Loading...
HomeMy WebLinkAbout0150 DUNN'S POND ROAD /.moo .�i���� �°o��� � i ' � M . � I I riniiTown of.Barnstable i .-_ _ ._MAC, .>... .,. __ , ,�,� a: �� „_,_ - a,.. �., ,. »w�, � , , ., s. •:• p m Permit No B-17 3341 Applicant Name INSULATE 2 SAVE, INC. 'Approvals <, ;Current Use Structure Date Issued �: '10/13/2017 ,_ ... .. Pmit:;Type ;,'`Building-.Insulation-Residential Expiration Date Foundation: 04/13/2018 er ;Location: ..150:DUNN'S POND RUAD,'HYANNIS Map/Lot 270 156 Zoning District: RB a Sheathing: Owner on Record: LAFORGE,STEVEN a Contractor Name: INSULATE 2 SAVE,INC. framing: 1 C ntractor License &0747Accress: 150 DUNN'POND ROAD2 HYANNIS, MA 02601 Est Project Cost: $3,166.00 Chimney: Description: Weatherization 6 Permit fee: $85.00 Insulation: Fee�Pa�d p $85.00 Project Review Req: - ®ate 10/13/2017 final: F ; r dry Plumbing/Gas Ri Rough Plumbing: �Bu ilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author h Gas: ged by this permit is commenced within six months after issuance. Rough All work authorized by this permit shall conform to the approved application and the approved construction documents forwhich this permit has been granted. s> Final Gas: All construction,alterations and changes of use of any building and structures"shall-be in compliance with the local zonuig by lawsarid codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for"" mspedion for the entire duration of the work until the completion of the same. � � Electrical - Mimi, � tt �� Service_ The Certificate of Occupancy will not be issued until all applicable signaturesby the Building and FireOfficials are provaJe�on this permit. Minimum of Five Call Inspections Required for All Construction Work: � ^ 1.Foundation or Footing 5 , Rough: 2.Sheathing Inspection Final: _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 COw'Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) - 6.insulation Low Voltage Final: > 7.Final Inspection before Occupancy Health --Where applicable;separate.:permitsare required for Electrical,Plumbing=and•Mechanicalinstallations.- -Work shall not: roceed until=the ins ector has a roved the variou's'sta es of.consfriiction P PP g. _. ,, . Final .: „__ ,, ... .,_ . Fire De .artm'ent „,,,P rsons contr..,actln :w,ith>;unre Iste_rQd:co.ntr-a..ctors do;not.ha.Ve_access,to thee uarant <=:fund asset<focth.In, GL.; .i42A ._- P.. _g_. g g y.. Final ... Building plans are to be available on site All Permit'Cards are the:property of the APPLICANT-`ISSUED RECIPIENT" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION tMAV- ,S I�1- TOV;°M op' Sty ��STABLE Map '7� Parcel I Application # �Lv Health Division 1 ' tl rS Date Issued 0 h 3 )12d05__ Conservation Division Application Fee Planning Dept.. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address I SO pin As Pond( kd rl H znn« MA oa_u o I Village k/Nervm Owner Ste^ Cb/, Address /SD 4)ann6 0a&01 Telephone 5371 a Permit Request Kati- SPA(1JA )Z-sg R 3-7 4 r 4oz_ 2 rfi-r_. ;A. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valua -/ 6-6 >-Z-i Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family fr' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas .❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ►c. Telephone Number 608''-z Address &raYc. S-( License # ( off `91.0 d- r1A. Home Improvement Contractor# (907V2 Email A itkv.,0,L.s vla •r.of Worker's Compensation # .S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 oM A;rpa Rd 15-11 R -tom /�A a-io SIGNATURE ��� ��C DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE 4 7 OWNER Ia _ DATE OF INSPECTION: y FOUNDATION ` FRAME e - K INSULATION ,t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. DEBRIS FORM In accordance with the provisions of MGL c.40,s.54,a conditi nYof Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as deflned by MGL c 111,s, 150A. This Debris will be disposed of in: Re ublic Services Dum ster: 1080 Airport Rd Fall River, MA 02720 (LOCATION OF FACILITY) Signature of Permit Applicant Date IF D'UMPSTER IS USED IN EXCESS OF SIX ()CUBIC YARDS A.PERMIT FR6M THE. FIRE DEPARTMENT IS REQUIRED FOR COMMERCIAL,INDUSTRIAL,INSTITUTIONAL.AND MULTI:FAMILY RESIDENTIAL OVER 20,UNITS DEMO., RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: CIRCLE ONE #*,HAVE YOU.SUBMITTED THE A 06 NOTIFICATION TO THE IVIASSACHUSEnS DEP2 YES NO The Commonwealth of Massachusetts x _ Department of Industrial Accidents M o I Congress Street, Suite 100 Boston, MA 02114-2017 wwiv.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FiLED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Legibly Name (Business/Organization/Individual): Insulate2Save Inc. Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone#: 508-567-6706 Are you an employer?Check the appropriate box: Type of project(required): 1.❑X I am a employer with 20 employees(full and/or part-time).° 7. ❑New construction 2.F�1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 9. ❑:Demolition 3.[1 am a homeowner doing all work myself.[No workers'comp.insurance required.]? 10 0 Building addition 4.F I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.o t am a general contractor and 1 have hired the sub contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.' 13.�ROof repairs 6Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.OX Other Insulation 152,§1(4),and we have no employees.(No workers'comp.insurance required.] "Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information. 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 cheek 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. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWS 56418741 / Expiration Date: 12/10/2017 f. Jab Site Address: /- OVAnS Panel P-4 City/State/Zip: annr`s MA 060l Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under I/s an er ties of perjury that the information provided above is true and correct Signature: Date: 9 Phone#: 508-567-6706 Official use only. Do not write in this area,to be completed by city or town official. r- City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2..Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector - 6.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston, Mashusetts 02116 Home IQroveme' ,. tractor Registration Type: Corporation z 2 Registration: 180747 INSULATE 2 SAVE , INC. ,� Expiration: 12/28/201.8 410 Grove St Fallriver, MA 02720 +d dw . Update Address and return card. Mark reason for change. 3CA 1 0 2OM•05/11 _._�❑�4ddr� s Q'Renewal ❑ Employment ❑ Lost Card �/u Ipi»��arvrtulea��i,a�@/�lir�acrof uaelld _..__ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Expiration Office of Consumer Affairs and Business Regulation -- 12128l2018 10 Park Plaza Suite 5170 i* 80797 Boston,MA 02116 INSULATE 2 SAVE iN- �wt Roland Langevii,-, 410 Grove St Fallriver,MA 02720,., Undersecretary Not valid without signature Commonwealth-of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ' Constr 14 AWpejvisor CS-103861 �' E��pires:0$I24t2019 ROLAND LANdtft 56 HIGHCRES, ROAD FALL RIVER IM 02720 c1' °t c'L Commi ssioner r w DATE(MM/DD/YYYY) AC40 CERTIFICATE OF LIABILITY INSURANCE 12/8/16 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: Anthony F. Cordeiro Insurance PHONE FAX (508) 677-0407 A/ No: (508) 677-0409 171 Pleasant Street E-MAIL ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, MA 02720 INSURERE: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSIR WVD POLICY NUMBER MMIDD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES DAMAGE (E.oc rrc e $ 300,000 CLAIMS-MADE F_x1 OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO- 7 LOC ECT A AUTOMOBILE LIABIUTY Y y $AA 56418741 12/10/16 12/10/17 EOMBWNEDtSINGLELIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ A X UMBRELLALIAB X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X I WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DYSCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requ red) "For Insurance Purposes Only" 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: RISE Em6neoring RISE S.E S Dupont.Avenue,South Yarmouth MA ENC?MEERING' G . NTRAACT 50&568;I$36 FAX 50 '5684,933 Page 1 PRQGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE NGCC44ES ENGINE EtilNti AND THE:COTOMERFOR WORK DEBCRIAEO�.BELOW- CUSTOMER - PHONE DATE - CLIENT11 WORK ORDER Steven Laforge (551)206-985.0 02/22120 7 230723 0.5202 'SERW E,STREET aILLINO.:STREET _ 150 Dunns Pond Road 1.50 Dunns Pond Road - SERVICE-CITY,STATE..ZJP B1LUNO CITY',STATE,ZIP. Hyannis,MA 02601 Hy is,MA-02601 ; JOB-DE ION AIR SEALING:Provide-labor and materialsao seal:areas of your,home against wasteful,excess air.leakage, 'This.work wi11 be perforated 5M0.00 in concert.with the.use of special tools and diagnostic.tests to assure.that your home will,be left with a heafthful,level_of air exchange. and.indoovair quality.Materials to.bc-used to seal your home can include caulks,Foams,weatherstrippingand other products. Primary areas.for seal ing include air leakage to attics,basements;attached garages and other unheated areas.(winddN6 are not generally addressed.) (8)working hours:A reduction in:cubic',feet.per minute(cfm)of air infiltration will occur,but the actualnumbcr ofcfm is not guaranteed. AIR SEAT ING:1?rovirk labor:and materials to instal{Q-1ibn weatherstripping;and a doocsweep to(3)dtwr(sj'to restrict air leakage: $240 0, DAMMING:Provide laboranl materials to install,a.12."1 er of R- ay 38:unfaced fibej1m,batts to(86)square:feet for damming purposes.. $211::56 . ATTIC FLAT Provide labor and materials to install a']0°.aayerof R-37 Class 1.Cellulose:added to(544),squarc feet gUopen attic:space, $84&64. A711C FLAT:Providelabof and,niateriats toinstall.a 4"layer of R-14 Class 1.Ce'liulose,=added:to,(272):squge feet.of open;attic space. $326A40 ATT1C,;'ACCESS::Piovide labor and'smateruslsao,insulate the back of the attic door with rigid board!at R=l O or greater with the:required $73s91` fire rating and seat the door`s edge*th weatherstHpping:;to restrict air IeA-age: - ATTIC ACCESS Provide tabor and materials'to'install.C,l ics I Cellulose insulation to the.shcetrock or plaster ceiling and/or walls of a stairwell�which are common to.hea 6:d•space th ough a surface drill and plug method. The holes:are;plugged Rath sl;nAoam-plugs;and- packled to a rough finish. Any sanding:and painting required are:the customer's responsibility. VENTILATION'..Provide tabor and materials to install(1)insulated exhaust Bose with;roof mounted:flapper vent to exhaust existing bathroom fan(s).:Broan model 9 636 or:equivalent. VENTILATIO Piov N: ,Ide latior and rriatet leis io' rstalf entilation chines In(51)rafter ba s to maintain air.flow.: y. BASEMENT'CEILING:Provide laborand.materials to install(.116)linear feet of R.14 unfaeed:fbetglass insulatiotito tine perimeter of. $254 04 the basement coil ng.2t the.house sill. BASEMENT D00R:Provide labor and materials to ins.ulatc the;tiack of the.hasemcnt-door leading to the:bplkhead with nV.d ioard:at R= $11 W 0 10 or�greater)Ath:he required fire rating that meets the.sections 1t-316.5.4and 3.16.6.requirements of building code: Seal all edges-and seams"with FSK tape. r. RISE Eligineeri ll 5 Dnpant avenue;South Yarmouth;?tk 62.60 CONTRACT' ENGINEERtNG' 508=668-1926 AX 5l&5 8I is F Page 2 . I. PROGRAM„ ` THIS CONTRACT IS ENTERED INFO BETWEEN RISE :' •, ENGINEERING ANO THE NeXC-HES CUSTOMER.FOR-WO"AS .. .CUSTOMER. - PHONE „�~� DATE s CLIENT:# WORT(OROER Steven Laforge . ,.