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0474 WILLOW STREET
UPC 12543 No.533"OR garca HASTINGS.UN � l Town of Barnstable Building e Post This Card So That it is Visible From the Street-'Approved Plans Must be Retained on Job and'this Card Must be Kept M'� Posted Until Final Inspection Has Been Made. Permit s639 Where a Certificate of Occupancy is Required,such'Building shall Not be Occupied until aTinal Inspection'has been made. Permit No. B-19-1368 Applicant Name: Stephen Dickinson Approvals Date Issued: 04/26/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/26/2019 Foundation: Location: 474 WILLOW STREET,WEST BARNSTABLE Map/Lot: 130-026 _ Zoning District: RF Sheathing: Owner on Record: ACKELL,ADELE B Contractor Name: STEPHEN T DICKINSON Framing: 1 Address: 474 WILLOW STREET Contractor License: CS=081843 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $9,579.00 Chimney: Description: same for same,replacing 3 sliding windows u factor 0.2.8, replacing l Permit Fee: $48.85 3 direct set fixed frame windows u factor 0.27 i Insulation: { Fee Paid:. $48.85 � F Date: �r� 4/26/2019 Final: Project Review Req: 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"Jssuance. All work authorized by this permit shall conform to the approved application and thesapproved 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. -~` Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: , Service: 1.Foundation or Footing /� 2.Sheathing Inspection - - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: i r I to S7 u D y Dtc-ic. 2o� p GATff - 5 Fco �. t 110 ' f SMOKE ®ETEC T REVIEWED i� BARNSTABLE BUILDING DEPT. D E FIRE DEPARTMENT DA E BOTH SIGNATURES ARE REQUIRED FOR PERMITTING o- f �,k . 1 b Ii fJ �R `7 ar45 �1Ef4jT t Q' C'ommonwea&o f Massackuseffs Official Use Only �} r a1JePartm¢nl o�,}ire�ervices Permit No. Occupancy and Fee Checked J BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of: 6A �n 6;,:,6le- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) q-7 L/ 10 J(,L()L-J 5 T. (J_ 6 y1-RA)STD J9 L,F— Owner or Tenant a LL- Telephone No. Owner's Address 14 AJ00 ' VO Is this permit in conjunction with a building permit? Yes No_❑,.(Check Ap ropriate Box) / _Purpose of Bnilding 5 - T1=FL Utility:Anthorization_No.— Existing Service IM Amps L / ay&olts Overhead Undgrd❑ No.of Meters i New Service DW D Amps l / ayC�olts Overhead Q�Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: S 1c- l 2- -&b v s - 94 fi Completion of the o be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil-Susp.(Paddle)Fans Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs MAYftegfigs KVA No.of Luminaires Swimming Pool Above ❑ - o.o ergency Lighting nd. �!N &IJery Units No.of Receptacle Outlets No.of Oil Burners iT1WX8&0 No. of Zones No.of Switches, No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices No.of Waste Disposers eat ump Num_er ___.__._.__._ Tons o.of Self-Containe Totals: __..... ..__........ Detection/Alertin Devices A o N No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection 'A No.of Dryers Heating Appliances KW Secunty Systems: o D x n No.of Devices or Equivalent m No.of Water o.of o.of m <m Heaters ' Data Wiring: m A_ Si s Ballasts No.of Devices or Equivalent T o No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: m m-,7,-p No.of Devices or E uivalent T A O OTHER: l D C o �m A m D a Attach additional detail if desired or as required by the Inspector of Wires. Z =P o AEstimated Value o Electric Wor . DO (When required by municipal policy.) -A Z Work to Start: S Inspections to be requested in accordance with MEC Rule 10,and upon completion. C) m �Mz INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless o> the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The �N undersigned certifies that such cov is in force,and has exhibited proof of same to the permit issuing office. z m Z CHECK ONE: INSURANCE e BOND ❑ OTHER ❑ (Specify:) I certify,undei thepains andpenalties ofperjury,that the infonnrmadon on this application is true and complete FIRM NAME: r 3-6yir y LIC.NO.: Licensee: e J—i IT dQ t{-f-4 & Signature LIC.NO.: (If applicable, enter "exempt"in the license n mber line) Bus.Tel.No..61-1 S 11 1 y d Address: / G.J f Y ty �uCs~STDrJ CAR O �-3 y� Alt.Tel.No.: *Per M.G.L. c. 147,.s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent Owner/Agent PERMIT FEE. $ Signature Telephone No. f 1 , 27l$Comu 0nweakh Of Mamadi 1 S Depmtwe t Of Induybid Accidm ft Office of Imvsfigafia= 6#0 Washfivton Street Baswa,MA 021 I v P nassgovIdia Workers' ComlipensafirnIns�ce Affidavit Buflders/Confimctors/Mectrician&Tb=nbers Apii i Infw naf .an Please Pr nt xa= �. �• �o �/ CAM P � � ' Address: c,JA(L F L r4/U F Are you an employer?Check the appropr�6te ba= Type of project(reqmri�_ L❑ I am a employer vith. 4. ❑I am a general coafz$ctar and I 6- [—]New boa eWoyeez(full andfor part-lime).* lave the 2[9<am a sole proprietor or partner- wed on the altarhed sheet 7- ❑Rem deling ship and have no employees . These sate-eazeiracfoss have g ❑Demolition wading fair me in any capacity. employees and have uzodre:rs- g_ ❑Building addition jNo ivo�ers camp.iamraace °�- d-1 5. 0 We are a cmporatian and its 10-[9'Ffectacal repairs cr additions 3.