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0015 LINDA LANE
i l i. .F ._- - _- � -r�-' +� � I s f - � p` ` � W \n �..J ,. .__ T_ .._._. _____-.�. r � � �- P� � �� � � � � � � � � � �,� �,�\� i� 13 � MAR-14-2012 15:48 From:MAP INSULATION To:15083856342 Pa9e:V 1 M.A-P. INSTALLED BUIL131NC PRODUCTS P.O. BOX 1309 SACAMORE BEACH, MA. 02562 (508) 888-3599 (508) 888-9609 Fax :Date job completed: Address of foam /"rT t wn application: t Inches sprayed in: (_,oc , Ceiling Walls. _ ^_ Slopes OverhaRg l3smt Ceil Stwl Blockers &Runners Cath Ceil Cath Walls Knee Walls A/H Walls Crawl Ceil Installers Signature: w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Pp"Parcel Application xA9/(91/)i.01Health Division Date Issued �"— Conservation'Division Application F'` Planning Dept. _ Permit Fee . Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation /Hyannis Project Street Address /o�� L/,e� 19 L f9 s1 P Village IlLy' 9 i7 n r Jr Owner ✓r S-P NPo 0 Address Zvv !-: m Telephone JP_Y7,K Permit Reque r,�f`i r✓�v H /�f i/C`e P� d 1 n�&d6.1 ZJv� %Prig owl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuationA?,Q 00 Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure s - Historic House: ❑Yes VNo On Old King's Highway: ❑Yes WNo Basement Type: XFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft:) tO 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: 14 Gas ❑ Oil ❑ Electric ❑ Other -° Central Air: ❑Yes g No Fireplaces: Existing New Existing wood/coal stove3 ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:bd existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes X No If yes, site plan review# Current Use Ke& WsL// Proposed Use in APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name os-em h n a Telephone Number�SU9 ,3�.5 !S�" Address 3 b ex l0 tee License # 4 QS 6 Y Home Improvement Contractor# �O® Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S1GNAfiJ7R DATE --Z 3// 2 FOR OFFICIAL USE ONLY _.,IAPPLICATION# x - ,,-.DATE ISSUED -,_ ,MAP/PARCEL NO. ` ? fir^` ADDRESS VILLAGE OWNER Y lY DATE OF INSPECTION: Ci-FOUNDATION-: - FRAME INSULATION, FIREPLACE a • ' I _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL { GAS:- ROUGH FINAL '. r _ F]NAL BUILDING ?� . _r T . DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth oMassachusetts ;h a ` f Massac usett� Department of Industrial Accide r Office ofInves6gaaans 600 Washington Street Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician.S/Plttmbers A ficant Information Please Print Le 'bl Name (Business/Organza on/tndividual): Address: City/Mate/Zip: d/c Phane#: F you an employer?Check the appropriate bogs I am a employer with 4. ❑ I am a general contractor and I Type of project(required): . employees(fan and/or part-time)* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- Listed on the attached sheet 7. PLmodeling, ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity, employees and have workers' ' [No workers'comp.insurance comp.msiraace,$ 9• ❑Bu ldmg addition . required.] 5. [].We area corporation and its I0.0 Electrical repairs or additions 3.01 am a homeowner doing all work officers have exercised their.-' I I. Plumbin Q g repairs or additions myself [No workers' cornp, right of exemption per MGL 12. Roof insurance mquired.j t c. 152, §1(4), and we have no . Q repairs . .employees. [No workers' 13.❑ Other , comp.insurance required.] 5 *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 the.hire outside contractors must submit a new affidavit indicating such tCoatractors that check this box must att.cbed an additional sheet showing the name of the sub-contractors and state whether w not those entities have employees If the sub-contractors have ]o ees, �P Y the} mastprovidetheir workers'c oli mrmber. omp,p. cy , I am an employer that is providutg workers'compensation insurance or information. f m1'employees Below is the pofncy and job site ; Insurance Company Name: Policy#or Self ins.Lic.# Expiration Date: Job Site Address: City/State/Zip: . A tEach a CO PY 0 fthe o py 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 imprisomment,as weIl.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 [[ISS do hereby certify . o Perjury that the-.information provided above is free and correcL- a Phone.# Dfficial use only. Do not write in this`aren, to be completed mP by city or town official City;or TOVM- Perm%tlLicense# Issuing Authority(circle one): 1.Board of Health;Z.Building Department 3'City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other t � , Contatrf Person Phone#: oFE Ta,, Town of Barnstable ti Regulatory'Services 9IMANSMI4g" Thomas F.Geiler,Director 'pTf0.19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwwA wn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as.Owner of the subject property hereby authorize S to act on my behalf, in all matters relative to work authorized bythis building permit application for. C1� L (Address of Job) Signature f Owner ate 0` -r, rea Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERPERMISSION S �oFtKE t�y� - Town of Barnstable Regulatory Services Thomas F.Geiler,Director Mass. 1639• ,�� Building Division lFb MA't a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstabIe.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include_owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for.compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. a Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet cr•Tart w�quired to coFnpV wrth`the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomung work for which'a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt { Massachusetts- Department of Public Safct� Board of Building Regulations ;uul Standards Construction Supervisor License License: CS 11059 Restricted to: 00 JOSEPH R':PALING 9 DUNES VIEW RD DENNIS, MA02638 c Expiration: 3/12/2012 1 (:uganissiuner Tr#: 21.664 ^License or registration valid for individul use only 'I Office �0 BYPA�"P e i before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Registration 160021 Type:, Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 ` Expiration: `6l17/2012 DBA- r, Boston,MA 02116 1 PALINO-CIt I 6 JO iEPH F71rLllO�' 9 DUNES VIEW R� -- Lc fJNIS,.MA 02638 <i. '• Undersecretary ot"valid without signature. • 5 #. gwO ' lo pxygot r 3 � AST �" 1-9 .. ... its t �� f r .1� � .' 1�����4 I ) �•'� �� 1 ��� � / f a s »:k 'X. �a' id _ i "4^t^';. �sT'-.4,wrw. .•w:aw„..,i tr.. «f,x;�=: c: — n.t 74M. , J f MIM , i.;... , _ l • t \ 1 j„{ ,lpf .1 WIT i 4 MO LIAM& 1• -ti : , t , ! L.- RUMIWO - =Wlnm Ogg `1 , Azz , .:..:. Sh WIN y 4 : y 1 ,: WE LTAXIS _. . _ At it r _ 1 4 h ' Y a...-7 `,;\���` All .....: ...... ....r. w 4 S • ... ! -' i ., • .v. 4 FIT S QI ,. � y +01 i _ , "I Fir- 1 , ._.._ - 01jj y : 1 - r- VOL ,. . . , RA AAA- y « i' `�,._ -- __ /� ,�� ( �' �' _! f !� /�J' i '/ ;� �'// �� - _ . �� �\ �'� �� �. , t , , -�, .�- 1 dio be tee it Mt AMUR 1. Pei b0 C plo -04 �.. E Li .. uG` .Ay ♦/ p ii �z C _ Tv1 + ut .? s ar . T 3 41 Q i .: msax..cx.iir+ontum�,,ucm'.+; ++rusrkec,^�m.«„'ic,a:.»,w•+.»r ,...�:s. v�,�Msw r,�n a,wr:.;;a....,,., .,w�p. < .w .. »r, :,o w pp .�r..,..a. ,•n. ...�.a.+m i,.w.+.,..<...rr.+avaum+sa.usca+.,�-gem,-.. .«..,..,,.m. ,-,.N, ...w,„,«...,-....+ 100, 04 �6� LeaW. 0R s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (— Historic - OKH _ Preservation/ Hyannis Project Street Address elOV 4,017 P Village/Y'-1.