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0186 BAY LANE
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'�-nv �,'s,t�� �"•.�S'y ,� - 5t a i C ^ p x a v i 1 a` e; o , L D i a C a - r Town of Barnstable Building : P t This Card So That rt is Visible From the Street „Approved Plans Must be Retained on:I and this Gard Must be Kept sw�nsrwece s r z '"^� Posted Until Final Inspection Has BeenMade s ?' l63p. �� sk .,e.. w., �' r£ a sr�•_ .,�? w1, „f� yam r ` Whq, a Certificate of Occupancy is Required,such Building,hall Not be-Occupiedluntil a F nal'Inspection ha been made:, Pey jjilt Permit No. B-18-506 Applicant Name: Paul A Carrigan Approvals Date Issued: 03/02/2018 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 09/02/2018 Foundation: Location: 186 BAY LANE,CENTERVILLE Map/Lot: 1867026 Zoning District: RD-1 Sheathing: . Owner on Record: BAYRIDGE REALTY LLC ! Contractor Name."-,,Paul A Carrigan Framing: 1 Address: 16 KINGS WAY ,� Contractor License 3288 2 HYANNIS,MA 0260I ¢ Est Project Cost: $0.00 Chimney: Description: Install a Bryant 85,00 BTU Furnace w/4 toncoolmg 1st floor Permit Fee: $85.00 Basement ' " ) �' _ Insulation: ID_Fee,Paid.° $85.00 second floor, Install a bryant 45,000 BTU 80 w/(2)tons of cooling. : Final: rg Date � 3/2/2018 Project Review Req: Plumbing/Gas Building Official Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is commenced within six.months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application.and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and struttures shall be in compliance with the local zoning by laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street`or road and shall be maintained open for public mspett:on for the entire duration of the work until the completion of the same. q Final Gas:. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on thiis�permit. Electrical Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or FootingService: t � � 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is`installed,. g 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 "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: - 1 !'M Commonwealth of Massachusetts r1 ( � Sheet Metal Permit Map Parcel V Y� 50 Date. Permit# Estimated Job Cost: $ L Spa Permit Fee: $ (/ 6 IZ Plans Submitted: YES NO Y) eviewed- YES NO Business License# Applicant License# ° P68 2 Business Information: PT(Q*' er/Job Location Information: Name: C A P( wyQY, lA k,, �c— Name: Street: 2C)^Rp--y\jeA e, ja V-e. Street: /&-(, City/Town.: City/Town: L�n IEft` U I!_e ern Telephone: ���'`3 �� 7�5 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1/M-1-unrestricted license/\ J-2/.M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 famil f- Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other Square Footage: under 10,000 sq. ft. _�_ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: i3VAC Metal Watershed Roofing '`. Kitchen Exhaust System Metal Chimney/.Vents ' Air Balancing Provide detailed description of work to be done: Coro F /3-A 7, ttiN nsYYA;e\-jam 603 0-+() 0% �� r r INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No ❑ If you have checked)�U, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waiyes this requirement. Check One Only _ Owner Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Proiress_Inspections Date Comments Final Inspection Date Comments it Type of License: By Master A Title ❑Master-Restricted CZ�C City/Town ❑Journeyperson Signature of Licensee . Permit# �. ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.agX Email: Inspector Signature of Permit Approval The COM907"Mah*Of 4fiU5 Ch=eftY Depwtmav&fru&YfYidAccUwft - f Office afIM-WMgafio= 600 WashhWon Street Bost an,M4 02111 mvw ma gvvIdra Workers' Cumpensa[ian Iusmrance Affidavit:BBw'l&r dCuntxa.chws fFIecb "an s bmbers AppIiantIflfarmai n FleaseFrint f y 30 P6m`V-eA s a Cr€yfS#ifitef�ip phanoi- ®'- 7 Tire you an employer?Cbeckthe appropriate bum ' Type of project(required): L❑ I=aemplayerwith 4. ❑I am a ge cral cmtmctarand€I ❑ employees(fell anVor part,-timed* have hired the sub-cam bmdors 6. New boa 2.N I am a sole prnpdetor orpartuer- listed on the attached sheet ?- Kid ding ship and have no employees These sub-cmiractms have 8-.❑Demalifion wod-ng for me in any capacity. erqiloyees and have wogwre 9. ❑Bui1 adciitioa jNa w-odmrs camp-ms=me comp. itsurarxp# 5. ❑ We area-cogmratinnaudifs 10-❑IIet�al repairs or ad�ons reldim -j. officers have exR�ed their 1L Phnabsn re ams or gdvns 3_❑ I am a hd�flvner doing zu Vo k ❑ P - myself[N8 wdilms'=F- tight of exempEon d we r MGL L.❑Roofrepd= r�e� mmncerequited-]d c.1.52,�1{4} 13_❑other employees.