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Home My WebLink About0294 SCUDDER AVENUE Ir �9 'i SCUDPE9- Avg - - I� i Ta,�dj D lariS - Jla-ns� LA� if S��s �4�L S �T Town of BarnstableBuilding snxtNsrn;€ Post"This Card So That it is Visible From the Street.-Approved Ffans Must be Retained on Job and this Card,Must be Kept MAS& �POSted Until finaF-Inspection�Has`Been Made. er mit Whe're a Certificate of Occupancy ,is Required,such Building shall Not be Occupied until a final Inspection has been made. 'Where Permit NO. B-20-1676 Applicant Name: BRIAN DENNISON Approvals Datelssued: 07/02/2020 Current Use: Structure Permit-Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/02/2021 Foundation: Location: 294 SCUDDER AVENUE, HYANNIS Map/Lot: 288-225 Zoning District: RB Sheathing: Owner on Record: BAKEWELL,JENIFER J Contractor Name',SOUTHERN NEW ENGLAND Framing: 1 WINDOWS LLC Address: PO BOX 657 y 2 Contractor License: 173245 HYANNIS PORT, MA 02647 Chimney: Description: INSTALL( 1) REPLACEMENT PATIO DOOR NO STRUCTURAL Est Project Cost: $7,508.00 ! Insulation: Permit Fee: • $38.29 Project Review Req: Fee Paid": $38.29 Final: a " Date:' 7/2/2020 Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official h Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough All work authorized by this permit shall conform to the approved application and the approved construction,documentsfor which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or-road and shall be maintained open-foe public inspection for the entire duration of the work until the completion of the same. ) _° Electrical until all applicable signatures b -the Building and Fire Officials are provided on this permit. Service: The Certificate of Occupancy will not be issued u pp g y g p I ,.�' Minimum of Five Call Inspections Required for All Construction Work:, Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 br :=a► =)E` Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �r►n� SF.-r-i .Kw• Town of Bamstable =Perm lSQ E s 6 mo ronr issr�e date (Regulatory Services Fee m BexrrsTast t; nb q: Richard V.Scali,Interim Director e Building Division .PREJPEPtifny Tom Perry,CBO,Building Commissioner 200 Main Street;Hyannis,MA 02601 NOV 0 4 2015 1vvgv.town.bamstable.ma.us w �A�LE Office: 508-862-4038 t r TOWN ®FIU�hl 0-6230 ...,.. - - UNDRESS�i'r1llVH APPLICATION — JL` ESID L:1NTLA!!.l ONLY Map/p arcel Number a Not Valid wi0rorrt Red X-}Tess Lnprint l�� -��S - , PropeAy—Address_ o��7 �1Cyc7�d t°/ 4✓e - ✓Q - /1 i S �� [Residential Value of Work 5 Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address Al Contractor's Name ik ( e, 91-e-Oinc6,5 &66 1 tlon n i �.,n Telephone Number( 01)Z2k-g U)C) Home Improvement Contractor License_(if applicable)__ /j 3 Email: Construction Supervisor's License_(if applicable) p 5 5:O-r Of Workriian's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ .I�am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A r !Q n c t _l-.n5 u Cg Y 1 Cam. Work-man's Comp.Policy 3 9 9 ` Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping,old shingles)- All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over .. existing layers of roof) ❑ Re-side (]'Replacement Windows/doors/sliders.U Value , 5 t) (maximum;5)-of windows of doors: ❑ SmokelCarbon Monoxide detectors 4 floor plans marked with red S and inspections required.' Separate Electrical&Fire Permits required. Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. '`--Note: Propertyipwner must sigh Property Owner Letter of Permission. A copy ut the Home Improvement Contractors License&Construction Supervisors License is ' required. Y - SIGNATURE: G � �:�..... • ,� Q:Nik,'PFILES1FORi14S\building permit PotmsXMRESS.doc Revised 061313 in Wc� Renewal : p All;neaar92u' RENEWAL BY ANDERS,EN,. �, , t a24s' wr�ooi� ■vuscrar:�,iea�.,nco :r 26 Albion Road"t Lancolri RI 02865' • icid c�rmai2:{z Phone 866 5631JB3 i Fax 4161.63.66ft``►� LLC Fid�ry�r io rr A,! . (Y` $outhern New Sn&M-WindoWs, :d/h/a �D Reaesval by.An_deesea'of_Sota�ern_New Bpgimd-• I- y CUSTOM W-INDOW AND DOOR REiyIODELINt3 A6REI3MEN7 •¢ �cni•�« �'en:r'Fer' QAKew��11 ��„� � 2z r��' ",l S6 Adii_.:Cay Sam irx!rp CClt,RO-Goii. 29� S'�ltl d d t et a}u_-L _ 1 ,tS?.64'l 6CLIIAddress; -..- TNnm6er�� ` 7W6rk1NM�r��" . Butri•(s)herebypintly and severally agrees to purcFiase:lhe acts=and/or service`s of Southern Ne y:l ngland}Vmdows Id.0,iUb/.i Ren6yal by Andersen of"Southern-New England Iit cordance w th the terms and:conditions described'on the front and the;reverse of ihts agree`nent and on the a.[tached'specifim. s}ieet(s)(cull nveiy,'ibis Agreement.}. p Historic O Condo`::O lIOAT r nn LL TutalJob Amoantl��r y"�� Snrung Ott MEthod Oi PaymenC f OC,ttedt �'Caih a f financed, t R.66i ed(33X) a Credrc Car6s are accepted for,!T?!tt onry--trwc6num I13 of the'. Balance.ae 5art of job(33%). al i_.:' prgac oost(fk�e m Grdt t drd i�ment.Forrn)BY sigr'tn8 e'h CO11p °i'Dace Agreement yea tdmotiyleclee that the Bahihce at Start of job and ehe', Balance:oih Substantial p "/Z W, Balance on 5ubsnritlal Campletlarof Job careiot be bade by credit .Coln etton of ob 33_ aM anal mutt be'maile by Vetsomldietit;bank che�kor rani., i$ayer•4s)agreee:aod turderxtands:that ttsis�. t coss6titatee ttte entire nnderstandiag between the pasbtes;;and that !here are no verbal understasdmgit changing any. f the terms of-'this Agreement Buyrr(s)achnowletlges that;Buyee(is) (I}has cent ties Agreement,ondecstands the teroi of this Agreement,and Gas hmemd a co>inpleteds'stgned;;and dated, copy:ofllbas Agreement,_inchadangythe two ailached trees oCC—'ellsi<oa�on Le date'firat warren abovc.and(2)was orally ''irrformed.ofH s ttocascel.this meat+ ONOTSIGNTHISCONtmdTIFTHEREARE"ANYBIANKSPAC)3S:' AB' RkodelelnxdSa[eat�s[y)Notsceto'Bayers(ljDono ergs rhis;Agreementsfaayofthe acesinteadedfordse terme, �,, to the e>nest of rhea available tntorrssation,are leR,b (2)•You sae-entitled to a copy of tlsis Agreement at the tiseie you asga it (3}Yon may at any trrne pay off 6e fuII unpaid: ce due under.tlns Agreement,and in so doing yoa:may Ise entitled to, " MAR,aet,al Yrebate of thet6naoee and inrrrean `c 3�arges (� The sellerr has - right to utatawhtpy e{ter�yopr premistw: --_ _ . :or comm.t any l;e earls ol�ilie peace eo teposseas goo s p aAdee t /lgreemeriti(S)§1"on magi cancel lh�s algi eesitin!' d n'bas"aot been signed at:the.mam ot6ce or a b 4ee of the seller,provsded'you notify the seller at:hrs or he,r.main- offece;orbranch o�hce shown m t>&e Agreement by „stored or cerd8cd marl,whsehstiatl beposied not later than audsighr of the tlifird cWsn tar day aRerthe deg on wLich tf ngsr si�tis the A g cement;e:etndik' S>.oday anti guy hohds►y;on:vhieh' Eregntar:marl delivcrles are not"niadc Si-*tie aecom ynssg notia'of a►aeellation Corm for an espiaaation of bnyes's dghss: );Buver(s)cecesred the comatmereJiucauon hnatcnals ptvi+tded the Rhone lsiand Co nttactorsrRegtstrat�on&tara (Buyo'r inrttalt` rReaewaLby'Andeesen of Southern!Yew F,ttglsnd _ u = Vj' � Y f Signatu f Prodnciltifanagie Stgnaiure JSignature A` 1�6L Point Name of Ptnduc Manager:. {Frith['"Dame,., Print Vame - =YOU, TIC BUYERS},"MAY GAIVCEL THIS CTION AT ANY TMMTRIOW! 'MIDNIGHT OF THEZTHIRD? BUSINESS DAY AtiTBR T[•IE DATE OF THIS T1tAN$ •CTIOIV:�SEB THB ATTACHED NOTICE OF CA1�TtTION FORMS: =FOR AN E)M ANATION OF THIS RIGHT CE _ NOTICE OF GANCELt ATION 0 QZ 1 L1ate ofTransactron You cancel, Date of Tharssaction You may cancel Sohn transactton,i�M'tit yip natty or -litiga�on witfiin this transaction,without atry penaky or oWigatton;wtthtri three business d' from the aboya:date.It' a tan 1,any; thrctbussr►ess,da�s from the above date:ff you eancN,any. property traded"in,arty;piyments:made^br,you-fin er ti+e, i, V1,9M y traded tn,euiy:payroeihts made by you under.'tke :Convect or Sale;and anj ne�ttbaWe trig _.rr*nt ate I: -Contract or Sale,and aihy negotisble:inatritment executed' bq you,yiiill be-.returned witfim ten tsusiness dajn Iowisig: {; by ypy will Wmtureed whthin:,ten 6tniness days following, recerpt b)r the Setter of your,cancellation snodte any-^� receipt b)r the'.Seller ot.yourz cancellation notsce;and ariy seeursty interest arsstng out of tits trarhsacdon II br security 1.00*st arising out o! the transaction shrill be tarceitad ff you eancet,you:mwt make available to eh Seller I: canceled It thou cancel you must make available to the Seller at your nesrdence,'in suhstandalty as good co"ndhaon ,when `i at your reaidencei�n subatantWly as gaol condition as when s'necesved,ashy goods delivered to you under ehn Con tor; t'. reu�ved,arry.goods delivered to you under this Contract or? rSale or you may,rf you wish,comply'Aim d e rnstsv "ons of j:'Salti;.or you may,hf you wssh,coivtply wstl+.tte mst'ucbons of; i the Seiler regarding the return shipmarst of the at tine the Seller regarding the retasrn shipment of the goods at efts Seller`s eexxppeense and risk If-you do;make Ilse gg0000ds lahia� Seller y e�erase and risk,If you do make the goods available^, to the Seller and':ihe Seller dees;'eot Ficktfiem withrir. !' to'this' er salt the Seller does not pick them up within twenty,d'sys of the date of cancellation,y6 may rt o'r i, twenty da of,the date.of cancellation;`you may,retasn;or dsspose of tilt g"ds without at►y';fiirtheii, bbgatb It you I dispose of tee goods without asiir furtter;obitgapon It you fait eo matte the"goods available to tte:Setler or if yo agree i fail'to make.the goodi avahlable,:to tfhe:8cller,or.if you agi ee to return the goers to the.Seller grind fast to do soi t n you l- to,return the goods co the Seller:and fail;to do so;`then you iesrhasn tFable for'p�rfarmaswe of sill oWigauknstu: .r the'. remain IIaW-, r perfonnaneefo!all obligations under thrt Contrast To ranee!thus transaction;mail or Qelhrer sighed. l' ComracCTo cancel this frarhsacton,mail or deltvara agned: artd dated co of this >. py cancellation notice or other i ark dated copy of tH�i cancellation notice or=any otl+e' written notice,orsend a tNr'A to.Renewal An en of I, ,written nodte,or send a teleggrraamen to Renewal byAndersan of: SouthernNew En" au.3on,Road, 865,: j 'Southern NevrEngUutd"nit IifAltiion RoadLhnrntn,:R102865:. NDpOT LATER.TNIDNIGHT OF - a"' j; (NOT LATERTHAN,MIONIGHT OF, i,HEREBY CANCEL THISTRANSACTlON ' i HEREBY CANCELTHISTRI►NSACTtON"r n ' X airyris Etpii!v} Pitnc Maiiu`- om: - hpryut ftpn!tuo Prim Naito tlr6e: kO'Copr.VVFite Buyer'.Capy Telkiw &irekCopr Pink, Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS4)957V? I � ♦` I BRIAN D DN �' I 7 LAMBS POND' 4 Chariton MA 01507 Expiration Commissioner 09/0 mis _ Office of Consumer Affairs hnd Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registiation: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL , Expiration: eflsnols DENNISON BRIAN 26 ALBION RD -- LINCOLN,RI 02865 Update Address and return card.Mark reason for change. ecn r o 2n445m Address []Renewal I]Employment Lost Card *Expirstion: m of Coueer Affairs&Business Regulation License or registration valid for individui use only IMPROVEMENT CONTRACTOR before the expiration date.If found return to: Office of C.omomer Again and Business Regulation n: izk2* Tripe 18ParkPlaza-SuiteS176 9/1912oit; Supplemerd-.;aid Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD a--,dLdJ.— r_ LINCOLN,RI 02865 Urtilary Not valid bout signature The Commonwealth of Massachusetts Department of IndustfialAccidents. - Office of Investigations I Congress Street, Suite 100 Boston, AM 02114-2017 www mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd city/State/Zip:Lincoln, RI 02865 Phone #:401-228-9804 Are you an employer? Check the appropriate bog: Type of project(required):, I 20+ 4. am a general contractor and I l,Q I ails a employer with ❑ g 6. New construction employees (full and/or part-time)_* have hired the sub-contractors, 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7_ ❑Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y p tY + 9. ❑Building addition [No workers' comp.insurance comp.insurance.} required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their I I.Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI 12.❑ Roof repairs insurance required.] f c. 152, §I(4),and we have no = employees. [No workers' 13. Other �1 rlJ(�t�L�� comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy infonnati ' 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 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 poMZy and job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lic. #:WC 928058352394 Expiration Date:8i21/201$ Job Site Address: `a'N SC uc'd Pr Ale- City/State/Zip:l7✓q/!/Ila Rgn 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`pfMGL 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' prance coverage verification. I do hereby cerd&undDer the and penalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: 4012289800 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 b.Other Contact Person: 'Phone#: r SOUTNEW-01 SHETTYSHT ACORL�® DATE(MM/DD/YYY`� CERTIFICATE OF LIABILITY INSURANCE DATE DNY 015 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 endomement(s). PRODUCER NAMEACT : Willis Certificate Center Willis of New Jersey,Inc. PHONE FAX c/o 26 Century Blvd A/c No Ext:(877)945-7378 Arc No:(888)467-2378 P.O.Box 305191 ADDRESS:certificates@vAllis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen 26 Albion Road INSURER D Lincoln,RI 02865 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDLSUBK POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/D MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR S 2029459 08110/2015 08/1012016 DAMAGE TO R N PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ J 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 Ea accident A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS paraccident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ r $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE EERH B ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA 0000068028 08121/2015 08121/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/2112015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD PROJECT DAME: ADDRESS: ck LA VAs PERMIT# PERMIT DATE: M/P 2 Z LARGE ROLLED PLANS ARE IN. SLOT Data entered in MAPS program on: BY: r. r .. q/wpfiles/forms/archive. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel— 7- 7.5 Application Oao 1,/0. Health Division Date Issued - Conservation Division f�� ✓ Application Fee �J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village la%4..V y a Owner �"E IV I' E72xC� �� Address Telephone 77� Permit Request SE ewAA9 deLwf- D 1!)z2A.0 4�IA 4 Square feet: 1 st floor: existing rJ 8'Z proposed ! ?2 2nd floor: existing VZ-proposed 132-6 Total new qq y Zoning District K 8 Flood Plain Groundwater Overlay Project Valuation / /l,000 Construction Type -1) UX5W Lot Size 4 S, T76 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 30 Two Family ❑ Multi-Family (# units) Age of Existing Structure X7 _ Historic House: ❑Yes a No On Old King's Highway: ❑Yes 3 No Basement Type: I Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) It � Basement Unfinished Area(sq.ft) g Number of Baths: Full: existing 2. 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: Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0 Yes ❑ No Fireplaces: Existing XNew Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn:fl'existing ® new size_ Attached garage:,Clexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other-4.1 c Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use R65, D6-+A)1% L- Proposed Use IQESI DEAI%1*'L, y` APPLICANT INFORMATION t= �:(BUILDER,OR HOMEOWNER) • Tyr- Nar e � � S T GI A91✓; .Le» Telephone Number Address 11'Z.7i l fJUOW— NLe--.L 80 License # CY 71 S. if tl{�Wl c. 0)+ 0a 0 5 `: Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO • P SIGNATURE DATE 7llt Cf. FOR OFFICIAL USE ONLY APPLICATION# F DATE ISSUEDlei r �' MAP/PARCEL N0. ADDRESS VILLAGE 3 � � OWNER fr _ DATE OF INSPECTION: �'+ ,• r FOUNDATION FRAME INSULATION " f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' ` GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT 4 nw•. 