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Dwelling Type: Single Family Two Family ❑ Multi-Family units) Age of Existing Structure ZHiric House: ❑Yes C�No On Old King's Highway: ❑YesBasement T e: ❑ Full ❑ Crawl ut ❑ Other Type: Basement Finished Area(sq.ft.) 3bao Basement Unfinished Area (sq.ft) 1Y9r Number of Baths: Full: existing_ new Half: existing i 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 Z o Fireplaces: Existing_ New Existing wood/coal stove: ❑Yes a<o 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 A orization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use R Proposed Use 40i►r-c. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name doyi �ULft Telephone Number 7,y 9 73 76 7 Address 1, o License# 6'7 S"1.3) IMA ® Da I Home Improvement Contractor# )37 5 tt3 Email Worker's Compensation # LV�Dgl C,S' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2( l) 1 /cam 1 FOR OFFICIAL USE ONLY APPLICATION # ti DATE-ISSUED y .j MAP/ PARCEL NO. + , ADDRESS VILLAGE i OWNER DATE OF INSPECTION: FOUNDATION " FRAME 9 ZA INSULATION 41 ZA� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING cos 5 j(, k DATE CLOSED OUT ASSOCIATION PLAN NO. ' Ile' Conrrriarrivealth of-Massachusetts Departir iew t of rnrdarstrial-4cciderds Q,ffike of lniwsfigadons 600 Washington Street Boston,AL4 02111 , twit mass:govIdia Workers' Compensatian Insurance Affidavit:Buildei-s/Cantracturs)EIectricians/Plumbers Applicant Information Please Print Legibly Name(Busmen'�OFganQationllndi�iclual)-�,,,r s� Address: 1 { Cityr/Statel ip 006al Phone tAk'7 7 0 2 rare employer?Check the appropriate box: Type of project(regnired),: 1. I.am a employer with Af 4. ❑I am a general contractor and I employees(full and/or pert-time). * have lured.the sub-contractors 0 New construction 2..❑ I.am a sole proprietor or partner listed on the attached sheet 7-'[ model ng ship and have na employees! These sub-=trac-tors have g-}❑Demolition working for mein an capacity. employees and have workers' y � �. 9. ❑Building addition x [No workem'comp.insurance comp.insurarum# required-] 5. ❑ We are a corporation and its 10.OTMectrical repairs or additions 3.❑ I am.a homeflumer doing all work officers have exercised their 11.❑Plumbingrepairs or additions self o workers' right of exemption per MGL �' � gip- 12_❑Roof repairs insurance required.]i c.1,52,§1(4h and we have no t° employees.[No workers' 13_❑other comp.insurance required.] *Any applicant dut checks lox AEl umst also fill out the section below shoving then.woiRexV compensation policy information. 1 F omeDwners who subunit this af5davu indicating they are doing all wal and then bi a outside contractors amst submit a new affidavit indicating such. trantractors-d=check This beak must attached as additional sheet shouiag ihrename of the sub-cantrwAors and state whether or not those entities hive eoxployees.I€thesubtoatactorsbave employees,theymustpmvide their workeW romp.policy number. lain an eniiplaj yr tlnat ispratzilrizg worker.s'congwistigon iumiranzce for my e.uiplof�ees Belosv is the pvM7 imd job site incformatiom Insurance Company Name: , Policy-4 or Self-ins..Lic.;� twG e 906- 7/-r Expiration Date 4 1 Job Site Addre=: City/State/Zip: *., 0.24,:3.> - Attach a copy of the workers'compensationpolicy declaration page(showh3g 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 andror one-year imprisonment,as well as ciiril penalties.in the form of a STOP WORK OORDERand a fine of up to$250-00 a day against the violator. Be addsed that a copy of this statement maybe forwarded too tbe.Office of Investigations ofthe DIA for insurance coverage verification. Ido hereby cett fly ander the pahis andpenahYrs afpeg'aty.that the inrformatioin pmtrzded abmfs`is tree and correct SiEnature: Date: Phone# 7714 9q3 !b al Official use only. Do not write in this area,to be caainnpleted by city ortonnn offs at City or Tout.: Permitffikense 4 Emuing?Lntlior€ty(circle one): ' 1.Board of Health 2.Building Dep.aitnent 3.Cityfrpvm Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts G& eral Laws chapter 152 reginres all employers to provide workers'compensation for their employees. pmm=ftD this statute,an empkyee is defined as."_.every person in the service of another under any contract of hire, express or implied,oral or wdtttn_" An enplvyer is defined as"an mdividnaI,partnership,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 trastee 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 maintemnce,construction or repair work on such dwming house or oa the grounds or building appzrrteamt thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25g6)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 corumonwealth for any applicant who has not produced acceptable evidence of compliance with the hiwrance_coverage required." CrL chapter 152 25 es"Neither the commonvrealth nor any ofits political subdivisions shall Additionally,M ap ,§ C(�states contract for the erfoi ance of ublic work until acceptable evidence of compliance wife the in cnrance._ enter into any P P P .w. , requirements of this chapter have been presented to the contracting auffiozity." Appficanis PIease flI out the wofcers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their certfacate(s)of insurance. Limited Liabflity Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partaers,are not required to casy workers' compensation insurance. Nan LLC or LLP does have e this affida " ma be submitted to the De arfineat of Industrial T ee a olic is r B e advised that Y¢ y P emp_oY s, P Y equn-ed- . 't should aeon ofm�nce cove e. Also be sure to and date-the affidavit. The,affidavit ccidents for confirm � A � be ret=e;d to the city or town that the application for the permit or license is being requested,not the Department of Ladusftial Accidents. Should you have any questions regarding the law or if you are rec u ed to obtain a workers' compensation policy,please call the Department at the number listed below Self-insured cohnpanies should enter their self-msnrance license number on the appropriate line. City or Town Officials Please be sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to frill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemlitllicense number which will be used as a reference number. In addition,an applicant that must submt'multiple permitYlicense applications in any given year,need only submit one affidavit indicating current p olicy information(if necessary)and under"Job Site Address"the applicant should�,vnte"all locatives ia (cry or `wwn)-"A copy of the affidavit that has been officially stamped or marked bythe city-or town may be provided to the - applicant as proof that a valid affidavit is oa file for Unre permits or licenses. A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venizre (ie. a dog license or permit to bum leaves etc.)said person is NOT iequired to complete this affidavit The Office of Investigafions would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Departmenfs address,telephone and fax number. 'I.1e CG.=2 Vjtaja of Massachusc-Ats Ilegau1nmt cif 1�dustdd Aoent t , Office of jvegagatio--� _ 604 WasbiVoll Sit ' Bosto u,MA G2111 Tf-L A 617'27-•4g00 ext 406 or 1-977-MAS&AFF Fax#617'27 7749 Revised 4-24-07 go �dia AWC Guide to Woad Construdiorr in ff4g-1r end Areas:110mph kYind Zorre Massachusetts CheckUst for Comoiauce (7sD cI4TR mot�.1.I�' P1 CIz=Tc . CDMPIian= 1.1 SCOPE. ' Wind Speed{3-se gust)__ -_-.._-._ _:_..____._____ .�__----------------•--:----____.. 110 mph Wind osure C o Wind Exposure Category__:.............Engineering Required For Entire Project...........................•............0 12 APPUCABILITY -Number of Smries(a roof which exceeds 8 in 12 siape shall be considered a story) stories 5 2 stories Roof Pitch _ .__.__.______�--____ 2} ---r._:_�-___._�:;.--_.-- _1212 Mean Roof Height , Bulding Width W__._.____._.-------_--------__--(Fig 3)____..�-._.___..:_-•_-_•--_ft <_8V BuRdrng Length;L fg 3)____�..___..__._-_-------__it 5 80' Bulding Aspect Rafio(1NJ),;---___._4 Nominal Height d ..__ _�_:__._.__--:--Fg�)_--- -------- ---------- `3:1 f Tallest Dpening� - :�__.---__-_-( g );_.-'----=---------------- :_-_.__ 5 6'8' 13 FRAG1[ING CONNECTIONS General compliance with framing c6nnedioris__:.:------ 2) 2.1 FOUNDATIDN ' Foundation Walls meeting requirements of 78D CMR 54D4.1 Concrete.......................... .