[NO wodness' corm.inwarmme required-) ;Amy e Szt; apayeyiafficros�aa ffnmeaaraeiswbD sat�it dos sf6daru i they mmdaiag-i'a wadi EMd&Mhae aut5i&e Caatmcdas—st submit anew affidweit mdicrtiro soclL aatcsciar5ifisl cbecIriiras Fax must sttsdh mt stiAw—sl sheet sbamingtbensmeof dse sal-=ntzct2msad statewheflim armatthase emffdesbasa e=0337yees.Iftbesah—t-t3—]Mce theg=nstF—•idE d—uala-'—Mp.paTiCY amubM I am an erltplayer f hat ispra rOng ivarkers comperimiz6on in=raace for my emplal ev Mow is fiiepaUry and joh sits in,jarmatian. Insurance Compaay-Fame: PO-ficy 40,or Self-ins.l ic- Expir-±iaaDate-- Job Site Address: Citgl5tafeE�.rg: Arch a copy d:f the workere eampemxfion.polic_declaration page(showing the poFicy number and expiration.date). Faslmm to secure coverage as requiredunder Section 25A o€MCP.d<M can lead to the imposition of rdmihal pen 19 s of a fine up to$ ,500-00 and/or one-gear impfismanetdt,as wiell as dvil.peuatties ja the form of a STOP WORK 01MI R mid a flue of ulr to$254.D{1 a day against ffie violator. Be adi}ised that a copy of this statem�maybe farward3ed.to the Office of. Iavestega#ions ofthe DIA,for i=mce covemge veciffbahnn. I Ufa hereby c ' �under the prtiids asdpsr�s a.fparjury'fhatf7i ift ramamprmd abaiv ig hue and cdrrrect SiEnatare. U�7 phmeik �. third rrss an ,TJa sat Arita in tf irxd'a,to ha cdrumpfetc b citp arfaiFn dxf j4cial City or To��n: Pe mibUcense 4 Bsning?u8aority[circle one): L Board of$•ealtlt 2.B'Idmg Depasiment 3. Fovm Clerk 4 Electrical Inspector S.Phmmbiug Inspector Other Contact Person: Phone#: — -- - 6 Information and Ias-Lueflous i Ma�sar�aceft C t al Laws ffiapt=M regaires all emplapesm provide Wor50as'=:UPeasaton forfli==9]IOY=S- this singe,an�foyee is&-fined ss.`� v7myperson in$ie service of snoilim madm awry contract oflf cspress or finpliecl,oral Cr mitft� An employer is defined as"au fieaid�oal,per,assoc�iam,corparaiion or other IegaI eatiiy,or rap tvvo or more of the fnregDing cagaged ill a1Oir±e[puse,and mcmding the legal Fepserd-fim of a deceased=3-player,or$e received'or tros of an bavir.nA parb cis .as,ocoafin or other Iegal eaiifL=Ployiag emPlnyees- However the ownm of a dweIIinghmse havingnotmdre than three apartmezds andvvho resides fimmin,or fhe occapaaf oftlM - dwelTmg hD-me of anofher who eo=plops persons to do mahftnmm.crosf rtr:Finn or repair woik oa such dwellmg houses or an flier grounds or bmMig appurknanttheaeto shallnotbwmm of such emplUmmtbe deemed to be an employer." MGL cbaTtr-r 152,§25C(6)also sees that¢every,sit or Iocal ficeasmg agency-shZ witIi GId i ie issaaace ar reaewaI of a licerzse or permit to operate a business or to construct buZdiugs rn the cofumgnwealtTi for any applicantwho h:as notproduced ac=ptable evideuce of compr=m with tIm hmr mnce.cove zg-e required." A dorally,Wff-cbapirr 152,§25CM stags-Teitbrr the mmTn_awcalft nor;�3y ofits politcal subEvisircns shall enter mtn ray contract fzrthepesfomnimice ofpublic vmkumfTs atable evMmm of campliancevvith the insurance.. =eq===Its of this chtea'sphavelienpresenhEdto the Cr*ftaCting a3fhoziy.i " Applicants - � . PIease flI oil the WDrkeas'compensation affidavit compleftln by cbec!:ffig!bD boxes that apply to your sifnafion and,if necessary,sPPh'sib-co (s)name(s), addv=Ces)mdphonem¢nbe s)alongvvitb_t"Ec r c e(s)of mscia„ce. I=itrdLiahil-dy Companies(LLC)orL=3tm&I abr-[rt'p-Pa tacabips(LIP)W no =aPloyers otberthanthe members or pis,are not required to carry Workers'campeusafio a firm m= Bran LTC or LT P does haye employees,apoIicy isre used. Be advisedtbattius affidayhmaybe snbmiffr.d to the Depatimeat of Industrial Accidents ror confSmaiiM ofmsnr�ce coverage Alsa be sua a to sign and daisire affidavit The affidavitshould beTeazaed to`lic city ortoWn that fbe aPPHC;atioa for the p=:dt or license is bekgrequesb�iL notthe Departmed of T„rTn�f,i�T A ,drTmtg Shoaldyou have any gncstions regarding the IavP or ifyou are regoic$d t o obtim a wad=' camp=saicmpoFey,please call famDepmtneofatfhenzcmberlish�dbelow. Self-ins2nDcicamp233iesshgnlden their s elf-jasar m license numher an the approgrlate Ime. City or Town.Otfidals- Please be sore that the affidavit is complete a ndpridedlegmly. The Departmeaithas provided a space at t]ie both= ofthe affidavit for youin:EU otrk inthe event the Office ofInvestigafions has to cmfactyo¢regardingthe applicant_ Please besvretn fMjnfhepennh/lic;=semunberwhichwil b ;usedasarcfeaeacennmber. InarlcRdon,anapplicant •that must submit mutdple peMniffficense applit ati=in ray given year,need only submit ono affidavit indicating current . policy mfbrmatian(ifnecessaly)and m dra`Job 5ibe M&ess"the applicant shouI "all Iocatli-Ls in (caiy ar town)_'A copy of the-affidavitthat has bey,officially stamped or make&by the chy or tuwn maybe provided fn the ' applimmt as prooffiat a valid affidavit is on file for fofu mmits or ficenses A new affidavit�st be fmcd otit each ali year.