❑ I am a hotneowner doing all work officers have exercised their 11❑Flua bingrepairs or adclitioas tight of==Ptioa per MGL ❑ t �€[No�� c.152,§1{4),andwe have no L. Rcofop insmaace requin-A]1 13.0 other employees-[No worlms' cow i,nzarance me&] mPs�Bratchectsboz 1 alsoffioafthtsediaabnTa�vshtvtffiSB wodcerecumvasad parkyinfarzm�aa l omeowaPa nw stilt dais affidav9 tLep ate Baia;aIl va d�and Bien lgte off$co�armts snbmii a new affidavit mdi socii =Cannacmastia rherl<this bo=Est attarb as additional sheer doming th ename of ttre sub-cuatmCtm sod sts e-+P*-ar not8ose bxM employees If the MAK=M==have ifieg I F=Vide twir-othea oa=P.POELT abet I aai an eniplofer treatirpraurdir�g worJccrs'eo�exsadan iasurareee for ury ettrploy Bdiow is the pV cy atsd job site irfot�aadon. . TFTSUMCe Company Name: Policy 411'or Self-ins.Uc_ E.pisaCiaaDate Job Site Address` Citpmbtelzip: Attach a CO' of the workere compensatioapolicy decbratiom page(showing the policy somber and expiration date). Fail=e to secure coverage as required under Section 25A of MGL,c.152 can lead to ffm impositiaa of crimslal penalties of a fine up to S SUd 00 anchor one-yew imprisonment;as we11 as civil penalties in the form of a STOP WOEK ORDER and a fine of up to$250_t)0 a dap against the violater. Be advised first a copy of this statement may be forvnwded to the Office of Investigaheas of the DIA for coverage verffcab m. I do rwre!7 the pain pea (!n atflie i for4ea&w prmi&d abmw is tree and correct _ - Si Date- phone; tp of f idol uss amIF Do not write in figs area,to be cattrp&Md by adp or tmm City-or Taws.: PCrmi fLieense f Lwamg Anihoritp(circle one): ' L Board.of Health 3. Department 3.CRyYTosm Ckxk 4 Elec&iml Inspector 5.Plrmabing Inspector 6.Other Contact Person: Ph-one#: 6 • r lnformatton an dlust'uefions :• Massa_chaztts c c=xal Laws chapter M req�es all�gloyas'm provide Wows'�eusafiam frs =npioy=s- pmsaax�-to this sf�,as ea�Ioyee is dcfated as.6.every pasdn in fie sca-vice of anon ffider euy cardract ofh�e,. express ar implied,onl or wziftm." An=V&ydg-is defined as"an.indrvi& l,parfneisbip,pssoci-Lu,cmpM3 M or ofl=legal etity,ar any two or moan of the f regoing m a Joint s arvi mab>dmg the legal mix eves of a deceased employer,W tht receiver or tU.gf a of ao individual,per,associatiaa or affimlegal entity, CMplOy=S- However fhe owner of a dwelling loose having not more than$nee apmtn=ds and Who resides t mmi3o6 or the occogant of isle- dweIlmg house of micCerwho a qAM p= ms to do maw concftuLEon or repay wmic on such dwelling hanse or on tha grounds or btdIdmg appmrtenatffierefn shallnotbecanse of such eraplaymem be deemedia be an employe" MCH.chapter I52,§25C(6)also stairs that'every stale or local licensing agency shall withhold the issaance or renewal of a license or.per� to opeiate a':b>�ess or to'cansiruct b> qdrogs;ia file eommo r any applicantw•lo has notproduced acceptable evidence of cdmtpliance-witl i3� ir m uran=coverage requed." Addy onaIIy,M(s`T,chaptcr 152, §25CC7)stairs�Ncdherf bz o ' 'nor a'uy ofitspohfical snbdrvisions shall e int co o aP7 ntract faor th c pe nance ofpnbIio waa c u3 ttl a able-e�vidsace of cIpIiance�t�ith ffie insm�ce. 1 regm:r m3j 0,iS of tf115 � *C�pt=life been pICSGQiLd�D t�G -y 1 �` C e I�J . Apphcaafr , PIease fill otzt the W 0330='campeasation affidavit completely,by cl�the boxes that apply to yens stogy and,if n. Y,S`appIy s)name(s). a ces)mdPhcm n=d=(s) aIong WrtT &=ems) of insurance. Limited Imbue*Campaomes(LLC)or Limited Liabi-EtyPaxt=zhips(LLP)wino =3PIayees of a=fisan the membsrs or parfaexs,are not regoaed to cagy warb=?c�pmsafian iaso mce- If an LLC cr LLP dory have employees,apolicyisregaked. Beadvisedffiat this aTzkyk maybe salnmitte:dto the Depadmentof Tndastxial AccirT for conf=z im of msarm=coverage: Also be sure t9 sign and dafethe afudavit The affidavit should be retied to the city or town that fhe appHca im for tha permit or license is being rzgvesled,not fhe Departme t of dal Accimts Sbodldyoa have arty fines km rzgardmg the law or ifyon are regained to obtain a tvoIras' corapensationpoficy,please caIll oDepmtacntatf=mmnberlistedbelow Self-insoredcompaniesshonIdeotert5� self-insurance license,abet a a tine aiz line. City or Town Of acbils r - Please be sore flat the affidavit is corplefz and prir ed Iegibly- 'Ile Depa t eothas provided a space st fly both off z affidavit for you in fM out in the event the Office ofk7mfigations has to cotactyoaregadmgthe,applicant Pleasebesatetofilliaflitpeamh- =asememberwhim.-wMbousedasarmr== en=31= luaddi60n,anappic ffiat mnst submit multiple p=H CMISP appIlt�m any givcd yca;need only submit one affidavit indicating c=rmt p olicy mforma fl=Cif n=cssary)aid tundra`Job Site Addres'the applicant should vnitz aaU locaf;oas in - Cmty or town)--A copy oftheaffidavitfathas been officbIly stamped arum ki bythe ray or inwnmay bepavvidcd to fbe applicant as proof that a valid affidavit is on file for frdnre pcuniis or Tac=m A new aflzdavitmzzst be BI ed out each year.-hero a home owner or rid is obt daiag a I D==or p=mitnot xzlated to any business or commercial Tentu= Cie. a dog licm=or pemnit to bum leaves ef-.)said pmsson is NOT regui-c d to c this affidavik The Office ofTnvestigad=vomIdhlmto tbankyoniaadvance foryamr coapW�rmand shoald yam have aayquesstirms, please do nothesitaft to give us a cxffi Zhe Depaitm eat's address,tDIThone and f== =b=- OfM&Ma' elm ix . ., i MA M1 I I Ta 4 617-T2T4900 Cat*6 4r 1-377 I A ZATF Fax#617727-7M Revised 4-24-07 - wig rn a wffR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel I� Apphcatio �GJ Health Division BUILDING DFRT Date Issued - ' Conservation.Division APR 212016 Application Fee Planning Dept. TOWN OF Permit Fee BARNSTABLE Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ^ Village �i� ry't` �1 Ah 1 Owner_ �C� C �,�� Address 33t Telephone, Permit Request ��J���,V ti �, Q�A� S , (�LAnNt (NE. PD0 Ili bb64(ZANG* yiAtAi AT s`' Square feet: 1st floor: existing 06 proposed 2nd floor: existing proposed Total new _0 Zoning District Flood Plain / Groundwater Overlay / Project Valuation VC,O IDT.' Construction Type w� Lot Size l Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes YNo On Old King's Highway: ❑Yes No Basement Type: 0,Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 4 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 WNo Fireplaces: Existing 4—New Existing wood/coal stove: ❑Yes U/No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �( Name JAk'' Telephone Number AA� Address bb Yk(� �J&S'V,- '201 0'-e-d" License # LS 6 -S1 S 1 Y ff Home Improvement Contractor# 6�)9 0 Email is �1W�{���S�r/�1�(.