-.--_ -------- - - -- .. _._... - - CDnciate Masonry....... r__._:___-_._-_ •22 ANCHORAGE TD FDUNDATIDN''3 518'Anchor Bolts*imbedded or 518`Proprietary Me tianical Anchors as an abrhafive in concrete only Bolt Slicing-general (Table 4).____;.:..__••--------- in Bolt Spa="'g from endl•oint of plate :_.__�- -•- Fi Bolt Embedment-concrete------- '.-_(Fig 5)-.--_. ______________ .� _in.>7- Bolt Embedment-masonry-------_.. --- ------_---• ' Plate\l►rashe� --- _-_._.._--------- --(F9 ____-- - - ---_-?3`x 3'X'/�` ' 3.1 FLOORS j` Floor-framing member spans checked (per 7BD CMR Chapta;r 55) Maximum Floor opening Dimension ------(FJgE3)....... ----------- Full Height Wail Suds at Floor Openings less than 2'frum Exterior Wall(Fig 6)----------------- ...................... Maximum Floor Joist Setbacks Supporting I-Didbearing Wails or Shearwali_---____ --•----- --------•_- ft 5 d Maximum Canflevared Floor JOisfs ' Supporting Laadbearing Wails or Shearwall -.-__(F9 8)__- _-- ._--•-- - ----:----__ft 5 d FloarBracing at Endwal[s-....._...._..__._ .-----._-.-[Fig 9)_- _----------.-----_-- Floor Sheathing Type t..,___-•--- ---- --_.__ .._(per 780 CMR-Chapter S5) . Floor Sheathing Thickness (Par 790 GMR GhaPfa r55)._..._.•-- -__-.-•Floor Sheathing Fastariing..........._....... ___--__:.-(Table 2)__d nails at in edge I.in field 4A WALLS S " Wall Height .. 10 and Table 5)___..-,______:._ fit 510' hlan-Loadbearing walls___ ___ —(Fig 10 and Table Wall Stud Spacing 10 and Table 5)___-._-_-._rn s 247 o.c. Wall Story tDffsets 7_ 8 _-_._._-..:. ft <_d ` ( 9s } - . — 42 EXTEPJ D WALLS' Wood Studs Laadbe-aring•v�ra[ls___ .._ ......._......_.....___._,_�_...(Talafe')--------_------------ -�. c_ in. Non-Loadbea�ing walls -�._. _:(Table 5).__..._:__.:... -- — - __. --- - -_- — rrt Gable End Wall Braang -� Full Hefght Endwall WSP-Atfc.Root Lengtfr._.__ ft�-Wf3 Gypsum Cerfng Lei g (if WSP not used)-- ---_: -(Fi 11) —ft;t 0.9W and 2 x4 Continuous Lateral Brava 6 ft o_r-_(Fig 11).............................._:.----____-�._ or't x 3 cetTrng furring strips @ I Sw spacing-min.wn 2 x 4 blocking @ 4 ft.spacing iri end joist or Cuss bays Double Trip Plafi: Splice Length __---fig 13.and Table B) _ SpUc--Connecfion(no:of 15d common naJ s)-----__(Table -.- 4TVC Guide to Woad CattEtrudiau irz High FrindArsas_ IIO Faph H17nd Zone, ' Massachusetts Checklist for Compliance(7so Cii;R-53012-1_1)' Loadbearing Wall Connections - Lateral (no.of 16d common nails)__----------.__._____-(Tables 7)--__---------_.___-._---__-_.: Non-L•aadbearing Wag Connections Lateral(no_of 16d common nails)__-.- ---•----(Table 8)__..... __ Load Bearing Wall Openings(record largest opening but check all Dpenings for carnpflance to Table 9) Header Spans (Table 9)__-_:_.�__-____._fit—in.-<11' Sig Plate Spans -.. _-_ ......(Table 9) ------------ ti_in._<11' Fug Height Studs (no. Df sfuds)____- _(Table NDn4xad Bearing Wall Openings(record largest opening bill check all openings far campffance to Table 9) Header Spans_. (Table 9)_____________.._-_--_ft•_in.51Z Sill Plate Spans.._. _(Table 9)_._------__.-..—ff_irL-<12' Fug Height Studs(no.of studs) _(Table E)di:�rior Wag Sheathing to Resist Uprdt and Sheaf Simultaneausly4 Minimum Building Dimension,W . Nominal Height of Tallest Openingz ----------------- - ---_-----•----------._- _.._.=�6`B' Sheathing Type_.-_-. __---•-•--__:._(note 4}_._-_---•�---_-•--__---_ -- Edge Nail Spacing �__.___-_.. _,_.-.(Table 10 or note 4 if less)_____._._._.__._. In- Field Nail Spacing-----------•_------ ._____.(Table in Shear Connection(no.of 16d common nails)(Table 10).--•_-_-------------------------------------_ Percent Fu1f-Height Sheathing..___' _._..:_(Table 10)__.________---_----------,---___---•-_`� 5%Addiionai Sheathing for Will with Opening>VW(Design Concepts) Maximum Building Dimension,L Nominal Height of Tallest Opening2_______...................................................:__- _�6'8_ ` Sheathing Type.___ __ -------...---------_(note 4).___.-------------------------------- Ed a Nail Spacing Feld Nail Spacing------- __.__:_(Table 11)_.____--- _----_--- ------•-- in. Shear Connection(no. of 16d common nails)(Table 11)___-__._�_ Percent Fug-Height Sheathing.,__-.._�_.(Table 11)____ 5%Additional Sheathing for Wall with"Opening>6'a'(Design Concepts)_..----r_Wall Cladding Cladding Rated far Wind ---------_ 5_1 ROOFS Roof framing member-spans checW7_____.. .(For Rafters use AWC Span TDol,see HBRS Websr ) RDDf overhang __-__.______---____-__..----------_-_--(Figure 19)____:-___---ft 5 smaller of 2`or LI3 Truss or Rafter Connections at Loadbearing Wags Proprietary Connectors Uplift____.---_--._..______ _.(Table 12)-_____ ---------...______.�_U. pff Lateral----_----------------------------(Table 12)-------_ ---__.__ ---.__..___L= plf (Table 12).___-•-----_-__-----•__---___ S= ptf ` - Ridge Strap Connectors,if collar ties not used per page 21... (Table 13)___-----,__._._..____T= plf Gable Rake Outlooker__--------------- 2a) •--_--•----ft s smaller D_f 2'or L12 Truss or Rafter Connections at NDn-1.nadbeMng Wags Proprietary Connectors Uplift___.-____.- _---_(Table 14)-_--------_--._-_.___U= 1b. Lateral(no_of 16d common nails)___(Table l4)......................................L= . lb. Roof Sheathing Type_-._.---:-- --._.__-_---(pet 780 CMR Chapters 53 and 59)..........._ RDof`Sheathing Thickness___...._--_-_. _-___.--------_--_-_ __-•_in?7116`WSP Roof Sheathing (fable 2)__._.____.-______._ __---•_--__ NDtes_ •1. , This dvN*Ast shall be met in its entirety,excluding the specific exception noted in 2, to comply with the requirements of 780 CMR5301.2.1.1 Item 1. If the checUM is met in ifs 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• 2b Gage Straps per Figure 11 c_ UpIiff Straps per Figure 14 d_ All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1Ba and Figure lab 2 'Exception:Opening heights Dfup to 8 ft shall be permr>ted when 5%is added to the percent fug-height sheathing - 'requirernents shaven in Tables 10 and 11. 3_ The bottom sill plate in e6kior walls shall be a minimum 2 in_nominal f*kness pressure treated#Z-grade. -A WC Gicide fo Wood Corrstr-uctiorr in Rji, h lllzrzdAreas_ 110 rnph 1-1-7171d zane Ma.ssachusetfs Checklist for Compliance(7so 4. a- From Tables 10 and 11 and location of wall sheathing and Bulling Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7116'and be installed as follows 1. Panels shall be installed v%th strength ands paralel tD studs. n. All horimnfal joints shall occur over and be nailed to framing. ' ffL On single storyy cDnsfrucfion,panels shall be attached to bottom plates and top member of the double top platf-- 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 nal spacing at double top plates, band joists,and girders shall-be a double row of ad staggered at 3 inches on center per figures below:Vertical and Horizontal Naffing far Panel Attachment 5. Glazing protection:a)'new house orhDrizontal addition—required if ppject'is i mile or closertD shore(generally,south of, Rte.2B or north of Rte.6) b)vertical addition_not required unless there is erterisive renovation to the first floor c)replacement wiridows—needs energy conservation compliance only(chap 93) S.Wood Frame Construction Manual(WFCM).for 110 MPH, Exposure B maybe obtafned from the American Wood Counrif (AWb)webst=te, r ' WrMN TH6IDG1=F1FSSiS DH FFAmm usETd NkiLs. TU u n 1 11 ; ti a t t i t o 1 t [•� - 7 . - It ri t I Q t t o !r It IrII t m n tl • 1 I- . 