`9/'I'd/ Owner el ovir �` -AddressT aysYa Telephone SD? &7led, Permit Request �> &Liz 4 v /Z �/ / 11Oo ,0; (nCiS kttr, Roogrlc°x/,wed /0 anD Aolori-,;/ "M//, lnwggr it &,,u> 4 4d Pf&s /CZ'k dire /2 of nnl e [d,r hmn } C oll vt r ny-e`1 &mc 4liI eAtg Square feet: 1 st floor: existing/ sproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ! S ooa °G Construction Type 4,100 W ow,"P, Lot Size /4 36 O Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Dd Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes kNo On Old King's Highway: ❑Yes XNo Basemerk Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other BasemeAFinished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: -3 existing _new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: W Gas ❑ Oil ❑ Electric ❑ Other h Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing d`hew•'_size_ Attached garage: $existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number,5O? ,ma`s Address. ///&-J R/- a#_o/:FA*License # Home Improvement Contractor# 0 oaf Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGN U DATE IF FP J 1! r FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED MAP/PARCEL NO. ' • v _c ADDRESS VILLAGE • OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING � DATE CLOSED OUT ASSOCIATION PLAN NO. C The Commonwealth ofMassachusei s Department of fndUstrial Accdderts Office oflnvestigatians 600 Washington Street Boston,MA 6211.1 www dia A m�Workers' Compensation Insurance A Mdavi g�e rs/Co licantInformation n tractors/Electrid2m/Plixmbers r Please Print Legibly Name (Business/Organization/IndMdual : OSP14 Address: .S !C� City/Stat 1A f Are you an employer? Check the appropriate hone#: �Soe�S�/S PP prints box: I.❑ I am a employer with A 0 I am a general contractor and I T)Pe of project(required): employees(fan and/or part-time).* have hired the sub-contractors 6. 0 New construction I am a sole proprietor or partner- listed on the attached sheet ship and have no employees . These sub-contractors have �' ❑Remodeling working for me in any capacity, eMPloyees and have workers' S �]Demolition [No workers'camp, insurance comp,insurance.# 9. ❑Binding addition 3.❑ I am as homeowner doing all work 5 We are a corporation and its 10.0 Electdcal repairs officers have exercised their or additions myself [No workers' comp. right of exemption per MCL 11'0 Phnnbing repairs or additions nzsrmince required]t c, 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.❑Other *Ally 11PPli-W that COMP•im=nce required] mit this afdavit indicating out the section below showing their workers'compensation t a meowners who subpolicy iaformatim #Contractors that check this box must aitached an addi t additional s an work and then hire outside contractors must submit a new affidavit indicating employees. If the sub-contractors have employees sheet showing the name of the sub-coatracinra and state whether ar not those entie such they must provide their workers'cam.Policy number. I am an employer that i'Provjdjng workers'compensation iswance or information, f my e:•rrployees. Below is the poficy and job site Insta-ance Company Name: Policy#or Self-ins,Lie.P Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing y//e Z II Pai7ir'e to secure coverage as required under Section 25A ofMCL c. 152 can lead to the osition of andpn-sbon date). �e up to$1,500.00 and/or one year imprisonment, as well as civil mmP coal penalties of a Of up to $250.00 a day against the violator. Be penalties in the f6m of a STOP WORK ORDER and a fine Investigations of the DIA for insurance advised that a copy of this statement may be forwarded to the Office of coverage verification. I do hereby Certify un d en P allies ofperjury that the information provided Si ¢bore is true and correct D Phone# ate: Offcial use only. Do not write in this area to be completed by city or town ofjZcia( City or Town: Issuiug AuthorityPermitUcense# (circle one): , 1.Board,of Health 2.Building Department 3. City/TOwn Clerk 4.Electrical Ins P pector 5.Plumbl g Ins ect w 6. Other Contact Person: Phone#: Town of Barnstable Regulatory Services MASS Thomas F. Geiier,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Property O P �Ywner Must Complete and Sign This Section If Using A Builder as Owner of the sub'ect prop J P Pay hereby authorize - e to act on my behalf in aIl matters relative to work authorized by this building permit l H;Jr (Address of Job #*Pool fences and alarms are the responsibility of the applicant. are not to be filled before fence is installed andpools are not to pools be utilized until all find inspections are performed and accepted. Signature of Owner �, S' e of A `�... . pplicant 7 Pr1nt.Name Print N e Date Q:F0RMS:0VngIWER MNSI0NPo0LS I �T Town of Barnstable Regulatory Services '• n°R*,�°Arm f Thomas F.Geller,Director �A time ' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"cerdfiies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Jy Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the y State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible, To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:horneexempt • - i ',I Offce 6f/�o6? ffilki°rg��$ftti�� License or registration valid for individul use only +, HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 160021 Type: Office of Consumer Affairs and Business Regulation j Expiration: `6%17/2012. DBA 10 Park Plaza-Suite 5170 ` Boston,MA 02116 PALINO CO l JO 3EPH pkkd7li 9 DUNE5.VIEW DENNIS,4. MA 02638 = Undersecretary i of valid without signature. I Massachusetts- Department of Public SafetN Board Of Building; Regulations and Stan(Lu(is Construction Supervisor License License: CS 11059 Restricted to: 00 . JOSEPH R., PALINO 9 DUNES VIEW RD , DENNIS, MA,02638 Expiration: 3/12/2012 ('u�nmissiuncr Tr#: 21664 -J J Boise Cascade Double 1-3/4" x 1177/8" VERSA-LAM® 2.0 3100 SP Roof Beam\RB01 BC CALC®3.0 Design Report-US 1 span No cantilevers 0/12 slope Tuesday, December 20,2011 Build 517 File Name: J Palino_15 Linda Job Name: Ventnglia Description: RB01 Address: 15 Linda Lane Specifier: Joe Madera City, State,Zip:Hyannis, Ma Designer Customer. Jos. R. Palino Co. Company: Shepley Wood Products, Inc. Code reports:. ESR-1040 Misc: 1° 12 . '" gag-, -'u . �, -" .• ,—may, 7`2 "r a ti p.r 's: '`-- IRS �> `: svg, `- �' '.r _ 17-00-OU BO,3-1/2" B1,3-1/2" DL 992 Ibs DL 992 lbs SL 1,785 Ibs SL 1,785 Ibs Total Horizontal,Product Length=17-00-00 Live Dead Snow Wind Roof Live Trib. Load Summary Tag,Description Load Type. Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 17-00-00 15 30 07-00-00 Controls Summaryvalue. %Allowable Duration case Span Disclosure Pos. Moment 11,174 ft-Ibs 45.7% 115% 3 1 -Internal Completeness and accuracy of input must, End Shear 2,358 Ibs 26.0% 115% 3 1 -Left be verified by anyone who would rely on Total Load Defl. U352(0.563") 51.1% 3 1 output as evidence of suitability for Live Load Defl. U548 0:362" particular application.Output here based ( ) 4$.8% 3 1 on building code-accepted design Max Defl:. 0.563" 56.3% 3 1 properties and analysis methods. Span!Depth 16.7: . n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supoort"4 :Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post . 3-1/2"x 3-1/2" 2,77 (8 ask questions,please call 7 Ibs n/a 30.2% Unspecified p (800)232-0788 before installation. 