(551}2Ob-9850: 02/22/2017 230Z23 05202: SERVICE STREET 250 Dunns Pond Road t50 Dunns'Pand Road SERVICE CITY.STATE,.ZIP x BILLING CRY;STATE,DP Y. Hyannis,MA 026U1 - i, Hyannis,MA 02601 JOB DESC,RiPTi®N" INCENTIVE:RISE;Engineering wilt apply all appiicable,eligible incentives.to,this-contract- You will be bil.ied'onlythe Net;amount. $165:M Currently„for cligibl`e measures,National Grid offers 750/o;incentive;-not to e`xeced$2,000"'per calendar year,and,an incentive of.I04°lA for the Air4eal46g measures,, For the satiety and health ofyour home's indoor air;quality,ape might:be conducting a blou!er doordiagnostic'of the available air flow in your borne both betore.tlte work is begun,and'after the weaiheriration work is-corhplete(not to be conducted if asbestos is present).4ye will also conduct a diagnostic assessment of the:crimbtlstion fumes in the exhaust flue of"vour heating system and Nvater ,heater,This has a;value of S90 and isat no cost to yoIU, The Pennit wit!be secured by the insulation contractor.This has a value of S75 and i-at:no cost to.you.It is'tlic honito Tter's responsibility to close oat this permit 6y contacting their municipafity at the 'o£completionthis wor k. y x ` 41 M n f `Fatal:_ $3,18fi:29: I 4, Program Incentive: $2;s35:97 !V Custamler Tdtat:' „ $530.32 WE AGREE 1tEREBY TO F11RN4SH SERli)CES•COMPLETE IN ACCORDANCE WITH ABOVE SPECfFICATiON$.FCR THE Stud OF. ***Five Hundred Thiity-A 321100 Dollars �530 32' UPON fUJALdNSP£CTfO D APPROVAL BY. E ENGWEERINI.CUSTOMER'AGREES TO IN REMIT AMOUNT Out .FULL.INTEREST OF %MLL BE CHARGED MONTHLY ON ANY �.". "l1NPAl0 BALANCE O GAYS,SEE WR IMPORTANT INFQRMATION ON GUARANTEESr:RIGHT3'OF RECIS.ION,SCHEODUNG;AND CONTRACTOR REGISTI,2ATfON..' `': •, - s , » x. r S <t= AUTHORREO SIG A RE-RISE-ginee,ing.' :: ' CUS it NOTE:THtS CONTRACTMAY BE MTHDRAWN BY'US.IF NOT EXECUTED WITHIN: DATE OF ACCEPTANCE `gib ..,.. � '—-:R— - ACCEPTANCE OF CONTRACT ABOVE PRICES,SPECIFICATION SANO'L'ONDITIONS ARE: 30 OARS. - SATISFACTORY TO�USAND ARE HEREBY ACCEPTED.YOU�ARE AUTHQRQEO TOD0:7HE WORfG - 'A55PEClTCE PAttAENT:WiLC.BE MADE-AS,r)ttTl.tAiED A80YE - . W&AgDwhision Tam Perry,�3culttig:Coniss€anz s 00 XWEL Stpet H Mk 62,661 Offi : 508-3624038 fax &-79{}-6 3t} a 4 , T7Cf33 O tTS'and Sigg This *c 1 �S- , ..,� 3C , -i e:✓ p sAtr t}xe s „ W Insulate 2 Save hob maize an;ix.Ly a r kive w-wark:aud dieted this b liras ;f t i are : be ar c 3 efOb is t :a�If l " - r r o r .:; +.;. ,�-,,_ -�. .. ..,,c_.� .; �.� � � � '• � ., � III d• e i .nmzE* . plz`e�z� ... ,. 1. amL x v 'E 17 't,�:FfJRl�"tS:O1Vf�'`F.�iPE.�T«SFSfi�ONP.Q03S: i p - ?ele hone: 508/563-6049 COLONY INSULATION, INC.' 28 onothan Bourne Drive, Pocasset, MA 02559' CLOSED-CELL FOAM INSULATION SPEC SHEET CONTRACTOR Or t JOB SITE ADD SS: DATE: R- VALUE — AREA' THICKNESS Ceiling , Cathedral Ceiling Garage Ceiling Basement Ceiling _ Slopes_ Exterior W all Garage Hse. Wall W alkout W all. Cathedral W all B lockers 0verhang Stair/Risers All R-values/rand th:',ekness measure ents are deemed to be accurate by the following installers: l . TECHNICAL DATA FOR MATERIALS IS ATTAC�IED TO:THIS FORM spa Arnthane Therma/Guard CC2 TECHNICAL DATA SHEET PRODUCT NAME PHYSICAL CHARACTERISTICS Property Value Test Method � ���� Density(nominal): 2:0IVA' —"ASTMD-1622 R-value: 7/inch ASTM C-518 ThbrmalGUard CC2 . Compressive Strength: 35 PSI ASTM D1621-94 Tensile Strength: 70 PSI ASTM D1623-78 PRODUCT DESCRIPTION Dimensional Stability: <4%A ASTM D 2126 Closed Cell Content: 96% ASTM D 2856 I ThermalGuard CC2 is a fast set,closed- Air Permeability: .002 L/sm2(@ 75 Pa @ I") ASTM E283 celled,245fa-blown spray polyurethane Vapor Permeability: .8 Perms @ 2" ASTM E96 foam(SPF)insulation designed for use Fungus Growth: None ASTM G21 in residential&commercial structures,: Service Temperature: 250 OF(120°C)* exterior foundation or perimeter Service lemperamres will vary depending on application. Contact your Technical Representative for insulation,below grade ap plications, * z recommendations and limitations.Ahvays test ngrmolGuard"CC2 jar suitability for your particular application in exterior tank/pipe' insulation and etc. a Safe manner. ThermalGuard CC2 is applied as a PP LIQUID PROPERTIES liquid and expands 25x in seconds to fill pro proytv Value Test Method and seal"building cavities of any shape Viscosity(A) 200-250 CPS• -ASTM D-2196 and size: It exhibits superior thermal Viscosity(B) 1100-1300.CPS ASTM.D-2196 j insulation,air-barrier,and sound Weight Per Gallon(A) 10.25 lbs/gal ASTM D-1475 attenuation properties compared to Weight Per Gallon(B) 9.4 lbs/gal ASTM"D=1475 ' conventional insulation materials.. REACTIVITY PROFILE Once fully cured ThermalGuard CC2 PropertyValue remains rigid maintaining significant Cream Time: 2-3 seconds @ 25°C(77°F) structural strength and thermal Rise Time: 12-16 seconds @25°C(77°F): insulation properties'in adverse . conditions across a wide variety of COMBUSTION PROPERTIES applications: Pro e Value T t Method Flame Spread Index: S25 ASTM E-84 MANUF.AiCTURER Smoke Development: :450 ASTM E-84 ThermalGuard CC2.is manufactured PACF:AGING&STORAGE exclusively-by Drum Weight(A) 551 lbs Drum Weight(B) 500 lbs Arnthane Inc. Total Set Weight 1051'lbs 1002 West Main Street Storage Temperature Range(STR) . 60-80 OF i Richmond,MO 64085 ;Shelf Life at STR 6 months P.816.776.3015 F.816.776.3215 *Do not allow material to freeze.Do not pre-heat or recirculate(B)material as it ivill cause frothing and loss of wlyw.grnthane.com blowing agent. Storage at temperatures above or below STR mayshorten shelflije and cause degradation or loss of - blowing agent. Cold material will develop higher viscosity which can cause during processing such as pump cavitation and poor mixture of(A)and(B)components.For best processing performance during application(A) CORROSION and(B)drum temperatures should be between 60*F—80 F ThermalGuard CC2 is chemically& PROCESSING PARAMETERS physically compatible with all common Processing Pressure Range: 900 4400 PSI* building materials including electrical Processing Temperature Range:. 115_145°F* w nn ,wood, o ermemetal,concrete, and r lass,plastic Ambient Temperature:Temper e Range: 35 1 OS OF p Substrate Temperature (PVC),copper, g 35-105 OF Substrate Moisture Content: <19% INSTALLATION Yield: ` 3800-5000 Board Feet Per Set* Maximum Lift Thickness: 4 inches** I TliermalGuard CC2 must be spray applied Using approved egllipment.U$0 `Processing parameters&yields can vary widely depending on substrate temperature,type&condition,ambient 1:1 ratio proportioning system that can temperature,elevation,humidity,equipment and other factors. During installation the applicaiormust observe the quality and characteristics ofthefoam and adjust equipment temperature.&priWt9t settings as needed to If achieve the specified temperature and accommodate these variables in order to ensure optimum yield,proper adhesion;proper cell structure,mid pressure requirements." performance ofthefoam. ,� *'ALWAYS test Thermalt6rd CC2 at desired thickness in a safe manner prior to insulating structure to ensure that it can be safely iiistalled at the desired lh thickness without risk of clwrring or combustion. It it the exclusive responsibility of the applicator to achieve proper ih thickness for safe application. Safe lh thickness may vmy i from application to application. ® 1002 VV Ma Richmond,M1 P 816.7 F 816.7 www.arnthr Arn' th ne . R ' Y N, q rx. p 'y U. Thermai Guard ' ThermalGuard Thermal Gc�E cc2 ocI 0C�.5 & Nominal Density: 2.0 Iblft3. Nominal Density: 1.0 Ib/ft3 Nominal Density: .5 IMF CC2 R-value: 7.0/in 'R-value: 5.241in OC.5 R-value: 3.8/in Compressive Strength: 45 PSI Compressive Strength: 7 PSI OC.5R R-value. 4.31in Vapor Permeability: 0.8 Perms @.2" Vapor Permeability: 3.6 Perms @ 5" Compressive Strength.-..O.6 f Vapor Permeability- 4.2 Perris Product Description Product Description Product Description ThermalGuard CC2 is a semi rigid,fast set, ThermalGuard. OC1 is a soft, fast set, ThermalGuard OC:5 & OC.5R ar closed celled, spray polyurethane foam open-celled, 100% water-blown spray low density,open celled;100%water bloc (SPF.)insulation system designed for use as polyurethane foam (SPF) insulation system. polyurethane .foam (SPF) insulation a high performance thermal insulation. r designed for use in residential & commercial designed for use in residental&commen wall,attic, and roof-deck applications. attic, and roof-deck applications. Both.I can reduce energy consumption by up to ThermalGuard CC2 is a spray-applied insulate & air-seal the structure in a sinr system suitable for a. variety of insulation ThermalGuard OC1 can reduce energy y y ThermalGuard OC.5R is a bio-renewable applications including..in plant, tank & consumption in structures by up to 50% thatexhibits superior fire-resistancepropei compared to conventional insulation systems increased R-value. ThermalGuard OC.5 pipeline, , residential & commercial because it insulates&air-seals in a single step. construction, f goundation and below.grade optimized for i'kkallation in cold.tempt down to 150 F. applications where compressive strength or ThermalGuard OC1 is applied as aliquid and impact resistance are desired. expands over 40x in approximately 8 seconds fo ThermalGuard OG5 & OCSR are appliE fill and seal building cavities of any shape and liquid and expand over 100x in approxirr ThermalGuard CC2. is applied as a liquid size. It exhibits superior thermal insulation, seconds to fill and seal building cavities and expand 25x in a approximately 12' air-barrier, and sound attenuation properties shape or size., They deliver superior seconds to form a smooth, durable surface over,conventional insulation materials and has insulation, air-barrier, and sound- atte perfect for the application of primers or been proven to improve indoor air quality & properties compared to. conventional in; comfort. materials and contribute to.a healthy indo finish coatings, )utdoor environment. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C� Parcel Application Health Division O/VG` Date Issued ` Conservation Division fU ��pApplication Fee N Planning Dept. TpwN " ��?OAS Permit Fee, 0 O p o O eJ Date Definitive Plan Approved by Planning Board gRAr� TAeCE 3 Historic - OKH Preservation/ Hyannis Project Street Address Village Owner L-a e— Address J�7 J� /l,�dl /"0�� lfeiL- Telephone S�l Q a>p 47 976t [,Y D. o Permit Request rr1l a .eY1J--8& :rla-mf 1-1� )4 XID riffr45- tm aL�& JMa J7 Square feet: 1 st floor: Qxisting OP'lproposed IM q, 2nd floor: existing_proposed Total new OA Zoning District W Flood Plain Groundwater Overlay Project Valuation4x4w, Construction Type &/P/e, 0a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure t� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: C9"Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) � Basement Unfinished Area (sq.ft) ��lo Number of Baths: Full: existing 1 new �_ Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes *No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals uthorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No. If yes, site plan review # Current Use ��on Proposed Use �-1 10L� ( Met APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -- Name Telephone Number A dress 6 �y�t d'�l License#' e s (�^ L)� F D Home Improvement Contractor# / a e— Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 614641z,- SIGNATURE DATE 'r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 4�,._!-`? 6 1 > .MAP/PARCEL NO.,:: ADDRESS:' - VILLAGE OWNER T DATE OF INSPECTION: OUNDATION _ :��1 [ ti FRAME Q I Q fi 4?, lo- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS! - ROUGH __ >: _' - FINAL y,DATE'CLOSED_.OUT. : , : ` ASSOCIATION PLAN NO. 7,fhe Com nonrrealtl7 oflf�assachusetts Department ofXndustrzalAccidents : . fi ce of In Of 600 Washington ;Street c Boston;.MA 02111 ' y ww:w:nass.gov1dia Workers' Compensation Insurance Affidavit: Builders./Contractors/Electricians(Plumbers Applicant Information Please Print Lei bly IN' 1 Name (Busin /U essrganization/Individual)':... �O 75 / Address: /4 1 C C,4L AAZI City,/St 'e/Zip: `P'w� Phone #: 7 Zr L l Arey anemployer?"Check the appropriate box. Type'o roject(requi:red): 1. Lam a employer with ❑ 4. I are a general cont:actor.and I 6 New construction hired the sub-contractors . employees(frill and/or"'part time)..* 2.❑ i am a sole proprictor.or partner- listed on the attached sheet. T, ❑ Remodeling ship and have no employees These sub=contractors have g ❑Demolition working for me.in any capacIT employees and;have workers' 9. ❑ Building addition: [No workers' comp. insurance comp.insurance:# required:.] 5. ❑ We are a corporation and its 10:❑ Electrical repairs or additions officers have exercised their 1 1. Phimbin repairs airs or additions 3.❑ 1 am a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per Iv10L 12.❑Roof repairs insurance required:] t G. 152, §1(4), and we have no ernp]oye-8. [No workers' 13.0 Other 'comp.insurance requuired.j `Any appli:cant'that checks box 4.1 must alsoifill out the scction'hcloiv showing their workers'compensation policy information.. t Homeowners who submit-this affidavit indicating they arc doing all work and then bare outside contractors must sub.mitanew affidavit indicating such. tContractors that check this box musbattaehtd an additional s,hcet showing the name of the sub-contractorvand state whether or no"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'cornpensation insurance.for my employees. Below is the policy and job site. informadon Insurance Company Name: Policy#or Self ins.Lic...#: / P J ✓ 2 6 7�/ � 1.) Expiration Date: D � . ty p � S�_9 6-� of Job Site Address: s�y �� S _p� �—.Ci /Sstate/�i : _ Attach a copy of the'workers' compensation policy declaration page(showing the policy nu errand expiration date). Failure to secure coverage as required under Section 25A of IMOL 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 DP-DER 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;thc DIA for insurance coverage verification. I do hereby certify ur., the pains and penalties ofperjury that the information provided above is true and correct. Signature: - Date. .....-- Phone#:. � 7dA- 1 �/ Official use only. Do not write in this area, to be:completed by cih;)or town official, City or°Town: Permit/License#, Issuing,Authority(:circle one): 1.Board ofH, ealth'2.Bti l.din; Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6, Other Contact Person: Phone r": ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: � �� Site Address: 0/�° A) print - Town: 3A114 / Applicant Phone: 0 ov 79(` ` ( Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE, AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM �eilingpr Slab Option 1: Basement L Fenestration exposed Wall Floor Wall Perimeter ' AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy R-10, ConServationAct(NAECA)of .35 R-38 R-19 R-19 R-10 4 ft. 1987 as mended,minimums or greater as applicable Note: This form-is not required if you choose either of the two versions of REScheck as listed below. ❑ Option'2: ,REScheck'Version 4.1.2 or later variant software.analysis must be completed 7.80 CMR 6107.3.2) REScheck Web which can be accessed at http://www.energ codes.gov/rescheck/ ADDITIONS OR ALTERAATIONS:TO EXISTING BUILDINGS OVER.S YEARS OLD* *Buildings under 5 years old must use option#El or#2 in New Construction section above. Complete the following formula to determine the % of glazing: .(a) Gross Wall & Ceiling Area,equ4ls Formula: (100 x b- a) CF ul 100 x - _ % of glazing b a (b) Glazing area.equals �SF If glazing is:5 40%o use the chart below, If glazing is > 40-0/ proceed to "SUNTROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE.COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM ❑ Ceiling and J Slab Perimeter Fenestration Exposed floors -Wall Floor Basement Wall R-Value U-factor R-Value R-Value R-value R-Value and Depth 39' R-37 a R-13 R-19 R-10 R-10, 4 feet a R-'30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not`com ressed over•exterior walls, and including any access openings). SUNROOM-An addition or alteration to an existing building/dwelling unit where the total J Elt glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120T) A FYC Gu.irle /0 1'Yonrl Cnnstrarctiorr it.] fljolr Jfyind Areas: 110 ncph 1•yind Zone N4,-1SSac1111SettS Checklist foi- Compliance (780 CI1'IR 530r:�.i.l)` Check Compliance 1.1 SCOPE ..................... 110 mph Wind Speed(3-sec. gust)......................................... .. WindExposure Category ............................. ............................................................. Wind Exposure Category................Engineering Required For Entire Project .................. 1.2 APPLICABILITY Stories :5 2 stories Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) <12.12 RoofPitch.............................. ..........................:.........:.......(Fig 2 ft 5-33' .....(Fig 2)........................... ......................_ Mean Roof Height .....................................................:... ......._ft <-80, BuildingWidth,W ...............................................................(Fig 3)...................:...................._. ....._-ft.<80, BuildingLength, L ..............................................................(Fig 3)................................................. <3:1 Building Aspect Ratio L/W ................................(Fig 4)................................................. 56 8" Nominal Height of Tallest Opening .............................. .....(Fig 4).........:...................................... 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)............................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 ........ ............................. Concrete.:........................... ...................................... ........._ ....................................... ................................. Concrete Masonry............................. , 1'3 2.2 ANCHORAGE TO FOUNDATION - 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as`an alternative in concrete only i n. Bolt Spacing-general ........................................:.(Table 4).................:...................-• in._6"-•12"- . i Bolt Spacing from end/joint of plate................:...........'(Fig 5).................................... in.>_7" ..........................................._ .....................(Fig 5 Bolt Embedment-concrete.................... (Fig Bolt Embedment-masonry....:.............:......................( 9 )......................_.......................>3"x 3"x 1W ........................................(Fig 5).............. Plate Washer......:.........:....... 3.1 FLOORS ••. <.... ft Floor-framing member spans checked ...............................(per 780 CMR Chapter 55).._................... Maximum Floor Opening Dimension...................................(Fig 6)................. Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6).............. Maximum Floor Joist Setbacks ft < Supporting Loadbearing Wails or Shearwall................(Fig 7).................... _ . Maximum Cantilevered Floor Joists _ft _<d ' Supporting Loadbearing Walls or Shearwall................(Fig 8).......................................... (Fig )................................................... . Floor Bracing at Endwalls.....::................:....................•• "'(per 780 CMR Chapter 55 •.'n Floor She Type p ) Floor Sheathing Thickness ...........:...............•...............:.....(per 780 CMR Chapter 55)........::............. Floor Sheathing Fastening. .................................:...(Table 2).. _ d nails at in edge/_in field 9 ............ 4A WALLS Wall Height ..............._ft <_10' . .....(Fig 10 and Table 5)............ Loadbearing walls..........:........................................ ......_.......___--ft s 20' ......(Fig 10 and Table 5)............. Non-Loadbearing walls,..... ...:......... g in.