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HomeMy WebLinkAbout0067 FERNBROOK LANE -�11 V OR vt py;�,gx- gii' p pw IN N, Vj- ?I Fr A-4 �vvi �IY'11 v its Mil- 1��"1 7 low MN T,*; y0w G'"NUIRM much M 2 IRE 1, V� 'Aix om ON -Men: MR- ��� 11010,111ozom and; ­Q­ gr NAM— ­=­w, It's- vy ffi� �`v IS ........... ROTS gms. M W"sw room --Mom Uq �1`,� U ','�JNT ,f,", , , �'ffi���ly",ij I ,, "I'l,"M, ;k 4 �tq Ew 'i I gy q4" MOM= MOM, RN g� I ,r 41 MAN, K� WAN la A I ones vsho Mxg M .ago I COMME VI-M 4,v­ g g, wA, HMO N L,"&s not AA ii'M �10U�WW4,e q 4,1pA WT. ­N1 WWI xn�,,ij �4gT X j��Wl "I - M". Xm I i:�Y Wil Cl- p MAMMA :q ME Rut MIR: NO, Al-"M Saw �R,04 MOM, yyy CIA ,"MUT _M-1 T,�ulw- 'N �21 .°� Town of BarnstableBuilding Post Tfi�s Card So That.it-psi<VisibleF,�om.the Street A" ''roved Plans Must be°Retained on Job and.tk�s Cad.Musi,be KeBAMINStA t �` v� s �$ Posted UntilFina1 Irispectton Has Been Made �.° WhereaCertificate`of Occupancy�s Required,such Building shall Notbe Occupied until a Final Inspection has been made Permit Permit No. B-19-3603 Applicant Name: W. Ray Colwell Approvals Date Issued: 10/29/2019 Current Use: Structure Permit Type: Building- Insulation-Residential Expiration Date: 04/29/2020 Foundation: Location: 67 FERNBROOK LANE,CENTERVILLE Map/Lot: 208-085-018 Zoning District: RC-2 Sheathing: Owner on Record: MOMBOURQUETTE,ARTHUR&JULIE Contractor.Name 5C Energy Framing: 1 Address: 67 FERNBROOK LANE Contractor License: 194390 2 CENTERVILLE, MA 02632 'Est. Project Cost: $3,408.00 Chimney: Description: Insulation;See Contract Permit Fee: $85.00 Insulation: Project Review Req: i Fee Paid: $85.00 "Date.. 10/29/2019 Final: Plumbing/Gas - ' r Rough Plumbing: . �Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six=months after.:issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for publicpspection for the entire duration of the Final Gas: 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 ar&O.rovided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing x y 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: "Person ing 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 �� �C Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 14 �� r IOF 72NQ/LOo . ,1ers r EDWARc- : LIV CJSTEa o� / EZ 6+►/. "p c / 1 01 1 148. 77 e' N A /�� LoTN Z 3 ELbY. 1� ?RjD/6 FbIl I 1 �'• IL 0 aID" , u ,f 1 Ilor AA Oi l 7 S-p,rl f i `o?• --7 pq ,�• Io/ LOCATION . ./.L. .L.B.,—. SCALE . . . . . . . DATE .,. . . . . PLAN REFERENCE If S, ow.,v O /. L�}�✓t� Cvv.eT /.v G • -Ora I CERTIFY THAT THE f SHOWN ON THIS PLAN IS LOCATED ON THE GROUND / •� AS SHOWN HEREON AND THAT IT CONFORMS TO THE SET13ACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . . ... . . . . . . Town of Barnstable *Permit# ' Expires 6 months from issue date Regulatory Services Fee 35, anxNsrps�,E, MASS. Richard V.Scali,Interim Director IT 63 .I Al b!®tl IVIA Building Division SEP 24 2014 Tom Perry,CBO,Building Commission"'o 200 Main Street,Hyannis,MA 02602 WN OF BARNSTgg�E www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint - Map/parcel Number 202/0kr o f Property p rty Address ? Fe!' bno e Labe, 5 Residential Value of Work S 3 , 9.(M Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ( I_�1 1njOffihoalr, (d7 rCW r Labe) m Contractor's Name " 46 Telephone Number Home Improvement Contractor License#(if applicable) o2 6 Email: Construction Supervisor's License#(if applicable) Q7 O—17 �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Co Insurance Company Name �� �p � �a� ` Workman's Comp.Policy# 0 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders:U-Value . 30 (maximum 35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&lire Permits required. *Where required_ Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc_ ***Note: Property er sign Property Owner Letter of Permission. A copy of H Improvement.Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN D\Building Changes\EXP S RESS.doc Revised 061313 HOME Il41PR):idV'FINENT CON TACT PLEASE RF_AD TIM 99 Sold,kkimished and It sighed by: . Branch Name:Boston North Bt South Datel-SA THD Al-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch-Number:31 and 33 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 Toil Free 877-903-3708 Federal ID#75-208460:MELic#C 02439:RI Cant.Lie*16427 Cr Lic it MC_0 MA Home Imp wminent D: or Reg.#126893 Installatinu.Address; n h rv01.,.� kw w��.if-ryL ll f� C7 aZ J jl� City State Zip Purciase''(s)' I Work Phaner Hatare Phone: Can Phone: L 0 Home Address: (If different from installation Address) City State Zip E-mail Add—(to receive project communications and Home Depot updates): [J I DO NOT wish to receive any marketing emails from The Home Depot Proieet Information: Undersigned("Custenter'',the owners of the ptvperty located d at the above installation addrem,agrees to buy, and THD At-Home Services,Inc.