'B1 Post 3-1/2"x 3-1/2 2,777 Ibs n/a 30.2% Unspecified BC CALC®,BC FRAMER®,AJS- Caut10I1S ALUOISTO,BC RIM BOARD—,BCI®, BOISE GLULAMTM',SIMPLE FRAMING For roof members with slope(1/4)/12 or less final design must ensure that ponding instability SYSTEM®,VERSA-LAM®,VERSA-RIM will not occur. PLUS®,VERSA-RIM®, For roof.members with slope(1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND®,VERSA-STUD@ are surcharge load. trademarks of Boise Cascade Wood 9 Products L.L.C. Notes Design meets Code minimum(L/180)Total load deflection criteria. Design meets Code minimum(U240) Live load deflection criteria. Design meets arbitrary(1")Maximum load deflection criteria. Fastener Manufacturer: TrussLok(tm) Pagel of 2 (g►)BalsaCasoade Double 1-3/4" x 11-7/8" VERSA-LAM@ 2.0 3100 SP Roof Beam\RB01 BCC CALCO 3:0 Design Report-US 1 span No cantilevers 10/12 slope Tuesday, December 20,2011 Build 517 File Name: J Palino_15 Linda Job Name: Ventriglia Description: RB01 Address: 15 Linda Lane Specifier Joe Madera City,-State,Zip: Hyannis, Ma Designer. Customer. Jos. R. Palino Co. Company: Shepley Wood Products, Inc. Code reports: ESR-1040 Misc: Connection.Diagram Disclosure �.I b d. Completeness and accuracy of input must L' be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based on building code-accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c=7-718" (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALCO,BC FRAMER®,AJS- ALLJOISTV,BC RIM BOARD TM',BCI®, All TrussLok screws.may be installed from one "side of multiple ply VERSA-LAM beams. BOISE GLULAM- SIMPLE FRAMING All TrussLok screws m from one be installed fro one side of multiply Versa-Lam beams. SYSTEM®,VERSA-LAW,VERSA-RIM Member has no side loads. PLUS®,VERSA-RIM®,VERSA-STRAND®,VERSA-STUD®are Connectors are: FMTSL338 trademarks of Boise Cascade Wood Products L.L.C. AWC Grcirle to Wood Construction in Hi;tr F ind,4reas:IIO ttcp/r kYind Zone • Massachusetts Checklist for Compliance (780 CK115301 2..1.1)' ch=IC _ 1.1`SCOPE Compbancc 0 'Wind Speed(3-sec.gust)............ ...................................................... Wind Exposure Cate o ......................................... ........................ ........ 110 mph Category .................: .................:........... Exposure Category .......................................Wind CB ••-•••••••••._..Engineering Required For Entire Project......................12 APPLICABILITY .......... Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story 5 2 Roof Pitch )_/ stories stories ......................... - •�J&512:12 Mean Roof Height .. .................... Fig 2) .._....._.._.._..............-----•-•--.... ................................................. (Fig 2)......_.............._............... Building Width,W "�"'_"'-"_' ft 5'33' .......�ft <80' v ----....-•----._................................._.:. ....(Fig 3)...................• Buildng Length, L .................................................................................(Fig 3)..........._..........................._.........�f <so, v Building Aspect Ratio(L/W) Nominal Height of Tallest ; .................(Fig 4).......... / s 3:1 t�Op .............. ....(Fig 4)..................................................3 <618. 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 ................................................................. ........................................................ .............................................. . ....... y 2-2 ANCHORAGE TO FD'UNDATiONt'' 5/8'Anchor Bolts,imbedded or 518'Proprietary Mechanical Anchor;as an alternative in concrete only Bolt Spacing-general............... (Table 4 Bolt Spacing from endroint of plate ............. <(i in. ................:............(Fig 5)..........._......I........._...... '-12'. Bolt Embedment-concrete................... (Fig 5 - J904w ..................... ( g )..-..:................._.............:---.----•• in. 7 v Bolt Embedment-masonry...............•.-_... (Fig 5 '- ,vg6'yY ( g ).....:...... ............................... in._: 15- Ptate Washer..: .................._.....--- ........ F'i 5 ..............................................• ( g ) >3'x3'x�/' . 3.1 FLOORS Floor framing member spans checked .................... ...(per 7BQ CMR Chapter 55) Maximum Floor Opening Dimension "' """" - .............."-....._.............(Fig 6)................._. <12' Full Height Wall Studs at Floor O enin s less than _.... """"""""""""""P. 9 an 2'from Exterior Wall(Fig 6)....................................... MbximtimRoorJoistSetbacks Supporting Loadbearing Walls or Shearwall.................(Fig 7)..............: Maximum Cantilevered Floor Joists ..................................... ft 5 d Supporting Loadbearing Walts'or Shearwall................(Fig 8 FloorBracing at Endwalls...................... )..................................................... ft s d .............................(Fig 9).................................................. v Floor Sheathing Type ......._._:..-........-_._... (per 780 CMR-Chapter 55 .................... )........._...........•. .. Floor Sheathing Thickness -•• --••--• � ----••.....................................:....:(per 780 CMR Chapter 55 Floor Sheathing Easterling ) m. _...:........ .....(Table 2).. d nails at 4, in edge/ -in field 4.1 WALLS Wall Height Loadbearing walls..........:........._... ..(Fig 10 and Table 5 ....... ) .ft <10' Non-Loadbearing wafts """'�-'-•=-••--•-•--•••• Wall Stud Spacing _..:."-••:......... .... . ....(Fig 10 and Table 5).... ......_ft s 20' Wall Story Offsets ........(Fig 10 and Table 5) in.s 24'o.c. ............................. :..(Figs 7&8) ..._.............. 4-2 EXTERIOR•WALLS' Wood Studs Laadbearing walls..... (Table Non-Loadbearing waits ).............................2x� ....................(Table 5 — - ..............................2x —ft_in. Gable End Wall Bracing' —' Full Hei `ht Endwall Studs 9• ..................:.. .:................(Fig 10)...................... WSP•Atiic Floor Length........:..... ' ....... ....._....._...(Fig 11 Gypsum Ceiling Length (if WSP not used ........................................ and 2 x 4 Continuous Lateral Brace @).6 ft. o.c. . (Fig'9 1))......_... --ft>-0.9W _ or 1 x 3 ceilingfurring strips 9@ 1 s'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 15d common nails).. rrnhrc R� """""'"""""•-""""' ft 02 6 �� AFYC Guirle to Wood Corrstructiorr in High WMd Areas: 110 rrrph f h7d Zorie Massacliusetts Checklist for Compliance (790 CrH1;R5301_Z.I.1.)r Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Tables 7)..................................................... .. Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... A Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).......:.......................... G in.s 11' ri SIR Plate Spans ..............:.. (Table 9).................................. It in.511' Full Height Studs (no. of studs)....................................(Table 9).................._._--•-• .....• 3 Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9)..................................off Gin._< 12' v Sill Plate Spans..:..........................................................(Table 9)................. ft 6 in.5 12' Full Height Studs (no. of studs).....................................(Table 9).......................................................__... 