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0085 SIXTH AVENUE (HYANNIS)
;F - f Town of Barnstable _ ° ° :; Post This Laid SoThat�it, s 1/is�ble From the,Street ,Approved„Plans;Must be Ret �ned on Job and this Card Must;be�Kept areas Posted U til`F�nal Inspection Has Been Made v, re,a Certificate_of Occupancy is'Required,sucfi Building shall Not„be Occupied until::a Final Inspect�orr has been,made ��,: , Permit No. B-19-2671. Applicant Name: mark walsh Approvals Date Issued: 09/04/2019 Current Use: Structure Permit Type: Building-Fence Over 6' Residential Expiration Date: 03/04/2020 Foundation: Location: 85 SIXTH,AVENUE(HYANNIS), HYANNIS Map/Lot:_ 246-137 Zoning District: RB Sheathing: Owner on Record: CRANE CHRISTOPHER B&JANE A TRS Contracto Framing: 1 Address: 39 INDIAN LANE Contractor License: 2 FRANKLIN, MA 02038 _' Est Project Cost: $6,700.00 Chimney : Permit Fee:Description: 6 high to 8 $85.00 high privacy vinyl fence i I Fee Paid Insulation: $85.00 . Project Review Req: Dater 9/4/2019 Final: Plumbing/Gas Rough Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance. Final Plumbing: All work authorized by this permit shall conform to the approved appl ca n and the approved construction documentsfor which this permit has been granted. Rough 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. eet o This permit shall be displayed in a location clearly visible from access sh r r oad a d shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Afin The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Official Pare provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work aService: .z 1.Foundation or Footing 2.Sheathing Inspection Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. Health "Person contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �z Fire Department Building plans are to be available on site �,'�� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final Application Number.................. .......... ..��Q.a MAS& Permit Fee................ ...................Other Fee........................ 1639. Total Fee Paid................ ................................................. ...... TOWN OF BARNSTABLE Permit Approval by..................on. BUILDING PERMIT. Map........... ........Parcel....................V�:,,.,E....... APPLICATION t Section 1 — Owner's Information and-Project Location Project Address- A-Lf6l Village Owners Name Owners Legal Address 9 6- Ay✓c C toi State. zip Sri-C.- Owners Cell # E-mail Vze".t. Section 2 —Use of'Structure Use Group_ F-1 Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,060 cubic feet Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate E] Accessory Structure F_] Change of use El Demo/(entire structure) 0 Finish Basement El Family/Amnes'ty 0 Fire Alarm Rebuild El Deck Apartment E] Sprinkler System F] Addition E] Retaining wall Solar' El Renovation ❑ Pool El Insulation Other-Spec I 4.r,4 5�zr Afy I-- Section 4 - 'Work Description 6 Af 7r Z-,Y AJ-y L_ ran Last undated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of,Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring' ` ' _ ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney gAdd/relocate bedroom Water Supply ❑ Public.. ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District Hyannis Historic District Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required ' Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 1093 Main Street(Rte. 28) Ouer'50gea�s 161i2ce IP56 ORDER NO. S. Yarmouth, NU 02664 #:;SALES AGREEMENT 508-398-6041 / 800-352-7785 1�i • sales@capecodfence.com 5� 'b�00 FENCES MAKE 0000 NEIGHBORS' Follow Us On Facebook EMAIL__� -�.� t �r� E NAME 1 SHIP TO STREET STREET ( Y-7 , �� CITY STATE ZIP CODE NSTALLATION CITY / , n� ���ATE ;IP C DE INO CATION HO E O E BUSINESS PHONE TELLEE PHONE j �STYLE� /�� /r� Q NO.OF RAILS HEIGHT ON YOUR tPROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY D E S C R I P T 10 N UNIT TOTAL 1/rr Al L4 i— S C-,4 t 60 A /JA A(-- —7 . Q 00 SUB TOTAL TAX I'1 GL - o TOTAL LESS:50%DEPOSIT BALANCE DUE UPON COMPLETION s r g CHECK LIST 7_ I0 INSTALL OR ❑ DEL.ONLY CUSTOMER AT HOME YES ❑ NO , TAKE DOWN OLD FENCE fiCYES ❑ NO lot V4:Ae tk TAKE AWAY OLD FENCE ❑ YES 7r N0 CLEAR BRUSH OR TREES YES WNO FACE FINISH SIDE ❑ IN +OUT TOP OF FENCE TO FOLLOW GROUND, �l'YES 0 NO SIGN LOCATION TIF DIG-SAFE INFO 9 TERMS AND CONDITIONS 1. 50%DEPOSIT WITH ACCEPTANCE OF CONTRACT,Balance due immediately upon completion. 6. Purchaser to acquire all necessary permits and variances. 2. A credit card number must be left on file at Cape Cod Fence Co..Any remaining balance alter job 7. All property lines and grades to be established by purchaser.. completion will be charged to this credit card.In the event of an overpayment,the Cape Cod Fence Co.will process your refund within fourteen days. 8. Cape Cod Fence Co.is not responsible for damage to unmarked underground pipes or wries;septic, 3. installation extras may include labor,compressor and cement charges in the event of striking ledge,rock irrigation,invisible fences,etc, or other difficult ground. 9. Price is determined by Cape Cod Fence Co.based upon tootage shown,but may vary depending upon 4. 20%Restocking charge.No returns on custom orders. 5. Customers to incur all collection charges,including attorneys tees,on past due accounts.ANY UNPAID actual footage used. BALANCE RAFTER 30 DAYS fS SUBJECT TO A 1 112%PER MONTHFINANCE CHARGE.. 10.Additional terms apply when written. BY %'t�( //l,_ �y�S/ __ _ ___� ACCEPTED BY 2' .- N87°2250"E ----- 100.00- 41 18.6' 00,. w T P � K ca` cp 10' � ppp rA 29AY v 9'7� y�a�5� Ed 9*8 0 u Ile z 10' LOT 468 m o` 11.6' Iwo Q 7981 S.F. - -P& / MT .e tank 85.01 N87°22'50"E EXIST G j CESSPOOLS water �"zo PINE (40.00 wroE) STREET - . ,-ate• • if" AREA RLAN 246 137 46B B5 SCALE. 20'>"= Town of Barnstable, MA Pagel of 1 Town of Barnstable, MA Thursday, May 26,2016 Chapter 240. Zoning Article IV. Supplemental .Provisions § 240-41. Vision clearance on Corner lots. In residential districts, on corner lots, no fence; wall or structure, planting , or foliage more than three feet in heigght above the plan of the established grades of the streets shall be allowed in any part of a front or side yard herein established, that is included within the street lines at points which are 20 feet distant from their point of intersection measured along said street lines which will materially obstruct the view of a driver of a vehicle approaching a street intersection. http://ecode360.com/printBA2043?guid=6559505 5/26/2016 r TOWN OF BARNSTABLE PERMIT CHECKLIST Sign off hours for Health and Conservation are 8-9:30 a.m. and 3:30-4:30 p.m. 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing-setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"x17"(plans may require a stamp by an architect or engineer). ❑ Residential- 5 Sets of floor plans no larger than 11"x 17.smoke/co detectors marked ❑ Worker's Comp.Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council(IECC) Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑ Performance bond made out for$4.00/foot of road frontage(new construction only) i 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following.utility.companies: ❑ Gas ❑ Electrical ❑ Water . .. � r• . . .. .� .,.. . : ._ ❑ Sewer(if required) } 3.-DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail(if new framing), Pools Barrier details,pool specs(engineers design) ❑ Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. DAVEREA-01 NCANUSO '4�020: CERTIFICATE OF LIABILITY INSURANCE D0 2/1 1 12 0 1YY) 02l11/2019 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT E: Valley Forge Captive Advisors PHONE FAX ---- 630 Freedom Business Center Drive (A/c No Ext_(610)468-3659 A C No:(484)966-9627 Suite 203 E-MAIL King Of Prussia,PA 19406 ADDRESS, INSURERS AFFORDING COVERAGE NAIL a INSURERA;Zurich American Insurance Company 16535 INSURED INSURER B: Cape Cod Fence of MA Inc, wsuRERc: c/o Davenport Realty Trust 20 North Main Street INSURERD: South Yarmouth,MA 02664 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, IL SR TYPE OF INSURANCE ADDINSDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ .1,000,000 ' CLAIMS-MADE aOCCUR GL08196255 03/01/2019 03/0112020 DAMAGE TO RENTEDnce $ - 1,000,000 PREMISS(EaMEDEXP(Any oneperson) $ 1,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: , GENERAL AGGREGATE $ 2,000,000 X POLICY❑,PE a LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO BAP8196256 0310112019 03/0112020 BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per acdtlent $. HIRED NON WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY , • per acddenl S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ OED j RETENTIONS 8 A WORKERS COMPENSATION , X PER OTH AND EMPLOYERS'LIABILITY YIN! WC8196035 0310112019 03/01l2020 E.L.EACHACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ 1,000,000 OPFICER/MEMBER EXCLUDED? NIA 1,000,000 ((Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ U yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) CERTIFICATE HOLDER CANCELLATION 1 + SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 89 CANCELLED BEFORE ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence Of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. k AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD w d t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmbation/Individual): Address: I ®ill ��`E �LIF City/State/Zip: S607t, '1. _ __ /��: Phone#: �� Are you an employer?Check the appropriate bo : Type of project(required): 1.D�I am a employer with- 1 _I'- 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. []New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.. 