("The Hume Depot")a„grem to furnish,deliver and arrange for theInstallation("Installation").of all roaterials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hcnto and any Change Orders(collectively, "Contract"): ' Jon# (mceo+Kaaexe) trds Spec Shee s# 11rolect Amount • l a 1 Railing Sid'ang rrrdows Insulation $ j ❑Gutters I Covers ❑Entry Dtxrrs ❑ to t-, 'a Cl Rooting LISIding Ll wndowz 0 Insulation - ❑Gutters/Covers ❑Entry Dour% ❑ lttx no U.qiffin2 U Rr:prlOws 0a3t5113tS^n ' ❑611tlers I Coro=❑Entry noors Q � Roofing . Sidino Windows Jsulation _.. ❑Gutters/Covers ❑Entry Doom. C-1 $ Mttdmum254bDeposhofCoffitudAmcoma upummocttianuftl&caabmm Total Contract Amount $ ItiIffine Pm+diasers array eat t mote iban erne-third of the CorM.utAraoum, Customer agrees that, immediately upon a timpletion of the work for each Product,Customer will execute a,Completion Certificatz (o::r f-:x each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Custoitiei Under thin Contras agrees tote jointly and scvemlly obligated and liable hereunder_ The Home Depot reserves the right to issue a ChaW:Order or terminate this Contract or any individual ProduLt(s)included herein,'af its discretion,Wilie Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the horne,environmental hazards such as mold,asbestos or lead paint.ether safety concerns,pricing errors or because work required to complete the job was not included in theeA Contract. N t Sum : The Payment Summary# T d �, included m part of this Contract. sets forth the total Contract amount and payments'required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a:completely.Ylled-ln copy of the Cataract at the time y4m sign. Do not sign a Completion CertMeate(note: there is one Completion Certificate for each listed Product as defined by individoW Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,C:arstutner agrees to pay The Hoene Depot the cosh:of materials,labor,expenves and services provided by The Hesse Depot or Authorized Service provider through the date of termination,plus any other am ants set forth in this Agreement or allowed under applicable law. THE HOME DE POT MAY WITH1EIOLD AMOUNTS. OWED TO THE IMF. DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: .Customer agrees and understands:that this Agreement is the.entire agreement m.between Customer and The home Depot with regard to the Products and Installation se rvicea and supeasedea all prior discusntms and agreements,either oral or written,relating,to said Products and Installation.This Agreement cannon be assigned or.amended except by a writing sided by Customer and The Horne Depot.Customer acknowledges and agrees that Customer has read,underc^talds,voluntarily accepts the terms of and has received a copy of this Agreement. e ted by: -i Subtnd by: �OD _is c s Signature Date Sales Con It_ sipatury k TCliphtute No. gF9 i7 l Qj Z9 V Costa s Sigrtatura Date• Sales Consultant License No. CANCELLATiONt CUSTOMER MAY CANCEL 'PHIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY A1TER SIGNING THiS AGREEMENT. THE; STATE SUPPLEMENT ATTACHED 1E0WTO WNTAINS .:A FORM TO '1S ,IF ONE IS SPECMCAi.LY PRESCRMIM BY, LAW IN CUSTOMER'S STATE. NOTICE:ADDr170NAL TERMS AND CANDMONS AKF,STATED ON THE ttE VERSE SIDE AND ARE pAR7 op TMS CONT1tA(.T - tt-1 33 White-WanchFile Yellow Customer Tel WdLb:OT TTOZ SZ '-+pW TLZZZ9£80S: 'ON X1dJ pie6wer: w0dd n: L o . r� l The Commonwealth o Massachusetts �.�. f r ;: Department of Industrial Accidents .�� rvl. „ ��,1 r Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Legibly Name (Business/Organization/Individual): r ir—/wV,6/moo Address:_ /S W/LSO iU City/State/Zip: F kL0 U M'd Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling, shipand have no employees These sub-contractors have S, Demolition ., ❑ working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. � required.] 5: ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs.or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also till 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: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the a' s and pen!Lies o er ur that the in ormation provided abo a is true and correct _ _ . Signature: ZLA Date. . _l- Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: s i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 Home Improvernent'.Contractor Registration _ - Registration: 126893 = Type: Supplement Card Expiration: 8/3/2016 THD AT HOME SERVICES, INC. . ANDREW SWEET ------- ------------..