-Where a home owner or cozen is obtaining a license or pew notrel tEd to any bush=or commercial Tmuf= (i-m a dog license or permit to bum leaves ei�.)saMperson is NOT MT31 edto complete this affidavit The Office afIn s Would lzlmta:thamkyoumadvaace foryoDr cooperation and AoDLd yam have aaygaesticm. please do not hesifato to give us a call. The Department's address,telephame anti fax zmmber_ Ca=mm-Vmd- E of Iassachutts at�E e�f�Ac�deni� • [�tce��e�fig�f�oA� Q M&oil II -TCeL.:#617--' -4 ult4063 or I-977 IfA�A R Fax 617 727-'749 Kevised4-24-D7 W sagpvIdia , V EVE Town of Barnstable Building P uildin Department Services Brian Florence,CBO XAS& 163 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 QJI'1V�4S ,as Owner of the subject property hereby authorize 0 �� to act on ray behalf; in all matters relative to work authorized by this building permit application for. (Address of Job) **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 are performed and accepted.. ,- Ic"i , Signa a of Owner Signature'of Applicant PPb �— Print Name Print Name Date Q:F0FJZ:0wrrMERM1ss10rrP00ls e Rev:08/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 KABa www.town.barnstable.maus Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEIVIMON Please Print DATE: JOB LOCATION: number street. village "H MEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town• state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_pemut. (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 r Dote: Three-family dwellings containing 35,000 cubic feet or larger will-be required to comply with the State Building Code Section 127.0 Constriction Control. ` HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner person(s)a engages s for hire to do such work,that such Homeowner shall act as supervisor." P Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor Rules&Regulations for Licensing Construction Supervisors,Section 2.1 This lack of awareness often (see Appendux Q,R s gala g p , 5) .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.\WFMES\FORMS\building permit fomu\EXPRESS.doc 08/16/17 ,x • „F �. � �-��� �� DRIVER - 51 . NO* � 43 5 2bwZ: NE, �� �V�V�}�� ��+ w� o 2aa8 7a � ��6A: n` w 2 Eft , fl �fl19 u .. �,, il ., � .�.. ,�' �:a� ��na 'r�1 '� ioi�z�zo�a4�v�o�a,�s oe.*�•*�,,F"` " , M �� , H ry , _ COMO W M • N E/�►L 'O s F SE ate: SHET BQ NiETf�L3WORKERS ISSUESgHE FG�LLQWING LICENSE R f. UNRESTRICTED ,sr ts A"b` A3N P4tJlCARRIG ty, v..C7 rip tit . 'own. 7 a'sa y asp; k C F .+n + a r �1 r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION P- NSTAELE 4P 1.x �} Map 0 Parcel 0CW ,�, Application Health Division a Date Issued .: V Conservation Division �y Application ` Planning Dept. - R'�'= Permit Fee Date Definitive Plan Approved by Planning Board \ZAN- Historic OKH _ Preservation/ Hyannis Project Street Address Village lam'wvy, )I & Owner btu ri 44 4L2, 1Ze k J i-�/ L_L L_ Address l(o �Gi� «. Telephone $/'��� Permit Request 6C_ /n 6ir? -e 2 {���ruc►M S f-na/ea_ / m t'£,.L 11 e C!�/►d� U �itit � .r � ��:.,,g�,` ,•.�,,.r'�,.. .. y y+y� 41 ww e ry 'r ' N;Rr•/,feiC�''yi{Zlll'Fl"5'..:Kv' .M Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00J Construction Type "Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) - Age of Existing Structure ki'll 19LI Historic House: ❑Yes V o On Old King's Highway: ❑Yes ❑ No Basement Type: U411 ❑ Crawl ❑Walkout ❑Other ' Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 3 Half: existing � new Number of Bedrooms: existing _q new Total Room Count (not incl ing baths): existing new First Floor Room Count 3 Heat T e and Fu ❑was ❑Oil ❑ Electric ❑ Other Yp Central Air: es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No �i 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 Dennis Telephone Number Address License 0-.