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Home My WebLink About0042 WILLIAMS PATH Z W Ul-f,M S o ti��,E'1T • `�'�a o� 0 --�Ir,Y'1 •1��0� I O cn ,no gz CL DZ En�Z a I,x a r p d 4 Town of Barnstable Building r iPost This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Swats, - 7 - I - 163¢ 1Posted Until Final Inspection Has Been Made. Permit t° jWhere a Certificate.of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-3425 Applicant Name: Jonathan Whipple Approvals Date Issued: 11/03/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 05/03/2018 Foundation: Location: 42 WILLIAMS PATH,WEST BARNSTABLE Map/Lot: 111-040 Zoning District: RF Sheathing: Owner on Record: SCHERMER, DOLORES Contractor Name- • JONATHAN N WHIPPLE Framing: 1 Address: 42 WILLIAMS PATH Contractor License: CS-078683 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $2,844.00 Chimney: Description: Insulation.Air Sealing. Insulation in kneewall slope.Ventilation �; Permit Fee: $85.00 chutes Insulation: Fee Paid:' S 85.00 Project Review Req: Date: f 11/3/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas: work until the completion of the same. .1" -- ------ --��' Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing -'rt! 2.Sheathing Inspection - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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 for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). qm. Fire Department ',I- �� Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable RECEIPT ` a'' ' 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-3425 Date Recieved: 10/4/2017 c�A Job Location: 42 WILLIAMS PATH,WEST BARNSTABLE 71 Permit For: Building-Addition/Alteration-Residential `n Contractor's Name: JONATHAN N WHIPPLE State Lic. No: CS-078683 Address: , Webster, MA 01570 Applicant Phone: (508) 279-1110 (Home)Owner's Name: SCHERMER,DOLORES Phone: (508)380-4719 (Home)Owner's Address: 42 WILLIAMS PATH , WEST BARNSTABLE, MA 02668 Work Description: Insulation. Air Sealing. Insulation in kneewall slope. Ventilation chutes Total Value Of Work To Be Performed: $2,844.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Jonathan Whipple 10/4/2017 (508)279-1110 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $2,844.00 Date Paid Amount Paid Check#or CC# I Pay Type Total Permit Fee: $85.00 10/4/2017 $35.00 Paypal Paypal Total Permit Fee Paid: $85.00 10/4/2017 $50.00 Paypal — Paypal THIS`IS-NQTA Town of.Barnstable Building " Post This Card So That Otis Visible From.the Street-,Approved Plans�Must be=Retained�on Job�.a'nd fhis�CardxMust�be Kept .: ` ''�. • Posted�Until Final Inspection Has�Been Made. 4 '� �` Permit � Where a Certificate of�Occupancyh�syRequired,such Building sha119Notbe�Ocsupied�untiha Finahlnspedion�has been�made, �- Permit NO. B-17-2729 Applicant Name: MOGAN AND COMPANY;INC. Approvals Date issued: 09/01/2017 Current Use: Structure- Permit Type: Building-Addition/Alteration Residential Expiration Date: 03/01/2018 Foundation: Location: 42 WILLIAMS PATH,WEST BARNSTABLE Map/Lot 111-040 Zoning District: RF Sheathing: Owner on Record: SCHERMER,DOLORES � �Cont�actorName: MOGANAND COMPANY,INC. Framing: Address: 42 WILLIAMS PATH ray r •� -�`� Contractor Ucense 180182; 2 WEST BARNSTABLE,MA 02668 EstProject Cost: $48,000.00 Chimney: . Description: New Kitchen Cabinets.new windows in sunroom mrexisting opening. Pe�mie: o c �. $294:80 Insation. ` 'Cut opening back wall kitchen to sunroom(dining)F ul b Fee`Paid-. $294.80 . Final:Pro ectReviewRe4� NewKitchenCabinetsnewwmdowsin T om�ii existing Dat 9/1/2017 opening:Cut opening back wall kitchen to sunroom dining) N s Plumbing/Gas x` .. . Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author¢ediby this permit is commenced within siknionths;afteerr issuance. All work authorized by this permit shall conform to the approved applicaYionaan the approved construction documents for whict ih s permit-has,been granted. - Rough Gas: All construction,alterations and'changes of use of any building and structuresshall be in compliance with the local zoning,by laws and codes. final Gas: %mow`b q This permit shall be displayed in a location-clearly visible from access street or road=and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. F Electrical MAN The.Certificate of Occupancy will not be issued until all applicable signatures bathe BuildinganmFireOfficia `are provided onsthispermit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 4 Rough: ��K s 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections tobe completed prior to Frame Inspection 5.`Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector'has approved the various stages of construction; Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire.Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O O Application #3 I� Health Division Date Issued Conservation Division ` Application Fee Planning Dept. Permit Fee a I y. 5u- Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village Owner Address Telephone t Permit Request -vAz,_, ec S,,, -An Ine-, z— 01 ;"St Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Zoe Project Valuation /U Boa Construction Type Lot Size Grandfathered: ❑Yes• 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes O-No On Old King's Highway: &Yes ❑ No Basement Type: ®'Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) — /( 2 0 Basement Unfinished Area(sq.ft) ILa v Number of Baths: Full: existing 3 new —. Half: existing new Number of Bedrooms: 3 existing v new Total Room Count (not including baths): existing new First Floor Room Count 6� Heat Type and Fuel: ❑ Gas ❑�Oil 0 Electric ❑ Other Central Air: Cl`?es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 3-No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: @`e'xisting ❑ new size _Shed: ❑ existing ❑ new size — Other: _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # AUG 22.2011 Current Use Proposed Use ( g itS S ABLC Nt _.. APPI:ICANTINFORMATION - - (BUILDER OR HOMEOWNER) Name Q �;4 AA_ Telephone Number Co 7I L a.c)-7 y Address L 3 w w Av,-- 'Q License# a > � 1\A- Home Improvement Contractor# LEd i 2�2_ Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING -FROM THIS PROJECT WILL BETAKEN TO %✓`eve u,...-f�. IJ-w�-,) SIGNATURE DATE ? FOR OFFICIAL USE ONLY APPLICATION # ' -DATE ISSUED MAP/PARCEL NO. 1 . - ADDRESS VILLAGE OWNER Y DATE OF INSPECTION: FOUNDATION " FRAME _ INSULATION FIREPLACE 'z ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t, GAS: ROUGH FINAL FINAL BUILDING t. DATE CLOSED OUT - ASSOCIATION PLAN NO. 4 f Ile Co omveakh.qf 1l�rtFcr��I, Deparbwent of sin-d Accidm ' Oirwe VfdfiffW 600 Wasb&gion S`hvzt BastoY4 MA 02HI wrc MMfi=9M1 a Workers' Compensation Insurance Affidwit BwlderslEun ess Am ice#IufQrMAiDU Please Print v Name —r CO Address D 3 J d2j-c< C4-, ,,. S -9 -77G 2U-70 Are you an employer?Checkthe appropriate bay Type of project(reqaired): L❑ I am a employer with 4. ❑I am a general confractar and I 6. ❑New cc= employees(fall amifor part-iime)-* bove hired-the sub-coo a 2.❑ I am a sole pmpEietaff orpartuer- fisted catbe attselmd sheet. 7- oftemmo8ebng ship andd have no emp1%mes These sub-caafractc=have $ ❑Demolition Vmddng Tonne is any capacity. employs aEtdhave wormers' [No w0dom,Comp.fim=nce comp-msuran�l - -MFiM 9. El Bnildmg addition -I 5. EO'We are a-c;mporafioa and its 16-❑Eleddrd repairs or adcEEoas 3.❑ I ama ltomeawmes doing all work ofiicess have eKm=ed emir 1L0 Plumbiagrepairs or adcrdiam yself[No 'gip- agld:of a fiou per M(B. I-)-El goofregaim ,n�required-]i �oYem[No dwa�s welme no comp..ia�required.) •day agp6�dastcbe box 1lyoustslsoffioattheswfiaabdow filecvmdcece eMMfi=PGr1CYiUfiMMffff= ffameeara�vitro snbagt sixis pep lain;zg vra�c aud�ea tine aatsid�csanzsaazst sebmit a nesv afdavrt maicsSi-snob. ZC==LCtCsff=1ecYt1ds box noststtecbed=zddiii—ldw sbowiag the of the xudstafevrhedmor not fbwee eshzve employees.7ftbesab-cad kweB=21oYeE%deY— Pmvideti '—MP•FUHFnM3*- I am��euipIffysr flict is praurdir�g tvcrkets'coCsrnimt ucsriraacsor artrptuy Betait*is ifte pa�icy a job sits i$�orm�nn. - Iss amce,Company Name: Paficy or Self-ins.JUC-t Fagiraiou Date: Job Site Addre= Citgf5 : Attach a copy of the vrarkere cbmpensatioapolicg deci um&n page(showing the poficy number and expiration date). Faye to secs coverage as requiredunder Sw i=25A o€MQ.c.M can lead to ffie imposition of czimiaal pemltaes of a fine up to SL50a Oa andlor ossagearimprssorimeak as v6U as civil peuslties.n the farm of a STOP WORK DRDEgand a fine of up to$250M a day against the violator. Be advised that a copy of tip statement Wray,be forwarded to tine Office of IrcveskSadom of ate DJA far fisacance,coverage man. Ido herzby cerftfy andcr fife pis andpenaEgar afpedWY that the fi forsragun provi&d abom is bus Cmd correct PbQmik 77L' ,2.U7,0 O cid usa ate. Do not write in ffds area,to be cmnpleted by chp artoiou of t City ar Tawa: —Per h'LiceFsss# Issuing AUffiority(code one): L Soar l of r.Big Depatmsat 3.Brown Qerk 4 Electrical In S.Phmmkmg>nspeclmr C.OffiW CoM12ct Person: Phone : 6 laformation and Ins�atctions l all re Ge M qa ecEp"sat M fortheir ea�Iayess. R�carlmee¢tS �irdalLaws c7ia�I52 clan�s �Iayexs ie ' p tn.his sue,an w pkyze is defined as¢.everyprdson.in$le seavire of bra ffider buy co�xact°fbm'y . Mqn=or implied,oral.