7. 0 Remodeling ship and have no employees These sub-contractors have S. F1 Demolition working for mein any capacity.acitY• employees and have workers' • [No workers'comp.insurance comp.instnsuce.t 9. El Building addition required.] 5. El We area 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 s mY � workers el£ o ' P. right of exemption per MGL. comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 'employees.[No workers' 13. ther � comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those.entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� - Insurance Company Name: -Lrr" J4?M-e-ttC"4,1 �. �- Policy#or Self-ins.Lie.#: W C-7(q 6 ®3 s Expiration Date: Job Site Address: 957 -Si ,-1, Ave City/State/Zip: i . 4�i a Q S Po Kr A tiq, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature:%4 4,,e - /� �S Z- Date: Phone#• Ofjicial 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 iri 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-contractors)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 penmittlicense 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 numnber: The Commonwealth of Massachuset s' . Department of Industrial Accidents (f'tee of Investigations 600 Washington Street Boston,MA 021.11 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www:mass.gov/dia Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,.specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10 Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Ce11 or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature �%/ �� ��� Date c Print Name MH K W 4LS fC Telephone Number 5-bS 3 g Z 04 k E-mail permit to: M W 4L5 e__"E <=.�b e-Ac-e , C_- t Last updated: 11/15/2018 F ` Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval. Section 13— Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name w Last updated: 11/15/201 S y , Town of�Bar�stable s i F , .. x < ..es^<,. fy ." . - uildl g r Pot .has' rd. Th to -a Vasibt .Fro he Stree roved P..ians Must be:Reta�ned on.Job andahis C"tAW'dst be '_ t� _s. T,�.,.�Ca.., ,5p 5-.,a t s:., a m x _t�.4rpP „ p ...fi s s - F « •✓ '" ur, ;.; ....- f. )§r" „ -�t: s it `k .z- -•sue <s• t`° '�' `.� „ ':: •r a' ..;�E :..::_. 'MASK•:. ,« .:> r, ..,. .. ,.. i a< P.<osted Untal_.Finalrins ection Has:Been.Made... ,. _ yy - ' ' < - Where a Certificate, f®Gcu anc, as Re wired such,Bu�ld�n shall Not�be Occu red;until•a tF�nal.lns ectaon.:has;bean made,., �p�< ^,:gyp __<��.�. . . ...��� .�,,,�M_•_ , Permit No. 6-17-2758 " `'"" Applicant Name Cape Cod Fence Company Approvals Date Issued ` 69/19/2017 Current Use: Structure Permit Type:--Building='Fence Over 6'-Residential Expiration:Date: `.03/19/2018 foundation: Location: 85 SIXTH AVENUE(HYANNIS), HYANNIS Map/Lot: 246-137 Zoning District: RB Sheathing: Owner on Record:' CRANE,CHRISTOPHER B&JANE A TRS IVI Contractor Name framing: 1 Address: Contractor�License 2 39 INDIAN LANE .. FRANKLIN, MA 02038 Est Project Cost: -$9,837.00 Chimney: Description: . Install 8' high to 6'high scallop vinyl privacy fences along right side of Permt Fee: $100.17 Insulation: PrOPe►*yR, Fee Paid $ 100.17 Project Review Req: Install 8'high to 6'high scallop vinyl privacy fences along righter Date 9/19/2017 Final: side of property 3lv Plumbing/Gas s a L Rough Plumbing: .., Building.Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorised by this permit is commenced within six months afterissuance. �� � Rough Gas: All work authorized by this permit shall conform to the approved applica#-ion and�the approved construction documents,,, which#his permit has been granted. All construction,alterations and changes of use of any building and structures shal[be in compliance with the local zoning by laws'and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open forfpubliC mspettio9 for the entire duration of the work until the completion of the same. kii Electrical It The Certificate of Occupancy will not be issued until all applicable signatures bythe l3uildmg a d Fire Officials are provided on�this>permit. Minimum of Five Call Inspections Required for All Construction Work ; Service: 1.Foundation or Footing M 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. - Final:,, "Persons contracting;;wlthtunregistered:contractors do,not.have access to the, uaran fund"•(as set;forth.in MGL c.142A)., ,. ;.•;; , . g tY ' Tice Department Building plans are to7 be available on'site Final. All Permit.Cards are the property of the APPLICANT-ISSUED RECIPIENT . { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # _ -7 Health Division Date Issued q °1 7 Conservation Division Application Fee Planning Dept. Permit Fee 1 D U Date Definitive Plan Approved by Planning Board Historic -.OKH _ Preservation/ Hyannis Project Street Address Village Owner Address Telephone .Sad '/ 4-1 �0 O Permit Request e 4 t g 4. tI'i AJ L pf_1,VfA Square feet: 1 st floor: existing proposed 2nd floor: existing-proposed4 Total new Zoning District Flood Plain Groundwater Overlay Project Valuations Construction Type00 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orti g,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 0 new size_Pool: 0 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 Telephone Number 552)7 3 97 6 4 Address ( ® 13 Are-, 0?' License # S®. 1 A-P—A&qu7t( _MA. d;l Y Home Improvement Contractor# i Email MW4(5I_Q Worker's Compensation # 9 4 (3a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO1 y 3 2 Lo SIGNATURE % - �� �s DATE �3_/'77 If FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1kw � 6M W=fihwtM� ant M4 01111 wwMMMMgOrldw Wmimrs' C mpen L nice Affdzvit ers APPHemadlufmmatiou Please PriMt •RTame ��� �a� F�� LE �..d o • Addre= CPT 3 �( ( �P Mo M . ® �6 .�. 7° 9 V' CPS Are ym an empluer?fheckthe approuiafe ba>v I_ aa�a e�10 ti 96 4. ❑I am a ge�cal c t=tor ad I 6. Of ew co € �� • emglagees.(hill andfor Bart-Eme)_ 7. �_❑ I am a sole FroF�orpat�tuer- Tisted cm t$e aftsrhed.sheep ❑Reran�g slz r and IsaFe eospla ees These sub-cm*act=.have 9- []Demolition waidng forte is acrg capacity- empl°re;andbave xvadars 9. BuWmg addiiioa INO wod=W camp.&WIM-... c004L 1 5_ ❑ We are a oosparafifla and its 10-❑Eleckic3l repaiis or addifm= 3-❑ I am.a bameovmer doing all work officers have messed their 1 L❑Phtmbffigrepaim or addfiong MYSCIE o workeW - Tigbt of etomzpfioa per MGM IZEI _ iMMMMM d-1 l c-M¢1(4k andwe hwe no 13-El=F'"ees.[No w�' comp_iamum=e require&] ado sat�i :�darra` ep�r �dH�ea3>i�a�id�ecn sa6>mtsae�sf6r3eindirsda sacb- ZCadD�S3s[ %--+trigs 6= bsv m I•ant m2 evgAgw tliot-is prauidvg nrorkets'raaTasfitian w5 mratr a jbr my. empkwL SeTDw is the pv&7 anad jab sits ix�Qt�afiaa ,. In=xMnce.Compaay e: 2- Li c rq nd Poficg or Self-ms_IiC 4,_ e--S (Vo ®( 3� a F. aaDsie: 1 Job Sita ddress: S S t �t-y' cit9lstata� A,14 t_S p�MA d o`t&7'1 Afbch a COPY of the warkers'compensafimpoHcy dechwatiou gage(sh'avmg the policy no mber and expiration fie). Faffim to serum age as regaucdvnder Secfmn 25A of UM c�152 can lead 10 the imposition of a imbtal petsahies of a fine mp to$1,501k OD eadfor one-yearimpriis=mezA.es well as civil peaalties in ttie fa=of a STOP WDKK C DIRand a i>x of up to a ring against ffie violator. Be adsdsed did a copy of f3is statement maybe fmvwded to ise Offfm of . Rrvediphom of9te D1A.fcw coverage v Ida hffejly csr*under&c pants antdpwalfks ofpedWy fhatt►is&fartuzu5augro ahmw is but and correct Big � ' /� _ �� �--C-• gate: Phone a.0%ciat sw only. 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Ia. •t ►;a■ ■ _ G■1. 1 n11 •- i71�• ■ / r. _\ ._a f1■� ■•l■ •••■�' •t Mte /.±1 •.•:•.■1n• ►�•� •1 ■�■.•1 l• .t■�/ l• .t■ 1{YIl wR • r•Ill n r w. •ifale•1 - _ •. rw. . a.tall 1 It a llal .:a ••:■l •:at.•11 � �a■t1 �e .1 ranln Wit' ■n ■■/. t a 0 ■• • l •.+■':•■■1■ ■1 • �- to a1_(■ •1 to :■ ..1 r. 1•I •at r.•. :■■•11 :n• l■■ ■ •.• ■_ - .■■ •a w■•It lip 6" �:aa au�{ :.■1 ti r .am _na r.■ unn•r ME lair .- t • :•JI■■- _ ■ • a ...curt• .•±. ti■ • �a_t ►• ' Irk �• 1 AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7s0 CMR 5301.2.1.1)1 Check Compliance 1.1 SCOPE WindSpeed(3-sec.gust)................................................................................:.............:.....,.:...........110 mph WindExposure Category...............................................................................................................................B 1.2.APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch ..........................................................................(Fig 2)........................................... 512:12 MeanRoof Height ..............................................................(Fig 2)................................................._ft <_33' BuildingWidth,W...............................................................(Fig 3)................................................ ft 5 80' Building Length,L ............................ ...............(Fig 3)....................... ' Building Aspect Ratio(LNV) ...............................................(Fig 4).................................................. 