\Y�PJ`1 ��- Worker's Compensation # 0 Ck 5111 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Q 0,0 0A O (SIGNATURE DATE 2-0 i i f o FOR OFFICIAL-USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. p , ADDRESS ' VILLAGE OWNER ` DATE OF INSPECTION: + ti • FOUNDATION FRAMEAtol" 1Q�ZC INSULATION w FIREPLACE f ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH . FINAL r GAS: ROUGH FINAL - s FINAL BUILDING i DATE CLOSED OUT. : l ASSOCIATION.PLAN NO. • Z 17ze Comrfromveafth of-Vassadliusetls Department trf 1ndusfriat Acciderztr Oj�ce of Fmcidgadons 600 WaslraiWon Street Boston,MA 02M mmmassgovfdia Rrorlmrs' Compensation Insurance Affidavit:Builders/Contracturs/EIe ianslPlumbers licant Information } (� Please Prim Iggi lI Name(Sus�ee�Fgauiratidrn�FndErvi3ual� '1 � U 1��W (AC, Aci&ess: v �-, S Ot,�Lvv M wiz CitylSt.& Phone Are you an employer?Checkthe appropriate box± T of ect r 4. I am a general contractor and I Yl?e �] ( ���� 1.®I am a employer with ❑ g 6- ❑New construction employees(full andlor part-time)-* have hired the sub%-contractors Z.❑ I am a sole proprietor or partner- listed on the attached sheet~ I- KRemodelizrg strip and have no employees. . These sub-contractors have g- ❑Demolition working for me in any capacity. employees and have wodiers' 9. ❑Building addition. worms'comp.iravu=e comp.tnsuMMI required-] 5. ❑ We are a corporatifln and its 10.❑Electrical repairs or acicStions 3.❑ I am homeoticm-er doing all work officers have ese_rcised their 1L❑Plumbingrepairs or additions mysdi[No workers'camp. right of exemption per MGL 12.❑Roof repairs ias rrance required.]Y c.152,§1(4X and we have no employees.[No wod=s' 13-❑Other comp.insurance required-] 'Anyapp11a=dwt checks box 91mast also fM cut the sectioubeiowshossingtheirwaxkexs'compeasati upo5cyizffomstioo- I Sameo nmuwho submit dais sfhdavd inglic=1g they axedoing RUwa$and thra hi M autsi&CDn==M mnst submit anew affidaryt indicating such. fCa=actoxs&t check tbds boor must attached an additional sheer shooting the name of&a sutrccutruc m.and state whether ar not those entidesham employees.I€thesub-caatacturshave employees,theYnu stpmvidrthek warken'Comp.policy number. lain an eutplayer that is praurding x�orkers'compensation inmirance for my enrptoyees. $elviv is i7te paTicy and job site isfarmatian, n �� .� Insurance Company NamLr 'Q-� Policy or Self-in,c.I ic. �irf b 2 ! 1 dP I ExpirationDate: Job Site Address: l 1 k"U8 01i _)T_ CitylStawzl p:V f Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requimdunder Section 25A of MQ.cd 1ST can lead to the imposition of criminal penalises of a fine up to$1,50aOD andlor one-year imprisonment,as wen as civil peualties.in the form of a STOP WORK ORDEIRand a Ene of up to$25Q00 a day against the violator. Be advised that a cagy of this statement may be forwarded to the Office of Iaveskigations of the DIA for iflsuranca coverage verification. Ida hereby under th s dpena&es ofperjuty fhatflre iraformatimrtprmidrd abot is bate and correct Sia�rature- Date: � 1 (D Phone;k Iff I 'f'7 O,Bictat use anly. Do not write in firs area,tit be cmnpfeted by rafp ortnirn officiaL City or Town: PermitMicense# Issuing Authority(circle one): 11 L Board of Health 2.Building Depax-tment 3.City1I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Coniact Person: Phone#: - --- - - -- - - - - 6 ormation and lastructions h assay usetts General Laws cbapi:ea 152 regaaes all empIoyeas to provide woxiceas'compensation fur their=3ploye-es. Pm su ntto ties sbftxte,an employee is defined as.'.every person m me service of another under any conract of bae, express or implied,oral orwtiftcm" Au.err pfoyer is defined as"an mdividnal,partnership,=MiB an,corporation or other legal entity,or any two or more of the foregoing engaged is a Joint entaprise,and including the legal representatives of a deceased employes,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees• However the owner of a dweIIing house having not more than three aparimenis and who resides therein,or the occupant of the - dweiling house of another who employs persons to do maintenanm,construction or repair work on such dwelling house or on the grounds or bucldmg appun�thereto shall not becanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also that"every state or local licensing agency shall withhold$ie issuance or renewaI of a licen a or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of conpHance with the insurance.coverage required-" Additionally,MM chapter 152, §25C(7)states fileither the commonwealth nor arty ofits political subdivisions shall an into any contract for the performance of public work-u ohl acceptable evidence of compliance with the insurance.. requsements of this chapteahave i cenpreseufedto the contracting anthoiztyf Applicants , Please fill ovt the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sob-contractors)name(s), addresses)and phone numbers) along with their certi acate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees other flaathe i members or pact e:rs,are not required to cry workers' compensation insurance. If an LLC"or LLP does have employees, a policy is required. Be advised that this afdavit may be end m,itb--d to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the afdavit The affidavit should be retained to the city or town that the application for the permit or license is being requested,not the Department of i h pia?Accidents. Should you have any gnestions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the n=bea listed below. Self-insured companies shoutld enter their self-fi surance license number on the appropriate,line. City or Town Officials i . Please be sure that the affidavit is compkb-,and priated.Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemxitllicrose number which will be used as a refurace number. In addition,an applicant that must submit muxltiple pennitllicense applit:ations in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sib--Address"the applicant should write:"all locations in (city or town)-"A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided in the applicant as proof that a valid affidavit is on Or.for fuel m peumiis or licenses. A new affidavit must be flied out each year.Where a home owner or citizen is obtaining a license or permit not=ated to any business or commensal venture (ie. a dog license or permit to burn leaves etc.)said person is NOT regnired to complete tins affidavit The Office of Investigations would lake to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departmenf's address,telephone and fax nunnber. 'he I*of chnsetts , Depailment c&lii& izl Accidents Mitre of 7.nvP0fio= 6Q��ashing�n�`ize�� Br�r�uz NfA E�111 - Tf,-1.:g 617-727-49W=t 406 or 1-M MA&SAFFE Fax#617 727 7M Revises 4-24-07 .mgPvfdia r + AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 0MR 5301.2.1.1)1 EZ Cbe�k Compliance 1.1 SCOPE WindSpeed(3-sec,gust).................................................................. .................................................110 mph — WindExposure Category.................................................................. .............................................................B — 1.2 APPLICABILITY Number of Stories ..............................................................(Fig 2)............................ stories 5 2 stories _ RoofPttch ..........................................................................(Fig 2) ........................................... 5 12:12 — MeanRoof Height ..............................................................(Fig 2)................................................. ft 5 33' _ BuildingWidth,W...............................................................(Fig 3)................................................_ft 5 80' BuildingLength, L ..............................................................(Fig 3)................................................. ft 5 80' — Building Aspect Ratio(L/W) (Fig 4).......................... 5 3:1 ............................................... ....................... Nominal Height of Tallest Openine ...................................(Fig 4).......................... ...... 5 6'8" — 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(fable 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. _ ConcreteMasonry.................................................................................................................................... 2.2 ANCHORAGE TO FOUNDATION1'3 5/8'Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing—general ..........................................(Table 4)............................................... in. Bolt Spacing from endrjoint of plate ............................(Fig 5)..................................... in.5 6"—12" —_ Bolt Embedment—concrete.........................................(Fig 5)................................................._in.z 7" Bolt Embedment—masonry.........................................(Fig 5)............................................ in.-a15" — PlateWasher...............................................................(Fig 5)...............................................2 3"x 3"x Y." — 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55)..........:......................... _ Maximum Floor Opening Dimension...................................(Fig 6)............................_ft 5 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)....................................................—ft s d _ Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... ft 5 d _ Floor Bracing at Endwalls...................................................(Fig 9)...................................................................... _ Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)...................... _ g ..... .(per 780 CMR Chapter 55)............... _in. _ Floor Sheathing Thickness.................. ....................... ........ 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 5 10' Non-Loadbearing walls................................................(Fig 10 and Table 5)........................... ft 5 20' — Wall Stud Spacing ........................................................(Fig 10 and Table 5)........I.........._in.5 24"o.c. _ Wall Story Offsets ........................................................(Figs 7$8)........................... .........._ft 5 d 42 EXTERIOR WALLS-' Wood Studs Loadbearing walls........................................................(Table 5)...............I..............2x - ft_in. _ Non-Loadbearing walls................................................(Table 5)..............................2x_ __-—ft_in. Gable End Wall Bracing' — Full Height Endwall Studs............................................(Fig 10)..............................................................:... _ WSP Attic Floor Length................................................(Fig 11)..............................................—ft zW/3 _ Gypsum Ceiling Length(if WSP not used)...................(Fig 11)............................................_ft z 0.9W _ 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Fig 11)............................................................ Double Top Plate — Splice Length ........................................................