��^�O] � �® � Home Improvement Contractor# Email d"Jo (PG�-r 41 1 i cot-, Compensation # (9Z7�/,31 l-53-7v '991/ T' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO be._, � SIGNATURE DATE '7 ZOI 7 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. Town of Barnstable Building - �. °s Post,This""Card So That it is Visible From the Street-:Approved Plans Must be Retained on Job and this Card Must'be Kept M"SrABL& s MA Posted Until Final Inspection Has Been Made. '. Y i Permit Fa °� Where a Certificate of;Occupancy Is Required,such Build ing.sha11 Not be Occupied until a Final,lnspection has'been made. Permit No. B-17-2279 Applicant Name: DENNIS KERKADO Approvals Date Issued: 01/05/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/05/2018 Foundation: Residential Map/Lot: 186-026. Zoning District: RD-1 Sheathing: Location: 186 BAY LANE,CENTERVILLE r Contractor Name:--. BAYRIDGE REALTY LLC. Framing: �3 7/1 tr KM Owner on Record: MCNAMARA,LISA M TR 3 i _ ;: k:>' - Contractor License I77919 2 Address: 16 KINGS WAY = . ( Est Project Cost: $25,000.00 Chimney: HYANNIS, MA 02601 Permit�Fee: $177.50 r f Insulation: Description: COMBINE 2 BEDROOMS TO MAKE 1 LARGE MASTER W/CLOSET. Fee.Paid' $177.50 RECONFIGURE MASTER BATH. UPGRADE SMOKE/CO DETECTORS I) Date , 1/5/2018 Final: Project Review Req: Plumbing/Gas d � Rough Plumbing: Building Official F -Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application,and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall 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 for public inspection for the entire duration of the work until the completion of the same.` Electrical *= .• The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work h• 1.Foundation or Footing �' ,. Rough: 2.Sheathing Inspection " 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r. POO 1°1 r1 tt,� beck Room 2 2 x,I .Arlin Garage 1Lc1C#Bl.' . SMOKE DETECTORS REVIEWED :1 1 a'1` ter € 0N,1 BARNSTABLE JILDING DEPT. ATE FI E DEPARTMENT DATE BOTH c!GNATURES ARE REQUIRED FOR PERMITING !f - -- - T' l 7 3 drocTym Bedroom y� 1 ,-t6 o Landing 'I-81 Attic Space �t "x 7' p a. ■ ■ 23'X 1 r RReal :0 X8, Room 22OX: 5 t 3 x1 ,- r Landing l-titits ■ ® MEMBER REPORT Level '2;Copy of RHS Drop Beam, PASSED ®�0 4 piece(s) 1 3/4" x 9 1/4" 2.0E Microllam® LVL Overall Length:75'7" o — o I 16 7" U All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal. Design Results Actual @ Location Allowed Result LDF .Load:Combination(Pattern) System:Floor Member Reaction(Ibs) 3887 @ 2" 10413(3.50") Passed(37%) -- 1.0 D+1.0 L(All Spans) Member Type:Drop Beam Shear(Ibs) 3357 @ 1'3/4" 12303 Passed(27%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) 14503 @ 7'9 1/2" 22408 Passed(65%) 1.00 1.0 D+1.0 L(All Spans) Building Code IBC 2015 Live Load Defl.(in) 0.479 @ 7'9 1/2" 0.508 Passed(L/382) 1.0 D+1.0 L(All Spans) Design Methodology:ASD Total Load Defl.(in) 0.683 @ 79 1/2" 0.762 Passed(L/268) 1.0 D+1.0 L(All Spans) Deflection criteria:LL(L/360)and TL(L/240). Top Edge Bracing(Lu):Top compression edge must be braced at 15'7"o/c unless detailed otherwise. Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 15'7"o/c unless detailed otherwise. Member should be side-loaded from both sides of the member to prevent rotation. Bearing Length Loads to Supports(lbs) Supports PP Total Available Required Dead FlL°ive Total Accessories 1-Stud wall-SPF 3.50" 3.50" 1.50" 1160 2727 3887 Blocking 2-Stud wall-SPF 3.50" 3.50" 1.50" 1160 2727 3887 Blocking •Blocking Panels are assumed to carry no loads applied directly above them and the full load is applied to the member being designed. Tributary Dead Floor Live Loads Location(Side),, Width (0.90) (1.00), Comments 0-Self Weight(PLF) 0 to 15'7" N/A 18.9 1-Uniform(PSF) 0 to 15'7"(Front) 11' 10.0 30.0 Residential Living Areas 2-Uniform(PSF) 0 to 15'7"(Front) 2' 10:0 10.0 Weyerhaeuser Motes _ (IS)SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser expressly disclaims any other warranties rekated:to the software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards.For current code evaluation reports,Weyerhaeuser product literature and installation details refer to www.weyerhaeuser.com/woodproducts/document-library. The product application,input design loads,dimensions and support information have been provided by SITE REVIEW ` �\i1H OF fAgsO��y. MICHELE CUDILO U N0.34774 �+ STRUCTURAL 7/6/17 Forte Software Operator Job Notes 7/6/2017 10:31:55 AM MICHELE CUDILO 186 BAY LANE MODIFICATIONS Forte V5.3,Design Engine:V7.0.0.5 MICHELE CUDILO.P.E. OSTERVILLE.MA - 201 7-149kerkado 186BA YLANE.41e (508)771-7601 mcudilo@comcast.net Page 1 Of 1 r !Massachusetts Department of Public Safety Board of Building Regulations and Standards License:.CS-093445 Construction Superviso• DENNIS KERKADO 16 KINGS ROAD ' J HYANNIS MA 02601 `" L_ =x Oommissioner Piration: 02/26/2018 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WIWW.MASS.GOV/DPS a 'Thic< r.