:i•i':;:.:::•.i................ ..............:i:v:•; i:•:• i':? .a �''`# ',•"'ry;. . .:.' :...;i..?.... .:iiii:;.;isi.;is:j.'?:%.i:�i :.ire htr .. :..z /. Faflme to secure coverage as required wider Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,So0.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi the pains and penalties of perjury that the information provided above is tnm.and correct Signature Date - Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required []Selectmen's Office ❑Health Deparilnent contact person: phone#; ❑Other UgYAW 9/95 PJA) 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 supplying company names, address and hone numbers along with a certificate'of insurance as all affidavits maybe .:;<•, DPP Ymg mP Y P tsubmitted to the Department of Industrial Accidents for confirmation of insurance coverage., Also be sure to sign and - the city or town that the application for the permit or license is date the affidavit. The affidavit should be returned to 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 permit/license number which will be used as a reference number. The affidavits may be returned to 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 Depamnent's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesffgallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �opZHE, Town of Barnstable Regulatory Services = mmirAzLr. Thomas F.Geller,Director UASQ& E659.�A•0� Building Division D MA Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: timated Cost a Address of Work: I �— Owner's Name: n r Date of Application: TJ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Fhb under$1,000 []Building not owner-occupied �w er pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME UYUROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. R Date Owne ame The Town of.Barnstable .Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: D3 JOB LOCATION: Q1 Al A number stye t village "HOMEOWNER": ,, _ name Q home phonj# work. # CURRENT MAILING ADDRESS: city/town J state t 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 Deparqasent minimum inspection procedures and requirements and that he/she will comply with said proce ur s d require ents. 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 shall 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,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The 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.