__._�____ 2690 CUMBERLAND PARKWAY SUITE 300 - ---------- - ---- ---- ATLANTA, GA 30339 Update Address and return card.-N ark reason for change. SCA 1 c:• 20P:1•05r11 1 J Address j _I Renewal — Employment I` Lost Card - =Office of Consumer Affi irs&!Business Ileguhtion License or registration valid For individul use only:1. i_ y 1..`H"OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation = Registration: 126893 Type: 10 Park PI:¢x-Suite 5170 Expiration: 8i3i20'16 Supplement Card Boston,AAA 02116 Tun P:T LlnndC Cf-EDM!`CO T1-.E F10iVIE DEPOT AT HOME SERVICES X ANDREW SWEET 2690 CUMBERLAND PARKWAYS ,per The Commonwealth of iVassachusetts �•\ Department of Industrial Accidents office of Investigations . 600 Washington Street Boston,MIA 0-11 I 1 www.mass.gov/dia insurance davit: Builders/Colatractors/-Electric>i P l"Plumb bl workers Compensation In Pleas licant Information Vi��c�e5 11 a(B, ;ne*organizatioin►dividual)' ^ 1,39 303 Phone#: `7 7 j_ City/ tate/Zlp: 7New ject(required): Vj. l�an�aempl on employer?Check the approprlat,i,,,z: construction 4. i� am a general co>;tractor and I oyer with qD have hired the suo-conWcIc.lo'ieling .(full and/or part time).* listed on the attached sheet 0 1 am a sole proprietor or partner- These sub-contractors have olitionship andhave no employees employees have workers' ding additionworking forme in any capacity. cep,insurance.l tritl repairs or additions[Noworkers'comp.insurance5. We are a corporation and itsr �:airs Ot additionsieguirea.j Omcers AisvG L_W:5 dtl'ei� , mbing eP 3 Q I am a hone doing all work right of exemption per MGL 12.0 Roof repairs • l myself.[No workers'comp. c. 152,§1(4),and we have no 1 C 0 �/ insurance required.]fi employees.[No workers' COMP.insurance required.] win their werioas'con4,=tion policy info �• e�y arpticant that checks box#1 taus'also fill out the sectton bvela w and then hire outside conftwWrs must submit a new affidavit indicating h such t Homeowners who subttnt this affidavit indicating iiscj a r,c a— of t1 workhe subcontractors and a�tn;-=6W=r"`'t entities have tCot►itactors that check this box must attaclkd an additional sheet showing the name policy number. have wvloyees,they must provide their workers'col 1m cY ,,V loyees. 1f the sub•contractms and job site ensation insurance for my employees Below is the policy I am an employer that is providing workers'comp information. Sh im1 ` � �© IVP.trt1 insurance Company Name #a�.m 1�. t1�Il G Y 1 l — r piratioii Date Policy#or Self-ins.Lic.#: fd nt �li�f l D Cei,9'ZQ City1St&jzip: Job Sits Address: the li number and expiration date). Attach a copy of the workers'compensation policy dectaraHon page(showing Po penalties of a Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal Vere 1 under Section ss.vglt aQ civil penalties in the form of a STOP WORK ORDER and a'fine fore up to$1,500.00 and%or one-, �— of up to$250.00 a day against lator. Be advised that a copy of this statement maybe forwarded to tiie i�il7c�vi Irnresti ations of the DIA for ce covers a vca--lion a is i r and correct: 1 do hereby certify under b allies of perjury that the in ProvidedCj Date• ` ? # � -- Si tore' 00 Phone#: iai use only. Do not write in is area,to be completed y city or town ofjiciaL City or Town: PermitIlAcense# Is3:i:n®As„t rarity(circle one): .r s C Din hind Inspector Y.Board of Health Z.Building Department 3.0ty/Town Clerk 4.Eiecd,ca�,rMpe:,o, �.-_um 6.®'her Phone.#: Contact Person: ATE iMMiDD.ffr-1­ - l CERTIFICATE F LIABILI ! Y I U �lC l 02!1Gi2f.71 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 BE74VEEN 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 1S 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER AJCNr o Ext: (fc,Not: 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE I NAIC# 100492-HomeD-GAW-14-15 INSURER A:Steadfast Insurance Company 26387 INSURED Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. INSURER B: _ 'DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 3OM9 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-(M242685-01 REVISION NUMBER:3 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. I T R ADDLTYPE OF INSURANCE S R POLICY NUMBER MMIDDY� MWDIDY EXP /YYYY LIMITS LTRIm A GENERAL LIABILITY GL04887714-04 03/01/2014 03/01/2015 EACH OCCURRENCE $ 9,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY_ PREMISES Ea occurrence $ 1'000'000 CLAIMS-MADE OCCUR LIMITS OF POLICY XS MED EXP(Anyone person) $ EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9.000,000 GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMITAPPLIES PER:. PRODUCTS-COMP/OP AGG $ 9,000,000 X POLICY JECT LOC $ B AUTOMOBILE LIABILITY BAP 2938863-11 03/01/2014 03/01/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO BODILY INJURY(Per person) $ ALL or SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC049101882(AOS) 03101/2014 03/0V2015 X I WC sTA7u- oTH. AND ENIPLOYERS'LIABILITY TORY IMITS ER C YIN WC049101884(AK,AZ,VA) 03101/2014 03/0112015 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ _ D OFFICER/MEMBER EXCLUDED? N J A WC049101883 FL 03/012014 03/0112015 1,000,000 (Mandatory In NH) ( ) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C WORKERS COMPENSATION WCG49101885(KY,NC,NH,VT) 03/01/2014 03/01/2015 (EL)LIMIT 1,000,000 -- C WC049101886(NJ) 03/01/2014 03101/2015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THRAT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE,EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED,IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS: ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �!Lu�aom►:: 1 s� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD .Marcel Lookup Page 1 of 1 { u Logged In As: Wednesday, Pa rce I Lookup September 24 2014 - Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options Search By Street _ -k Street Street Name FERN- .............. — - - Village All Villages I= <PrevNext>Page 1 :9 Rows/Page: �0 1 of 1 Parcel Location Owner Village Index Map 208- 67 MOMBOURQUETTE, 085- FERNBROOK ARTHUR & JULIE CEN 0584 208085018 018 LANE ' http://issgl2/intranet/propdata/lookup.aspx 9/24/2014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 TOWN.:OF BARNSTABLE Map __Zo'� Parcel 1_ Application # Healthy Division , 1° { Date Isstue l Conservation Division ` " Application Fee Planning Dept. Wd*a�4j Date Definitive Plan Approved by Planning Board 71 /13 Historic - OKH _ Preservation / Hyannis Project Street Address Village C&CT:+P—��11 LL.: Owner 30 ui -, Address Telephone Permit Request \WbEtA —TA,00 CPE-N ,.(5t5>' `M �,c�� 1 Wit'•� � Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure - Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes. ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number s2a Address License �Py Y.Namc arH M4 _ Home Improvement Contractor# �56Z770 Worker's Compensation # l WC�24 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. .s ADDRESS rVILLAGE OWNER { DATE OF INSPECTION: w FRAMEY"(-Q 7 2, (3 Yt� INSULATIONS ve FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:, ROUGH FINAL FINAL BUILDING: "R c t tieeoQ ,? ,. CIS Aa DATE CLOSED OUT ASSOCIATION PLAN NO. 7 The Commonwealth.of Massachusetts Department of Industrial Accidents Office of Investigations UV600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information a/ r A Please Print Legibly Name(Business/Organization/Individual): ��TC9 = &u�:A 1 �� ��1. �N ` ���J n4cj Address: `�� ID-Ts ,� �. City/State/Zip: -PrQW LM4 M Phone#: 24c Are you an employer?C eck the appropriate box: I am a general contractor and I Type of project(required): 4. 1.tk I am a employer with i ' ❑ g * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time).. ,,... i , 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance. $ 9. �Building addition , required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their, 11.❑Plumbing repairs or additions myself o workers'comp. right of exemption per MGL . 12.[]Roof repairs insurance required.]t c. 152, §,1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: JZA- Job Site Address: t\ City/State/Zip:Ckm"iu.!�-/ FAA o-?�63z Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 1 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 14formation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as`?an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-NlASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Town of Barnstable Regulatory Services Thomas F.Geiler,Director i639. oA Building Division ', Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.u§ Office: 508-862-4038 " Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, tAA S Q..., o—yyL�a6 LIA U.-. 'Owner of the subject property herebyauthorize +� �� '��-�- � to act,on my behalf, in all matters relative to work authorized by this building permit. . 67 I !2- ITT--p-V)l.Ls (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. ' S' te of Owner Signature of Appli cant cant Print Name Print Name Date Q:FORMS.OWNERPERNUSSIONPOOLS 6/2012 ,acoRl CERTIFICATE OF LIABILITY INSURANCE 0 DATE (M DDf YY) 13 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, CLUETT COMMERCIAL INS AGY PHONE I FAX 8 PEMBROKE ST Arc No Ext: (Arc,No): E-MAIL - Kingston, MA 02364 ADDRESS.'