�vliftmf An Foyer is d as"an dal, Pod cdtaofirm other % = ±y,or any two or mutt of the foregoing engaged in a joint tpdg and mcEg the leggy of a&==ea omployrx,cn fe rzceavrr or tUStn-Of an individual,pnt=Mb p,association or other legal a ntity,employing CmIp]DYMCG- l�owr vet the own=of a.dweIIing house having not mare;than three apa dm=fs and who res lh dw ercin,or fhe octet ofthe - &m ing house of anoferwho emplays persons tD do mafitance,crosta n or repair workon.such dweIling house or am.the gmmn& or appurt mzI3tf rein shaIlnotbecanse ofsnrh employmeaatbe deemedto be an employee Mq,chapter I52,§25C(6)also statesffid¢everysfate or local Firms agmcy ShZ wiffhold$e iss¢anc-or renewal of a Tcease or permit to operate a business or to construct buildings is ffie co—Dnwean for ray applicanftvho has not produced acceptable evidence of coxupjum— ePitlt ffie insvrance cove 2pregaired AdffifionaTTy,MCiL Cbapter I52,§25CM s•Eates-Nelffi=the nor imy ofits political subdivisions shall into any camtrad for the perEmmia cC ofpoblic*ofic wniil acceptable evidaa=of compliance VIhh$e mst¢mzc6. rni�of tfiis hM I;e=prese� th d to e=&acting a��-Y" reqcdr' AppIi� Please fill out flie worl=w cum eusatzou affidavit completely,by d=Jdag ffia boxes that apply to your sitn� and,if nay,amply sus)name(s), address(es)and phone numbers) slang wift ffieir cetficate(s)of insurance. L�itedLiabi7ity Companies(jc)orj=tcdLiabiUTPsrt= sblps.�P)w&no�p�o$�f9zantb.e merhbegs or partners,are not rbgaHrd to cry wuri=-e compeusabtoa fiL=MCr- If an LL C cr l_Z2 dDes hate employees,a policy is required. Be advised that this affida:ykmaybe sohmittmd to the Depmfine t:of Industrial Aeeirl for conEa afion of insu raace coverage+ Also be sine to sign and dafE�e sf davit Iha affidavit should be retained to me city or tDwn that fhe application far the permit or liceose'is being requested,not the Department of ; I�strial A= . =ts- ShouldyDn havo any question ing ffie la�v or ifyou are reganrd toobtain a wotkrss' 0ampceatirn,poHey,please call fficDepmtn.eotatthen=brrlistadbelow. Self-insm-rdcompaniesshc)uldeartheir self- cr,rancC license mmnbm on ffie Ime. City or Town Oif-xdals t Please be some ffiat the affidavit is cnmpleb-and pmittdlegibly- TheDepartmcothas pro4ided a sparo at f ccboth= of the affidavit for youtui fM out intho event the Office of uyestigations has to cairfar uregardmgf3ie applicant Pleas e b e stre to f M in the pcna icemse munber whichwM be used as a mf xmco mmmbe r. Iu.'adcfd arL,an applicant fat must submit multrple p emWHceose applit&=in any grvm year,need oaly submit one affidavit MAUmtM9 eat policy infarm ati9fi on-Cif ncccssaiy)and-, "lob gte,Address"Ihe applicant should wr>tr--all 106aiims in Cdty or- town)_'A copy ofthe-aifitdavitfhathas berg officsaIIy stampod orm,6mdbythe city or to may bepmvided to the applicant as.proof that a valid affidavit is on file for firtnre paumits or liiceuscs A new affidavit mast be filled ovt earth year.There a home owner or citizen is obb i� ag E=Lw or pmmit not ielatrA to any business or dal (Le.a dog license or p®¢to buts leaves ei�.)said person is NOT rc�ed is�p�this affidavit The Off OfInvestigsfinaswouldhb--tothankyoumadvm=for yourcoopeaafiam and sbouldyou.ha:=any quesstions. please do not hesitates to give us a call The Dgap rtm &address,t4ephone and Paz mmzber= of Mjssach - D mt ofhidm�sl A is n=h�4 E�1lF Fay 617 727-'749 xeYised4--24--07 trlffa AWC Guide to Wood Construction in High Wind Areas:I10 mph.Wind Zone Massachusetts Checklist for Compliance(780 CNIM 5301.2.1.1)' 0 Cbrxk 1 SCOPE Compliance . . WindSpeed(3-sec,gust)...................................................................._.............................................110 mph WindExposure Category..............................................................................................................................B 1.2 APPLICABILITY Number of Stories ........................................................_...(Fig 2)............................ stories 5 2 stories _ RoofPitch ....._...................................._.............................Fig 2)........................................... 512:12 Mean Roof Heigh ........................(Fig 2)_.............. ..:... . .... Building Width,W.......................................A......_..............(Fig 3)................ ...._......_...... _ft s 80' _ BuildingLength,L ..............................................................(Fig 3).................................. _ Building Aspect Ratio(L1Vd) ...............................................(Fig 4)......................................... 5 3:1 — Nominal Height of Tallest Opening2 ................._.......__.....(Fig 4)................................................ 5 6'8' 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.......................................................................................................... _ ConcreteMasonry.................................................................................................................................... 2.2 ANCHORAGE TO FOUNDATION" 5/8'Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing—general..........................................(Table 4).............................................. in. Bolt Spacing from endrjo int of plate ............................(Fig 5)................_................... in.5 6"—12" —_ Bolt Embedment—concrete.........................................(Fig 5)................................................ in.z 7" _ Bolt Embedment—masonry.........................................(Fig 5)...................... _ PlateWasher...............................................................(Fig 5)...............................................Z 3'x 3"x,/4" 3.1 FLOORS Floor frarrung member spans checked ...............................(per 780 CMR Chapter 55).................................... _ Maximum Floor Opening Dimension........................ _ _ ...........(Fig 6).............:..............—ft s 12'or L/2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks — Supporting Loadbearing Walls or Shearwall................(Fig 7)...................................................._it 5 d Maximum CantileveredFloor Joists — Supporting Loadbearing Walls or Shearwall................(Fig 8)..................................................... ft 5 d _ FloorBracing at Endwalls................................................:..(Fig 9)...................................................... .......... _ Floor Sheathing Type ........................................................(per 780 CMR Chapter 55).................................... _ Floor Sheathing Thickness.................._..............................(per 780 CMR Chapter 55)....................... in. _ Floor Sheathing Fastening.................................................(Table 2).._d nails at in edge/ in field 4.1 WALLS Wall Height Loadbearing walls.................................. ...(Fig 10 and Table 5).................._....... ft s 10' Non-Loadbearing walls.........._....................................(Fig 10 and Table 5).................... _ft 5 20'(Fig )..................._in.5 24'o.c. _ Wail Stud Sparing .......................:................................ Fi 10 and Table 5 . Wall Story Offsets ........................................................(Figs 7&8)........................................._. ft 5 d 42 EXTERIOR WALLS' Wood Studs Loadbearin walls................................................ (Table 5 ___ _ Non-Loadbearing wails able 5 - — Gable End Wall Bracing i — — —" — ! Full Height Endwall Studs............................................(Fig 10).................._.......................... _ WSP Attic Floor Length............................_..................(Fig 11)..............................................—ft 2:W/3 _ Gypsum Ceiling Length(if WSP not used)...................(Fig 11)..........................................—ft a 0.9W _ 2 x 4 Continuous Lateral Brace @ 6 IL o.c...(Fig 11)......................................................... Double Top Plate — Splice Length ........................................................(Fig 13 and Table 6)..................................... ft Splice Connection(no.of 16d common nails)..............(Table 6)....................... ................................ F AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connedions Lateral(no.of andnalied 16d common nails)..._.........(Table 7)........................................................ Non-Loadbearing Wall Connections Lateral(no.ofendnaffed 16d common nails).._...........(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(fable 9)................................._It In.511' Sill Plate Spans ....................................................(Table 9)................................_ft_in.s 11' — Full Height Studs (no.of studs).........................._....(Table 9)........................................................ — Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9)................................. ft_In.512' Sill Plate Spans...........................................................(Table 9).................................._ft_in.s 12' . Full Height Studs(no.of studs)...................................(Table 9).................................................. Exterior Wall Sheathing to Resist Uplift and Shear SlmultaneousV — Minimum Building Dimension,W Nominal Height of Tallest Opening ................................ .......................................... .... . 5 6'8' _ SheathingType..............................................(note 4)...................................................... Edge Nall Spacing.................................. (fable 10 or note 4 ft less)........................ in. Field Nall Spacing —� P 9..........................................(Table 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 Opening2........................................................................ SheathingType........................................_..(note 4)...................................................... _ Edge Nall Spacing.........................................(Table 11 or note 4 if less)........................ in. _ Field Nail Spacing..........................................(fable 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................ — Percent FulkHeight 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:9 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls — Proprietary Connectors Uplift................................................(Table 12).:..........................................U= plf _ Lateral able 12 .I.............L= plf _ ::....:.:..(T }....:.....:.:.:.............. Shear..........................................._..(Table 12)............................................S= plf Ridge Strap Connections,If collar ties not used per page 21.....(Table 13)..............................T= pif Gable.Rake Outlooker.........................................(Figure 20) _ft s smaller of 2'or L/2 ..................... .............. Truss or Rafter Connections at Non4-oadbearing Walls — Proprietary Connectors Uplift_..............................................(Table 14)............................................U= 16. _ Lateral(no.of 16d common nails)...(Table 14)............................... = lb. _ Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59).................. Roof Sheathing Thickness.............................................................:............. ...........—in.a 7/16'WSP — Roof Sheathing Fastening.............................._...........(Table 2)........._................._................_......... Notes: — — 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2-1.1 Item 1.if the checklist Is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14. d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a. 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2.In.nominal thickness.pressure treated#2-grade. r 4WC Guide fo Wood Conx&LrcddzY i u 1{i fr KuTdAreas_110 mpfr IIf=dZone Massachusetts.Checkl&t for Compffmco cea cn-ins3oi f 1_1)r . a. From Tables ID and 11 and location cf wag siring and Building A.spadRafio,determine Pit Fu&Hefght Sheaff*g and Marl SpaciV requirements b. Wood ct„tom,► i panab shall be mbimr m thickness of 7116`and be hzialled as follows: - - _ Panels sha11 be fnstaDed ter singrhgth azs paralfe!Tn sfsrns. I M horh=tal jokft shall o=over and be nailed to twriltng. uL Dn single stDfy const tcfiDn,panels shall be affadhed to boffnm plates and tap:rnembef of the double sha1 a zi!t3dled.tojhi t* nembernf the upper double tap-- ---- pfate and fn band joist at botmm of paneL Upper affadmmnt of lower panel shad be made to band joist and lower aftadrment made to lowest plats at fast ffoorfisming. ' V. Hor¢mnfal nail spacing at dpubIe top plates, (sand joLd.-,and grtders shall•be a double rew of Bd - staggered at 3 inches on center per figures below:Vaicaf and Hwhmntal Narrmg for Panel Atar .hmer,t 5. Gfau.-bg prolac5t=a)rew house or hortmnfal adOon—required ffprojecV i mle or dossertm shore en Rfa ZB or north of Rte 6) '•soufh of b)vertical addMon—not regdired r IIiless them Is a ve rsnovafion io$he fast-ffoor c)replammentwiridows—needs energy consEsvafion mmplfafhc;only(chap 33)S.Wood Frame CortsturSon Manual MFCMI for 110 MPH, Expasm-a B maybe obta-medf[DM the American Wood Council (AWt)websRe. : • >�3ssoar - . va�aa r�rs "ATrs— Ll tl -C •I I i I> Q I - LI - r t • iI f(� • III [ r - L� �� cr f ` l [• ! r r - xU - (L. Ll p t '; T p ( L F k i[ u tt I c [ r! .t - • {, f It ! � �� . • �1>�c� � STAB s`!dl4. 2 �kckdG ,, i' ls4�PAI-r rr PAML . � �- �1?E � mtea c uae cxr�spAei4t:bF31SL See Data on N.wd Page _ DeW - VerBaal and Hrdzon{al NWTrng , = VU5=I And NDAMLnW Nailing for Panel Afiar:hrr>ent lot P&=1 Afisnhma-it _ Town of Barnstable _ Regulatory Services :AM ' Richard V.Scab,Director. ►`� Building Division Paul Roma,Building Commissioner ' 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 1 Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject property hereby authorize ��t! '�� : w ��.w h '�' Cy �-c to act on my behalf in all matters relative to worm 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. S' a of Owner Signature Applicant Print Name Print Name Date Q:F0RMS:0VVWMERMISSI0NPO0LS Town of Barnstable Regulatory Services dF Richard V.Scali, Director Building Division 11MINEM+33M t Paul Roma,Building Commissioner a�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EIEIVI MON Please Print DATE: JOB LOCATION:. number street village -HOMEOWNER-: name home phone# work phone# CURRENT MAILING-ADDRESS: cityhown state zip code .The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage.an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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-flunily 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 ceder the buildingpermit (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 biuilding permit is required f"-- - 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 responsibilitids;ot 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. ��• �w�l 1��c 1...�cQ �w - i AC R® CERTIFICATE OF LIABILITY INSURANCE °A'E'"�"'°DI'""'' TFYS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TICS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ffINSURED NT: If the certificate holder is an ADDITIONAL INSURED, the Policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to and conditions of the Policy,certain Policies may require an endorsement. A statement on this certificate does not confer rights to the holder in lieu of such endorsemengs). l & Schlegel Ins Broker rciA°r"u1EacT JIM HINDMAN Street PHONE (508 771-8381 EaIAaL FAX No: (508) 771-0663 rmouth, MA 02673 AODREss: schlegelinsurance@gmail.com DING COVERAGENAIC— INSURER A:PHEONIX MUTUAL RICHARD H GARDNER INSURER B:TRAVELERS MARA GARDNER INSURER C: 92 PARK PLACE WAY INSURERD: MASHPEE, MA 02649-2725 INSURERE: COVERAGES INSURER F CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAREVISION MED ABOVEBFOR 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 PAID CLAIMS. R INS LTR TYPE OF INSURANCE ADDLSUBR�— ------ POLJCYF POL PICY — -- INSR j� GENERALLUU3IUTY POLICY NUMBER I MlDD/YyyYI MM/DdYYYY —--— LIMITS -- — -X COMMERCIAL GENERAL LIABILITY - CPP0709341 8/20/16 8/20/17 EACH OCCURRENCE $ 1 000 000 DAMAGETORENTED CLAIMS-MADE FZ OCCUR I S fEa ocarrenW S 50,000 ME EXP(Aryone person) 1 $ 5,000 PERSONAL&ADVIWURY S 11000,000 GEN'LAGGREGATELIMITAPPLIESPER GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCTS-COMPlOPAGG $ 2,000,090 AUTOMOBILE LIABILITY $ COMBINEDSING ELIMrr ANYAUTO (Eaaccitler2) $ ALLOWNED SCHEDULED BODILY INJURY(Per person) S AUTOS AUTOS NON-OWNED EPROPE LY INJURY(Per accident) $ HIRED AUTOS _AUTOS RTYDAMAGEccident $ IUMBRELLA UAB I$ OCCUR r XCESS LIAB CLAIMS-MADE EACH OCCURRENCE I $ DED RETENTION$ AGGREGATE $ B WORKERS COMPENSATION AND EMPLOYERS'UABILITY WC-0179798 6/3/17 6/3/18 WCSTAIU- OTH- $ ANY PROPRIETOR/PARTNERIEXECUTIVE Y!N (MandatoryOFFICEMM In H)EXCLUDED? 7 N/A E.L.EACH ACCIDENT $ 100 000 (Mandatory in NH) If yes describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERA770NS/LOCATIONS/VEHICLES (Attach ACORD tot,Additional Renerks Schedule,if more space is regti red) RICHARD GARDNER HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR�POLICIS-BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOILL BE DELIVERED IN IN HAND, ACCOR CE WITH THE POLICY P AUTH ROE SENTATWE ©1 8-2010 ACORD CORPORATION. All'rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: r • ACQtRU® DATE(MWDDNWY) CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 08/07/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis of Tennessee, Inc. PHONE 877-945-7378 FAX 888-467-2378 c/o 26 Century Blvd. -MAIL P.O. sox 305191 certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Zurich American Insurance Company 16535-005 INSURED MAP Installed Building Products of Sagamore,LLC INSURER B:American Guarantee & Liability Insurance 26247-004 165 State Rd (02562-2415) INSURERC: Ironshore Specialty Insurance Company 25445-002 P. O. Box 1309 Sagamore Beach, MA 02562-1309 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:25598701 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 TYPEOFINSURANCE DDL SUB pOLICYNUMBER POLICY EFF POLICY EXPITR LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GLO 9139527-10 0/1/2016 10/1/2017 EDDAACCMHApGCO�CCCOURRRENCE $ 2,000,000 CLAIMS-MADE OCCUR PREMI$FES(WRaENocT%D..) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LI MIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY JET � LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER:FAI $ A AUTOMOBILE LIABILITY Y Y BAP 0156620-00 10/1/2016 10/l/2017 COMBINED SINGLE LIMIT $ 2,000,000 X ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) X HIRED X NO"WNED PR PERTYDAMAGE AUTOS ONLY AUTOS ONLY (Paraaident) $ B X UMBRELLA LIAB X OCCUR y Y AUC 9314206-05 10/1/2016 10/l/2017 EACHOCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10.000.000 DED I RETENTION$ Retention $0 $ A WORKERS COMPENSATION Y WC 9139526-10 10/1/2016 10/1/2017 X AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVEO N/A Y WC 9139528-10 10/1/2016 10/l/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? IMandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Excess Auto Liab Y Y 002907300 10 1 2616 167172017 $3,000,000 Occurrence (Excess of underlying $3,000,000 Aggregate $2,000,000 Auto Liab) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Mogan & Company Inc. 63 Joyce-Ann Road Centerville, MA 02632 Coll:5109311 Tpl:2083922 Cert:255 701 ©1988-2015&ORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I PAULWSA-01 RALLIETTA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 08/08/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Almeida&Carlson Insurance Agency,Inc alto,No,E:t:(508)888-0207 FAX,Ne:(508)888-0550 PO Box 719 Sandwich,MA 02563 E-MAIL INSURERS AFFORDING COVERAGE NAIC# INSURER A:Travelers IndemniN Company of Connecticut 25682 INSURED INSURER B: Paul W Sandborg INSURER C: PO Box 19 INSURER D Sandwich,MA 02563 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_X]OCCUR 6805186BO15 11/1512016 11/1 512017 DAMAGE TO RENTED PREMISES We occurren $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PEA LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY Ea accident)SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NpN WN D PROPERTY DAMAGE AUTOS ONLY AUTO ONTY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY YIN ST ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N/A Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ I/ es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mogan Company THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g p y ACCORDANCE WITH THE POLICY PROVISIONS. 63 Joyce Anne Road Centerville,MA 02632 AUTHORIZED REPRESENTATIVE��C��: - ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r A�® DATEIMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 08/07/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Neill&Neill Insurance Agency Inc NAME: PKONE (413)732-4137 ac Not: (413)731-6629 662 Riverdale Street I . I West Springfield,MA 01089 ADDRESS: nn@neiilins.Com INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: State Auto Insurance INSURED Doug Askew Electric INSURER B: Po Box 1714 Cotuit,MA 02635 INSURER C: 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 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE I POLICY NUMBER IMMfDD1YYYYl IMMIDD COMMERCIAL GENERAL LIABILITY BOP2732474 04/13/2017 4/13/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED50,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence S MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRO- POLICY JECT PRO ❑LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea ecddent ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEO I I RETENTION S S WORKERS COMPENSATION AND EMPLOYERS*LIABILITY YIN STATUTE ERH ANY PROPRIETORIPARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER 1 CANCELLATION ED MOGAN 63 JOYCEN RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CENTERVILLE,MA 02630 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A REPRESENT • @ 1988-2015 ACORD C RATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Client#:762395 2TAVANOME ACORD. CERTIFICATE OF LIABILITY INSURANCE F8/2212016 ATE(MYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil Insurance Ag PHONE., 508 775-1620 5087781218 A/C N Ell: A/C No 973 lyannough Rd,PO Box 1990 EMAIL ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAICSI 508 775-1620 INSURER A:Safety Indemnity INSURED INSURER a:Associated Employers Insurance Tavano Mechanical Systems LLC INSURER C: 201 Capes Trail INSURER D West Barnstable,MA 02668 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. INS TYPE OF INSURANCE ADD Sjly p POLICY NUMBER MM/DDY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY BMA0024003 8/14/2016 08/1412017 EACH OCCURRENCE $1 000 000 X;COMMERCIAL GENERAL LIABILITY POEM S( ENTEO PRE AG S a occurrence S 500 O00 CLAIMS-MADE FX�OCCUR MED EXP(Any one person) S10,000 X PD Ded:500 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG I$2,000,000 POLICY jE,T F I LOC s AUTOMOBILE LIABILITY Ea accciden IND SINGLE LIMIT s ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident S UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS UA13 CLAIMS-MADE AGGREGATE S --TDEDTI RETENTIONS S B WORKERS COMPENSATION WCC50050149582016A 08/14/2016 08114/201 X WC STAMJ OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTWE V I N E.L.EACH ACCIDENT $SOO OOO OFFICER/MEMBER EXCLUDED? a N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE1$500 000 If es.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT SSOO OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Job:Little Beach insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Mogan and Company Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 63 Joyce Anne Road ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S175424/M175412 CBD I Client#: 15228 2BRANNDR DATE(MMMD/YYYY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE 02/17/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling$O'Neil Insurance Ag PHONE 508 775-1620 FAX 5087781218 A/c No Et): A/C No): 9731yannough Rd, PO Box 1990 EMAIL ADDRESS: Hyannis,MA 02601 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:NGM Insurance Company 14788 INSURED INSURER B:The Hartford 19682 Richard Brann D/B/A Brann Drywall 3701 Falmouth Road INSURER C: Marstons Mills,MA 02648 INSURERD: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY MPB1438S 12/31/2016121311201 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $5OO 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $1 O 000 X PD Ded:250 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accdent UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ r $ B WORKERS COMPENSATION 08WEGLD8356 2/13/2017 02/13/2018 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N IT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Mogan and Co.,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 63 Joyce-Anne Road ACCORDANCE WITH THE POLICY PROVISIONS. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE C.C. ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S186178/M186153 CBD Massachusetts Department of Public Safet-i Board of Building Regulations and Standard, License: CS-02607.1' Construction Supervisor FRANCIS E MOGAN 63 JOYCE ANN R'b 'CENTERVILLE MA 0 = j �J►l^^^ Expiration: Construction Supervisor Commissioner 10/03/2017 Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. UPS Licensing information visit: ------__�WWW`MASS.GOV/DPS . ,yy�• V/ce W��zanusealC� �CJ/�� F office of Consumer Affairs&'Business RegulationIMPROVEMr in ENT CONTRACTORpefo'rerthe eXPirati alid on date.!Af tci hd".,retu�ri to:. Type:'Corporation pffiee of Consumer Affairs ditd Business-.i...:;;o. . Xp. —__ Reaistratiort ExDiratiox 10,park Plaza-Suite 5170 �• .y-180182 10/19/2018 Boi fon' MA 02116 Mogan and.Co IparIy,,, ncj- francis Mogan:Jr=-;o� 63-JoyceAnn Rd: .>r_: :., �. Centervillej V,IA 026a2==_t ' Undetsectetary 1No ali withoasr Si,�nati re ,: .. ...: sr.. / 35 Pound Snow-Double LVL BeamChek v2012 licensed to: Schaefer Design LLC Reg.#4009-67629 Date: 11/16/16 Selection (2) 1-3/4x 9-1/4 1.9E GP Broadspan LVL Lu =0.0 Ft Conditions NDS 2005 Min Bearing Area R1=5.3 in2 R2=5.3 in (1.5) DL Defl= 0.08 in Data Beam Span 8.0 ft Reaction 1 LL 2992# Reaction 2 LL 2992# Beam Wt,per ft 8.43# Reaction 1 TL 3966# Reaction 2 TL 3966# Bm Wt Included 67# Maximum V 3966# Max Moment 7931 '# Max V(Reduced) 3201 # TL Max Defl L/240 TL Actual Defl L/411 LL Max Defl L/360 LL Actual Defl L/612 Attributes Section in3 Shear in2 TL Defl in LL Defl Actual 49.91 32.38 0.23 0.16 Critical 35,17 16.85 0.40 0.27 Status OK OK OK OK Ratio 70% 520/6 58% 59% 1 Fb(psi) Fv(psi) E(psi x mil Fc I (psi) Values Reference Values 2600 285 1.9 750 Adjusted Values 2706 285 1.9 750 Adjustments CF Size Factor 1.041 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use . 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Loads Uniform LL:748 Uniform TL: 983 =A Uniform Load A 0 R 1 =3966 R2=3966 SPAN =8 FT Uniform and partial uniform loads are Ibs per lineal ft. r ry k YON TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel pp( � D lication it �y A Health Division Date Issued /o L%J- c Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 1U/ Village `a' g14:1'I Owner faJj!"0_5 Sck Address y,2 1_14bul. - Telephone _O%> 350 _/W lii Permit Request VZ 3 b A..g.c_ r cza•. cic As 1.c GG_( 4 s tr � (,i'�11 a� �k 2 f`-A u Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new r Zoning District Flood Plain Groundwater Overlay Project Valuation soro, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family UY" Two Family ❑ Multi-Family (# units) Age of Existing Structure 30 Historic House: ❑Yes UHgo On Old King's Highway: ❑Yes ❑ No Basement Type: 3 5ull ❑ Crawl &Walkout ❑ Other Basement Finished Area (sq.ft.) o Basement Unfinished Area (sq.ft) Number of Baths: Full: existing ', new -y Half: existing / new y Number of Bedrooms: existing Unew e v��o1/►� Total Room Count (not including baths): existing new 6 First Floor �t y Heat Type and Fuel: &Gas O Oil ❑ Electric ❑ Other J11 ,g Central Air: El Yes LiYNo Fireplaces: Existing New OEANiW�y od/coal stove: ❑Yes El No ERNS Detached garage: ❑ existing ❑ new size_Pool: El existing ❑ new size _ Barn: ❑ eft ❑ new size_ Attached garage: Cexisting ❑ 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 a,, Telephone Number Address 6 S 4o 4 cc_ V.C q_�_p License # C 5 021, U?1 Home Improvement Contractor# / 50 / 2- Email U-MC> ,wwt L'XUV►-X Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROMTHIS PROJECT WILL BE TAKEN TO i SIGNATURE DATE II SIIL 3 mpL t FOR OFFICIAL USE ONLY . y APPLICATION # DATE ISSUED ;f MAP/ PARCEL NO. ADDRESS VILLAGE w OWNER DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 3 -.,r The l:oMATaarwveakh erjfMaigadtseift i)pmrbnent ofrRdrrs&idAccidan!r Off"00vVes4afiv= 600 WashfiWm,S�reet Boston,MBA 02111 wrvmmmmgor/ a Worlmrs' CamzpreusafrnInsm-mce Affilavit SMIders(f, �ers Am3Hc2m#Iufkm=tiuu Please Print dame Ol oG .a- Addre= 1, 3 J c)Hu- A,,•,, e� C�gf � ✓v�l e Phone Are you an employer?Checkthe appropriate boor Type of project(req ed)_ L❑ I am a employer wi& 4. EP—am a geri s confoctcr and I 6- ❑New eensixuctian employees(fWIan&brpart-fime).