<24"o.c. .............(Fig 10 and Table 5)..................._ Wall Stud Spacing ........................................... < :...........:..(Figs 7&8)._...:............................... . —ft - Wall Story Offsets .........:............................. . 4.2 EXTERIOR WALLS' Loadbearing v alls........................................................(Table 5-)........................ ......2x_ ft-_ _in. Wood Studs ..............................2x^-—ft_in. :. Non-Loadbearing walls............................ (Table 5) Gable End Wall Bracing (Fig 10 Full Height Endwall Studs...................................... ft>_W/3 .............................(Fig 11 ft>0 9W - WSPAttic Floor Length................... ( 9 ........................ ..._...... ...... ,. Gypsum Ceiling Length(if WSP not used)......:...........:(Fig 11).....................:......................_ and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11)............................ or 1 x 3 ceiling furring strips.@ 16 spacing min.with 2 x 4 blocking @ 4 ft spacing in end joist or truss bays Double Top Plate Splice Length ..(..... ............................................. . (Fig 13 and Table 6).............................. Splice Connection no.of 16d common nails)..............(Table 6).........................---•••• AWC Gfririe fo Wood Coirsfrrrcfiorr iff Pliq/r 110 ffcp/a !l'irid Zane _ P�flasSaCIIIISettS .CIIeCICliSt tot- C01UpW111Ce (790 CiNIF2-5361.2.1.1)t Loadbearing Wall Connections Lateral(no.of 16d common nails);...............................(Tables 7).............................I....................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9).................................. ft_in, 5 11' SillPlate Spans ........................................................(Table 9).........................:........�ft_in,_<11' Full Height Studs (no. of studs)..........:.........................(Table 9).............................I................. Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9).................................._ft_in. 12' SillPlate Spans.... .......................................................(Table 9)..................................._ft in.5 12" Full Height Studs(no.of studs).:..................................(Table 9).............................................. ..... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension, W Nominal Height of Tallest Openingz ..............................................................................._s 6'8" SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ in. Field Nail Spacing..........................................(Table 10).................................I...I........... 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 Opening ............................. ............ 5 6'8. .............................. SheathingType..............,._...........................:.(note 4).............................................1....... Edge Nail Spacing.....................I...................(Table 11 or note 4 if less).....................:.. in. Field Nail Spacing..................................... (Table 11) ' Shear Connection (no. of 16d common nails)(Table 11)........................................................ Percent Full-Height Sheathing........................(Table 11)......................................................_% 5%Additional Sheathing for Wall with Opening> 68"(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 s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary.Connectors Uplift................................................(Table 12)......,.;.....: - plf Lateral.............................................(Table 12)..,..........................................L= plf Shear...............................................(Table 12)...................................:........S= p►f Ridge Strap Connections, if collar ties not used per page 21... (Table 13)........:......................T= pff Gable Rake Outlooker...........................................(Figure 20 ft s smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no. of 16d common nails)...(Table 14)........:..............................L= . lb. Roof Sheathing Type................:...................... ...........(per 780 CMR Chapters 58 and 59) ........:... Roof Sheathing Thickness...............................:.....:..... ............................................._in. >_7/16"WSP =- Roof-SheathinFastening ::::....:(-Tab1�2�-- _ Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 C.MR.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'S, b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure.18a and Figure i 8b 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 AJF'C Gu.irle to 1J'uvrl C.'vn.rtrrrction in IIifli JYind ftreus: 110 niph IVixrrf Zvrr.e 1Vtassachiisctts Checklist OF CO111J)1ia11Ce (7S0 01'ilt 5301 2-1:l)' 4 - a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing: iii. On single story construction, panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered 3t 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a)new house or horizontal addition—required if project is 1'mile or closer to shore(generally,south of Rte. 28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. -WHEN THIS EDGE RESTS ON �' FRAMING Lr-=W MAILS - AT 6"az_ --�-^--—i.— ——rr--- - 11 i! . u 11 11 11 1 p . 11 tr � S Z N + - y{ - 11 it o LG A o ry r1 ul (uO v i� li r z 1 1 �, W ;, �, � � •III{ t r 2, i i t - r ' FRAMING MEMBERS 1 i w i i i EDGE 9TIFFRIAMATE { t` Q � Y 11. rr ,I Y�J 1 1 1 z • 11 p ii fi � 1 ; 1 � ; { IL U 3"MIN. i -11 DOUVIl:EEDG€ -- --- 0 STAGGERED 3+M� MAIL SPACM — I �. NAIL PAIN PANEL PAtJEt_ J PAN L EDGE DOUBLE NAIL EDGE SPAC9413 DErAL See Detail on Next Page Detail Vertical and Horizontal Nailing Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment ,r T y Town of Barnstable' Regulatory Services HARNSTOL.S,. i. vJdAB& Thomas F. Geiler,Director $RFD�Awe Building Division Tom Petry.:$wilding Commissioner 200 Main Street,Hyannis,.MA 0260.1 ve,w;Jow:n.barnstable.ma.us Office: 509-862-4038 Fax: 5.08-790-6230 Property Caviler Must COrfiplete and: Sign`This Section, If Using, ABuilder Own.er.of the subject.property hereby authorize /vl�r� 1 ��[ to act on n'ly behalf,. ep in 0 matters relative to work authorized by.t his.wilding permit application for Is-0 0 44 (Address of job), LI aiiati. Owner Date nit Name .......... ..,. _. _:_ ... If Property., Owner is applying for pert-nit please complete.the: Homeowners License Exemption Form on the reverse side. Q:F�RMSi�WNE.RPERhfISS10,�� --....�.�_.. ................._.__............_....._...... ` 1., WEn�ZEi,..'~R11MING INC.. 415 t y�im'' t Ot Y 02632in— r� CA n 1 C � 0 w,t ��>•�' � I1 a 04. t 4.,5 CL M rryy I""' r B I• iV � ( I WEINZEL r-RAN ING 'INC. F 4. VIP:CENTEIR is - VIZ-i.F. MA 02662 64 A� - d J C �� #r a n- ' i 1lr x 6-_ ik Wl--NZ t 'R'-'jA,AlNG INC- ,��_t .MA Cry � .-��`c��.;� 0,2632kt . f, 704 o Print this page • Owner Information -Map/Block/Lot: 270/ 156/-Use Code: 1010 Owner Map/Block/Lot GIs,MAPS, 270/ 156/ LAFORGE, STEVEN Property Address Owner Name as of 1/1/15 150 DUNN POND ROAD 150 DUNN'S POND ROAD HYANNIS, MA. 02601 Co-Owner Name Village: Hyannis Town Sewer At Address: No GIS Zoning Value: RB • Assessed Values 2016-Map/Block/Lot: 270/ 156/-Use Code: 1010 2016 Appraised Value 2016 Assessed Value Past Comparisons Building $ 63,800 $ 63,800 Year Total Assessed Value: Value Extra $ 28,400 $ 28,400 2015 - $ 159,900 Features: 2014 - $ 160,000 2013 - $ 160,000 Outbuildings: $ 2,100 $ 2,100 2012 - $ 158,600 $ 69,400 $ 69,400 2011 - $ 159,000 Land Value: 2010 - $ 194,900 2009 - $ 238,900 2008 - $ 272,500 2016 Totals $ 163,700 $ 163,700 2007- $ 290,900 Residential Exemption Received=$90,000 • Tax Information 2016 -Map/Block/Lot: 270/156/-Use Code: 1010 Taxes Hyannis FD Tax $ 396.15 (Residential) Community Preservation $ 20.58 Act Tax Town Tax(Residential) $ 686.15 Fiscal Year 2016 TAX RATES HERE 1,102.88 I Model Residential Total Rooms 4 Rooms Appraised $ 69,400 Value Style Ranch Heat Fuel Oil Assessed Value 69,400 Grade Average Heat Type Hot Water Minus Year Built 1971 AC Type None Effective 25 Interior Hardwood depreciation Floors Stories 1 Story Interior Drywall Walls Living Area sq/ft 816 Exterior Wood Shingle Walls Gross Area sq/ft 1,916 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features - Map/Block/Lot: 270/ 156/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement- 816 $ 18,200 $ 18,200 Unfinished WDCK Wood Decking 144 $ 2,100 $ 2,100 w/railings FPL 1 Fireplace 1 story 1 $ 3,400 $ 3,400 FEP Enclosed porch- 140 $ 6,800 $ 6,800 roof,ceiling • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio Microsoft VBScript runtime error'800a01a8' Object required: " /Assessing/print16.asp, line 151 • Sales History-Map/Block/Lot: 270/ 156/-Use Code: 1010 History: Owner: Sale.Date Book/Page: Sale Price: LAFORGE, STEVEN 2015-08-21 C207175 $227000 ALMONACID, CARLOS R& THERESA M 1994-08-15 C134693 $80000 DORAN, JOSEPHINE R 1989-03-15 C 116970 $1 DORAN, THOMAS L &JOSEPHINE R 1986-06-20 C 106949 $0 • Photos 270/ 156/-Use Code: 1010 • Sketches -Map/Block/Lot: 270/156/-Use Code: 1010 r- - 34 FEP WDKi BAS 1 4 BNIT .24 10 9 .. 34 l 54► y As Built Cards:Click card#to view: Card #1 • Constructions Details -Map/Block/Lot: 270/156/-Use Code: 1010 Building Details Land Building value $ 63,800 Bedrooms 2 Bedrooms USE CODE 1010 Replacement Cost $85,101 Bathrooms 1 Full-0 Half Lot Size 0.27 (Acres) AC R® CERTIFICATE OF LIABILITY DATE(MM/DD,YYYY) �- Y INSURANCE 05109/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T14E POLICIES BELOW. THiS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT HUB INTERNATIONAL NEW ENGLAND LLC NAME; Anne Sanzo Fax PHONE 508 945-78fi3 Ex : C o £o MESS, 265 ORLEANS RD. anne.sanzo@hubinternational.com INSURERS AFFORDING COVERAGE HAIC# NORTH CHATHAM MA 02650 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSUREO WENZEL FRAMING INC INSURER B:INSURERC: INSURER D: 45 WHIDAH WAY IN$URERE: CENTERVILLE MA 02632 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 51133 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 ADOL SUER POLICY EFF POLICY EXP L R TYPE OF INSURANCE POLICYNUMBER MMMD MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Ah!AG£T R D PREMISES(Ea occurrence) S MED EXP(Anyone person) S NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY a PRO-JECT ❑LOC OTHER: PRODUCTS-COMP/OP AGO $AUTOMOBILE LIABILITY S COMBINE SINGLEUMIT S dden ANY AUTO Ea acBODILY INJURY(Per person) S ll ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accIdent) $ HIRED AUTOS NON-OWNED AUTOS PeracMdentYDA Per a MAGE $ UMBRELLALIAB S OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ OED RETENTIONS WORKERS COMPENSATION $ AND EMPLOYER$'LIABILITY YIN X I 3TA UTE I ER A OF�FICERWEMBEREXCLUDED�ECUTIVE NlA NIA NlA 7PJUB073iN44915 07/11/2015 07/11/2018 E.L'EACH ACGDENT $ 100,000 Ues,(Man describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS beleW E.L.DISEASE-POLICY LIMIT S 500.000 N/A DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if moro space is required) Workers'Compensation benefits wilt be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,no authorization is given to pay claims for benefits to employees in slates 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.govAwdlworkers-compensationrinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE Barnstable MA 02601 1.