5 3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)..........................:.... ....... - 5 T8" 1.3 FRAMING CONNECTIONS General compliance with framing connections......:.......:.....(Table 2)................................................................ 2.1 FOUNDATION ,Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.........:.....................::.:..........:..............:.....,......... ................................:....:.......... ConcreteMasonry.............. ....t................................................................... ..... .. . .... .... .... ....... 2.2 ANCHORAGE TO FOUNDATION ,3 ' .5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general .......(Table 4) '. .. .... ................. ....... ..... Bolt Spacing from endfjoint of plate ......:.....................(Fig 5).......::............................ in.5 6"—12" Bolt Embedment—concrete........................................(Fig 5)................................................. in.Z 7" Bolt Embedment—masonry..........................:..............(Fig 5)............................................. in.2:15" PlateWasher.............................. ...............................(Fig 5).........................,......................Z 3"x 3°x VV 3.1 FLOORS Floor framing member spans checked ................................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension...... ........................ .(Fig 6).................................................._ft 512' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).....,:..........:.................................. ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall..................(Fig 8)......................:....:::.........................—ft 5 d Floor Bracing at Endwalls..........:.:.............y.. ...................(Fig 9)......................................:................:............ Floor Sheathing Type ...............:.....:.....:...................:...:....(per 780 CMR Chapter 55)....................::....:..::..... Floor Sheathing Thickness ................................................(per 780 CMR Chapter 55)......................: in. Floor Sheathing Fastening. ...... ............................... .(Table 2). d nails at in edge/_in field' 4.1 WALLS ` Wall Height Loadbearing walls..............:.....:..................................(Fig 10 and Table 5)........................... ft 510, ' Non-Loadbearing walls......... . .. ..... ............ ..(Fig 10 and Table 5). .................. . _ft 5 20' Wall Stud Spacing .................................(Fig 10 and Table 5)................. —in.5 24"o.c. Wall Story Offsets .............................................(Figs 7&8)........................................... ft.5 d 4.2 EXTERIOR WALLSs Wood Studs Loadbearing walls........................ ..(Table 5) ..............2x_-_ft - in. Non-Loadbearing walls.................................................(Table 5). ........................ ..2x -_ft in. Gable End Wall Bracing 1 . Full Height Endwall Studs............................................(Fig 10).........................::..:.:.......:...........:.............. WSP Attic Floor Length. (Fig 11)....:................................... ft 2:W/3 ` Gypsum Ceiling Length(if WSP not used) (Fig 11). ..................... ............... _ft z 0.9W .................. .. .... . . and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Fig 11)............................................................. or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4_blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ..(Fig 13 and Table 6)............:.............. Splice Connection(no.of 16d common nails).....:.......(Table 6).....................:................................... AWC Guide to Wood Construction in Sigh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(78o cmR 53oi.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Tables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9)..................................._ft_in.511' SillPlate Spans ........................................................(Table 9).................:................_ft_in.511' Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9).................................._ft_in.512' Sill Plate Spans....................................... .... ................(Table 9).................................._ft—,in.512" FullHeight Studs(no.of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist.Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest OpeningZ ' ' SheathingType.............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)....................... in. Field Nail Spacing.........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)........................................................ Percent Full-Height Sheathing.......................(Table 10)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... Maximum Building Dimension,L . Nominal Height of Tallest OpeningZ........................................................................._s 6'8' SheathingType.............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 11 or note 4 if less)....................... in. Field Nail Spacing.........................................(Table 11)................................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................_ Percent Full-Height Sheathing.......................(Table 11)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?............................................................................................................................. 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............._ft 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U= plf Lateral.............................................(Table 12).............................................L= plf Shear..............................................(Table 12)..............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker.........................................(Figure 20)............._ft 5 smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no.of 16d common.nails)...(Table 14).......................................L= lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)............I Roof Sheathing Thickness........................................... .............................................. in.z 7/16'WSP RoofSheathing Fastening..........................................(Table 2)....................................................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 ' c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone c� l Massachusetts Checklist for Compliance(780CMR5301.Z.1.1)1 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment _Wf'IENTHE EDGE FMM ON PRAAQFIG MEW NAts AT;M 11 I1/ 11 11 1 1 u u 1 Y 14 I 11 11 1 ' 11 11 11 11 If 11 1 d 1 11 11 N O ti �I H • I m ii l a ' •~4 ii it fn . 1 d u Lf / U 11 f l F, w ii H -il b1A�SF/�CpHG — � • EAfli 1 � See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment f AWC Guide to Wood Construction in Sigh Wind Areas:110 mph Mind Zone . Massachusetts Checklist for Compliance (7sa Cmx 5301.2.1.1)' ► a� I 1 a i 1 it r 1 I i �r 11 k r m� iI II � 1 FRAMING M r � 1 EDGE.11TERMEM E I► 1 , I M r . bTA M NAE PATTERN PANS, _ PAIL EDGE DOME MAL EDGE SPACING��DETAL' Detail Vertical and Hotizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7so CMR 5301.2.1.1)t FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a iio mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM1oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category (B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you_tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. { Town of Barnstable Regulatory Services ` I i' ` Richard V. ScaTy Director 1639. Building Division. Paul Roma,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 I �� �/ /'t�� f , as Owner of the subject property hereby authorize to act on ray behalf in all matters relative to work authorized by this building permit application for. (Address ofjob) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections arc.performed and accepted. Signature of Owner , Signature of Applicant ?4< Print Name Print Name 1-Z:3 2-Of. Da e Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ;Y dF Richard V.Scali,Director Building Division s%xrtsrABM Paul Roma,Building Commissioner MAM ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ' JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less.and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who.owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which's building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided.that if the homeowner 'engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomis\EXPRESS.doc , 06/20/16 I __ 09/18/2017 16:21 5085416788 POSTALCENTER PAGE 02/02 Town of Barnstable Regulatory Services xiiebard V.Scal4 Direeltior44N E Building Division` w : II xsraetsr = Tom Perry,Building C&AIM'r9sionex e A 200 Main Weet, HYann s,MA,02601 www.town.barrrstable.ma.us ilE Office: 508-862-4038 Fax: 508-790-6230 HOMMOWNER]LICENSE ZXEMFUON Please r int .DATE- JOB LOCATION: F-S.udu /S • ::�� v�lage -xOWowx>,tz^: n home phone# wodc phone CURRI=NI MAIx M ADDRESS: Q O zi code • P c• hown state �Y The curremt exemption for'il,4meow crs"was extended to include MEaff-occttrtied dwelliM of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,orovid d that th o --e-r 39E Al Merviau. Dffrq] 'xoN OF IROMEOWNER persons)who•ow. w a laareel ofland-om-whi«ch 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 sfitctures accessory to such use and/or£arm stxuctMes• 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/ _ resoonst le•for al such wo nerfo ed un er the hnildinfa 't• (Section 10�.