••�nri oira Ca-C/i I/(--- Zrizf cIn Office of Consumer Affairs&Business Regulation MEIMPROVEMEN:fCONTRACTOR o gistration: 17791 Type: r xpiration: :,2a4f m s, LLC BAYRIDGE REALTY LLi;.. DENNIS KERKADO 16 KINGS WAY HYANNIS,MA 02601 Undersecretary ' License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 0211.6 Not valid without signature The Commonwealth of Massachusetts Department of Industrial,Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Bayridge Fealty LLC/Dennis Kerkado Address: 16 Kings Way City/State/Zip:tennis, MA 02601 Phone#: 508-577-7?58 Are,you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. El I am a general contractor and 1: 6. ©New construction employees(full and/or part-time).* have hired the sub-contractors 2.[] I am a sole proprietor or partner- listed on the attached sheet. x 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me,in any capacity. _ workers' comp.insurance. 9, ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their 10,[] Electrical repairs or additions 3.[] 1 am a homeowner doing all work right of exemption.per MGL 11.0 Plumbing repairs or additions myself, [No workers' comp, c. 152, §1(4),and we have no 12.[J Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showimg thug workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensiatton insurance for my e imployees. flelow is the policy and job site information. Insurance Company Name; Am t f YC(Atl zur 1()k Policy#or Self ins.Lic. �10 90I 1Expiration Date 3Ic1 CZ 186 Bay Lane Centerville, MA 02632 Job Site Address: City/State/Zip: Attach a co off the workers' compensation policy declaration page(showing the olicy number and expiration date). copy F- P p g ( � p. p ) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a one up to$1,590A0 and/or one-year-iXnprisoilment,as well as civil penalties itl 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 cerld nd . e pains__ d pen ties of perjury that the information provided above is true and correct. Signatur bate: 01/19/2017 Phone L5 -7258 Official use only. Do not write in this area,to be completed by city or town official M City or Town: Permit/License# Issuing Authority(circle one): _ 1.Board of Health 2.Building_ (Department 3.Gityfrgwia Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone Town of Barnstable Regulatory Services ]Richard V. Scab,Director Building Division. Paul Roma,Building Commissioner 200.Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 f Tax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder iAl d �'/�iiI�'I!S ",as&er of the subject l property' hereby authorize to act on aliy.my beh in all matters relative to work authorized by this building permit application for. (ikddress of Job) **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 are performed and accepted. igna a of er- " Applicant Print Name Print Name k L21fi2 Date Q:FORMS:OWNERPERMISSIONPOOLS . Town of Barnstable t Regulatory Services Y p�FI HKE Richard V.Scali,Director 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 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 provided at the owner acts as su ervisor. e who does not possess a license rove that homeowners to engage an individual for hire w p ,p P 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 i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a 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 lackof 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 forms\EXPRESS.doc 06/20/16 AC49RV CERTIFICATE OF LIABILITY INSU �� DATE{MM/DD,YYYY) �°'� O6/26/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV.ELY 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 tMSUREp 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). jPRODUCER CON TAC ._ .. . NAME; Calla Fogarty ROGERS& GRAY INSURANCE AGENCY INC PHONE.ExU: (508)268-2105 FAX (AIC No E-MAIL" l: . 'ADDRESS cfodarty@rojersgray.com 434 ROUTE 134 — INSURER(S)AFFORDING COVERAGE _— j _ NAIC#_ - SOUTH DENNIS MA 02660 INsuRERA. AMER ICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURERS BAYRiDGE REALTY LLC - - I INSURER C: ---'• .------ INSURER D: --- -- F- 16 KINGS WAY INSURER E HYANNIS MA-0260.1 INSURERF: COVERAGES CERTIFICATE NUMBER: 167848 REVISION NUMBER: THIS IS TO CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$SUED.TO.THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR^ -- - ADDL SUBR -- _ —` POLICY EFF POUGY EXP�— -- T---------"--- (_LTR I TYPE OF INSURANCE 4 POLICY NUMBER MNi1DDf! (MMIDDNYYYI LIMITS II( I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCES CLAIMS-MADE I—I OCCUR DAMAGE TO'RENTED i -PREMISES Ea occur once S -:------------ ,.._._ i I MED EXP(Any one person) I S — i_ N/A i PERSONAL&ADV INJURY i S _ GEN'L AGGREGATE LIMIT APPLIES PER: I 1 I GENERAL AGGREGATE POLICY I_�JE� LOC I - I I PRODUCTS-COMPIOP AGG$ OTHER: -- I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 'Ea accident) _ ANY AUTO j BODILY.INJURY(Per person) $ i I ALL OWNED f SCHEDULED I --� F-.