* havehiredSie sub 2.❑ I am a sole propiietcmr or partner- fisted cnthe att6ched sheet 'i- ❑RemodeNng slip and have no employees . These mb-contrarta=have ❑Demolifron wonting far me in any capacity- employees andbave wadmm' WO WadmM,comp- a Camp-irisuzzme, ' • 9. ❑Buffiring addition reTEred-] I ❑ We are a tro;porati=and its 160 Electrical repairs or additions 3_Q I ama homeowner doing all vrodc officers have exercised dmir 1L❑Plnmbiagrepaim or adcfitioas mysd f[No waxes'gyp- riot of es .ou per MGL 7 k��ro reed-]Y a.M§1(4�nadweImmno I Rnof:epaas employ-[NoWalimMs, 13-0-0tlrer Cam- l '$ay Bpp &sc chersbo=gi mast elsn snoaEt seoaheiowg ffiesse�'�e�asporcpiaino,L sub -Ca�cmatbsr i�tha bmc mast s =sddi>ianal sheer sboa3agtheamneof the snb ca sad staip-vrhelhm ar=f nse I�v� employees.IftLesnb� kwe=giapers,tbegffisstigmvide&ek Falky M*- lam all eriipl �sr tliatis prcuiJdirfg workers'campertsttiiort ursureracs for emp Blow is ffrepoUcy and job site iaforraerlioa . Ismmnce Company Fume: 'Poficy 4 or Self-its Iic.Q I F�gii iau Date= Job Site Address tl iL W J U .4- Attach 2 copy Qf the werke=.rs'cbmpensafionp.olicy declination page•(showing the policy mmfher and expiration date). Faihire to serum coverage as required nudes Sec€ion 25A of MGL a 157—can lead to the imposition of cimmal prTmhies of a fine up to$L50a IDD andlor one-yearimprrisonment,as we!as civsl penalties ai the fb m of a STOP WORK ORDERaad a fime of up to$250M a dap abainst the viola nr. Be advised that a copy of this statement maybe forwarded to the Off m of IrrvestEgatiom ofthe DIA for ihsus coverage vim. I&hereby confry under ttre pm'and psnakks afpeliuy fhatfJre mfor azieva promW above is hue and correct Phonelk Ojfficiai use anfy. Do not write in ibis area,to be cmnp&ted by city arlown ofdat City or Task p t�T; •�• Ling AzdbQrity(dreie one): L Board of Reahk 2.BmTdiog Dqmrtnent 3.Cd To► n C3erk 4L Electrical%specto, S.»bing Inspector 6.other contact Person Phone#: _ _ 6 lbaformation and Tnstrucfions M � i�� yn e ��frs tbei£=q)lap�s- pzFrsnto.this sty,as e�Fayee is dcfined as=every pesos m$ie scavice of anDfh er uQd=eery contract afhars ' or oral or associafian,ca¢Por °n err affim legal CffxU ,or xMY two or maze An eagsfzy is dcfmzd as'eau indiviffi3g per, P�Yfafives of a deceased empInYQ,oa$le of�fiaegoing cmgaged is a Joint cote�asq sad inc�g ti�.e Tegat relaes l�awevez fbe rmezvm or of an kffVidreal,P association or of mlegal entity,�Y• g��' owner of a.d,MII,g house having not mare thtm three BPMtmeats andwho resides or the occapa�ofthe hrmse dwz nig hDBse of MAW who emp�PLOW to do m coon or rcpait wont:on such dwel&ng or cam the groffids or bzadimg appn� sbA notbecanse of snap esaplaymeEtbe d=medto be an emplDyrr-" MGL chapter I52,§25C(6)also stets fiiat¢every a f or IocaI ficeusk agency shaII withhold the issuance err renewal of a ficease or permit to operate a business or to construct bmTdings in the comnanweal ffi for any apPuc=f-who has notprodnced acceptable evidencs of cdmpfian.,witiz tbr-iB.sa c:e covexzam-" ge r AddrdonaIlY.Md�Pinr L52.§25CM sbfrs�Te bes the nor auy ofifs political snbd33visians shall io any caniract far the p �ofpnblic�'� acceptable evidence of ccanpliancewitlZe msmce• requir n ents of ibis chaff bave been present�d to tine corkaCtiUg Y--" APP�� Please fill oil the w0r10 .compemsaiaon affidavh completely, ec3ting the bm=s fhb a apply to your sitr crn and,if necessary,supply ne(s)' s(s)and phznemmmber(s).alangwithth=certficate(s)of antes orImn6i dLiabffiYP s.( T)wno =P�'M oihertbanthe i =mzce_ Limited Liabfly Came (LLC) mM±Ll:, s or paw,are not rtquired to cnry wozice& co33pemsafr❑n iasarance- If an LLC or LLP does have Moyers,&policy is required. Be advisedfbA this affidaytmaybe salmi to the Department of Iudns vial Accidents for cones of m-sazance coven gm Also be sure to sign and daf-61 sffid'vit Tho affidavit should be retmmed to the city or town that the application for fhe permit or Iicense is being regaeshA not fhe Department of ; _ tTie IEW or 3Cfyo4 e?e MpiMd fn obtain a wo3:10rs' courp®satonpohcy,please d¢Ilf ,-,Depatfineaitatfhen=berlis�dbeloW. Self-ftL3CM sbavIde rtheir s elf fijm =c;6 license amber on the line. City or Town.Oiffdials f Please be score brat the affidavit is complc--and printed legibly_ The Dcpaztnenf has provided a:space 4 tic bow of faze affidavit for you to fill ant in tiro eve03t the Office ofj csfgati=s has to comfactyour 9t1m aPPhcaut- PImsebe sum tnfillmtliep=t/IicensemrnbezwhichwMbe used asarefmmce�bcs In-adddio�anapPlicant fhat mzLst submit zault�Ie p e�!"cense appI�ions in any g�yew,ncod only�¢one affidavit t cm�n policy inforsnatan cif=ssasy)and ra>de-lob�Addresses'f c appllcaut should �aIl Iowticns in ( 5 or town)-" py A co of the-affidavit that has be=officia QY sta�cd or matmd by the city or town may be pro7kkd to the applicant as proof tbzt a valid affidavit is on file for f❑= petutits or ficeases A new affidavitm mt be filled out earh -1h=m a hDme owner or citizen is ob iMi c a license or peort not=atetl to any business or c=nnM oral year. Cie_ a dog license orpminh to bom.leaves eft-)said person is NOT rc edto 1h>s affidavit The Off of Investigate would him to thamk you is adva o=for your coapcaafaon and sbonld.yo¢haven any questions, pIaase do not he bdc to eim us a czIL The I}epaztmr�t's ad&=r.,tele�e and fm n=,ber: - f�o�StbE of Ia�h D nMt of Awidenta of ra=ebvvd�gktio= 604n Sit Bastoax.MA Oil 11- Tel..#61T- -WW eft406 err 14 M SAM IZevised4-24-07 g CQdlwa. ►-fit—chwD Z I....� 'k�..�.��.:-i�y--• �.77� �,U6! ,yes�� L� :Nov.25.2015 10:41 AM Richard Brann Drywall 5084209449 PAGE- LI 26MNNOR i CIIerItN:75228ACORD� CERTIFICATE OF LIABILITY INS NO URAIFS STS NCEEo VE CERTIFICATE MOR THIS THIS CERTIFICATE 18 ISSUED A8-A MATTER OF INFORMATION ONLY AND CONFERSW CO RA POUCIES D OR R THE CovERAGE AFFORDED By T"E CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV C0 CONSTITUTE EO�CT BEEIWEEN E ISSUING INSURERS),A THORIZED BELOW.THIS CERTIFICATE OF INSURANCE DOES N REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE MOLDER _ A figment on Ihls cahlflest•does not COrtfor rights to the IMPORTANT:If the ceRifN:BLs holder is an ADDITONAL INS i require P_0I wt endorsed.ff SUBROGATION IS WAIVED,r deleot to ceeNip s and holder di ionIle j of en•_ydOfe6flNfit(s cterlain��NAN my ppODUCER __-- Dowling a VNell t Insurance Agency AD° 1 NAIc�-" INSIRFRI.S�.�ROa01NG 8T3 lyannough Rd., PO Box 1880 "'-'_"-' National Orange Mutual insurenc - - INRURER A Hyannis,MA 02601 lMsulaRq:T__ tlartfOrd_ IMauRED Richard Bran DIVA Brann Drywall INS IIRERC: -- 3701 Falmouth Road INSURER°- _.. Marston Milts,MA 02648 INEURERE: I P: REVISION NUMBERS COVERAGES CERTIFICATE NUMBER: CY NAMED ABOVE IREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TOICTHETRMS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED POLICIES 0 SCRIBED DOCHERUMENT IS SUBJECT TO ALL LITHE PERIOD INDICATED. NOTWITHSTANDING ANY REGU rERrFIcATE MAv BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE EDU --•- _.._.... LJMn•---- EXCLUSIONS AND CONDITIONS OF SUCH POLIC�I.fie LIMITS SHOWN•MAY.NAVE BEEN REDUCED BY PAID CLAIMS-. e1000� __— -_ pMAT NUMBER �� _ ---- _...__—• -._... LTe TrvEOF.wsuRAN�_,_._---_IN 811 blflP .. . _. . .. . 2l3112014 1?J311201 EACHoccuRRE � . --'—- - MPB14309 6TF0 A GENERAL UARIM .. a10 000 X COMMERCIAL GENERAL LIABILITY CLAIMO-MADE ❑X OCCUR PERSONAL 46AOVINJURY e_1000s000 X PDDed: O GemERALAGGREGATE t 000000 - PRODUCTS.COMPMP A(ib s 000 000 GERL AGGREDATE LIMIT APPLIES PER: >S POLICY .IEGLJ.._ LOC _ .. .... .• 1 SINEO SINGiE 1 ?J2612016 0?126120 . 000,000 A AUTOW"'LA UAatuTY Mt 814�85 BODILY INJURY Wilt POW") 3S ANYAUTO BODILY INJURY(Per$0*4L® 0 AVTQ5 ED X SOS LED pRO PERTY DAMAGE E X HIRED AUTOS X N AUTOONS-0VMED ' EACH OCCURRENCE umeiki.A UAB OCCUR ExoEBB UAB ClA1MsJ!IADE AQORECATE _-- _ EX -. ..... . s B WORKERS COMPENSATION 08YyBpLDene it X ITORYUM �+ ANNyD EMPLOYERpSp UAMUTY ECUTIVE Y E.L.EACH ACCIDENT 8500000-- OFFICETB7 R fJtCL7 N!A EA_DISEASE•EA fiMPLOY66 fQQOaOOO, (Mandatory In NH) If yyss,,WR7{b•Y,IdN GA.OISEASE.POLICY L MIT f6o0 eoQ OEBCRIPTION OF OPERATIONS Debw_—'_ ---'- '----- _— -- ---— '--�-'-- •-- .. ... 0ffs=PTION ar OPERATM"I LOCAT"S/YEMICL=(Aft-h ACOND 101,Addkkmml R•.,WM•WLrdN•,S mon►SPx+r nWu•al Insurance coverage is limited to the tome,conditions,exclusions,other limitation and endoreements, Nothing contained In the certNicate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATF HOLDER CANCELLATION Mogen and Co.,Inc. SHOULD)P��NA DESCRIBED on�ECE��eE 0ELaveNCELIAD� IN 68 Joyce-Anne Road ACCORDANCE tAfITH THE POLICY PROV11MONS. Centerville,MA 02032 AUTMORM RBPREEEMATM 0IM-2010 ACORD CORPORATION.All rights reserved. ACORD 25( 01010 ) of 1 The ACORD name and logo am registered narks of ACORD 4A 7 L81 DATE(MM/DD/YYYY) ,�coRo® CERTIFICATE OF LIABILITY INSURANCE 07/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: John Lynch IV PAUL PETERS AGENCY INC. P"C"N . (508 477-0021 FA No): E-MAIL linda aul etersa enc com ADDRESS: @P P g Y• 680 FALMOUTH RD. INSURERS AFFORDING COVERAGE NAIC# MASHPEE MA 02649 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: MACKEY THOMAS P DBA TOM MACKEY FRAMING INSURERC: INSURER D: 135 CEDAR STREET INSURER E: WEST BARNSTABLE MA 02668 [INSURER F: COVERAGES CERTIFICATE NUMBER: 69271 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MM/DDY EFF Pip EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE O RENTED PREMISES Ea occurrence) $ MED EXP Any one'person $ N/A PERSONAL 6 ADV INJURY $ MOTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JETLOC PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Pera.'