1 ASSOCIATION PLAN NO. s The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (J /� Please Print Ledbly Name(Business/Organization/Individual): �rGk KO�� 4-'O VeT/LIJC-xlox/ Address: 1:2-3 14 Q VE6 N #N4.C-- 1?d City/State/Zip: 1+149W 1 cN !M►q aaU-Y5 Phone#: SO?- '13-:? -14BY0 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. D� 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 workingfor me in an capacity. employees and have workers' Y P h'- 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 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. $Contractors 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: ELO A EDGE + L Urrlda l4 iru 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 coverage verification. I do hereby certify u r e pains and penalties go,6perjuyy that the information provided above is true and correct Signature: ` Date: zz Z12- Phone#:' 501 —`/3J -47 t f 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.CitylTown 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 1.52,§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 024I'l- 4 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE - Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE 4I 30(/2012 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 INS[IRER(S)� AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAP'ED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement On this certificate does'not coffer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAM Alan Long Eldredge G Lumpkin Insurance Agency, Inc. PHONE . (508)945-0393 ` (sga)9as-aoa6 697 Main Street EIIrIUL _alan@elinsurance.com INSU S AFFORDING COVERAGE I NAIL e Chatham MA 02633 INSURErRA_Sccttsdale Insurance C INSURED o B007 INSURERD:Continental Indemni Ca.j 8259 Rick Roy Conatruction, LLC, and Rick Ray ,,S C: 123A Queen Anne Rd INSURER O INSURER E: Harwich MA 02645 INSURER COVERAGES CERTIFICATE NUMBER:CLI243001134 REVISION NUMBER` i 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 OT14ER;DOCUMEW WITtt RESPECT'PO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT.TO AL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LI AD TTRR TYPE OF INSURANCE POLICY EFF PIMODDY EXP; LIMITS I POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE s ( 1000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oocurterice $ 100,000 CLAIMS-0tWOE FX1 OCCUR SCS0026SSS 2/23/2011 /23/2012 MED EXP(Any arre ) S I PERSONAL&ADV INJURY S 1000000 GENERAL AGGREGATE S I 2000000 (aIFIELAGGREGATELIMITAPPLIESPER PRODUCTS-COMPA7P`AGG $ I 2000000 X POLICY PIECT LOC $ AUiOMOBILELIABILITY MBIKED BINED IN LIMB ANYAUTO BODILY INJURY(Perpmon) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peracadent) S NON-OWNED HIREDAUTOS AUTOS Pno AMAG 5 s X UMBRELLA tJA9 OCCUR EACH OCCURRENCE $ I 5,000,000 EXCESS uAB HCLANS-NME AGGREGATE s I 5,000,000 DED X RETENTIONS ID,000 0026586 2/23/2011 2/23/2012I L- WORKERS $ COMPENSATION AM[ on( AND EMPLOYERS LIABILITY ANY PROPRIEfORIPARTNE110(ECunVE YIN OFFICERIMEMBER EXCUJDED? NIA E.L.EACH ACCIDENT S I 500,000 (MmuNtory In NH) 6-839431-01-01 /29/20 2 /29/2013 ELD SE-EAEMPO $ I 500,000 If yes,des�e under DESCRIPTION OF OPERATIONS below ISEASE-POLICY 6MIT s I 500 000 s DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES(ARach ACORD 181.Ad(Bft l Remadm Seh".B more apace is eequUad) General Contractor including Carpentry & painting Operations; Certificateholder is an "Add't:ional Insured" as respects the General Liability coverage indicated above. j CERTIFICATE HOLDER CANCELLATION '; + SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN I1:lI Fn BEFORE THE EXPIRATION DATE THEREOF, NOTICE I ViItE1I BE ELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I ') AUTHORMED R a � Alan Long/BLDALI ACORD.25(ZtNOIl05) IN8025(zmoo5).ol ®f 988- O ACORD CORPORATIONI i!A117---j rights reserved.e„ The ACORD name and logo are reghrWre�d marks ACORD �I 07/31/2012 14:38 FAX 508 430 1350 SNOW & THOMSON INS AGCY 0 001 ACORNTM ! CERTIFICATE OF LIABILITY INSURANCE DA7073N112012�� TM. PRODUCER Phone: (500)432-0130 Fax: (soa)430-1350 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SNOW AND THIOIVI.SDN INSURANCE AGENCY,INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 514 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HARWICH PORT MA,02646 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Scottsdale Ins Co SUMMIT INSUI_A'riC)N COMPANY, INC_ INSURER B: Natl Union Fire Ins Co of Pitt5burr h PA- ----.... ... -..__......_......... -... INSURER C: P 0 BOX 1337 --... _..---- _._._....- ._..._.._....... . HARWICH MA 0213,165-6337 INSURER D _ INSURER E; COVERAGES THE POLICIES OF INSURANCE LISPED BEI.OW HAVE BEEN 16SUED 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, THG INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI.LTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE I:M(TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _.. ._.... ..._ ..._..... _.... . .........—_ ........ -- --" .. ..._._. _._._..-........ INSR ADD'L POLICY EPNECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DA'n3 nrt DDYY DATE MM/DDIYY LIMITS -- $ 1,000,000 GENERAL LIABILITY GPS1478281 03101112 03/01/13 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 6 50,00 _ PREMIPE8SEo omurcnco) CLI51.NS MADE�j OCCUR MED.EXP(Any one parson) $ $1000 PERSONAL d ADV INJURY S 1,000,000 — GENERAL AGGREGATE 6 210001000 GEN'LAGGREI ATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG. $ 1,000,000 ' PRO- -"---' ....----•-----•--.._...,..._._ POLIcy JECT LDC _ l AUTOMOBILE LIABILITY COMBINED SINCLE LIMIT $ I ANY AUTO (Ea oocidenq ALL OV1iNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED P.LITOS BODILY INJURY q NON•DVJIV (Per accldon EDAUTOS ' ._.—.._ .. —_.. . PROPERTY DAMAGE S I (Par accident) GARAGES LIAEVF._ITY AUTO ONLY_EA ACCIDENT 3 ,•_ ____- ANYALITO OTHER THAN EA ACC 6 AUTO ONLY; A13G EXCESS I UM13-RELLA LIABILITY EACH OCCURRENCE S OCCUR [—I CLAIMS MADE AGGREGATE $ 6 DEDUC,IBLE RETEW I)N S $ !:ATION AND wC l.L-11T Im OTIICR WORKERS COMPEN WC001.60-2108 06/28111 08126/12 TDR LIITa EMPLOYERS'LIAI31LITY E.L.EACH ACCIDENT b 100,000 B ANY PROPRIEYORIPARTNERIEXECUTIVE - OFFICERIM12MDEREXD4UDED'r E.L.DIBEASF,-EA EMPLOYE s,de 6 100,000 If YopaciiDo under SPo, e PROVISIONS MVlow E,L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 1 r -� CERTIFICATE:HOLDER CANCELLATION Rick Roy Construction EXPIRATION ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS I Queen Anne I'td. WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE Harwich,MA 0204t, TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR REPRESENTATIVES. Fax:508-432-AW14. AUTHORIZED REPRESENTATIVE '. AtUentlon: dAF'V41-'ifK�fll �� A• ACORD 25(2001/10) Certificate# 2648 ®ACORD CORPORATION 1988 —� ARNOL-1 OP ID:MP CERTIFICATE OF LIABILITY INSURANCE r DATE 07/31112 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 endorsements. CONTACT PRODUCER 508-385-2464 NAMS: Edward J.McGrath Insurance 508-385-5991 PHONE FAx P.O.Box 1003 AIC No uC No Dennis,MA 02638 E-MAIL E.J.McGrath Insurance Agency ADD Es INSURERS AFFORDING COVERAGE NAiC# INSURERA:Commerce Insurance Company INSURED Robert Arnold dba INSURER B:Liberty Mutual Insurance Group Fleetwood Plastering INSURER C: 2 George Holbrook Way E Harwich,MA 02645 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA Po TYPE OF INSURANCE POLICY NUMBER ADDLSUBR POLICY MM/DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY M33911 02/16/12 02/16/13 PREMISES Ea occurrence) $ 50,00 CLAIMS-MADE OCCUR MED EXP(Any one person $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY PRO LOC $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY accident) y HIRED AUTOS AUTOS I P $ UMBRELLA LLAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTIONS $ WORKERS COMPENSATION X WC TORY Lt. ER AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNERIEXECUTIVE Y© C631 S342039011 03/16/12 03/15/13 E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) \ E.L.DISEASE-EA EMPLOYEE $ 100,00 If Kai,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD t01,Additional Remarks Schedule,if more space is required) Plastering CERTIFICATE HOLDbR CANCELLATION RICKRO1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t" �t THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rick Roy Construction ACCORDANCE WITH THE POLICY PROVISIONS. .t. 123A Queen Anne Rd }• Harwich, MA 02645 AUTH ID REPRESENTATIVE E. rath Insurance Agen y 019 2010 ACO -CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered m of ACOR T00[n XVJ 66:6T ZTOZ/Te/LO 141 Zjll l.l'a,A 1\1—G v/ 1/ GV1G O 1J : VJ H!•1 YHId L, G/ VVG I"d..X �E.1'V("-.I' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/01/2012 IFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PASSARO,LEVERONB&BUCK PHONE FAX (A/C,No,Ext: 239 ROUTE 28C_ r PO BOX 160 PRODUCER DENNISPORT,MA 02639 CUSTOMER ID#: 28W7W INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OFAMERICA TOY,MATTHEW A INSURER B: INSURER C: INSURER D: PO BOX 694 INSURER E: SAGAMORE,MA 02561 INSVRER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY HE 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MIMDDIYYYY) (MKDMYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. DAMAGE TO RENTED $ REMISES(Ea occurrence) MED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER, ENERAL AGGREGATE $ POLICY O PROJECT [::]LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB F70CCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-5009P08A-12 03/17/2012 03/17/2013 X LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATION&LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. TOY,MATTHEW A IS COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION RICK ROY CONSTRUCTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 123A QUEEN ANNE RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT9TiVE f HARWICH,MA 02645 , ACORD 25(2009/09) 1988-20 9 ACORD CORPORATION. All rights reserved. ,. > , . . r",.. .-- , 4.. 4 i d #I.�I..I.I I.I�.I I.�I I.�.II�I 1"�-..I.��,I.��I..I,..� I. 1 I I I I II....-r1-i-.l.I I�1..� I I I�I I � �.-:.�:I1 II�,...I.I�-,�.1 1..I,..,.I I.�..-.I�I..I,.1 14,.iI I-II%,��5-.,I.�I�,��.��.'—.1,I -`�-�.i-.�-�`�, .I:'I:�t I'�-�.,�.',,...,Ii��.,;�I_,..,;,:_-,,L,��.-,'.�6__""-U,�-,-!�-._",,,"-"�-,_K,,�,,�:;:��,::�;�t ff_,,,,'.-,._"_.'-_1-.��",-_�_-'-"-'_--,1,_"--"_I--:,�I.1 II-1 1.�._- . I ia,athu':etti Del�a�tment fi PuIi1 C,Z-1 . 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": -.. - .. .. - ._. .. _ , X, y j T w ., ... ...: ' Y 3: j _ v rY 3 t- li, 11 1 { 3 6.F S F 2 +Si (:, :) z'. tit " c i �r I h M. 14 „ E a ti { roe rREScheck Software Version 4.4.2 �vfl Compliance Certificate Project Title: Bakewell Energy Code: 2009 IECC Location: Hyannis,Massachusetts Construction Type: Single Family Project Type: Addition/Alteration Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 294 Scudder Ave. Rick Roy Construction Hyannis,MA 123A Queen Anne Rd Harwich,MA 02645 •.. • - •. - ' fs .. ..;� ° ;',*,7"" 32�',i, �'�^°, ��w�' v�`.ur�.id��bz v�`*tt� lk�t y�3c a z ;,ro.t5n� l;u �x,F`�..: Compliance:1.2%Better Than Code Maximum UA:84 Your UA:83 The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. fP r ., c '. + w ,.;y 5 1 _'.k�G`� ��rff `t; rJa"+°+r'n„r' tg ^�` .` sr4J.m �Mk • "fi+ Ceiling 1:Cathedral Ceiling 21 30.0 0.0 1 Ceiling 2:Flat Ceiling or Scissor Truss 473 38.0 0.0 14 Wall 1:Wood Frame,16"D.C. 550 19.0 0.0 29 Window 1:Wood Frame:Double Pane with Low-E 34 0.310 11 Door 1:Glass 39 0.300 12 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 494 30.0 0.0 16 Compliance Statement. The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 009 IECC requirements in REScheck Version 4.4.2 and to comply with the mandatory requirements i ed the RESchec spe Checklist. Name-Title gnature Date Project Title: Bakewell Report date: 07/11/12 Data filename:\\SBSERVER\Users\RichGonet\My Documents\REScheck\Bakewell Gatage.rck Page 1 of 4 REScheck Software Version 4.4.2 Inspection Checklist Ceilings: ❑ Ceiling 1:Cathedral Ceiling,R-30.0 cavity insulation Comments: ❑ Ceiling 2:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-19.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.310 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1:Glass,U-factor:0.300 Comments: Floors: ❑ Floor 1:All-Wood Joistffruss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Air Leakage: ❑ Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or solid material. ❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between window/doorjambs and framing. ❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed to maintain insulation application. ❑ Wood-burning fireplaces have gasketed doors and outdoor combustion air. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Air Sealing and Insulation: ❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower door test result of less than 7 ACH at 50 pascals OR 2)the following items have been satisfied: (a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or repaired. (b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c)Above-grade walls:Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d)Floors:Air barrier is installed at any exposed edge of insulation. (a)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or sprayed/blown insulation extends behind piping and wiring. Project Title: Bakewell Report date: 07/11/12 Data filename:\\SBSERVER\Users\RichGonet\My Documents\REScheck\Bakewell Garage.rck Page 2 of 4 f % t (0 Comers,headers,narrow framing cavities,and rim joists are insulated. (9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall. Sunrooms: El Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: LI Materials and equipment are installed in accordance with the manufacturer's installation instructions. Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. O Materials and equipment are identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation: Cj Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: Ll Building framing cavities are not used as supply ducts. All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet-metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). Duct tightness test has been performed and meets one of the following test criteria: (1)Postconstruction leakage to outdoors test:Less than or equal to 8 cfm per 100 ft2 of conditioned floor area. (2)Postconstruction total leakage test(including air handler enclosure):Less than or equal to 12 cfm per 100 ft2. (3)Rough-in total leakage test with air handler installed:Less than or equal to 6 cfm per 100 ft2 of conditioned floor area. (4)Rough-in total leakage test without air handler installed:Less than or equal to 4 cfm per 100 ft2 of conditioned floor area. Temperature Controls: 0 Where the primary heating system is a forced air-fumace,at least one programmable thermostat is installed to control the primary heating system and has set-points initialized at 70 degree F for the heating cycle and 78 degree F for the cooling cycle. Heat pumps having supplementary electric-resistance heat have controls that prevent supplemental heat operation when the compressor can meet the heating load. Heating and Cooling Equipment Sizing: Ll Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. ❑ For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). Circulating Service Hot Water Systems: Ll Circulating service hot water pipes are insulated to R-2. Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: LI HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: Ll Heated swimming pools have an on/off heater switch. Pool heaters operating on natural gas or LPG have an electronic pilot light. Timer switches on pool heaters and pumps are present. Project Title: Bakewell Report date: 07/11/12 Data filename:\\SBSERVER\Users\RichGonet\My Documents\REScheck\Bakewell Garage.rck Page 3 of 4 Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems. Ll Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: Ll A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a)Compact fluorescent (b)T-8 or smaller diameter linear fluorescent (c)40 lumens per watt for lamp wattage<=15 (d)50 lumens per watt for lamp wattage>15 and<=40 (e)60 lumens per watt for lamp wattage>40 Other Requirements: 0 Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement'c'). Certificate: O A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or obstruct the visibility of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) Project Title:Bakewell Report date: 07/11/12 Data filename:\\SBSERVER\Users\RichGonet\My Documents\REScheck\Bakewell Garage.rck Page 4 of 4 07/17/2012 17:17 508--778-9429 FEDEX OFFICE 0386 PAGE 02 Town of Bar.nstabrle Regulatory Services Thomas F.Goiter,Director Building Division Thomas Perry,CHO Bailding Commissioner 200 Main 5rJW, Hyannis,MA 02601 www.town.ba rnsta bl e.m a.ins Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must CdnxApiete and Sign This Section If Using A Builder I, N �� ? �� , as Owner of the subject ptopearty hereby authorize f�xJSTi C7%Qll� ,., to act on my bclzalf, in all matters relative to work authonzcd by this building permit application for: spy ,Sc✓Ot�� gth��v rJ a� _ (Address of job) _ .ece 7 1 o z. sipdlre Of "Vr Date ,T64-lt E2 Prixat Name If Property Owner is applying for permit,please complete the.Homeowners License Exemption xorm on the reverse side. C:\Usura\dcculliktAppD—ats�t.,ncal\MicrosoR\Window4\Temporary Intcmct FilavlCcmtcnt,0utiopkU)DV87A Z\EXPRL5S_doc Reviset1077110 f-- Y y _ .. - - • ��7-• jam. -. - - i� d ry - A A� L0 rg J of ZO ,At . :: R-naj s OF - A - w /oo v �rrr as 7�"s 0 c Z O LEGEND CERTIFIED PLOT PLAN EXftTIN8 SPOT ELEVATION - O:O- oi ; EXISTING- CONTOUR --- O fINISHED SPOT ELEVATION FROMEPT FINISHED CONTOUR O M.4 �— APPROVED s BOARD OF HEALTH , �l9w -SAJlA 3 tAAJL J4 JdASd DATE AGENT - � SCALE, /`I 4v" DATES 7/2/9S /Vicx��.�s 1 CERTIFY THAT THEFvorAjpA--idA LDREWE ,E'NGIWEERIN6 CO. CAI CLIENT SHOV►N ON THIS PLAN IS LOCATE EGISTF-RE REGISTERED SOS NO_ �`�"°2-3 ON THE GI OYND AS INDICATED AM CIVIL LAND A- A_ GWORMS TO THE ZONWO LA" EN61•NEER SURVE 0 DR.BY: n'1- Of SARNSTAS Ev N�A88 - ,. 712 MAIN STREET CIL BY, �" _ 7 8� .' ;r -l=`---r HYANN IS,. MASS. MET / OF � TE REa. LAND SURVEM P�� La � � Swanson ,Structural Inc. Paul W.Swanson,P.E. Engineering Services 116 Forest Street commercial Franklin,MA 02038-2579 residential u Phone 508-520-1333 heavy timber Fax 508-520-1334 PauMCyansonStructuraL com PRO 60SED DORMER_ E-- WIq XISTING-j - `EXISTING f A 2�• �s� jo ' - N <<gi�--- ,.sy _ v Z 1 3l S' ''T _ �.�• Z X � � 0 ®'o SiRU�i�J�,l_ ;jam r �`z } 3�/ �� Ap 360a4 > • J L i _.._..�._i......._.....t -- a _ ._. „. i ._r_..�........._... ..__..._ ...__.. ....--:_ O _ F Job Name � �- �-- t • Job Number Location 24 AUC gnAlNIS, AM Sheet of -7 Client /&f ck n0y CoN5 T. L.L G By ?J,ds i Date 77 / Z A Main Wind Force Resisting System—Method 1 h 5 60 ft IM Figure 6-2 Design Wind Pressures Enclosed Buildings Wags g` Roofs V �. E 0�I t © =a i O :. 1 a 5 . lL�t ri°fi1Br Transverse ' tPJ8112 OCOaIU � - Longitudinal Notes: L Pressures shown are applied to the horizontal and vertical projections,for exposure B,at h=30 ft(9.1 m),for 1=1.0. Adjust to other sS.:;F,:: exposures and heights with adjustment factor 7`. .!rs;;u:Y 2. The load patterns shown shall be applied to each comer of the building in turn as the reference comer.(See Figure 6-10) 3. For the design of the longitudinal MWFRS use B=0°,and locate the zone E/F,G/H boundary at the mid-length of the building. "^^: 4. Load cases 1 and 2 must be checked for 25°<B 5 45°. Load case 2 at 25°is provided only for interpolation between 25°to 30°. ' 5. Plus and minus signs signify pressures acting toward and away from the projected surfaces,respectively. - - — 6. For roof slopes other than those shown,linear interpolation is permitted. 7• The total horizontal load shall not be less than that determined by assuming g ps=0 in zones B&D. 8- The zone pressures represent the following: Q Horizontal pressure zones—Sum of the-windward and leeward net(sum of internal and external)pressures on vertical projection of: <:k A- End zone of wall C- Interior zone of wall F..- . B- End zone of roof D- Interior zone of roof Vertical pressure zones—Net(sum of internal and external)pressures on horizontal projection of ^ E- End zone of windward roof G- interior zone of windward roof 3 : F- End zone of leeward roof H- Interior zone of leeward roof 9• Where zone E or G falls on a roof overhang on the windward side of the building,use Epy and Goy for the pressure on the horizontal projection of the overhang. Overhangs on the leeward and side ties shall have the basic zone pressure applied. 10. N g 1's Ps ya Notation: a: 10 percent of least horizontal dimension or 0.4h,whichever is smaller,but not less than either 4%of least horizontal dimension or 3 ft(0.9 m). • h: Mean roof height,in feet(meters),except that eave height shall be used for roof angles<10°. ff Angle of plane of roof from horizontal,in degrees. knlmu rn Design Loads for Buildings and Other Structures 41 Main Wind Force Resisting System-Method 1 h<_60 ft Figure 6-2(cont'd) Design Find Pressures W2tllSo©$S Enclosed Buildings Simplified Design Wind Pressure , PS30 (psfl (Exposure B at h=30 ff. with 1=1.0) a) Zones Basic Wind Roof 10 v Horizontal Pressures Vertical Pressures Overhangs Speed Angle Co(mph) (degrees) A Br D E F G H EoH Gorl 0 to 5° 1 11.5 -5.9 -3.5 -13.8 -7.8 -9.6 -6.1 -19.3 -15A 10° 1 12.9 -5.4 -3.1 -13.8 -8.4 -9.6 -6.5 -19.3 -15.1 15° 1 14.4 -4.8 -2.7 -13.8 -9.0 -9.6 -6.9 -19.3. -15.1 85 20° 1 15.9 -4.2 -2.3 -13.8 -9.6 9.6 -7.3 -19.3 15.1 25° 1 14.4 2.3 2.4 -6.4 -8.7 -4.6 -7.0 -11.9 -10.1 2 -2.4 -4.7 -0.7 -3.0 - 30 to 45 1 12 9 8.8 10.2 7.0 1.0 -7.8 0.3 -6.7 �.5 -5.2 2 12.9 8.8 10.2 7.0 5.0 -3.9 4.3 -2.8 -4.5 -5.2 0 to 5° 1 12.8 -6.7 8.5 -4.0 -15.4 -8.8 -10.7 -6.8 -21:6 -16.9 10° 1 14.5 -6.0 9.6 -3.5 -15.4 -9.4 -10.7 -7.2 -21.6 -16.9 -1 115° 1...__16.1 -5.4 ..__10.7 -3.0 -15.4 -10.1 -10.7 -7.7 -21.6 -16.9 �� 20° 1 17.8 4.7 11.9 -2.6 -15.4 -10.7 -10.7 -8A -21.6 16.9 25' 1 16.1 2.6 11.7 2.7 -7.2 -9.8 -5.2 -7.8 -13.3 -11.4 2 -2.7 -5.3 -0.7 -3.4 - 30 to 45 1 14.4 9.9 11.5 7.9 1.1 -8.8. 0.4 -7.5 -5.1 -5.8 2 14.4 9.9 11.5 7.9 5.6 -4.3 4.8 -3.1 -5.1 -5.8 0 to 5° 1 15.9 -8.2 10.5 -4.9 -19.1 -10.8 -13.3 -8.4 -26.7 -20.9 10° 1 17.9 -7.4 11.9 -4.3 -19.1 -11.6 -13.3 -8.9 -26.7 -20.9 15° 1 --19.9 _ -6_fi._..13. &_, -19.1 =12_4 -13.3 -9.5 -26.7 -20.9 20° 1 22-0 -5.8 14.6 -3.2 -19.1 -13.3 -13.3 10.1 -26.7 -20.9 25° 1 19.9 3.2 14.4 3.3 -8.8 -12.0 -6.4 -9.7 -16.5 A4.0 k 2 - k2391 -6.6 -0.9 .4.2 - - 30 to 45 1- 17.8 12.2 14.2 9.8 -10.8 0.5 -9.3 -6.3 -7.2 2 17.8 12.2 14.2 9.8 -5.3 5.9 -3.8 -6.3 -7.2 0 to 5° 1 19.2 -10.0 12.7 -5.9 -13.1 A6.0 -10.1 -32.3 25.3 10° 1 21.6 -9.0 14.4 -5.2 -14.1 -16.0 -10.8 -32.3 -25.3 ' 15, 1 24.1 -8.0 16.0 -4.6 -15.1 -16.0 -11.5 -32.3 -25.3 20' 1 26.6 -7.0 17.7 -3.9 -23.1 -16.0 -16.0 -12.2 -32.3 -25.3 110 25° 1 24.1 3.9 17.4 4.0 -10.7 -14.6 -7.7 -11.7- -19.9 -17.0 2 -4.1 -7.9 -1.1 5.1 30 to 45 1 21.6 14.8 17.2 11.8 1.7 -13.1 0.6 -11.3 -7.6 -8.7 2 21.6 14.8 17.2 11.8 8.3 -6.5 7.2 -4.6 -7.6 -8.7 F 0 to 5° 1 22.8 -11.9 15.1 -7.0 -27.4 -15.6 -19.1 -12.1 -38.4 -30.1 10° 1 25.8 -10.7 17.1 -6.2 27.4 -16.8 19.1 -12.9 38.4 30.1 d e 15° 1 28.7 -9.5 19.1 -5.4. -27.4 -17.9 -19.1 -13.7 -38.4 -30.1 f 2® 20° 1 31.6 -8.3 21.1 -4.6 -27.4 19.1 - 99.1 -14.5 -38.4 -30.1 25° 1 28.6 4.6 20.7 4.7 -12.7 -17.3 9.2 13.9 -23.7 20.2 2 -4.8 -9.4 -1.3 -6.0 30 to 45 1 25.7 17.6 20.4 14.0 2.0 -15.6 0.7 -13.4 -9.0 -10.3 2 25.7 17.6 20.4 14.0 9.9 -7.7 8.6 -5.5 -9.0 -10.3 F 0 t0�° 1 26.8 -13.9 17.8 -8.2 -32.2 -16.3 22,4 -14.2 -45.1 35.3 10° 1 30.2 -12.5 20.1 -7.3 -32.2 -19.7 -22.4 -15.1 -45.1 -35.3 15° 1 33.7 -11.2 22.4" -6.4 -32.2 -21.0 -22.4 -16.1 -45.1 -35.3 30 20° 1 37.1 -9.8 24.7 -5.4 -32.2 -22.4 -22-4 -17.0 -45.1 .35.3 25° 1 33.6 5.4 24.3 5.5 -14.9. .-20.4 -10.8 -15.4 -27.8 -23.7 2 -5.7 -11.1 -1.5 -7.1 30 to 45 1 30.1 20.6 24.0 16.5 2.3 18.3 0.8 -15.7 -10.6 -12.1 r 2 30.1 20.6 24.0 16.5 11.6 -9.0 10.0 -6.4 -10.6 -12.1 Unit Conversions-1.0 ft=03048 m; 1.0 psf =0.0479 kN/m2 r P ASCE 7-02 42 i vs2 = Nominal unit shear capacity for side Z lbs./ft. 4.3.3.3 Summing Shear Wall Lines: The nominal shear capacity for shear walls in a line utilizing shear walls i (from Column A,Table 4.3)- sheathed with the same construction and materials, shall ' vs, = Combined nominal unit shear capacity of two- be permitted to be combined. sided shear wall for seismic design,lbs./ft. 4.3.3.4 Shear Capacity of Perforated Shear Walls: The nominal shear capacity of a perforated shear wall shall be Nominal unit shear capacities for shear walls sheathed taken as the nominal unit shear capacity multiplied by the with dissimilar materials on the same side of the wall are sum of the shear wall segment lengths, Y-Li, and the ap- not cumulative. For shear walls sheathed with dissimilar propriate shear capacity adjustment factor,Co,from Table materials on opposite sides, the combined nominal unit 4.3.3.4. shear capacity, vs,. or vim, shall be either two times the smaller nominal unit shear capacity or the larger nominal unit shear capacity,whichever is greater. Exception:For wind design,the combined nomi- - - -nalunit shear capacity vw,,of shear walls sheathed :with a csmbivation efwocd str chiral nanels_and - gypsum wall-board on opposite sides shall equal the sum of the sheathing capacities of each side separately. 'fable 4.3.3.4 Shear Capacity Adjusts ent Factor�a MAXIMUM OPENING HEIGHT' 1 WALL HEIGHT, h hl3 h12 2h13 5h16 h 8'Wall 2'-8" 4'-0" 5,4., 6._8,. 8'-0" 10'Wall T-4" 5._0" 6-8.1 8'-4" 10'-01, Percent Full-Height Sheathing z Effective Shear Capacity Ratio 10% 1.00 0.69 0.53 0.43 0.36 20% 1.00 0.71 0.56 0.45 0.38 30% 1.00 0.74 0.59 0.49 0.42 40% 1.00 0.77 0.63 0.53 0.45 50% 1'00 0.80 0.67 0.57 0.50 60% 1.00 0.83 0.71 0.63 0.56 70% 1.00 0.87 0.77 0.69 0.63 80% 1:00 0.91 0.83 0.77 0.71 90% 1.00 0.95 0.91 0.87 0.83 100% 1.00 1.00 1.00 1 1.00 1 1.00 ' The maximum opening height shall be taken as the maximum opening clear height in a perforated shear wall. Where areas above and below an opening remain unsheathed,the height of the opening sball be defined as the height of the wall. z The sum of the lengths of the perforated shear wall segments divided by the total length of the perforated shear wall. AMERICAN WOOD COUNCIL. I o , -'------ 'e'r,- Table 4e3A Nominal Unit Shear Values for WO®d-Frame Shear Wallsa,c Wood-based Sheathing A B Minimum Minimum SEISMIC WIND Nominal Fastener Panel Edge Fastener SpacingInches Panel Edge Fastener Spacing inches Sheathing Material Panel Penetration in Fastener Type 8r Size 6 4 3 2 6 4 3 2 Thickness Framing v_a G_a v_s G_a v_s �Ge v_s G_a v_w vw v_w v w (inches) (inches) 1 ki sAn I ki s/in I In I ki s/In I I I I Nail(common or galvanized box) Wood Structural 5/16 1-1/4 6d 400 13.0' 600 18.0 780 23.0 1020 35.0 560 840 1090 1430 Panels-Structural I' 3/8" 460 19.0, 720 24.0 920 30.0 1220 43.0 645 1010 1290 1710 7/16" 1-3/8 8d 510 16.0, 790 21.0 1010 27.0 1340 40.0 715 1105 1415 1875 15/32 560 144 860 18.0 1100 24.0 1460 37.0 785 1205 1540 2045 15/16 1-1/2 10d 680 22.0; 1020 29.0 1330 36.0 1740 50.0 950 1430 1860 2435 > 36 1-1/4 gd 360 13.0' 540 18.0 700 24.0 900 37.0 505 755 980 1260 400 11.0� 600 15.0 780 20.0 1020 32.0 560 840 1090 1430 Wood Structural 3/8 b 440 17.0 640 25.0 820 31.0 1060 45.0 615 895 1150 1485 D Panels-Sheathing" 7/16b 1-3/8 8d 480 15.0 700 22.0 900 28.0 1170 42.0 670 980 1260 1640 T 15/32 520 13.0 760 19.0 980 25.0 1280 39.0 730 1065 1370 1790 M 15/32 1-1/2 10d 620 22.0 920 30.0 1200 37.0 1540 52.0 870 1290 1680 2155 19/32 680 19.0 1020 26.0 1330 33.0 1740 48.0 950 1430 1860 2435 Q° Nail(galvanized casing) Plywood Siding 5/16 1-1/4 6d rn 280 13.0 420 16.0 550 17.0 720 21.0 392 588 770 1008 X 3/8 1-1/2 8d 320 16.0 480 18.0 620 20.0 820 22.0 448 672 868 1148 Nail(common or o Particleboard galvanized box) n Sheathing- 3/8 6d 240 15.0 1 360 17.0 460 19.0 600 22.0 335 505 645 840 (M-S"Exterior Glue" 3/8 8d 260 18.01 380 --TO.0 480 21.0 630 23.0 365 530 670 880 z and M-2"Exterior 1j2 280 18.01 420 20.0 540 22.0 700 24.0 390 590 755 980 Glue") 1/2 10d 370 21.01 550 23.0 720 24.0 920 25.0 520 770 1010 1290 (common or 5/8 400 21.0 610 23.0 790 24.0 1040 26.0 560 855 1105 1455 Nail I galvanized roofing) ad common or 11 ga.galy. Fiberboard Sheathing 1/2 roofing nail(0.120"x 1 112" 340 4.0 460 5.0 520 5.5 475 645 730 Structural long x 7/16"head) 8d common or 11 ga.galy. 25/32 roofing nail(0.120"x 1 3/4" 360 4.0 480 5.0 540 5.5 505 670 755 long x 7/16"head) a. Nominal unit shear values shall be adjusted in accordance with 4.3.3 to determine ASD allowable unit shear capacity and LRFD factored inlit resistance. For general construction requirements see 4.3.6.-For specific requirements,see 4.3.7.1 for wood structural panel shear walls,4.3.7.2 for particleboard shear walls,and 4.3.7.3 for fiberboard shear walls. b. Shears are permitted to be increased to values shown for 15/32 inch sheathing.with same nailing provided(a)studs are spaced a maximum of 16 inches o.c.,or(b)if panels are applied with long dimension across studs. c. For framing grades other than Douglas-Fir-Larch or Soulhern Fine,seduced nominal unit shear capacities shall be determined by multiplying the tabulated nominal unit shear capacity by the Specific Gravity Adjustment Factor=[1-(0.5-G)],where G=Specific Gravity of the framing lumber from the NDS. The Specific Gravity Adjustment Factor shall not be greater than 1. d. Apparent shear stiffness values,G_a,are based on nail slip and panel stiffness values for shear walls constructed with OSB panels. When plywood panels are used,shear wall deflections should be calculated in accordance with the ASD Wood Structural Panels Supplement. i r SW31SAS JN11SISM-33HOJ *IUMVI S Table 4.313 Nominal Unit Shear Values for Wood-Frame Shear VVallsal Gypsum and Cement Plaster A B SEISMIC WIND Material Max.Fastener Max.Stud y_a G_a V_W Sheathing Material Fastener Type&Size edge Spacing` Spacing If Icl s/in It Thickness 7" 24." unblocked 150 4,0 220 24" unblocked 220 6.5 bd cooler(0.086"x 1-5/8"long,15/64"head)or Wallboard nail(0.086"x 1-5/8"long,9/32" 4" 200 head)or 0.120"nail x 1-1/2"long,min 318"head 7" 16" unblocked 200 5.5 200 4" 16" unblocked 250 7.0 T' 16^ blocked 250 6.5 250 No.6 Type S or W drywall screws 1-1/4"long 4" 1 g" blocked 300 9.0 300 1/2" g/12" iG^ unblocked 120 3.0 120 4/16" 1 B" blocked 320 . 8.5 320 No.6 Type S or W drywall screws 1-1/4"long 4/12" 24" blocked 310 9.5 310 Gypsum wallboard, 8h2" 16° blocked 140 4.0 140" gypsum veneer base,or 6/12" 16" blocked 180 5.0 '180 24" unblocked 230 6.0 230 water-resistant gypsum 6d cooler(0.092"x 1-7/8"long,1/4"head)or wallboard nail(O.o915"x 1-7/8"long,19/84" 7" 290 8.0 290 backing board head).or 0.120"nail x 1-3/4"long,min 3/8"head 4" 16" unblocked 290 7.5 7" 1g^ blocked 290 5/g^ No.6 Type S or IN drywall screws 1-1/4"long 4^ 16" blocked 350. 