HomeMy WebLinkAbout0088 LONGFELLOW DRIVE ��'�� �f/v � s
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BARPMABM
PostThis.Cacd SoThat>itisVisible romthe:Streetw A' rgved Plans Must be.Reta�ned gn Job and this ad�Mustbe,,Kept
sb PostetlUntil%Final lnspect�an Has Been Made r g j _
R ., ��� t. r � Permit
- her ertuficate,of Occu anc. �s Re, u retl,such Burld�ng shall ot;be Occupied until a Final Iri`spect�on has been made
.....
Permit No. B-16-1466 Applicant Name: GARLAND,ADAM T& LISA C Approvals
Date Issued: 07/14/2016 Current Use: Structure
Permit Type: Deck Expiration Date: 01/14/2017 Foundation:
Location: 88 LONGFELLOW DRIVE,CENTERVILLE Map/Lot 188-014 Zoning District: RD-1 Sheathing:
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Owner on'Record: GARLAND,
ADAM T&LISA C K Contractor Na a Framing: 1
Contractor Ucense'
Address: 3 ROBIN HILL ROAD >�r1 2
1�'_ _ A� �
DANVERS, MA 01923 Est Project Cost: $0.00 Chimney:
Description: replacing current deck with 32x12 deck 3/14/17£1sVe'Rtentions to Permit Fee: $ 185.00
expire 7/14/17 �' 1�'k-'F
Insulation:
P _ ee Paid; $ 185.00
Project Review Req: replacing current deck with 32x12 dec�3/14/1,7�1st extentions W Date , 7/14/2016, Final: ,
to expire 7/14/17 �� ... G
rk & J
Plumbing/Gas
ing/Gas
,p /�aTY
Rough Plumbing:
,Building Official Final Plumbing:
g:
This permit shall be deemed abandoned and invalid unless the work authorized y this permit is commenced within siz months after issuance.
p Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction documents for whicthis permit has been granted.
All construction,alterations and changes of use of any building and structuures shall be in compliance with the local zoning by,laws;and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or"road nd shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. k Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and=Fire Off c al are prowid don thii$ermit.
Service:
Minimum of Five Call Inspections Required for All Construction Work.,, ��
,.
1.Foundation or Footing Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low'Voltage Rough:
6.Insulation
7.'Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
r
Mr. Paul Roma
Building Services
Town of Barnstable
200 Main St.
Hyannis, MA.02601
Mr. Roma,
Attached is a building permit, B-16-1466,for a deck replacement at our home at 88 Longfellow
Dr. in Centerville. Unfortunately,we were unable to start the replace last fall and were hoping
extending the Permit for another 6 months. We are hoping to replace the deck this spring. I have also
included a $75 check for the extension. If the fee amount is incorrect, please let me know. Thank you in
advance.
Adam T. Garland
3 Robin Hill Rd.
Danvers, MA. 01923
425.269.5197
• x-mow
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel `� Application #
Health Division Date Issued 1,
Conservation Division Application Fee
Planning Dept. Permit Fee i t o•a
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
�r►�a-iL S EST
Project�Street Address
`Village. nn C�2t��-2r\4\
Owner 1 t� A(2, Address
,Telephone " ��2� �_ CV1 \
Permit Request �Or C\4e
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 wooal stove:.❑Yes❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑exii�ting a New Ssize_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1 -"
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 `lZ S Z 6 1-7
(Address PcA License #
(�� S r\A b��1�-3 Home Improvement Contractor#
Emailn 0, Gy—�G Worker's Compensation #
,ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s
qy>,['YN� �� �� c�.c� �Z�-w �\►n. C.sz� -ems
SIGNATURE - __-_.-,._ _. DATE
c'
FOR OFFICIAL USE ONLY
APPLICATION #
DATE ISSUED
1
MAP/ PARCEL NO.
ADDRESS VILLAGE
a
OWNER
DATE OF INSPECTION:
FOUNDATION
1 FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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1 _ ,
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Deck Plan Update for 88 Longfellow Drive Centerville MA.