(Fig 13 and Table 6).................... _ Splice Connection(no.of 16d common nails)..............(Table 6)........................ ................................. 1 � AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(7g0 C:NR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of endnalled 16d common nails)..............(Table 7)............................ _ Non-Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails)...............(Table 8)............ _............................................ _ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans .......I............I.................................. (Table 9).................... —ft—9) :5 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 compUance to Table 9) HeaderSpans .........................:............................... (fable 9) .................................. —ft—In.s 12' .. SIII Plate Spans.............................................. (Table 9) ........... ....................... —ft—in.5 12" ............. Full Height Studs(no.of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously° '— — Minimum Building Dimension,W Nominal Height of Tallest Opening2 ..............................................................................._s 618" SheathingType..............................................(note 4)............................................ — Edge Nall Spacing """"" 9 P g.........................................(Table 10 or note 4 if less)........................—in. _ Field Nall Spacing..........................................(Table 10) in. ................................. Shear Connection(no.of 16d common nails)(Table 10).......................... — Percent Full-Height Sheathing g.......................(Table 10).................................................... _- 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,Lo Nominal Height of Tallest Opening2.........................................................................-5 6'8" SheathingType..............................................(note 4).......... —............................................ _ Edge Nall Spacing.........................................(Table 11 or note 4 If less)........................—in. _ Field Nail Spacing..........................................(Table 11).................................. ............—in. _ Shear Connection(no.of 16d common nails)(Table 11)........................................................... Percent Full-Height Sheathing.......................(Table 11)........................ — —' 5%Additional Sheathingfor Wall with O Wall Cladding Opening>6'8"(Design Concepts)......... —'o Rated for Wind Speed?.....................: — 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)ecti ails ( g ft s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls — Proprietary Connectors Uplift................................................(Table 12).......................... ...U=—plf — ............... Lateral.............................................(Table 12)........................ - P if Shear...............................................(Table 12)............................. —pif — Ridge Strap Connections,If collar ties not used per page 21..... S � P P 9 (Table 13)..............................T= pIf _— Gable Rake Outlooker................................ .......(Figure 20) _ft s smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls — Proprietary Connectors Uplift................................................(Table 14)............................ .U= lb. .............. Lateral(no,of 16d common nails)...(Table 14)......................... ......1.......L==_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 specfic 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. • I r AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' 4. a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. iii. All horizontal joints shall occur over and be nailed to framing. ui. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per the Figure, Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(7so CMR 5301.2.1.1)' _WH�lY THB EflGE RBTS ON PRAMM UM 8d NAK 4 AT Gb,- M H + i i i� r► ' n IF I Q u it 00 + +e is +� + o n jr Q ' E9 ��. u .j 44 IF d +' q � 12 li fl " 1 11 �ll y - `7 WALSPACM ; v� See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment 1 oar Town of Barnstable Regulatory Services - ' E RaStNRT��Rr� i Richard P.SmE,Dh for RuIldhagDivWon `romPerry Buaftab Commissioner 200 Main Stmet Hy=i*MA 02601 wwW-townlamstablLma_us Office: 50&862-4038 F= 508-790-6230 Property Owner Must ' Complete and Sign Tbis Section if Usigg A Builder d, X,k ,as Owner of the subject m J P PAY to apt on mybehA in aR matters relative to wozk antbo&-ed by-this being p=it appEcattan for. s of Job I "I'oolfenres and alarms are the responsibMtyof the applicant Pools are not to be Med or i tbl ed before fence is installed and all final ' inspections•ere performed and accepted.. Signature of Owner Signature of App ' Prime Name Print Name Dare . QFa�:o opts . 'down of Bamsfiable Regdafory Services roy� Richard V.SeaH,Director , w f Tom Perry,But Uog Ca�oissioner 20D Mdn Sftret; $yams;MA 02601 ��� WQPFP.iD�PII.ITar++ciaT�i�tna� Office: 508-862-4038 _ Fa= 508-790-6230 $OnO;owt M�(L�T�CEZ g ore . Z1rL�GPiimt JOB LOCAQOK- ' homeplanc# :avadcpbo=0 CQRRaTT MAIMM ADDRFS3: cifyftVV zip wdc The r-*•a t exemption for"homeowners"was to mclpde owner-0cc�ied dweIlmas of sx or Less and in allow homeov,ners to engage an individual for hire who dDes notpossess a license;movided thatthe owner act as supervisor_ DEFIN=14 OBHOMFOw ,person(s)who owm a parcel of lmcl on winch he/she resides or intends to reside,on which th=is,or is h�ried to be,a one or two- family dwelling,attnrbrd or detached sttattmms acces orp to such um and/or fa=cf nctm-c A person who constrocis mare than one Timms in a two-ycar peaod shall motbe=uideredAhmmeownw- Smc h`homcownee*.shaU snbmitto the Bmlding Official on a fnrm aueptable to the Bm�Of EicK fbathelshe shaU be responsibIc for all sash wadc Deed mad=-Em bml ma pg mLt (Scot Lcm 109.L1) The tmdesigned`homeowner"amsmnes rmponsfr�'y for compliance wifh&o Stare Big Code and ohs applicable codes, bylaws,roles and r m hti rsr�e_ _ 'the nadessigned.