1 l - ha W lI try 1 [ r Ii . :i ii t 1 } ! �d If i i L+ IABER i 5` W 11 f 1 A: uit u z t I S if _ 1 i - r t a STAG IdY� NAE;S�kt PkNB UA&F'ATrEFN PANS ---- r:rU4IDCzz 4! MU3LEr141LID7_Es?ACM r7ETAL See Detail fln Next Page Vertical and Horizontal NaTing ' Dei�il Vetml and Horizontal Nailirg for Pane]Aftachment for Panel Aitachmarri Town,of Barnstable Regulatory Services - ' E Rlti'1NLT-l�3 f - p Richard V.S=Ii Mrednr a 16` Building Division TomPerry,Ems ComaTisdoner 200 Mam Street,Hy=i*MA 02601 www.townlarnstable ma.us Office: 508-8624038 _' Fay 508-790-6230 Propeify Owner Must Complete and Sign This Section If Using AB r as Owner of the subject property bere�yaurho*+?R to act on mybehA in all mat Len relative to work authorized by-this bUMing permit application for. (Address of job) '"Pool fences and alarms are the responsibilkyof the applicant Pools are not to be filed or uii�zed before fence is installed and all final inspections_are pesfomed and accepted- S;==,re of Owner Sigaatum of Applicant R Pint Name Pant Name Base �Fo�n�rs:owrmiP�smr�oors - Town.of Barnstable Reg-datorp Services �-ME ri Richard V.ScaA Director �+ - $�IcIing bivisioit . t t Tom Perry,Btu COmmnccinner r$ z�MASS-- tia 200 Maim Street Hyammss,MA 122601 �`°D� wePs�to�a.barasfabIanaa_IIs ' Office: 508-862-4038 - Fag: 509-790-6230 HOMEOWNM Li ZEM MCEA=ON PIcaccPtiat ' JOB LOCAnOAL- numb¢' sixut Ttamr_ hamcphonc#, WoiicPIiOM# C RpENI'MAILIldGADDRESS: zip cods The==-ant exemption for"homeowners' was extended to include owner--or d dweIlmes of sir or Less and to ino ess a 'cease vided that the,owner acts aS eryisor_ homeowners to en a an individual for hirewho does notposs h ,uto s� DM71UIION ORHOMFAWNER . .1 r . P erson(s)who oy s 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; aifached or detached stractores accessory to such use and/or farm structures. A person who contracts more than one bnmo in a two-year period shall notbe conddm-ei ahameowner. gurh`hnmeawn .shall submitto the BTn"1�Official on a farm acceptable to the Bun1dmg Official,that hdshe shall be responsible for all such work performed umderthe bmading 1>gga t (Section 109.L1) The tinder.signed`.`homeowner"acc=m rmponsiffiMtY for compliance withthe State Bu -Iffin Code and other applicable codes, bylaws,rules and ragala fmLS _ Tbz=l=igned`homeowner"certifies thathelshe uadcrtdan&the Town of$amst hEabIc Bm-dung Depaiimmtminin=inspection procedures and requirements anti at he/she wM comply with said grocedmes and regaaemeots. sigaahac ofHnmcovncr Approval ofBm3dmgCd5dzI Note. Three family dwellings containing 35,000 cubic feet or larger wMbe requhedto comply wrtlithe Siaite.Bu ildmg Code Section Y27.0 Ca strmction C;antML HDNMWNM S SON The Code states that "Any homeowner performing work for which a bm"t�permit is required shall be exempt from the provisions of this section(Section I0911-Ticensing of construction Smpervisors);provided that if the homeowner engages a person:(s)for Time to do such work,that such Homeowner shall act as supervisor." Moray homeowners who use ffiis exemption are unaware that they are assnning the responsMiliities of a supervisor (see Appendix Q,RnIes&R.egu ations for Licensing Construction Supervisors,Secfinn 2_I5) This lack of awareness often results in serious problems,pardeularly when the homeowner hires unlicensed persons. In tins case,Our Board cannot eo a as S erd r is e t�Ticeased ersoa as if wou ld with a fir�ased Supervisor. Tile hour wave chins uP .Pm� � p tslf=tely responsible. To eusise that the homeowner is fully aware of his/her respoasffi itiies,many commutufies require,as part of the permit 2.ppHc2±Ion,that the homeowner certify that he/she understands ffie responsibilities of a Supervisor. On the List page of this issue is a form currea$y fed by.several towns. You may rare t amend and adopt such a R)rm/certiffcation.for use in your community. ��rp��1pR��+,����pcffiit�s1F�XPRFSs.doc Rmised 061313 f BASEMENT FINISHING SYSTEM'" DESCRIPTION ;.. .f,.,. The OwenFinishing Basement ,.:.:. Sstem icomprised ,.v. ..;<..•<,>..:.>r.+;;f:f>� :, ..:::+.::.::,..f::.'• ,.,::..'.:;,.f;,..:�,.::;::.;�;<����::::;;:s of h htwei t fib r Yass Panels,PVC hneals which replace conventional ft-aming)and .a. >.x ,.. Darned PVC s4.. .:......... tjim moldings .,.....+. � ,.' �,,.:...:.....: ,:w:.:;<.......... w:..:.♦„y:: .,.:::.:•:..,�„s+::�,f>.z::.�,.. (W111Ch replace tnm lumber).The trim moldingsF.,;> � ,... snap into the lineals,holdingthe panels in place. " "� P P Moldings and wall panels are Basil removed Y access to p easy a homes foundation walls.Because tradition al wood and er--. PaP 4+v. based building materials are replaced with fiber glass ass and PVC e Basement Fini sh ing 4 i ,. System'offers i rs nh Brent i Ytt res istance to mois ture, '.; i mo ld an d dmil dew.* t The !r i s cover ed I 1 Y y a � 8 1 u' rir "u a lifetime <,�r limited transferable I fr om Owens Coming. USESy The Owens Corning Basement Finishing System"is an innovative system designed to » . insulate and finish basement walls.It insulates, ;£♦f: - acoustically treats and aesthetically finishes walls in a few simple steps.The system can be installed over both masonry foundation walls PHYSICAL PROPERTIES and interior partition walls built with either wood or metal members. Property Test Method Value For Fiber Glass Board: AVAILABILITY WaterVapor Sorption ASTM C 1 104 <2To by wt.@ 120NF, 95%RH n x 48"x 2-I/2"Panels Li Compressive Strength ASTM C 165 Lineals @10%deformation 25 P sf t Trim Molding; @25%deformation 90 esf Cove Molding Thermal Resistance ASTM C 518 Vertical Battens Normal Density ASTM C 303 PCF Base Molding For Finished Panel: Outside Corner Casing Noise Reduction Coefficient ASTM C 423 Jamb Extender Type A'Mount 0.95 Chair Rail Surface.Burning Characteristics ASTM E 84+ Class A Flame Spread 25 Color Choices: -Meets Class A Burn Rating Smoke Developed 450 ' InteriorTextile Finish Fire Classification NFPA-286 • Meets Acceptance Panels:"Linen Mist"woven fabric Criteria Trim:All trim available in White or Woodgrain. Mold Resistance ASTM C 1338 - Pass In addition,vertical trim available in fabric look ASTM G 2.1 Pass finish or fabric wrapped to match panels.. +The surface-burning characteristics of the finished composite panel were determined in accordance with ASTM E 84.This star, lord measures and describes the properties of materials,products or assemblies in response to heat and flame under CODE COMPLIANCE controlled laboratory conditions.Data from ASTM E 84 testing cannot be used to describe or assess the fire hazard or fire risk of materials,products or assemblies when considering all of the factors pertinent to an assessment of the fire hazard of 2000 BOCA Evaluation#21-24 a particular end use.Values are reported to the nearest 5 rating. See ICC-ES Evaluation Report No.ESR-1872 at www.icccs.org. While the materials and design of the Owens Coming . . , Basement Finishing System,resist mold and mildew,the System can not prevent or mitigate mold if the conditions necessary for mold growth otherwise exist in your tusernent " **See actual warranty for details,limitations and restrictions FEATURES AND BENEFITS Feature Benefit Pre-finished,integraed components Installs in about 2 weeks* Snap-out moldings and panels Complete interior foundation access Resilient glass fiber construction Will not dent like drywall Moisture resistant materials Resists mold and mildew growth 2 1/2"thick panels Added RI I Insulation Tackable surface Hanging pictures or papers without leaving permanent holes with proper use of picture support plate High Noise Reduction Increased comfort, Coefficient(NRC) outstanding sound absorption Wall panels indexed 1-3/4"off of floor Helps to minimize flood damage potential Removable base molding Provides wire chase for speaker wires, TV cable,computer,and other low voltage cables Lifetime limited transferable warranty** Offers homeowner peace of mind Dupont Teflon®fabric protector Stain resistant Certified installers Individuals trained for quality installation Ceiling design flexibility Integrates easily with drop or drywall ceilings *Based on an average basement,with two certified installers. **See actual warranty for details. fOt LRIr6' ; OWENS CORNING REMODELING SYSTEMS,LLC ONE OWENS CORNING PARKWAY TOLEDO,OHIO,USA 43659 1-800-GET PINK' www.owenscorning.com Pub.No.44071-H.Printed in U.S.A.June 2007.THE PINK PANTHER'"& 01964-2007 Metro-Goidwyn-Mayer Studios Inc.All Rights reserved. The color PINK is a registered trademark of Owens Corning. @2007 Owens Corning. BASEMENT INNTE W11,A3fWA§L41 �P�ANiE� , ' FINISHING SYSTEM- DESCRIPTION : DESCRIPTION The Owens Coming Basement Finishing System'is comprised of lightweight fiber glass vi panels,PVC lineals(which replace conventional ` framing)and foamed PVC trim moldings g d. (which replace trim lumber).The trim moldings snap into the lineals,holding the panels in place. = Moldings and wall panels are easily removed forr t removing or adding wiring.Because traditional wood and paper-based building materials are f replaced with fiberglass and PVC materials,the Basement Finishing System'offers inherent resistance to moisture,mold and mildew* r , The system is covered by a lifetime limited j � T transferable warranty"from Owens Corning, USES , The Owens Coming Basement Finishing System'is an innovative system designed to finish basement walls in a few simple stepsa . ` while providing acoustical treatmentThe interior wall panel provides a Class A flame spread rating,meeting the requirements for building codes for single and multi-familyRM , residences.The interior panels can be installed " over interior partition walls and stairwells ' ,4 ' built with either wood or metal members. Panels may be used on existing wood framed ' portion of walkout walls,wood foundation walls,and Structural Integrated Panels(SIPS) "•- that are insulated and utilize vapor barriers where required to meet local building PHYSICAL PROPERTIES code requirements*** Property Test Method" Value AVAILABILITY For Fiber Glass Board: 94"x 48"x'Shb'Panels Thermal Resistance ASTM C 518 R-3.5 Lineals WaterVapor Sorption ASTM C 1 104 <21Y.by wt.