-I AUTOS r--- AUTOS I I N/A I BODILYINJURY(Per accidant),s i NON-OW l ` HIRED AUTOS L AUTOS NED - f I PROPERTY DAMAGE § —'-i I I `Per accident) -- 1. UMBRELLALIAB OCCUR I L— i EACH OCCURRENCE $ 'EXCESS LIAR r--�CLAIMS-MADE j N/A - ----- F— - (--_1___ _ I I AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION +✓ PER - - OTH- AND EMPLOYERS'LIABILITY STATUTE ER ____ _ i1 ANYPP.OPRIETOR/PARTNER/EXECUTiVE YIN i - I - L i A OFFICER/MEMBER EXCLUDED? N/A NIA I WA 5" s F.L.EACH ACCIDENT $ 100,000--� ❑I 6ZZUB9F,�37099,7 j 03/09/2017 0,/09/2018 (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEES$ 10^u,000 If yes,eescnbe under _ DESCRIPTION OF OPERATIONS below - E.L.DISEASE,POLICY LIMIT I$ 500,000 iI N/A I I I i I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more apace is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay i claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. I I This certificate of insurance shows the policy in force on the date Ehat this certificate was issued(unless the expiration date on the above policy precedes the issue data of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search Tool at mwv :mass.govilwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION. ( SHOULD:ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN fl ACCORDANCE WITH THE POLICY PROVISIONS. i - - - AUTHORIZED REPRESENTATIVE - Dariel M.Cro019y,CPCU,Vice President—Residual Market—WCRIBMA i ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD k MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY n f U it MA.DATE 1 a l PERMIT# -1 7-!q j JOBSITE ADDRESS a OWNER'S NAME tPJ Ii; 2ea c POWNER ADDRESS 1 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:E1 REPLACEMENT: PLANS SUBMITTED: YES 0 NO® 'FIXTURES 1 FLOOR- BSM 1 2 s 1 4 5 6 7; 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICES __ I DEDICATED SPECIAL WASTE SYSTEM —�-� - DEDICATED GAS101USAND SYSTEM - DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM - DEDICATED WATER RECYCLE SYSTEM - I DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ' FLOOR 1 AREA DRAIN I' INTERCEPTOR(INTERIOR) z KITCHEN SINK - LAVATORY ROOF DRAIN - SHOWER STALL SERVICE!MOP SINK (- TOILET URINAL WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES �� I WATER PIP] OTHER INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142: YES NO IF YOU CHECKED YES,PLEASE INDICATrTHE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYOTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' n with erfinent vision of the Massachusetts State Plumb'ng Code and Ch ter 142 of the General Laws. / PLUMBER'S NAME d �f-7 t d 0'VLICENSE# Y3 SIGNATURE MP® jP3 CORPORATION D-#PARTNERSHIP®# LLC[I# COMPANY NAME p S vV+� (rl ADDRESS � C�- (P` CITY is a f rr�-&-07 STATE ZIP 0� '� TEL FAX CEiL 7 7�( S` EMAIL �,t/r 1 f o S^o l,na t C 6 Y►1 71- Town of Barnstable, RE i 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-2006CIO Date Recieved: 6/27/2017 - u Job Location: 186 BAY LANE,CENTERVILLE, Permit For: Building-Siding/Windows/Roof/Doors = L Contractor's Name: DENNIS KERKADO State Lic. No: CS-093445 Address: Hyannis, MA 02601 Applicant Phone: (508) 577-7258 (Home)Owner's Name: Bayridge Realty LLC Phone: (508)$34-9768 (Home)Owner's Address: 16 KINGS WAY, HYANNIS,IMA 02601 Work Description: Strip 27 Sq of siding.Redo with with cedar shingles.Replace 19 windows and 1 sliders.No header changes. Total Value Of Work To Be Performed: $25,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of,workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his-intent to" accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the} Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans,and specifications. All information contained within is true and accurate to the best of my knowledge and belief. ; All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: dennis kerkado 6/27/2017 (508)577-7258 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost ; $25,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $127.50 6/27/2017 $127.50< XXXX-)D=-XXXX-i Credit Card ................................7121 Total Permit Fee Paid: $127.50 I MRMIII__�A`111 ,v. ., TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. ryApplication # Health Division "Date Issued cl Conservation Division .,;,Application;,Application Fee Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner I.,JRW- Mk Address Telephone�j i�'r25!)'' 