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0034 MOUNT VERNON AVENUE
,jt�/LjounT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. 2157 Parcel \ 1`* Application # 9cbS(0a Health Division Date Issued - a Conservation Division Application Fee Planning Dept. Permit Fee o Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address -2,4 NAT- QAE 2& 10r1 Ae-Jr. . Village Owner Qk&&&-rT MAJLy: o. + Ak-k. cg4 M. ET- kLS Address P.o.30x kJ-1 'TiLks"" Telephone Q`f�Lo Permit Request S,Oc I��t Square feet. 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 756. Construction Type Ooo ) o Lot Size S ALC."t Grandfathered: ❑Yes ❑ No If yes, attach supporting doc cementation. Dwelling Type: Single Family W Two Family ❑ Multi-Family (# units) - w Age of Existing Structure 41 40 Historic House: ❑Yes 9 No On Old Kings Highway: es N No Basement Type: i."Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new - Half: existing new Number of Bedrooms: existing -new Total Room Count (not including baths): existing '1 new - First Floor Room Count S Heat Type and Fuel: I-Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes I-No Fireplaces: Existing +- New Existing wood/coal stove: ❑Yes 9 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 W No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name (2'er- -i N.P J 1 , t NNC- Telephone Number 5-6 S 425. 6 61. Address `41fS 0S-► . UJ AAkzC . 2n . License # \ OS Is! &,A. 6"SS Home Improvement Contractor# Worker's Compensation # wd.- %-1 to-00 t'1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN Ta j Rllc- Cb. SIGNATURE DATE 1 1 I t2l oq l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP i PARCEL NO. 3 ADDRESS VILLAGE OWNER _ DATE OF INSPECTION: f FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL_ + GAS: ROUGH FINAL FINAL BUILDING ► ' DATE CLOSED OUT ASSOCIATION PLAN NO. 1 j The Commonwealth ofMassachusetts .Department of rnd.ustrial Accidents' Office of lnvestigalions 600 Washington Street .Bostolll M, 02M °• y-t,wy�.mass.gov/dta • Workers, Compensation Ingarance_ Affidavit: Builders/Contractors/Electriciaas/Plumbers Applicant Information Please Print LeEibly NaMr, (Businoss/Organization/Tndividual): + wdt. 1�'C W t. Ad&ess: No . City/State/Zip: 8 Phone.#: Ar�e(�on an employer? Check the appropriate box: Type of project(required): 1.lJ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees (full and/or part-time):* have hired thc.strb-contractors listed on the attached sheet 7. ❑Remodeling2.❑ I am a'sole proprietor or partner- Thcse sub-contractors have 8. D cmo lition ship and have no employees ❑' working for me in any ca employees and have workers pacity. 9, ❑ Building addition . [No workers'.comp.•insurance comp. insurance.t 5 : are a corporation and its 10.❑Electrical repairs or addition . ❑ We. s required.] . 3.❑ I am a homeowner doing all work officers have exercised their 1I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs c. 152, §1(4), and we have no inst,rancc required.].t I3.S4 Other 0m6CAc- employees. [No workers' comp,insurance required.] *Any applicant that checl5 box 91 must also fill out the Section Below Showing their workm' compensation policy infor=tion. t HomoawnerC who submit this affidavit indicating they art doing all work and then hire outside contractors must submit anm affidavit indicating such. tContractnrs that check this box must attached an additional sheet showing the nanc of the sub-contrarturs and state whether or not those entities have employe. Ifthe sub-contractors have employceA,they must providb their workers'comp.policy number. I am an employer that is prcv[dirtg workers'compen•safLon insurance for my employees. Below,is the policy and job site inf rmatlon Insurance Company Name: Policy#or Self-ins, Lic.#: WG 101 to CO-kZ Expiration Date: 1 Job Site Address: , P�1�- City/State/Zip: E-111J+SRt��". N�LI' Attach a copy of the workers' compensation,policy declaration pabe (svofviug the policy number and expiration dafe). Failure to secure coverage.as required min under'Section 25A of MGL c, 152 can lead to-the imposition of criminal penalties of a fine iip 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the b14 for.insuza=r cov rage vcrif cation. I do hereby ce odes th ins• nd p es.of per' ry ticat the information pra,Yided ab:av is true. nd col rest ' Si Store: D atc: Phone#: Offx1al use only. Do not write in this area, to be completed by city or town officiat City or Town: Perudnicense# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone Ih Nov 16 2009 5: 58PM Maura Morel 41.5 435" 3512 p. z 11/16/2009 17:11 5084203550 ROGERS & MARNEY,INC PAGE 02/02 .._OF` tr� Town of....Birnstable., Regu.tafory Services z s ALL, Thomn-i F. Ccilcr,Director ��prco7►�� B>,jldingZ Divi.