-o L`9 Daniel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts B Department''of Public Safety oard'of Building Regulations and$tandartls License CS-009055 Construction Supervisor MARK A WEN2EL � e 45 ViINIDAH WAY; � CENTt=RVILLE MA 42632-7 :M . missio,ner: Expiration>'. 66/17l201$ i i /tr (("a�7i»tcnc4�aC�o�'C. 1lcJ3rcrliJells - ;. Office ot•,Eonsuifi&Affairs&.Business Regulation HOMEJMPROVEMENTOONTRACTOR Registration A,100285r TYPe4: r Expiration-4-6-TT:. . a 2018 Private`Corporation }* }r WENZEL FRAMING-1� Mark Wenzel "S# � " 45 VI(hitlah Way Centerville,MA-02632 ` Unilergecrefary i Town of Barnstable THE Y, Regulatory Services Thomas F. Geiler,Director • RAMSTABLY. 9 1b5939. g Buildin Division .� p>FDy►. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623( PERMIT# �6DY 6ubS FEE: $ SHED REGISTRATION 120 square feet or less v.� _ o` Location of she (address) Village xc tn� -fi-1�ne mso Al wnn oar i'd L3D-S) i?? i` I Property owner's name Telephone number Size of Shed Map/Parcel# a rf� R I 019 Signature Date C= - Hyannis Main Street Waterfront Historic District? �J _ 7 C-Pr Old King's Highway Historic District Commission jurisdiction? N - , Conservation Commission(signature i equired) SSign-ofihours-for-Cons`ervatio_-y n-8-00 9;30-&3:30=4:30� j PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY.BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 rt� a a P All tv yL 15 7' „R• ! J X , LOT, V. .v Sc ?. f -i'—'.- 3".— ��u�4�. .'_•".. �Rt��ixx.-'d' 4+"lcIFr3Ga'�w�w'.":,Rs.63v'%�eu�w.«T.r.,a,..:,a"'� � _ ..c,d+_a, vSm'e,.Wa'2f.[L" .�-e±'fa3.ia."c.�:.^*..vE JA2F.�c`L^tvE.'Y"•.sa'fi.:.�sJi' re "-x.-., r-,- t Y� !)• i. f"i f T 7 '\ •"Y_.f.l �t H �t 10IFj 4 tiTl a l! r i `�= t P `'t� fl iS GT Fr/ !.7 f�11 a' — — _ � r use. Gz 4 T s 7—, t J 1 u>.L'1 a�' 4/L�. W..r U lY A" }_' �l��t�lS' —— IT }i11R. �C�,S�P sr'l_JJ _I. f 0; A ha ilk -, �) f"; C '� nub ` fir' tf'r�-rr r-rSti/ F*r x.�..l 11 a�— _ —. �' f C/J CS,.' !�� f�f / 2 F ! , r ' L, R ...1 1. E _... _. i. _„ _ .l � .r< .tom c ry TT — rptn / l— .C-�J.x.: _6._.. .t V J ;.�� L� _ ,..C.�. 1��-.. ! 1�:�;F; �T C..E'JJ.v xl.�'-Y ..TQ4Y }'./l}S t,J�� �GIs 0�"r Jam,+grit h�� F,T �_'//�� r. !'I-JIM .."? B�U I f.:f�i ,(1= .K U�tT^'ti PIA1 :IS "�tCA �t7, VN .L" �s.'� ' ;,_ �� s , �E Lr I .-:�fT� " � l C 11 � _ l e .crC� r THAT SITI I\T �( 1< tl el;! y I>< 1J. A'A iT 1 ©N :1..� J/t%.IJ1 �[ IM[ ^ T L� < i< �?I'1-(117j0.1. -1' F,'Cttr C''C�m��^{ H.� Tr*-.�„f Ill k: +`t r T-�t" `i.:.t lif FE I .�_ �_._..A L•i.Y SL+B A� �j,.-,;RE.IYA_... J � .� V i _ � � �� 1JJ � ! 1q ; _ _— — --- kl\-! THk -� L, _It1�] T�jF T"S7j^�6i,x1�T '�('+�;� �p'FCITAl, J`'L l� D "_iLaA.:�i N d��` f> ���� ��h tr ARSTOII\S Iv'IUg, 1.�A. 02C. � r 6( 4 f, 5 S.�Otm 03-N T IE r U VfA DATL D_ � ``� �— � `�� `'�"` � x L: 428-0055 i � ft,ts`e - t. ,- 5 Q,u—liFl-iJE aTfcl '4.. ,250001 000 i� � �F�1�-�.�5`5 r:-n�aaamtL xv�.szaw.t;�' .r_v+ szt.�:�•x.�aratar:^5,cart, c:Pw,:t++t�x�..<�..�.i�"� .a:cxc c°y"��:-�- ^_^^�—�aec�m�*..za=.-+.saepa��z�-ar- j . — ---_ _ THIS' j'AUN t�R^r MLAD"� i` elf li\�IRIIiNri} A. Pf}RT N{,'1' T:=;— T ,rt,�' N .;i r .1 r: :,..n f:1,,r 'V.T e rf.✓ f c E11-f is TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7d Parcel Application# n?C�74 U , Health Division. Conservation Division Permit# Tax Collector Date Issued 5,t ci Treasurer Application Fee Planning Dept. Permit Fee q Date Definitive Plan Approved by Planning Board P 1— Historic-OKH Preservation/Hyannis Project Street Address S' 0 CU AJ NS 90 A.) Pd Ad Village 14 VANNt_S Owner 1 UZ_S A�(AtI M .4 010 A)Add Address ISO f)(4PPS RA Telephone 0 3 Permit Request PACE OQSe-d j QX 14 Su&-laWl-A 30-b 0 )JLA i 14 0 A&20(& L-C(c. a-'k A 7 )(16 'Qv�o d uT c[c, Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation'"VIS00 Construction Type -&AMCM)l Lot Size g0 0 �� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family r3' Two Family ❑ Multi-Family(#units) Age of Existing Structure n cs Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other / �14 Basement Finished Area(sq.ft.) — /) .a_ Basement Unfinished Area(sq.ft) /0/4 Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new A- Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other 0 &) OS �. r Central Air: ❑Yes ❑No�)A lreplaces: Existing iw4 Existing wood/coal stove: ❑Yiie.. t Detached garage:❑existing 0 new, size Pool:❑existing ❑new size / h Barn:0 existing ❑new3-2 ize Attached garage:❑existing ❑new size Shed:❑existing ❑new size /��Other: o Z3 Zoning..Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# w r+� Current Use :A 04%J_kT_ Proposed Use iA/Qy&_*)6 t BUILDER INFORMATION , Name i I . S A SU0te-W5 Telephone Number SdSf -i�r 0 Address 9- 7u/?P-)t,2i 1 C t-- R J License# 0 Home Improvement Contractor# �S y Worker's Compensation# 3 S wl(_3G 3,3 935_7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -7 L4 t&, `i pd r SIGNATURE ok9!� o DATE FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUEDLiN v MAP/PARCEL NO. c ADDRESS VILLAGE J , OWNER DATE OF INSPECTION: FOUNDATION—®f L- J O FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' kv. j • w�•dw.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name(Business/Organization&dividual): Address: —1 �11�11 0[�� k CO i�O A d City/State/Zip: 1 Phone.#' Ste- �-10 O O [2, e u an employer?Check the appropriate bog: :Type of pioject(required)-. I am a emplo,Xe-�r with 4. I am a general contractor and I 5 New construction . employee; full�tgd/orparttime).* have hired the sub contractors �✓ listed on the'attached sheet. 7. ❑Remodeling 1 am a'sole proprietor or partner- These sub-contractors have 8. []Demolition ship and have no employees employees and have workers' iIorking for me in any capacity. 9. ❑Building addition [No workers, comp insurance comp insurance.$. 10.[]Electdcalrepairs or-additions and its . We are a corporation , required.] 5 0 3.❑ I am a homeowner doing all work . officers have exercised their 11.[]Plumbing repairs or additions ' myself.[No workers'comp. right bf exemption per MGL 12,(]Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached ' additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: ' . -Cl Policy#or Self-ins.Lic,#: J S� -tog G, 139 IS 3 Expiration Date: -- Job Site Address: 130 O uhsi-,S Q�U city/state/zip NfJlS 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 pennalttfies of perjury that the information provided above is true and correct C -�- Date: i Szenature a .�� Phone#: s�o� Fs'1dC �v `� . Official use only. Do not write in this area, to.be completed by.city ar 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 b.Other Contact Person:' Phone#: Information ann instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership;association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a:-deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or,the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, § ( also,{s�tates that,"every,state or local licensing agency shall withhold the issuance or renewal of a Iic se b�r rtiuf to operate aIiisine`ss or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evideaee•af•compli�iee vrithtlie insurance requirements of this chapter have been presented•to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability-Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the . members-or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate'line. City or Town Officials Please be sure that the affidavit is complete-and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city-or town)."A copy of the aff davit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please"do not hesitate tc give us a call The De* aximent's address,telephone-and fax number:; The Cozx onwwi&ofMas aduse is ]Department of Industrial Acoidouts P. " of Invest Bons 600 W 06 St=t B�tox�CIA 02111 - TO.#617-727-4W ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22,06 www.mamgov/dia Town of Barnstable yP °^ Regulatory Services " BAR?f9rABM Thomas F.Geiler,Director y MASS. . �'prfn MA. Building Division Tom ferry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-7.90-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: sut.,k "D �q Estimated Cost '9a S-y ` Address of Work: S-O D U440"s A OA-A Y 1 u A al 01 S. Owner's Name: 4 2 F,S .Q 11 c�nJA-C r� Date of Application: I hereby certify that: ; Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 OBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IQVIPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date _ Contractor ame Registration No. OR Date Owner's Name Q:forms:homeaffidav 10, EX1511N6 5117000 P?OPO.` P?00M I OJNGA710N(I0'XI1-'A'ITC0 '.OM HOLM I.2Xa"T�?A,Vf @ I6"O.C, 2.I-EGGE?30aTEG I/211X5"LA65I611 Of. 5,.1015T H A\19,g5 f30TN ENG5 /-,G3L 51GE 1015T5 CHIMNEY 5,2Xe Pf f'.I''LE 3EAM HIGGEN @ 10,P?OM HOUSE 6,(5) 12110 X c.8"GEE0'I65'N/iANCIi0R5 '?0'OSvG?OOM, 1 00'ECHV0-'O5f5 7,5/4"AGVANTEC 5UP E1,00?--OP 20OM AAA �21 5.liPLACE RO19tN GOOF/II ?1E IW5N�,i v' '?OP05�G NM 0°EN GECK "Y,16'(A'PZOX) I,2XB Pf FRAME @ 16"O.C. VE/� 2.J015T HANGEP5(BOTH EVG5 09EN GECK GPI. 2X5 MI7[SEAM IB�7EV '4,(5) 12"✓X;ee"GEED;5 W/ANCH05 ` OR TECI-NO-PO5f5 5.6X6 0055 6.5'M5 X6"Pf PO?OPEN GECK,5fA1'.5&'.AlL5 6 t NOTE: (1) "C"WALL STARTS 10" FROM HOUSE CORNER (2) ROOM FLOOR(1)ONE STEP DOWN FROM HOUSE FLOOR PR0P0�G 3�A50N 5JN?O0M 10'X 1 (A'PROX) 5'JGIO 5W EU050- 5"HC 4OOP 5Y51t,M (10'5°AN) (2)WIV6' OO-5 NE'M6'G0M N1CPo i.6 GOO. 