Adam T. Garland
425.269.5197
Number of Levels: 2 Footer Depth: 48"
Total Square Feet: 503
Summary
Component Size Wood Type
Joists . Doubled 2x10 Top Choice Treated
Beams Doubled 2x10 Top Choice Treated
Posts 4x4 Top Choice Treated
Decking 7/8 x 6 Trex Composite
Railing Composite
Material List
Lumber Materials
Item Number Quantity Description Usage
468945 4 Top Choice#2 Prime Pressure Treated Lumber(Common: 2 x Rim Joist
10 x 16;Actual: 1.5-in x 9.25-in x 16-ft)
468944 49 Top Choice#2 Prime Pressure Treated Lumber(Common: 2 x Internal Joist
10 x 12;Actual: 1.5-in x 9.25-in x 12-ft)
468943 12 Top Choice#2 Prime Pressure Treated Lumber(Common: 2 x Beam '
10 x 10;Actual: 1.5-in x 9.25-in x 10-ft)
488910 , 8 Severe Weather 5-Step CA Copper Azole Treated Deck Stair Pre Cut Stringer
Stringer
639134 12 Severe Weather#2 Pressure Treated Lumber(Common: 4 x 4 Railing Post
x 8-ft;Actual: 3.5-in x 3.5-in x 8-ft)
468950 7 #2 Pressure Treated Lumber(Common: 4 x 4 x 6;Actual; Post
3.5in x 3.5-in x 72-in)
468942 3 Top Choice#2 Prime Pressure Treated Lumber(Common: 2 x Beam
10 x 8; Actual: 1.5-in x 9.25-in x 96-in)
4643 8 Severe Weather 3-Step Alkaline Copper Quat Treated Deck Pre Cut Stringer
Stair Stringer
1 Wd h
319Vl5 910 NMOi
Beam Layout Level 1
3 �
A
i
i i €
3
i
l
' 3 _
3 t
€ i !
BEAMS Doubled 2x10 Pressure Treated
BEAM LABEL BEAM LENGTH POST COUNT POST SPACING
A 19' 10 1/4" 4 6 8"
C 9'7 1/4 3 4 10 y
D 8'4 1/2" 3 41311
E 9'7 1/4" 3 4' 10"
I
Beam Layout Level 2
BEAM LABEL BEAM LENGTH POST COUNT POST SPACING
A 11' 10 1/4" 3 5' 5 1/2"
B 11' 10 1/4" 3 5' 5 1/2"
r
Joist Layout: Level 1
:HOf
A I I LF
I: I I I I 11,l
M
LABEL NAME QTY LENGTH BEVELS LABEL NAME QTY LENGTH BEVELS
5
A Header ill 19' 7 1/4" 0;0 H Internal Joist 10 11'7.1/4" 0, 0
B Rim Joist 2 11' 10 1/4" 0, 0 1 Internal Joist 9 11' 11 1/2" 0, 0
C Header 1 2' 0, 0 J Internal Joist 9 11'9 3/4" 0, 0
D Rim Joist 1 13'4 3/4" 0, 0 K Cladding 4 5' 0, 0
E Header 1 9'4 1/4". 0, 0 L',, Pre Cut Stringer 4, , 5' 0, 0
F Rim Joist 1 13' 5 3/4" 0, 0 M Stringer Support 2 3' 0, 0
G Header 1 8' Y 0, 0 N Pre Cut Stringer 4 5' 0..' 0
Joist Layout: Level 2
B
t
•E
E
LABEL NAME CITY LENGTH BEVELS LABEL NAME QTY LENGTH BEVELS
A Rim Joist 2 11' 10 1/4" 0, 0 D Cladding 2 , 5' 10" 0, 0
B Header 2, 11'7 1/4" 0, 0 E Pre Cut Stringer 4 5' 10" 0, 0
C Internal Joist 11 11' 7 1/4" 0, 0 F Stringer Support 1 3' 0, 0
•
BRACE AT JOIST
3'_6, POST CAP,,
BEAM
APPROVED
POST CAP =�
FLOOR JOIST PER PLAN
0
0 0 .
ao � •
V V
0
5/8"x'8"THRU BOLTS t'l POST`-
BEAM PER PLAN ri .
