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Permit No. B-18-2369 Applicant Name: GARY J GRAHAM Approvals
Date Issued: 07/24/2018 Current Use: Structure
Permit Type: Building-'Deck Expiration-Date: 01/24/2019 Foundation:
Location: 75 SCHOOL STREET, HYANNIS Map/Lot 327-258 Zoning District: MS Sheathing:
Owner on Record: HOUSING FOR ALL CORPORATION Contractor.Name -GARY J GRAHAM Framing: 1
Contractor License' CS 110569 .
Address: 82 SCHOOL ST 2
HYANNIS, MA 02601 Project Cost: $8,000.00 Chimney:
: r Y
Description: 8x10 x 8x10 Roof Deck and Railings i Permit Fee: $110.00
t rM Insulation:
Project Review Req: 2X6 JOIST SIZE MINIMUM Fee Paid ' $110.00
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Date 7/24/2018 Final:
kk �� 3
Plumbing/Gas
s � Rough Plumbing:
Building Official
_ ! .. •.,;Fs Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved applicat on and thapproved construction documents for which this permit has been granted. g
All construction,alterations and changes of use of any building and structures shall be in with the local zoning b, laws and codes. Final Gas: '
This permit shall be displayed in a location clearly visible from access street or`roadrand shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. ` '• Electrical
a
The Certificate of Occupancy will not be issued until all applicable signatures by the B�Idmj�and Fire Officials are prowded on this'permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:
1.Foundation or Footing , ' Rough:
2.Sheathing Inspection '"
3:All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation ,
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
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BUILDING DEPT Number..Z_IX.......10,3.
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' KAM JUL 24 2U!0 P=itFee.................... ........OtherF ..
TOWN OF BARWTAS-L
Total Fee Paid /
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TOWN OF BARNSTABLE Permit Approval by..:... '..'u., ..........oa.....�a ! _
BULLDINO PERMIT .. .. ...................Pam............. J ..................
APPLICATION
Section I — Owner's Information and Project.Location
Project Address -1 J 'SGkoo l Village
Owners Name a M 10 'A
Owners Legal Address S c;rn e
1 S State t A --Zip- oiol-
Owners Cell# 50% �� - � 1 C� ci rn 64r n M�► 1 CQ
Section 2—Use of Structure
Use Group—ov
/ Commercial Structure over 35,000 cubic feet
Ln! Commercial Structure under 35,000 cubic feet
❑ Single/Two Family Dwelling
Section 3—Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire struetre) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm
Rebuild Deck Apartment a Sprinkler System
❑ Addition ❑ Retaining wall ❑ Solar
❑ Renovation ❑ Pool ❑ Insulation
Other—Specify
Section 4-Work Description
Ina
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i act nndxhed:2192019
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ApplicationNumber....................................................
Section 5—Detail
Cost of Proposed Construction Q S e Footage of Project
p
Age of Structure - c Dig Safe Number
#Of Bedrooms Existing Total#Of Bedrooms(proposed)
110 MPH Wind Zone Compliance Method ❑.MA Checklist ❑ WFCM Checklist ❑ Design {
I
Section 6—Project Specifics
❑ Wlnng ❑ Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing ❑ Gas .❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
--- ---
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal '❑ On Site
Historic District [] Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
j
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq.Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No-
Last imdated:2/9/2018
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ROOF DECK PLAN NOTES: SCA E:=
1.)CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS 114"=1'•0°
&DIMENSIONS IN THE FIELD DATE:
2.)CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, 5
DETAILS,&FINISHES IN THE FIELD WITH OWNER • DWG N NO.O.:
3.)ALL CONSTRUCTION TO CONFORM TO.THE IBC2015 BUILDING CODE
&THE MASSACHUSETTS 9TH EDITION AMENDMENTS
4.) 110 MPH EXPOSURE B WIND ZONE,
Dept. li,tTjf z 3c� �cg
Barnstable Bldg. Dept/ sts
Approved by: D�
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Permit#:—i—
The Commonwealth of Massachusetts
Department of lndustrialAccidents
Office of Investigations
_ 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name(Business/Organizatiombdividual): G oft Ic- Q10,
�G4 N1
Address: -7L4 Ca41ew ocO `_CCle
City/State/Zip: a 11 tl 15 Phone#: b 0l " '�15
Are you an employer? ck the appropriate bow Type of project(required):
1.❑ I am a employer with 4. D<I am a general contractor and I
have hired the sub-contractors 6. ❑New construction
employees(fuII and/or part-time).* -
Z. 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'
$ 9. ❑Building addition
[No workers'comp.insurance comp,insurance.