`homeowner"cmtf=tbathelshe u dcmtands ffic Town cfBamstabjs B1 U ft Department mspeetimn pmmdmcs andrega remrmfs andfathclshswill complywifk said procedures madrtqpfi=m=d3. . 5i�ofFiameo�enrr _ . ApFmv-4 eBmldingOffcaal • Note: Three fa= dwmUbW containing 35,000 cubic fret or larger wffibe requixed to comply with tins State,Building Code Section f27.0 Crsric�n Comhml. �O�owx�s��Ox The Code stairs that: aAny hamcowner performing work for which a b—Idm' g permit is refired shall be e:empt from the provisions of this seefion(Section I09-11-I.iCMM-dig of coashruction Supervisors);provided that if fhe homeowner engages a person(;)for hire to do sack work,that Bach Hnmeowaer shall art as superrbar." Many homeowners who use this exemption.are mzaware.mat they are ass=Lug$ie rnspowIT-UTiH of a Sup or (see Appendbc Q,Rules&Regulations for Tag Canshr acHmn Supervisors,Section 2.15) Tuts lark of awarraess of= results in serious problems,pardculady when fhe homeaw=hires�rcensed persons. In this rase,our Board cannot proceed against the roMcensed person as it would with a ficensed Supervisor. The homeowncr acting as SnpexTxmr is IIItinz.ately responsible: To ennwe that tine hour weer is MY aware of his/her resgaasr'brTih'es,many communfdes requizq as part of the permit applic" n,tbat the homeowner certify thathelshe $ie reFponsiiTiif mf a Supervisor. On the Iastpage of fh is issue is a form currently used by several towms You map can t amend and adopt such a formlemr ifuafinn for mein your mmimuniiy. P� Rz6wd D61313 . C job ��p Z S L►OG->�S Po 2Lt (ot �I CW z 6AS LpOff'� � ( T� qp�� l2 ��►`�, 12®,6` i VwIUN6 ST W. bAZPVA.(bL-C— .r 1 I VVV VVV��1 P f • � � f �er r 3 fs 'y ;a ;# 06/ f� _ Vie_ ..Y. ,..r-.-.a-a*.Y--..._.^•.e.....+ �.,.....w�......F_.... ate..-.. �. .r«- .w...............�........�..-..-_+._...V _..��...�.�......,_....__......,..� _..... ...'�` __.. ACORO® DATE(MMIDD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 1/4/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: NancyBrennan, CIC, CPIW AX Risk Strategies Company PHONE (781)986-4400 IF C No:(781)963-4420 15 Pacella Park Drive ADDR1ESS:nbrennan@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAICN Randolph MA 02368 INSURERAACadia Insurance Company 31325 INSURED INSURERB:Safety Insurance Company 33618 Harden Design & Build Inc. INSURER C:Bvanston Insurance Company 60 Dedham Avenue INSURERD: Suite 207 INSURERE: Needham MA 02494-2307 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1510701857 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. ILTRR TYPE OF INSURANCE ADD S BR POLICY NUMBER POLICY EFF MMIDDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11 000,000 A CLAIMS-MADE ❑X OCCUR DAMAGETORENTED 500,000 PREMISES Ea occurrence $ ADV5211358 6/1/2015 6/1/2016 MED EXP(Any one person) $ 15,0,00 PERSONAL-&ADV INJURY $ —1+,,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERACAGGREGATE c'-$ 2,000,000 X POLICY PELT L06 PRODUCTS-iiCAMP/OP AGG :$ _2,000,000_ OTHER: S7 ii Z$ Q AUTOMOBILE LIABILITY Ea ecBcl,ideD'SINGLE LIMIT �)$ i 000,000 ANY AUTO BODILY INJURY(Per person] '$ J:; B ALL OWNED SCHEDULED AUTOS X AUTOS 6233816 6/1/2015 6/1/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPER DAMAGE $ td7 AUTOS Per accident Rental Collision Covers e $ [70 30 ' X UMBRELLA UAB HOCCUR EACH OCCURRENCE $ rt n 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ MKLV10LE011852 6/1/2015 6/1/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) WCA5211361 6/1/2015 6/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Issued as evidence of insurance Highland Montrose LLC is listed as additional insured excluding workers compensation.. CERTIFICATE HOLDER CANCELLATION (617)254-7823 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MCROle Management THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tim Rafferty ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Christian/NCB '- ©1988-2014 ACORD CORPORATION. All rights reserved.. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ontanil Massachusetts -Departmemt of PubOic Safety � Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153910 Type: Private Corporation Expiration: 1/24/2017 Tr# 262646 HARDEN DESIGN & BUILD INC WILLIAM HARDEN 60 DEDHAM AVE STE 207 NEEDHAM, MA 02494 Update Address and return card.Mark reason for change. sCA 1 Co 20M-05n1 F] Address [-] Renewal E] Employment ❑ Lost Card _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 153910 Type: Once of Consumer Affairs and Business Regulation :-Expiration: 1/24/2017 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 HARDEN DESIGN 8 BUILD INC WILLIAM HARDEN 60,DEDHAM AVE.STE 207 NEEDHAM,MA 02492 —� Undersecretary Not valid without signature i ConsarVWon 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 474 Willow Street (application#201402387) has been inspected by a certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State requirements. L� o Sincerely, C> ._ Cn NO '.. Conor McInerney ConserVision Energy 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-; Parcel o z,c� � � Application #poi 3S Health Division ' Date Issued ti Conservation Division Application Fee ! 1 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address -%y-1 �, `..c �.., S•�.c.� .— Village ..� : .a z.•.». p.�` E Owner �,D e NJ Address y w % Telephone -Arti Permit Request �a.