�iorl Tom Perry,,n►iiidingwComm,selaner" 200 Main Sir6t1;-'ITyannis,MA 02601 1 wtyK'tawn,brirnstabl^ mn',us Off"ira; 509-962-4039 lax; 508-790-6230 Property Owl-let Must Cwom letti 7•pd-S1. n his SFCtiQ"Zl If uaiag',A.Bui dr 10 to A.s owner of the subject property 4WD +" �1►v ao.aet on rriy holialf, • ehy authorize in aU rrmattrrs relative to work nutltiorized by tl is building"permit aprlicRrion for: V �e7 � '� . c truc•�.t Alba 16 . Sign1 of 0..:�rr Date W50N G RR�T( EDNhKp �Qpi 1 �F ,Vi � s . F.ant.Narnq� 6Mken If P.ropcoy Owner ig "Ipplying"forpermit incase complete the Horn Co=-Crs Licensc" Exemption Fort.on the reve.*.sc side. w Town of Barnstable Geographic Information System November 10,2009 287101 X 8.67 \\ / M. 287100 #41 X 47.0. w 287113 i'f 51" 287114 #34 287098 #31 X 1$:6 287,116 287,115 #100 287097 #18 #25 0 eet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:287 Parcel:114 � N boundary determination or regulatory Interpretation. Enlargements beyond a scale of - Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:ONEIL,GISELA I Total Assessed Value:$896700 E are only graphic representations of Assessor's tax parcels: They are not true property Co-Owner:%GARRETT,MARK D&ALISON Acreage:0.35 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:34 MOUNT VERNON AVENUE t/ such as building locations. - - Buffer ff f",; d - — Z H F K rQ m u 10'-7" 6'-3° 0 13'-4„ 12'-2" a E K/TCHEN a (D a , BEOIf'00N 2 N x RENO VE EXIST FAR T/T/ON I------------- --- N 3,-0,. W 12'-9., U N11 u --- ---- ------ - - - Z W --- - -- --- --- > Q :o o W Q ID REMOVE MO VE EX/5 TING P R T/T/ON � w Q O � ---- NEW !V6 x 15 STEEL B AN FL U5H � ^ Z 0 It It a W IL x F Z ----------- - Z Q d } > 3 � I Y W _ BEDROO/% L/V/NG POOH 3'-2" O REPLACE FX/S T 14'-2" DECK 5 TRUCTURE ------- DATE: p,. L SST,-"S tat 8 QT �ti SCALE: 1/4"=1'-0" FLOOR 38'-0° PLAN a m v EXISTING FIRST FLOOR PLAN a N O COPYRIGHT 2009/KAREN 9.KEMPTON INC. C:\DATACAD 12\DRAWINGS\MOREY\DECKP--.AEC 9.4e -� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 _ - Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164688 Type: Private Corporation Expiration: 10/30/2011 Tr# 290070 ROGERS AND MARNEY, INC. _ GARY SOUZA i P.O.. BOX 310 -------- ------------- — �OSTERVILLE; MA 02655 -- ---- ---- Update Address and return card.Mark reason for change. `l Address J Renewal Employment Lost Card [)PS-CA1 0 50M-04/04-G101216G - - �%<ee i�om��Zancuea� o�.1�.aasc��<u�e� Office of.Consumer Affairs&'Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:. Office of Consumer Affairs and Business Regulation Registration: 164688 Expiration: 10130/2011. Tr# 290070 10 Park Plaza-Suite 5170 Boston,MA 02116 Type: Private Corporation ROGERS AND MARNEY, INC.. GARY SOUZA 445 WEST BARNSTABLE RD. 4 OSTERViLLE, MA 02655 Undersecretary Not v id it out signature Massachusetts- Deartment of Puhlic Sateh 'Board of Building; p"Con-struction emulations and Standards SU'pervisor License 10299g License: CS LG,L�4 ic Ot�,SX dM�t2Ao�1�10 020 BYIT, 5_6 35 mmi. inner Expiration: &16✓2012 Tr#: 102999 03/12/2009 14:37 5083932273 NORTHWOOD INSURANCE PAGE -01 OF ID TO DATE IMUM01YYYYI AOR CERTIFICATE OF LIABILITY INSURANCE ROGER-1 03 12 09 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ]Northwood Ins. AgNsrlay, Ina• HOLDER-THIS CERTIFICATE DOES NOT AMEND,EXTEND OR $ nr Suite 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. 5 or Fain Hyannis MA 02601 NAIC# Phone-, 508-771-1632 Fax:508-393--2955 INSURERS AFFORDING COVERAGE INBUREo INSURER A: AMF.RICAN INTERNATIONAL INSURER 9: General Caeaalry Insurano Co. INSURER C Ro� Ss & Mareyr Ic• p.0E INSURER D: .rox 310 . Ogtervill® MA 026SS INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. POLICPeft OLICY NUMBER OAT! MAID DATEEOJ ^ LTA TYPE OF M8URANCE - EACH OCCURRENCE . ' GEMRALLIAVILITY $ }( COMMERCIAL GENERAL LIABILITY CC10395621 03/20/08 03/20/09 PREMISES Ea 00CWan� CLAIMS MADE OCCUR - MEO EXP(Any ane Perwn} $ CCI0395621 03/2O/09 03/20/10 PERSONAL aADVINJURY GENERAL AGGREGATE PRODUCTS•COMPIOPAGO f.$2 000 r OOO OEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEC0j F1 LOG - AUTOMOBILE LIAELLRY COMBINED SINGLE LIMIT - (Ea awl0400 ANY AUTO ALL GINNED AUTOS BODILY INJURY 1 - (Per DerwnF SCHEDULED AUTOS HIRED AUTOS BODILY INJURY f (Per awanU NON-OWNED AUTOS PROPERTY DAMAGE $ - (Per scelden0 AUTO ONLY-EA ACCIDENT f GARAGE UABILITY - - OTHER THAN EA ACC $ ANY AUTO - AUTO ONLY: AGG 1 EACH OCCURRENCE 3 7 'MawUERELLA LIAMILITY AGGREGATE 3 OCCUR a CLAIMS MADE - f DEDUCTIBLE 3 RETENTION f WORKERS COMPEIIEATKNN AND X TORv UMR9 ER . A MPLOYEIkVUlARLTIY WC176-00-17 01/01/09 01/01/10 E.L EACH ACCIDENT f$500 0.00 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.DISEASE•EA EMPLOYEE 11000 000 OFFICERlMEMBER EXCLUDED? Hyey,dasdibeun0er E.L.DI5EASE-POLICY LIMIT 3$500 00O SPECIAL PROVISIONS belew - OTHER pE$CRIPTKNI OF OPlRATIONB f LOCAT1ON8/VINICLEB I EXCLUMONS ADDED 8Y lNDORSEMlNT T SPECIAL PROV1810NS CERTIFICATE HOLDER CANCELLATION $ARNSTA SHOULD ANY OF THE ABOVE DESCRBED POLICIES OIL CANCELLED BEFORE THE EXPIRA TM DATE THEREOF,THE ISGUINO INSURER WILL ENDEAVOR TO MAIL DAYS II W"EN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 9O SHALL Town Of Bamnstable IMPOSE NO OBLIGATION OR LIABILITY or ANY KING UPON THE WGURJSR,ITS AGENTS OR 367 Main 8treelt REPRESENTATIVES. Hyanni a MA 02601 AUTH D REPSENTf�IY§S , ®ACORD CORPORATION 1998 ACORD 25(2001f08) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I Parcel' 1 Ik U© o Z OsoMap G Health Division Date Issued �1 d Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation/ Hyannis Project Street Address 3 4+ rr-r. rztitN o,J AVM Village I D J AA OwnerPAAcct�nat� ��',, Morcu.Address Ind At Telephone 'Z 7 S- %;X'S IT Permit Request 1Nr� ��uS�►l ST�c�- '13C4,--�. 