95B f _ Permit Request 2� � 1 v� c r� _Sdfm R Mmfi f — -TWO C2 � dAXS �i PJ ri Square feet: 1 st floor: existing proposed C� 2nd floor: existing proposed Total new Zoning District i Flood Plain Groundwater Overlay Project Valuation t 000 Construction Type Lot Size !r / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )Cr Two Family ❑ Multi-Family (# units) Age of Existing Structure I Z-- 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 2-- new Half: existing newer Number of Bedrooms: 3 existing _new G41A= Total Room Count (not including baths): existing new First Floor Room Count i o Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑Other ` Central Air: U Yes No Fireplaces: Existing New Existing wood/coal stove: UJYes`- No Detached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ nave si e_ Attached garage:)�'existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ro Iff es, site plan review# Current Use - - Proposed Use j APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � C. Telephone Number Uw_ `'{[Y; Address . 0 , l ! 1 License # ,�� `�1 , Home Improvement Contractor# 1,SJ 8_3 v Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I — 4 (4"A&A I =41,"11) SIGNATURE " ��''� \. DATE 1 �� r FOR OFFICIAL USE ONLY APPLICATION# 3' DATE ISSUED r MAP/PARCEL NO. ._ r I ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION SOWO °( 1l :? FRAME INSULATION ` ' + FIREPLACE i ELECTRICAL: ROUGH FINAL - i PLUMBING: ROUGH FINAL -GAS:- :ROUGH F- FINAL ' FINAL BULLDINGi x0.1 );1)I;'AL4 coq1z-hfA"44w DATE CLOSED OUT r' ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts r Department of Industrial Accidents v O i ' Investigations ffceof 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly l 4 G� Name (Business/Organization/individual): Address: 1?7 s City/State/Zip: � � ( � Phone Are you an employer? Check th appropriate box: r Type of project(required): . am_a general contractor and 1 1.� 1 am a employer with � 4 ❑ I - g 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner.- listed on.the attached sheet. 7: T Remodeling These sub-contractors have ship and have no employees, � 8. Demolition ., working for me in any capacity.' employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ - required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their _ 1°l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. No workers' 13.0 Other comp: insurance required.] ' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#; �'( Expiration Date: �� Job Site Address: 12 a cbio (ap—, City/State/Zip: I Ae<W 64V 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 r y der the ains and penalties of perjury that the information provided above is true and correct. Si nature: Date: '74 Phone#: _ s Official use only. Do not write in this area,to be completed by city or. own 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#: ACORV ' CERTIFICATE OF LIABILITY INSURANCE DATE,MMID°"""' 111.1 � 07/06/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME: German)Insurance Agency - PHONE _ FAX 908 Main Street c o t:(508)428-9194 _ A/C No: 508 428-3068 E-MAIL _. _ ADDRESS: Osterville,MA 02655 PRODUCER CUSTOMER ID M - INSURER(S)AFFORDING COVERAGE NAIC If INSURED JNSURERA: SAFETY INS CO Scott Peacock Building&Remodelling, Inc. P.O.BOX 171 - '- INSURER B:' Osterville,MA 02655 INSURER C: INSURERD; .National Union Fire Ins.Comp` INSURER E: _. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE - ADDL SUBR POLICY EFF' POLICY EXP LTR POLICY NUMBER MMIDDIYYYYJ (MMIDDIYYYYI LIMITS A GENERAL LIABILITY CP00001152 r 7/5/2011 7/5/2012 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY AMA T RENTED s PREMISES Ea occurrence $ CLAIMS-MADE OCCUR- MED EXP(Any one person) $ r - PERSONAL&ADV INJURY -- $ GENERAL AGGREGATE ' $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: r PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ E T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person). $ ALL OWNED AUTOS BODILY INJURY(Per acc dent) $ SCHEDULED AUTOS ' PROPERTY DAMAGE $ - HIRED AUTOS (Per accident) NON-OWNEDAUTOS $ _ $ OCCUR - EACH OCCURRENCE UMBRELLA LIAB EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE.. S "` RETENTION $ $ D WORKERS COMPENSATION WC 5815464 6l22/2011 6/22/2012 1 WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/N IQBY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT_ $ 100,000 OFFICER/MEMBER EXCLUDED? N/A - - _ (Mandatory In NH) - E.L.DISEASE.-EA EMPLOYEE 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 ___77 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) .