10.0 350 unblocked 140 4.0 140 No.6 Type S or W drywall screws 1-1/4"long 8/12" 16 180 8/12" 16" blocked 180 4.0 Base ply--6d cooler(0.092"N 1-7/8"long.1/4"head)or wallboard nail(0.0915"x 1-7/8" Base:9" D 5/8 long,19/64"head)or 0.120"nail x 1-3/4"long,min 3/8"head 16' blocked 500 17.0 500 Z Face ply--8d cooler(0.113"x 2-38"long,0.281"head) or wallboard nail(0.113"x 2-3/8" Face:7" O (Two-Ply) long,3/8"head)or 0.120"nail x 2-3/8"long,min 3/8"head 4" i 6" unblocked 150 5.0 150 Q O 1/2"x 2'x 8' 350 n 0.120"nail x 1 314"long, 7/16"head,diamond-point,galvanized 4" 74" blocked 350 10.0 z Gypsum sheathing 1/2"x 4' 7^ 16" unblocied '200 5.0 200 n 6d galvanized cooler(0.092"x 1-7/8"long,114"head)or wallboard Hall(0.0915"x 1-7/8" 4/7° 1 g^ blocked 400 13,0 400 P 5/B"x 4' long,19/64"head)or 0.120"nail x 1-3/4'long,min 3/B"head Gypsum lath,plain or 3/B"lath and 0.092'x 1-1/8"long,19/64"head,gypsum wallboard blued nail or 0.120".nail A 1/4"long, 5" 16 unblocked 200 6.5 200 perforated 1/2"plaster min 3/8"head xpan a me a or woven 6" 16" unblocked 360 12.0 360 wire lath and portiand 7/8" 0.120"Heil x 1 yz"long,7/16"head cement aster at construction requirements see 4.3.6. For a. Nominal unit sear values shall be adjusted in accordance with 4.3.3 to determine ASD allowable unit shear capacity and LRFD factored unit resistance. For gener h specific requirements, see 4.3.7.4. b. Type S or W drywall screws shall conforin to requirements of ASTM C 1002. c. Where two numbers are given for maximum fastener edge spacing,the first number denotes fastener.spacing at the edges and the second number denotes fastener spacing in the fie I i fCtml J K 1 1 OD This product Is preferable to similar connectors because o/ a)easier fnst2llation,b)higher loads,c)lower installed cost, I W p or a combination of these features. , = Post size by �'r•... o. ,.0:` - Designer The HDU series of holdowns combine the advantages of low o c deflection and high capacity from the pre-deflected geometry with the ° ' o ease of installation-of Simpson's patented SUS screws. HDU SPECIAL FEATURES: j Pilot Holes for < •Pre-deflected body virtually eliminates deflection due manufacturingzl, — to material stretch. purposes o e Pressure-treated (Fastener barrier may be •Uses SDS screws which install easily,reduces fastener slip, not required) m H v required a s and provides a greater net section area of the post compared to bolts. •SDS /<°x2/z°screws are supplied with the holdowns. - (Lag screws will notachieve the same load.)This ensures the o _ proper fasteners are used and is convenient for the installer. •No stud bolts to countersink at openings. �" q MATERIAL:See table. FINISH:Galvanized •. o'. INSTALLATION: -. - C.;•� •Use all specified fasteners.See General Notes. i Vertical HDU Installation •Place the HDU over the anchor bolt. j -No additional washer required. isga HDU may be installed raised off • to tie double 2x members together,the Designer must determine {. HDU ? 'he sr,','p,°te With no incrase iir the fasteners required to bind the members to act as one unit ' deflection values(see note 7). without splitting the wood.See page 20 for more information. -See SSTB Anchor Botts on page 33-34 for anchorage options. I For holdowns,per ASTM test standards,anchor bolt nut should be -Refer to technical bulletin T ANCHORSPEC for post-installed finger-tight plus%to 1h turn with a hand wrench,with consideration anchorage solutions(see page 199 for details). given to possible future wood shrinkage.Care should be taken to not CODES:See page 12 for Code Listing Key Chart. j over-torque the nut.Impact wrenches should not be used. I l I i Dimensions ._-Fast ners__—_ ___.Allowable Tension Loads r Model Holdown.Deflection ighestAil No. .... ..-- Cede . --- W H B _ --of SDS _:; Ref. BoIC (133/960). (133/160) Design Load- - __Yex2>rz HDU2 SDS2.5 14 3 8+V1s 3+/4 11/< s 2625 1 2260 0.017 HDU4-SDS2.5 14 3 101s/is 3Y4 11/4 % 10 4190 3600 0.049 HDU5-SDS2.5 14 3 13s/is 3Y4 1 Ya 11 5A 14 1 5430 4670 0.061 146,160 HDU11-SDS . 10 3 16% 3Yz 1Y4- ,- -z/e—>- 20 �8350� � —7180 0:037� o HDUII-SDS2.5_. 10 3 22% 3Yz 1 1'/4 11275 9695 0.040 N w 1.Allowable loads have been increased for earthquake or wind load durations with - 8.Deflection at Highest Allowable Design Load: z no further increase allowed;reduce where other load durations govern. The deflection of a holdown measured between the a 2.Loads are based on static tests on wood posts,limited by the lowest of 0.125" anchor bolt and the strap portion of the holdown deflection,lowest test ultimate divided by 3 or the calculated values of the when loaded to the highest allowable load listed SDS Y4°X21h"screws. in the catalog table.This movement is strictly due 3.The Designer must specify anchor bolt type,length and embedment. to the holdown deformation under a static load 4.When using structural composite lumber columns screws must be applied to test conducted on a wood fig. the wide face of the column. 9.Tabulated loads may be doubled when the HDU is W 5.Post design shall be by Designer. installed on both sides of the wood member provided c 6.SDS screws install best with a low speed IN right angle drill with a W hex head driver either the post is large enough or the holdowns are 7.Deflection values are valid for holdowns flush and raised off of sill plate. offset to eliminate screw interferences. = h Refer to note q,page 14 for installation instructions of raised holdowns. Z o - - i7 m N - The Anchor.Tiedown System(ATS)is a method for anchoring —._..._ shearwalls in mid-rise wood frame construction to resist large ---•----—' - uplift forces in stacked shearwall systems caused by earthquakes and high winds.The revolutionary ATS method restrains i overturning forces through bearing plates and Simpson - I Strong-Rod providing a high capacity restraint system far exceeding the capacity of traditional holdowns.The patented ATS also offers Take-up Devices to compensate for wood _ T shrinkage and settling common construction. -_- -- - - � - _ For design information request C-ATS or visit www.strongt/e.com. � = Free ATS Selector Software available 35 Boise Cascade Double 1-3/4" x 18" VERSA-LAM® 2.0 3100 SP Roof BeamlBeam01 BBCC/CALCO 3.0 Design Report-US 1 span No cantilevers 0/12 slope Saturday, July 07,2012 Build 517 File Name: BC 4517 Job Name: Bakewell Residence Description: Beam01 Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City, State,Zip: Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 4517 �o 12 ! 2 ( 13 i m's G4 1_c"..2.1_{ •`n;-':S '.m�s�S# 11n'.'.�'"�.t;•...FmY x...,T�+.`�v:..�r::f zS�'Ry y �' 24-04-00 BO,3-1/2" B 1,5-1/4" DL 2,017 Ibs DL 2,042 Ibs SL 3,867 Ibs SL 3,913 Ibs Total Horizontal`Product Length=24-04-00 Live (Saar+ Aui, N'.ii. Roof Live Trio. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area (psf) L 00-00-00 24-04-00 15 - 30 08-06-00 2 Add'I Roof Load Unf.Area (psf) L 00-00-00 07-06-00 10 . 30 03-06-00, 3 Add'I Roof Load Unf.Area.(psf) R 00-00-00 07-06-00 10 30 03-06-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 31,798 ft-Ibs 59.2% 115% 3 1 - Internal Completeness and accuracy of input must End Shear 4,916 lbs 35.7% 115% 3 1 - Left be verified by anyone who would rely on Total Load Defl. U296 (0.961') 60.7% 3 1 output as evidence of suitability for Live Load Defl. U455 (0.626") 52.8%p 3 1 particular application.Output here based Max Defl. 0.961" 96.1% 3 1 on building code-accepted design properties and analysis methods. Span/Depth 15.8 n/a 1 Installation of BOISE engineered wood - ,products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x" Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2".x 3-1/2" 5,884 Ibs 16.0% 64.0% Versa-Lam 1.7 or ask questions,please call B1 Post 5-1/4"x 3-1/2" 5,955 Ibs 44.7% 43.2% Spruce Pine Fir(800)232-0788 before installation. BC CALCO,BC FRAMERO,AJS-, Cautions ALLJOISTO,BC RIM BOARD-,BCIO, For roof members with slope(1/4)/12 or less final design must ensure that ponding instability BOISE GLULAMT"^ SIMPLE FRAMING 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 Products L.L.C. Notes Design meets Code minimum (U180)Total load deflection criteria. Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. ,' ffV�rl" e Connection Diagram b �d '� �l•'� i':`rii'V�;�ii`) `tab-r� `JY a T _i „ I 9 ,. 33. ;n;t !� c2 a minimum=2" c= 14" b minimum.= 3" d=24" Member has no side loads. Connectors are: 16d Sinker Nails Page 1 of 1 Boise Cascade Triple 2 x 10 SPF #2 Roof Beaml13eam02 BC CALCO 3.0 Design Report-US 1 span I No cantilevers 1 0/12 slope Saturday, July 07,2012 Build 517 File Name: BC 4517 Job Name: Bakewell Residence Description:.Beam02 Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City, State, Zip: Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: NLGA _ Misc. job 4517 12 i. M k `' r� . -r-a r "may, ntv-. ..,c w '' x %�Y } `s� •ec ^x _.x .; ,.a,t Y _vr .. Fr _ u 03-00-00 BO 3" B1 3„ DL 1,140 Ibs DL 1,140 Ibs SL 2,047 Ibs SL 2,047 Ibs Total Horizontal Product Length=03-00-00 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% i 33% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 03-00-00 15 30 02-00-00 2 Wall Unf. Lin. (plf) L 00-00-00 03-00-00 40 n/a 3 Beam01 at bearing B1 Conc. Pt. (Ibs) L 01-06-00 01-06-00 2,042 3,913 n/a Controls Summar�r Value %Allowable Duration Case Span Disclosure Pos. Moment 4,028 ft-Ibs 68.0% 115% 3 1 - internal Completeness and accuracy of input must End Shear 3,044 Ibs 70.7% 115% 3 1 -Left be verified by anyone who would rely on Total Load Defl. U3,250(0.01") 5.5% 3 1 output as evidence of suitability for Live Load Defl. U5,011 (0.006") 4.8% 3 1 particular application.Output here based on building code-accepted design Max Defl. 0.01" 1.0% 3 1 properties and analysis methods. Span/Depth 3.4 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x M Value Support Member Material building codes.To obtain Installation Guide BO Post 3"x 4-1/2" 3,187 Ibs 32.6% 55.5% Spruce Pine Fir or ask questions please call B1 Post 3 x 4-1/2" 3,187 lbs 32.6% 55.5% Spruce Pine Fir(800)232-0788 before installation. BC CALCO,BC FRAMERO,AJSTm, Cautions ALLJOISTS,BC RIM BOARDTM BCIO, For roof members with slope(1/4)/12 or less final design must ensure that ponding instability BOISE GLULAMTM SIMPLE FRAMING 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 Pain-on-Snow VERSA-STRANDS,VERSA-STUDS are surcharge load. trademarks of Boise Cascade Wood Products L.L.C. Notes Design meets Code minimum(U180)Total load deflection criteria. Design meets Code minimum(11240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. The analysis of solid sawn wood members is in accordance with the NDS and is limited to the :• � •-:�, output shown above. All other support and design for these products, including but not tr, ;,�—z limited to notching, connections, installation, and engineer/architect certification is they A responsibility of the project's design professional of record. /;_' PA(IL STRUCTURAL y 14 il°.35— 1AL a� Page 1 of 1 ®Boise Cascade Double 2 x 10 SPF #2 Floor BeamlBeam03 BC CALCO 3.0 Design Report-US 1 span I No cantilevers 10/12 slope Saturday,July 07,2012 Build 517 File Name: BC 4517 Job Name: Bakewell Residence Description: Beam03 Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City State, Zip:Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: NLGA Misc: job 4517 j I I I I I 'S,a °� *'i," �' N,x„"e°s t �.7 a}. ,..aaila�.�". `�' .ct ." + . ,k �,;:..:S�ziR�" .2fv',`z &&s�.� .y„,c'sG+'< .k q, 3 "� a. , �..aa`5a�h..�. 'z.,uu . 09-02-12 BO,5-1/2" B1,5-1/2" LL 415 Ibs LL 415 Ibs DL 652 Ibs DL 552 lbs SL 415 Ibs SL 415 Ibs Total Horizontal Product Length=09-02-12 .._ _.-. ue_.i o_0f.Live - Live Dead snow an id :wv:►.:vc a u. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Ceiling Unf.Area(psf) L 00-00-00 09-02-12 10 10 09-00-00 2 Roof Unf. Area (psf) L 00-00-00 09-02-12 15 30 03-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 2,860 ft-Ibs 72.5% 115% 2 1 - Internal Completeness and accuracy of input must End Shear . 1,088 Ibs 37.9% 115% 2 1 -Left . be verified by anyone who would rely on Total Load Defl. U765 (0.132") 31.4% 2 1 output as evidence of suitability for Live Load Defl. U1,366 0.074' 26.3% 2 1 particular application.Output here based Max Defl. 0.132" ( ) 13.2% 2 1 on building and code-accepted lysis design properties and analysis methods. Span/Depth 10.9 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Searing Supports Dim (L x VI) Value Support Member Material building codes.To obtain Installation Guide BO Wall/Plate 5-1/2"x 3" 1,483 Ibs 21.1% 21.1% Spruce Pine Fir or ask questions,please call B1 Wall/Plate 5-1/2"x 3" 1,483 Ibs 21.1% 21.1% Spruce Pine Fir(800)232-0788 before installation. BC CALCO,BC FRAMERO,AJS-, ALLJOISTO,BC RIM BOARDTm BCIO, (Votes Design meets Code minimum (U240)Total load deflection criteria. BOISE O,VE TM' SIMPLE FRAMING g SYSTEM@RSA-LAM®,VERSA-RIM Design meets Code minimum (U360) Live load deflection criteria. PLUS@,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD@ are The analysis of solid sawn wood members is in accordance with the NDS and is limited to the trademarks of Boise Cascade wood output shown above. All other support and design for these products, including but not Products L.L.C. limited to notching, connections, installation,and engineer/architect certification is the responsibility of the project's design professional of record. rAUlL . SWANSON S i RUCT54 ;!! a rti Page 1 of 1 i Boise Cascade Triple 2 x 10 SPF #2 Floor Beaml13eam04 BC CALCO 3.0 Design Report-US 1 span No cantilevers 0/12 slope Saturday, July 07,2012 Build 517 File Name:. BC 4517 Job Name: Bakewell Residence Description: Beam04 Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City State,Zip:Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: NLGA Misc: job 4517 I I i I 3wokd""'S` 12-00-00 BO,3-1/2" B1,5-1/2" LL 405 Ibs LL 490 lbs DL 391 Ibs DL 519 Ibs SL 168 Ibs SL 247 Ibs Total Horizontal Product Length= 12-00-00 Live Dead Gnaw vvuw Roux Live Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 12-00-00 40 12 01-00-00 2 Beam03 at bearing BO Conc. Pt. (Ibs) L 07-00-00 07-00-00 415 652 415 n/a Controls Summary Value %Allowable Duration' Case span Disclosure Pos. Moment 5,014 ft-Ibs 84.7% 115% 2 1 - Internal Completeness and accuracy.of input must End Shear -1,181 Ibs 27.4% 115% 2 1 -Right be verified by anyone who would rely on Total Load Defl. U579 (0.236") 41.4% 2 1 output as evidence of suitability for Live Load Defl. U996 (0.137") 36.1% 2 1 particular application.Output here based Max Defl. 0.236 23.6% 2 1 on building code-accepted design properties and analysis methods. Span/Depth 14.8 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x Utz Value Support Member Material building codes.To obtain Installation Guide BO WalUPiate 3-1/2"x 4-1/2" 964 Ibs 14.4% 14.4% Spruce Pine Fir or ask questions,please call B1 Wall/Plate 5-1/2"x 4-1/2" 1,257 Ibs 11.9% 11.9% Spruce Pine Fir(800)232=0788 before installation. BC CALCO,BC FRAMER@,AJS-, Notes ALLJOISTO,BC RIM BOARDTM,BCIO, Design meets Code minimum (L/240)Total load deflection criteria. BolsE O,VE TA° SIMPLE FRAMING Design meets Code minimum U360 Live load deflection criteria. SYSTEM@,VERSA-LAM@,VERSA-RIM 9 ( ) PLUS@,VERSA-RIM@, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRANDO,VERSA-STUD@ are The analysis of solid sawn wood members is in accordance with the NDS and is limited to the trademarks of Boise Cascade Wood output shown above. All other support and design for these products, including but not Products L.L.C. limited to notching, connections, installation, and engineer/architect certification is the responsibility of the project's design professional of record. OF JIV? Wktl 4 iir;,i hay '"'his.,,_ 'J;1..