3 v Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously, Minimum Building Dimension, W Nominal Height of Tallest OpeningZ ..................................... .. 5 BY t/ SheathingType..............................................(note 4)..................................................-... /a" X L__� Edge Nail Spacing.............. ..(Table 10 or note 4 if less) • '-/_• n. Feld Nail Spacing......................... .................(Table 10) in. �- Shear Connection(no. of 16d common nails)(Table 10)...........................................•............... `. Percent Fulk-Height Sheathing........:..............(Table 10).......... - --•• % 5%Additional Sheathing for Wall with Opening> 6'B'(Design Concepts) Maximum Building Dimension, L Nominal Height of Tallest Opening�......................................................................... 5 6'B' v Sheathing Type......................... ..................(note 4).........--••---___......:_................._--_-_...�a oX v Edge Nail Spacing.........................................('Table 11 or note 4 if less)........................_/in. Field Nail Spacing. •..(Table 11) / in. c� Shear Connectlon (no. of 16d common nails)(Table 11).._...._... -..- y-- •�....................................... 24 Percent Full-Height Sheathing.......................(Table 11)..............................:._...........:..._.... % 5%Additiona_i Sheathing for Wall with'Opening> 6'B"(Design Concepts).................:.. Wall Claddin Rated for Wind Speed? 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang ...................................................(Figure 19) ............. ft 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Wails Proprietary Connectors Uplift...................................... .....(Table 12).................. ........:........ -..U=30 3 plf Lateral .............................................(Table 12)................... . ...:..................L=41Eplf Shear............................:..................(Table 12)............................................S=S�PIf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Oudooker............................................(Figure 20) ............. ft<smaller of 2'or L/2 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift........................................._....(Table 14)................ _•••- U= lb. Lateral(no.of 16d common nails)...(Table 14).......................................L lb. Roof Sheathing Type....................................................(per 7B0 CMR Chapters 58 and 59) ............. v RoofSheathing Thickness.............................._._. .............................................k in._>7/16'WSP Roof Sheathing Fastening............................................(Table 2).............................:........................... Notes: •1. .'This checklist shall be met in its enfirety, excluding the specific exception noted in 2, to comply with the requirements of 7B0 CMR-5301.2.1.1 Item 1. if the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Ba and Figure 1 Bb 2. 'Exception:Opening heights of up to B ft shall be permitted when 5% is added to the percent full-height sheathing requirerrients shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated 92-grade. AWC Gilide to Wood Coastrixtion in High bind Areas: 110 nzpll 11'ixidZone Massachusetts Chec,ldist for Compliance (780 CIVIR5301?.l:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio, determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shbll be minimum thickness of 7116"and be installed as follows: 1. 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. Dn two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at'double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below: Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a) new house or horizontal addition—required if project is 1 mile or closer to shore(generally, south of Rte.28 or north of Rte. 6) b)vertical addition—not required unless there is'extensive renovation to the first floor c) replacement windows—needs energy conservation compliance only(chap 93) ' G.Wood Frame Construction Manual (WFCM)for 11 D MPH, Exposure.B may be obtained from the American Wood Council (AWC)website. •—WHENTNLS ED6ERESTS ON FRkUIW USEW WAILS AT6= ii �� li II_ �• t II i D 1 j 1 O i•1 r I•{r- ' e ' I r - n @ 1 I m l 1 FAAW&I@RB�y �1 EDGE LilTREWEDLCTE 11 ! ' i t 1 1 g 1 11i 1 I 1 .k 1 Li IJ r r p,t 1 t is 1 i r 3`MIN. i i Ile DD(11#L E '� I�I STAGGUED 3'MMN tti141t$PAGkJG PANEL 1 NAILPATTIMN PANEL ~ PRNL EDGE DOUBLE NAIL EDGE SPACING DML See Detail on Nazi Page Vertical and Horizontal-Nailing Detail for Panel Attachment Vedicai and Horizontal Nailing for Panel Attachment a eI. p kov 444 rig) x Y Cti + . kne Le W&C Ott T. WON TA L NO or 5 an 44 �$"Ee��iu �C@GAf6Ao ti 4 r 3 Off �aOva yv tg fl 1j4 TAW r MUMS yw. vial A${� A/ Pinda _Pans Slown LIO wade .l ot- 67 .I- 10360 31N ( ; ¢4'Z 13iZ'6 f�N � I o , .tot. 08 N N �Owi't 0 2d w eT. - --. 4 <I 16 /o-o' 49. a �IV p '`` to��erec✓ Ali �E12'� Ac/t/1/rm•1 � Sd i 'n ' VENT Iz1 _.-- I. So.z vep G NO. beclicooI'lfd. .. �. .cot 70. no.. Xo-t 69 fatu c<.ted :Cow.:._ 3 O.:mod 15bJ j:at sJ.s .Pecclvu2cl.. &tea ow 3 ..gpd , ., .,.: .�.., •:.....s- b• �i/ti��1�✓��G •wou .. .��o�� i vn ope, T�ONI ........ fy,L Cl�Y a..'L. �,� oe'GM p•.d.,.L _. - per• � _1 !.-1 LN. ` 3' 38,A T. 1 Slr+ uaei 6 . adpa.t ty f ... ya't Ct& Seine tot 67 .ai d.l-town. on plan 16S/4l -tPUatio r,..n. On an ad4ti, ed d.Crrtl.112. -8-9 5 rJtt Cain e tG.lnn��ir u �r9 /:la�o-t r-,oad . Pgca-u z , l,'n 02601 , �e/s.t �� t #,�-8 5 7�' hicde..9-21-9.5.: No coal er=u4a teaed !� Pe cc. tee. 2 n:" ��et SIP 1 4-9 4 �- CO coCE�P_ fkDF 4a. J � � q �Y ,;. . edCu m rted t'LUrti to / 0 coo 3 4( i '-Engineering Dept. (3rd floor) Map Parcel t�'.' Permit# 3-2,?,?4;9 MAL In House# �� Date Issued card of Health(3r oor)(8.15 -9:30/ 0-430 - Fee onservation Office 4th floor 8:30-930/1:00-2:00) - fit. (lst floor/School Admin. Bldg.) �(�� P ®. �►C fts�trrf�ejet n Approved by Planning Board19 'BARN$TA��339,TOWN OF-BARNSTABLE..Building Permit Application Address �� L lei y r- �- Village 14 S Owner Lmyu% -(V)MuC7 N Address (T" r—c_,J Telephone ` '7/ 2-0 Permit Reque-479EA �� SC�,iC �"�4/t �1 �i -lei Qf!X f, i` T® /®.' l� t b e, G3 a0a First Floor / yL/ square feet Second Floor _A7-r7 L square feet Construction Type /L A Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure •L 5 ;M,o Historic House ❑Yes [51No On Old King's Highway ❑Yes PJINo Basement Type: ®.Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) SA e=r Number of Baths: Full: Existing New Half: Existing _� New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: S<as ❑Oil ❑Electric ❑Other Central Air ❑Yes 21qo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ 'Appeal# Recorded❑ Commercial ❑Yes Oho If yes, site plan review# Current Use Proposed Use P Builder Information Name !� _ ! Telephone Number -3 3 7 -C70 Address License# 4:f:-:5 G O Z� 1 Home Improvement Contractor# t1®� �+ - Worker's Compensation# UE�1711770 lob NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ppppp- FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. t _ i. , - Af ADDRESS l VILLAGES OWNER , � ~' ' ' .r rry,, - - ;' `'•-�•'`r£� �. �J "' DATE OF INSPECTION: .FOUNDATION •�'{ '� --... - - 4 �- t � ,.