�... �Z�Z a: .o� ' .,� A 7�_-'So Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation\o00. Construction Type 'Lot Size Grandfathered: ❑Yes ❑ No If es, atta y & upportin� doc�u7nentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) a ' , Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other la 77� Basement Finished Area (sq.ft.) Basement Unfinished Area (sjft) ' Number of Baths: Full: existing Z new Half: existing OeW m Number of Bedrooms: _°I existing _new Total Room Count (not including baths): existing new First Floor Room Count r Heat Type and Fuel: was ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number _ a—04- ab"l - '8� y Address 3-,t t0. License #—,,o z - % 1 ���� �.A ortcG.t_ Home Improvement Contractor# z5 Email Worker's Compensation # Lo 3 (.3y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 SIGNATURE C', , DATE �'� I b �` t t FOR OFFICIAL USE ONLY `ix APPLICATION# s DAZE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r OWNER. DATE OF INSPECTION: . o F s FOUNDATION y' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: . ROUGH FINAL ' sA GAS: ROUGH FINAL FINAL BUILDING V r DATE CLOSED OUT ASSOCIATION PLAN NO. ACORO' CERTIFICATE OF LIABILITY INSURANCE 7(MM/DDNYYY) /17/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. H 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 CSBS/WORKCOMPONE NAME: PO BOX 946580 PHONE FAX MAITLAND,FL 32794-6580 E-MAIL Phone-877-724-2669 ADDRESS: Fax-877-763-5122 INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A,Continental Casualty Company 20443 INSURED INSURER B: CONSERVISION ENERGY 376 ROUTE 130 INSURER C: SUITE C INSURERD:Continental Casualty Company YQ443 SANDWICH,MA 02563 INSURER E,Continental Casualty Company 20443 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. sR ADDL SUOR POLICY Po c LTR TYPE OF INSURANCE 01SR WVD POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 CLAIMS-MADE ®OCCUR PREMISES(Ea occurrence)) A Y N 6011316335 03/11/2014 03/11/2015 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO-PE o- LOC AUTOMOBILE LIABILITY C(Ea INGLE LIMIT $1,000,000 OMBINED S accident ANY AUTO BODILY INJURY(Per person) ALL A AUTOS OWNED SCHEDULEDAUTOS N N 6011316335 03/11/2014 03/11/2015 BODILY INJURY(Per accident) HIRED AUTOS NON OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE 1,000,000 D EXCESS LIAR i I CLAIMS-MADE N N 6011316352 03/11/2014 03/11/2015 AGGREGATE 1,000,000 DED 1XRETENTION$ 10,000 WORKERS COMPENSATION WC STATIL OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N N 6011316349 03/11/2014 03/11/2015 E.L.EACH ACCIDENT $100,000 E OFFICERIMEMBER EXCLUDED? (Mandatory In NH) El E.L.DISEASE-EA EMPLOYEE $100,000 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) Certificate Holder is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION Ise Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1341 Elmwood Ave THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cranston,RI 02910 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD cmA865 ' v The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiorOndividual): ConserVlsion Energy Address: 376 Route 130 Suite C City/State/Zip: Sandwich, MA 02563 Phone#: 508-833-8384 Are you an employer?Check the appropriate box: Type of project(required): 1.[it I am a employer with 8 4. ❑ I am a general contractor and I 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. # Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y p h'• 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.®Other Weatherl2atlOn *Any applicant that checks box#t 1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: CS&S/WORKCOMPONE Policy#or Self-ins.Lic.#: 6011316349 Expiration Date: 03/11/2015 Job Site Address: City/State/Zip: Attach a copy of the-workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb fy der th p 'ns nd penalties of perjury that the information provided above is true and correct. i- Signature: Date: — `s- V Phone#: Official use only. Do not write in this area, to be completed by city or town of 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 F t. Contact Person: Phone#: lI/1P Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date If found return to: gistratlon: 171251 Type: Office of Consumer Affairs and Business Regulation piration: 3/1/2016 Partnership 10 Park Plaza-Suite 5170 x 0 Boston,MA 02116 CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH,MA 02563 Undersecretary Not valid without signature "/Sassacn�sezts eaarcne ;^E?uL tc 5a" f Board,;�#Building R egafallons iid 5ta�<aax _ce:13e CSSL-102778 CONOR D MCMRNEY w 39 SIASCONSET.DRIVE SAGAMORE BEACH MA 02562 r umsSan^ee 08119/2014 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at i (Property Address) (Property Address) I hereby authorize g i 10 A) , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature {� Date i /f�Assessor's map and lot number 60.Q.0..p Jr..4 ^d....�l �F TH E TD`y ' 2 G /).r 'Sewage Permit number ��.. f�t�!! !..f........ ' Z B9SH9T11DLE, i House number .........::................ ............... 9po ,rb 9 �0 M03 TOWN OF BARNSTABLE BUILDING. INSPECTOR APPLICATION FOR PERMIT TO ...16W." . IX ...4,VDJ.7-L?.9.?Q......................................:.. TYPE OF CONSTRUCTION .... ����ZZ .. E.��, �7................................................................ t. - /t�... .....................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: wkt Location ....... . .. ...... '......................... .................................... ....... ... .................................................. es 0 e K fie. ProposedUse .. ... ............................ ........................................................................................................................................ Q ...................................................Fire District ..e sf (Ba r n si�b 1 e . A Zoning District ....!.