✓/,��' Page 1 of I I ©Boise Cascade Quadruple 1-3/4" x 18" VERSA-LAM® 2.0 3100 SP Floor BeamlBeamOS BC CALCO 3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Saturday, July 07, 2012 Build 517 L✓L 15 rUo at File Name; BC 4517 Job Name: Bakewell Residence Description: BeamO5 fiSE g � Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City, State, Zip: Hyannis, MA Designer: W (2 x 3 p Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 4517 * ,.:�� ''"<:... �' '�, .._ .: fw#,.svr.;._"'",.,:. �.esj x s s. �c �'" �„x< 24-04-00 BO,3-112" B1,5-1/2" LL 6,287 Ibs LL 6,373 Ibs DL 2,684 Ibs DL 2,721 Ibs SL 245 Ibs SL 249 Ibs Total Horizontal Product Length=24-04-00 Live Dead Snow Wind Roof Live TPib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 24-04-00 40 12 12-00-00 2 Beam04 at bearing B1 Conc. Pt. (Ibs) L 07-06-00 07-06-00 490 519 247 n/a 3 Beam04 at bearing B1 Conc..Pt. (Ibs) R 07-06-00 07-06-00 490 519 247 n/a Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 53,588 ft-Ibs 57.4% 100% 1 1 - Internal Completeness and accuracy of input must End Shear -7,803 Ibs 32.6% 100% 1 1 -Right be verified by anyone who would rely on Total Load Defl. U343 (0.83") 70.0% 2 1 output as evidence of suitability for Live Load Defl. U487 (0.584") 74.0% 2 1 particular application.Output here based Max Defl. 0.83" 83.0% 2 1 on building code-accepted design properties and analysis methods. Span/Depth 15.8 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x Vlr) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 7" 9,216 Ibs 12.5% 50.2% Versa-Lam 1.7 (8 ask questions,please call B1 Wall/Plate 5-1/2"x 7" 9,343 Ibs 57.1% 32.4% Spruce Pine Fir00)232-0788 before installation. BC CALCO,BC FRAMER@,AJSTm, Notes ALLJOIST@,BC RIM BOARD- BCIO, Design meets Code minimum (U240)Total load deflection criteria. SYSTEBOISE M@,VE T" SIMPLE FRAMING Design meets Code minimum (U360) Live load deflection criteria. PLUSO,O,VERSA-LAM®,VERSA RIM g PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD®are Fastener Manufacturer: Simpson Strong-Tie, Inc. trademarks of Boise Cascade Wood Products L.L.C. Connection Diagram b d � �QtJ(V,9tit�af St�L f�E��, a ' a minimum= 1-1/2"c=5" r� 1� b minimum=4" d=24" 5 5 J• o � , OF rqS, e minimum= 1" , Connection design assumes point load is'top-loaded'..For connection design of'side-loaded' ` , SrNAt.SSOI l point loads, please consult a technical representative or professional of Record. STRUCiURAI Beams 7 inches wide will be assumed to be either top-loaded only, or equally loaded from P,a q�. a �, h each side. � � �� , zh 3 3� Install screws from both sides, staggering screws by%of the spacing to avoid splitting. Member has no side loads. S/01 IIAL j 1 Concentrated loads are not considered in side load analysis. P,ggeelotgr$are: SIDS 1/4 x 6 '] -7 It, ®Boise Cascade Double 1-3/4" x 11-1/4" VERSA-LAW 2.0 3100 SP Floor BeamlBeam06 BC CALC®3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Saturday, July 07, 2012 Build 517 File Name: BC 4517 Job Name: Bakewell Residence Description: Ream06 Address: 294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City, State, Zip: Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 4517 4 3 5 I 1 I I i .1' x'=�� ». flN$Z& :, a s.,,t a ra � '4,trf"F ,�'aa7a .+ '4, �t�n �� m"-7 `3r` ' '�xKr"` �."� I .,w, - .,,-M........ `�` .:�kf'.d -Ytt. _' 03-00-00 BO,3-1/2" B1,3-1/2" LL 3,247 Ibs LL 3,247 Ibs DL 2,655 Ibs DL 2,655 Ibs SL 2,170 Ibs SL 2,171 Ibs Total Horizontal Product Length=03-00-00 Live Dead Snow 'Rind Roof Live Trlu. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf. Area(psf) L 00-00-00 03-00-00 40 12 01-00-00 2 Wall Unf. Lin. (plf) L 00-00-00 03-00-00 80 n/a 3 Beam05 at bearing B1 Conc. Pt. (Ibs) L 01-06-00 01-06-00 6,373 2,721 .249 n/a 4 Beam02 at bearing BO Conc. Pt. (Ibs) L 00-00-00 00-00-00 1,140 2,046 n/a . 5 Beam02 at bearing B1 Conc. Pt. (Ibs) R 00-00-00 00-00-00 1,140 2,046 n/a Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 5,854 ft-Ibs 30.5% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 4,586 Ibs 61.3% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. U4,478(0.007") 5.4% 2 1 output as evidence of suitability for Live Load Defl- U6,411 (0.005") 5.6% 2 1 particular application.Output here,based Max Defl. 0.007" 0.7% 2 1 on building'code-accepted design properties and analysis methods. Span/Depth 2.7 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x M Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 8,072 Ibs 22.0% 87.9% Versa-Lam 1.7 or ask questions please call B1 Post 3-1/2"x 3-1/2" 8,072 Ibs 22.0% 87.9% Versa-Lam 1.7 (800)232-0788 before installation. BC CALCO,BC FRAMER®,AJSTm, Notes ALLJOIST@,BC RIM BOARDT"0 BCIO, Design meets Code minimum (U240)Total load deflection criteria. BOSSE M@,VE ITM',SIMPLE FRAMING Design meets Code minimum U360 Live load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM. 9 ( ) PLUS@,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD@are trademarks of Boise Cascade Wood Connection Diagram Products L.L.C. b d a I I 44 ' I 4 a minimum= 2" c= 7-1/4" I ! b minimum= 3" d=24"Connection design assumes point load is 'top-loaded'. For connection design of'side-loaded' point loads, please consult a technical representative or professional of Record. _. •` Member has no side loads. Concentrated loads are not considered in side load analysis. ']/-?��L Connectors are: 16d Sinker Nails I Page 1 of 1 ®Boise Cascade R Double 1-3/4'° x 14'' VERSA-LAMO 2.0 3100 SP Floor Beaml6eam07 BC CALCO 3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Saturday,July 07,2012 Build 517 File Name: BC 4517 Job Name: Bakewell Residence Description: Beam07 Address: .294 Scudder Ave. Specifier: Paul W. Swanson, P.E. City, State,Zip: Hyannis, MA Designer: Customer: Roy, Rick Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 4517 s � 41 1 s v s 2 - i 5 I I 3 ' xsFQU-Mr,.,#xs'^.:'F;,"' Srya`Fpi rFsw_.{ £ `''..'ttf �„& sa�m 16-09-00 BO,4-1/2" B1,4-1/2" LL 2,509 Ibs LL 2,321 Ibs DL 2,287 Ibs DL 1,980 Ibs SL 1,049 Ibs SL 1,222 Ibs Total Horizontal Product Length=16-09-00 Live Dead snow `rViiw rwv,Lwv Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 16-09-00 40 12 06-00-00 2 Roof Unf.Area(psf) L 00-00-00 02-00-00 15 30 06-00-00 3 Roof Unf.Area(psf) L 11-00-00 16-09-00 15 30 06-00700 4 Wall Unf. Lin. (plf) L 02-00-00 11-00-00. 120 n/a 5 Roof Unf.Area(psf) L 02-00-00 11-00-00 15 30 02-00-00 6 Beam04 at bearing BO Conc. Pt. (Ibs) L 02-00-00 02-00-00 405 391 168 n/a 7 Beam04 at bearing BO Conc. Pt. (Ibs) L 11-00-00 11-00-00 405 391 168 n/a Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 21,405 ft-Ibs 64.1% 115% 2 1 - Internal Completeness and accuracy of input must End Shear 4,927 Ibs 46.0% 115% 2 1 - Left be verified by anyone who would rely on Total Load Defl. U307 (0.631") 78.3% 2 1 output as evidence of suitability for Live Load Defl. U509 (0.38") 70.7% 2 1 particular application.Output here based u _ on building code-accepted design Max Defl. 0.631' 63.1 /0 2 1 properties and analysis methods. Span/Depth 13.8 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x M Value Support Member Material building codes.To obtain Installation Guide BO Post 4-1/2"x 3-1/2". 5,845 Ibs 51.2% 49.5% 'Spruce Pine Fir or ask questions,please call B1 Post 4-1/2"x 3-1/2" 5,522 Ibs 48.4% 46.8% Spruce Pine Fir(800)232-0788 before installation. BC CALCO,BC FRAMERO,AJSTDA, Notes ALLJOISTO,BC RIM BOARD-,BCI®, Design meets Code minimum (U240)Total load deflection criteria. BOISE GLULAMT" SIMPLE FRAMING Design meets Code minimum U360 Live load deflection criteria. SYSTEM®,VERSA-LAMO,VERSA-RIM g ( ) PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD®are trademarks of Boise Cascade Wood Connection Diagram Products L.L.C. Lib �d a I I o T_o • 0 s'o .p 0ff1d a minimum=2" c= 10" b minimum = 3" d=24" r t•� ,,ON, Connection design assumes point load is`top-loaded'. For connection design of'side-loaded' �� a;r,,' point loads, please consult a technical representative or professional of Record. Member has no side loads. 7 -7 P1 Concentrated loads are not considered in side load analysis. Connectors are: 16d Sinker Nails Page 1 of 1 V i 1 f 1 A r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # a(9 D 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 2 q q ,Scvl&1*tL L_V c_ Village 4tvN/ 5 _ ( c7 Owner Xi�N it;�:2 g,4,eEZv&-,L Address �9y , 5CVPd Telephone 50 8 - 7 7 8 ' 5S/9_tS Permit Request 196---1c- E)l TENSIOry /-0 _A�,C V- oA-2Z- _ �/US T4!/cT/ory y x (, E KfiC-iU51t)nN Square feet: 1st floor: existing proposed 092-2nd floor: existing 'F37- proposed r3z Total new D Zoning District Flood Plain Groundwater Overlay Project Valuation J� '�D Construction Type Lot Size 491174, Grandfathered: ❑Yes ❑ No If yes, attach supportir1g doigmentation. Dwelling Type: Single Family ;4 Two Family ❑ Multi-Family(# units) -r - C> Age of Existing Structure aw Historic House: ❑Yes A No. On Old i rr s HighvyW: L4es X No ! '4 v Basement Type: V Full ❑ Crawl ❑Walkout ❑ Other 4 Basement Finished Area (sq.ft.) `��'° ? Basement Unfinished Area (sgft) Number of Baths: Full: existing 2- new Half: existing rn Number of Bedrooms: 3 existing _new Total Room Count (not including baths): existing 5 new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing ' New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:P(existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes LKlo If yes, site plan review# Current Use RC-3 I OL-Av r1 Proposed Use IZ&S>/J4-Nr7 Yt2 -- APPLICANT INFORMATION (BUILDER OR'HOMEOWNER)- _ Name IC) O-y � 7-�ZUG OatJ,L� Telephone Number Address Z3 A QUA 41VAIY--' License # y7/95 Home Improvement Contractor# Worker's Compensation # �� -839�3/ �o!-o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r' SIGNATUREFY DATE Z`/z// FOR OFFICIAL USE ONLY APPLICATION# ; r ti DATEISSUED R MAP/PARCEL NO. ` ADDRESS VILLAGE OWNER t . lit 4 t DATE OF INSPECTION: Y f FOUNDATION { FRAME 4 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED.OUT ASSOCIATION PLAN NO. } i - I m � d Ta pAi O O O()� n2X - nrn.- `Oo o' ° # A° ------------- no oz n 70 1 n Ta O ------------ mn _ T Q I- D z --- __-_-_-T- s oc o� I 4 F I I I _ IIm(Jl,1 I 4 o-2- f�YY I 4 >2 c z 4 Q 0 Ip I o I I 0 - m 7u y o r I I i I I I I V 1 I I ; I I I i I W Rick Roy Construction LLC JENNiFER BAKEWELL 123A Queen Anne Rd. s. 291 SCUDDER AVE. Harwich, MA 02345 HYANNIS, MA Tele: 508-432-6840 Fax: 508-432-4814 rroycon@comcasL.net �z A_p - =m om 0 . m O G D O z D� A Oc A IN - n 4 on oo° m �� um \ \ o mo u n A P A a D A A m O vm x y D -jm - 3 m D m D 'A m m in 1 o n ° 0 c c o Z A n � D N J m - D m z a � , W m Rick Roy Construction LLC JENNIFER BAKEWELL 123A Queen Anne Rd. �- 29` SCUDDER AVE. Harwich, MA 02345 o, HYANNIS, MA Tele: 508-432-6840 Fax: 508-432-4814 rroycon@comcast.net The Commonwealth of.kassachusetfs Department of Industrial Accidents Office of Investigations il, V 600 Washington Street Boston, MA 02111 e www:niass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians,Plumbers Applicant Information Please Print Legibly Name (Business/Organ zation/Individual): 01,e_ 12.6.1 VC TRW Address: )Z 3)9 A."Vlyre City/State/Zip: Q, Y Phone-4: rj o91 -1I3Z—1,V Yo Are you an employer?.Check the appropriate box: Type.of project(required): 1.® I am a employer.with, 15 4. ❑ I am a general contractor and I 6. New construction employees(full'andlor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑ ng Remodeli ship and have no employees These sub-contractors have S. ❑Demolition working forme in any capacity workers; comp: insurance. g, ❑ Building addition I, [No workers' comp.insurance , S. ❑.We are a corporation and its 10.❑;Eleotrcal repairs or additions required] officers have exercised their right of exemption per MGL 1 1.❑`Plumbing repairs or additions 3.❑ I am a homeowner doing all workp p c.`152, 1(4), and we have no myself. [NC)vrorkers' comp. § 12.❑Roof repairs insurance required.) employees. [No workers' 13.0 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 the affidavit n hire outside contractors must submit a new adavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy infDnnation. I am an employer that is providing,workers'compensation insurance for my Employees.,Below is the policy and job site information Insurance Company Name L b�2E��'� '� LtJtMP Klti Policy#or Self-ins..'Lic # ��o"$3 9y --D( ~a 1 Expiration Date: Job Site Address: .2.`�`{ Sey00r> !L 19t/� City/State/Zip: ' 1H6.(V/N!5 Attach a copy of th.e 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 eD IA for insura nce cove rage e verification. Investigations,of the g I do hereby certify n r the pat Wand pena perjury that the information provided above is true and correct Si2natvre: Date: Phone#: 5 - Official use only. Do not write in this area, to be completed by city or town official City or Town: Perm it/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Phone ff: Contact Person: I l ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 5/16/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Alan Long PRODUCER _NAME: PHONE (508)945-0393 FAX (508)945-4046 Eldredge & Lumpkin Insurance Agency, Inc. c arc No: E-MAIL alan@e1insurance,com 697 Main Street ADDREss: PRODUCER p0009124 Chatham MA 02633 INSURERS AFFORDING COVERAGE rSB007 # INSURED INSURERA:SCottsdale Insurance. Company INSURERB:The Commerce Ins. Co.Rick Roy Construction LLC INSURERC:Continental Indemnit Co. 123A Queen Anne Road INSURER D: INSURER E: Harwich MA 02645 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1151600134 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MM/DDIVYYY GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMAGE TO ED $ 100,000 PXCOMMERCIAL GENERAL LIABILITY PREMISES EaoccurrenceACLAIMS-MADE Fx_]OCCUR CS0023728 12/23/2010 2/23/2011 MED EXP(Any one person) $ PERSONAL&ADV INJURY S 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 X POLICY i LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 9110 4/24/2011 4/24/2012 B ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Uninsured motorist BI split limit $ 100,000 Underinsured motorist BI split $ 100,000 FEE A LIAB OCCUR EACH OCCURRENCE $ 5,000,000 IAB CLAIMS-MADE AGGREGATE $ 5,000,000 LE AN $ 10 000 S0073181 /18/2011 12/23/2011 $ WC STATU- OTH- CMPENSATION - AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 5OO OOO OFFICER/MEMBER EXCLUDED? N I A 4/29/2011 /29/2012 (Mandatory in NH) 46-839431-01-01 E.L.DISEASE-EA EMPLOYE $ 500 000 If es,describe under E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS below _rT__1 - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpentry - General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable . 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Alan Long/ELDALI ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD I -THEr�y Town of Barnstable t Regulatory Services Thomas F.Geiler,Director '�Enr�rt"' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, ,7-E A//.#*A ��)�1,y6'L L_ , as Owner of the subject.property hereby authorize Pt- 4-K 12P Y Two✓, C to act on my behalf, in all matters relative to work authorized by this building permit application for. :2 f .SC",DE/Z (Address of Job) G aY 1/ SignatuVf Owner Date J ,Wj F&9— Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS.O WNEUERMISSION I I. I . I . .I. I .j , .1 � . - ,. .. . , .. - I .� I .1 . � I � I. .1�I � ... ,� - . .: . - �;.':�: - ,, , - -,,-��::�� :' -- :�: I I I - " ' � � .. . 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I - , . .��. � �� - I � : �..:, 777V"�', - " , - Office�to m°"eer AAA airs "mess egu ah'� License or registration valid for iridividul use only, �.�I�1I.II�I��I.��,I�:...1.�.',I.�1:1-�II.I,...,.-ffi..I�.:�.:...��I II.�I t%�I I:I1I I�-.:-:,,:.I�1*��:.I...,::.tI.I�,I-I 1...,.,�-�.-..�.-r I-.�,,.I��,,I-':.:II.I-�I�,,.,-.I1r.I..I.-,.�.I-,I.-.--I I-��:..,�I,4.�..1I��-��-,I.�,I-�I�::,.,.:,..:.,:..Z I 1,.II-��.,I.,.��.�1 I..�,�...I,-,I�,-�1-,:�I!�1...-...:1.,.I,I.-.::.,-�,...:�:..�-.�.�.I*1 I I.�I,�:I.I:*�..I. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: g_ ':�"-,--�-,,.:I."��-,. Reg istrationi f�I11696 Type:.; Office of Consumer Affairs and Business Regulat►on Expiration: 3 2 2013 Ltd Liability CorporaU 10 -Park Plaza Suite 5170 $ Boston,MA 0211ti R OY CONST 4QI✓ r _ GIs h RICHARD ROY +� 1 '✓ 123A QUEEN ANN T � ',. �� HARWI- MA 0264 ` � ry Not valid without sig a re' k Undersecr t t, l r D, a 7- 0 2D - - _ xs A' T Jv a�� PoPoPosE►� p°2CH /00 i fr 7 b�s-f �� _' D�cKS "UN9C- gS. � L�pNST�uCnO/tJ - o LEGEND CERTIFIED PLOW PLAN �,e,sa.�n ..e EXltTING SPOT ELEVATION OxO .� o . EXISTING CONTOUR -- 0 --- y�F��:l-- ss, Z 7-8 Sc FINISHED SPOT ELEVATION -7 RCRIERT .':�.