@ 120NF.. 95%RH Trim Molding; �,_ - Cove Molding Compressive Strength ASTM C d 65 min. Vertical Battens @109/6 deformation 25 psf Base Molding @25%deformation 90 psf Outside Comer Normal Density ASTM C 303 5.0 PCF Casing For Finished Panel.• Jamb Extender Chair Rail Noise Reduction Coefficient 'ASTM C 423 0.75 Color Choices: Type A Mount Panels:"Linen Mist"woven fabric Surface Burning Characteristics ASTM E 84+ Class A Flame Spread <25 Trim:All trim available in White or Woodgrain. -Meets Class A Bum Rating Smoke Developed:s 450 In addition,vertical trim available in.fabric look Interior Textile Finish Fire Classification NFPA-286 Meets Acceptance finish or fabric wrapped to match panels. Criteria •While the materials and design of the Owens Coming Mold Resistance ASTM C 1338 Pass Basement Finishing System'resist mold and mildew,the ASTM G 21 Pass System can not prevent or mitigate mold if the conditions necessary for mold growth otherwise a dst in your basement +The surface-burning characteristics of the finished composite panel were determined in accordance with ASTM E 84.This '"See actual warranty for details,limitations and restrictions. standard measures and describes the properties of materials,products or assemblies in response to heat and flame under The Interior Panel may be installed over wood controlled laboratory conditions.Data from ASTM E 84 testing cannot be used to describe or assess the fire hazard or fire frame portion of walls if walls are insulated to local risk of materials,products or assemblies when considering all of the factors pertinent to an assessment of the fire hazard of code requirements including vapor barrier use.This a particular end use.Values are reported to the nearest 5 rating. product may be installed either over eAsting drywall construction walls or without drywall. FEATURES AND BENEFITS Feature Benefit Prefinished,integrated components Installs in about 2 weeks* Snap-out moldings and walls Complete interior access Resilient glass fiber construction Will not dent like drywall Moisture resistant materials Resists mold and mildew growth 1 Y4t6'thick panels Ease of use for stairwell situations,fits standard door jambs,use over wood frame construction Sound Control Tackable surface Hanging pictures or papers without leaving permanent holes with proper use of picture support plate Wall panels indexed 13 44'off of floor Helps to minimize flood damage potential Removable base molding Provides wire chase for speaker wires, TV cable,computer Lifetime limited transferable warranty'" Offers homeowner peace of mind Dupont Teflon®fabric protector Stain resistant Certified installers Individuals trained for quality installation ' Ceiling design flexibility. Integrates easily with drop or drywall ceilings 4 'Based on an average basement,with two certified installers. —See actual warranty for details. " I11I01 IS FOI IlPtY6' L OWENS CORNING REMODELING SYSTEMS,LLC ONE OWENS CORNING PARKWAY TOLEDO,OHIO,USA 43659 1-800-GEFPINK- www.owenscorning.com Pub. No. 59199-H. Printed in U.SA. March 2007.THE PINK PANTHER- & @1964-2007 Metro-Goldwyn-Mayer Studios Inc.All Rights Reserved.The color i PINK is a registered trademark of Owens Coming.02007 Owens Corning. BOCA International Evaluation Report o � pi . i/ _I0 condition of use R@S@aCCh Report to c ttltlaeo 1 u g d This report is limited to applications and 21 .24 Products as stated herein. BOCA-ES intends r, that this report be used by the code official to t determine that the report subject complies with ctln p et c t e the code requirements specifically addressed;' MANUFACTURER provided that this product is installed in accor= '' dance with the following conditions: OWENS CORNING ■ cttLn trn e�trtats ■ OWENS CORNING Basement Wall Finish- ONE OWENS CORNING PKWY n :ter ing SystemTM is intended for finishing walls TOLE DO,OHIO 43659 f in basement applications.Other applications are outside the scope of this report. nNICEate ' DIVISION 7-THERMAL AND ■ The maximum`permitted area of the PVC MOISTURE PROTECTION ata�� w moldings shall not exceed 10 percent of the � i aggregate wall and ceiling area of the room. Section 07200—Insulation `� „ . ■'Installation of the Basement Wall Finishing �'-_amepreadrn ` ,- SystemTM shall be in accordance with this fee Srri e<�� report and the manufacturer's installation DIVISION 9—FINISHES to g manual. t Section 09540_Special Wall eron $ �esttn ■ Basement Wall Finishing SystemTM shall be Surfaces - ' installed over cast-in-place concrete or concrete masonry unit walls, or wood or description metal stud framing. Supporting structural EVALUATION SUBJECT: systems shall conforming to code require- OWENS CORNING Basement WallFinishing' ments for that system and are outside scope . BASEMENT WALL FINISH SystemTM is an alternative to conventional wall 'of this report. SYSTEMTM framing and gypsum wallboard.The Basement The electrical whin in the chase at the Wall Finishing SystemTM consists of PVC support lineals,base, batten, and cove mold- bottom of-the Basement Wall Finish Sys- - temTM shall conform to the requirements of ings, and rigid prefinished fiberglass panels. the code and is outside the scope of this Panels are prefinished with.a fabric cover. report. Basement Wall Finishing SystemTM is primar- ily intended for installation in residential applications. Refer to Figure Cat the end-of 'Items requiring this report for illustrations of the Basement 'verification Wall Finishing.SystemTM. Tlie following items are related to the use of the The Basement Wall Finishing"SystemTM shall report subject,but-are not within the scope of be installed in accordance with the manufac-,,this evaluation.However,these items are related. . turer's installation instructions and this report. to the determination of code compliance. Installation typically consists of either me-., ✓�Concealed electrical,mechanical,or plumb- chanical fasteners or adhesive fastening or a ing components shall be inspected prior to . combination of both io the supporting sub- the installation of the Basement.Wall Fin- strate. Thermal resistance (R-value) for the ishing SystemTM panels to verify comph- `fiberglass panels is 11. : ance with related code requirements.Evalu- Basement Wall Finishing SystemTM.panels ation of these components is outside scope x re meet the requirements for classification as a of this report. 