64 POST
(LOCATION
6x6 KNEEBRACE: PER PLAN,)
5c8°x.8"THRU BOLT NOTCHED POST
R
• � 2 1/2"MIN:; -
BEAM
(2)1/2"DIAMETER
THROUGH BOLTS
WITH WASHERS .
iv DECK. ,
J POST NOTCH
` 5=1/2"MINI POST
SEE SCHEDULE`
8'-0" MAX. GRADE TO TOP OF DECKING
NOT FOR.CONSTRUCTION TO BE ENGINEERED TO LOCAL CODES -
NOT TO SCALE
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carbaeNt of ludrrstrid Accidedr
Office qfbzPem*afio=
600 WM%hhWM Street
Boston,MA.02HI
WwImn' Cumpensatian Tnsmmce davit S•ttildersiC;t nt ractur&M ' Lausd I•=,_..hers
APPECamt 1]If II \ Please Fri Lezihlv
Cif sta ;4Knq,(-,r kyk 0R- m-,c)a
Are you an employer?Cfizclrthe appropriate bay Type o€project(regaireed)_
I_❑ I am a employer v'itlr 4. ❑I am a geneml cAfractrr and I 6. ❑Now cons ota
employees(fall ar►cifor Part dime * bave hired i ie st&La aors
I El am a sale gzopeLetx orpsrtaw lined the aftarhed sheet; ?- ❑ g
ship and have no employees . • These sob-caaftacdnis,.have g_ F]Demoi6on
wo>idng forme in any capacity employees andhave woke ,
[No wdlSr gip.iasmance COMP-insuraM g- ❑Bt<il atiriition
] '5. ❑ Wt a are a coaporafi=and its 16.❑Ekd iad repair of ad&Eons
3.N lama hrmwwaar doing allwmk officers]savecRcisedemir • 1L❑ph=bsagrepa-=orad(Eiioas
[No 7orke& riga 12.of perM(M ❑Roof
immmce d-I i � c.M§IM andwe have no
MpIDyem V90 WorilMs, 13-1p Other /�
comp.insuram=required]
i ny aFyk=fiiat cbe K mast alsa flla�gibe s�oabeTow shvzim%die t=&m'cn®p—sat; .poyCp �
T 1€aamawn=Wbo b¢hat&s si2dn,&is x ZCbntactamba6mit a neW af�damt $sacFL _
ffigt Akk this btsx Est addiEaasl street sbo�rrng tbenamg of the acid stye arbeths arnotthnse ent esba
emptcyees.I€tbe5uh-c=�haveempIgyw-%&ey—, pwvdaihea%mdcme M=p PG&Y �hez
I am an errtplaPsr f7iatis prauidirrg xvrkers'trran irrszrrattca for m�empFay $eloev is�tsPg�F arrd jab srta
$rrformalrnn.
InsCUMce company Name: a
Pficy�Cr Self-iu€Iie. F�piratiaaDade_
Job ems: Cyp:
Attach a copy of the vFarlo?rs'compensationpacf declaration gage(shaving the policy,member and expiration date).
Fa&m to secum coverage as requited under Section 25A of MCM a 152 can lead to the imposi i=of czirdral penalties of a-
fine up to$UOO OU mWor one-yearimpdsmmexd as well as civil peaaffm is the fora of a STOP WORK 01MERand a f ,
of up to$25OAO a day agaimst the violator. Be mh ised gnat a copy of this zbdemesd maybe warded to the Office of
imyestigagons ofthe DIA.for i aster caverege verkcfion_
I do kerAy &gFams and psndgu qfFerfruy fhnttha info r mdua pro FieW abate fs Eras and cmrect
_ I
rPhone
that sm a jZy. Do uat m tr in 693 Via,to be cmriptstcd by do ortborn of t
Cry or To a u• PeraxRUcense;ff
Amfiar4 tCirde one):
L Scam of Health MI Bwlffing Departrat,s.soma Cleri~ 4�E,imtr cal Iispectflr S.Pimmbiaj Enspector
6.other
oombd Person: MOW
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�o�zHEro�,, Town of Barnstable
ti
Regulatory Services
t tcaS[NRT�sif F! s - .