�- r.J r✓jam FINISHED CONTOUR 0 a. •-- - � APPROVED r,o. i��c? = BOARD OF HEALTH `-' ,,� ��,►�� • �� v �� SCALES / - � v " DA'�E$ 7/�&S DATE AGENT ' LDREDGE ENGINEERING CO. IN Nlcxul-,4 s I CERTIFY THAT THEFO��°�T'`'�' CLIENT SHOWN ON THIS PLAN 18 LOCAT90 EGISTERE REGISTERED JOB NO, u402-3 ON THE GROUND AS INDICATED AND CIVIL LAND By. A• -4 CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR. -� Of SARNSTAB E� MA811,� , 712 MAIN STREET CH. 8Y! HYANN I S, MASS. SHEET OF TE REG. LAND SURVEYOR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION- Map 2 Parcel 7-2-5 Application #CiO l/b Health Division _ Date Issued Conservation Division ,�J,�— Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis i Project Street Address Cf` ' ScL�� - /IV Village HY,41O S Owner 'ZV 1J f F ER_ N 90K&- w6us Address RoX (,C,7 1Y1f NwJ5PQP 11 M)9 O Z 6 Telephone Sal —77�'- 17.5� Permit Request (49 S°)^. .14 Square feet: 1 st floor: existing 11 1'7- proposed 2nd floor: existing 8�'L proposed Total new Zoning District 1? Flood Plain Groundwater Overlay Project Valuation .2gy0 Construction Type Lot Size 1 4 7— Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure ;t 41 L � Historic House: ❑Yes 'Of No On Old King's Highway: ❑Yes No Basement Type: )Q Full ❑ Crawl ❑Walkout ❑ Other :M Basement Finished Area(sq.ft.) 75 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 7' new Half: existing new - Number of Bedrooms: existing _new - ' Total Room Count (not including baths): existing new First Floor Room Count g? r Heat Type and Fuel: XLGas ❑ Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:34 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 14 No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �1�-� RQq 6W57721A--7/_0/ / Z-L-Co— Telephone Number. Address J 13 0- Qt.6F_-'i1/ MA45 License # 9-71 e5 "f4vtCt4 &Vp9 Oq1.qj; Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Get /'•tT/0,1 SIGNATURE DATE S G a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED . MAP/PARCELNO. ADDRESS VILLAGE,' OWNER DATE OF INSPECTION: 7 � A FOUNDATION 4. FRAME INSULATION �i t FIREPLACE �r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 6 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 6 x The.Commonwealth of Massachusetts Department of Industrial Accidents i I Office of Investigations `ire i 600 Washington Street Boston, AM 02111 g www.mass. ov1dia c � Workers' Compensation InsuranceA-Midavit Builders/Contractors/Electriciatis/PIumbers Applicant Information Please Print LeiTibl, Name (Business/Organization/Individual): �tG' K �l'� 4 iJ 7gvCT1C71 L-Cc t Address: 113 4 c>VLGA 1'}AtNC- City/State/Zip: `l�' (e114 MA D�-6 cl5 Phone #: ,5�8`43 � —, ��'t® Are you an employer? Check the appropriate box: Type of project(required): - 1. I am a employer with 1 .4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors - 7• Q.Rem ode-ling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g. N Building addition [No workers' comp. insurance 5. El We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 1 I.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all workp p myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other camp. insurance required.] *Any applicant that checks box g I must also fill out the section below showing their workers'compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is tine policy and job site information. Insurance Company Name: CL 612&W E L v AV K I Policy#or Self.-ins. Lie.#: 4g^ i-3 q 431 —0( —U 1 Expiration Date: Z°Z '2— Job Site Address: 2,T1 Sw` 0CE17 AVE- City/State/Zip: l�%N/f/l_S �rY► �` 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 welt as civil penalties in the form of a.STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification.: a 71do hereby certify d thepainsandp aloe perjury that the information provided above is true and correct ature: Date: Phone 4- _ 50T -Y3Z-6 Official use only. Po not write in this area, to be compLeted by city or town official City or Town: Permit/License# Issuing Authority.(circ}e one): }. Board of Health 1. Building Bepartment 3. City/Tovrn Clerk 4. Electrical Inspector S. Plumbing Inspector g 6. Other Contact Person: '^ PFione+:. 1 L o 7- �J L5 '-o-r Z0 i PRo,POSE g 0 e c K , i tiroN /� pcc►c vNo�2 r do N sww CriDN � G O Z- O' Z LEGEND CERTIFIED PLOD' PLAN EXI'S:TINO SPOT ELEVATION Ox0 EXISTING CONTOUR --- 0 -- - Z,.cT� Sc�vr�E2 vE . FINISHED SPOT ELEVATION i RC;3F-,T "J fJ/A FINISHED CONTOUR 0 f B. c_��, :�cE IN APPROVED t BOARD OF HEALTH1''A �;o. 1;vU� DATE AGENT �'.�,c SCALE, DATE�.. 7/z1's LDREDGE ENG/NEER/NG CO. IN s I CERTIFY THAT THE FOyAI°'�T'�/ CLIENT SWOWN ON THIS PLAN 19 LOCATED EGISTERE REGISTERED JOB NO. ON THE GROUND AS INDICATED "ID'' CIVIL DR.BY IL LAND A , ,� 40KFORM_S TO THE ZONING LAWS ENGINEER SURVEYOR � 'Of SARNSTAB E j MA88, 712 MAIN STREET CH. BY. 7 g� HYANN I S, MASS. SHEET-� OF TE REG. LAND SURVEYOR Maximum Span Calculator for Joists&Rafters Page 1 of 1 "" cAN Maximum Span CalculatorCOVWX Qq �000 for Wood Joists & Rafters www.awc.or Species Southern Pine Size zxs Grade No.z 1 Member Type Floor Joists Deflection Limit U2ao it Spacing Wet service conditions? Exterior Exposure Incised lumber? Yes l Live Load (psf) ao Dead Load (psf) 15 Calculate Maximum Horizontal Span Go to Span Options Calculator for Wood Joists&Rafters LIMITS OF USE i HELP 1 RESTART Span Calculator for Wood Joists and Rafters sR,N '' available for the Whone. The Maximum Horizontal Span is: 12 ft. 3 in. with a minimum bearing length of 0.59 in. required at each end of the member. Property 11vaiue Species IlSouthern Pine Grade INo. 2 Size 112x8 Modulus of Elasticity (E) 1368000 psi Bending Strength (Fb) 938.4 psi Bearing Strength (Fcp) 378.55 psi Shear Strength (F') 135.8 psi While every effort has been made to insure the accuracy of the information presented, and special Comments? info@awc.org. effort has been made to assure that the information reflects the state-of-the-art, neither the American Wood Council nor its members assume any responsibility for any particular design prepared from this Online Span Calculator. Those using this Online Span Calculator assume all liability from its use. http://www.awc.org/calculators/span/calc/timbercalcstyle.asp?species=Southern+Pine&siz... 5/10/2011 - . I 1. I : I I .. -11 ., z � , ;- 1�1,, ---��. , �:, .�, J�:��, -, . ,-- �. I I . I I , , ��;-- � . �.- 4- � . , " ' *' ` �'I �""�,.:.�,]� , - �: i . - �, � I . � . I I I I I ::�i:. - . ,. ..- . � , , , ,. ". . - . - , . . � . � . � . .. ,Z. I � :- I, .:., - - - - , 1.. , ,:.,., �.:j.- �. - - -� ,. . ,�� -,�!� � . . I I I . � - " ,.. .---��:. ,, I � I I ".I - - ; I 11 , I I - 1� I - � . . , �. �- I,��. I . I.i I. .: I - , � , , I . I ....�-1 Z.!.-., ,.I � I � I I I I . . - I .1 � 1%. I %., - - . I ., ,,, . I . . I -- '. . . . , .I , - :� . . I I � , -.� , .;, ! ., I I I I.�. ,..�'., �� . , I !:�, ,,, �I '.�..,�"..1:1: I ,.,I;,,,� . . � �, ,,. .�I � . .I I-1 I. � I I. . � : . - I. I..�7:" � -. .I. � .. I ..� .% �� . I : . ,,�,� :, , ; I :��.. I 11 I , � I . - � � ��, . . � . . . ... - .�, �:; - 1 � I I 11 I I,� , , : ,:, :, � I -. . 11 ,. ' ' . - .1 : �- �--,�,�- I -. . 1 . . - -: - , , -. I:. �, . � , -I I : , . .1 I :-. -1,-�-I,I,:t � , " . 11� -�. �:�. �-,-�-�,, 1, ,..; - - I . ,-� ---- . . I I. � . I I-� � . .,I,. I . - - --"-- : , I �, ,. . 41,1 � . %i :,, . I :,-. �- - �,, �:-, ; - � I . . .�. % I , �. , .. , '- - .. I I . �. �., : -: , - : 11 .. .1 � :��-.,� , 1. - ;1 . . .- � ". - �: .:.; ,: : , :�-- .,,....-.�........., - , . , ..� I ; - . I . . . . , �--------� -,,------�,-"--"�." . - I .", ,- ,�I . . � .� , :.,-.I I �I 1.I .I -,:.�,.:!�..��-�7, -,.�%�,:,�*- tl'I IssiiChusetts- Department of Public S.iteo _ �---,- 8oxril of Builcbn��Ri��ulutibns:uul St.►ndai ds . I I :::.: .1 .. . 9Construction,Supervisor License," License: CS 47185 ,"' w �, . �. Restricted , 1. �. W: I � . to: 1 G,-' = ,RICHARD J ROY r »: ! PO BOX 25 t a - . S,CHATHAM, MA 02659 - ,..-" , t ;; �a --�-- —' "�' ExpiraUon: 7/14/2011 (�rnunissit - Tr#: 18528 ? � ' t i : OfticeA*o m°"e A airs VidssZFegulation. License or registration valid for mdividul use only b HOME IMPROVEMENT CONTRACTOR before the expiration date. If.found return to: Registration111696 Type.?. Office of Consumer Affairs and Business Regulation Ij Expiration: ` 12013, Ltd Liability Ci rporati 10 Park Plaza Suite 5170II Boston,MA 02116 R OY CONS], rr jf r�'F I RICHARD ROy � ; A _ 1 123AQUEENANN _ ,,$" 4m5B� HARWIC:_ .. .1 6d�s' . Undersecret ry Not valid without sig re "� d .. :. - , S t. :. .. . h j¢ .-lI II , ... .1 - I m.- , — , -1 - I I . , � . '� !'I % :�' - .. ..: r ® DATE(MMIDD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 5/16/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Alan Long PRODUCER NAME: Eldredge & Lumpkin Insurance Agency, Inc. No.Etlo (508)945-0393 FAX csos>eas-aoae A/C No 697 Main Street ADDRESS:alan@elinsurance.com PRODUCERCUSTOMER to 00009124 Chatham MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Scottsdale Insurance Com any SB007 INSURERB:The Commerce Ins. Co. 134754 Rick Roy Construction LLC INSURERC:Continental Indemnity Co. 28258 123A Queen Anne Road INSURERD: INSURER E: Harwich MA 02645 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1151600134 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. ADDL SUBR POLICY EFF POLICY EXP INSR TYPE OF INSURANCE LIMITS LTR IN SR D POLICY NUMBER MMIDD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMAGE TO RENTED lOO,OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE X❑OCCUR BCS0023728 12/23/201012/23/2011 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 X POLICY jE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED AUTOS 9110 4/24/2011 4/24/2012 BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Uninsured motorist BI split limit $ 100,000 Underinsured motorist BI split $ 100,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ s,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DEDUCTIBLE A X RETENTION $ 10,000 LS0073181 3/18/2011 12/23/2011 $ WC STATU- OTH- C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ (Mandatory In N OFFICER/MEMBER EXCLUDED N/A 46-839431-01-01 4/29/2011 4/29/2012 E.L.DISEASE-EA EMPLOYEE $ 500,000 f yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpentry - General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Alan Long/ELDALI �� ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INSO25(200909) The ACORD name and logo are registered marks of ACORD sr° ti Town of Barnstable Regulatory Services ,PttxMAE& Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,'MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property CNvAer Must Complete and Sign This Section If Using A Builder I, T YJ) �'jti E [ t-- , as Owner of the subject property 0 hereby authorize Q,C•-14 PDY rl✓S`72,/d-7701t-*� to act on my behalf, in all matters relative to work authorized by this building permit application for. 9 %GC. # lf4J II-5 (Address of Jab) Signa -of .0jr __. _ . _ Date print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION t ray Town of Barnstable yam. Regulatory Services �xxsrwsLe Thomas F.Geiler,Director t�tAss. . Building Division TFD µA't Tom Perry,Building Commissioner 200 Mairi-Street,_Hyannis,MA_02601 www.town.barnstable.rna.us Office: 508-862-403 8 Fax: 509-790-6230 HOMEOVNER LICENSE EXEMPTION Please Print DAZE: a�/ 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 HOMFOwI.ER Persons)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 constrycts 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.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 Cont rol. HOMEOWNER'S EXEMPTION .The Code states that: "Any bomcowner performing work for which a building permit is required shall be ex t from the provisions �P of this section.(Sectian ID9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a pason(s)for bin;to do such work,that such Homeowner shall act as supervisor." Iiany homeowners who use this exemption arc unaware that they are assurning the responsibilities of a supervisor(sce Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) •Ibis lack of awareness oftzn results in serious problerrrs,particularly when the homeowner hires unlicensed persons. In-this case,our Board cannot procce:d 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=spoimbilitics,many communities squire,as part of the permit application, that the borneDWMCr certify that beshe understands the respmsibilitica of a Supervisor. On the last page of this issue is a form eurrcntty used by several towns. You may cart t amend and adopt such a fonWcertificztion for use in your community. Q:forms:homccxcmpt �?l � Tv /71 a �o mn A D ------------- ------------ z m,® -------Ig I Iv O O c A I z � N I I o n m I ®I I Z am I 1 r I 1 Z I I I I I I I I a I I Y I W Rick Roy Construction LLC JENNIFER BAKEWELL 'b 123A Queen Anne Rd. S. .299 SCUDDER AVE. Harwich, MA 02345 H Y A N N S, MA A Tele: 508-432-6840 Fax: 508—432—4814 rroycon@comcasL.neL Y f z -0 O �O n 70 p �o D o m 0 m Q < O m o �_ n m O r Xm �I1IIII1IIII m % Lull n 1p G) n �✓ L'fi IT n _.-------- O xit _ n A ----- ------------- i'TTTTTTTTTTV ---------------- ______ �111111J.11t1;, 70 D �, ----- 70 In --- o D ----z - -- W Rick Roy Construction LLC JENNIEER BA,KEWELL 123A Queen Anne Rd. s 299 SCUDDER AVE. Harwich, MA 02345 a H Y A N N I S, MA Tele: 508-432—6840 Fax: 508-432-4814 rroycon@comcast.net r' TOWN OF ABLE,BUILDING PERMIT.APPLICATION,,. BARNST.... ,, .., .. Y: Map Parcel !i Application # Health Division Date Issued IC t Conservation Division c r ,Application Fe Planning Dept: Permit Fee 16 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village ✓t/I / S Owner e✓� G� �.�.C,� 1 Address CA CC / Telephone >09 /0,5 Permit Request (3^ A NCJw 0 X/w C�ri� ep< '` �✓ 'j 1�cXCr� h'l ��i3T(n :�cw►��vv� --G�4� L Tv Get rA j Lf �8� 1 Jc6i< y/U S :/1o0 pill ti Square92- feet: 1 st floor: existin proposed 2nd floor: existing S 3/' proposed-: / Total new Zoning District Flood Plain / Groundwater Overlay Project Valuation 10100 O Construction Type Lot Size / �Z Grandfathered: ❑Yes ❑ No If yes, attach supporting-documentation. 9 Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) // c, s-;1 Age of Existing Structure rZ lP YIS. Historic House: ❑Yes >(No On Old King's Highway: ❑Yes kno Basement Type: b(Full ❑ Crawl Walkout ❑ Other Basement Finished Area (sq.ft.) � Basement Unfinished Area(sq.ft) 3S(� Number of Baths: Full: existing 9t new e,*`� Half: existing new Number of Bedrooms: existing ,**new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: >Gas ❑Oil ❑ Electric ❑ Other Central Air: Xes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes a`go Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garageX. existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ,- (BUILDER OR HOMEOWNER) Name9\,(-K L4 4tAQCt10 V\ Telephone Number Address 12.214 Q06a" hlv^) License# v! !9A4 WlU - Home Improvement Contractor# Worker's Compensation # G�6,?C W y q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS P OJECT/WILL BETAKEN TO t. . SIGNATURE DATE l 4 FOR OFFICIAL USE ONLY APPLICATION# R DATEISSUED , I MAP/PARCEL NO. ADDRESS VILLAGE OWNER' • DATE OF INSPECTION: FOUNDATION f FRAME INSULATION FIREPLACE f'; ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 6 ASSOCIATION PLAN NO. , � r rTown- of Barnstable Regulatory Seryices Thomas F. Geiler, Director L6s¢: Building Division Thomas perry, CBO, ,Building Commissioner 200 Maim Street, Hyannis, MA 02601' tvww.Cown.bar L5-table.w2.us G 0ffccc 508-86274038 Fa--K 508-790-62= PLAN RE VIE Owner: C L—L Map/Parcel: Project Address Builder: '�` PLC) /4-� The following iter.n.s were noted on reviewing: r SC) A . T---I E s Y Po s'7- ( G- 2`-r rN Re7iewed by: -� Date: The Commonwealth of Massachusetts Department of Industrial Accidents \ Office of Investigations ' 600 Washington Street Boston, MA 02111 ) www.mass.gov/dia / Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): R\CV, CQ^-5MVC7h0kA Address: 12,34 1444 e-- �. City/State/Zip: we� W- d 50,0- Phone#: Sd 5- /3a 6 510 Are you an employer?Check the appropriate box: Typ of project(required): LX I am a employer with 1-0 4. ❑ I am a general contractor and I New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. ❑ Remodeling ship and have no employees These sub=contractors have X/g. ❑ Demolition working for me in any capacity. employees and have workers' '� [No workers' comp. insurance comp. insurance.$ 9. ,Building addition ( &g S 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 11.0 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. $Contractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. / Insurance Company Name: P/Z d d e,4, �GtSvC�,G �' i✓S. Policy#or Self-ins.Lic.