- >r �'f , FRAME INSULATION , FIREPLACE i f v ELECTRICAL: ROUGH - FINAL' PLUMBING: ROUGH FINAL _ 1 j GAS: ROUGH FINAL' ` % FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. ', ''W TOWN OF BARNSTABLE ' r CERTIFICATE OF OCCUPANCY PARCEL Il 248 224 GEOBASE ID 15610 ADDRESS 15 LINDA LANE PHONE (508)778-5004 Hyannis ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PERMIT 13444 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPfi" BCOO TITLE CERTIFICATE OF OCCUPANCY. CONTRACTORS Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: SINE ' BOND $.00 , CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY/ r * 'BARNSTABLE. +► MASS. OWNER KIERSTEAD, ELEANOR V. 1639- A� ADDRESS C/O JOHN LE BOEUF(BUILDER) EDINA� 95 -PRINCESS PINE ROAD BUILDInNG DIVISION HYANNIS, MA BY - DATE ISSUED 02/23/1996 EXPIRATION DATE A �: -.=1:_1_.:..�_:.`=._._��i:•�_".._s_.ti:..._.,l'._�..=:..1::.�L�3.::1�t:., .--+-.:ham _ .�_��. TOWN OF BARNSTABLE � - �� ` BUILDING PERMIT . PARCEL ID 246 224 GEOBASE ID ` `1561(7 ADDRESS 15 LINDA. LANE. PHONE (508)'778-•501 Hya:units ZIP - LOT BLOCK Lo- SIZE DBA DEVELOPMENT DISTRICT PERMI 11566 DESCRIPTION a'INGLr FAMILY DWELLING PERMIT TYPE BUILD TITLE 4EW 'RESIDENTIAL EV4g ilhient of Health, SafetN C0NTR,".=:'.1!0RS: 12 BOLUF JCHN A_ and Environmental ServicesY ARCHITECTS: TOTAL FEES: $60 00 V'� BOND 8.00 CONSTRUC`i'IG ! $135,000-00. 101 SINGLE rAM HOME DETACHED ?. PRIVATE Q :;J �•E. s' MASS. OWNER KI ERS`:EAD, ELI ANOR V_ p A ADDRi S ' C/O JOHN LE wOEU.T(BC;I LDER) � 95 PRINCESS PINE ROAD HYAAZN k.a, MA BUILDING D ISIO DATE I uUff''D 11/09/.1995 EXPIRATION DATE By THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, HER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE. ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. wei.-ININIE.-Tou M • = � • � BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �•-Ff Z/ 2 2 G 3 �,,i/ 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH /Vt961 OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 508-790-6227 TO / �, TI Eo JO = geiuri�ed 1D C�le�to - M y see you OF ease;: ,[�W,aalsia ea�'�"' see you PHONE [}Williall .ysnr'll' knave i t Wo MESSAGE i. I v OPERATOR: 05h 23-024-400 SETS 23-027-200 SETS •. The Town of Barnstable X"s �g Department of 11e:1lth Safety and Environmental Services Building Division 367 Main SUM Hyannis MA 02601 Ralph Crosson Office: 509-790-6227 Building Ccrosaissic.:. Fax: 308-790�0 For otIIce use only Permit no._ Date AFFIDAVIT SOME IMPROVEMENT•CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. I42A requires that the "reeonstracdon, alterations, renovation, repair, modernization- conversion. improvement, removal. demolition, or contraction of an addition to any pre-ezisting owner occupied building containing at least one but not more than four dwelling units or to structures which are adiacent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements. 111-'t'ype of Work: ^•' ` ` �-�ntTI010 Est.cost Lo;5 /Address of Work: /Owner's Name S T Once of Permit Appil=d0n: 7 A - I hereby certify that: Registration is not required for the following reason(s): Work ezdaded by law ' Job under SI.000. uilding not owner-occupied Owner poiling own,permit Notice is hereby given that: OWN PERMIT OR DEALING WTITi QNREGISTERED OWNERS PULLING 'THM _ _ CON I'R -ro T S FOR�TIO�R RAM OR GTJARANIY FUNDFUNDwUNDER MGL I42A � ACCESS TO TSE•�I SIG;;VED UNDER PE;YALTZS OF PERJURY t beery Vpiy fora permit as the agent of the owner- . 0 j Name tion No. Date ' Contractor OR Owners Nume Date �r The Commonwealth of Massachusetts Department of Industrial Accidents °== • � Offico of/nyestigations - 600 Washington Street 0 Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city phone# [] am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees worlung on this job. cons anv name: address: city phone#- insurance en. pniicv# ///////%lLlk'i///LL!!✓.lk'leC%.G/./.(/l✓i.'1�..'(ti'Sl/.�/"� %////.��////////////////////////.(///////%///////.e'l/'////////G/////%//////%////////////�'�////////////%////////////%////////%/////////////////////////%////////////////////%//////.G%�/////////�/////G ❑ 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: .... .. tom anv name, address: dt,. phone#- insurance cn cam anv name: address- dtv phone#• : .... insurance coROlfcv Failure to secure coverage as required under Section 25A of 11GL 152 can lead to the Imposition of criminal penalties of a Me up to 51,500.00 and/or one years,imprisonment as wea as civil penalties in the form of a STOP WORK ORDER and a Me of S100.00 a day against me. I understand that a to"of this statement may be forwarded to the 011lce of Investigations of the DIA for coverage verification. I do hereby certify Ike pains and penalti of per' t at the information provided above is true and correct Signature Date l Print name /�lJ/P/el -AZ—&axacl Phone# oM ial use only do not write in this area to be completed by city or town of c.W city or town: peemitlucense# Mudding Department CLicensmg Board rnenl checkif imm ❑Hcaltaiediate response is required ❑ tth Depee Ogee attmeut contact person: phone#• ❑Other (carom 9/95 P1A) Information and Instructions a. Massachusetts General Laws chapter 152 section 25 requires all employers to provide Nvorkers* compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contra: 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 rec.-wer . trustee of an individual , partnership, association or other legal entity, emploving 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 6 -...i...P...,�....�„o�.,.,�to do maintenance , construction or repair work on such dwelling house or on the grounds o: QU.,WL"CA .....,...._,...�., t,...... -- building appurtenant thereto shall not because of such employment be deemed to be as employer. 1 MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha. not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and 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 call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permtt/lrea'cse number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have bees made. The Office of Investigations would Iike to thank you in advance for you cooperation and should you have any questions. please-io not hesitate to give us a call. OVENE The Department's address,telephone and fax number The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Iwestluallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL ADDITIONS OR ALTERATIONS H located North of Route 6-any work visible from outside-needs proval from OKH In Hyannis-If work visible from ou 'ide-Check to see if it's included in the Hyannis Historic Waterfront District-if so it needs app 'vai from them APPLICATION PACKAGE MUST INCLUDE: Map/parcel number / Sign-offs from Health. / Conservation(if exterior work) Tax Collector Street address Owner's name&address Permit request- full description of proposed project Square footage-proposed project Estimated project cost Complete Dwelling informatibn for Assessor's Office / e g Builder's information Signature / Plot plan Z sets of reduced(8.5"x 11:or 8.5"x 14")plans wi cross section&framing schedule Home Improvement Contractor's Affidavit / / Worker's Comp form must include: Insurance company's name&Worker's Comp policy number o i Copy of Construction S >so ' icense&Home improvement Specialist's License OR Homeowner's ption . Fee NOTES: CEMVINEYS Need Home improvement License No plot plan required PIERS&DOCIGS - Need Construction Super license AND Home Improvement License Owner cannot pull own permit !