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 Batxlstable Building pepart nent minimum inspection procedures and requirements and that he/she will comply with said procedures and 3• ofl waer 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 HOMEOR'1.4ER'S EJCEMPrxON The Code states that: "Any homeowner performing work for which a building permit is required span be exempt from the provisions of this section(Section 109.1.1-Lkensiung of construction Supervisors);. provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner wall act as supervisor." Many homeowners who use this exemption are gnaware that they are assuming the responsibilities of ndig ,hales& ulations for Licensing Construction Supervisors,Section 2.15) o supervisor(see, Q articularl`y when.the homeowner hires unlicensed This lack of awarenemessss often results in serious problems,p .persons. in this case,our Board cannot proceed against the unlicensed person as it would with a licensed' Supervisor. The homeowner actiaag as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of bis/her responsibilities,many convoduniNes refits Of as part of the.permit application,'tbat the bomeowner certify that he/she understands the responsibilities o.a Supervisor. On the last,page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. 09/18/2017 16:21 5085416788 POSTALCENTER PAGE 01/02 t� ov f _ter r -... . .�.: arm . t r..:, . ,r,.:. 5. rr;.•s » a ,err ,. ^t,3 �Yse^1.i .m. 7 n`r� c .;'�' .+".i .._..: ,. .:. ,.:. :; x.».. -:,r,_ .�Fx. :.x �- :.�,...p,r. .r..H . .. x.._... ,.R.r .+... �t Tw -7`. lJ=.L.�.' � �.. t ,.. •, .�'�� ,.r _.;F,.. .. ...z , z -3xw .. - y_...,n.. ?'r. 7 ,.z?.. '�� :...r. �.��r..€ 9�3�..:: '�€� 6�...., . _. s,�? ,F.. ,x s. .. ,....,., ,. < .r.. ,.a r.- :.._.,...;a, K. Af,"+ ,.. ` .._..s,n.•3,ttx g f . 4:..,;,,. w'j .,.r.c .. w.L 041 ...aCSL. a,: n :n4 r3a a s_ � r ,,. oristruet►on:Su Ltl 5 P. :�i". A-: °'�'s''�. ...;w.di.fsaa`rw ! 4� �Y' r4..<i a2'•. '�'.-s;r. ,�_.n ,�.e..- six Y.t.,+, r�R e°�.�Desl naLlonfr tit�p�:'"�ely3•;�.;rkR4�'.#x��•-.^ �'.,`�is,��-,t,�:�`5_"�. none' CSL' a,b,c,d Construction,reconstruction, alteration,repair,removal,or demolition none CSL 1&2 Family b Construction,reconstruction, alteration,repair,removal,or demolition Dwellings 1A CSL Masonryb a,b,c,d Construction,reconstruction,alteration,repair,removal,or demolition of masonry structures that require apermit. Not applicable for construction of masonry buildings RF CSL Roof- Construction,reconstruction, alteration,repair,or removal of roof covering, including Coverine a,b, c repair and replacement of 25%of sheathing and 25%of sistering roof rafters CSL Windows Construction,reconstruction, alteration,repair,or removal of doors,windows and siding including repair and WS Doors Sidine a,b,c replacement of damaged window or door framing <4' wide and up to 25%of sheathing CSL Solid Installation of solid fuel burning appliances but does not allow work on any structural elements,including SF Fuel-Burning A li a,b,c sheathing,with the exception of that required for the installation of either the inlet or exhaust elements DM CSL Demolition a,b, c,d Demolition only. IC CSL Insulation a,b,c Installation of insulation including repair and replacement of sheathing and siding necessary to access wall cavities. a Formerly known as the `00,Unrestricted' CSL b Specialty CSL z a Buildings of any use group which contain less than 35,000 cubic feet(991m )of enclosed space. _ b One-and two-family dwellings or any accessory building thereto,irrespective of size. c Building or structures for agricultural use. d Retaining walls less than ten feet in height at all points along the wall as measured from the base of the footing to the top of the wall. 3 1 �r ,e ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY.Y) `� 1 8/9/2017 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. PRODUCER CONTANAME: Kristina Converse E. K. McConkey&Co. (Valley Forge) PHONE FAX 717-755-9237 2555 Kingston Road, Suite 100 E-MAIL ,kconverse@vfcadvisors.com PA 17402 @vfcadvisors.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Zurich American 16535 INSURED DAVEN-1 INSURER B: Cape Cod Fence of MA Inc. INSURERC: c/o Davenport Realty Trust INSURERD: 20 North Main Street South Yarmouth MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:743118336 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 AUUL bUtSKI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS-MADE F1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JERCT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY Y Y BAP8196256 3/1/2017 3/1/2018 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS NON-OWNED $ AUTOS Per accident X Comp$100 X Coll$500 $ UMBRELLA LIAB J:T0CCUR EACH OCCURRENCE $ EXCESS LIAB LAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION y WC8196132 3/1/2017 3/1/2018 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE a NIA 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$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Cape Associates THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.BOX 1858 ACCORDANCE WITH THE POLICY PROVISIONS. N.Eastham,MA 02651 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC RO " CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YY`FY) 8/9/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CT Gayle McLean Risk Strategies Company PHONE (617)330-5700 (FAX, AX No:(617)439-3752 160 Federal St. AIL ADDRESS:gmclean@risk-strategies.com 2nd Floor INSURE S AFFORDING COVERAGE NAIC# Boston MA 02110 INSURERAAssociated Industries Ins Company INSURED INSURER B Houston Casualty Company Cape Cod Fence Of MA Inc INSURER C: 20 North Main Street INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1762837644 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. ILTR TYPE OF INSURANCE NSR ADDLISUBR POLICY EFF POLICY EXP INSO WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A =CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 100,000 DAMAGE TO RENTEIY . AES103838702 6/1/2017 6/1/2016 MED EXP(Any one person) $ n/a PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDTINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10 000,000 __FDEDT I RETENTION$ H17XC5061101 6/1/2017 6/1/2018 $ WORKERS COMPENSATION PER 0 H- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Issued as evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Associates THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1858 ACCORDANCE WITH THE POLICY PROVISIONS. N. Eastham, MA 02651 AUTHORIZED REPRESENTATIVE Michael Christian/IYP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 omann �y; Ili � � i � 9 • k �' •_ '' �.� �.y . + g�a � E � r gg,,{{ q 7 _. a.. %•.r"rY�X r m�,rrse.mh*• .._ t _ .. 7 Home R w 4 W,-kome to the Town of Barnstable GIS Property Maps 2 61-38 To begin using the ma zoom in and click on a property 9 9 p- p p Y _ � to view detailed Assessor's data. " For additional ways to interact with the map, click on the "I want to..." button to the right, or click one of the shortcuts below. F r' Find a property by parcel number ' Fir. J a property by address fit.. 'ew the Quick Start Tutorial sy View the Help Documentation , qs * + Important note on map accuracy. Plea. mail us here with any questions or comments. 'y� A -01 9 M F � r Cock„ .I . j July 1996 July 2009 1 I _...__� Ay2009 Home layers 4Oft a. 0'. _ [ Home Welcome to the Town of Barnstable GIS property Maps To beciin using the map,zoom in and click on a property Z40 to viev.,detailed Assessor's data. For additional ways to interact with the map, click on the "I �14t want to..." bt:,,�'on to the right, or click one of the shortcuts below. Find a property by parcel number i ♦♦ ) M Find a property by address 2 !D IE,3? V yv the.Qulck Start Tutorial Vvv the Help Documentation i Important note on map accuracy. Pleas mail us here pti th any questions or comments.; M 44 4 y a � � 5ba7 2 ast € "1 July 1996 July 2009 -.July 2009 I Home . Layers • � ` ' 1093 Main,Street (Rte. 28) ; 0oer SO ears cSiitce 1956 ORDER NO. S. Yarmouth, MA02664 .AGREEMENT 508-398-6041 / 800-352-7785 SALES Fax 508-398-0091 DATE email sales@capecodfence.com. EMAIL J�1 �X L © U�t r Z c1�t 'GOOD FENCES MAKE GOOD NEIGHaORS' NAME' SHIP TO STREET ,e. "o-, A a�1 STREET 9 5` � ($Vx- CITY STATE ZIP CODE CITY STATE ZIP DE INSTALLATION HOMEn PHONETELEPHONE / BUSINESS PHONE ✓� 1 ,� 2 T � NOTIFICATION E y t0 r STY E ` NO.OF RAILS HEIGHT / y FT. S (L .� L L o (' V I ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY D E S C R I P T 10 N UNIT TOTAL S 5 N L Asti LI,4 -7 ae t/A L41 __&o .2 n(Ah--dS rb C r 4 Ts� 0�28 a y r r � 1 t ( 0 VtN f/A. r u,4 t ✓� to-ei( CD ' Tn y' � , �C �-� -e./i o.a-,� fl Tq SUB TOTAL TAX -2.. Sb TOTAL , 7. .Sa LESS:50%DEPOSIT BALANCE DUE UPON COMPLETION CHECK LIST I INSTALL OR D DEL.ONLY CUSTOMER AT HOME YES ❑ NO TAKE DOWN OLD FENCE ❑ YES 11�f'NO TAKE AWAY OLD FENCE O YES X NO CLEAR BRUSH OR TREES ;�rYES ❑ NCB PA/lCA, FACE FINISH SIDE ❑ IN D OUT 6 'TOP OF FENCE TO FOLLOW GROUND YES, ❑ NO SIGN LOCATION DIG-SAFE INFO L I I TERMS AND CONDITIONS 1.. 