#: C.L� -.2 / Expiration Date: 7 l Job Site Address: City/State/Zip /,f L(go Attach a copy of the workers' compensation policy declaration page(showing the policy number an expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: 3 Y /I Phone#: o 9 7 3� 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 bum 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 i ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/27/2010 PRODUCER 508.94S.0393 FAX 508.94S.4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Lumpki n Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 697 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 Alan Long INSURERS AFFORDING COVERAGE NAIC# INSURED Rick Roy Construction LLC iNSURERA Scottsdale XSB007 123A Queen Anne Road INSURER B: Ace Property & Casualty Ins Harwich, MA 02645 INSURER C: INSURER D: 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. INSTR NSR TYPE OF INSURANCE POLICY NUMBER ADD'LPOIJCY EFFECTIVE PO Y EXPIRATI N DATE MM/DD/YYYY DATE MMlD LIMITS GENERAL LIABILITY BCS0023728 12/23/2010 12/23/2011 EACH OCCURRENCE $ 1900jov X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEI[F— PREMISES Ea occurrence $ 100,00 CLAIMS MADE OCCUR MED EXP(Any one person) $ A PERSONAL&ADV INJURY $ 100000 GENERAL AGGREGATE $ 200000 GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 200000 POLICY PECT RO- J LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ANYAUTO (Ea accident) $ ALL OWNED AUTOS 1 ! BODILY INJURY $ SCHEDULED AUTOS (Par person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS I (Per accident) $ PROPERTY DAMAGE $ _ (Per accident) GARAGE LIABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION C46288944 04/29/2010 04/29/2011 AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY B OFFICEWMEMSERIPEXCLUDED?ECUTIVE❑ E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH)If E.L'DISEASE-EA EMPLOYEE $ SOO,OO Yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,0O OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Contractor - Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE L UT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY KI O ANY N N E INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009(01) 01988-2009 ACORD CORPO ION. All rights reserved. The ACORD name and logo are registered marks of ACORD r' Town of Barnstable ` Regulatory Services . r • , i • BARN6rABIY_ MAas. $ Thomas F.Geiler,Director s63¢ �� • Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder V.(e_,'e'�l , as Owner of the subject property hereby authorize ��c:V� I w �c /lyC,�"�LI to act on my behalf,' in all matters relative to work authorized by this building permit application for: C G .SC vCUt;'t dgUe� `7� Gc✓I✓!t y (Address of Job) Signature of Owner. Date A i3c.LkCwC_k Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISStDt1 h Town of Barnstable �Op'[tiE Tp�y Regulatory Services t sw�xsz.AsrF ; Thomas F. Geiler,Director MASS. 1659. A.�� Building Division Tom Perry,Building Commissioner 200 Matn.Street,_Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOVNER 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. DEFINMON 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 Barnstable Building Department minimurn inspection procedures and requirements and that he/she will comply with said procedures and require ts. IL Signatu of omeowner 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." 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 fomr/certification for use in your community. Q:forrns:homcexempt 780 CMR STATE BOARD OF BUILDING REGULATIONS AND STANDARDS APPENDICES CONSUMER INFORMATION FORM-"SUNROOMS" Massachusetts State Building Code(780 CMR 61013.2.2) The Massachusetts State Building Code(780 CMR)includes provisions to ensure that houses and house additions meet energy efficiency standards.This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall,seeks to utilize a special energy conservation exemption option for"sunroom" additions to an existing house (780 CMR, 6101.32.2). This FORM is not intended to prevent a homeowner from selecting a"sunroom"of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year-round comfort considerations involved in selecting and utilizing a"sunroom"addition The connection of"sunroom"structures to residential buildings maycreate comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house.In the selection and construction installationof"sunrooms",includedbelowisanon-required,open-ended list ofproduct and design considerations that a homeowner may wish to consider before actually constructing/installing a"sunroom".It is recommended that consumers carefully review these options with their designer,builder,or contractor,in order to minimize potential energy consumption and/or house discomfort issues. In addition,the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation-Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings v Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods:Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code,780 CMR 610132-2,requires that the actual property owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER MORMATtON FORM prior to issuance of a Building Permit for a project that includes"sunroom"additions to an existing residential building. In accordance with this requirement;the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. ,1. Sign of Actual Building Owner Date �ENN/Fe�L �,<}KEWEL.L ��vl... JVVc�ccX{^ QuC� • �7' QvIV�IS Print Name Address of Permitted Project 1 Svc -771 S/ 9� Owner Address(if different than project location) Owner's telephone number 8/8/08 780 CMR-Seventh Edition 1051 ENERGY CONSERVATION APPLICATION FORM VOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the following two-options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM - Ceiling or Slab . Option 1: Fenestration exposed Wall Floor Basement perimeter Wall AFUE HSPF SEER U-factor floors R-Value R-Value R=Value R-Value R-Value and Depth National Appliance Energy .35 R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of 4 ft. 1987,as amended;minimums or reater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. Option 2: REScheck Version 4.1.2 or later Variant software analysis must be completed (780 CMR 6107.3.2) REScheck--Web which can be accessed at http:J/www.energ cy odes.gov/rescheck/ ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS. VER 5 YEARS OLD* *Buildings under 5 years old most use option#1 or#2 in New Construction section above. Complete the following foimula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b a) SF 100 x _ _ % of glazing (b) Glazing area equals SF - b a If glazing is<40% use.the char(below. If glazing is> 40.%proceed to "SUN.ROOM" section 780 CMR TABLE 6101.3 - PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING. LOW-RISE RESIDENTIAL BUILDINGS 7Fenestration MUM MINIMUM Ceiling and Slab Perimeter ❑ - Wall Floor Basement Wall. Exposed floors R-Value ctor R-Value R-value R-Value R-Value and De th 9 R-37 ,a R-13 R-19 R-10 R-1`0; 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value.over the entire ceiling area(i.e. not compressed over exterior walls, and including any access openings). SUNROOM—An addition:or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the g g addition. Note: Owner to fill out Consumer-Information Form (found in Appendix 120.P) ------------- Massachusetts- Department of Public Sufetc Baird of Building Re„sulationa;and.Standards Construction Supervisor License License: CS 47185 Restricted to: 1 G RICHARD J ROY PO BOX 25 . S CHATHAM, MA 02659 Expiration: 7t14/201:1 Commissioner Tr#: 18528 Ottice-tkonsumer a�irss✓�'13ilsine�g`uianon License or registration valid for individul use only. HOME IMPROVEMENT CONTRACTOR before the expiration date._ If found return to: Registration:;,p-111696 Type: Office of Consumer Affairs and Business Regulation Expiration: 1-2013 Ltd Liability Corporati 10 Park Plaza-Suite 5170 Boston,MA 02116 TRO CONSTI1= ;`r' RICHARD ROY SI 123A QUEEN ANN � 4o HARWICH,MA 026d5 u~ Undersecretary Not valid without sig a re, r LO r g �' 171 \ v L DT 2.0 .00 • J . aa ( , a i l 0 o g -7G 0 � V• O I Z ' O g LEGEND CERTIFIED PLOD" PLAN EXI'S.TING SPOT ELEVATION OXO EXISTING CONTOUR --- 0 - - - js� ---- 'r [..c 7-8 Sc FINISHED SPOT ELEVATION ificar-RT FINISHED CONTOUR 0IN ; APPROVED = BOARD OF HEALTH`, r;o. 183G7 AAh3TAALJ4 MASS,*. DATE AGENT ;;u�� SCALE' /"- (, v ' DA7E,l: 7/ s LOREDGE ENGINEERING CO. IN I CERTIFY THAT THE�dL1A/a,a7-1dN• CLIENT SMOWN ON THIS PLAN 19 LOCATED EGISTERE REGISTERED JOB N0. '41)Z-3 ON THE GROUND AS INDICATED ANC CIVIL LAND C,QNFORMS TO THE ZONING LAWZ ENGINEER SURVEYOR DR.BY, OF AARNSTAe E MASS, 712 MAIN STREET CH. BY? T�• 7 BS" �,, �' `� N YA N N I S, MASS. SHEET--.� OF TE RES. LAND SURVEYOR ;loins TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map Parcel# 2 Application # Z.0�d 14 Lto Health Division Date Issued Conservation Division Application Fee Planning Dept. "Permit Fee Date Definitive Plan Approved by Planning Board �l— Historic - OKH _ Preservation/Hyannis Project Street Address 294 Scudder Avenue Village Hyannis Owner Jennifer Bakewell Address same Telephone 5o8-778-5185 Permit Request air sealing, install 944sq ft of R-30 to attic, insulate 1 attic access hatch, insulate h back of 1 attic door and install 1 insulated exhaust hose Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 23s5 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - - - _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401 780700 ty li _n Address 1341 Elmwood Ave Cranston, RI 02910 License# 100459 i t Home Improvement Contractor# o-� 120979-o Worker's Compensation # ' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ell SIGNATUREX DATE 3/25/10 Erik Nerstheimer for RISE Engineering FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE k ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of 1 asil acDae setts department afllndustrrriaf Accident Office of Investigations 600 Washington StreetBoston, AM 02111 UV vwli w.rnass.gov/di a \W prke>r sl (Compemsation ffnsu>r ahce,Afft1davi>to ]Putn➢�ler��Icl✓®>ra�>r��®>r�/�➢ee�>rIl�➢�>iD�/]�➢anl uib�>r� �»�➢>lea�n>t�lrnff®>ra�attn®n P➢ez�e P_Ir>int Le&ih➢y Dame (Business/Organization/Individual): RISE Engineering; A :Division of Thielsch Engineering •. Address: 1341 Elmwood Avenue - City/State/ZIP: •,: , Cranston RI 02910 Phone #: 401-784-3700 or 1-800-422--5365 Are your an emp@®yeir?Check the�Rppropi iate 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.❑ 1 am a,sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. workers' comp. insurance. 9, ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10:❑ Electrical repairs`or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions .myself.. []\To workers' comp. c. 152, §1(4),and we have no., 12.❑ Roof repairs J insurance required.] t R. employees. (No workers' comp. insurance required.] 13.Fx� Other Insulation Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.poi icy information. I am an employer that is providing workers'compensation insurance for my employees. .Below is the policy,and job site information. Insurance Company Name: The Preston Agency Policy#or Self-.ins. Lic. #: WC2-Zl l-259874-019 Expiration Date: 04/01/ 10 Job Site Address: o < �� - �•r �: City/State/Zip; H3dS Attach a copy of the workers' compensation policy declamtibn page(showing the policy number Ad 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$250.00 a day against the violator. Be advised that a copy of this statement May be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certc un ., r the ins an - enaltaes o�' p jperlury that the information-provided above is true and correct. Signature Date Erik Nerstheimer for RISE Enggineering •'Phone#: '401-784-3700 or 1-800—' 422-5365 , Ext. 133 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# L ority(circle one): ealth 2. Building Department 3.City/Town Cleric 4. Electrical Irosliector 5. Plumbing Inspector on: Phone#: �r I'age 1 0I 1 The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Public Safety Department Of Public Safety Licensee Complaints- License Type Construction Supervisor License# 100459 Restriction WS,IC s # Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 „ Status Current No complaints found for this Licensee. Back To Search ./lt�.U/G✓.r,7/IYLpyLU/P� 6�✓/�ClZQ4YZC'FZ(C�(a � - ��: _ - .. _ .- .. Board of Building Regulations and Standards l b-Cense.or registration valid for individol use only' HOME IMPROVEMENT CONTRACTOR i* before the expiration date. If found return to: Registratiob,:. 120979 Board of Building Regulations and Standards P*_ �25/2010 Ex;:rati:og One Ashburton Place Rm 1301 3 4YYPe ��,,p ement Card rPSIGU,hla; 021-0$ v HIELSCH ENGINEERING RIK NERSTHEIMER 341 ELMWOOD RANSTON, Admtn.istt:ator { Not valid ^---l'd without signature I. hrtp://db-state.ma:us/dps/licIdetails.asp?tXtSearchLN=CSL 100459 ACORD- CERTIFICATE OF LIABILITY INSURANCE ®PAD 27 =(MAWDD1NffWY) PRODUCER TEIEL-1 9 - The Preston Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO 1350 Division Rd Suite 303 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 810 ND OR AL TTHE COVERAGE AFEF�pEp gy DOES TT pp�IC1 AND D E ES BELOW East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURER A: BartEord Underwriters Ins. Co Thielsch Engineering, Inc INSURER B: Bamford Casualty In Thielsch Group Inc. Hi Tech Realty Inc. INSURER C: Liberty matual Insurance Group 195 Cra Frances Avenue Cra INSURER D: North American nston RI 02910 ci 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 CONTRACTOR 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. MMAM LTR NS TYPE OF INSURANCE POLICY NUMBER � GENERAL LIABILITY EACH OCCURR= $1,000,000 A TXCOMJMERC�L�ALGENERAL LIABILITY 02UUNM5678 04/Ol/09 04/Ol/10 PREMISESIUK (Eaooauer�ce) $300,000 CLAIE ®OCCUR }?' MED EXP(Arty are Person) $10,000. PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,OOO,OOO GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,00O,000 POLICY X JECOTT LOC AUTOMOBILE LIABILITY Emp Ben• 10001000 B X ANY AUTO 02UENTD4850 COMBINED SINGLE LIMIT ~ 04/01/09. 04/01/10 (Ea a t) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ Pam) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE $, .. (Per accident) . GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ } OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY OCCURRENCEEACH $10,000 B X OCCUR CLAIMS MADE 02XHUUF6573 04/01/09 04/01/10 AGGREGATE 000 $10,000,000 DEDUCTIBLE X RETENTION $10 000 $ WORKERS COMPENSATION AND . $ C EMPLOYERS'LIABILITY X TORY UMfTS ER ANY PROPRIETORIPARTNERIEXECUTIVE WC2-Z11-259874-019 04/01/09 04/01/10 E_L EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? If es.describe under E.L DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below OTHER EL DISEASE-POLICY LIMIT $500,000. D Professional Liab DVL0000259012 04/13/09' 04/01/10 Prof Liab 2,000,000 A Leased/Rented Eqp 02UUWM5678 04/01/09 04/01/161 E t 100 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY EMDORS81BfT I SPECIAL PROVISIONS *Except 10 days for non payment of premium. .Holder is included as an additional insured when required by a written contract with respect to the General Liability coverage. CERTIFICATE HOLDER CANCELLATION TWNOAI03 SHOULD ANY OF THE ABOVE DESCROW POLICIES BE CANCELLED BEFORE THE ExPIRA710N OA7E THEREOF,THE ISStWG I R W'&L ENDEAVOR TO MALL *30 DAYS wRfITEN MOTICE TO THE CERTIFICATE HOLDER MIMED TO THE LEFT,BUT FAUMM TO DO SO SHALL WPM NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSIIRIp.ITS AGENTS OR RBMiEBBITAWA& AUTIIOIIREO ACORD 25(2001/08) ©AC D CORPORATION 1' 7� �I '�elsch $ ,� Mh ` Also for RISE Engineering, a division of Thielsch Engineering, Inc. - Gaskell Associates, a division of Thielsch Engineering, Inc, r BAL Laboratory, a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch.Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. ;:. Water Management Services, a division of Thielsch Engineering, Inc. . " t ' t Federal ID#05A405629 H RISE ENGINEERING RI Contractor Registration No alas A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 ai 1341 Elmwood Avenue,Cranston,R102910 4 � (401)784-370o FAX(401)784 3710 CONTRACT Page 'THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENC-INEEgING DESCRIBED BELOW CUSTOMER - PHONE DATE Client# Jennifer J Bakewell (508)778-5185 02/10/2010' 108056 , SERVICE STREET -• `BILLING STREET " 294 Scudder Avenue 294 Scudder AY. SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Hyannis,MA102601 Hyannis,MA 02601.' JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 17 man hours. ' $1,122.fl0 RISE Engineering will provide labor and materials to install a 8"layer of R-30 Class l Cellulose added to 944 square feet of open'attic space. $1,038.40 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 1 attic access hatch(es). $25.00 RISE Engineering will provide labor and materials to insulate the back of the attic door with 1 rigid foam board and seal the door edge with weatherstripping to restrict air leakage. $100.00 RISE Engineering will provide labor and materials to install Iinsulated exhaust hose w\roof mounted flapper vent to exhaust existing bathroom" fan(s). ' $100.00 RISE Engineering will apply all applicable,eligible incentives to this contract. Rise will deduct 100%air sealing incentive.. -$1,122.D0 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only.the Net amount. Currently,for eligible ` measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. -$947.55 1 _ WE AGREE HEREBY TO FURNISH SERVICES-`COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Fifteen &851100 Dollars $316.86 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY. , UNPAID BALANCE AFTE 0 DAYS.SEE REV WE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION: - y 'l DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURE-RISE ENGINEERING CUSTOM ACCEPTANCE NOTE:THIS c�VTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN - DATE OF ACCEPTANCE •// I D I i1 ` '1 ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. - - - AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE Town of Barnstable *Permit#d 6 4S-1t a Expires 6 mont/is from issue date X-PRESS PERMIT Regulatory Services Fee .--- Thomas F.Geiler,Director (� SEP 2 0 2007 Building Division /�— TOWN 01: BARNSTABLE 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 - RESIDENTLAL ONLY ? JNot Valid without Red X-Press Imprint Map/parcel Number1-7 Property Address Z- 'Y' 5G(1c !J P/! �y �/ AI;411 !O G z,-h o l Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 2- 0 Contractor's Name �G � ' "' l Telephone Number",j ��`7 0 ` i)W) Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance ` Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side Replacemen Windows/doors/sliders. U-Value (maximurh.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: rop rty 0 e sign roperty Owne Letter of Permission. A co y of a Hom ]m v t Contra ors L• se is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Z Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ' 1 N e (Bus ess/Or$b vie dividual): . �ve •Adciress: OF N� City/State/Zip: �� yT/f Phone.#: 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 6. El New construction . . employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Q Demolition workingfor me in an capacity. employees and have workers' Y P tY• #. 9. []Building addition [No workers'comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers 3.❑ I am a homeowner doing all work 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_RL�7'i / comp. insurance required.] . W/Al P,9 kV,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 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 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: Policy#or Self-ins.Lia M /' Expiration Date: P Job Site Address: / �� 1' ,� N V City/State/Zip: A)lV),f 4 U. I Attach a copy of the workers' compensation policy declaration page(showing the policy n ber 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 a against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Invesdeations of a VIA for insurance cov a e veijfication. I do hereby c u der the p s•a nalties o ery ry that th information provided abov is tr a and correct Si afore: Date: Phone#: �� Official use only.. Do not write in this area,to be complet 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#: ` 'J/)E' fnf'i'i2')'.('.J'iii;'Y//�I 1./�, �/!/.{:i✓"LC'f- C..F,/.,1 Board of Building Regulations and Standards License or registration valid for individul use only i'�,' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: .d Board of Building Regulations and Standards \ Registration: .154837 One Ashburton Place Rm 1301 - Expiration: -4/10/2009 Tr# 254890 Boston,Ma.02108 TypeC Private Corporation LLEWELYN BUILDING CORP DAVID LLEWELYN /a ✓ �,. 11 STANDISH WAY ' - �.�Qa ..� l { W.YARMOUTH, MA 02673 Administrator Not vah with ut si nature i j BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR ' Number.CS 090468 z + Birtfidate 03/2911946 c :. ;Expires: 03/29/2008 Tr.no: 90468 . � - Restnsted kr00 ' .I i DAVID L LLEWELYN r 15 STANDISH WAY I s: W YARMOUTH, MA 02673 1� t Commissioner i I oFjHE� , Town of Barnstable. Regulatory Services saxrtsraBLX. 9 MAss $ Thomas F.Geller,Director ]Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ",w-town.b arnstab le.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder /I, ,as Owner of the subject property O hereby authorize � L to act on m behalf2*YJ Y , in all matters relative to.work authorized by this building permit application for: . c-7 9s (Address of Job) nature of Owner 61 Date o /X G r fflye&)'L--/-DiY Print Name Q TO RM S:OwNERP ERM IS S ION Assessor's map and lot number .....r `r."� ..... T HE f3. Sewage Permit number ........................................................ Z EAR33TADLE, i Mquse'number MARL r:.,...�E- .......................... 900 i639. \00 . �`�MPY a• e TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................................... ........ ....................................... .................... TYPE OF CONSTRUCTION ...... .............................. J ........................................ .. ...................... .. ..................19.:..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....4.a..` .............{ ...........� .1 �" �.. :.. =. ........:°�� "1`;`d/s,�1 /..�.......................... ProposedUse ............` //Z�. � .. :.....'..../......................................................................................... Zoning District ................. :...............................................Fire District ` s .......... � ............................................................... Name of Owner �f -2/9�'U�4- ..Address X621 CI h, is Nameof Builder ..............................Address .................................................................................... Nameof Architect ..................................................................,Address .................................................................................... Number of Rooms ................. �" ....:.r:..Foundation ......................f.................................................. �............. ......... ,.. r ° Roofing ............... �a........................................Exlerior ........A)(-, . .... .. .. em�ss--,2..sr ` Floors ... ......... ......... .........r ,....Int mar ......... L)t{G .......... .....-;!..................................... Heating '*t�................................................�%.Plumbing ...................... ....................................................... Fireplace ............. .l.............. .................. •. yApproximate. Cost ........................................................... . Definitive Plan Approved by Planning Board,=t__ ` ___-------19 _ . Area Diagram of Lot and B,uilding:•-withm`Diensions Fee "" ! � f... ... SUBJECT TO APPROVAL OF BOARD OF HEALTH , ' Ll Ll OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name /'� /.,r/ 1 .Y . . ..................... Construction Supervisor's License .. ..L. ,.,..,,,, y ' V NICKULAS, LARRY A=288-225 No ...,,28213 Permit for ......1 StorY............ • i` Singqle Family Dwelling.. ..G7.......... ...y... ................. Location Lot 8; . 294 S udd„r„Ayenue,.,, ..................Hyannis................ . Owner .....Larry Nickulas .................................. Type of Construction ........Frame .................................. ............................................................................... Plot ............................ Lot ................................ Permit Granted ......JNly.....................19 85 Date of Inspection .....................................19 Date Completed ......................................19 ' 6 1 aft„E ram, Town of Barnstable *Permit# �� Expires 6 tnontlts from isstre dare OD .UMsTABr.E. :; Regulatory Services Fee v� MASS. rep Thomas F.Geller,Director t6s9• �• '�fo►�+& Building Division , Peter F.DiMatteo, Building Commissioner •pf?e5 367 Main Street, Hyannis,MA 02601w Office: 508-8624038 T SEP 7200, Fax: 508-790-6230 O EXPRESS PERMIT APPLICATION - RESIDENTIAL_ V g gRNST Not Valid without Red X-Press imprint AB�E Map!parcel Number d Property Address Residential Value of Work r� � h �� Owner's Name&Address Telephone Number Contractor's Tame Home Improvement Contractor License#(if applicable) ��9 r Construction Supervisor's License#(if applicable) ❑workrnan's Compensation Insurance . `. r Chec ne: am a sole proprietor ` (Y: ❑ I am the Homeowner ' ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) [4e-roof(stripping old shingles) 3 S 9 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windo«s. U-Value ( •44) ❑ Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town d artment regulations.i.e.Historic.Conservation.etc. Sienature Q:Fomis:erpmtrg:rev-070601 TOWN OF BA.RNSTABLE Permit No. -----2821.3_____________ B Building Inspector Cash 6; OCCUPANCY PERMIT Bond F___ _--__1_-Q1_ A _ d Issued to Larry Nickulas Address ' Lot 8, 294 Scudder -Avenue, Hyannis Wiring Inspector f Inspection date Plumbing Inspector�' /�7-r �4- Inspection date r✓ v Gas Inspector �� Inspection date XEngineering Department < .; °f f ��,+� :f., , Inspection date Board of Health r :�,y,.� L L,y.�!t.;�� Inspection date - /� 8, THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUIILLyDING;CODE. n� ' ffcq / 19 Building+Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT i ssaaerAU TOWN OFFICE BUILDING r�ua HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department/—,ft0' DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #.:............ �....7....... 52.....�3..............�..��.1�.......... .. { issued to , f✓'" /.C+.i,ft .5 Zq� -1 Please. release the performance bond. z t 9 i a a ti Z_q.7 i sl?? Q O t - _ G r' 1 - 1,/, /' '• 2-0 -0 ;. ��cirrL,clTlorl Fk LEGEND CERTIFIED PLOT . PLAN 3 EX18I.N.G SPOT ELEVATION OxO i'p\ 0 ass EXISTING CONTOUR --- p --- � .• y Z.vT 8 sc�.�»E� sk FINISHED SPOT ELEVATION �Q� � FACB RT +r ,�. � � f✓ N/S' :FINISHED CONTOUR 0 eLM�-a�rE 1N , � fJo. 1S�G7 'APPROVED , BOARD OF HEALTH ' SAJIAS tASLJWdA , asp�r iSfEB<. �w L ' ' L DATE AGENT SCALES /"= Gv, DATES 7 t��,;;. v . . CDREDGE ENGINEERING CO. IN AfiCK01-A s I CERTIFY THAT THEFvvA1,0A dn/ } CLIENT S14OWN ON THIS PLAN 19 LOCATED f EaISTERE REGISTERED JOB NO. �4`' 4-3 ON THE GROUND AS INDICATED AND,. 1 CIVIL LAND �. CONFORMS TO THE ZONING L.AW.S ENGINEER SURVEYOR DR.BY OF SARNSTAS E � MASS, 712 MAIN STREET CH- BY -� f H Y A N N I S MASS. � �� "�r""'�'� � •y ,' ' SHEET_ OF / TE RES. LAND SURVEYOR ' (�A6�7 OF � 'a`w8) K0 1,f: 6K Bi- Assessor's map and lot number :ca g.. '7... .� .. fTNET g �..`7�................ TIC SYSTEM MUST Se a Permit number ......:............ C $EP TEM IN', IN COMP = BA"STADLE, House number. ........:.................. . 5 2.9.Y:.:.......::............... WITH TITLE ASa (!6 639• \0� r ENVIRONMENTAL CODE 0 UP TOWN: OF 'B•A ATIONsRNS `� RULDING INSPECTOR • /'7 z APPLICATION FOR-PERMIT TO ..:......��.�� ........ o ...( TYPE OF CONSTRUCTION dl.. .t ...................... ......19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .©.T........ ........... .... ..��- �r..C.......... . . .......l!/!ll/ ............................................. ProposedUse �`��T' -' / J�./........................................................................................... Zoning District .................r�..........................................Fire District ......:..,I(1 Y�/I/.�/ Name of Owner ......... '!X4 Address .......... Name of Builder !� ........r.'a......................................//...............Address .................................................................................... Name of Architect .... .. ...........Address .................................................................................... Numberof Rooms ...................-..........................................Foundation ......................, .................................................. Exterior .........li�. //U�Y� S.................Roofing / ................ ................. .............. . ...... ............................................................ Floors .....:............. ...........................Interior z Heating ................. .................................................Plumbing ................................. � 5....................... Fireplace ............... ..................................................................Approximate. Cost Definitive Plan Approved by Planning Board (________________19 __:. Area � Z�o 'S' Z......00.................... / Diagram of Lot and Building with Dimensions Fee !� e.......�.j,.. . ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH u� rk�6 Il OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of/enBarnstable regarding the above construction. ' Name .. ...... .................. Constvisor's License ... a.z . f"... I�KULAS, LARRY 28213.. 11 No ............... Permit for .....?...Story........................... Single Family Dwellin ..........................................i............ ...................... "Location Lot 8, 294 Scudder Avenue ...............................................:.................. ....................Hyannis............................................. Owner ......Larry...N.........icku..l.as.............................. .... Type of Construction ...........Frame........................... ................................................................................ Plot ............ Lot ................................ J 6, Permit Granted ....................July 1.....................19 85 Date of Inspection .......................................19 A�t 3 Date-Completed- .......................Ion— kr 16. 16- CC 3t rl - Oil -In M Cr n All - a ---- ---- ,l 0 �.�.—./�I SONO oTUBES L(J N STEP> 2-- 2X8 PT 4'-O" BELOW —1 �+ CC) ABOVE GRADE TYP. _ _ _____ +, t CO PROPOSED NEW DECK LINE OF - / . ' ' � O co 4 DECK ABOVE SONO TUBES O C U LINE OF 4'-0" BELOW DECK ABOVE GRADE TYP. _ �. 't O PROPOSED NEW DECK - I - - b N - 1 _ O o CD rREPLACE, WG12011-4 A ©� 1/m © © p I Q' U 10 Lo o NG ING SLIDER/ EXISTING REPLACE 1 U SONO TUBES 4 X 4,POST PT WEXfSALL - - Qi ? r� CID 0 EXISTINGSUNROOM ��. T EXISTINGF EXISTING - EXISTING FOUNDATION FOUNDATION Lj ' EXISTING O KITCHEN / DINING O I'1 L1J " EXISTING \ / GARAGE . - - PROPOSED cv FOUNDATION PLAN uJ 4, - I ,n . Lv J r� - V z WINDOW SCHEDULE Z Z UNIT P.000H OPENING SQFT TOTAL SOFT EXISTING -- ! TW21036 5'-11 3/8" X 3'-8 1/8" 1110 22.20 LIVING - r W 6 ?- � NZ e e s'rev PROPOSED FIRST FLOOR PLAN . SCALE:1/1" I'-O" 22.20 o Date Revised 4/oli2olo 2/8/II EXISTING 4 3/29/2011 - DECKS BEDROOM EXISTING ® a DOOR SCHEDULE BATH - " UNIT ROUGH OPENING SQFT. TOTAL SOFT FWG12068-4 11-9 3/4" X.6'-8" ll.8l 118l y Al ,rip a C�2 C�J U co ah � � � U N Cc NI @) O p p p' u Lo o Qco o ® r7TI ® ® E� w oa 00 • . . F�oAR LJ W W PROPOSED L_] •..... ..J I•—. �..I J J l :� RIGHT ELEVATION SCALE:1/4" = 1'.-0" � Q 6 - PROPOSED �. REAR ELEVATION ION W <C .. SCALE:1/, = I•-O" (1/ Q ( ) L W 6 I I a, ' fJ NZ u H4. L NO TYPICAL 3_p HGM t i i ` � RAI1 ht IGMi' 4II�I rA R x� �IR,PRAAeLLAeAKI Date Revised 77M 4/OI/2010CELL CEC<IIG PT 14 Posrre Pr Posrs 2/8/II ABIll �,AIsrRAR� s POST—BE3/2.9/201I — DECKS G o I.\ .��GRAD eE m +, PICAI cRAoe TYPICAL PROPOSED PROPOSED - LOWER DECK SECTION UPPER DECK SECTION SCALE;I/4" i'-O" SCALE: I/1" 1-0" -