- INSURER(S)AFFORDING COVERAGE NAIC#' INSURER A: - INSURED INSURER B:.AmGUARD Insurance Company r I 4239b Fine Building and Finish Inc — FINE BUILDING&FINISH INSDRER a: 79 D Mid Tech Drive INSURERD: West Yarmouth, MA 02673 INSURER E INSURERF: - COVERAGES CERTIFICATE NUMBER: o 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 ADDLISUBR y POLICY EFF POLICY EXP LTR I I D POLICY NUMBER MMlDD1YYYYI MMlDD/YYYY LIMITS GENERAL LIABILITY r r _ f - I I EACH OCCURRENCE I$ O COMMERCIAL GENERAL LIABILITY I I DAMAGE TO RENTED' I!I PREMISES Ea occurrence O I S; s,. F-P CLAIMS-MADE OCCUR ' I, - MED EXP(Any one person) j S - 0 PERSONAL It ADV INJURY S 0 i ( I GENERAL AGGREGATE IS 0 PGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG S O ' j POLICY I JE O- ! 1 LOC i''t r „ ..� 'I - i • - -- I S AUTOMOBILE LIABILITY .I _ Ea MINED SINGLE LIMIT S ANY AUTO 1 -- BODILY INJURY(Per person) $ ALL OWNED i SCHEDULED - 1 1 BODILYINJURY Per accident S AUTOS AUTOS f { I " ( ) - NON-OWNED I j I - PROPERTY DAMAGE S ` HIRED AUTOS AUTOS r Per accident j--1 I �s ' H UMBRELLA LlA6 j I u OCCUR .EACH OCCURRENCE '.S ' EXCESS IJAB CLAIMS-_MADE i I.AGGREGATE DED I RETENTIONS - r 1 ^- ' S ~ WORKERS COMPENSATION I WC STATU- I OTH- I AND EMPLOYERS'LIABILITY ... - -I •ti X TORY LI ER ANY PROPRIETORIPARTNERVEXECUTIVE j E.L.EACH ACCIDENT. S 100,000 t B OFFICERIMEMBEREXCLUDED? a N141 FIWC424591 01/24/2013 01/24/2014, - - ---- (MandatoryinNH) - I _ - , _ �E.LDISEASE-EA EMPLOYE S.100,000 If yes,describe under �' I - ---- - DESCRIPTION OF OPERATIONS below i' `?• {E.L.DISEASE POLICY OMIT $ 500,000 DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) �. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t THE EXPIRATION DATE THEREOF, NOTICE WILL B_E DELIVERED IN, Fine Building and Finish,Inc. y ACCORDANCE WITH THE POLICY PROVISIONS. 79 Mid Tech Drive West Yarmouth, MA 02673 , AUTHORIZED REPRESENTATIVE 1 "p ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I (9/e�payni�naraaueaLCl aa9oac�iuJe License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation registration: 156270 Type: 10 Park Plaza-Suite 5170 expiration:`61-1912015 DBA Boston,MA 02116 STEPHEN KLUG FINE.:BUILDING_&..FINISH STEPHEN KLUGE " 79 D MIDTECH DRIVE" '.- - W YARMOUTH,MA 02673 Undersecretary Not valid without signature _.._._..----------------- Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-093441 ' STEPHEN KLUG . - r. 79 MID TECH DR W YARMOUTH CIA 'W. '+ Expiration Commissioner 05/07/2015 N ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor Beam\F1302 Dry 11 span No cantilevers 1 0/12 slope Friday, May 31, 2013 BC CALC®Design Report- US Build 2377 File Name: BC CALC Project Job Name: Mombourquette Residence Description: girt above hall/kitchen Address: 67 Fernbrook Rd Specifier: City, State, Zip: Centerville, Ma Designer: BC Customer: Stephen Klug Company: Shepleys Code reports: ESR-1040 Misc: I 1 1 2 3 m — - - r w �� BO 10-07-00 B1 Total Horizontal Product Length= 10-07-00 Reaction Summary(Down/Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,699/0 1,268/0 B1, 3-1/2" 2,699/0 1,268/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. .Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area (lb/ft^2) L 00-00-00 10-07-00 40 10 08-06-00 2 wall Unf. Lin. (lb/ft) L 00-00-00 10-07-00 0 60 n/a 3 attic Unf. Area (lb/ft^2) L 00-00-00 10-07-00 20 10 08-06-00 Controls Summary Value %Allowable Duration Case Location Disclosure Pos. Moment 9,606 ft-Ibs 68.8% 100% 1 05-03-08 Completeness and accuracy of input must End Shear 3,155 Ibs 49.9% 100% 1 01-01-00 be verified by anyone who.would rely on Total Load Defl. L/343 (0.354") 70% n/a 1 05-03-08 output.as evidence of suitability for 241"0 Live Load Defl. L/504 . . n/a 05-03-08 particular application.Output here based ( ) 714% / 2 on building code-accepted design Max Defl. 0.354" 35.4% n/a 1 05-03-08 properties and analysis methods. Span/Depth 12.8 n/a n/a 0 00-00-00 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide or ask questions,please call BO Post 3-1/2"x 3-1/2" 3,967 Ibs_ n/a 43.2% Unspecified (800)232-0788 before installation. B1 Post 3-1/2"x 3-1/2" 3,967 Ibs n/a 43.2% Unspecified BC CALC®,BC FRAMER®,AJSTM, Notes ALLJOISTO,BC RIM BOARD TM BCI®, BOISE GLULAMTM SIMPLE FRAMING Design meets Code minimum (L/240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum (L/360) Live load deflection criteria. PLUS®,VERSA-RIM®, Design meets arbitrary(1") Maximum total load deflection criteria. VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Cascade Wood Calculations assume Member is Fully Braced. Products L.L.C. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Fastener Manufacturer: Simpson Strong-Tie, Inc. Page 1 of 2 i .. 1. ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor BeamT1302 Dry 1 span ( No cantilevers 1 0/12 slope Friday, May 31, 2013 BC CALC®Design Report- US Build 2377 File Name: BC CALC Project Job Name: Mombourquette Residence Description: girt above hall/kitchen Address: 67 Fernbrook Rd Specifier: City, State, Zip: Centerville, Ma Designer: BC Customer: Stephen Klug Company: Shepleys Code reports: ESR-1040 Misc: Connection Diagram Disclosure z�I b d Completeness and accuracy of input must 1— be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based c on building code-accepted design properties and analysis methods. • �—• • Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable e building codes.To obtain Installation Guide or ask questions,please call a minimum = 1-1/2"c=6-1/2" (800)232-0788 before installation. b minimum =4" d = 12" e minimum — 1" BC CALC®,BC FRAMERO,AJS- ALLJOIST@,BC RIM BOARDTM,BCI@, Install Screws with screw heads in the loaded ply. BOISE GLULAMTMTM SIMPLE FRAMING Member has no side loads. SYSTEM@,VERSA-LAMO,VERSA-RIM Connectors are: SDS 1/4 x 3-1/2 PLUS®,VERSA-RIM®,VERSA-STRANDO,VERSA-STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 f ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 1 span No cantilevers 1 0/12 slope Friday, May 31, 2013 BC CALCO Design Report- US Build 2377 File Name: BC CALC Project Job Name: Mombourquette Residence Description: Girt above hall/dining Address: 67 Fernbrook Rd Specifier: City, State, Zip: Centerville, Ma Designer: BC Customer: Stephen Klug Company: Shepleys Code reports: ESR-1040 Misc: 2 i. 3 g 10-07-00 BO 131 Total Horizontal Product Length= 10-07-00 Reaction Summary(Down /Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,328/0 1,083/0 B1, 3-1/2" 2,328/0 1,083/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area (lb/ft^2) L 00-00-00 10-07-00 40 10 08-06-00 2 wall Unf. Lin. (lb/ft) L 00-00-00 10-07-00 0 60 n/a 3 Unf.Area (lb/ft^2) L 00-00-00 10-07-00 20 10 05-00-00 Controls Summary Value %Allowable Duration Case Location Disclosure Pos. Moment 8,261 ft-Ibs 59.2% 100% 1 05-03-08 Completeness and accuracy of input must End Shear 2,713 Ibs 42.9% 100% 1 01-01-00 be verified by anyone who would rely on Total Load Defl. U399 (0.305") 60.2% n/a 1 05-03-08 output as evidence of suitability for Live Load Defl. U584(0.208") 61.6% n/a 2 05-03-08 particular application.Output here based on building code-accepted design Max Defl. 0.305" 30.5% n/a 1 05-03-08 properties and analysis methods. Span/Depth 12.8 n/a n/a 0 00-00-00 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide or ask questions,please call BO Post 3-1/2"x 3-1/2" 3,411 Ibs n/a 37.1% Unspecified (800)232-0788 before installation. B1 Post 3-1/2"x 3-1/2" 3,411 Ibs n/a 37.1% Unspecified BC CALCS,BC FRAMER®,AJSTM, Notes ALLJOIST®,BC RIM BOARDTM BCIS, BOISE GLULAMT"" SIMPLE FRAMING Design meets Code minimum (U240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum (U360) Live load deflection criteria. PLUS@,VERSA-RIMS, Design meets arbitrary(1") Maximum total load deflection criteria. VERSA-STRANDS,VERSA-STUD®are trademarks of Boise Cascade Wood Calculations assume Member is Fully Braced. Products L.L.C. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Fastener Manufacturer: Simpson Strong-Tie, Inc. Page 1 of 2 ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301 Dry 11 span I No cantilevers 1 0/12 slope Friday, May 31, 2013 BC CALC®Design Report- US Build 2377 File Name: BC CALC Project Job Name: Mombourquette Residence Description: Girt above hall/dining Address: 67 Fernbrook Rd Specifier: City, State, Zip: Centerville, Ma Designer: BC Customer: Stephen Klug Company: Shepleys Code reports: ESR-1040 Misc: Connection Diagram Disclosure b d Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based on building code-accepted design properties and analysis methods. ' • • Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable e building codes.To obtain Installation Guide or ask questions,please call a minimum= 1-1/2"c=6-1/2" (800)232-0788 before installation. b minimum =4" d = 12" e minimum = 1" BC CALC®,BC FRAMER®,AJSTM ALLJOISTO,BC RIM BOARD-,BCI®, Install Screws with screw heads in the loaded ply. BOISE GLULAMTM SIMPLE FRAMING Member has no side loads. SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, Connectors are: SDS 1/4 x3-1/2 VERSA-STRANDS,VERSA-STUD®are trademarks of Boise Cascade Wood Products L.L.C. I I Page 2 of 2 3�/ � 2 �ineering Dept. (3rd floor) Map c2! Parcel 'aS�7 0 /Or # v - r House# . `��3 �' Date Issued 10 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30x • Fee SEPTIC TSYSTEM a A Conservation Office(4th floor)(8:30-9:30/1:00-2:00) LiA8 /L INSTALLED IN COMPLIANCE Planning Dept.