- - - CERTIFICATE HOLDER CANCELLATION Scott Peacock Building 9&Remodeling,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax#"508-428-7625 ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE elle— —900=16= ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Town of B 'nstable Rigulatory ervices Thomas F.Gellei Director Building Di vision. - - 'Thomas Perry,CHO _ Building Co nioner 200 Main Street, H s,"02601' www.town.barne ablema.us , Office: 508-862-4038 n Fes: 508-790 623p z Property Owr Cr Must Complete.and SigE This Section If.Using A Builder as Own of. the subject property hereby authorize to act on my behalf, m all nutters relative to work authorized byti�sybuafi3g permit application for. ss of jo ) 4t;u�rwe—of Owner Print Narm !r�rsT�e, k5 QAWPFILES\)70RMS\bui)dins permit furms\iEXPRs8S.d0c Revise020108 f Massachusetts Department of Public SitfetN Board of Building Regulations and Standards Construction Supervisor License License: CS 94500 r . JAMES S PEACOCK PO BOX 171 � OSTEVILLE, MA 02632 Expiration: 7/22/2012 ('uumissiunci Tr#: 29233 o. E� • • - �.' r.: Office of Consumer Affairs&B sines Regulation License Or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: s Registration:sg"151853 Type: Office of Consumer Affairs and Business Regulation Expiration:_ -7/7l2012 Private Corporation 10 Park Plaza-Suite 5170 r Boston,MA 02116 SCOTT PEACOCK BUILDING&REMODELING INC JAMES PEACOCK 1046 MAIN STREETtSUITE§7 OSTERVILLE,MA 02655 4= Undersecretary _ Not valid without signature vlq �G — _. i• 41 �_P. i '!. i i r„ S«-a `[O e L.a ju �,..�,.,.. .,.3._=,...+_,..�.�.•- -� 6\.(� ,..PIT- 4 )N F • � - _ ._ ��y � is �� � � ,y _ - . � ter:..,. .._____�_— _�--� '.=,•��" .. ¢��;�.�.._.. �'�� �"' ,-� ��� � ,�� y` I ' ' _€E. •. �, <.+.v�,Si.:EN..,. ��,'" ���M1 �+ � r d - :rt 4 \n S �4 � i� ■�����■ ,y 1186 018 6 Town Bounds #356 .23'�Sfi Parcels FY2011 2 t; Address Street Numbers /r � �✓ ��'„„ g Buildings Approximate Locations of 186 022 t--4 New Buildings from Plot Plans iZ�.,,: Aq Decks/Patios 's s ®� W �Above Ground Swim min Pools ✓ r. " : ;6N t�Q In Ground Swimming Pools f<t `F., �,:;�' f� '` b e v x ,.�,. € _.... r NX Walkways Improved 4 .F 2 �'. l FS Walkways Unimproved Paths t : a ' ,; s ® Stairways ,k, �. f w i> s x f, mote. T e fi Tcm g9^ ?' Paved Roads ;,• :` Nrl ^•�:"- E' F^ Unpaved Roads „� �. ,� .m,rwo Paved Driveways : Unpaved Driveways ;. �t 'j g � ♦ ��:� �,� _ �-�,� �+x� Painted Lines 16D 186025 � i 0 Paved Parking Lots '• K t$,, l°"• /� . 0 Unpaved Parking Lots r t "9s..., Bridges a .. -C "`., iv. - �� Railroad. r. .tl ,/ _ 8�IF � � 1#6-026 186 186-028_ �� Fences ,tt 146 Goardrails ^ —0-- Retaining Walls a t tl c>cac> Stone Walls 00 Sports Areas •� l 1 N �.. �' � A IV GolfAreas Docks/Piers Q l Boardwalks Jetties / :A .Streams s - Drainage Ditches : ; 0 Marsh Areas - ! Water Bodies `€ tz - - , Spot Elevations(NAVD88) O Topo 10 ft Contours(NAVD88) o y xCatchbasins MonumentsSa Lam Posts 9 1$6 0075,E p Towers _ w s 19.4 Manholes Q '� 111 O Satellite Dish `® .•� ` ~ �; Utility Poles / Signs Fuel Tanks ', 186-076 Si a g Water Tanks s tl�.^ f # 176 — Flagpoles � •J a8P •` , Q Utility Boxes MN O Posts � • Pilings Town of Barnstable Data Source Human-made features, Disclaimer This map is for planning purposes only. It is 1 inch equals 40 feet N hydrography,topography,and vegetation were parcel lines on this map are only graphic not adequate for legal boundary determination Feet CohServahon DI1V1Slon. interpreted from 2oo8 aerial photographs and representations of Assessor's tax parcels.They or regulatory interpretation.Thus map,does no mow, i; O 10 20 O 80 W E http://—.town.ba-siable..a,us may have been updated from more current. are nottrue propeity boundaries and do'not "represent an an-the-ground survey. ''' 1 - 4 60 zoo Main Street,Hyannis;MA 626ot sources. Parcel lines were digitized from represent accurate relationships to physical Enlargements beyond a scale of 1"-too'may (5o8)862.4093 FY20ii Town of Barnstable Assessor's maps. objects on the map such as building locations. not meet established map accuracy standards. - S `QF,NE T Town of Barnstable ' Regulatory Services BARNSTABLE. ` MASS. MP i6M �0 Building Division pfED '�a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Ck L- Location in 6/YY LA) Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: LEbG6C Arsi'T tL RM&J7" To hLtwa NS t4 iFe-r l� S PfsCT46 Fq Z 0 PEW ATSER,S T—S G RSA'E�2 All, R- o3y Please call: 508-862-4$38 for re-inspection. Inspected by Date tHE Tp�� Town of Barnstable BARNSTABLE. Regulatory Services li MASS. 1639. -> Building Division pTED MAC , - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice 'i Type of Inspection C Location A L A) Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: (_ LF-)GF( A CN mCrJ-r To Pbi4.5C TN,s(,E;sczE/UT- A* 5 m(-T'4G Fro z C) P E, ..TS e(;?-S G R E Ai-F rz tl� y�3y Please call: 508-862-40-38 for re-inspection. Inspected by L I& Date