%I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STER ATUTE ERTH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? I NIA N/A NIA 6S62UB4774P98315 07/27/2015 07/27/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensationTiinvesfigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ED MOGAN ACCORDANCE WITH THE POLICY PROVISIONS. 63 JOYCE ANN ROAD AUTHORIZED REPRESENTATIVE CENTERVILLE MA 02632 Dj C�(� Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i CERTIFICATE OF LIABILITY INSURANCE DATE(M�THIS YYY) TIFICAT9 IS ISSUIED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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 e terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: HAROLD H WILLIAMS INS AG PHONE FAX 81 BASSETT LN (A/C,No,Ext): (A/C,No): E-MAIL HYANNIS,MA 02601 ADDRESS: 728JG INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA ASKEW,DOUGLAS J INSURER B: INSURER C: INSURER D: P O BOX 1714 INSURER E: COTUIT,MA 02635 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-922X8895-15 08/17/2015 08/17/2016 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE MN OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ASKEW,DOUGLAS 1 IS COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION MOGAN HOMES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 63 JOYCE ANN RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT E } CENTERVILLE,MA 02632 1V1 [ti.p�, ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. CAPECOD-27 TQUIRK YM ACORQ• CERTIFICATE OF LIABILITY INSURANCE ' DATE/F18/2D/Y 71s/2o16 s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER cEA°T Barbara DeLawrence ROgers 8,Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: AIC No): South Dennis,MA 02660 E-MAIL SS:bdelawrence@rogersgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 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. INSR ADDTYPE OF INSURANCE L POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MWDD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR CBP8263063 04J0V2016 04/01/2017 PREMISES(Ea o�xurren0 ce $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO 6232707 COM 01 04/0112016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTO S AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPER enDAMAGE $ HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE EXCI0006635001 04/0112016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N WCE00431902 06/30/2016 06/30/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Morgan$Company THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 68 Joyce Anne Road Centerville,MA 02632 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r - Town of Barnstable Regulatory Services MAB& Richard V. Scab,Director. ►`� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, SC446;E tISe , as Owner of the subject property 'hereby authorize l=(Y- e, to act on my behal> in all matters relative to work authorized by this building permit application for.(Address of Job) 'k*Pool fences and alarm s 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 f Applicant 94 21CA�-s Print Name Print Name Date Q:PORMs:owNERPERMISSioxPoor s Town of Barnstable Regulatory Services s dF Richard V.S� call, Director ; Building Division Paul Roma,Building Commissioner MAM 659• `�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE1VfMON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. r ' ,. ,. t • . 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. a ' 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 . 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. r - Massachusetts Repartment of Public Safety t Board of Building'Regulations and Standards License: CS-026071 Construction Supervisor j \\ FRANCIS E MOGAI4 63 JOYCE ANN RD -CENTERVILLE MA 0263 CA— Expiration: Commissioner 10/03/2017 C�eanznaaiva�alC/a,�%vGuaeac�u6elt� i If ce of Qonsumer Affairs&'Businessliguletion MEWPROVEMENT CONTRACTO egistration: 180182 `,TyiP�: a- Expirationxii� 10/20/2'016 Corpoi9tJ6Q COMpA 'MDCYAN AND NY-Y INC' i Fl ANCIS MOGAN Jfjj _ 2 •.6&JQYCE ANN RD ( . .CENTERVILLE,MA 02632 i lJndersecretary License-or registratibh�valid for;i e_itlul':gge,opk� Pi before the eX'piratior,t6ate.. If found re ..t k;:'to I, .. Offic�•of Consumer Affairs•-and Business-k�gula,—n Y '10 P9rk-Plaza-Suite 51.70 " ,boston,MA 02t16 'Not vid Nth o►tt ignaYur,p a . ,.- FINE Im LINE wN Room _ BUILDING DEPT. e i E9a! g^TM e2 • FAMI TOWN OF F.�t�RNSTABLI: ., a m w ENTRY LNMG LLI N _ _; CON Q EXISTING FIRST FLOOR PLAN ewe:uv. ra E-N, F, : : i BEDROOM �____� y BEDROOM u3 5 HALL r ie6 bAME R� t KITCHEN RENOVATION GL El EXISTING PLANS DRAWN BY., EXISTING SECOND FLOOR PLAN DW aewe:,..•. ,d i FINE LINE ar i 9€ORmOOMnoiaxx g FAMILY 8 KffQfE I O 3 's w I S� E NO N7RY LNING w I U� — — J"< ............... ............ ¢ FIRST FLOOR PLAN REVISED 1 2-I------i_M [3UI_DING DFPT OOgg® '� OCT 2 2016 KITCHEN RENOVATION FIRST FLOOR a TUWIv OF BARNSTABLE RENOVATION • -�= DRAWN BY: p KITCHEN LAYOUT cw J � .uLE I�. r•Q Town of Barnstable Final Inspection Affidavit Date: l - /, - Thomas Perry, CBO Building Division 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed at: Street: W?- 4& Village: Woo k kl — has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit application number: [ 3 2-- Issue date: - 24 - l Sincerely, � o 0 cn c .� o z 'o w a�. Francis Sheehan z President op- Frontier Energy Solutions, Inc. 502 Harwich Road 0% Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel ��/ / 3a p Application # Health Division Date Issued1 7�4 Conservation Division Application Fee �2 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 42 Village. /�f s�' Owner Al 2:x Gi n �/ S F I•i 2,rgv►1�! Address u 2- � �l` Telephone -o �5' — �i C� - 1 ( �/`� �r,�s Permit Request We-A.k-were 21�h'On �2� de;z -wp r e)U S c,c,k y re,le Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docum&�. ation. � 1 � Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) c o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's=Highway: 0 Yesgb No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other " L Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) i ! 4.z ;�, 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: 94 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use S ��li(Q V1 G2- Proposed Use 2=e- i'd e_1y_Q— APPLICANT INFORMATION (BUILDER OR HOMEOWNER) . �_ _ Name er r ^ ` , G�� 0 n -f-�zTelephone Number �Z�" 2-3-7 'G Address SD License # l G s gra-y Suer, kA (f E6 3 ( Home Improvement Contractor# Email �S S�n1n� ��i1 Q�qt-1�Q1�'►Ct -CV Worker's Compensation #Vw(--1 UCH-(61 S 3 l s�--2[` A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE M, 1 FOR OFFICIAL USE ONLY i APPLICATION# DATE-ISSUED, r' MAP./PARCEL NO'. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ti GAS: ROUGH FINAL FINAL BUILDING s DATE:CLOSED OUT ` ASSOCIATION PLAN'NO: OWNER AUTHORIZATION FORM -A I., sc. 'leyll �. (Owner's.Name) owner of the}property located at I - t t Ck.Y1 (Property Address) N Y,-"'SAr- (Property Address) hereby authorize. .;. L , (.Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform Wottc on my property. Owner's Signature Date Signature-. exaoEea.< ee +Nsx�iHet'Ser.6lurr'42,'a"'174� Email: aierschermer@gmail.com 3/18/2014 1 : 10 : 10 PM 8740 12. 03/06 �o CERTIFICATE OF LIABILITY INSURANCE 0ATE(MWDDTfYffl 03/1812014 TM CERTIFICATE IS ISSUED AS A MALT71ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT.AFFOWTIVELY 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):AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE'NOLDEiL IMPORTANT:H itre certificate holder is an ADDITIONAL INSURED,the pofir y(ies).must.be endorsed If SUBROGATION IS WARRED;subject to the terms and condifiens of the policy,certain policies may require an endorsement.A statement on this cart ficate doesnot confer rigfsts to the certlficate holder in fieu of such endorseurarrt(s). PRODUCER 00W9-001 IRWCT Jetftey ford Rogers&t7aylosurance Agency N,_ • (800)5534801 (508)398.0248 434 Route 134 South DennLs.NA 02660 &RfltB;_AJM Mnruat Insurance Cornpany 33758 INSURM Fron9er EnergySolNoris Ina 502 Harwich Road Brewslsr,PIA 02631 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 PERIOD INDICATED. NOTWITHSTANDIPIG ANY FWQUfflEMENT,TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VM11CH,THIS CERTIFICATE MAY'BE ISSUED OR MAY PERTAIN,THE..INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNIS, EXCLUSIONS AND-CONDMONS OF SUCH POLICIES.LIM M SHONM'MAY HAVE BEEN RED BY PAID CLAM TIT TYMOF94SURANM POUCYNumem LIMITS - GBrERALLMElLiT.Y SkCACCWRRENCE S COMMERCIAL GENERAL UAElU Y D - y Ed86Fr S i CLAIMS-MADE El OCCUR HA$1_BCP(AnYmtepwsbaJ S y PERSONAL&ADV INJURY S GIDISM AGGREGATE S BRL AGGREGATE LUTAPRIMPER: PRODUCTS-COMP.'OPAGG S JCY c AUTOMOME LIABDAY CO S . a � ANYAUTO BODILY 8�.41RY.(E'er pr wfl) S .AU.OvWm AUTOS AUTOS BODILYWAM(Psrap0woHUREDAUTOSHSMMLED NON-0WNED AUTOS "acd $ UMBRaLA I]AB .00CUR .EAM—OCCURRS CE S OMESSUAS CLAMS MAEEE AGGREGATE S DED RErFNrIbM.S $ XiN%YpROPbR��W X `Ifni A OF M ErMi IAME?Si9GLtEDED? mVFXA NIA U1KC-100d'iOISS:1S30Mt1 3t14Pt014 3H4Y1015 EL $ 1,000_DQD_00 thlalydatoryfoMH) EA.DIXACC-EA.RAPLOY- S 1,000,000A . R"OFOPERATIONS6W ml EJ_DI-SEASE-POL! UMTr $ 1000400:00' . DESCRIPTION OF OPE RAInONS I U=TU)NS'I VBUCLES(r=Ch ACORDiD1,:AddRbnW Ronark5.SchedLo—.amom spma is regriuodj CERTIFICATE HOLDER CANCELLATION Town of Sandwich 130'Main Street SHOULD At3Y OF THE.ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE Sandwich,MA02563 THE EXPIRATION DATE THEREOF. :NOTICE WILL BE. DELIVERED Nd ACCORDANCE WITH THE POLICY PROVISIONS.. AUTWOR2EDREPRESEMATNE " l..-,yG.75CJR- 01888-2010 ACORD CORPORATION,.AII Hlghts revered.. ACORD 25(4010106) The ACORD name and logo are registered maths of ACORD 3201 M ssm*usefts-f3oalSif14ent of PUb 4C.Safky OfTce:ofConsamc�A ;rs& u BuaroofSWIdngRegulathms and Stmurds' ><r bBstratfieft SLW.r►asur Sgr&Atr Y 'rJYGfSl7 �..:".•3y!'. -.-(_is-. BREWSTQ�MA tYL631 " edersrritWY - Cca�itrQs§t :" �'I712076 I,ieeuse or r v �€ate iaii►didul. oniY 'Restricted To:CSSL4E--MsWot<on Cwdrddor_ �•_ . - b�fere'Cite'e��a�ion'dale:If�O�tdE•dncarfQ:-. ,;;_..__..._ _; . - pifieofGonomer _ -=-: 10'Parkpim-Sni€e 3$7E1- 'rs MA,(MI 16 =: FAurstopossemaommaeftmaf*eMamadvaseft stguatare " sstftBufft tmCodelscause:faT ano#tittsltcense fbr OPS triievsmgsd t iC v m 6av/DPS Y i j i - {3 I ne Commonwealth of Massachuseft boardnen!of 7ndust> 1 Accadents Office o,f Inmdgations . -.: . . bt?Q Was Ail' ngtoit:S Meet . Boston,M,4 02111 www mass:gov/dia Workers'Coopeasatiozi Insuirauce.Affdavitt`Builders/ComtrattorslElectrric anstPluuitiers Annlicant I0br'm'atian P#ea a Print_Le i Name gNsiues-downiratiodfadivWal):j?-o 1`i t9e � �lt'�rG; i LS�� 4 C 7 t%1f ! Address:'.;7Q- � Cary/State bp: t ..�- Phone#: Are you an employerY Chgck:the appropriate tiox: T of ro ed �,/ i-Ly I am a employer with- � 4.-[�I am a geuerat.contractor.and I - employees(fall and/or parE-tune). have.hired the subcontractors New construction 10 1 am a sole proprietor or partner- listed.oh thee attached sheet:. . ship.andhave no employeesheseaab-Eaontractors have....... 8:::0-IJemolition working for me in any capacity, employees and have workers' t 4. []Building addition [No workers'.comp_ nsarance comp..insurancat i0.- : Electrical or additions 5. We are a corporation:and its repairs.. }. mil- :..�..�. :�.. . : . .. .. . 3.Q 1 am a homeiiiynei doiag:all work: o cars' WICKeretsed`itieit::. .:. ; I I:Q,Phimbing-repairs-or additions _ .ri t of ex on MGL }£ o workers ... emptl.. .1 ...:..,::: :. 0 mpaus::::: ..COW- 'Myself{N cOW- :. - 12.�oof. insurance.re , .3a.0 I am-a homeoovaer acting as a eiloyees:jl�Io workers' 13. Other a:. geaetaFi�tractr;r(iefeit to�`4): - -.romp:iusurauce.regtured. . `A-!appticm that checks:boi, must also fiti aut.the.section below.showing:thea weducre.coa�atioil.oiicy informstiaa t Homeowners who submit tbis affidavit ia�catmg they ats doing•sil..woik aud then hire outside cmtmetots:must submit:s new afidavit.ihdicatiag stick:. traetats that .ihts 4iot : attacked as addtaoaal.sheet showing.the aama of the sub-caatrsct not those!arises have:..: .... employees..Tf the.sab.cantractan(tasc emPtayees+t#�eY mnsr.Qrrzvide:therr•wt�aers.camp:1��9- :.: .: - arts.an ear that is . ' workers'co : affair haurance. or e. ees Maw is pfoye>' pmvrdurg - 1� m3' r►rPloY potrc}+a�rdlob site _ - information :.:. . Insurance Company.-.A ame: Policy#or Self--ins Lic..#: G Er l 46[l{ Expiration.IIate: { Job Site Address: :.!Z i {- I a Vt�S �� " CifytSrateiTp:iN 1,Gif S{YI - Attach a copy o[tree work'compensation policy declaration.page.(showing the-policy number and expiration date). Failure to secure coverage:as required under Section 25A of MGL c. fk cantead.to tire,imposition of criminal penalties.of a fine up to$1,500.00 and/or one-yea imprisonment as well as civil penalties in the form of a STOP w RK OitDEii:and a fine of up to MOM a day against the violator.:.Be advised.that a.copy of this statement rnaiy:be-forwarded to the Office:of investigations of the DIA for insurance coverage verification. I dokere r penalties fpedury fa proWdedd by �u�rder7 auu and v . that tlu in rniatloii shave is.Prue a>id-corrii!iY. .: Da _f c)4 6 Official rue only. Do not write in Mh area,to berrompleted by city or_town.gjYWal City or Town: Permit/I;icense-# Issuing Authority,(circle one): 1.Boant of Health 2.Building Department 3.City/Town Cleric. 4..Electrical Inspector 5.Plumbing Inspector 5.Other Contact Person: Phone#: Parcel Lookup Page 1 of 1 � itie 'i RA[{NSTAtiLE.� MASS' �p 1619. Logged In As: Parcel Lookup Monday,June 16 2014 Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options , Search By Street 1= Street# 42 Street WILLIAMS Name — -- Village All Villages f- I Search <Prev Next> Page 1 of 1 Rows/Page:F10 Ili Parcel Location Owner Village Index Map 111-040 42 WILLIAMS PATH SCHERMER, DOLORES WB 1842 111040 I http://issgl2/intranet/propdata/lookup.aspx 6/16/2014 Assessor's map and lot number ... THE Sewage Permit number ..... �.........................: 33AENSTAM E. House number ...................................... NABL ........................ 039, D 11 M &- TOWN OF BARNSTABLE ' . BUILDING INSPECTOR ......................... APPLICATION.FOR PERMIT TO TYPE. OF CONSTRUCTION ... ....... ......................................................................................... ...... ................. .......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ......... .............. ......................... ............... 4(l ........................ Proposed Use .... ............FA.Kt.L- t-L lu c-.r.............. .......... .............�p..................... .................................................................. Zoning District .... 3...... .....................................................Fire District W;�7571 ...... ......................... Name of Owner ....... ...................Address ................. -7— 7- IVA&5- Name of Builder ..............................Addre'ss ......... ......... ................ Nameof Architect ..................................................................Address ............................. ...................................................... Number of Rooms ................................................................. Foundation x?.*A ........................ 7 ..................... Exterior ....................................................................................Roofing ......z000.,�.�. ,o.ow-!I�:-,;7 ..................................................... Floors .......... ...................................Interior ...... ........................................................ Heating ...............Plumbing. . ................110//C colwve ............................................................... ............................................ Fireplace .....7�v.................................................................Approximate-cost Definitive Plan Approved by Planning Board -----------—--—---—---------- Area- ............................... Diagram of Lot and Building with Dimensions Fee------4 .............. .............................. ,SUBJECT TO APPROVAL OF "BOARD OF HEALTH e-I? OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS j hereby agree to c6hform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. /� 77 /' Namel� .................................. Construction Supervisors License .... ................... MALCHMAN, NELSON A-51 11-4 0 24773 13-2 Story No ................. Permit for .................................... Single Family Dwelling .............. .............................................................. Location Lot....#.1.1.,....4.2...Wi.l.l.i.ams...P.a.th . .. ..... .. . .. ....... .. .. ... AU West Barnstable ................................o.............................................. Owner Ne.laon..Malchman......................... Type of Construction ......Fmame....................... ................................................................................ Plot ............................ Lot ................................ Permit Gra ted ..... e.Pr u.ar y... ......19 83 Date of Inspection ...............................;....19 Date Completed ......................................19 '4 �"+ '.FbS' - a•, -�r• il.. _ • f xf�'A,•;,'�, .fir; ::. .ley. rf . :�N '+ .f.. w,?�•h w15`,., Town of Barnstable % BAR`.,;-q E. Regulatory Services T MASS. g 039. Building Division p1E0 N1Pr A• i 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 r� f Inspection Correction Notice Type of Inspection a1V r'F it n?i 7,-,E— Location Y--2= Gf/rc c i A-,�,�s Permit Number N a m Owner to to/cNaro)d Builder N K w One notice to remain on job site, one notice on file in Building Department. The following items need correcting: /70'�C L /'�L-C 64 C)Cj PC—W eq 7' /EAJAL 7- 1 A.vy /V��s � /r�iLi� ST izl //V /`gyp&-,;,_ 7 •. l3 to YOA .� py o of `1633 Please call: �-508-862-4 R8 for re-inspection. Inspected by Date �oFWKETay, Town of Barnstable ry 'co�(0(2 Expires 6 months from issue date sARNSTABLF, = Regulatory Services Fee (01( �3 9 16 9 ,0� Thomas F:Geiler,Director Building Division R Town Perry, Building Commissioner / yJ 200 Main Street, Hyannis,MA 02601 V �, Office: 508-862-4038 Fax: 508-790-6230 ' EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY r� Not Valid without Red X-Press Imprint Map/parcel Number Property Address ! `\ Q YYI Residential Value of Work Q t•SSS o Owner's Name&Address C� C+ 0 Contractor's Name Pic-C)A P��o� ,yne IY-\4,(UUe Y\-tc?N Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Worke Compensation Insurance Check �A✓G Q� Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insuranncce Insurance Company Name Workman's Comp.Policy# C Z 1 S.- 3 66 G/ a' Permit Request(check box) PERMIT []'Re-roof(stripping old shingles) All construction debris will be taken to O C T i 4 2008 ❑Re-roof.(not stripping. Going over existing layers of roof) OWN OF E3ARNSTABLE ❑ Re-side �+Y"o _%?