MASS. $, Richard V.Scab,Director
SAT 616 Building Division
Tom Perry,Building Commissioner
201 Mam Street Hyannis,MA 02601
www.town.b arnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner.Must .'
Complete and Sign This /, -
a
If Using ABuilders Owner of the subject property
hereby authorize to.act on my beha4
in all matters relative to work orized by - building permit application for.
(Ad ss of Job)
''Pool fences and alarms are responsibility of the applicant Pools
are not to be filled or utilized efore fence is installed and all final
inspections are perfomsed and ccepted.
Signature of Owner S tore of Applicant
• -
Print Name r Print N
' •yeti F ••
Date
Q:F0RMS:0WNERPERIMSI0NP00LS
Town of Barnstable
Regulatory Services ;
of rgry� Richard V.Scali,Director
Building Division
31,133MMA33 Tom Perry,Building Commissioner
MARS.
pQ�&516 200 Maim Street, Hyannis,MA 02601
wwW town_barnsfabkma_us
Office: 508-862-4038_ Fax: 508-790-6230
HOMEOWNM UC NW EXEMPTION
1
,• b t PIrasePrint
DATE: t b
Cam„ �
JOBS t .�:�� per (
.
number VMW
4
ow> ►a,r, C— l �t w�2-5-2 1-3
name home phone# woxc phone#
,CURRENT ��\� 1 nNAr S V-11 � C�1`i23 T
MAlI1rTG ADDRESS: 0�\� _
city/tDVM sla>z up code
The current exemption for"homeowners"was extended to include owner occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFR-7MON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one.
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such workperformed under the building (Section
109.1.1)
The undersigned`.`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,roles and regulations.
The undersigned"homeo es hat-he/she understands the Town of Barnstable BuuiIdi ag Department minfi um inspection
p cednres ements and that he/she will comply with said procedures and requirements.
iga omcowricr_'. ,
Approval of Building Official
Note: Three-family dwenbigs containing 35,000 cubic feet or larger w01 be required to comply with the State Building Code
Section 127.0 Couistruction Control
HOMEOWIM'S EXEMPTION
The Code states that "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section(Section 109.1-1-Licensing of construction Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor-
(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often
results in serious problems,particularly when the homeowner hires unlicensed persons. Ia this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:IWPFELESTORMSI,bwZdmgpm=itfmm XMRFSS.doe
Revised 061313
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
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May
• � �R_ �y � F � rr��a - w wv • -p'
SCaPE-
j� Wod-%peedfiy'
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 1 Application #
Health Division Date Issued
Conservation Division V Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
P o ect Street Address 1...C1 w
1
Village �n �''V
Owl er P\AOvv\ GA-CA e4k0 Address P,6ar)* Z� OfinJr wi,5123
Tele phone S
�P rmit Request R-2�.(A-r s.-PjA Oe ,C -'V `Z ` od
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Prot -ject�Valua ri» —0)3 Construction Type
Lot Size Grandfathered: ❑ No If yes, attach supporting documentation.
DwellingType: Single Family ❑ Two Family ❑
YP 9 Y Y � amity (# units)
Age of Existing Structure Historic o ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑ a'I�ou ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existi 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 q new._,,a size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:<P
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review # n
f
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name l n 1 � V Telephone Number ZS�,� '�1�7
n l
Address 1U , r A t\ �d License #
cqv'se� Home Improvement Contractor#
Emil Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
IINATURE
DATE �--�,
FOR OFFICIAL USE ONLY
} APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
Y
f
{
t ADDRESS VILLAGE
ti OWNER
,t
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
4
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
}
z
c, DATE CLOSED OUT
r
ASSOCIATION PLAN NO.
Town of Barnstable
Regulatory Services
�F THE Tp�
c Richard V. Scali, Director.