4- 4CW%oJ E, I-JAL.A_ Square feet: 1 st floor: existing l0 2proposed O 2nd floor: existing (nog proposed o Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation l &S-m —Construction Type Wpoo - Lot Size • 3 S A C 9-,c s Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family(# units) Age of Existing Structure 4 9 WA, Historic House: ❑Yes ANo On Old King's Highway: ❑Yes Id No Basement Type: W Full ❑ Crawl 11 Walkout ❑Other Basement Finished Area (sq.ft.) 0 Basement Unfinished Area(sq.ft) ► 092- Number of Baths: Full: existing Z. new O Half: existing O new o Number of Bedrooms: existing O new Total Room Count (not including baths): existing '7 new O First Floor Room Count S' Heat Type and Fuel: R Gas ❑Oil ❑ Electric ❑Other ,, . v � 0 , Central Air: ❑Yes 1A No Fireplaces: Existing 1 New 0 Existing wooer foal stove;- ❑ allo Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new .size _ Barn: xisting nevsizeT.s CO Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ °Q w -Commercial ❑Yes &No If yes, site plan review# c� Current Use Proposed Use T APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Y Name 1 Je. Telephone Number So$ 42.$-- 6 t C � Address '-�`F� bS'T. �,,5.iiA�`DL, 0-0 License# Os �u.,� �4• 62-6,557 Home Improvement Contractor# 1 00 11% Worker's Compensation # WC. ►?(e Oo - k 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T$ 3`1 r AAr c(SM.t3z,,t l .C C—Q S_ Co. SIGNATURE OQ �_DATE 3 k cm FOR OFFICIAL USE ONLY J APPLICATION# DATE ISSUED Syy MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION;- FOUNDATION f FRAME - INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL 'GAS: ROUGH FINAL s FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO. ti The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations g 600 Washington Street _ ref Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C:A J -k- 'Q{ 1 Address: City/State/Zip: ®«-y,��,� Phone #: 56;W 4U&_ U O 6 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �.i 2r .�k�o0 1 ";=nJ erg Policy#or Self-ins. Lic.#: "I G \'j\o _ c, - 1' Expiration Date: t \ � p Job Site Address: 7`k M.t_ co..,Jo j • P�J^�. City/State/Zip: �(��.J�J S>l p,(.� mA 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 cert' under the p and hies of perjury that the information provided above is true and correct. Si nature: Date: CL a� Phone#: b to 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#: Information and 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, §25C(6)also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(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 affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 - Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia 03/12/2009 14:37 5083932273 NORTHWOOD INSURANCE PAGE. 01 CERTIFICATE OF LIABILITY INSURANCE OP ID TO vATEtwAMWY M ACORQ ROGER-1 03 12 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Inc. BELOW. Northwood Ins. Agency, ALTER THE COVERAGE AFFORDED 8Y THE POLICIES 540 Main Street, Suite 9 Hyu is MA 02601 NAIC Phone: 508-771-1632 Fax:508-393--2955 INSURERS AFFORDING COVERAGE INSURED INSURER A: AMERICAN INTERNATIONAL INSURER B: —Val casualty 2neurano CO. RO�era E Ma=ey, Ina• INSURER C P.O• Box 310 INSURER D: Osterville 14K 02655 wsuRERE: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LtR TYPE OF MSURANCB POLICY NUMBER GATE 11gIID DATE LlM1T8 EACH OCCURRENCE !$1,000 OOO GENERAL LIABILITY 8 X COMMERCIAL GENERAL LIABILITY CC10395621 03/20/98 03/20/09 PREMISES(EaOCG+� !$50,000 CLAIMS MADE D OCCUR MED ExP(Any One perwn) !$5,O00 CCIO395621 03/20/09 03/20/10 PERSONAL eADVINJURY !$1 000,000 GENERAL AGGREGATE !$2 O00,OOO GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPIOPAGO !$2 000,O00 POLICY JEC LOC AUTOMOBILE LJABILTY COMBINED SINGLE LIMIT ! (Ea eCdavrt) ANY AUTO ALL OWNED AUTOS BODILY INJURY - ! (Pet perSpO. SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Per"awl) NON-OWNED AUTOS PROPERTY DAMAGE ! (Par Wd6ent) OAMGB LIABILITYAUTO ONLY-EA ACCIDENT ! ANY AUTO - OTHER THAN AUTO ONLY: AGG S V PXCKMUMMU LLII � EACH OCCURRENCE ! OCCUR CLAIMS MADE AGGREGATE ! i DEDUCTIBLE s RETENTION f - _ WORKE COMPEIISATION AND X. RS TORY LIMITS ER EMPLOYERS' BR.RY A LJA WC176-00-17 01/01/09 01/01/10 E.L.EACHACCIDENT s$500 0 00 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYE !$5OO OOO Myea,de5mbeurm, E.L.DISEASE-POLICY LIMIT S$500 000 SPECIAL PROVISIONS below - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES)EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL P ROV1810NS CERTIFICATE HOLDER CANCELLATION BjMNSTA SHOULD ANY OF THE ABOVE DESCRIBED POLt0W BE CANCELLED BEFORE TIME EXPIRATION DATE THEREOF•THE 150UM0 INSURER WILL ENDEAVOR TO MAIL DAYS WRITRN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO Bp SMALL Town Of SarnstablA IMPOSE NO OBLIGATION OR LIABILOTY OF ANY HIND UPON THE WGURER,ITS AGENT'S OR 367 Main Street Hyannis MA 02601 REPRESENTAtIVES. AUTHOPIABO REP� T/SEN �W§S v c,rJJ� ACORO 25(z001/08) ®ACORD CORPORATION 1998 Dated 6/3/2009 Timer 9:08 AM To: @ 9,15084203550 Page: uu2 Client#:36532 2EVERSONTH ACORD,N CERTIFICATE OF LIABILITY INSURANCE 0DATE 6103I 009 ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency _ HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insuranc Thomas R.Everson INSURER B: Associated Employers Insurance 426 Flint Street INSURER C: Marstons Mills,MA 02648 INSURER0: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DALITEE(MCY EMfDDD/YYE PDATE EXPIRATION IDO TION LIMITS A GENERAL LIABILITY MPP5391L 01/31/09 01/31/10 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY _ DAMAGE TO RENTED ce PREMISES(Ea occurren 1 $500 O00 CLAIMS MADE �OCCUR MED EXP(An one person) $10 000 X PC Ded:250 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY JPERCOT- LOD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS .(Per person) $ HIRED AUTOS - BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE ` (Par accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC. $ "OTAUTO ONLY: qGG $ EXCESSNMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ A $ DEDUCTIBLE - $ RETENTION $ $ B WORKERS COMPENSATION AND WCC5008187012009 04/26/09 04/26/10 X W"RyC STATU- FR EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE - E.L.EACH ACCIDENT $SOO,000 OFFICER/MEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE1$500 000 I yes,describe under ' SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT 1$500,000 OTHER f DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Thomas Everson is excluded from coverage under the workers compensation policy. Operations performed by the named insured subject to policy conditions and exclusions. Certificate holder is named additional insured for general liability. CERTIFICATE HOLDER CANCELLATION c SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Rogers&Marney Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR.TO MAL If) DAYS WRITTEN PO BOX 310 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Ostervll le,MA 02655 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED PRESENTATIV�E IV c- ACORD 25(2601/08)1 of 2 #S58287/M58286 LS1 0 ACORD CORPORATION 198i3 i 08-17-'09 15:03 FROM-Legacy Insurance Grp 5082956730 T-782 P001/001 F-527 Roy CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DWYYYY) 8/17/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Legacy Insurance Agency Group, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 213 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 'Wareham, MA 02571 INSURERS AFFORDING COVERAGE NAIC jNSVRED T^_ - INsuRERla Providence Mutual - - James Festog INSURERS: Granite State Ins Co Wood Floors �'r I INSURERC 52 Hunter Ave ! INSURER D. E Ware am, MA 02538 INSURER E COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDIN3 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 AFFORD50 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPC OF INSURANCENSR ADD' POLICY NUMBER _ MUM OLICY EFFECTNE PDATE(MMIDIYYYYY) OLICY EXPIRATION LINTS GENERALUASIUlY EACH OCCURRENCE $ 59 A coM1AERCIALCENERALLWBILITY CPP0051525 3/18/09 3/18/10 DAMAGE TO RENTED $ 100,000 CLAIMS MADE OCCUR NEO @(P(Alyona p6mon) $ 5,000 PERSONALBADVINJURY 5 500,000 GENERAL AGGREGATE $ 1,000,000 G£N'L AGGREGATE LIMIT APP LIES PER PRODUCTS-COMPIOPAGG $ 1 000 000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTOa acci0ent) $ ALL O WNEO AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIRED AUTOS i BODILY INJURY $ NON O WNE D AUTOS (P er ac6dent) PROPEkTY DAMAGE $ Por accidant) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ — AUTO ONLY: AG $ EXCESS IUMBAELIALIABILITY EACH OCCURRENCE $ _ OCCUR _CLAIMS MADE AGGREGATE $ DEDUCT ISLE $ RETENTION S WORKCAS COMPENSATION WC STATU• OTH- ""- AND EMPLOY19AVLIAHILiTY ___..IORYLIMITS- -- ANYPROPRIETOPoPARTNERfEXECUnVE YIN WC006387286 7/15/09 7/15/10 F,LEACHACCIDENf 3 1'0U.000 OFFICERNEMBER EXCLUDED? (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE 100,000 IIye�s descib S11do, SPE(:IALPR0IASIONS6dow -E.L,OISEASE-POLICYLIMIT s 500,000 - OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY E NDOR5 WENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLEO BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WIaTTEN Rogers & Marney Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE L5FY,BUT FAILURE TO DO SD SHALL P O BOX 310 POSE NO OBLIGATION OR LIABILITY OF ANY KIND LIP ON THE INSURER,ITS AGENTS OR 445 W Barnstable Rd RR SENTATIVES. OSterville, MA 02655 AU R1ZED REPRESENTATIVE 1,17 Z. ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a J„ OFTHF r Town of Ba"rns� table N� O_. Regulatory Services • ..,R..SrA8LE. MASS. `0m Thomas F.Ceiler,Director aTF0 a' Building Division Tom Perm, Buildina Commissioner 200 `lain Street, Hyannis, NLk 02601 Office: 508-S62-403S Fax: 50S-790-6230 i Property Owner Must Complete and Sign This Section If Using A Builder I, JA6 , as Owner of the subject property- hereby-authorize ROGERS &TM�ARNtE , INC. to act on my behalf, in all matters relative to work authorized by-this building, permit application for(address of job) Signature of _ Date CLUMA 0 tint Name A �LL r — 3`- Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License License CS: 16174 Restriction: 00 Expiration: 5/7/2010 t •,! i �..: Till 23727 j CHARLES D ROGERS �, % t ► . . �, �.! PO BOX 310 OSTERVILLE,.MA 02655 Update Address and return ca Mak reason for ch:u:i c. rd. r Address RcnMrai ! j Lint ('anl OI--- s.CAI A 50M.07/07•PC0490 Board of Building Regulations and Standsrds Constructiop Supervisor.License LIGepc. Sa.\•CS 16174 Tr# 23727 plr tlQf:._5lT�2s10 l ! CHARLES D ROGERS.pl/` PO BOX 310 OSTERVILLE,MA 02655 Commissioner i Board 7Building ReguIa ons and t�rs One Ashburton Place - Room 1301 Boston. Massachusetts 02108 IIome lmprovement:Contractor Registration Registration: 100134 4 ... / .� Type: Private Corporation Expiration: 6/9/2010 Trtt 2G7877 ROGERS & MARNEY, INC. Charles Rogers P.O. BOX 310 Osterville, MA 02655 Update Address and return card. Mark reason for change. )PS-CAI 0 50M•07107-PC6490 Address ❑ Renewal 1_1 Employment (.-I Lost Card �✓�o lJo»t�non�urw���. o�'✓tfnua�.�taella �— Board of Building Regulaliom aid Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: l l3o Registration: 100134 ard of Building ltcgulations and Standards j _ = - Expiration: 6/9/2010 Tr# 267877 One Ashburton Place Rm 1301 Il !I jType: Prlvale Corporation Roston,Ma.02108 i ft. ROGERS&MARNEY INC I i 7 \ i , Charles Rogers t . 445 WEST BARNSTABLE ROAD Osterville.MA 02655 f Administrator Not valid without si atu'e Basement Girder Reinforcement by•.Veyerhae�s" r TJ-Bea User:2m®6.30091033:48A: 2 Pcs of 1 3/4" x 9 1/4" 1.9E Microllam® LVL User:2 8/26/2009 10:33:48 AM Pagel Engine Version:6.30.14 MEMBER,IS INSUFFICIENT DUE TO LOAD ----------------- _ 1 • I b 7.10•• 1 Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 1' Primary Load Group-Residential-Living Areas(psf):40,0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 500.0 150.0 0 To 7'10" Replaces first floor Uniform(plf) Floor(1.00) 375.0 150.0 0 To 4'10" Replaces second floor Point(lbs) Floor(1.00) 2568 1099 4'2" - second floor beam reaction SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplif total s:e. 9 1 Steel column 3.50" 2.31" 4425/1643/0/6067 L5 None �• ���.-�•---�-�<Ft4 2 Steel column 3.50" 2.02" 3872/1426/0/5299 L5 None \�F Or�., � �s1/ oyfir -See iLevel@ Specifiers/Builder's Guide for detail(s):L5 J DOfAEN)C 11a/ Gip DeANGELC! DESIGN CONTROLS: <' STRUCTURAL Maximum Design Control Result Location No.35062 Shear(Ibs) 5870 4809 6151 Passed(78%) Lt.end Span 1 under Floor loading o 2/ST- e Moment(Ft-Lbs) 14009 14009 11204' Failed(125%) MID Span 1 under Floor loading Live Load Defl(in) 0.248 0.250 Passed(U362) MID Span 1 under Floor loading Total Load Defl(in) 0.343 0.375 Passed(U262) MID Span 1 under Floor loading -Deflection Criteria:STAN DARD(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 0 o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. x ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel@. iLevel@)warrants the sizing of its products by this software will be accomplished in accordance with iLevel@ product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel@ Associate. -Not all products are readily available. Check with your supplier or iLevel@ technical representative for product availability. -THIS ANALYSIS FOR iLevel@ PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the iLevel@ Distribution product listed above. -Note:See iLevel@ Specifiers/Builds Guide for multiple ply connection. A- U` ,�, 0� Or 1 , i 1ff d"- �"I pS,'�� �'tleiyS O PROJECT INFORMATION: M ti009- 11' O4 f" OPERATOR INFORMATIONlyp�� � (-I) Ikx �Ylfj Morey Residence 7 n Domenic DeAngelo (yJ�, H Mount Vernon Avenue L f�"'� a. �j DWD Engineering, Inc. 1 �N^ }, ��p yannisport,MA 5 Michael Road � W�1 po 09-249 n' V° 1 N o1��C 11Y East Bridgewater,MA 02333-215 �I,,+ Phone:(508)378-9602 �N 3 3 Fax :(508)378-2922 ivy%3,�11;' ' % I, ', w domdean@aol.com Copyright o 2007 by iLevel°, Federal way, WA.' - Microllam® is a registered trademark of iLevel°. living room beam � 7 V, 2 PCs of 1 3/4" x 11 114" 1.9E Microiiama LVL �'L TJ-�arnS'u 5:30 Serial Numbar: User..2 W,'Tl Cj11.32:W1W THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page'. Gnninn Versian.5,30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED D Product Diagram is Conceptual. LOADS: .,,,s x2. _ 41 (r Analysis is for a Header(Flush Beam)Member. Tributary Load Width: IT Primary Load Group-Residential-Sleeping Areas(W:30.0 Live at 100%duration,12.0 Dead y I•c 3 2 SUPPORTS: j 2� '�?la Input Elearing Vertical Reactions(lbs) Detail Other Width length Live/Dead/UpIMTota! 