✓ 0 o .('irula Xane t9,1 gown. 401 wide 49.1 gi.so I ( 44 ,Po•t 67 'i u I b 4q.: r 10360 3 N , 1 z E Q cySTl N CaaCofio AveueCoz 68 0 down 40 wide 49 22' fisr :be:-;,zmn. Oo C _.-..- t Jp» -1 41.1 Xoz 70 Ab. bedzoom& 3 Xo-t 69 J,poaa-Z no CjtirxLted if ow 330 ypd , er,,. -tank 1500 'y 1. s►.s` ,trackim. at.ea :lot. 15'x-2;t 330=a? x o,74 t 24 _gpd Z• :• -:�A.�te� F Irv: qpd '%o-tal. 344:gpd. 4'P✓c e.g .'F'i�✓G i `d lO ��+- —� ,p s..v.c���u ruc.• ..' •Icaiu. D 4. 1ve •'4 .r C.r ci a.ai CT.ON �'r .__.. .�.. ._'F �• V��✓O.L G+[JOuL �� _rltil► � �!`.t've' � t, 44..0 .0�•/i=v ,. r�-..0+- ti�Y��i I MLN. - 2 1?o ws0 F 3 --I- 3' + ISM . I (,-ors` T N.'A Fa1w.Lt I I&e 6 h.i qh capaci,q 'Lz���t4 o in i l yams- )e,.,Af •lot 67 a4 51wwn on plan. 165/41 ` eva ti ory rrJ'(' on an a&SlllYlP.d dQ&,js. I )at,: 10-,?6-45 cSca e. 111-30 ' i lieu, l 1-8-95 -I)-t Cape fng lno�rr i,z� �r9 /la,�bot ('oad Pga4l-niAj An 02601 `the )ouralat n dlwwn on •tAi i ptan i4. .loeated o.i .lzown and caret& the 4otback. rrr�li�tencent� o? the gown o i 13a4n&t ab.Le, 1 )e,,A pit #P-8572 Date 1 I-27-95 !~lade q-21-9 S rAt. Cd ,:fatty . 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F �00, j it ji OTC PO P05� PC) I , :3 1 ��:.:. f.E W:.., -, •_ - 'i �,f: - e .r 1�In - „ -6,p..• :.e.�u�'i+, �F - :. v ..�, �a-i ., '... <.-i..f..,. �.�i. e.{. j-hl'+. i --.. �.f1": ..�. ir ,..: ..F' F b t ii - N .1 #4'•sa.f- .. ♦. t. +d, - .- � ..,.. .. E:.• ..} .....: .- •. N .: � ���� rR ��..t 50, :��F'- r�'y ,�y,•�. r�v ,c, ' ' ,C',ind a .Cane <4•t E� gown 110 wide -� - I 71-0 r3IZ� fin`E�So.fil(°p h8 l i o 'r 9OWYL y t 24=_ U Clu�l - - 44' . p 00 t. S f q v cNT � i l toi.tt So.� 4 .Z i I 4 3 . �� � 1 11 i i ' �• i �: AA $ - , t , I (3-7 Z ` 1 : r , , ! { . : i I 1 i i 1 ' I � i _ ._ —I— •— '• � ` iAZ fz- , I 1 - I I - ! , ! , 1 - _- r� " -'. � •Y as 9,,� !. , 'T—"T'--i-- i { � - --. v , , .. { i ,a' i _ .�p OF BARNSTABLE L ATION )',`�`t r SEWAGE # l - �1U ASSESSOR'S MAP & LOT 2 q g4INSTALLER'S NAME&PHONE NO. J4'z1:��% > r SEPTIC TANK CAPACITY �/`. . LEACHING FACILITY: (type) �''—5t,1^ `F' i ( , ize) «„ NO.OF BEDROOMS J �X L 2 � L"/e� 'Z ©NBUILDER OR OWNER- �or K�r---,44 , PERMITDATE: i I i cA `�`> COMPLIANCE DATE: .�'" '2` Separation'.Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Q Private Water Supply Well and Leaching Facility (If any wells exist on site orwithin 200 feet of leaching facility) ~- - Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) '°Furnished by M r•t � J z 1 frWrsXY ti ut} tna.f AX a Vr i fY t 4 r H jrzi�l A. �U k1,4 l ca 5—AA7`fyre- 5.-;' •.�C i-f 4-0V &-p. 'IT 6.4RQ�o� ,� CH,'v6 - y 3 i --JZ t e i WrP,,PP47 Lt � ' 1 _. - ------- ft , '{.. („ #'_, Y.~ r 4 ' �$a�F+.." Txg7 wr #} `•z� 3f}".,!`F kkp�{, .'�a6;4 �i yf .his �-:i; &.Y .r[.,r `'.` .r. F: _ -s ti ;t -'--- - -- ---- - -_ XR, i'/A7!P- 'El 2RE� $ 4X� It ti - - . -- Pl�o i I r �H ..�y'* .'� Y7".Y'`t.:'. '' 7 ,:',., ra> '".7 454r.",�' s ., '.?{zRZ-.. ,'"t, 1�.� Y'"bkt-'N�°'E.. t,AqqV) 70 EX5o SfI-L- I r it i t fi i r-All i to /� DoUgmA lXbo S r�T { Ll 1 — lli EAS(5 1U�50A)0 >, 3 �.v _ u_ —4if_�i_� -— --�-- — N u3iof 5ovo m- so lUro4t / CjefiF,r. P� ( 4 �I ..ty i'�"'�p-i;S .. , ,. '�r_�s, -�•..t - ..: '�'K-.. rJ��',. �.(y,-�-'A. 'C�� f2.r P, yy • ,F R fYx { xes e. .. .�.M ..& Y'. _.. ._ {. vrt- � N +�)�- t.- -.. rf..� .r� �n.:yc _..,•z { '"t-Sik l t.��.n ,." � �L: ?..'W�. '-A��, �;�.�'-.: 'v:.e I ...�.- -� ...ry ,,...... 'K ^-�a�� w rz:r:•.F.������ !Y'.... 1�...Y L. �. .s.:��-� % M1� �R.: :it�r � R. a,✓ .x� �t:� vti k. r.,A :yc Y fsx .�; �.�,» j •.�./ - } - r' r .� .a - a �owrc'c.t0 -- _: szSb L`3 ` ,Cot 67 31 N f31T� Fsrl p 36p `� Et So•o _.. .._ 3 ! a I.; �. Pot 6$ down i -j l04 0. 4-9.4 49. . p 22 COO ' 3• a-� � -� � j !:n nnrinnnnrin. 1. i l S�j ' 1 : t I +g �__? r A Q_®_cLc 1 � t f 1 1 , r S1Ll - - ----�--- ---- -- -i- -- --- -U - - - - �t r:- I • L _ I t 1 _ { ILUVng�Cvi + - s t A.� $ y »' ?• i _+:' 'k .+,eb,°g:,. 3rd; - �c. 101 T i 6wN O.F BAARRNSTABLE r, LPCATION 61- 7 L i� � -i� , SEWAGE # /VI n ASSESSOR'S MAP & LOT ` c f Z Z 1-1 . Z. INSTALLER'S NAME&PHONE NO. SEPTIC TANK.CAPACITY LEACHING FACILITY: (type) S I^ C a i'N•', 1, NO.OF BEDROOMS 15 "X L "L 'F BUILDER OR OWNER L IC- l7r lr r -z- u ' PERMIT DATE: lL �9 5 COMPLIANCE DATE: ` Separation Distance Between the: �Maximurri Adjusted Groundwater Table and Bottom of Leaching Facility Feet % r�a Private Water Supply Well and Leaching Facility (If any wells exist ` on site ofwithin 200 feet of leaching facility) �— Feet x r Edge of Wetland and Leaching Facility(If any wetlands exist , within 300 feet of leaching facility) Feet' z Furnished txy t k L t lob a� S y to{rt r ,4 t i ti r 4. tf, a 1r f0�S1EE"110N RR � Ii 10 �2 l �f'�..Mw o' iT 1. E �'iflPN ,4U , 1�1-,1� 7• C� ,•,r.,y. :. f:r�_�_ ;VY�1tClin„!y P1�;� V L�� ?S;1 --:' _.A' ci'Ofii:<St O�£36'"'L L'-tl rt cf. T41 To Date Time WHILE YOU WERE OUT rvI of n / Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOU�Rq CALL / Message L -� Operator MAMPAD 23-021-200 SETS EFFICIENCY® 23-421-400 SETS CARBONLESS `oF1HE►o,�� The Town of Barnstable BARAIQS. LE. M g` Department of Health Safety and Environmental Services ASS "rFoy''0 Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection ( y�J Location � LA'rj � ��`� Permit Number i r Owner L eA Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: IY i L Please call: 508-790-6227 for reeins�pection. Inspected by � �h-ram Date ' .- i `OFINE ipyY� The Town of Barnstable BARNSTABLE.o` Department of Health Safety and Environmental Services MASS. 0 t6yq. �0 "rFo +a Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection ►J2 � - Location Permit Number Owner Builders One notice to remain on jobsite, one notice on file in Building Department. ` G'( Co The following items need correcting: OVA r A2 B v 0 Please call: 508-790-6227 for reeinspection. Inspected by R \c to Date 2, A.M. I FOR DATE TIME P.M. IM or OF- PHONE AREA COOE NUMBER EXTENSION PLEASE CALL I! MESSAGE �Jf CAME TO . WANTS T0; 1 S� Q_. L SEE YOU F SIGNED TOPS FORM 4006 C �— r � Assessor's Office(1st floor) Map ,Q Parcel n Permit# p Conservation Office(4th floor)(8:30-.9:30/1:00-2:00) x AAA__--A N'-Abate Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) - )�,,jFee `�D.�O Engineering Dept. (3rd floor) House# ,--Planning Dept.(1st floor/School Admin. Bldg.) �• f"`- 0 ��` ' �� r a_.f• . ��� N ABLE. ` Definitive pproved by Planning Board 19 c}�Fe �a l7 �I L S- �. P S U t ' n • TOWN OF BARNSTA LPO �� Building Per-mit,Applicat' n e � °a �`'WO Project reet• ddress' ��rI 4 -/1•,: ,►, G v�, �eul� � ° �°r,a r f� "tea 1,1 Village Owner 1 hc-;4/I of U /I lenrl ex -Address Telephone 190//� arc Permit Request ,moors/, //1�.n/l �%7 !