'P t -RINTED AUGUST,2000 Class I interior finish as tested in accordance V Framing supporting the Basement Wall Page 1 of 2 with ASTM E84 and also has demonstrated Finishing SystemTM shall be inspected prior v that it will not spread fire to the edge of the to the installation of the panels to verify Copyright@ 2000, specimen or cause flashover in the test room in compliance with related code requirements. BOCA Evaluation Services, Inc. accordance with the testing requirements Evaluation of this framing is outside scope specified in Section 803.6(2) of the BOCA of this report. A Participating Member National Building Code11999. of the NES, Inc. Page 2 of 2 Research Report No.21-24 information submitted product identification ■ IntegrexTM Testing Systems,Report No.73143,dated April 17, All OWENS CORNING Basement Wall Finishing SystemsTM 2000,containing results of physical testing. manufactured in accordance with this research report shall bear ■ IntegrexTM Testing Systems,Report No. C423-99065, dated the following identification: August 19, 1999,containing results of physical testing. ■ "See BOCA Evaluation Services, Inc. Research Report No. ■ Omega Point Laboratories,Report No.13060-103216a,dated 21-24." ehs May 14,1999,containing results for fire testing in accordance with ASTM E84 for rigid fiberglass wall panels used in All Molding Basement Wall Finishing SystemTM. Snaps g into Existirig Foundation Wall ■ Omega Point Laboratories,Report No. 16218-106644,dated. PVC or Interior Partition April 13,2000,containing results for fire testing in accordance Support with ASTM E84 for moldings used in Basement Wall Finish- Grid ing SystemTM. ■ Omega Point Laboratories,Report No. 13060-103213a,dated 2.5"Glass June 7, 1998, and Report No. 13060-104470a, dated March Fiber Board 24, 1999,containing results for fire testing for full-scale room Panel with corner testing in accordance with requirements contained in _ Facing PVC Section 803.6(2)of the BOCA National Building Code/1999. Cove Molding ■ OWENS CORNING Product Literature, dated May 1998. PVC Support Lineal ■ OWENS CORNING Submittal Sheet.for Basement Wall (top, bottom, Finishing System(BWFS), dated April 2000. vertically ■ OWENS CORNING Basement Wall Finishing System every 48") Installation Manual, dated January 2000. application for permit To aid in the determination of compliance with this report,the PVC following represents the minimum level of information to Molding PVC accompany the application for permit: Vertical Molding 9 ■ The language"See BOCA Evaluation Services,Inc.Research Base Report No.21-24"or a copy of this report. ■ Plans indicating the aggregate area of the room and the area of the PVC moldings being used. Figure V Sketch of Basement Wall Finish SystemTM ■ Plans and specifications .of any electrical, mechanical, or Showing Typical Components plumbing items installed within the wall system. *THIS DRAWING IS FOR ILLUSTRATION PURPOSES ONLY.IT IS NOT ■ Details and specifications-of the supporting construction to INTENDED FOR USE AS A CONSTRUCTION DOCUMENT FOR THE which the system is to be applied. _ PURPOSE OF DESIGN,FABRICATION OR ERECTION. NOTICE TO REPORT USERS This report is subject to annual certification.Reports that are not certified shall not be used or referred to.To determine the status of certification of this report,contact BOCA Evaluation Services,Inc.,or consult the latest edition of the BOCA International Product Evaluation Listing published periodically in the BOCA magazine.: This report is subject to the conditions listed herein and to the specific product,data and test reports submitted by the applicant requesting this report. Independent test were not performed by BOCA Evaluation Services,Inc.and BOCA-ES specifically does not make any warranty,either expressed or implied, as to any findings or other matter in this report or as to any product covered by this report. Evaluation reports are not to be construed as representing aesthetics or any other attributes not specifically addressed nor as an endorsement or recommendation for the use of the report subject.This disclaimer includes,but is not limited to,merchantability. Please contact BOCA Evaluation Services,Inc.,with any questions you may have regarding this report.Additionally,please contact us if you have any information on the performance of the product described herein which is contrary to this report. 4051 West Flossmoor Road•Country Club Hills, IL 60478-5795 telephone(708)799-2305•fax(708)799-0310 e-mail: boca-es@bocai.org 9 http://Www.bocai.org Koch, Matthew& Kristen —"------ 244 Buckskin Path CONTRACT Customer Name, Centerville,MA 02632 Customer Signature ° SKETCH Contract Date_ 774-212-0367 Sales Representative Signature :t��it ,ALL°,�Q�•�--- ATTACHMENT Customer Phone ' 61.7-455-9274 _ Contract Price -03/, 9 8'6•�° 1 2 0 1 5 8 7 8 9 10 it 12 10 11 11 18 17 18 19 20 21 22 20 24 25 25 27 29 29 00 01 02 JJ 51 05 38 07 W 99 40 41 42 40 44. 45 46 47 48 49 50 51 52 0 54 55 58 57 58 59 80 } 2 , , : I. I L I I I 7 V I , if I � I ! I I 10 12 13 14 .I ! I , I ; .i ,. r; _i � n IB 21 20 w 2. R5R i 999333 I 25 I I 27 ! : I 1 I I I I � f 'f I 14t- •2930 01 1 I I I , 94 I I ! , j I I I I I I I� � '•I r� 'I I � I .. I I_ I �. 05 I I ! ; ' I I � I I I � _I._". � I •I I I ..I ..I.• _I. _ i NOTES: tJ X� p- o V- Each box equals one foot unless otherwise noted.This sketch Is a good faith representation of the work to be done, it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change if necessary. Koch, Matthew& Kristen -------------. __-___— -_ _ 244 Buckskin Path _ CONTRACT Customer Name) Centerville,MA 02632 Customer Signature;O • SKETCH Contract Date_ 774-212-0367 Sales Representative Signature i TIiLc,� — ATTACHMENT Customer Phone ' 61.7-455-9274 ' _ Contract Price 9 8G•�° , 2 3 4 5 9 7 9 9 10 11 12 13 14 1516 17 19 19 20 21 22 23 24 25 29 27 29 29 30 31 72 03 3r 35 39 37 39 39 40 41 42 43 44 45 49 47. 49 _49 50 51. 52 •53 U 55 59 57 59 59 90 I I I I i I I .'z f ' 4 I I ! I I' •I � i I: I 1 I i I 'I � I� I I' I I i ' I -I I I I I I I I I i I 9 I I ! ' I ' j L. t I i ! I I j ',� I •! .� I I I II ''� II i.(Q,. I� 7 riX. !' ,. I 1 i I .I I k, I I i !� � i i i � I � � I I I, 'p i I �I '+1► I� � I��,I 4 I � � I u�1{!I I ' I I 10 I ! I l I I = I I j 12 13Is I�;e.'9' _ '• .0 ( i I�i ' II i I ! I I ! I I I - I a{ s r i.. I ~:'>l�� �/i/�'l far 17 � i . 9 .I I i I i 21 , i ' � � I I• p I --1.�.•.. .. .. �,.. - a ...._ �_ ,..... - �- -I : IT� � : . 27 .j. I ! : I i I I j 29 31 32_ .. I I ': I I ! I f u I ' � I � I � � � � � � lil ! i � � • � ! j ; I� II _ ; , ,� I , � ; i� -I � I �L_ , j �, I I NOTES: tJXJ p- D' V Each box equals one foot unless otherwise noted.This sketch Is a good faith representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change if necessary. r , Massachusetts-Department of Public Safety toard of Suiiding Reguiatior•,s and Standards ruui___. _._.:_- s - a u_u ti lipci i iSvi- License:,CS-075131 EDWARD T.ALLJ9N , 30 STORMY HILT. ' > g_ Dedham MA-02026 "v °`,•G•-�l�6G�c. Expiration Commissioner . 02/27/2017 Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts* 02116 Home Improve ontractor Registration Registration: 137943 z Type: Supplement Card ; F Expiration: 1/29/2017 LUX RENOVATIONS, LLC. _ f _ EDWARD ALLEN i a 60 SHAWMUT RD w ---- CANTON, MA 02021 4 _ Update Address and return card.Mark reason for change. Ica I t, 20M-05N1 r] Address n Renewal Employment 0 Lost Card Vfia iomvmzonwe�r�a�C�/�aa�ac�ir�aella ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVgT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 9 egistratio 43=>3 Type: 10 Park Plaza-Suite 5170 Supplement Card Exp�raf�o Boston,MA 02116 LUX RENOVATIONO{ OWENS CORNING tISHING SYSTEMS EDWARD 60 SHAWMUT RD CANTON,MA 02021 Undersecretary Not valid without signature .a AC40R ® - TE(MM/DD/YYY1� AD DA CERTIFICATE OF LIABILITY INSURANCE 9/15E(MW 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 CONTACT NAME: Andrew G. Gordon, Inc. PHONE 781-659-2262 FAX 781-659-4725 306 Washington Street E-MAIL Norwell MA 02061 .info@agordon.com INSURERS AFFORDING COVERAGE NAIC it INSURER A:Peerless Insurance 24198 INSURED 4440 INSURER B:Star Insurance Company 18023 Lux Renovations, LLC INSURER C:Pilgrim Insurance Company 21750 Owens Corning of New England INSURER D 60 Shawmut Road Canton MA 02021 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1319789055 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 APOIL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/D MM/D LIMITS A X COMMERCIAL GENERAL LIABILITY CBPB 12851 9/5/2015 9/5/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED— PREMISES Ea occurrence $100,000 MED EXP(Any one person $5,000 PERSONAL 8 ADV INJURY $1,000,000 . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY❑PRO F LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: C AUTOMOBILE LIABILITY PGC10007161409 1/17/2015 1/17/2016 Eaaooident $1,000,000 _ ANY AUTO BODILY INJURY(Per person) $ x ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS x NON-OWNED PROPERTY D G AUTOS Per accident $ $ A X UMBRELLA LIAR X OCCUR CU811953 9/5/2015 9/5/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X I RETENTION$ $ B WORKERS COMPENSATION T _ AND EMPLOYERS'LIABILITY Y/N WC0428715 5/24/2015 5/24/2016' X STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ N/A - E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lux Renovations LLC, ACCORDANCE WITH THE POLICY PROVISIONS. 