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 C 5
employees.[No workers' 13.XOther Oi3 �eGk C �n�
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state vrbether 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coyeragp verification.
I do hereby certi u der,the p ' s d penalties of perjury that the information provided above is true and correct
Signature: - Date: " D
Phone#• J5C�
Official use only. Do not write in this area,to be completed by city or town offccial „
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#:
f
f
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an errrplayee is defined as"...every person in the service of another Tinder any contract ofhire,
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."
MCTL 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
Ple
ase be sure that the affidavit is complete and printed legubly. 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 appl
icant
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
P .cY (
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 fist re,penmits 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 hike 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 COIItMCMwean of Massachusetts
Department of ludustW Aeeideuts
Qf m of Investagatioas
600 Washington Weet
Rostan,MA 02111
Tel,##617-727-4900 ext 406 car 1-977-MASSAFE
Fax 9 617-727-7749
Revised 4-24-07 wmass.gov/dia
Massachusetts Department,of.Public Safety
Board of Building Regulations and Standards
License: CS-110569 .;
Construction Supervisor r ft
;
GARY.J GRAHAM
74 CASTLEWOOD
HYANNIS MA 02601
Expiration:
'Cornrnissioner 11124/2.020
0
DATE(MM/DD/YYYY)
Ace CERTIFICATE OF LIABILITY INSURANCE
7/20/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorseme s.
PRODUCER NAME:CT,Christian Barber, CIC
The Oceanside Insurance Group PHONE (508)775-0500 FAX No:(508)790-79s5
E-MAIL
ADDRESS:
52 West Main Street INSURERS AFFORDING COVERAGE NAIL
Hyannis MA 02601 INSURER A:Ca itol Specialty Insurance
INSURED INSURER B Associated Employers Ins CO
McNamara Home Improvement, LLC INSURER C:
69 Castlewood Circle INSURER D:
INSURER E:
Hyannis MA 02601 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL186806064 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL UBR WVn POLICY NUMBER POLICY EFF POLICY YY LTR YI UNITS
S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED -
A CWNSMADE OCCUR PREMISES(Ea occurrence) $ 100,000
CS1700329602 4/26/2018 4/26/1019 'NEDEXp(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
g POLICY❑JECaT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: • $
AUTOMOBILE LIABILITY COMBINED SINGLE UM $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ 500,000
OFFICER/MEM13 (Mandatory
H)EXCLUDED?. WCC-500-5025138-2017A 10/7/2017 10/7/2018
(MahMatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
0 yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsement of
the policy. Nothing contained in the certificate of insurance'.shall bye deemed to have altered, waived,
or extended the coverage provided by'the policy provisions.
r
CERTIFICATE HOLDER ' CANCELLATION
Garpjgraham87@yahoo-com
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Gary Graham THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
85'Castlewood Circle ACCORDANCE WITH THE POLICY PROVISIONS.
Hyannis, MA 02601
AUTHORIZED REPRESENTATIVE'
C Barber; CIC/MARIE
m 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025(2m loi)
ApplicationNumber............ ............. .......... '
Section 9—.Construction Supervisor
Name L C�7 ca a rh Telephone Number
Address c, " �eWo C i f City ` q/m/5 State zip, O A O I
License Number CS - 11090 License Type Expiration Date
Contractors - cap sVA ha 19-77 Cell#
`/Q I-00 Carr,
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachus State Building Co . I understand the construction inspection procedures,specific inspections and
documentation y 780 CMR' To of Barnstable.Attach a copy of your license.
Signature t1 Date - -)
Section-10—Home Improvement Contractor
Name Telephone Number
Address City State Tip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Bamstable.Attach a copy of your EUC...
Signature Date
Section 11-Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
Signature Date-7- o —15
G
Print Name C Pr4; C' v- Telephone Number
E-mail permit to: ®,c- ���A w! (�r�e l� -Ccr�-J
T-..F.....3..aa.ninhni 0
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation
For commercial work,please take your plans directly to the fire deparknent for approval
Section 13—Owner's Authorization
I, Mgv as Owner of the-subject property hereby
authorize r eK to act on my behalf in all
matters relative t ork authorized by this building permit application for:
'75 Sc koo l
(Address of j ob) '
Signature of Owner date
d,14A4
Print Name
Last wdit :219/2018