STAB . ; Building Division BARNSTABLE
MASS. Y4510MSBM LLC�OSlEPV111ENbTrtB19N5TNI191F
9cb 16gq. �� Thomas Perry, CBO 3639.2U14
ATED �A Building Commissioner 575
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
September 1, 2015
Adam Garland
3 Robin Hill Rd.
Danvers, Ma. 01923
RE: 88 Longfellow Dr., Centerville, Map: 188 Parcel: 014
Dear Mr. Garland,
This letter is in response to application number 201504565 submitted to construct a deck at
the above referenced address. Unfortunately, as explained on the phone on or about August
3, 2015, the application can not be approved'at this time because of the following:
1) The application as submitted is incomplete. A plot plan showing the location of the deck „
in relation to the lot lines is needed to ensure compliance with required setbacks.
Please do not hesitate to.contact this office with any questions:
s
Respectfully,
OWL. Lauzon
Local Inspector
jeffrey.lauzon@town.barnstable.ma.us
(508) 862-4034
171-e C'ominortirealth ofMassaclrrrsetts
Deparament of Indush ialAcciderds
f?, -ce of w stigations.
: 600 Washington Street
Boston,ILIA 02111
ivio inass_govIdia
Workers' Cumpensat on-Instu fu-ce Affidavit-B:uilderslContractursMectri,cians/Plumbers
Applicant Inftarmatan:� Please Print Legibly.
Addres � �\n
<jityy/Stat,_tZip-DanqfrVA A `� �23 Phones
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(o part-time)-*part-time * have]sired the sub-contractors 6. New construction
2.❑ I am a sole propnetor or partner listed on the attached sheet. 7. ❑Remodeling
ship and ltave no employees. These sub-contractors have $. .Q Demolition
wodcing for rase in any capacity. employees and have wodcers' 9. E]Building addition
[No arorke'rs' comp.insurance comp.insurance l
r ired 5. We are a corporation and its 10_0 Electrical repairs or a dditpons
3. `�%am a homeoumer doing all Work officers have exercised their 11.Q Plumbing repairs or additions
`' nVmff [No vuorba fs_comp- right of exemption per MGL 12.0 Roofrepairs
insurance required,]o c,I52,§I(4X and we have no
employees.[No workers' 13.0 Other
comp.insurance required.]
*Any applicant wtchedrs box Al mast also Mloutthe section below showing tbakwor ieie compensationpolicyinfbnnsdan-
Eameawners who submmt this dfidz%rd indicating they ale doing all woaly and then hire auts ide contractors amst subnut anew affidavit inEcariagg such-
fCantractmrs that ebect This bra must attached an additional sheet shouting the mmne of the snb-caatractxs and state whether or not those entities hav
employees. If the sub-coat mcints have employees,they must provide their nrorkers'comp.policy number.
I am au employ r that is prenzding workers'ronrapettsali n iatstnraace far arty*employ es 8etory is fhepoticy a>zxi f ab sate
information. ,
Insurance Company Nam:
Policy fi or Self--ins.Lic.k' Expiration Date:
Job Site Address: citylStatellap: "
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. 157 can lead to the imposition of criminal penalties of a
fine up to$1,50D_0D andfor,one-yew imprisorttment,as well as cMI penallies.in the form of a STOP WORK ORDER and a fine
of up to$250-00 a day.against the-violator. Be adi ised that a copy of this statement maybe forwairded to the Office of
Investigations of lfit'DIA for insurance coverage yerification-
I do If ere b .c`{ �tiafdrr tlta ins aril tiah�ies o u. ,tltattlne in ortriation ided aboa g is bang and carrect
3' ;f1 p� Pe .fF�'l �3 .1� P�
$itaattire � Date:
Ph-4ne
Ojy7dat use onty. ,Do not arrlte in this area,to be completed by city ortoarn o,�rciat
City or Tann: PermitMicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.C tylPown Clerk 4.Electrical Inspector 5.Plumbing Inspector
(a.Other
Contact Person: Phone#:
Information and Instrucfious
Massachusetts Geheral Laws chapter 152 ragaires ail employers to provide workers'compensation for their employees.