50%DEPOSIT WITH ACCEPTANCE OF CONTRACT.Balanced a imm ately upon completion. 6. Purchaser to acquire all necessary permits and variances. 2. A credit card number must be left on file at Cape Cod Fence jCo..Any remaining balance after job T All property lines and grades to be established by purchaser, completion will be charged to this credit card.In the event of an overpayment,the Cape Cod Fence Co.will process your refund within fourteen days. 8. Cape Cod Fence Co.is not responsible for damage to unmarked underground pipes or wrier;septic, 3. Installation extras may include labor,compressor and cement charges in the event of striking ledge,rock irrigation,invisible fences,etc. or other difficult ground. 4, 20%Restocking charge.No returns on custom orders. 9. Price is determined by Cape Cod Fence Co,based upon footage shown,but may vary depending upon 5. Customers to incur all collection charges,including attorney's tees,on past due accounts.ANY UNPAID actual footage used. BALANCE AFTER 30 DAYS IS SUBJECT TO A 1 112%PER MONTHFINANCE CHARGE.. 10.Additional terms apply when written. BY �� ACCEPTED BY t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcels ,N O-' , r j1 I Application #00 Health Division Date Issued j Z /1 - fS7 PF Conservation Division Application F e _ Planning Dept. y Permit Fee �I �' •� Date Definitive Plan Approved by Planning BoardSf" <t4 Historic - OKH _ Preservation/ Hyannis Project Street Address f 1c`}h \1 e n V l Village Owner (' ��2\� �� ��, ��i�l.� Address Telephone Permit Request NrLJ W o Y\4&o U-�,_ y,%,I '\g,Y-" ,pnh Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay `Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 01-1 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes d*No On Old King's Highway: ❑Yes UrNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other C."t 'k c f'\NyL 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: dGas ❑ Oil ❑Electric ❑ Other Central Air: ❑Yes 2"N'o Fireplaces: Existing -/_ New Existing wood/coal stove: ❑Yes ff 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 1frNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Qpt. �>31 (_VbJ o rh \_0CQ& �__ Telephone Number Address,—,I I® License# hfiflir 0;)S 6 7L— Home Improvement Contractor# I S© _Q C[1 Email_ C_Ct v `.�L Q_ Co w4k&TT > r Ylt-T� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i�ouMt!l eL SIGNATUR � DATE � I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER :r DATE OF INSPECTION: FOUNDATION FRAME i_ INSULATION ,t FIREPLACE t - ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL. GAS: ROUGH FINAL 1 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f 6• ' ?lie Commorritvealtih of-Vassachusetfs ., Department of Industrial r� @ffue of Investigations 600 Washbigton Street ...r_ Boston#MA 02111 t 4'FN'ek:rl mmgtvl fd�ia Workers' Campensafian Insurance Affidavit:Builders/ContractarsMectricians!Plumbers Applicant Infarmatian Please Print Le-MbI Name BusffiesstDFganizat�aalFndiv nil}: �C3R�"rt 1 C J�� V�(��C Jl.�- (_L< Address:-3 ��Q\L CityfStatel �, ant; '7� �� r A;7uan employer?Checkthe appropriate box: Type of project(required}: I. I am a employer urtf� 4. ❑I am a general contractor and I ` * have hired.the sub-contractors 6. ❑New construction.employees full a�OF part-time)-* • 2.El am a sole proprietor orpartner- listed on the attached sheet.* 7. deHng_ ship and have no employees These:sob-contractors have g_ ❑Demolition w g for me in an capacity- employees and have workers' °�-°b y9. ❑Building addition - � - • WO,M- rkerg'comp-insurance Comp.insurari 1 required_] 5. ❑ We are a corporation and its 14-�ectrical repairs or additions officers have exercised their 3.El am.a hbmeoumer cluing all work Officers lambing repairs or additions myself-[No woskus'comp- righl of exemption per MGL 12.❑Roof repairs. insurance requited.]a c.152, §I{4 andwehaven 13_❑Other S1cS.\b� employees-[No worms' comp.insurance required.] 'Any appticaut.that chedcsbox ttl mast elm fi m t thx section belawshowkZ the wodere compensation poay fi formation. .Iiamemmers who sub¢ t this af{dmit indicatmg they are doing all woo}and then}roe outside contractors mast submit a new affidavit indicatiq;such-. fC'anuactors that ehec$.This boa mast attached an additional sheet showing the name of the sub-coaz=Aacs and state whether or not thnse,etrtitieshom ... � employees.If the sub-coatacturshave employees,they mastpmuide IlLeir workers'comp.policy number. Tam au eeiepkil er tliat ispr4n id rrg it�orkers'comperrsativre insurance for my entpL y ees ,Below is the pvht6_ 'and job srfe informations Insurance Company Nam: soC T ia, La Nk;, Policy,44 or Self-ins.Lic.is ( *)C L k o\S N ' Rxpit ation.Date: k\ Job Site Address. 1`l.+L% E City/Statel2:.rp: Attach a copy of the workers'compensationpolicy 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 imiposition of criminal penalties of a fine up to$1,540 OQ and+or one-year imgtisa euta$s we11 as curd p ng1fes.in the form of a STOP WORE ORDERand a Rine of up to$250.00 a day against the violator.- Be advised that a copy of this statement maybe forwarded too the Office of Investigations of the DIA,for insurance coverage vetifsca im I rIo hereby c need the paints rf periaftces afpet,jury that the in,�or mafioaprave&d abmw is trim and Correct $itrahzre:. Date: r Phone;k L "-C! Of cid use only. ,Do not write in this area,to be completed by city ortolm a,f j�reiat City or Town.: Permitllrieense 4 Issuing A.nthor€ty(tarde one): 1.Board of$ealth 2.Budding Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Coact Person: Phone#: -Information and Instructiolls ; Iylassachnsetts Ge=al Laws chapter 152 requires all employers to provide workers'compensation for their employees. purm�this spa,an mTLUme 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,p=tnership,association,corporation or other legal entity, or any two or more of the foregoing engaged is a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trnstee of an individual,partnership,association or otherlegal 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 - dvTeUing house of another who employs persons to do maint!:nan ce,construction or repair work on such dweIling house or oa the grounds or budding appzn�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 perla t to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the b'isurance.cove 7age required." Additionally,MGL chapter 152, §25C(�states`�Teithes the commonwealth nor any of its political subdivisions shall enter iatn any contract forthe perfo=mm ofpn ho woik=til acceptable evid_ence of campliapccvMh the insm7arce.. requirements of this chapter have been presented to the contracting ao hozity_" Applicants Please fill otrt the workers'compensation affidavit completely,by checking the boxes that apply to Your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their cMrtif c3±e(s) of inar7ranc0. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation fi surance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submit?-d to the Department of Industrial Accidents for confsrmaiion of msm-ance coverage. Also be sure to sign and date-the affidavit. The affidavit should be retzmmed to the city or gown the the application for the permit or license is being requested,not the Department of BoAnstial 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 s elf-fi sazance license number on the appropriate line. City or Town Officials f . 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 till out in the event the Office of Investigations has to contact you regarding the applicant_ Please be sure to fill in the pen lit/liceuse number which will be used as a reference number. In.addition, an applicant that must submit multiple perm license appli-cations in any given year,need only submit.one affidavit indicating current p olicy bafbmation.(if necessary)and under"Job Site Address"the applicant should write"all locations in (cit3'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 fie permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining alicen se or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person-is NOT required to complete this affidavit The Office of Investigations wound 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 Departments address,Telephone and fax number: The C�o.�onW(-,attie of J ssaclivsetts ' De paztramt cif ludnstzal Ac cidenta Office of j yr igatio--� �Q�'�ashiz�tan Siz�l BoAon�MA 0�1 I I Tf,-L 4 617 ' 7-4900 cxt 406 ar 1-977-IASS.AFE Fax#617-727-7M Revised 424-07 gog�dia n rr t— C![u ac cv rr v.,m l_vxtj"P&LL4 IA wd ale&r 1.1 u..•.�..••••...• �.�.•• ••Massachusetts Checklist Checklist for Co,mp.�ian�e(7so C�-rR53oi_7.l.t)` 91 Check Compiianca 1.1 SCOPE Wind Speed(3-sec.gust)..._............... _...•=•-•....... w.........._...._... - ....-:......110 mph WindExposure Category....................................__..__._.___:._................_.........___......._....__:_._...._....._......,.._B Wind Exposure Category................Engineering Required For Entire Project...........................:......... :._:C 1.2 APPLICABIL[7Y Number of Stories(a roof which exceeds B:n 12 slope shall be considered a story) stories 5 2 stories Roof Pitch._:_....__.....:.........:_...._...............................(Fig 2) .._._..._...- .......__.... -..:. s 1212 Mean Roof Height ................_...._.........................._......-Fig 2)_..............................................' ft 5'33' Building Width,W ......