(1st floor/School Admin. Bldg.) . ? WIT E 5 ` . ENVIRON ODE AND Definitive Plan Approved by Planning Board 19. TOW a IONS MASS TOWN OYBARNSTABLE; (� Building Permit Application Project Street Address 1 L am-c Village lyl/t�t Owner Address 69 i G1TL'�—o-k L, -Telephone �< 7 Permit Request y 4 4 -First Floor square feet Second Floor square feet Construction Type 14ay , pl Estimated Project Cost $ 5/Qotl o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family U-111, Two Family ❑ Multi-Family(#units) Age of Existing Structure Irl 4&AA Historic House ❑Yes &H6 On Old King's Highway ❑Yes ❑Ko- Basement Type: ❑Full ❑Crawl r alkout ❑Other 01 Basement Finished Area(sq.ft.) 3 Basement Unfinished Area(sq.ft) Zoo 2g Number of Baths: Full: Existing New C> Half: Existing New 0 No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: 2 Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces:Existing _ New _ 0 Existing wood/coal stove Yes ❑No Garage: ❑De ached(size) Other Detached Structures: ❑Pool(size) Attached(size) ' ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Aut orization ❑ Appeal# Recorded❑ Commercial ❑Yes No If es, site plan review# Y Current Use—�( /�'Q Proposed Use S-10-,eA4 Builder Information tName PA"k a Tele hone Number — ! J� P 2 c-� Address ���,L � v� License# d��J�,7 LZ �/ / ,L Home Improvement Contractor# �D3� D Worker's Compensation# IT 7- M 04 94$ 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 SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FO LOWING REASON(S) TGq J FOR OFFICIAL USE ONLY �- PER~IT NO. DATE ISSUED ,. A _ MA$/PARCEL'.NO. r r , t. • f r .VILLAGE - — - DRESS " r _ ` ' AD :t OWNER ` DATE OF INSPECTION: FOUNDATION FRAME f INSULATION . FIREPLACE , ELECTRICAL: ROUGH ' � FINAL PLUMBING: 'ROUGH FINAL - are 1 *� � ! - GAS:_ r 4 W11GH FINAL FINAL`BUILD24`4 DATE CLOSED OUT. ASSOCIATION PLAN NO. f t ?Y1 OF EDWAR / L /G P2/V. i t, i 261m C'►STEP oa I � . I / o r , p 148. 77 V ON A � ref .v �• Q LoTN Z 3 ti pos EZ4-v 1yq�n j L► 6 ►�' I �' 1. ZIP.00 0 ` `: O 1 6� 9/,/� �,�,• ,�� to k Doi 6\ rA - IX �� Oil 3s�2 7 s�FTf . �• i �o?• N tig1 �• � •� -" /V67-e= LsG,FV,977o1vs 13�9.sffD o A/ f 6 LJocATION CE ! :r21/iLLE. !�-l•Jss. 33 /!h�\i \� SCALE . / �=- o' . . DATE PLAN REFERENCE .447. Ylq. . �oT Z3 WV OA/ -on I CERTIFY THAT THE . SHOWN ON THIS PLAN IS LOCATED ON THE GROUND • AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . ..:. . . . . . . r OF THE?I L The Town of Barnstable sAaivsM= 16?Qs. `0$ Department of Health Safety and Environmental Services ATEo ' Building Division 367 Main Street,.Hyannis MA 02601 A Office: 508-790-6227 Ralph Crossen Fax: 5087790-6230 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: %W.111r Est.Cost OD d i Address of Work: 0 C L-c Owner's Name Date of Permit Application: /,o_Z t r "I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN 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 N e Registration No. OR Date Owner's Name �rt , ••..�[ � .s. . , . I I!C �.kin••••......�...... vJ •�t+arJli/i.nw....•... DepartlrrCJrl of IndtavialAcridents Oflfceollmrestl9ayoas , + x, F Bu,tr n..11usm .02111 `• Workers'.Compensation Insurance Afridavit Please PRi !—..._-......�—_�, AiEIic:rnt mforntatirin= NTlen FIV name Iecatiem cit% nhttnc e [I I am a homeowner performing all wort:mvself. " I am a`sole propricior and have no one%vorkin_in anv capacity 01 I am an employer providing workers* compensation r my employees working on this job. cone t m n, e• G� adrlrccc• ��f� AH' /n > t nhnne rh 70'-�' incnrnncc e. ' lin•1i / � � w �d`0 � V __ _ . .. _...•,..« .................. ��. .�.. I am a sole proprietor. -eneral contractor. or homeowner(drdde one)and have hired the contractors listed beiow who: the"following workers* compensation polices: cninn�m• Hamer adiirocc• - II phone 0? iwmrnnrA rn, IV •f..••» .�..•....«. Truer•... ...L'. _�..r...+����r�",�-�...�.r..w,y-.t.. ...... ••rt7R•s.�.. ...,,�........•...�.�._ cmm�in� n:irnr- ltltlrt•cc- : -in•• - nhnne N� ncurtnee cn - Helier� ' lttachAdditionalshectifaeeesiarv• ..:..:—'q.t'•+...♦ ..li't:...•• —• •r•......•...�. •r«•cr•f...�.rr..v.�.�.