60 Shawmut Rd Canton MA 02021 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014✓01) The ACORD name and logo are registered marks of ACORD Panasonic Energy Recovery Ventilator 1'arMSort1c Description �'�/fj-- Energy Recovery Ventilator provides a temperedy. /YTI//i�pe/,- control,and a balanced amount of exhaust p smaintain neutral rENTaAT/Or FAN pressure throughout the home. Panasonic ERV shall not be installed in a bathroom. Only one unit is needed for a 1,750 sq.ft.2 bedroom home to meet the ASHRAE 62.2 ventilation requirement. (40/20 CFM) Motor/Blower: _ -O—T'VE i (20/10 CFM • Totally enclosed AC condenser motor rated for continuous run. Two highly efficient blower wheels running on single motor for i lower power consumption and decreased noise. / Power rating shall be 120 volts and 60 Hz. • Motor ui a>� � PPS with thermal cut-off fuse control: Housing; • Rust proof paint,galvanized steel body. • Dual 4"intake and exhaust ducts. / • Built in backdraft damper on exhaust duct • Filters on supply and exhaust air extend the life of the ERV core.' • Expandable mounting bracket up to 16"on center. Grille: • Attractive design using ABS material. • Attaches directly to housing with torsion springs. ,} Warranty: 13-1 • The factory warranty shall be a minimum of 3 years 7 limited warranty on parts. Typical Specifications: , ERV shall be of the ceiling mount type with no . less than ' 40 CFM on the exhaust port,30 CFM on the supply port,and no more than 0.8 sone as tested in accordance with HVI 915 and 916 standards at 0.1 static pressure in inches water gauge. Power consumption shall be no greater than i 2P31 23 watts. Apparent Sensible Effectiveness for heating shall be no less than 66% at 30 CFM net air flow under 32°F (0°C) as tested in accordance with CSA C439. Total Recovery Effectiveness for cooling shall be no less than 36% \ at 29 CFM net air flow under 95°F(350C). The supply port damper shall close. below 207 (-7°C) to prevent freezing of the core. The motor shall be totally enclosed, AC condenser type engineered to run continuously. Power rating Fan cove Fv-04VEI shall be 120v/60Hz. Duct diameter shall be no less than 4". Oso ' .Ventilation Performance: Air Volume Setting 40 CFM 20 CFM 10 CFM 440 Static Pressure in inches W.9• 0.1 0.1 0.1 Exhaust Air Volume(CFM) 40 20 10 supply Air Volume(CFMI 30 20 .10 Noise(sones) 0.8 <0.3 N/A Power Consumption(watts) 23 21 17 Speed(RPM) 1479 1 1292 1 1095 O20 Power Rating 120/60 ERV Core Technology. n10 • Indoor and outdoor air passes through Panasonic's capillary core technology. This process tempers supply air while transferring moisture and energy. L • Built in Frost Prevention Mode prevents the core from lieezing. 0A0 a ,o p 30 40 son 60. Frost Prevention Mode is free of interaction and operates without intervention. !�* Energy Performance: Apparent Sensible Effectiveness for Heating 66%at 30 CFM and 32°F(0°C) Total Recovery Efficiency for Cooling %at OM FM and 95°F(35°C) 4 As of 9/07 For Complete Installation Instructions Visit www.panasonic.com/buildtng cans Model Quantity Comments Project: Location: i Arlchitect. Engineer. Contractor. Submitted b i e . Owens Corning Basement Finishing Systems • of New England Koch,Matthew&Kristen 244 Buckskin Path Contractor / Agent Authorization From CAieryiue,*X'62632 774-212-0367 617-455-9274 authorize Owens Comm Basement Finishing $ Systems of Boston to sign the building permit application on my behalf,to perform the work at: Home Owners Signature: Date: Project Manager Signature: Date: 60 Shawmut Road • Canton, MA 02021 9 Phone: 781-821-0060 •Fax: 781-821-8552 • www.ocboston.com �TMET The Town of Barnstable Department o Safety f Health Safe and Environmental Services • > A= • Building Division � g 1639. 367 Main Street,Hyannis MA 02601 tip�•t� Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 3— 14- q-7 Name:_ Phone#:SO'R--7-7 R -0 b�2-4 Address: 0 4U- mac w ���17s�-N'1,�PR.1 - , I A vr : , Type of Business: Cyn4 3L QC-) Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4.1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwellingwhich are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigaed,have read and agree-with the above restrictions for my home occupation I am registering: Applicant:. 1-L'-01'A Date: C('74- Homeoc.doc — _ 9 Engineering Dept.(3rd floor) Map 1 Parcel F Js Permit# � Q House# 4 f Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30 ",,e, Fee a"' elv Conservation Office(4th floor)(8:30-9:30/1:00 2:00) Planning Dept. (1st floor/School Admin. Bldg.) , Definitiv an A!proved by Planning Board 19 sEpinc Siy E UN I-ALLE TOWN OF BARNSTA �WrM �AND 4 � � . , Building Permit Application Project St ddress Zyy Guc"g,nl IagTM r_>Pt Village, cENiTG1Z,fYLL Owner NORM qn1 A4 Address 2y y Telephone 7- 18-06Z.7 Permit Request oFF 2i? syA1aS Apc) 2 rcoSe=S Z SKuuTt:kc 9 Rutc rw �)a&h 2gSS Z rt ��tc S/ „ 1 25 nn /f3 �,,.irk�rr_c av���A� iNCt,i A, on( CHc'�TRor-Ae . First Floor q 12, square feet Second Floor q t 2 square feet Construction Type �o�t�ca�ttI�tL Estimated Project Cost $ 1qM Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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: ( J Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) q12, Number of Baths: Full: Existing New ( Half: Existing New No.of Bedrooms: Existing Z New Total Room Count(not including baths):Existing New _�_First Floor Room Count Heat Type and Fuel: (A Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing I New Existing wood/coal stove ❑Yes ONo Garage: ADetached(size) Other Detached Structures: ❑Pool(size) Attached(size) I G vZ 2 ❑Barn(size) ❑None (A Shed(size) 8)(t D ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use I Builder Information Name`R,SAM y1&tZU&Mn6 Telephone Number -7-7g—B4c)o Address 2x.Z License# C��,2c1Sfo H3 41qatr, M, Home Improvement Contractor# 1,7.olSl Worker's Compensation# Gr ,�21t�o2 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7-yt THommror4 SIGNATURE DATE,, BUILDI s eP RMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. , DATE ISSUED MAP/PARCEL,NO. ; ADDRESS VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION a FIREPLACE - ELECTRICAL: ROUGH t FINAL 1 PLUMBING- ;'.ROUGH; FINAL _ 4 tl GAS: ( 0--�tUGH FINAL FINAL BUILDINGS ' a Vs3 DATE CLOSED O.UT., ASSOCIATION PLAN NO. - i�CtU!45HQVP_S._.ActQutiQS n►K P t.NQEL1� RAY �pa'�tQrt l PL f KO ---- lo" erg „ y ►q „ ale , z -_ _ O , 71 &ALT ,N RIFCA1914M t 310 eALT-IN ORNA R5 ►nay EAvt'S w I WORK TO BE DONE NORMAN & SUSAN STRAUGHN III ADD 2 CLOSETS & 2 SKYLIGHTSTO UNFINISHED 244 BUCKSKIN PATH SECOND FLOOR. FINISH UPSTAIRS WITH SHEET:=.- CE4 BUCKSKIN MA. ROCK, INSULATION, 5/8 PARTICLEBOARD FOR CARPET. ADDS2EVE-DOORS, ".3BUILTIN DRAWERS AND 2 FILE CABINETS INTO EVES . t 2xb_RAFTE52S I ID' Q� W rni' r2-3o �NSutv�norl 2Xb (ZAFib'Sb5 !k;' CxAd 1- %SnN(r YV, ?I W ooD \'l I Far 2giPL-fZ ��ESTta�lCr KaLr �n w�i'S �xr-nyt tr Zit. Cck�2 L=S r r 2�� fib" nK . . a i �1L,SSRN(r «cxrT Rll Z� 1_6o!'L L f Sr$'1�7AC2ClCl G9X 1. 000 The Commonwealth of Massachusetts .� Department of Industrid Accidents MCC F!m�stl g FAMAS 00 Washington Street Boston,Mass 02111 Workers' Compensation Insurance Affidavit \,/namLl�e,4 ) ovation: Zip I Ha w-n _._ S'c4 city '01*NktS , MA phone# -77 -SDIOfI - I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. comoanv Heine. XX .. ..., : ..... i'...............:. ....... address... ..:. :.::..::.;....::. .... .....::::::....:.::.:.::::.:.:..............:::::... c p one: #� insul anee'co >: `::i :::::::::`i I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: * ., :. .:.::.::::.::::::.:::..:::::.::::.:.....:.:::..::::.::::::... . ::.. .. .,:........ . company name:- _:.:: .: ;..,:»:>;>::::;:;:<>:><>::::>:,:;;:.;>;:>:.»:<»::»<r::.>:f.. address: ctfv phone# insurance:co: ^;:::...:;;; :: nohcv# company . .:.::: address: »...:..:.. city phone#• insurance,co. oaa� e Failure to secure coverage as required under Section 25A of MGL 152 can lad to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a Nd copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cer fy u e the pains an en es ojperjury that the injonnadon provided above is Ime and correct Signat� ate Print name 1 R�A,J t. C�3vr�tvQ.1 Phone# 779-5` L)o r.,?, o ial use only do not write in this area to be completed by city or town official or town: permit/license# Building Department pLicensing Board t++ check if immediate response is required. pSelectmen's Orifice pHealth Department s contact person: phone#; MOther r (rinsed 3/95 PJA) t A S _ air'{ j }.. Z� �` .