'Ohl5JN200M ' o PROM WOO, (NOf 5H0'M/N IN ROM 5.1NR00h1 TH15 VI'Mi) LJ LJ LJ LJ LJ LJ 5fAIP&RAIL O 36"HIGH°AV; O II"f'.EAG 7-5 i 4 ?1y �"DALLUSiEI'5PAa 'ra)ect; Scale: C" Grawinq: Betterlim v iong kmoNAc ,iin p, NcF SUNROOMS 150GJvv's 0W.OAp A- 78Turnp� Road,estlmro,MA01581 HYANNI5,MA 02601 Phone(508)870 1900 Fax(508)870 5756 Gabe:5 G9/CYrn %c,-t I of I ct p F iE � E - - w IUSET r HEALTH BOAP Mai k .. .E GL tcd�3C✓aol�d � .. . ....... i .. �d, ........•........... 3 c to Constrtct. ( or 2epzr � anIncllvld l Sewage Jis osal System ,d .. 5 .. �t l�o;. _ 3�L1f �s�E k oaca .rl�r�nn7 s.. st��_..... as shaven & the application for I5isposal WorI.s onstructzori Permit No _.. s. .. - ..................... _eb _ i•• • � �"�,�� T3nard of FieaIth DATE., �EriRM 36 OB HOBS, SE;ERs .... . ... T HL CON M0NIh EALTH of MAE; SRCHUSE t S 7 ZFS=I `70'CE ?IFI'; That ehe�.Ir dividua'1 Se ua'(je Disnos t-S stem co Istruct�d ( } or Repaareri (�� ,y kt ..F.. M ........<. .. ........ .. I >7urn �; Pond Raad...: ?y inn is ..........................: ~ Zas peen installed in accordance with the provisions of TITLE I o The State Envlrorsmental Code as aesrrl'oed In r, Y dated :. ;:`lie ap tleatlo for I)isposale�X/orlIs Construction d FrinrC by .�.. ..: d1 I € C fs n-fi C ERTIlFhCAIE'' 'HALL NOT CONS E T..KE.. w �°.°"'"" �Ar' � ,,,.�^°°�'� inspectU DATE :................... . ... Fr......... .. r f Vy 4, 3 10 T QyYE w3 a Ff aJ A5 _ geA A. � i - '� ��' i �� is a, .��c�`.3a:_5✓.'.T- �j���` '����=P q '.�.,� � '(:: .F". �' "� �3II4�'YGOY341f^...:AP..[&t&16w.Y�,e3G:"'.'4�1d. �Fwm:aK�sv.n'G+.r.•.VS��i 95S'".'u"-L i'x'rA3u'u w��L `iv 3L ^T�Gt.Z^,' ..F3.;Y�' '-ek+� - -.. � . '9 tt !T. Pl yn s er . n , '. _ � t �Q ar: � a ot � kJ Crz A DC/ Lk-A/ {D. f; m _ lLX nEREBY CERTIFY T0' a ULYU-TE Z 7— (, , r R[: T _ J7 T\ 7 r `T.I�� , ITS �J I LI/11 T� � ar ki��(ty�ti t !l r tbv, �a Y INK EI_t STJp�"v CFE.,Y L S H J��l�I V'IS" A�:J 1 LAIN- 1S u�✓1'^ 7 E-D G�'�? rti Fl.hl ('S.h'/��J k.�:l ._ i..� i Fll I !� '�` 3 �G UL I� Ili 1 HIAT 1T., i,rJc 1'0 t7G� h �1 ij I TI r.T SU_._ (, i'.E T'D t;`E �tD INM LA-V7tr SE' A l� �tEJ IRFIIK lT1S�rJ %-IE 7 l 0,1`_I � ..`�'rrT TI� LTnrr, 'I�Gt_i't I (\�. rl _A".i.D -_1_ I iJ}fit �✓ .1 + 1 0: /t�DT_ L IE 14TaJ l+l�'rT�l f d4 S ter' /` T� r _ �Z ..I� it z e ? �E *�'t ri/E;RSZGI�TS lt�3LLS nA. 648 1A� A' V 1i y ij�rnF C�f ,T, 2 fit . 7. !�` 1i, �i loll EX%NG 3'POOP PPOP05FD I?OOM FOUNDATION(10'44'APPPDX) FFOM HOUR I I.2X8 Pf FLAME @ 16"O,C,. 2.LEDGEP 6OMP I/2"X5"LAG5 I6"O.C. 5,JOISf HANGM 6OV END5 A.PM 51M J015T5 CHIMNEY 5,2X8 PT TPIPLE 6EAM HIDDEN @ 10'FFOM HOUSE 6,'(3)12"0 X 48"MP FI65 W/AVCHOP5 PPOPOS DOOM OF TECHNO-PO5T5 7,3/4".AINAMC 5UD FLOOD MO DOOM AAA B.PMAa POfTEN POOP/JNM THFt9I01.D 2 PPO?OSED NEW OPEN DECK 1'KI6'(A°PPDX) 4' I:2X8 Pf FFAME @ I6"O.C. NEW 2,J015T HANGEP5 SOH EM75 OPEN DECK 3,M 2X8 END 9AM HIDDEN 4 (5) I O X 48"MP FI65 W/ANCHOP5 Op TECNN0=PO5T5 �'6X6.p05f5 >.. 6 STAIPS . A"AP PT OIZ-OPEN.DECK,5TAIF5&PAILS :. -, Y � 6 F r NOTE.. (1) "C" WALL"SfiARTS 10° FROM HOUSE:CORNER;;. 3 13 ROOM FL00R-(DONE„STEF� bOWN ROK HOUSE FLOOR , PPO'0io 3 SEASON SUNPDOM 10'X 14'(APPPDX) 2. STUDHG IO P.00F 5.Y5 C 10'5PAN) Ty' X. t 1s w. (1)NEW 6 DD..OPS NEW 6 DOOP FPOM 5UNP0b FPOM SUNP00 NEW 6 D00 (NOf 59, N 1N FROM SUNPOOM 1HISUIEW) ' h z£ 4 _ I I I v a I 5TM&PAID' { ` Z 3y 4"Pik M1,U51EV SPAa Project: Scale,I/8"-P-0" Drawiriq, Bett e rl ivi n &MQNACIP p�51bFNa SUNROOMS 150DUNi N'5PONDPOAD ' i �� NYANN15,MA 02601 fi 78 Turnppike Road Westboro,MA 01581 Phone,(508)870 1900 Fax(508)870 5756 Date;5/Cl/01 Sheet I of I ��V14, LAYOUT FLANS qll WALL5ECTION5 EXISTING BUILDINGr v / t / �� � A ' cn to 'w� g 4.5' STUDIO 51DE WALL(A) r'STUDIO SIDE WALL(C) DM 0 4.5'D 4.5'D A55EMPLY DETAIL5 - SEE ALLOWALE 6-WALL cj TABLE FOR PANEL 5�E5 STUDIO FLOOR PLAN O .� MINIMUM SLOPE 1:12 c�> O a � 4.5' 45- Z\ GUTTER.FASCIA f� P �� �� Q A HEADEP.SUPPORTBEAIA t Q TRANSOM(OPTIONALLE a" SLIDING DOOR h 5;,....4-p OR WINDOW STUDIO FRONT WALL(5)- �' ALLOWABLE LIVE LOAD TABLE FOR 11 FT, PANEL WITH 10 FT. OK LESS SPAN TEMPERED GLA55 1 20 OF 25 P5F 30 P5F 35 P5F 40 PSI, 45 P5F 50 P5F 55 P5F 60 P5F 3"HC 3"HC 3"HC 3"HC 3"HC 3"HC 3"HC 3"HC+H 3"HC+H FLOOR CHANNEL 3"EP5+H 3"EP5+H 3"EP5+H I 3"EP5+H 3"EP5+1 3"EPS+H 3"EP5+H 4.5"EP5+H 4.5"EP5+H NOTES FOR STUDIO CONSTRUCTION a DECK/SLAB 1.ALLOWABLE LOAD5 ARE BA5ED UPON 5.PANELS MAY ONLY BE USED IN ROOFS AND WALLS WHERE 16.ABBREVIATIONS: D=DOOR. GBM=CRAFT-BILT MANUFACTURING TYPICAL STUDIO SECTION fl& THE LESSOR OF THE ULTIMATE LOAD/2.5 CLA55 B OR CLA55 II INTERIOR FINISHES ARE PERMITTED DM=DOOR MULLION PSF=POUND5/5Q.FOOT r OR THE LOAD AT 5PAN/120. BY CODE. W=WINDOW FT=FEET 0 2.HC/EP5 REFERS TO CBM STRUCTURAL WM=WINDOW MULLION BC=BUILDING CODE 9.HORIZONTAL JOINTS BETWEEN THE ENDS OF PANELS ARE a PANELS WITH ALUMINUM SKINS BONDED TO HC=HONEYCOMB PANELS ' IBC=INTEP.NATIONAL BC ;?� N07 PERMITTED. UBC=UNIFOP.M BG HONEYCOMB/POLYSTYRENE CORES(3",4/V 10.CONTRACTOR TO PROVIDE FALL PROTECTION PER LOCAL CODES, EP5=POLYSTYRENE PANELS AND 6"IN THICKNESS).ADJACENT PANELS FOR 5UNROOM5 WITH A FINI5HED FLOOR.LEVEL OF 30" H=THERMALLY-BP.OKEN NBC=NATIONAL BC t'-O Y ARE CONNECTED USING VINYL CLEATS OR Hr, ALUMINUM H-5TIFFENER 5BC=STANDARD BC �r c R OR GREATER.ABOVE AN EXTERIOR SURFACE. P=PANEL �0 � ( ) 11.STRUCTURAL FRAMING AND CONNECTIONS TO BE INSTALLED L"=WALL HEIGHT 5PEC5= NUFA ICATIO 3:NINETY 90 MPH DESIGN WIND SPEED, �� EXP05UPE A OF,B. 5PE MAXI CIFIGATIONS `+ 4.DESIGN ROOF PANEL DEAD LOAD=5 P5F. PEP.APPLICABLE CODES AND GBM/MFGs SPECS. MPH=MILES PER HOUR. MAX MAXIMUM � 5.DOOR.AND WINDOW LOCATIONS/SIZES ARE 12.CONTRACTOR TO INSPECT ALL.EXISTING CONDITIONS PROJECT: CONTRACTOR: a., INTERCHANGEABLE PER MFG'5 SPECS. AND A5 NECESSARY REPAIR AND/OR REPLACE ALL N OF . 6.WIDTH OF B-WALL MAY VARY PEP. MATERIALS AS REQUIRED TO RENDER THEM STRUCTURALLY 4 ' 4S�Os T`' 10'X 10' DOOR/WINDOW LAYOUT UPTO 24FT. SOUND AND COMPLETE. CRAICa J. 4 5TU DIO ENGL05UI:E 7.PANELS MAY ONLY BE USED IN ROOFS 13.L"=96-3/8"(MAX)FOR ALUMINUM ENCLOSURE. Joss AND WALLS OF ONE STORY 13UILDING5 OF L"_107-1/4" MAX)FOP,VINYL ENCLOSURE. O sTRucrunAL DRAWN BY:CJJ DWG NO.: GENERAL LAYOUT ( 4o324 em50-tOx10 CONSTRUCTION:TYPE VB(FOR IBC/NBC), 14.AUTHORIZED FOR 13ETTERLIVING DEALER/MATEIAI Fo(61E e SCALE:1"=4' DATE:4/30/2003 TYPE VI(FOR 513C)AND TYPE VN(FOR UBC). 15.STUDIO FLOOR PLAN&SECTION NOT TO 5CAL ` O SSroNALE SI�Io� propeny 0,,7ymaer ?LS$ Complete and Sign 'Fits Section it Ming A. Builder T J �I r's' ,� r ! ,/�''1 Ctr, cr �.C^ `� 2S Owner 0f the Su 'e,;t prop e:v :i r 'i_i_g Patio Rt3i;__>S (u.b, —.C'at"t0 ROG'rr1S of A":eliCa).a%C act 0n, le_ —_ _ �rS -oy �;;=h, ,-,7, p� 'r i s ui d r g V ..A__ a_�p l' ..1 ii 1, ature of intr Data 1 C 1 S' �(Ul �U{- C� 2 6� !i a-oh S n� `c -ij'pr_!c�10i1 0 I e 10 e�01�� ��piiGc�lOr ToF i, �.1�.i.�' l\\:iv_IC..�. .._1�.. l.i�(�]( i�C■ �iJ._ 1... C...A A�1/� _. l'iG.CQl asC iij9Ul 1. SV q./VI N��s RL 4d, G.1�. t..t.. ^. .. i - .. .. t 1l, OPS� O. V K O �1ed J C L mar i,.L.P4 r;' 4 nOra� ;0e 0 11 i•i. Signature of 0-,.-mez/Agennt Pate . i . - _ k s,'I �/ZP, U/Q4%?/JiZO:"t,L(JgCL/�, �✓��yiJ JILC�CIQ� �, s j BOARD-OF BUILQING REGULATIONS :License: CONSTRUCTION SUPERVISOR V� Number CS; 1 081580 � t Birthdate 02/19/1950 } r } i I /Expires 02/19/2008 Tr.no: 16699 '. 'r . . Restncted 00 t, PATRICK A.STEVENS ' 24 FORD RD ti ; 5 . STERLING, MA 01564°4_. Comm,sM6ner y e. ��,% � ✓die �omz2�ZoozuleaC� o��cLJa�ccaeZla �a`i j '' i , Board of Building Regulations and Standards f HOME IMPROVEMENT CONTRACTOR r Registration; 148574i Ex irat 10/6/2007 Iel t, l } Type Supplement Card Patio Rooms(dba)BetterLivingtSun PaRc`k Stevens 781 Turnpike Rd. Y.rt Westboro, MA 01581 4 Administrator tr ,A s C'ONSUNIER INFOR_`IA.TIOTINT F'C P01- "SUINROOAB" 1 Massachusetts State Building Code (780 CMR, Appendix J, Section Jl.1.2.3.1) .The Massachusetts State Building Code(780 CMR)includes provisions to ensure that houses and house additions meet energyefficien cy ncy standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J,ySection J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size,,configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in,becoming aware, of some of the important energy.conservation and year- round comfort considerations involved in;selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential, buildings may create comfort and energy , consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation.of"sunrooms", included below is a non-required,_open-.ended list . of product and .design considerations: that .a homeowner may. wi-sh to :consider. .before actually constructing/installing a "sunroom'.:It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption.and/or house .' discomfort issues. In addition, the,qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" Solar Orientation and Natural Shading Type of Glazing s Insulating value Solar heat gain ® Frame materials, ® GIazing to frame.s:e'aling:and gasketinb materials/seal.durability and/or •e' . weather tight" ss:ofthe sunroom Adequate ventilation Qp Crab ie,windor+s and fans `Applied Shadinb Systems • Insulation level in floors,,Nyalls,and ceilings • Po�sible.Sunroom isolation frohn'the main house yia a wall and/or door or slider 4 It, Heating and Coolin.a,M thod:s: Efficiency, Zoning and Controls H.oineow•ner Ackno}vledgment # . the Massachusetts.State Building Code; Section J1.1.2.3.1, requires that the actual property owner (not the ' p , owners agent, re r�sentative),acknowledgereceipt:ofthls CONSUMER LNFORIVMATIUN FORM prior to issuance,of a Buildma ,Permit for JP� h „ ro t' t.at,includes .sunroom .. additions .to an existing residential buildma: `In accordance with this requirement;ahe undersigned hereby acknowledges-that's he/h has read the_information'in this''documenticoncerning`sunroom'comfort,and energy conser"vation Signature of Actual Building Owner Date AI;tS. /v hl�� n ' T j ; Nis �, a Print Name Address of Permitted Project ��� Owner Address (if different than project location) O.wner',s telephon number __ WORD -CERTIFICATE® OF LIA IL[TY IN RI A, ..,.-..