- First Floor °� O Q . square feet Second Floor square feet Estimated Project Cost $ g S p aG Zoning District Flood Plain Water Protection Lot Size /��0 G Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use ' Proposed Use Construction Type cam., Commercial Residential c 11- Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway / Number of Baths �`�-- No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel A S, Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached 6 .Y ��. Barn None Sheds d' d 'a�97 Other _ Builder Information Name ,70,7 Telephone Number Address f s / irlC�Ss� n£ License# p / o/ 6 /z�„a/W d /!?A�S� Home Improvement Contractor# ,//J$ 7 �— Worker's Compensation# y £S l • NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RES-UULT/ING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 1' C �ate - DATE BUILDING P IT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. �J CJ DATE ISSUED MAP/PARCEL NO. •, t t ADDRESS VILLAGE f OWNER + , > t _ _ 1 DATE OF INSPECTION: _ FOUNDATION ' J FRAME INSULATION - FIREPLACE, Z - Y i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' GAS: ROUGH .FINAL _ FINAL BUILDING.,�'y ' k r • F DATE CLOSED OUT ASSOCIATION PLAN NO. + ; f I Lt w • - � wn 0 wide - .tot-.Cott 67 3,10360 ZQ gn I > I ¢R.Z. ri - .O a(,o 6Q O 00/. T'�o vN�sTb►1 �A R. Q HU eyuw- N Down L40 wide 9 rp tP 49 zz' 1 S60'c�S T" RLS 1O _ A'o. 6 ed tl onui .Cott 70 3: -pot 6q C'jt' rX a ted 1-tow 330 d tank l 500 51.S ,te :C✓cet� I 0,74 ! Iz° rz" c l L1&.7� -d I I -- Jo-tat 3Srl gPd I GQ'q'•✓,.-Leo . I OT14A.. I 3 8.4- T.N" 113t 1,fis 6 J u2 ncu 1 l`� c)ue ;' ,.C- O� .L, 2C 2YL / I�G19,it/.1.� i �.C�xr.ho2 U - Keti�c�:tP.c� - .5-4 q� )-ot: 67 ad. down on p•P_an 165/4l r �te)02 iory On an 'a44wned: ' a te: gpnt: ar o ...o T-!(,T ,th - _. r. - Jat 10-?d-9S �aa,�e l "-301 1JeU. I I 9 n �Id la, bo t Po'a _ !f 1qarwti�, 02601 ; jhe- )ouxckt on shown on -th L4 p.tan 4'A toea ted ay shown, and aae& the 4p-tback �cery��i/�ence+�-tomI. o�- the Down o j iga&c v tc) e. p Date l I-27-95 _ Made R-21 9 S :`.gist: cd f a/vt y al wCvtPh e4zou."ItCheC� l 1 eJtc. t ei. 2 nuli„p e�G 1 f - s 4T 4- 41.4 . CO�- -_r co at, --- OF z p a 4`k t4t43.4 tt.P:E ! J: 'ec ioiAtm ,ec iu x 1t + t `No. 324 o f�: p 1 UCT- 99 PM 7homa. - !8(a4 .S)IORN Rom) ,� r r;):9c�k;i y � 'kl ►':cur, lY I NAB"tlki4: F CO=iL()ctr)her• 10, 1995 Kal h Crosson Q Building Tnspce16' �- Town of Barnstable South Street Sou i HYRnniS, MA 021601 ' - Re: Vacant 'Lot 57 Linda Lane. Hyztttrei.s, MA NJap 248 parcel 2124 i)car Mr. Cr4)95art: 1'represent roger Shcrmont. and Trene Shermont, the nw,"M of the above describe prernises. Please be advised that tFtis property has not beell 'hel.d in common ownership with any adjacent property since a,t i,:ast Cr°o-ni the date of purchase by tlic Sherrnonts (1970). Accordingly, it is the opil�ion of this off ice tktat t)+e premises qualify as buildable udder the Town of Barnstable Zoningy-Laws. ;please'Co"tact r1re,if you have arty gpestions with regard to this matter. Very truly yoUl d, TrJOM A UCT 11 a 39 PM Thomas •1 �lon���s N. 1 7THA<"1WK C1JOR1: ROAT)• YA M01THI J)i'vr,MA O..Y)7S • (50$)775-:i38o • FAX: (iO6)362 7804 FIL E October 10, 199.5 CO Ralph Crosson Building Inspector 0� Town of Barnstable South Street Hyannis, MA 02601 ' Re: Vacant Lot 67 Linda Lane, Hyannis, MA Map 248 Parcel 224 Dear Mr. Crosson: I represent Roger Sherrnont and Irene Sher tnont, the owners of the above described premises, Please be advised that this property has not been held in common ownership with any adjacent property since atleast from the date of purchase by the Shermonts(1970). Accordir►gly, it is the opiruon of this office that the premises qualify as buildable under the Town of Barnstable Zoning 13y-Laws. Please contact me if you have any questions with regard to this matter. Very truly yours, 1' ma• tieorgc TNG/rl .Pikzd a .6arze gown 40'1 Wide _f,o't .67 3ia I I 49.i. 10 360 It6 s&I- Crvr,Lo tta i dA•t 68 O �ow ; n �_ . r 7P 49 0 W o,g f -- IzI .Cot 70- .. _: - - -ldo.: beditaon�. -3 t 69 J iipoC no £a t tmr ted j.Lo><e , 130 d si.s e�ch� e, - : 4/0 AJ ' : _ _4'1�✓G !y-Z� 1 1 V p✓c p.g ''Fa,P✓c I - ^ � 1 � � •...a... � :9 O 6 :�C.VG1v �. -V �p gVfiv 4G OUVa+ +' ., :- 6• GellvaC ,uo�ll�► \�l�C"co"s�: vo o,t - -I Z b%iAaFL3._ i � �S' l �o'iio7Fise= 5•r.�e_/ Ccwc off` .C'cwuc in ycnl4i.,,, (��1 ' _ L I Se.,AF tot, 67 G,-1 41WWPi on ptan 165/41 st&j W_ <c". ok an; il�d (ja.&I&: . _ 1 + o TeddA , I date /0-26-9S Scato- ;1" ?0 Ai : ev -8=9 s zl),,e. 1 1 Cap e t.1cuw Ed., l` l 02601 ` S7est,p its?-8.Si72 i _ E Made 9 21 No'No'o wa tpt_ ejv_C!.f"�'t atc �ehc. •Lear. 2 nun e� � t 4#4 49,4 J: 41A. 43,4 :o ed i urr 0 iT +' No.324a0 . The Commonwealth of Atassachusettc Department of Industrial Accidents �t � Olffceo//n�estfgatlons 600 1I aslthigron Street 4, Boston.Alas. 02111 Workers' Compensation Insurance Affidavit plteant infnrmatinn.- PI—ea i PRINT;1Cnflil name, location: City nhonc# I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 77a,:!YN ._M+e�'r'C',.�'^;e-.-r+N^+'M-nn.•^+.e..,. -. �0-1 atn an emplover providing workers' compensation for my employees working on this job. Al �r•y name. r /� address: city: zz nn,rh, phone#• ' insurance / /S li # 0 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#: insurance co. policy# _ ,__. . . . I.�.:.a�it�_.,. .r.:.'.-:,,T. ":._ _'.. --4C/lt:r.�r-Ti....:TL�a'a"a-r�!�•%• +Rt .f :•'R:!!�!.' 71-!"���.. �^:�?�S ctimpam•name: address• city phone#• insurance co. policy# _ ;Attach additional sheet if oecessa a►s.: w:s-aa�-fit;�-.+r r. x R r�.tiJ _�re.� � - - '- --- .z�^• ,,:;;;; Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of it STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a cop}'of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. l do herehr certifj «u •r a airs and pe► ies ojperjuq•drat the information provided above is true and correct. Signature Date ,��— 1S Print name Phone# official use only do not write in this area to be completed by city or town official + city or town: permit/license# nBuilding Department C3Licensing Board check if immediate response is required Selectmen's Office 011calth Department contact person: phone#; M01her NOTICE OF ASSIGNMENT LOYER' JOHN A LEBUEUF O/B/A BUREAU FILE NUMBER STATUS OF EMPLOYER RENOVATOR 398404R INDIVIDUAL 95 PRINCESS PINE ROAD ADDITIONAL INSTRUCTIONS HYANNIS MA 02601 POLICY ISSUED SUBJECT TO PENDING PREMIUM CHANGE ENDORSEMENT (WC200401). COVERAGE UNDER THIS ASSIGNMENT THE WAIVER OF OUR RIGHT TO RECOVER FROM APPLIES TO MA. OPERATIONS OTHERS ENDORSEMENT IS AVAILABLE ON POOL ONLY, FOR COVERAGE OUTSIDE POLICIES. CONTACT AGENT FOR DETAILS. OF MA.9 APPLY TO APPROPRIATE ENT R O G E R S 6 GRAY I V S A S C Y INC INSURANCE COMPANY: 640 IYANOUGH ROAD ODUCER: HYANNIS MA 02601 TRAVELERS INS CO MS BRONWYN SIKES P 0 BOX 3556 ORLANDO FL 32902 IDENTIFICATION NUMBER: 04-225-4905 �(800) 842-9886 CLASS ESTIMATED ESTIMATED CLASSIFICATION OF OPERATION CODE TOTAL ANNUAL RATE PREMIUM REMUNERATION CARPENTRY-OETACJEU PRIVATE RESIDENCES 5645 51000 15.46 $ . 773 CARPENTRY-DWELLINGS-3 STORIES OR LESS 5651 15.46 EMPLOYERS LIABILITY 100/100/500 9845 773 STD PREM SUBJECT TO MASS DIA ASSESSMENT 60 EXPEVSE CONSTANT 0900 1b0 MASS DEPT OF INDUSTRIAL ACCIDENTS ASSESSMENT 3.8% OF STANDARD PREMIUM 29 TOTAL PREMIUM $ 962 AUDIT BASIS ANNUAL REQUIRED DEPOSIT PREMIUM $ 962 COMMENTS CaVERA'SE EFFECTIVE 12.01 AM ON 10/26/95 WITH ABOVE INSURAYCE COMPANY. DATE OF NOTICE 10/2-1/95 PREPARED BY MARTHA STURG£ M • t V7LUNTARY DIRECT ASSIGNMENT • �' THE WORKERS'COMPENSATION INSURANCE PLAN OF MASSACHUSETTS .� N00-08-1995 14:55 ROGERSRGRRY9HYANNIS 1 508 790 4212 P.01 :>Yi•i:^ii^ :k. :nt. ,t :2'::f" ni, 0 �'>" x.}„K�i2.<,�:� stRR�S?r'Ss`:•c'::;:i:i:a<.u3»rsr ,x.,t^'Y,i..; :dI88UE DATE M r,,l. lM tDOMC : pR i :.'i, .x.Y fQ s: ,ar•, 3, :ss •x r, ? :E`?` :x: ,�'�'F'£I>:xil::o":'< tE'•Qkrst?°Y. : r ..ii:�•u'�:<'G ii3il�� s....