( a.s'4-1c Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit exe liaace with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property�0'wwx-Letter of Permission. �f�=me rove t ontractors License is required. (�Qn,$T Jc t v ` r-� A__ Signature J 0W) Q:Forms:expmtrg Revise053003 i 1L �y �oFIIKE Tow -Town of Barnstable 4.P O " Regulatory Services MRNST"LE, Mass. Thomas F.Geiler,Director 1639. �oo'OIFDr�'�s`°� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 5168-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder I, i�,/�v A/,(JA//rf//�!'E.VEN , as Owner of the subject property hereby authorize J V 1 C h e C Jo �� ' _T YMt,R,',J e MP J to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) _ �9-a9-ozoo S e of Own. Date (21;VY VANIVA16ENEN Print Name Q:FORMS:O WNERPERMISSION a Liberty Liberty.Mutual Group 7� P.O.Box 9090 mu Dover,Nil 03821-9090 Telephone(800)653-7893 Fax(603)-245-5330 March 10,2008 I TOWN OF BARNSTABLE ATTNT:BLDG DEPT 200 MAII\T STREET HYANNIS, MA 02601- RE: Certificate of Workers Compensation Insurance Insured: MCAS LLC DBA NICKERSON HOME R,4pROVEMENT PO BOX 2476 ORLEANS, MA 02653 / Policy Number: WC2-31S-360989-018✓ Effective: 3 �/200�8apir lion: 3/1 /2009 Coverage afforded under Workrs Compensation Law of the f ): Employers Liability(L_i,,,sts). Sole Proprietor/Partner Coverage Election Bodily Injury By Accident $100,000 Each Accident Bodily Injury by Diseasc $ 100,000 Each Person Bodily Injury by Disease: $500,000 Policy Limits As of this.date,the above-referenced.policyholder is insuredby Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not altered'by any requirement;term or condition of any or other documents with respect to wl cb t cate may be issued his certificate y certlficate,uassuedas-a-matter of informatioii onI.and confers no right upon you,the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage i afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such cancellation. AUTHORIZED REpRESENfATIVE LIBERTY MU`UAL INSURANCE GROUP T4is Certificate is executed by LIBERTY MU`rUAL(NSUR4NCE GROUP as respects such insurance as is afforded by those companies. cc: Insured: MCAS LLC Producer of Record DBA NICKERSON HOME IMPROVEMENT ROGERS&GRAY INS AGCY INC. PO BOX 2476 PO BOX 3700 ORLEANS, MA 02653 PLYMO 3/10/2008 UTH, MA 02361 � o ,P t ✓,ce U�omv�reazcueai o�✓�aic�iccaetta .\ Board of Building Regulations and Standards License or registration valid for individul use only = 'F_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: =-- Registrati.il Board of Building Regulations and Standards on:, 133851 Ezpiration_=8/17/2009 Tr/1 259484 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Pnvate Corporation NICKERSON HOMElMPROVEMENT MARK NICKERSON 12 COMMERE DRIVE ORLEANS,MA 02653 Administrator Not valid without signature I I I I I I The Commonwealth of Massachusetts Department of Industrial Accidents ^ Office of Investigations a' d 600 Washington Street Boston,MA 02111' www.mass.gov/dia Workers''Compensation Insurance Affiddvit: Builders/Contractors/Electricians/Plumbers Applicant Information 1' T Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: 0(_ I-Perna ol(ror3 Phone.#: Are.you an employer? Check the appropriate box: :Type of project(required): 4. I am a general contractor and I 1. I am a employer with�_ ❑ 6. ❑New construction . employees(full and/or part-time).* • have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition vrorkin for me in an capacity. employees and have workers' g y p ty 9. ❑Building addition [No workers' comp.insurance comp, insurance,$ 5 ❑ We are a corporation and its 10.❑Electrical repairs or additions . required.] ' 3.❑ lam a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4), and we have no 13.® Other (,✓.I`� c o vi employees. [No workers comp,insurance required.] *Any applicant that checks box K must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or-not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. 1 - ' Insurance Company Name: i �7P1 LA 4 — Policy#or Self-ins.Lic,#: WC 1-;Z S- �° �� 'Gl Y Expiration Date: Job Site Address: Z `1 is rt ►tit' i�4 ) •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 correct. Sianature- � Date Phone#: a r a<{0_ 36 Official use only. Do not write in this area;tb be completed by,city or town official City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: '' �lassachusett�- Dep:u•tinent ol'„public Safe Boar of Btiildiii,, r �- _�Rcsulat:saiy;;ux1 �t.n tl.}i•d. .� - Construction Supervisor Specialty License I License.*-CS SL: 1011:85.:' —:� -Restricted to: RF,WS,DM MARK NICKERSON i 321 RED TOP ROAD fJ BREW.STER, MA 02631 V Expiration: 10/26/2 (,uinii,.i,.ncr Tr=: 1pp1't•�85 Restricted to: RF,WS.DM IA- Masonry only RF- Roof Covering WS-Windows and Siding SF= Solid Fuel Burning Devices DM-Demolition_only Failure to possess a current edition of the Massachusetts State Building Code is cause for revocatM>��v/DPSse. Refer to: WWw• I 1 1 TOWN OF BARNSTABLE Permit No. -.1 7 3_- t Building Inspector cash -------__-- "' OCCUPANCY PERMIT Bond Issued to Nelson Malchman Address Lot l_h. 42/Williams Path, West Barnstable Wiring Inspector Inspection date Plumbing Inspectorf � �' Inspection date Gas Inspector / _ Inspection date gEngineering Department i r / f Inspection date Board of Health Inspection date ip.; j 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. ! 4 �/ ----------------- Buildingnspector R Ace c-s 44 � M,LL/'A" _ ��la of w,,,� • �� RICHARD �Gm A. 3 BAXTER N CERTIFIED P�-bT Pt—aw NO.2,048 Q 14D SU tccATto*1 ytl. $AM04TABLS aos �! mP ua`I� " ____-- N� �OUI�DI�T�n4 5b1o+�c/►J P't--A1�1 R�FEQE�.IGE � G6RTIl^� THAT T , I. szr.CW C0AAPL` '6 W ITI.1 TNT 51DE.�.t►-ice LOT - A.1JD SE-mAC4 QEal-)lge E T.; 1'SN R, -Tow►. oF-3AT245'p q.�e►►N PL $+�-� I LOGATTS� WITS-i u BAXTS.9, r REG1cr�ED 1.r111p 5uev&,(D'ZS �ATrc J- l oSTERVIl-� 0 14CA►sS� o+-t Aw "y'1-�1'S C7L/�N IS Wo TS BA0F�SiFTS 61aoe'Jw APPt-i GA-"'14 �i 11�IS"T�GvME�JT StJitN�`f � LVt'ILETT hJGT HE USt:t� To DeTG2MINc �'_�� . Assessor's map and lot number ... ........................................ �• �/� Q�oFTHETo�♦ ' pp ) Sewage Permit number ......... .. ....O.ly US +�A o�� I? ��al i� BASESTADLE, i House number ........................................... ?�..................... A 1639. @t ��911.. v mu m tl TI 1� G 5�' �qqyy 'Fp YPY G. TOWN OF B A R -�Al BUILDING IN:SPECTOR APPLICATION FOR PERMIT TO .. !l{ ��N...... �- .:'.t�7!�'//� .` ...f�FovSC............................ TYPE OF CONSTRUCTION .. %cRc7J..... T:�� d� e......................................................................................... rf/L!...... ................�9. 3 ' Y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �aT `` 0il��Lls QyT �E'iU �l->vs Location ......................�1.........................................1�..................... .... ..lU................................ ProposedUse ....�J(�� ...........rf . ...... E;C ..G-............................................................................... .Fire District Uf ?......... 5 Zoning District .......... ................................................:.........:. . . 'S. ......... ................................. Name of Owner .01RL:(JkQ.......!%,41/ ...................Address Name of Builder kvlA �.......O!!9,4P....T!.... ��X ilk. Address ... `. Nameof Architect ......... .............................................Address .................................................................................... Number of Rooms Foundation�1�.... �v .a./v ...................................................... Exterior ....................................................................................Roofing ....... ........................................................:. Floors GU�t.L.....� �i.:.....................Interior .....�' .! `�7 ��.............�..`.�...�...........!.................... ..................................... Heating ��` �.......��..l �! ......�07�................Plumbing ..................................... ..�.........:.......................... Fireplace ..... 0................................................................Approximate. Cost ......1 j. ..................................... . .... Q (/ Definitive Plan Approved by Planning Board ------------_________---------19_______. Area ....... //... .................:... Diagram of Lot and Building with Dimensions Fee �— �.3.....s............ SUBJECT TO APPROVAL OF BOARD OF HEALTH o -&0,4j� Wig' - '��' �_ • - . VI)f��j�wtS QI�Tti OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name��/, r(, -It�t�.�!!............. f ...........:................................ Construction Supervisor's License ..0l.o�Q.....5........... "6;,# � AMALCHMAN, NELSON 24773 1�2- Stor No ................. Permit for .................................... Single Family Dwelling . ............................................................................... Location ...#.1.1......4.2...Williams. ....P.a.th .. . ..... .. .... ....... West Barnstable ............................................................................... Owner .... ....................... Type'of Construction ...FX4Mf�......................... .......... ..................................................................... Plot ..........11.'................ Lot ................................ February 2, Permit Granted ........................................1983 Date of Inspection ....................................19 Date Completed ... 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BALGONY BALCONY Lo BATH#3 I 1 ° I I 1 I 1 I F BEDROOM#3 BEDROOM#2 C0 I ALL GL GAME ROOM KITCHEN RENOVATION F—tDr-AL —=== _ TALL C,C) ` CL ❑ �L a EXISTING PLANS •. 1 SHEFTFIOF] DRAWN BY: EXISTING SECOND FLOOR PLAN cW ' SCAM 114' MTE;B�ARO18