� 1� 13 fitrt�.yY ; a - 9fi; tpp�, e8y - r ��.��. c �11' .�` �e� w'� �tL ar ��� +. st•shi (� & k- iyh t �. •-,.{.�� �.L c ��'I �: 7 t <;T � v'..• q�gay. r 31` w} ; COMMONWEALTH ,1e . ls. 'DEPARTMEP17'OF PUBLIC SAFETY s= �J :OF ,..:' . f ONE ASHBOATON PLACE i MASSACHUSETTS '' :z 1' BOSTON,MA)2108 CAUTION IRA�fl0 DATE" r I i :.CONSTR SUPS V I�I�R : �' ;FOR PROTECTION AGAINST,'; Y e EFFECTIVE DA.'E LIC-NO iESTRICTIONS ,? THEFT, PUT RIGHT THUMB PRINT IN APPROPRIATE z }}ate4 k�oi:?0`'�G oy�. BOX ON LICENSE. E BLASTING OPERATORS 13.111 PN G A!:,'t SUR j ' NUS DE s 82 FIYb, FI'- f t. S A ;961$ T INCLUDE PHOTO PHOTO(BLASTING OPR ONLY) FEE �•• ''.r:• _ f n!e .. HA I CIA r IA w�_._ Fal/ to ossesa NOT VALID UNfICSIGNED BY LICENSEE AND OFFICIALLY p ' r6lasaacAraettaStatoBr:I no w* HEIGHT STAMPED-OR-SIGNATURE OF THE COMMISSIONER COde Ia CaYte tOf lBYOCatI r± w r r _ vs this lives" sl D �- OB c � 4 if SIGN NAME IN FULL ABOVE SIGNATURE UNF CAftRIEDONTMEPERSONOf. �-.. -,- SIGNATURE.OFLICENSEE ( .� y wN y .THE HOLDER WHEN.EN- 'r' I, iTHUMB PRINT GAGEDINTHIS000UPATION, �: - R �. y K:. r: 1•- - .1s- -- _ _ T— _ �,wee I•+ 3 �z s OM <IMPROVEMENT.. .CONTRACTORS`.REGISTRATION I` Board of Building: Resul"ations and, Standards y ✓s I", New ,� . 'x One Ashburto"n;:Place- - Room •1301 •,,Boston,iiMassachusetts 02108 v- > IMPROVEMENT CONTRACTOR - - -- - ' Regi tration 1.120157 t .Expiir a'tiont 10/26J/97 j A ' DBA.' .� 4 } HOME IMPROVENENNTRA I .� Registration 120157 . RI " EDWARD .WARBURTON rY TYPe DBA% A.'BRIAN E. WARBIJRTON I �` Expiration 10I2 97, '. S2 RYDER HAR R , � 02645 f fARBURTONWICH MA .E !' 8RIAN E. YARBURTON , 82 RYDER;RI # x ( ADMINISipATOR r ' d HARWICN MA02645t ' r °FTMe r� The Town of Barnstable & Department of Health Safety and Environmental Services 659. P Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 ` For office use only Permit no. Date - AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing t not more than four r to owner occupied area adjacent ofning at least one such residence or building be done by registered dwelling contra contractors,structures which are adl certain exceptions,along with other requirements. Type of Work: t ANA Z"9 1-t- Est.Cost IGOC� Address of Work: Zq LA ` Owner's Name �1 �s n�g Al2t1V1 N Date of Permit Application: -Ll I hereby certify that: Registration is not required for the following reason(s): Work excluded by law _ _ ob under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR CABLE PERMIT HOME IMPROVEMENT WORK D OR DEALING WITH LO NOT HAVE CONTRACTORS FOR AP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I her apply for a permit as the agent of the owner. z y � ' ,2ror( 1 ZU157 Date Contractor Name Registration No. OR RBIs THE Q�oF TOWN OF BARNSTABLE BABBSTAIILL o 1639. BUILDING INSPECTOR em APPLICATION FOR PERMIT TO ............e. - ........................................................................... TYPEOF CONSTRUCTION ............. ....................................................... ..... ....................................... . ..... .. . .......... ....................19.7.3 TO THE INSPECTOR OF BUILDINGS: The undersigned,pereby applies for a permit Dccorpling �tothe followinginformation- Location ...... ..... Proposed Use .... )- ..... ............................................................................................... ......................... Zoning District ........ ............ ........... .......... M . .Fire District...................... .......... ..................... ...... . Name of Owner ......... .. ....... .... .... . ...Address ...... ... . Nameof Builder ....................................................................Address .............. ....................................................................... Name of Architect ..................................................................Address ......... Number of Rooms .......6.....................................................Foundation ..... .....4? ................. ................... ............... ................Roofing ........... Exlerior .. ..... ........ Floors ......................................................................................Interior .. .... Heating .... ..z..... ....................................Plumbing ......................... ........iler .......... ......:.......... .. Fireplace ..... ....... ...... .... .. ......... . . . .....................................Approximate Cost ........ I..................................... , ,� , Definitive Plan Approved by Pla ping Board -------------------------------- 9 a� CL F% 0 Diagram of Lot and Building with Dimensions 1Z!t SUBJECT TO APPROVAL OF BOARD OF HEALTH Ce LL, > O M M LL- tL LIJ 0 0 (n z :E co < LL, 0 Ld 0 C ul Ld Ljj L.LJ F- F- U U) < < CL 0 Q ¢ CL < LLJ 0 LLJ U Lu z LJ LLJ LLJ 0 F- 0 < L,J Lj 0 F- 0 Z 0 LLJ F- %�- — F- C) < < F- (1) 1-- Z U LLJ < W I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding he above construction. NameK .. ....e.... ........... ......... ............... .......... Small, Alan E. V/ No ..1:s8.r�...... Permit for .....on.....story.......... single family dwelling ............................................................................... Locationgq Buckskin Path `�. .......................................................... Centerville .................... ...................................................... Owner .........Alan.E... ?�?.... ........................... i Type of Construction ...............frame................ r ................................................................................ Plot ......... Lot .+37 i i January 26 73 Permit Granted ........................................19 e L, Date of Inspection .....:..............................19 i Date Completed .....� J ! ......9 C 60%P LEI - PERMIT REFUSED .................. ............... ...................... 19 ........................................ ................................... ...... ........................................................................ Approved .................................................. 19 ............................................................................... .................... ......................................................... l t Assessor's office(1st Floor):Assessor's map and lot number 71 -1 U33 &0 poi INC Conservation(4th Floor): Board of Health(3rd floor): C. • 2 ssas�r�nct Sewage Permit number � -• � ,- � ,,,,�� Engineering Department(3rd floor): oo,.�1639.`\�d° House number a esr Definitive Plan Approved by Planning Board i 19 I APPLICATIONS PROCESSED 8:30-9:30:A.M.and 1:00-2:00 P.M.only TOWN * OF BARNSTABLE i ,BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO S f r 4eo, . TYPE OF CONSTRUCTION t✓v op( l�ci.v., s ' off . ��ajvr 'r 19 _ E TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location �/ Y �.� Gt 9 1�a f`, ��► P,— V �`l/� O�?(�� Proposed Use r,11114., 29 u1�2/-7 e� f s °� - Zoning District C Fire District G �` Name of Owner Al ra�c� n <� Address o2 y �` �1 -'� /��-�� �n v.`i/P /1i4 Name of Builder Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost �S Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Si ipervisor's License Straughn, Norman M. III No � Permit For BUILD SHED V - Location 244 Buckskin Path • Centerville • 1 L Owner Norman M. Straughn III Type of Construction - _ Plot Lot Permit Granted August 2 , 19 94 Date of Inspection: F Frame 19 Insulation 19 y Fireplace 19 Date Completed /- ` 19 9-S f 11•,,ytEtt� �[-�pf ids r r - v r r TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE 0202 /� s c�1 . / / Y JOB LOCATION 2 V `/ S" /<S Y"_4 Number Street Address Section Of Town "HOMEOWNER" /1/a�. a n /�J. ���a�C �., �" 0 Name Home Phone Work Phone PRESENT MAILING ADDRESS `/CC T?,G elc 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 such 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 to six 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, by-laws, rules and regulations. The undersigned "homeowner." certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOETNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0,- Construction Control. HIScs v HOME OWNER'S EXEMPTION The code states that: "Any Home Owner permit is required shall be exempt. from the performing work for which a r (Section 109.1.1 - Licensing of Co Provisions of this building Home