1 Wood column 150" 1.501, 2568/109910/3666 L1: Blocking 1 Ply i 3i4"x 11 1 4"1.9E MicrollamV LVL 2 Wood column 3.50" 1.50" 2568/1099/0 i 3666 L1: Blocking 1 Ply 1 3/4"x 11 14"1.9E MicrotiamlD LVL -See iLeveI0 Specifier's/Buikdei's Guide for detail(s):Li:Blocking DESIGN CONTROLS: Maximum Design Control Result Location. ` ;151"'o 7 11,A ` Shear(lbs,) 3573 -2982 7481 Passed(40%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 11464 11464 1 137 Passed(71%) MID Span 1 under Floor loading n Live Load Defl(in) 0.326 0.321 Passed(U472) MID Span 1 under Floor loading Total Load Defl(in) 0. 6 0. 2 Passed(U330) MID Span 1 under Floor loading it -Deflection Criteria:STANDARD(LI-1/480,TL:U240). r -Bracing(Lu):All compression edges(top and bottom)must be braced at i V 11"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevelO. iLeveWD warrants the sizing of its products by this software will be accomplished in accordance with iLeveW product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevele Associate- -No(all products are readily available. Check with your supplier or iLeveI8 technical representative for product availability. -THIS ANALYSIS FOR iLeve*PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS, -Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevelilD Distribution product listed above. -Note..See 1LeveI@ Spec fieestBuildees Guide for multiple ply connection. -71R r' Gi- .PROJECT INFORMATION: OPERATOR INFORMATION: Morey Residence z� Karen Kempton !q Or�dgssA�fIq�� Karen Kempton, Inc. ti �- 4'!o [)0MEN1C W. sF 43 Angela Way = p2A!VGELC West Barnstable, MA 02668 STRUCTURAL Ph-one:(508)362-3447 No.35Q62 Fax ;(508)362-1236 e try 9�9Fg/S karenkempion@comcast.net F i� 7W �q PREo EMIT ` 'own o Barnstalble '-Permit Nq q, Ezp' 6 ntontAsfrom issue date Regulatory Services Fe 1 " usuvsrnsLE, Thomas F. Geiler, Director Cov\lly a. ABLE Building Division } Eb MA- Tom Perry,'CBO; Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint t Map/parcel Number Property Address (Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address Contractor's Name �` �{?/f j �,1�k� '.)/'i Telephone Number Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance C< �-s Check one: ❑ I am a sole proprietor VYI am the Homeowner I have Worker's Compensation Insurance f Insurance Company Name ' ,�?L�lS21fS Workman's Comp. Policy Copy of Insurance Compliance Certificate must be on,file. Permit Request(check box) ip Re-roof(stripping old shingles) All construction debris will be takeri toj� i �J. ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ,. x , ❑ Replacement Windows/doors/sliders. 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. A copy of the Home Improvement Contractors License is required. SIGNATURE: / a' QAWPFILES\FORMS\building permit forms\EXPUSS.doC - Revise020108 The Gomrnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washingfon Street Boston, M14 02111 www.mass.gov/dia Workers' Compensation Inmranr e Affidavit: Builders/Contractors/EIt ctricians/Plumbers AppUeant Information Please print Le itb� Name (Business/OrganizaiionflndmLivan: City/State/Zip:� Phone-4: 77 �� � '� Are you an employer? Check the appropriate box: rEW ct(required): 1.�I am a employer with _ 4. 0 I am a general contractor and I nstruction employees(fall and/or part.tima).* have hired the s'nb--contractors Z❑ I am a sole proprietor or partner- listed an the attached sheet eling ship and have ran employees 'These snh-contractors have tion employees and have workers' working for me in any capacity. g addition [No workers' �.-insrnanr_e comp.in¢rn 2nce.$5. [� We are a corparation and its al repairs or additions rf=a li] officers have exercised their ILL]Plumbing repairs or additions 3111 am a homeawnLT doing all work myself [No workers' camp. right of exemption per NICrL 12 to n f repairs t c. 152, §1(4), and we have no incrtrance r �] employees. [No workers' 13.