< �s, ...:r.rr:r ^^•+•r,�,,.:. :<......:, x:... :: .:<a¢:,.'.3 . . . t:>t.>..n F,:>r:::!:. ,.::rx,xt:Ka: >,<•;:4 i, 11 8/199 5 PkOoucEa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORIAATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Rogers & Gray — Hyannis DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 640 Iyanough Road/Route 132 POLICIES BELOW. Hyannis, NIA 02601-1999 COMPANIES AFFORDING COVERAGE (508) 775-0011 FAX 775-0866 ..............................-...................................r,r:.,......................... r: .................... .:........... COMP qY A Aetna Casualty & Surety Co. L ..fl.......B ...........................s :,::rs. Co. INSURED Travelers...In:r..............................: ...................... .....................................:......................................:.:.................................................. John A. Leboeuf COMPANYLEM C dba The Renovator COMPANY MERrr:.::.r..................................... .r.r,.rr.,:..........................................•.. 95 Princess Pine Rd. COMPANY Hyannis, NA 02601 ..................................r.r:::,........................................._.........,............. COMPANY LETTER ><Y;:.>a-:oyi y,."•,: ::., .x.ro-,;r•>:'rY:rt,:".Y :a r;; �,.:..:.-.: .trro i> x< gyros. is 33 ", .V > r s.. 0 . 3•� :...:. .:::�>o,:$s,;;:,:.,.xs,:f� r'':: .�,��.:k,>,.v:::::;:,a:,!..I"�:%fzi�<>>filf:1 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,TYPE OF WBURANCE POLICY NUMBER � ; POLICY EFFECTIVE :POLICY EXPIRATION LMRS i.Tfl i DATE (MM£OofM DATE(MMtQO A ..........................................................................r:r::,r GENERAL LmuTY ....................................... 5 , s.... 60,........ : GENERAL AOORE4TATE ` .............0,,.000 X :COMMERCIAL GENERAL LIABILITY . .. ........................:...rr:r.::. 600 0 0G8MPOD24512915 PRODIICTS00MPpPAOOr :S , 00 :.. .....,.:5...........:.:..:.............. .. CLAIMS MADE 7� occufl. 12/03/94 12/03/9 5 .° ONAL a ADa INJURY 300,900 i OwNER'S 8 CONTRACTOR'S PROT. ! EACH OCCURRENCE E S 300,OOO ..............................::........... FIRE DAMAGE(Any one are) s 300,000 . . ..., ., :> MEO,EXPENSE pero�t;S 5,000 .................................................... „................... „ LIABILRY COMBINED 81NM2 .. ANY AUTO UMIT S :........<ALL OuVNEO AUTOS ..........:.:.r..:..:.:r.,,:r...:.. ..,,..,............:......... SCHEDULED AUTOS BODILY INJURY `S (Per Parson) 8 MIflEC AUTOS 0 R DIIY I"AY _ ,,........;NON-OWNED AUTOS i (Per scalaonq �........ ..........._................... GARAGE LIABILITY !.........: PROPERTY DAMAGE ;S .........................................................i............................,......................................:........................._.-..;.................................L.................................. ..._........E................ ..... ........ .......,. EXCESS LIABILITY EACH OCCURRENCE S :................. .................._.... .. ._........._ ..... UMBRELLA FORM AGGREGATE ;S OTHER THAN UMBRELLA FCRM . .... .....: .... .. . ....I................. .... ............................. ..............,.. ..... ........... .. ..................... .. .. ........LVdIT'S..... WORI(EAt S COMPENWON B'' AND TO 9E ISSUED 1®/26/95 10/26/96'I EACH ACCIDENT _......ii .............100.f..000........ EMPLOYERS L� OISF/SE-POLICY LIMIT �S 500 000 .... ............ ............. . ........ ............. .... .... ... ..,. ......... .... .. ...... . L...... rr,....r,,.,........ , OL9ElSE•EACH EMPLOYED Is 100 000 OTHER :.. ...................._..................................:............................................ . DESCRIPTION OF OPERATIONSILOCATIONSMFHICLEffiSPECIAL ITEMS Carpentry/Renovations 415 Lina Lane Hyannis, MA Fared to 508-790-6230 �f sr . I >Etu •x• Y.V.. ��<F'•t .3r,t' ''iil'<:i:,...,.. ,.t 2'£'£:F$'',#::"iu' :.E`., x>.Y i�?;:'it;9atsr N.r: .,..�.. v.......:.......rr.r..r:;;r£� �r'r'Yi:`sr':Nx:}ts�'Y�':$.:r.,ks,..fLsi'Sri��!u's.L:.c..Y:':.......r... ! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE >r:'•„ EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO } MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Town of Barnstable >`; LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Atten a Kathy Maloney :_€ UABILITR01G0618SIdD�111�I�iQ� I� > g pl aq�$gNTAT(vF«g• main St. RE PRE A Hyannis MA 02601 •n•n rr>:a s:{•s ::>1G: ,r,;::r;;•,•.,:,•:!•;".,,,�."......,,^.n,jt'rYY:•; ;:r:l,�,r.:' ,, r •r::::.:.5:..:r:•:• :o>Ys,a<�'::'r:'�:"•'ia": `�{i4Y}}i^ii^ :i',ti:�x'•>'.a f:' •5 r. :�: :�iiLfYt' ::�:<o: ?�..��is .R � 3{:S..YY�'£i�,r.i•.',iw:£. x::t!i'1,>:�.5: i:X:i: Y�.}:! ..I.::k '.:!!.t�:l:..>Y r 1. Y. �r:Y'�<.Y.it{•'.:t•i:}l.:::: r Y. TOTFIL r.'01 ✓126 U/O�Il7�/I204tCl/ 6L i��!�(,p4!{Q�LIIQG'LL(Y ,i 1 t1 . \ estricted,To: 00 u OEPARTHENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE 0 - None Nueber. Expires: 6 - 1 i 2 Wily Hoses , > : Restricted To QO ailure to possess a current edition of the is assachusgtts State Buiildinj Codl JOHN A LEBOEUF s cause for revocation of tis license. 95 PRINCESS PINE RO HYANNIS, HA 02601 sii'. i o�' oil VC111 . X lid Gp cd5� Jcp /6 r------- Vi 14d CoX #4*oa4D Xx��xr N ask axe IL Y ell f--— y�rnrdc' 8 jncp 017C.fT �.+,Q•ron. �'�°ec. Flfc� �I c� rtl Fb°.- _a �„ll7 col✓ -------------- ^ ("C'ert PODS F �rg�i n sc�{fr��(E_ rriTs F/_aallo• V /r,<rsfr�n. t t F` �� �,S -- — - — --------_ ..-- ----- �-- ------ter -- -- � Plan.< ,a I I a L�E�EAl lye - ? ayyL J HNL el 1iC ayy, r�� �7 �•� t C/ac t' y'16 -]x-1 fl Q d44J- dvyl dyNY 3.ob6,� olti�l}- �� • y ECM@ S �P/EOYm�Y: DUWOIMV: DATt: REvmEA; Linpa ,4. auWworeu� i J . f _ U D TMI19i ji ICALIL ' 011►MY6/YWe6P ozz' Thomas N. George, Attorney 17 THACHER SHORE ROAD•YARMOUTH PORT,MA 02675 • (508)775-5386 • FAx:(508)362-7804 October 10, 1995 Ralph Crosson Building Inspector Town of Barnstable South Street Hyannis, MA 02601 Re: Vacant Lot., . � JS�'Lind Dane H anm's;iV 1" CC.Q i 6 7 Map 248 Parcel 224 Dear Mr. Crosson: I represent Roger Shermont and Irene Shermont, the owners of the above described premises. Please be advised that this property has not been held in common ownership with any adjacent property since at least from the date of purchase by the Shermonts(1970). Accordingly, it is the opinion of this office that the premises qualify as buildable under the Town of Barnstable Zoning By-Laws. Please contact me if you have any questions with regard to this matter. Very truly yours, Th s N. 2jelt TNG/rl UCT l i a:. 39 PM Thomae .'. �• : . i ,•.�• ' - :�. .�_ i i. "+r.• ' y I�'. Gco�•�e, . i.toi-iley — 17'I'f AO)IFER SIIt- i;ROW) • YARMOITHI lloizr,IAA 0..!0 5• (508)775-6386 • FAX: (508):362 7804 FILE October 10, l 99.5 CO: Ralph Crosson Building Inspector Town of Barnstable South Street Hyannis, MA 02601 Re: Vacant Lot �Tinda Lane, Hyannis, MA �? Map 248 Parcel 224 Dear Mr. Crosson: I represent Roger Shermont and Irenc Shermont, the owners of the above described premises. Please be advised that this property has not been held in common ownership with any adjacent property since at least from the date of purchase by the Shermonts(1970). Accordingly, it is the opituon of this office that the premises qualify as buildable under the Town of Barnstable 7.oning By-Laws. Please contact the if you have any questions with regard to this matter. Very truly yours, TNG/rl