Owner engages a g Construction Superviso section g person rs - P n s Own ( ) for hi � , provided Owner s re t ded hall act o do s that t as supervisor. " such work, that such Home if I� Many Home Owners who the responsibilities of use athis supervisorexemption (see A unaware that they *are assuming awareness often results in serious problems Rules and Regulations -Owner hires unlicensed ersons. Particularlyhis whenack theogome against the unlicensed person as it wouldcase witholi Board cannot Home Owner acting as supervisor is uwould el res Proceed sensed supervisor. ., The To ensure that the Home Owner is y Ponsible: ` many communities require fully aware of his/her responsibilities, Owner certify that he/she understandsthe thepermit ie responsibilit of is that the Home On the last page of this issue is a form currently used of a supervisor. You may care to amend and adopt such a form/certificatioby several towns. community. n for use in your k I R y CO MM O TH OF MASSACH USETTS , DEI`AF::1`IT-NTT OF 1-.NDUSTRIALACCIDU,7_17S _ 600 R7ASHINGTON STR—Ect y . lames Ga `,; BOSTON, MASSACHUISE-17S 02111 WORIaRS' COMPENSATION INSURANCE AFFIDAVIT (liccnscc/permincc) with a principal place of f/residence at: (City/Statc/Zip) do hereby certify, under the pains and penalcies of perjury, that: [ J I am an cmplovcr providing the following workers' compensation coverage for my employees working on this job. lnsurancc Company Policy Number [ J I am a sole proprietor and have no one working for me. j J 1 am z sole proprietor, generai contractor or homeowner (circle one) and have hired the contractors listed bclom, who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Police Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number I am z homcov.•ncr performing all the work myself. NOTE: Pi-sc be :.{•:rc tha while homeowners who employ persons to do maintenance,eonstruaion or repair work on : dwelling of not more than three uniu in which the homeowner also resides or on the grounds appurunant thereto arc not Fencrally considered to be employers undcr the Workers' Crrnpensation Aa(GL4C. 152,sea. 1(5)), application by a bomeowoer for a license or permit m:y evidence the lcg:d status of an employer undcr the Workers'Compensation Act l understand that : copy of this statement wig be forwarded to the Department of Industrial Accidents' OFzjcc of lnsurancc for coves=c veri6='on and that fa !urc to secure covcrgc as required undcr Section 25A of MGL 152 can kad to the imposition of�(jmina) penalties Consiscno of a f;nc cf tar to S1500.00 :ad/or imprisonment of up to one ycz::nd ei,,:i pcnJues in the form of:Stop Work Order and : Gnc of S100.00 a day against mc. Signed this 1A14 day of � , 19 2 � Licensee/Pcrmi c Licensor/Pcrmircor r FXt F. U�caa�t= Straug ZL toealriottiofproperty: Cent'ervitle tot 39 , 1 n 2 story e f. 44 'a „ „� '"• 38� n/f,Crosby'.,. Ara:15,453�5: garage , 152.66' t 37 ti r r ,• f 5271 . 45 fjood Prue; 250001 o015G f ood eon e:` C � jN OF y'fs� + o PAUI' yG J.hem6y cerr6 ihact th6 lnortgag¢ tns�¢cttgn. w�a_s.�n�-for T. n 1�11�riri and Wynn,V.C.and Mrye• COL . 0�tote Fast. ORO DER :. the 4well6ig showty haem does not'4fa1Z in ac spedca nme k-go0 E ♦ a'" h=%a anac witK am aRctive daze of S -19-85 anA qd to locattom a . ' the dwdl ng 'dm rto thti local,sorting 6y taws in•e*ct' apt t}te fiine oFCOWtrucrion wtft mpecrto horhonizl d&wnston Scale: 1" = o' Set ack.regyuv� or is emmPr-9vtn, vlolatfbn, enf oreern-enr-' Date: 5.28.93 q'�C1t'LOn, under Nam. GeneroaL lows Chapter 0A.-SectL' `7. ' File No.299393 PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments, if any exist, either way across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". r o COL ONIAL LAND SURVEYING COMPANY INC 269 Hanover Street Hanover, Mass. 02339 • Phone: 617-826-7186 • Fax: 617-826-4823 SPILLER'S • j r aX� PT LaoC" 1`� �r D q'O j i'fj� P.. J, .fir. .5 .. � ,: ` ,..,� ,�, ._ _ _ �.� i r. , Is to c +' { �ti .t ,_ 9 �8 w nit s , / 2 y yew l �' r `�Lr1 a Fs �� v) �l f/ sy I. 1. ' ` o /s z$ , '.. ' \ .. . . � �'.­'. - - .. ..-.. 1.1�'. ,I . , - ..� )0 ,1. �a " 1'. O.Op o t,�D . O i o N 1 rw fh , 2O' 2-T _` ; S.F.` rW - :fr r `t'I i p QO :H\io oA iI..:\ > !� ya ``- A 'X ' 5 ,y .. .. � ,.: o. o 11,E 4/ -,Tr z73 // 1' - ;.Ya vs� .y s't _ a. {.ice /� � ��.1 Y. �. �- i \ .. 1 1� . N ! '4 r' �oI r F �4 $O; -p 4Q �+ v S x x 2 3 0 o _p /S 2 3 7 S.F .% I. I. .q: a� m, _ 4 h .e \� �( \D _ . .: tt ,__�fr 6 ` '. r/ 0 .— '.ma's i ..`(� F - ..f./ y �I`� ''� �;a. o N jdb QS r �� z t:, :-s F-; c,, - :: �-1 9. =� �, k. puti .Si 1. ;�09. r3� w �,I X..:.o �1. a h1. ,�v b oo ;, . . , y M. S '�! ti - y 64 111 ; { t // 8 V. `n f cl .' 6 2 q f;� oo gG2s° FR +�, . } a . _ e $ Tom,�a.ac , - „ c p ]i !n11 s 4 "e"F.W ..�A4. ! - _ �'. - . a .. ., $. �' .. .. s L� :I - .... : ?.-. - _�a �. " . . - r r �. _ ._ - v as`�`l+i u 1 C , O44 a �r a� r, �° ` ray' `/ `` 3 qZ-:c-iyvi rw', _ '. - _ s��j x _ .o..ww� - ,� ._lam . -a .- ': .. - .. . - -----— The Town of Barnstable MASS. Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair, modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: YA e Co„s Est. Cost Address of Work: 02 y y./��.�Gc��,',, �� ��., �e�v tl Owner Name: Nor /47. S fv��, 4 - v Date of Permit Application:_ o�� I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR Odd PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME .IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor name Registration No. OR .22 /�y y 2 Date Owne name y�F7HET��� TOWN OF BAR.NSTABLE Q S r i E9HH9TAUX i ° aYa�•�� a BUILDING , INSPECTOR APPLICATION FOR PERMIT ,TO .......'..... TYPE OF CONSTRUCTION .........., �.7 l�........ ...:..:�=✓. :..:. ... .... ... .... ....................19,% .TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location ..... Q......... ... ................. �.. .... ^.......................................................................... ProposedUsewm' - f'............................................................................................................................... l ZoningDistrict ...................................... ..................................Fire District ...... :..................................................................... Name of Owner ..... ... ��..............Address ..... .. . .................................. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .............may...................... .Foundation ......... Exterior ............... `ec.........................................Roofing / ....f 1.5 :..................... � Floors .......... . ...........................................................Interior .. r ... .. Heating ........ ........................................Plumbing ............ .... . . ........��............................ Fireplace ...... ...... ..... Approximate Cost . . .. -..................... Definitive Plan Approved by Planning Board ---------------_--_----------- Diagram of Lot and Building with Dimensions 4-re— SUBJECT TO APPROVAL OF BOARD OF LTH 1 L r•' yM LQ U7 � ....J LIJ '�Li `� h i 0 Z � c � -ram {� R �C 7 f. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re ' g the above construction. Name .. ... ... ......................................... Small, Alan E. No. ..1..5W... Permit for ...Dwelling............... ?e fami],y..1%..story................................... Locatio� ckskin Path................................. Y Centerville ............................................................................... Owner ..Alan.E. Small .......... ..................................................... Type of Construction .....:F.z Frame.......................... ................................................................................ Plot ............................ Lot ........ 8................... PermitGr anted .Noaeb®s ••2 Y..a 12 19 Date of Inspection ........ ......... .................19 Date Completed ............19 PERMIT REFUSED I ......................... ..................................... 19 ............................................................................... L ................................................................................ , ............................................................................... t Approved ................................................ 19 ...............................................................................