❑ Other camp.nmzrance required.] ''Any applicant&cat chmix box#1 rmnt also fM out the section below sbowing their workers'coznpa=imI poFicy inforrrmtion t Ho�rrrowna%who subir it this affid-it indicating tbey are doing all work oat and than hire outside c motors must cub7it anew 2 L-Vit uidi�ng such tContxactnrs that cbcxk this box nuzst attached as arlditiorral shoat showing flit name of ffic sub—otratt=and stain wbetlrer or not those rntifirs have employees. If the sub-conhurdt=have croployccs,they must prvvi&tbcs workers'corny.ptA cy number. I am an emplayer the is providing workers'comperrsatzon insurance for my employem B'elaw is the polity and job site information. Inntranm CompanyName: Policy#or Sclf--ins.Lic.#: /, Q�� 7 a/ y Expiration Date: Job Site,Address: City�state/zip: Attach a copy of the workers' compensation policy der aration page(showing the policy nnmber and expiration date). Failure to secure-coven- ge as requhcd.under Section 25A of MGL c. 152 can lean to the imposition of criuYirial penalties of a fins up to S 1,50D.00 and/or om-year iaprisonmcnt,as weIl as civil pmalt cs in the form of a STOP WORK ORDER and a fi of up to S250M a day against the violator. Be advised that a cagy of this statcmer t may be forwarded to the OfEce of Inycstigiftims of the DIA for insurance coverage verifi.cation. I do hereby certi .under the pains-andpenaldes ofperjary that the information provided above u true vnd correct Phonc#' zz Ofj7chd use only. Do not write in this area, tb be completed by city or town of xIaL City or Town: Permit/License# Issufng Authority(circle one): 1.Boxrd of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plnmbing Inspector 6. Other Phone ff: f c;. P oFtHE r Town of Barnstable Regulatory Services g"R" E s. $` ThomasF. Geiler,Director 4jA 019. rF0 a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: S08-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sigh This Section If Using A Builder as Owner of the subject property hereby authorize� ��� to act on my behalf, in altmatters relative to work authorized by this building permit application for: (Address of Job} Signature of Ow at Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th:e reverse side. S_ Town of of Barnstable mop SHE rp�y Regulatory Services sa�vs�ws Thomas F.Geiler,Director ,P MAS& qp 16.9. Building Division Tf° � Tom Perry,Building Con -Wssioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us 1 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 ROMEOWNER Persan(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 1 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) C. ility for compliance with the State Building Code and other The undersigned"homeowner'assumes responsib applicable codes, bylaws,rules and regulations. The undersigned"homeowner'certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a 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 parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Mafiy 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 heshe undcxstands 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. Fram:Kaihy Geddes FOxIUa`doralrv6Oe:nsLronee -mye c vi c u�t4.,,,•;,_��� � �y� OP ID KG DAT!!(M10.T'!Li�'YY) AcQRP. CERTIFICATE OF LIABILITY INSURANCE DAVID-a 07 14/09 oRODUCNt THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northnaood IA6. AgenCY, Ind- HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND Q,8 540 Mica Strs�t, Suite 9' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis H& 02601 Phone:608-711-1632 Tax:508-393-2955 INSURERS AFFORDING COVERAGE 'NAIC0 IN N5UREI A Travelers Insurance Co. INSURER B Travalare 2nsusamc�em*any red Cox, QC. ifr_-uReR _ vv Box 4 1 dSURER D' S Yarmouth NIA 02644 !� I Wd�JRE;;E COVERAGE$ T-F p,?1!CIE°UI IviUR,aNCF 1.ISTE?3ELOW HAVE BEEN'SSI.ED T0'iE;NSUP5L NP•ED.YfsC`!E 'u2 THE CIOLIC.Y PEROM INDICATED NCTwITHSTAN-.A'dG Ja7 FV21."REtdkNT.7=RI4 iXk CONDIr0,I QF AW�;'NTFACT(-k.."THEE:00CUAE.I I VY'.rH RESPECT'C YN RC4-HIS' Ri iFlG??E P:.VO RE lKLED 0? roq'iPEPTAN,'r'1E 5Y THE YOLK ES DESCF:IDE:FRE!re IT:�:JBJEC-0%+LL-t1E-_F�+AF:.=ra.-U51iV5CCh;01T1?•J,S:,cSUC"- PCv ICIC3 A.r:d4EeiAT,e. Yea.'!I'A'JE El='J FEDLrV P. PAID CLAiA1S. .� !TR R TYPE V INSURANCE POLICY WINVER 0A E( D/t'YI DATE IM D�YY) UNITS A i GENERAL EA.^HO,:CUiRErdr_E 11'S_1000000 pPeP K ru r,E�Le•gl_I ;L{Tv ` I-C80-145324796-COS-I0903/14/09 i 03/14/10 eSa E.,I.I' " L'on. S 300000 i r--Ill- CLO,US MADE lK via nereo�,i I`••5000 I Fr tFSCP:aLKKU':Qd L-r' 1-000000 x B usiness Owners - i i !w� _rEge%L1:. c-Reca;re s 2000000� I �,L A0,)RC5ATELIMIT APP-IES PER' ,acLc -c^:tiIC;CP 3; S 200000® POLICY I ;'�� Lec '+ CSIa 2000000 AuTOMOBLE LIABILITY i j O'IN 'e C:ar:ca.E L!6tIT V i I�ANY AIJ-D i (Es(Par oifw! 1 � L'L'D`.YVEC AL,i�:S I i iB0011':N,/J�iY �-•-1 AUTOS—! �------- 1 wa>EDAJroo j SODILI 1W.Rl 1 1 {Pe,accld?Mi f Ii-- dON-�NNED AaIT05 �I � i � . `1 '-- l P;r aocido ifua'AGE I I I 0ARAOE LWILITY ml A'vTG Cr.IL'r- f.A^CC:DE`T S APd'!AU-0 OIHEPI ,T!Q` ,.E�AJ�. 