\ ..�. .................................................................... V 1D :. 1VeV ►�S Address ��� Wl�'O1.JJf 0 ,��1(�os-hLl�. e,Name of Owner . .... ............ . ............................. Nameof Builder CA.M f ...................:...........................Address .................................................................................... Name of Architect ' ! e r :...........................Address .................................................................................... I •� Number of Rooms .... ............................r............................Foundation Pavrzj.. U( t'1 >(1 �e S e If.�s S ............................................ Exterior �.�.� �.�.......�....�....�.. ........._...........Roofing �1.� .� .................. �.... ..y.............:........ I Floors" 1..N .Interior . ' ts li ' Heating ..... .........:.............. . -��........ ?:....Plumbing .. ©/.�.GJ ........................................................... Fireplace 44tl�Qa�l�-S.... `/.!.1.!7� ...............Approximate Cost .../ e.©D/ ........................................... Definitive Plan Approved by Planning Board ------------________---_ �-+.'..................... ------19-------. Area ................ Diagram of .Lot and Building with Dimensions Fee �/........ .................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH C2� 3 71 3 _. ' � S�N�aOrv1 as T.IN�i , x44C'u 36 { OCCUPANCY PERMITS REQUIRED FOR Nf DWELLINGS W lOt.� S'�"�• I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. x µr / Name .... . ��I. : �.. ....... ................................. Construction Supervisor's License NEVINS, DAVID L. A=130-26,/0-26 24779 ADDITION No ................. Permit for ..................... .......... ... ....Single Family Dwelling . ..... ....... ..........474..................................... Location ..A&@-Willow Street ........................................;.................... West Barnstable ............................................................................... Owner „David ......................... .... .. .... .... ..... .. . .. .. Type of Construction ,,,,.Frame.. .......................... .. .. .... ................................................................................ Plot ............................ Lot ................................ February '3, 83 Permit,Granted ......................::.................19 Date of Inspection ....................................19 Date Completed ......................................19 /C- Assessor's map and lot number .. ..00..1,3. ® ... THE �pf tp�♦ a Q ' ewage Permit number Z BAR399ET�LE, i House number ....�.. ........................................ :...., 9�C 039 `e00 �'0 YPY d' TOWN OF . BARNSTABLE BUILDING. INSPECTOR APPLICATION FOR PERMIT TO ...4-�}. ..r ................. .......................................... TYPE OF CONSTRUCTION ..... , ,� .............................:.................................. .....:................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .46Q...�-.`L.......................`.........:........... .. ......:.. ....r.......... ....... ... ............................................ Proposed Use .Re:�lc e to c e. - .....................................................................................................:...................................................... Zoning District A....................................................Fire District ..... .......... ........................................................ Name of Owner .—I�..�...IVLO: ��V .......................Address .. ✓.%1,.... �,� l(d:......?li..Jf.......C.: .! . Nameof Builder , �.�a `-.�.............:.................................Address .................................................................................... Nameof Architect h� ..........................:................Address .................................................................................... Number of Rooms .........................................................Foundation d ..}L t_� C}- . Exierior LA). A �:�'_ 41<.. .'.!n.� ��.. Roofing l�?�?. .... fi �,. .. :. g .. �....................... 7 Floors a.h�' ...............................:.Interior .... • /�J .....6"•t� ....... .......�... ..��............... .............................. . Heating ....�C...`✓�1� � ..... ... .� g �........................................................... Fireplace /.`/.�--�.k.�, : /,���.....f�...(.1.� f U... Approximate Cost ........�. ..... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..... .................... Diagram of Lot and Building with Dimensions Fee S SUBJECT TO APPROVAL OF BOARD OF HEALTH � 5 . 6 � I OCCUPANCY PERMITS REQUIRED FOR NE-DWELL►NGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameItl. �./................................. Construction Supervisor's License ..................................... NEVIN14M)AVID L. 24779 ADDITION No ................. Permit for .................................... Single Family Dwelling .............4 ....................................................... 01160ger Willow Street Location .. ........................................................... ..................West Barnstable............................................................. Owner .....David L. Nevins ............................................................. Type of Construction .....Frame........................ ................................................................................ Plot ............................ Lot ................................ Permit' Granted .....February 3 19 83 .. ................................All Date of lnspection Ty.... . . ...........1.9 0/ Date Completed ........... ............19