�Ht ... �.. .w•••��� allure in;;core ct»•crace sit required under section 3A of A1GL 152 can a ea to the imposition otenmtnai penalties of a fine up to 2.500.00 adi. ne%cars•imprisonment as well us cirii penalties in the form ofa STOP WORK ORDER and a fine u(S100.00 a day against me. I understand that OP) 'if thix-statement mar be forwarded to the 011ice of la�•estigatin of the DJA for cosenge rerirtcatkon. do hercht•crrrifi•under t r prri»s and pr raider ojperjurr that the information prot7ded above is true asd correu ^^acur.c Daze 10 — - 1 'riot name �� ��r}�L' Fttonet; Ta2/� 6 ofliciai use univ do nor write in this area to be completed by city or town oflkiai cin•or tntre: liertnit/license tY nlluilding Department ' pl.icensing hoard check:if immediate response is required QSeleetmen's Me ► (ZlIcaith Department contact pcivin: phoneft MUther��� c. �ie �arnnaaruaeul a�✓f�ala�iclicty//1 �R yk xx "a �' /�. DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE. Ocl — • Number Expires; & ?_ "tinily Hoist a Restricted T67 00 e to possess a Wtent edition of the `€ .Mate Bnildiag de �Pa `' SCOTT`6 CROSBY �w *, r `�� revocation"a� „w'x P✓! ' PA, t� z _ 62`CROSBY CIR { " jR � k�j t• V OSTERVILLE, HA 02655 �: ` ! .rrr• fit . 7 •:k � ��i��TOMf6l7lOy7�I[ �' � _ Y MO YMMPROVEKENT CONTRACTO ax anon:,=103582. _ . p� flRA AG ,-,1COOSP BUILDERS ts: , rosby U"Boi51/ 1112 MAIN ST ADMINISTAA �ster. 111e MA`02655': , ;> r • ` ryt y k X _ e Iqew R0 .r LIE RICO { it C Aa. £ via IV 't yj -. • 11 The Town of Barnstable Permit# /7 616 x Massachusetts Date 9Z-3/9� I L►uver�s�. % �' KAM � SOLID FUEL STOVE PERMIT e39. �. Fee This constitutes an official stove permit after inspection and approval by the building inspector. Owner 4,elffi6i? Telephone no. � /lfj�ifJG Vill Address of Property /G�P/1/ c�Ji(� ag r Location and Stove Type Date: Building Inspector The solid fuel burning stove at the above location passed: failed: inspection. rJT--1 �' S_r�L�..t 1,,�5. _ =r_1 L L.. 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L.,_ �� LT L._ L '.L, �� - r r -J 8 I r _ I Front Elevation SCALE:114" = i'T d ti 77 e _ Right Elevation / - SCALE:114'* = 1'-0' P•I it. ••.� /. w ,!�`y Spa � .� ��.. i�..:�•py _ _ __ .. d y -- Kitchen Renovation � _��—' �— fry ,� _ iJ ; j }• ate._ +� t' �r _ ARTHUR 8 JULIE=3s 67 Fernbrook Lane ``` MOMBOURpUETTE S S T-i f L1_�1' -'-`J =---1- rT--rT _Z, it-�-�-T-^•----�� �z`�,- i 1--r'rT� - - T 1 �L �rz�-Lr, s � _.� u—_s- _ _...:r. 1�..--. � �_r ..s= = T r-r _.:�'J- .'�1Y _1T-i'.}'' �\.� \"•.. F 02632� \ - 508.240.4286 79 Mid Tech Dri east.net FMI �.I ® West Yarmouth,MA i � 7hF1 SHEET:TITLE ' f, % ELEVATIONS LLT I Rear Elevation y Left Elevation A-l SCALE:114" = 1'0" - SCALE:1/4"= 1'-0" _Rear' 54' 8• C � C > \ m Lef[ i 4NEWFGOnNGS 17 x30'.30' — — — _ 4NM COLUMNS 14.p w —W Bfed Beam Pbove Bigpon Benin e GARAGE -- ----------------- A-0 A f 10— i NEW POSTS(ryp) I• / I Kitchen Renovation ARTHUR&JULIE. Bebaom Gale WallAOove .I. MOMBOUROUETTE UTILITY 67 Fernbrook Road RE Centerville,MA TAINING WALL 02632 • 1 BATH jUp ___ r fiINCS 1980 is 24 to —3'4--!-4•-8 1/2- f Stephen,Klug - 508.240.4286 SK[ugFBF@comcast.net 79 Mid Tech Drive, /Rront West Yarmouth,MA FOUNDATION SCALE:1/4 = 1'-0" SHEET TITLE FOUNDATION A-2 a� 'Rear J7 DECK . SCREEN" PORCH Douva^ — O ❑ O J6t E%I$TING BEAM, KITCHEN I Eg,mmmwh strrxn v4• I Exist np encnen pemn clW9 I f 292 sq 1t Ia„e oodwerc arrem ioee g, etlto elloxrasaage Fani IY Raom Lem BATH (Revised) ow \ Y �::— ilz4ta: MASTER ...... c 1 zoasyn I xEw eEax: W/D 1b 13'4'x sl/L' - ... . Tmeenoaa-zBtc I FAMILY _ 389Sgit -/ Ewslm9 Pm+utler room CNEW NEW teF to ne - —k wmnoceremwea wtwxs cem 2 712 oe amnee wmen . 14x0 r� - Kitchen Renovation t .. .. um ebov.sue. a9 omega )� B OG l B KRCM1en OPeninB .—._ .--.-- . se E4erior ARTHUR S JULIE _ tzt t-v4•xatrr LVL Tmceno�-s®ts•« 1O���a� MOMBOURQUETTE .148sgft .�.; �.. .. WALK IN CLS 1" 67 Fernbrook Road '48 sg ft: Ojos ENTRY - Centerville,MA 6 DINING -- -- 02632 173 sq ft UP 1 1' 14 - fiIP'CE 198a Stephen Klug 508.240.4286 SK]ugFBF@comcast.net 79 Mid Tech Drive, Front West Yarmouth,MA' First Floor SCALE:114" = 1'-0" SHEET TITLE FIRST FLOOR A-3 c 1.�_.,- 1� 1 I -ir �-r .S. 2. @t I I I m I i I 2.6 @t6'oc -'• - NEW BEAM ' ''I _- _ -_-__ __-, Islt2a•.Btrz•LVL- \ rime hocks 2®tfi•« 2x10 1x6@ 18"oc- STEEL BE. - -- - ------------- I O NEW COLIIYN6 la:al i (8`` HIV _.. -.-•.__ � - - _- _.—__.___—_._. �� +trr—_. __._ _,.__ _ ---_.___.__— ___— __ .. .sI IN �I 'T I i � � NEW FOOTING—/� 1 L 1z.w.w ,. I 2x6 16"oc I` Section 2 SCALE:1/4" = I'-IT' NEW BEAMS: Kitche n Renovation (2)1-3/4'x 9-1/2"LVL Timbedocks-2 @ 16"oc \ ARTHUR S JULIE Assumed 6-1/4 x 11-1/4 LVL 11 1/4" MOMBOURQUETTE - 00 - 6T Fernbrook Road i Centerville,MA 02652 III T 6" SINCE 1980 I I I _ Stephen Klug 508.240 4 NEW COLUMNS / I omc ast.net (4 x 4) — # 79 Mid Tech Drme Beams West Yarmouth,MA Support Bea I 4 NEW FOOTINGS 12'.x 30"x 30• 41 SHEET TITLE j SECTIONS Section 1 A-4 SCALE:30 = 1'-0" t