_-(Fig3 _ < ' Building Length, L _.(Fig 3)__ _ ` ' Building Aspect Ratio(LW) ...................._........................(Fig 4)................................................. <_3:1. Nominal Height of Tallest OpeningZ ........................ . . (Fig )__-:.:_.____________---- 1.3 FRAMING CONNECTIONS General compliance with framing o6nnectlons....... ..... :...(fable 2) Y' 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404_1 Concete__............................. ..--•--••. ..._.........._........_... ......--.............. Concrete Masonry 2.2 ANdHORAGE TO FOUNDATION'S " 5/8"Anchor Bolts•imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing-general ..........................................:.(Table 4).._......_:.._:___............____.._...._..__. In. Bolt Spacing from encVjdint of plate..............................(Fig•5)..................................... in.<-6"-12% Bolt Embedment-concrete.......... _____-----------------------(Fig 5)::.,.......................................,---_in_>7" . . Bolt Embedment-masonry..........................................(Fig 5).__..:......:......._....................... in.>:15' Plate Washer---------------------------------------------:..................(Fig 5)..............::_............................>Y x 3'x'/" 3.1 FLOORS Floorframing member spans checked .................(per 7B0 CMR Chapter 55) Maximum Floor Opening Dimension_.............`_..._....._.__ (Fig 6)....._..........................................._ft<-12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wail'(Fig 6):.:..........."" Maximum Floor Joist Setbacks Supporting Laadbearing Wafrs or Sheanvall...._..........(Fig 7)................... :5 Maximum Cantilevered Floor Joists` Supporting Lnadbeadng Walls or Sheanvall........._..__.(Fig 8)............:_.................... _ < FloorBracing at Endwalis............................._.....................(Fig 9)-.-_-----____---------------------------------- .... Floor Sheathing Type ................:.........:..:r.:_.__.__•---..:._.(per7B0 CMR-Chapter 55)................................_. Floor Sheathing Thickness ..e.....:.............I._._..:.........._.....: (per 7B0 CMR Chapter 55)........_.._......____. in. Floor Sheathing Fasterfin .................................................... able 2 _. d nails at in edge(_in field 4.1 WALLS R Wall Height Loadbearing Ovals........................._..:__._.........__._._....(Fig 10 and Table 5)--------------__....._..._ft <-10'. Non-Loadbearing walls ... (Fig 10 and Table 5) ft's 20' - Wall Stud Spacing (Fig 10 and Table 5 ................... in.S 24"o.c P 9 .. ........... ) Wall Stary Offsets ...(Figs 7 8:8)................................ s .... ., _ _ft _ d' 42 EXTERIOR WALLS' t Wood Studs Laadbeadng Walls....................._.................................(Table'1)........................_...2x _ ft in. Npn-Loadbeadng walls :(fable 5).......:........... .2x"' -_ft=in. Gable End Wall Bracing Full Height Endwall Studs:.._......._.....__.._.._...:_..............(Fig 10)......... ............. ... _---- Fi ` _ .......................................... ft zW/3 WSP-Affic Floor Length........._....::......_............... ( g 11} Gypsum Ceiing Length(rf WSP not used ...................(Fig 11)......................................_...._ft;-0.9W - and 2 x 4 Continuous Lateral Brace @ 6 fL o.c...(Fig 11)..................................................... or 1 x 3 calling furring strips @ 16"spacing min.with 2 x 4 bio0drig'@ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length .._......................:........__.......-..____..(Fig 13 and Table 6).................................... ft Splice Connection(no.of 16d common nails)..............(Table(3)..................................._...._............. Massachus"etts Checklist for Compliance (7sn C1,v1R5301.z.1.r)I Loadbearing Wall Connections Lateral(no.of 16d common Waits).._............: .............. 7)__.....w....................................... Non-L-Dadbearing Wall Connections Lateral(no_of 16d common nails).--- -----. _-.- --_---(Table 8)__.._..._..._...............................-.... Load Bearing Wall Openings(record largest opening but check all openings for corftpliance to Table 9) Header Spans ................_ .............(Table 9)-.__._:_.:_---•----•- ' ..._.. —ft_rn. 11 Sill Plate Spans _._...-.-_.(Table 9)_..._._._-_.................. Full Height Studs (no.of-studs)------------------------------(Table 9)..........__........_._..._......._ ............. Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.........................-..._............................(Table 9)..........._......-............. ft_in. Sill Plate Spans.......................................................(Table 9)............................... ft in.s 1Z' Full Height Studs(no.of studs).................____.:_.-_...(i-able 9)................................................ Exterior Wall Sheathing to Resist Upftlt and.Shear Simultani vusjy4 Minimum Building Dimension,W Nominal Height of Tallest OpeningZ SheathingType.............................................(note 4)...................................................... Edge Nail Spacing.........................................(Table 10 or note 4 if less)...................... in. Field Nail Spacing...........................................(Table 10) Shear Connection(no.of 16d common nails)(Table 10)-----------------------------------------------------_ Percent Full-Height Sheathing..._.._...........:...(Table 10)._-.............-............................._... � 5%Additional Sheathing for Wall with-Opening> 6'8'(Design Concepts).....:........ ..�► , Maximum Building Dimension, L Nominal Height of Tallest Opening............... ....... - s 6'B'. SheathingType..............................................(note 4).............:...•... - Edge Nail Spacing................................_._.___.(fable 11 or note 4 if less).......................... in_ Feld Nail Spacing..........................................(Table 11) -• Shear Connection(no.of 16d common rrails)'(Table 11) Percent Fulf-Height Sheathing..................... (Table 11) - ................................................... %•s - 5%Additional Sheathing for Wall with'Opening>6'8'(Design Concepts)................ .. Wall Cladding Rated far Wind Speed? . . 5.1 ROOFS Roof flaming member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Websfte) Roof Overhang ..................................................(Figure 19 ft s smaller of 2'or IA Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift...............................................(Table 12)..................................... • .U= plf Lateral.............................................(Table 12)..............................................L= pff _�__..___ able.12 ............. - Shear............ � ) ......................._.---..S- •pff- Ridge Strap Connections, if collar ties not used per page 21... (Table 13)......................0........T= plf Gable Rake OutlQoker................................_-------_.(Figure 20)......... ft ft s smaller of 2'or L12 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift.....................:..•--.._......---•.:...(Table 14).__.. .....--------...........---lJ= lb •,. Lateral(no.of 16d common nails)...(Table 14)...............0............. ..........L= . lb. . Roof Sheathing Type.......... :..__..._.........................(per 78D CMR Chapters 56 and 59) ............. Roof Sheathing Thickness..................... - —:..._.................._.._...:_...._..._..._.__.._in.?7/16'WSP . Ro-of Sheathing Fastening..................................... (fable 2)................ ....... ............................... Notes: _ -1. . This checklist shall be met in its entirety,excluding the specific exception noted in 2, to comply wrth the requirements`of 780 CMRSW1.2.1.1 Item 1- if the checklist is met in its entirety then the fo0owing metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. A Gage Straps per.Fgure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2 ' Exception:Dpening heights of up to 8 ft shall be permitted when 5% is added to the percent fluff-height sheathing.- requirenients shown in Tables 10 and 11, 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thirJmess pressure treated#2-grade. a_ From Tabies gig and 11 and location of wall sheathing arid Building Aspect Ratio,determine Percent Full-Height Sheathing and Nall'Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: r� 1. Panels shall be installed with strength axis parallel to studs, j- I All horizontal joints shall occur over and be nailed to framing. . WL On single stDry cDnstruCtbn,panels shall be attached to bottom plates and top member of the double top Plate. iv. On two.story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. V. Horizontal nail spacing at double top plates, band joists,and girders shall be a double rDw of ad staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment b. Glazing protection:a)new house or 11Drizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) . b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for'110.MPH, Exposure B may be obtained from the American Wood Cpuncil (AWb)website. , WHEN TM EDGE FESTS ON FP.AMM USESd r uX,% 1 1.1 rl Ir l y r? r 1 It r 1 r• 19 9 ' 1 C x 'F.F l .1 I - 1 r 11 4 t + r If t' • F .,; is l ate. ; ; zi o L I1 . ;l } I x 1 tl d L EI&ENn9WGD1kT£" 1 1 L L Ilf ii ilIlJ t �(]. l .. _ ! r1 • t .