Puusuant-to this stIttte,an e7nPIayPe is defined as."_.every person in the service of another ender any contrail ofhire,
express or implied,oral or wtitte�
An etrTtayI!�r is defined as"an mdividuA partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged is a Joint mterrgIIse,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.dwelli ag house having not more than three apartments and who resides therein,or the occupant of the -
dwelImg house of another who employs persons to do maintenance,construction or repair work on.such dwelling house
or on the grounds or building appUrtena�thereto shall not because of such employment be deemed to be an employer."
MCiL chapter 152,§25C(6)also sues that"every state or local Iicensiug agency shall withhold the issuance or
renewal of a license or permit to operate i business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance.coverage required_"
Addition ly,MGL chapter 152, §25C(7)staters"Neither the e commaawalth nor any of its political subdivisions shall
enter ink any contract for the perfomlance ofpubIic work uatil acceptable evidence of compliance with the incinan ce.
requin-emets of this chapter have Been presented to the contracting aoth0dty:"
ApPJican-b.
Please fill out the worker' compensation affidavit completely,by checking the boxes that apply to your sitnation and,if
necessary,supply sob-contractors)namets), addresses)and phone numbers) along with their cerfificate(s)of
hasu ance_ Limited Liability Companies(I.LC)or Limited Liability Partnerships(LLP)with no employees other than the
merilbers or partners,are not required to cant'workers' compensation fi s mace. Iran LLC or LLP does have
employees,a policy is requtretL Be advised that this a.ffidaykmay be submifted to the Department of Industrial
Accidents for confamation of insm*ace coverage. Also be sure to sign and date-he affidavit The affidavit should
be retained to the city or town that the application for the permit or license is being mquest�d,not the Department of
JudLvstriaj.A ccidents. Shouldyou have any questions regarding the law or ifyou.are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies shou�Id enter their
self-intirrance license number on the appropriate line.
City or Town Officials
r _
Please be sure that the affidavit is complete and printed legilly. The Department has provided a space at the bottom
of tine 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 pen:tWlicrose mrmber which will be used as a reference number. In addition,an applicant
that must submit multiple pennWhcense applications m any givfm year,need only submit one affidavit mdicatmg current
policy inf6n ation(if necessary)and under"Job Site Address"the applicant should write"all locations in (cry 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 obt-ainiag a license or permit not related to any business or commercial venture
(Lt. a dog license or permit to b=leaves efe.)said person is NOT rBq=d to complete this affidavit
The Office of Investigations would Iike to.thank you is advance for your cooperation and shoulld you have any questions,
please do not hesitate to give us a call
The Department's address,telephone and fax number:
Tht Ca-r�on iIr of Massachusz-tts .
Depaitnmt cif kiduslftial AQCWent
.face.4f jMv'esttatto=
�QQ�ashin.�Qu S# -
Bosto-n�MA 0�11I
TeL 4 617 727-4900 cat 4-06 or 1-477 hgASSAFE
Fax#617-727-7749
Revised 4-24--07 _masgo��c�ia
A FYC Guide fo Woad Consf-ucdorr in FIi, 14 Wznd Areas:11 a triply Wad Zane
Massachusetts Checklist for Campance gso o,TR5-301a l.1)i
cm0pliam=
1.1 SCOPE.
Wind speed{3-se' gust)-- 110 mph
Wind Es?osure Category--__-. ___ ___ .____—..- ------___--_ __ -B
Wind osum C EngineeringR utted For Entire Pni ect_________________EXP Category.-: ?g- I ....----------------C
12 APPLICABILITY '
-Number of Stories(a roof which exceeds 3 in 12 slope shall be considered a story) stories 5 2 stories
Roof Pilch-- -._ _ __.__.�__________-___.._-(Fg 2) ---_- 51212
Mean Roof Height (Fi9 2) ft <'33'
Building Width,W--_. _.._____ __ _�._r Fig 3)--.--�_-__:_.—_�. ft 5 EM.