1 1 A'vT4JPAY' A ,L� + ;EXCRSB!UIdBRELLA LIABILITY 111 :H:) t!RRENC,E s. l__ ._''_--- _jC'I+2M5MADE i (:xG eEsA:r 1 7-1 PETENT ON i S WORKERS CDBN9ATION AND &ftOYERS'L1A Iur( B 4�'r�'R=F IE('.h''PARTI eu/EtECU-i;F CUT RIL MUM MW Co 07!15/08 07/15f 09 _ EyC-ar_.:u=NT 100000 OF-ICEWNIEMBEREXC:LC;sDO I ATIN 5 DAYS 07/13/0.9 07/15/10 'E.L;,D!SEArE-Ea.E'.F_Cr'EEI s 100000 M if yes.Womb,)under Cl GISE ; ,4:3E IT 500000 jP-CrLPF%VISIl7KJOeID'�: .:JLICI LV� PEWRpMN160 5FORAMUZ 1 - Ni!V L !EX LL'S1CNS ADDED BY ENCORSERFITF,SPECY-AL PROVI6f0 z CERTIFICATE HOLDER CANCELLATION TOWNBAA OHOULC ANY OF TPE ABOVE DESCRIBED POLICIES BE CANCEI.6I0 BEFORE THE EXMRATION DATE THERECF,THE WuING INSURER WILL ENDEAVOR TO MNL 10 DAYS'A'RMl Fj,4 NOT"TO TIC CERTIFICATE WOLOER NAND TO THE LEFT.RUT FAILURS TO DO 20 SHALL TOM OT BARDISTABLlE WOSE NO OSLk;ATION OR LIABILITY OF ANY kIND UPON THE INSURER,ITS A.ENTS OR 367 =N STREET HYANKIS HA 02601 REPRBiBJTATIYEB. ACORD 25(2001108) oA ACOR D CORPORATION 1988 �� f� � _ oar of m mg egu ation and tand"a d onstruction Supervisor License License CS 63537. . B rthtiate t10/15/1953 fI Expiration 1015/2009 Tr# 6313 Restriction OOP E • - DAVID R COX PO BOX 401 �` S YARMOUTH,MA 0266 � Commisstoner., 1�71lze �omv.�w�uuea/C/o���aaoacJueea —— Board of Building Regulations and Standards License or registration valid for indivi HOME IMPROVEMENT CONTRACTOR dul use only before the expiration date. If found return to: Registration 100497 Board of Building Regulations and Standards .Expiration p 6/18/2010 Tr# 268012 One Ashburton Place Rm 1301 j f TYpe �Pnvate Corporation r Boston,Ma.02108 DAVID COX,INCH ��' David Cox H ,19 LAVENDER LN I W.YARMOUTH,MA 02673uKJ __ Administrator_ Not valid without s- nature -:i' 44'-0. - 44'-0- d Q co xcc y, z � o Q W O N N •1 13'-4' 12—3 2-8" 8'-0- 9r_7- W W R1 '�/-I' rr U eK/TCHEN o o ------------------------ ---- --------m -- --- -------------- ¢ � ' ' w o x EDROOM 1 D/N/NG ROOM f'' - o U z r 1 REMOVE EX/ST .PART/r/ON ,- BEDROOM -f 1 12'-9" - 1'I iv Q�i ___ _ ___- ____--_- F-'-i _ — __ - ^' EX/ST/NG P RT/T/ON NEW MW x/5 5 rEEL AM FLUSH CL 05ET w v BEDROOM/ L/l//NG.ROOM v ❑ o 14r_2" 3'-3- 19'-3 • JB'-0" - W W .�( W t 0 ,� p . F z o o :a z r EXISTING FIRST FLOOR PLAN EXfSTING SECOND FLOOR PLAN. LLI Z w ti 44'-0" EX151 Mr, EX/5 r/NG 3:1 x B .EX/5/rNG LALLY - NEIV ABOVE DATE: 4'-0- 5'—�� V-8" — 0� 8'-0" N NEB!//9/1'x 9//>'L VL - RXIS 6IR EA 5/DE OF - EX/5T G/RT. ExisriNc SCALE: FLOOR PLAN (V O EXISTING FOUNDATION PLAN N co ©COPYRIGHT 2009/KAREN 6.KEMPTON INC. • C:\DATACAD 12\DRAWINGS\MOREY\EXIST-7-20-09.AEC / x 2 S 7 R,4 PP/NG ,4 T SU OBE', EX z � w v 3 BFL O /S T G EXIST. 2 x 8 ,4T /6" CC a " m 3/8" P�E'OUD OF S TL 3E,4/'9 H 3 F,4 CE NOUN T /7,4 NOER 6� � a (y� v °m a X °D C LU i ♦ U ♦ W Z � Q EX/s T//VG BEDROOM C,41( � 4 GE B OL TS 5-T,406ERFD TSB Q a ll/6 X /F S TL , BE,4/"l Z w Exrsr2X8 � ri6�� , NEW W z STEEL BEAM DETAIL } REh/O/E EX/S MO PfiRT/T/ON z 2 ww m' 1 6„ EX/s TING 4/1//NG. EXrs TING DINING EXIST 2 x 8 A T // ANEW/3/4 x 9//4"L VL A T EA SIDE OF EX/S T 3: 2 x S. G/R T S//1PSON SDS //9'x 3" SCREWS 2 SCREWS A T/2" OC 13'-2" EX/s TING BA sEIYEN T SCALE: /4"= SECTIONS a r� In r SECTION AMy N .. -- 0 N 0 \ N 00 n 0 COPYRIGHT 2009/KAREN B.KEMPTON INC. C:\DATACAD 12\DRAWINGS\MOREY\EXIST-7-20-09.AEC H - - -44-0 c x y 7 m w C- H N F,-,T..- F U d W m U 13'-4' 12'-2` .. <. 12'-3' - 2'-8" 8'-0 ` i 9'-7" W.0.1 p o 'y - �f. z E, �' KITCHEN e o ------------------------ ---- --------� -- -- -------------- x ¢ � n o -DROOM.2 x a D/N/NO ROO/f" t---i I e � c a M'a --- REMOVE EX/ST I ,� � M 4 PART/T/ON '%-------____ _"_': I _ '" BEDROOM 3 BEDROOM 9 (x o `c ' N N __ _ - o ----- - -- -- i R - •_.. `-REMOVE EXISTING P RT/T/ON NE' Me x./5 5.7EE4 AM FLU5H " "'.. .. ,• - - . CLOSET o _ o 0 < BEDROOM/ L/1/NO.ROOM 14'-2" 19'-3 W 4, o w Z a EXISTING FIRST FLOOR PLAN , 0 _ EXISTING SECOND'FLOOR PLAN Z w Y; W o r - EX/5T%NG•3:1 x B EX/5/TNG LALL Y COLUMNS - ''..• MEW POINT LOAD FROM - 1 " r _ _ � s DATE:.. ABOVE - 4'-0" 5'-7" 3'-8` - 0` g'_p• 7'-3" NEW/31W x 9//9"L VL .- ATTACHED EA 5/0E OF - - - - EXIST G/RT.- V SCALE: 1/$"=1 1/�f -EX/STING - - _ -0 e 2,BAT/L'OC FLOOR PLAN a Lo 38'-0' - N EXISTING FOUNDATION PLAN to Awo co ©COPYRIGHT 2009/KAREN B.KEMPTON INC. C:\DATACAD 12\DRAWINGS\MOREY\EXIST`7-20-09.AEC / x 3 S TiEFA PP/NG A T /6" OC BUBFL OCR, EX/S T zID EX/S7. 2x8 /4T" /6" OC ° a , Q " m 3/8" P�POUD OF STL BE�I`9 a �D 3 W W a s o F,4 CE NOUN T h',4 NGEP U ¢z < 0. �4 � a m Z ro c W - EX/S TINO BEDROOM C,4 APR/,4 GE B OL TS . 24 OC _ [1] ' • �- Z . Q .�. . . .5 l,4 GGFiPFD TeB 2. 2x6 �- Z 0 �- EXIST 2 X B ,A r /6 lU6 X. /5 S TL µ BEAhI p W > Z,. � ' NEI// W L x/S S TL Q ] Q BEA/Y "STEEL BEAM DETAIL REMOVE EX/S TING 0 C L `. PART/T/ON h - EX/S T/NO 4/1//NO EX/5 TWO DINING EXSr2Xe ,4r /6„ E NEW/3/4'x 9 //4'L VL A T. EA S/DE OF EX/S T 3: 2 x B GIRT S/MPSON SOS //4"x.S"SCREIVS , 2 SCREWS A T/2' OC' 1 S-2„ 11 -2„ -' BX/S r/NO BA 5El'9EN T • + • SCALE: h_1, „ 1/4 -0 SECTIONS . A SECTION , N j - .. N Ao-42::] N © m COPYRIGHT 2009/KAREN 8.KEMPTON INC. ° C:\DATACAD 1.2\DRAWINGS\MOREY\EXIST-7.20-09.AEC