+1 ,t - t 4 e L ' •. - Lea 1 ll I sAr IC It 11 DWU LESXZ I�' STAGGERED 3`hdMJ { V+1LS?AGk } T TRAIL PATiEFRN Pig _t 11I''"--tea— _ •� 4 � FANS—EDGE DDU9LE Ul M-EDGE SRACr4G DML SeaD,efalf on Next Page Detail Vertical and Horizontal Nailing Vertical and Horizontal Nailing ' for Panel Attachment for Panel Attachment Town of BaMsfable Regulatory Services Xa.IM �, _Richard V.5cali luterim Director Building Division ' Tom Perry,Building Commissioner 200 Main Street,Hymais,MA 02601 www.towmbarnstable mains Office: 508-862-403 s Fax: 509-790-623 0 _ Property Owner Must Complete.and Sign-This Section ' If Using A Builder as et of the subject o Own t J P P� `. hereby autho �'�A L A 01-1 to act on mp beh4, in sU matters relative to work authorized by this building p etmit to Y\r-'-, (Address'of fob) **Pool fences and alarms are the:responsibility of the applicant. Pools are not to be filled ot-utilized before fence is M.Stalled and all final itLspecti.ons are performed and accepted. Signature of bwper Signafute of Applicam t Name Print Name I _ Dar I U W.0 U1 JL3ZU M Lakl.LG - Regulatory Services - oY Richard Y.Sc a%Interim Director_ ._ BuiIding,Division unz - Tom Perry,Building Commissioner 200 Main Street, Hya� MA 02601 www town.barnsiable ma.us Office: 508-962-403 8 .Fax: 50 8-790--623 0 HOMEOWNER LICENSE IMMIFTTON - Please Print DATE: JOB.LGCATION member street wage `F30MEOWI�Z": uame home phone work phone . CURRENT MAII.ING ADDRESS: cityltnwn state -- zip code The current exemption for"homeowners"was extended to include owner-occued dweI]mQs of six its 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. DEFR=ON OF HO IEOVaM 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,atached or detached structures accessory to such use and/or farm structures. A person who constructs more than one .. mil to the Building Official on a form home in a two-year period shall not be considered ahomeowner. -Such `homeowner' shall sub g acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section .. 109.LI) •. - The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,roles and regulations. The undersigned"homeowner"certifies that he/she understands the,Town ofBarastable Building Departme�±minimum inspection procedures and requirements and that he/she will comply witli said procedures and requirements. Signature of Homcowncr Approval ofBu$diagOfficial Note: Three-family dwellings containing 35,000 cubic feet or Iarpr v,ill be required to comply with the State Building Code Section 127.0 Canstr action ControL HOMEOVVNERIS EX12dMON 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.I-Licensing of construction Supervisors);provided that if the homeowner engages a persons)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 Licennin Construction Supervisors,Section 2.15).T ijack of awarene.ss.often - results in serious problems,.particglarly when the homeowner hires unlicensed persons.. In this ease;our Board cannot proceed aganast 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 responst-bMes,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On fhe last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. :�wpF��ORly(S'lhrnlrimgpGt�frmrtclRXPRFCS dOC. NEW HOUSE SU13AUTTAL SCHEDULE H Submitted By j' Will Not Be Issued Before* December 11 -December 24, 2014-----------------=------------------------------January 7i 2015 December 25-January 7,201.5-------------------------------------------------January 1,2015 January 8.-January 21,2015-----------------------=----------------------------February 4,2015 January 22-February 4,2015------------ '--=---------- =------ ----------=----February`l8,2015 February 5-February 18,2015--------------------------------------------- ---March 4,2015 February 19-March 4,2015--f----------------------------.-------------------------March 18,2015 March 5-March 18,2015--------- -------------------------------------- -----April 1,2015 March 19-April 1,2015--- -------------- --------------- ---=-----------------April 15;2015 April 2-April 15,2015----------=---------------------------------------------April 29, 2015 April 16_April 29,2015----------------------------------------------------------May 13,2015 April 30-May 13,2015----------=------------------ --------------------------------May 27,2015 May 14-May.27,2015---------------------------------------=------------------June 10;2015 May 28-June 10,2015--'----------------------------------- -----------------------June 24,2015 June 11 -June 24,2015------------- ------ --=-- --- --------------7------July 8,2015 June 25-July 8,2015---------------------------------------=------------------July 22,2015 July 9, -July 22,2015-------------------------------------- -------------------_---August 5,2015 ,-.,- ------ ----------------------------------- July 23 -August 5,2015------- --August 19, 2015 August 6-August 19,2015---------------------------------------------------September 2,2015 August 20-September 2,2015----- I-----------------------.---------------=--September 16,2015 September 3-September 16, 2015-7-`---------- -- ---- --=--- ---=--------September 30,2015 September 1-7-September 30, 2015-----------------------------------------October 14, 2015 October 1 -October 14,2015 ---------=-----------------------_----------------October 28,2015 . October 15-October 28,2015----- ------ -=-- -------- ---^--- -------- --November 11; 2015 October 29-November 11,2015-----------------------------.-------------------November 25,2015 November 12=November 25,2015------------------------------------- --December 9,2015 November 26-December 9,2015------------------------- ------------December 23,2015 December 10-December 23, 2015--=-------=---=---------------------=--------January 6, 2016 December 24-January 6, 2016-=------=-------- =-----------------;--------January 20,2016 *The Buklding Department has 30 Mays to review permits. . ti ��e rco�rrunzaruveull�a��luadac%udelts �p., License or registration valid for individul use only C\ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation gistration: 150297 Type: — _ .10 Park Plaza-Suite 5170 xpiration =3/23/201d Ltd Liability Corpor ; Boston,MA 02116 " COASTAL.CUSTOM WOODWORKS LI-C THEODORE POMEROY, { " 2 OCEAN PINES DR « � ��- ✓'l/j'"'� � — SAGAMORE BEACH,MA 02562 Undersecretary Not valid without signature` A 11M Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN isor License: CS-051311 1 THEODORE S POMEROY;, PO BOX 102 Sagamore Beach MA 02562" 'F Expiration Commissioner 02/15/2017 Client#:20662 2COASTALCU ACORD„, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD""") 12/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance Ag a/c°NIv EXt:508 775-1620 FAX ac No): 5087781218 973 lyannough Rd, PO Box 1990 E-MAIL ADDRESS: Hyannis, MA 02601 5O8 Hyannis, 0 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc INSURED Coastal Custom Woodworks, LLC INSURER B:Associated Employers Insurance P.O. Box 102 INSURER C: INSURER D: Sagamore Beach, MA 02562 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A GENERAL LIABILITY MP052143 3/22/2015 03/22/2016 EACH OCCURRENCE s2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES ER occurrence $500 OOO CLAIMS-MADE FX OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4,000,000 POLICY PRO JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WCC50050114952015A 1/13/2015 11/13/201 X AND STATU- oTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" E.L.EACH ACCIDENT $5OO OOO OFFICERIMEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 F1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Attach ACORD 101 Additional Remarks Schedule if more ace is required) ( . � P re4 ) _ Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Bldg.Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE a ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S161668/M161667 LS1 U N Y 3 0 0 0 3 OF BARNSTABLE 1.16 0 Ul :1 U N LI-qI hu �Zoc)►M Q 0 U cs 13zdlt�o►� S KE D TORS REVIEWED BARNSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DATE �'40TY'?FSARE REQUIRED FOR PERMI TING cac( cCIXe1'1 -PAN-I fro\�� W 7j��clZ �\r\ t . .- i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 2 Map Parcel I ✓ Application # 21 3 43 .Health Division Date Issued `757__/S ®� Conservation Division Application Fee �� •00 Planning Dept. Permit Fee lt'57& • d G Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address es fih AC- Village --�— Owner Address 5�, Telephone Wit-`1,5-510 i Permit Request 141P`A:!,c ,,:z c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I Ste' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Y' 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 Mike McCarthy Construction Telephone Number PO Box 52 Address West pennk, MA 02670 License # Cell (508) 280-6964 CSL 58633 HI[C-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE b- ir— FOR OFFICIAL USE ONLY APPLICATION# • DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. I w RI S E - FNCINFF4ING OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: (Property Address). (PropertyAddress)' CC) C hereby authorize CC. t�. I i (Subcontractor) an authorized subcontractor for RISEEngineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. O\kner's ignatur i I. Date F C IS IV U D _ MAY• 6 2015' RISE Engineering 5.Dupont Avenue South Yarmouth,.MA 02664 i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCAR ' PO BOX 52 s W DENNIS MA 8267 fZ2 � . '� "' Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Aoston, Massachusetts 02116 Home Improvement Contractor Registration ---------------- == Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY sa MICHAEL MCCARTHY P.O. BOX 52 i 5 1 yJ f WEST DENNIS; MA 02670 _ ~ eZ - - .f. Update Address and return card.Mark reason for change. 