�...._... `^ DATE(mwml n NCE 03/09/2007 6 PRODUCER - - 1 HIS CERTIFICATE IS ISSUED AS A MATT ER OF INFOP-MATION Joseph McKeone ( ONLY�AND CONFERS NO PJ-FI"FS UPON T`r§E CERTIFICATE JP€JIcK�ne Insurance Agency, InO. q HOLDEFL THIS CERTIRCA TE DOES NOT AMEND, EXTEND OR I Al THE COVERAGE AFFORDED BY THE POLICIES BELOW. r P.O. Box 333 Ann Arbor, MI 48106-0333 IKSURERS AFFORDIRG COVERAGE f IYCMUP�D BLSHE I dba BetterLiving Patio Rooms 1 INSURER B: — P 78 Turnpike Rd NSURER c: Westborough,WA 01581-173D D=R-d D: COVERAGES I ,HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE)hSURED NAMEDABOVE FOR HE POLICY PERIOD!NDICATED.NOTWITHSTANDING I ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT'OR.OTHER'DOCUMENT WITH RESPE TO WHICH—fH!S CERTIFICATE MAY BE-ISSUED OR r MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES:DESCRIBED HEREIN IS.SUE:IECIi TO ALLCT THE TERMS,a)tCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY=HAVE BEEN REDUCED BY PAID CLAIMS. -- --- - PV t"Y 1 [hSF PtJt R^Y 0P _ LTR TYPE OF INSURANCE I PO'.5.:'Y NuktBER �-DATE fWUM ! DATE f9 LIMITS . luAsairy ( 35 S61�J K1Ji6352 03dQ�l 7 I Q1/0112Q08 !EACI OCGURR=_NcE s, 2 000 o m 3 •X I COMMERCIAL GENERAL LU,611- Y FIRE DAA4fiGE(Arry'me Fita) •£ ( I J CLAIMS MADE 'X j' , - - 1 OCCUR &7ED�P(Any one pe son) X ContnctuallY - -- .. ... .... - •-I ... I I - I G M=RKL GGR=GATE Y o QDOJDtjD y 77.� GENLAGGREGATE LWITAPPUES PER:'. ;,PRODUCTS-•COMP/JPAGG - r� POUCY� PRO — ' X i LOC i I AfrTOI�asILEturtmr 35 UEG UDC 3441 09/0'1I2007 s�f104t203 I casiBlx asleace=u�ilT ,A ANYAUTO I (EtaLF=a ert) I y A?D,DDD I _ ALL OWNED AUTOS 130OLLY INJURY L. I SCHEDULED AUTOS I. (�P�nI: _ y--I j HIRED AUTOSXXNON•OWNED A UTOS �i i j �BODILY I NJU RY — L PROPERTYOAwAGE !.y (Pet exlde q r I G?RAuc LUtSiLIT � k I� ( I AISfO ONLY-EA ACCIDENT I L ( - - - - ACC — I OT R.THAN --- — �AUTO ONLY.. . A -^ES,sL)Aaatm 35 RHU 11C:8861 - Q1 0 Qf�7 Q17S�sr2.(k cx jEAC_H'OCCURRENCE r 2 ODD0 ��DrcuR. �cusrl,Is IaADE AsGrz_GAT= S _ 2,D�I,QDD i IDEDUCTIBLE -. .......RETENTION E WORKERSLI A 'EMPLOYERS c° A,m... i 351filBG'JJ9353 0: 1t01.1 3;37 p'1/0�/20018 X).TOR IAul s _-° e L.EACH E.L.DSEASECEAEMPLOYEEI£ 00,000 ,D>?O. p,SEASE,-POLICY LIM T011 j 5.. SDD.D4D T.: FIES"...itPMogK OF OPERAT*N8ti0 AMONSNEMCLE'SFD=-USIONS ADDED BY ENMRSElaER'TfSEC'.=AL PRDVPM*p—, - •,� ,.:.'a k .,, �,_„ .., J.,..Y. ., _;.,:: i t CERTIFICATE HOLDER ..; .,; ' ADDITIONALINSaRIEn;INSURER LETTER: I SI(ouLD Aw OF TmE ABOr,DESCRIBED PO=IES BE CANCELLED BEFORE THE=PIRATION DATE ENEREOF,THE ISSUIN AI G INSURER.MLL ENDEAVOR TO MAIL 30 DAYS WRITTEN INSURED COPY . NOTICE TO THE CERTIFr-ATE HOLDER NAUED To,THE LEa•T,BUT FAILURE TO DO Sp SHALL i I I alm N0 OSWAnoN OR LtABt 1FY OF A-MY IAND UPON THE IPSSURSL ns AGENTS OR I A ATri� ACORD 25-S(7t97) f�/ iCQ RPORATloht Isar -2 Pil 2: 27 VA sGr � o,-s Lu VY��v c 1'' �.�✓L� V lC y W\ Vl"- q w,4 rt-a c- Fq I Town of Barnstable *Permit#oho 6-7 6 6v(�,-�' Fxpires 6 months from issue date X Regulatory Services Fee c ` . Z NAM 'T Thomas F. Geiler,Director s6;9• , 2007 Building Division Tom Perry,CBO, Building Commissioner 'rOWNOF BARNSTABLE 200 Main street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Preys Imprint Map/parcel Number d l s—u Property Address Igo -Du r1 ns PUYI j M IN 0(�6 0 Residential Value of Work 4 7,d201 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address CO r ®,5 ' A I mc?n a C I d _ hl!�O Junns Jon R , H-/ann 's , MA 0c'�66 Contractor'sName,�3C 1'S ��QYt7E VY)fl1OVEMer ^�t2�5TelephoneNumber��o oci35'Sb2G Home Improvement Contractor License#(if applicable) /�V bn V /y , E X p ' I b 1/ 4900, Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner I have Worker's Compensation Insurance Insurance Company Name H C e- A YVt e f•1 sC o ) - -Y1 SlA r a y i C e C10,WPC4Y,) Y Workman's Comp.Policy#�L.R C.44 3 4®?6 V 1 E-x p ` 014/O J /,;?oo Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows. U-Value O0 33 (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "Note: Property Owner must sign Property Owner Letter of Permission. Z e I rovement Co actors License is required. SIGNATURE: _ Q rs P,vqt) Q:Fomis:expmtrg _. 80d, 9 3-5 , -50 Revise071405 l ` Board of. Building Regulations -anti Standards � y HOME IMPROVEMENT CONTRACTOR Registration: 148607 . izxpiiattona 10/11/2007 v Type: Public Corporation - SEARS HOME IMPROVEMENT PRODUCTS INC. ALFRED NYMAN JR. �CP�{ y LONGWOOD, FL 32760 Administrator I r Ate Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement-tor tractor Registration Registration: 148607 ` fs Type: Supplement Card # 1 — "� z-s Expiration: 10/11/2007 SEARS HOME IMPROVEMENT PRODUCT ` LUBOS SVEC ' , 1024 FLORIDA CENTRAL PKWY R LONGWOOD, FL 32750. '�`�, °' Update Address and return card.Mark reason for change. DPS-CA1 50on-05/06-PC8490 � Address Renewal Employment Lost Card ✓fZC �/6917/I)LOOtl.(lCCLL(./L O�✓4GClOJQC/7.[LOC�.6 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �e Board of Building Regulations and Standards Regist a ation: 148607 r One Ashburton Place Rm 1301 Expiration: 10/1'1/2007 Boston a a , _ �• ,Ma.02108' # Type`,-Supplement Card SEARS HOME IMPROVEMENT RR, LUBOS SVEC z ' ,f 1024 FLORIDA CENTRAL"PKWY LONGW000,FL 32750 Administrator Not valid without signatat e� ooe:0&31-1%3 F-P 08-3t-2"?7 n Class:2M Restr.8 eidOra:NONE seat.M t:6-02 Fyis".W issued:fl&26-2003 # s �.+ l BOS 827 TH6MP'S0WR �THOMPSON CT 0621 A` s: w GO- (-''�� .:�. .. �.. - �/ -22 fir, sv 11/17/2006, 1.3:42 407-767-8536 LICENCE PERMITS SUBS PAGE 01 DATE ACORD. CERTIFICATE OF LIABILITY INSURANCE 04/01/2007 03/10/20 %ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LOWON COMPANIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 525 W.Monroe,Suite 600 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CHICAGO IL 60661 EQL�AkD�iY�dItiP9�lCS B (312)669-6900 INSURERS AFFORDING COVERAGE ISURED Sears Holdings Corlmration INSURER AAmerican hm m 062163 dkda Sears Home Improvement Products,Inc. INSURER : r>`de=f•y1ns.Co.of No13 erica Attn,•Rlsk Management SS-177B y 3333 Berledy Rd. -INSURER , Hoffman Estates,IL 00179 :OVERAGES SE,AH004 C7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWRHSTANDING 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 OP SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIL SR TYPE OF INSURANCE POLICY NUMBER PDUGY DATE DAB L1MIT8 GENERAL LIABILrTY EACH OCOURREMCq 5.000.000 A X COMMERCIAL ENERAL LIABILITY HDO C21.729383 W0112006 04/01/2007 FIRE DAMAGE uM ft) Excluded CLAIMS MAKE EXI OCCUR D EXP one S Excluded PERSONAL&ADV INJURY 5,000,000 GENERAL AGGREGATE a 5.000 000 GERL AGGREGATE LIMIT APPLIES PER; PRODUCT'S_COMPIOP AGG S S 000.000 P - J LOC AUTOMCIMLF LIAGUffY COMBINED SINGLE LIMIT a 5,000,000 A X ANY AUTO ISAH08219953 04/01/2006 04/01/2007 (F&mo>: smIl ALL OWNED AUTOS - BODILY INJURY 8 XXXXXXX SCHEDULED AUTOS (Pm pew) HIRED AUTOS BODILY INJURY 'r XXXXXXX NON-OWNED AUTOS (Per waWar1) PROPERTY DAMAGE a XXXXXXX 1Per eud;19M) GARAGE LIMUTY AUTO ONLY-EA ACCrDENT a XXXXXXX A ANY AUTO S.-Is'$5,000,000 04/01/2006 04/01/2007 OTHERTHAN _FAACC XXXXXXXX AUTO ONLY; AC XXXXXXX EXCESS LIABILITY EACH OCCURRENCE S Xx7Xx= OCCUR CLAIMS MADE NOT APPLICABLE AGGREGATE 9 XXXXXXX n UMBRELLA a XXXXXXX L FORM DEDUCTIBLE _I RI1 a XXXXXXX RETENTION 4 0 XXXXXXX A WORKERS COMPENSATION AND WLRC44340960(CA)(DED.) 04/0I/2006 04/01/2007 X WcsTIMI.1�S OTN. RMPLOYERS'LIABILITY A SCFC44340872(W1)(RETRO) 04/01/2006 04/01/2007 E.L.EACH ACCIDENT $ 1.000,000 t3 WLRC44340959 04/01/2006 04/01J2f)07 ML,DISEASE•EA EMPLOYEE 4 1 A00,000 B ALL OTHER STATES E.L.DISEASE-POLICY LIMIT a 1 000 004 A OTHER S.).R,$5.000.000 (WO1/2006 04/01/2007 S.I,R,$5,000,000 Gafagckmpera liability DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES=CLUSIONS ADDED BY ENDOMBMENTISPECIAL PROVISIONS Alfred W.Nyman,Jr.,License NCGCO12538 located 0 1024 Florida Centmi Parkway,Longwood,FI,32750 and Alfred W.Nyman,Jr.,License 4CMC1249510 located @ 1024 Florida Central Parkway,Longwood,FL 32750 TE CERTIFICA HOLDER ADDITIONAL INSURED•INSURER LETTER: CRCELLATION 226M2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Sears Home Improvement Products DATE TtiEREOP,THE tS5UING INSURER WILL ENDEAVOR TO MAIL 30 DAYS Villff rEN 1024 Florida Central Parkway Longwood FL 32750 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IFFT,BUI FAILURE TO DO 90 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HINO UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, A1ITNORIZQD REPRRE6ENTATIVR r+- ACORD 2"(7197) For eaaollone reperdmpfAlo certllcak,cons n the number Netad In lfm Prodaeer cealm+kbwn mind sp*ft the ciMg is 4n%ANaC ACORD CORPORATION 1968 Received on 11/17/2006 1 :37:25 PM ua3-A'•U44 u 1-Uy DR Vinyl I vinllo NFRC 3ncro wanclal; IOW)1•t-Autg I Vant.Anm do dob.le guillotine Argoa.'P.ow-5 1 Aratln/LoA-E NsUonW RwhUm R*Q Coundle ]ftl" �:9f+7A ( 3.18 tree Vtdrip No i.4tvinae.e+. 6:lasq I 3izt vidrio Imninedo wt,ri iwiio I Iron tcilllas+ RRS 9 .~ ENERGY P ERFORMANCE•RATINGS ULLIIACN N DE�pENDC�71p EN£pAEfItJD U-Factor Solar Heat Gain Coefficient 0 . 33 �� NnO1 u 9 n rbefkfente: ana GncladeEnerglaSolar 0 . 3 3 �1 .. � ❑ . 2 G xri�S ADDITII)NAL PERFORMANCE RAVINGS Eva J.0 CM SUPUBAB 11'AM PE rtENW %wT0 Visible 7ransmitta rice Pansmidloh de LuzM iWe Ilk 3ftlales mm Omm m&q a wrdorm 1 i eppik"NW plooed m for datamnninp wow woo pea mlvoa.NFiiC mllnos are datennoletl fore O,ced ait of t dwlrorrrteN d cOndlOurs an0 a spodOc f>todust nine NfiiC does nol rawnxnarb any pmdcr OW does nal m"m ft iuk%l Ald of eq;wodtcl fo am sodk uae.cauua maMarAr am Nlfreaae mr outer prod rt perfpal m Mlfanlatlon.wwtkntrc.ary rate fatnita"aeOpulR 4ae"IN vabre!eur 11 a DIM prooedlmlonrm apN oft do NMC pale datomlilwd nuMlndanb Mat l;W _ dam.toe velmes umft pw WRC oat ddan-radon par umnrytnfo flu do wndkWm amblil tmlea y un lamerro do pm&ft igeclliw.NRIC no t>3mnVenda rtirtptn 1 rtducto y n�galerd�a vue N pn>duao sae menmdo per8ln lq0 f�pocflloo,tlormtdb can el - falols dal o 11*8lde W a el•llso apfdplsdo de We pmdaie.tvvuw.nAr om a1C fti! +rmlit ies 4or rNEKT $TAP `� �.xca3O .•n,.:....Iw; +:ter•�o-.. V..��* l'�•"�� trtvr<nrsr. 'Ptj3Dnlr+=?)^ZMVF..GS :XSAK: Noila, 1:` 2v .+ II� N1CLC �thtral. SpY �•rnL.!11., ?Vr. - -� {) 1Nn: P.ei+t n0l�lapv 1/A"/R-P25 TQsted Size: 48- x 80" IND: Pefu-nr=a on/vidrio 1.18 iwam-R25 ?) /•- 71- G48126.1/11 g037i ra phillira 19 5727069AM Keep ft bbol lof I risible ENS 6Y STAP mbdtes To lean more vipt www.eoeg0w.gov Gum*oft eliplela pom postbbs t ilwAolm E MY STAB Pam mmm n*ocem do go,vttlb www.analgy w gm tNe Town of Barnstable KAM h Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder moy1QC P 1 as Owner of the subject property I, car105 A I 1 P rty hereby authorize r S. i e t U 6s SVec �. -°`�—� 4-- to act on my behalf, in all matters relative to'work authorized by this building permit application for: L'i Y)rn5 -PcrVl C� (Address of Job) im C/ g O� Signature of Owner Date r Alwo"Y)OLCI Print Name Q:Forms:expmtrg Ravise071405 The Commonwealth of Massachusetts 4 Department of Industrial Accidents e xs • n X-,V, Office of Investigations 111U-1_ { `1 'll 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/Organization/Individual): IM in TO V e 'P TrIC , Address: /Oc24 rLorA, C Pkw 4o7 , ss1 > syoa �' City/State/Zip: FL 3Z 75 Phone#: R6h �9 S ' 570 ()4 --A a Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors . 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. x ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. orkers'comp.insurance. 9. [D 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' 13,�Oth 13 comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'.conp.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: AC(E- VYI6 t C Policy#or Self-ins.Lic. #: W L RC 4A 3- 0:'3 6 O Expiration Date: 0-4 O l a Job Site Address: / ,s® :D u n n s Po-r J kor-A City/State/Zip: a�� I 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 hereby certi n the pains d penaI l ooft perjury that the information provided above is true and correct. i a e p J r"S C' � Date: Acro Ph n # Official use only. 'Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ���,��,�� Location: �••'}� Sears Home Improvement Products,Inc. S p '771- FL 32nc Phone#: r - 1 f 024 Florida Central Parkway♦Longwood, sw� 5 11 4 FEIN 26-1698591 Job#: License Numbers: AL 5481;FL CGCO12538;LA 84194; Horne Improvement Products MA 14a607:MS 50222;NC 47330;RI 27281;SC 105836; TN 2319;Columbus,GA G17017;CT HtC-0607G69: Replacement WindOWS Name: �lT ���S fL�Y"" Lj2 "`arc rcl Phone:Re Bus. City: c' i r' St.: Zip: G3(r 01 Address:- �� �Improvement nafter referred to as hereinafter eferredttoh spContractor,tofurnish,deliver,r,land a h contractaS T"offer to le,the owners oremises described below, rrange for nstallat nof all mat r alsnecessary to impro ethe p emises ocatedr at: ,Cf}l�l E (City) (State) (Zip) (Street) According to the following spscthcations: 1. Remove existing units to be replaced. (NOTE_Removed units are likely to be damaged.} 2. Prepare openings as necessary to receive replacement units. (NO finish work other than normal installation is to be done unless otherwiwtndows noted below.) n openings described below to the following specifications, 3. Install Sears�Weatherbeater JlQ Color: p.White ❑Tan ❑White/Light Woodgrain Interior ❑White/Dark Woodgrain Interior ❑Beige/Dark Woodgrain Interior ,t Type: O DH l�SH Cl 2 LR 3 LR ❑PW M Other Iri �— Other Oty— Qty�- City— Qty— aY— Qly Oty— El Other— Q Other _ ~ EiH F0_1 Qty— OIY _ t s ❑Clear ❑Bronse ElOBS h Oty— Screens:CHECK IF OTHER THAN FIBERGLASS 0§Low E�/Argon ❑Gray IXOBS Full Oty L (On Sashes Only) ❑Alum ❑Tempered Oty— ❑Keepsafe QtY_ NOTE:Tempered glass will be installed to meet building codes. ri Col Sculp Col Flat Diamond Top Yes �White ❑ A`) V.1'nc�CGt 5 l No Q Tan ©� 1-FC Pr`� Bottom Bo PP Wd Grain ❑ Brass Warranty: Manufacturer's We sent upon completion.. C �1Lt n[ S [X— 4. Existing units NOT to be replaced: a\Gce 6. _t_ _ - _ _ 5. It applicable,after completion of project,the application and removal-(storage)of shutter-panels-shall be the responsibility of the purchaser. n e event the project requires the installation of storm shutters or egress windows,Contractor will not re-install any effected security bars.- RC-1L" - 5. Special instructions: 7. Clean up job related debris and provide necessary permits and insurance., 8. If applicable,in the event that Contractor is unable for whatever reason to obtain the proper permits prior to the commencement of any work, Contractor shall refund any previous payment and this transaction shall be automatically cancelled. 9. Allow approximately 3-6 weeks for installation. TIME FOR COMPLETION OF WORK.Contractor shall commence work within approximately twenty(20)days from the date shown herein and will be substantially completed within tarty-five(45)days thereafter unless a different estimated completion date is shown herein. Approximate starting date is: _Approximate completion date is: Pp —.- __--_ LA � NOTE:THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND WVE UNDERSTANDTHEM FULLY. ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ONTHE REVERSE SIDE AND AREA PART OF THIS CONTRACT. X C Please read the following bold type and initial corresponding line, agreements must be set forth in Verbal understandings and agreements with representative shall not be binding All understandings and ag� writing in this Contract.Due to climatic conditions,interior condensation may occur. Purchaser Initials: ` 1 Contract Price $ The TOTAL PRICE for all Labor&Materials(including any applicable discount)is $-7--00-07�1- .00 O Down Payment $_ V OD State Sales Tax(—%)$ `` (If applicable) $ Balance Payable $ �a� I' Total Contract Price $ 7a6 ' Terms: Credit (Subject to the approval of the Credit Department) Cash 0 (Final Payment payable to installer upon completion)Funded by: Bank: St. City Acct# _ 10%Preferred Customer Discount(PCD)awarded for any future Sears Home Improvement Products purchases.Current pricing available for one(1)year. It this is a credit transaction,the agreement for credit is contained in a separate document which is incorporated herein by reference and made a part hereof.I.'M the undersigned are hereby authorizing Sears Home improvement Products,Inc.to verity and review my/our credit record with an independent credit reporting agency and release them from all liability incurred from inadveri;ppi omissions or err rst O V C'fYl�f,20 CZ{Ctand acknowledge IN WITNESS WHEREOF Purchaser(s)have hereunto signed their name(s)this day of receipt of a true copy of this Contract and unless otherwise specified,it is understood that the owner is ready for work to begin. THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY:You the Purchaser(s)may cancel this transaction any time prior to midnight of the third day after the date of this transaction.See accompanying notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature affixed below ads as receipt that Purchasers)rerelved separate cancellatinn forms. SU D By:Representative Date Porch r Date D 9y:Sears 1m am P s,Inc. Date Purchaser Dare E2•SO 020 / -t,z) �FTHE rqy, Town of Barnstable *Permit# �3 Expires 6 months from issue date "• BAMSTAste, Regulatory Services Fee C 9 6 ss. Thomas F.Geiler,Director �A s63q. p1� Building Division 7 7,s r-�7 Tom Perry, Building Commissioner , 200 Main Street, Hyannis,MA 02601 (; Y CU Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0'7 4D/ Property Address J7 S ��� �r� _ dl 5 ❑Residential Value of Work d® Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 4-;,7 a(n? 60 L�vcart,5 Contractors Nameless�� p 1' Telephone Number u Home Improvement Contractor License#(if applicable) /,vy"J ­3 Construction Supervisor's License#(if applicable) ff Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance^ Insurance Company Name �� 7�� Workman's Comp.Policy# '5 61-` _ 10 V Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to t ❑Re-roof(not stripping. Going.over existing layers of roof) , ❑ Re-side ❑-Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. R e I veknent Contraclus License is required. Signature Q:Forms:expmtrg Revise063004 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street, fh Floor _= Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:BuildingRiumbin /Electrical Contractors s name: —��� address• /fit` —n GeJ' d--\- City t j zin• phone# ' work site location MH address): �`i 7j �/ �i s ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction[]Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition ,,:�„��'�" .g•-�+-%t4' . ....'A.� .Ni:;' .3�:I��,< ._:'i>.w9�'j:`.'i`r. .,.. "��%c"' t'�=.i••' I am an employer providing workers'compensation for my employees working on this job. company name address: l �i,� .�fti.C •� �9 a ...hone#: city. /cam '. insurance co. ter! O v ON# ' ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comtxeav name• address: city: phone M •Y insurance co. oli # comipany name: address: city: phone M — insurance co. of N # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties.of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. `• I do hereby c under th ain a penalties o ury that the information provided above is true and correct . Signature - Date E:• Print name .� LL���— �e�.��i Phone# a official use only „. do not write in this area to be completed by city.or town official city or.town: permit/license# ❑Building Department QLicensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept.2003) i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. I J . , \ An employer is defined as an individual,partnership,association,corporation or other legal entity,`or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or,the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers'-compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned.to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please tali the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,. please do not hesitate to give us a call. fx The Department's address,telephone and fax number: _ 1 The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext. 406 Fraser Construction Roofing .& Siding Specialists Payable immediately upon completion NO MONEY DOWN - NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD - VISA- AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1 '/z%for every 30 days the payment is late. Possible Extra-'After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per panel including Materials& Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing; or other carpentry needing replacement will be done and charged for as an extra at the rate of$45.00 per hour, plus materials, plus 20%overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 10 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years:. CERTAINTEED Warranties the shingles and labor 100%for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public ; Liability Insurance on the above work. a - DATE.OF ACCEPTANCE: • v . SUBMITTED BY: lop Homeowner a onstruction fLC . U/L�iryi�YbO�Z[!/QILGLIL O���i��lEdG47�C/LICQ�(6 Board of Building Regulations and Standards License or registration g valid for individul use only HOME IMfJ�OVEMENT CONTRACTOR befoi i the expiration date. If found return to: Re istra�5rr \� �� 12536 Boaiii of Building Regulations and Standards 22007 One.Ashburton Place Rm 1301 JL z z Boston,Ma.02108 FRASER CONS DEAN FRASER 71 TARRAGON CIR COTUIT,MA 02635 Administrator Not valid without signature a '