0 Address Renewal L_ Employment i-I Lost Card 20M-05/11 h The Commonwealth of Massachusetts � Department of IndustrialAcchlents I Congress Street,Siiite 100 Boston,MA.021I4-2017 wwrv.mass.govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Phimbers. TO BE FILED WITH TIIE PERN41TTING AUTHORITY. Applicant Information ll Please Print Legibly Name (Business/Organization/Indi4idual): 20_I—lox Address: West Dennis, MA 02670 City/State/Zip: CSL-5 3#: HIC-169393 A71'. an employer?Check th propriate box: Type of project(required): I. a employer with employees(full and/or part-time).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition In lama homeowner doing all work-myself[No workers'comp.insurance required.]t, ! 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 DBuilding addition ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.O I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp,insurances 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.90ther 152,§1(4),and we have no employees.[No workers'comp:insurance required.] *Any applicant that checks box#t must also fill out thesection 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 9n 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 provltling workers'compensbtion insurance for myemployees. Below Is the policy and Job site Information.Insurance Company Name:_ ATM /M,4,, Policy#or Self-ins.Lie. 1(t'6Gi 70-6--Id1`( � Expiration bate: Job Site Address: �S b fi ��L 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER. a fine of up to$250.60 a day against the violator.A copy of this statement may be Fforwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify 1////P [00anodties ryury that the-information provider/above is true and correct. Si nature: Date: Phone#: 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 S.Plumbing Inspector 6.Other Contact Person' Phone#• WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA fI=PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 800 876-2765, NCCI NO 26158 POLICY NO. VWC-1 00-6017656-2014B PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:*****3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location, 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability.under Part Two are: Bodily Injury by Accident $ 500,000,each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEJ CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements,is hereby countersigned by 12/15/2014 Authorized Signature Date Service Office: Bryden &Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, \ `� used with its permission. v f, lc2 l� . t oFt T Town of Barnstable *Permit a L10 Expires months from issue date Regulatory Services Fee, snaxsrnar E, 'T Richard V.Scali,Director _ •r G6MA�p� ' Building Division M i i 13 2014 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 ���� INSTABLE www.town.bamstable.ma.us O�� 0 862-4''38 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY r n 2 Not Valid without Red X-Press Imprint Map/parcel Number a V/ J Property Address cj- low `_t _4 C'' W SP01LT- [Residential Value of Work$ U 00�O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ✓OD_� Contractor's Name D_\,Je2- 1� �.1.`� Telephone Number Home Improvement Contractor License#(if applicable)12.f5'5 Email: Construction Supervisor's License#(if applicable) EWorkman's Compensation Insurance Check one:- ❑ I am a sole proprietor ❑ I am the Homeowner _ [�I have Worker's Compensation Insurance Insurance Company Name3�� Workman's Comp. Policy#.WC- 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 740_,"oU7Y J&.JZC&,X ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon 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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATUR Q:\WPFILESTORMS\building permit fonnsTXPRESS.doc Revised 061313 i KELLY ROOFING MA CSL #99167 PH 508 509 4640 8 RHINE ROAD. MA HIC #128957 YARMOUTHPORT MA 02675 kellyroofingC icloud.corn April 09' 2014 Proposal submitted to Mr Jack4114 n of 85 6th Ave. West Hyannisport Ma We propose to supply all materials and labor necessary to remove and replace the existing roof at the address above All debris to be removed to town transfer. 8" White aluminum drip edge to be installed on,all eaves. Ice and water protection membrane to be installed on the first three feet of eaves and around all protrusions. Remainder of deck to be covered with #15 Felt Paper. Lifetime limited warranty Architect style shingle to be installed, (Color to be specified) All shingles to be storm nailed:(6) Bathroom vent pipe boots to be replaced with new. 3 Repair/Replace all flashings as necessary. Install Shingle Vent 11 Ridge vent on all ridges with Hand Nailed Caps. Protect all walls, windows, decks, plants, shrubs, etc. during roof strip. Complete cleanup of area during and after procedure including all nails and cleaninq of At a Total Cost of$400D Payment schedule; 50% at project start, balance upon completion. Respectfully Submitted, Oliver Kelly. Proposal accepted by; Date / /2014 17/ -2-0 I The Commonwealth of Massachusetts 07 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 19 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letibly Name(Business/Organization/In " 'dual): Ut,�+✓� �`�-� 1 Address: City/State/Zip: �rGM h _ T Phone#: isQ� 6oq 4b'40 Are on 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. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. ❑Remodeling 2.❑ I am a sole proprietor or partner- _ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.[]Plumbing repairs or additions myself.[No workers'camp. c. 152,§1(4),and we have no 12.ff Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their wodrers'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. tCont mctors 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 the policy and job site information. Insurance CompanyNamett3aL\_-, 1`1 Policy#or Self-ins.Lic.M CS 22 S 3— 506 04— 05 ? Expiration D 1 Job Site Address: .fiy City/State/Zip: 144V1-1,3 .S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains and 'es Phone# of perjury that the information provided above is true and c. rrect paWlt i Date: 'ice Official use only. Do not write in this area,to be completed by city or town o iciai 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#• � �.:/ ��1�d/y������G�rt2��� � • ����� ;ri�t�i��2�t!tJP Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 126: TOW. Indhrldual Oliver Ke1iy - Expiation: 611412015 Tr# Oliver Kelly - 8 Rhine Rd Yarmouthport, MA 02675 . • - Update Address and return cord.Mark reor sCn t a xays av» es I] Address'f0 Renewal �Employment ' C✓/rc`�r:»rrac-irrttrrl�/cf�L•��a.::aclri.:ell3 '---._. .... rialstm1for. mee ofConsnmer Affairs&Business Regulation License or registration valid for individui use only ME IMPROVEMENT CONTRACTOR before the eapiratlon date. If found return to: t24g37 Type: 0111M ofConsumer Affairs and Doemess Replatlon ira"On: .SM412015 Individual 10 ParkPlaza-Suite 5170 Oliver Kelly Bost&,MA 62116 Oliver Kelly - 8 Rhine Rd, Yannouthport,MA 02675 ., - Underiecretarn Not valid wlthoutsignature 1 Massachuseits -Department of Public Safeqr Board of Building Regulations and Standards _icense: CSSL-099167 - �� r w OLIYER M E ELLY� r - ' - 8 RHM ROAD r Yarmouth Pore Ila 02695 Co�nissiorer 09/2812015 r P° ' MMMDN �►�=o CERTIFICATE OF LIABILITY INSURANCE DATE 5/1/2014/2014 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. . IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DOWLING&ONEIL INS AGENCY INC N CONTACT: 973 IYANNOUGH ROAD PHONE FAX No: HYANNIS, MA 02601 MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC S INSURER A.- LM Insurance Comoration 33600 _ INSURED INSURER B: OLIVER KELLY ` INSURERC: DBA KELLY ROOFING 8 RHINE ROAD INsuRER°: YARMOUTH PORT MA 02675 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 20051017 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. ADDE SUER POLIC EFF POLICY EXP LIMITS IR TYPE OF INSURANCE POLICY NUMBER MMID MID COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR PREMISES Ea occurrence $ MED EXP An one person $ PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO $LOC PRODUCTS-COMP/OP AGG POLICY JECT . OTHER: CO BINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per a HIRED AUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION A WORKERS COMPENSATION WC5-31S-338804-033 12/28/2013 12/28/2014 / STATUTE ER AND EMPLOYERS!LIABILITY Y/N 100000 ANY PROPRIETOR/PARTNER/D(ECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? �N/A 100000 (Mandatory in NH) E L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is regrdred) Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR OLIVER KELLY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE JERRY WALSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 110 KEL,LEY RD ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601-1990 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. 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