Building Length,L _._____ _- _-__._--r- (Fig 3) ----•-- _--- _$ 9 B0'
Building Aspect Ratio MW)• (Fig 4)--�_,_- ------_____-- 5 3:1
Nominal Height of Tallest Dpeningz _----_-•_-_ -(Fig 4)__-__-_---_____-- - s 6'8'
1.3 FRAMING CONNECTIONS '
General cnnipIranee vrlh framing innedions__•�._-:-(Table 2)_ -- -_-_ _.�__ ----_-_---
2.1 FOUNDATloN
Foundation Walls meeting requirements of 7B0 CMR 5404.1
Conat�fe-------• - - -•--••----•--•-•-------------------•----•----- _- --•-------••----•-• ---
Conrsete Masonry....... __-----_._- -------- -------- - --=- --__
22 ANCHORAGE TO FOUNDATIOMt3
5/6'Anchor Bolts4mbedded or 51B'Propdetary Mechanical Anchors as an aftErhative in concrete only
Bolt.Spacing-general..........._...................._�.(Iable4)---:.__.-.-- __N-__� in.
Bolt Spac"mg fromend�Dint of plate-_-______-_—_(Fg 5).—.__�_..__----- in.5(i"-12",
Bolt Embedment-concreia 5)------—__--- -_ in.>T'
BDIt Embedment-masonry-._-......--.-- __(Fg 5)_--i-______.____-- in_>_15"
Plate Washer_.__- - >3'x 3'x
3.1 FLOORS
Flooriiaming member spans checked _-_----(per 7B0 CMR Chapter 55)---:_---_--
Maximum Floor Opening Dimension-- -- --__Fig 6)__.__ -----_----:-------
Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)__
------------___:________ _.______-
Mk'dmum Floor Joist Setbacks
SuppDMng Laadbaaring Wa1Cs or Shearwall----_--(Fig 7)___________ ft 5 d .
Maximum Cantilevered FloorJoisEs
Supporfrng tbadbeanng Walls or Shear wall------(Fig 8)
_ =ft cd
•FloorBracing at Endwafls -_.._.._.._ '.___- -.___-_(Fig 9)_ ------------.�.__ _.-----__---•
Floor Sheathing Type (per 7B0 CMR-Chapter 55)_____..:_-------_---
Floor Sheathing Thlclmess_---. ------ _._.--_--- (per 7B0 CMR Chapter 55)_____ in-
Floor Sheathing Fasterivlg_..._.._...:____._________ -_------(fable 2)__d nails at in edge/=in field
4.1 WALLS
S
Wall Height a.
-(Fig 10 and Table 5)' ft 510'
Non-LoadbeMng walls - -_-(Fg 10 and Table 5)----_�__.-__ ff-s20`
Wall Stud 5 cut �._�---_ . __ _—_�__.� i 10 and Table 5 _[tL_<24'n
g --_--_(Fig )--- _ -
Watt Story Offsets .__._�_�;__.___-_____-____(Figs 7&8 ft 5 d ;
42 EXTERI OIL WALLS' M -
Wood Studs
4.
Loadbearing•vratls _ ____.__..---_...._:_. __{Taljfe 53--_----_=._:._:._.__.2x_" -_ft in.
Nori,-�adbeaiing walls.__-:_-_ --------__._..__:(Table 5}------- - = -'
Gable End V&U Bracing t ---._._-_
Full Height Endwall (Fig 10) _.-_--:--
` WSP-Affc Floor Length (Fg II)_ _- _- ft 2-_M
Gypsum Dung Length(rf WSP not used)- .___ -(Fi9 11)-----.-----_ _ft z 19W -
and 2 x4 Continuous Lateral Brave Q B ft o.c.-(Fg 11)._...._........................
-__�___----
or 1 x 3 ceiling fuming slips @ I T spacing•min_with 2 x 4 biar_Idng @ 4 fL spacing in end joist or truss bays
Double Tap Plate ;
i Spfice Length __,.__-__-__---Fig 13and Table 6)_.____ _.__.__.___._ft
Spftce Connection (no.of 16d cornrnon nai-s)--_____.(Table 6)---- - _ --•-_-__-- _,
AI-VC guide to Wood Carrstruc don irr jfigh Trtnd X reas: 110-wph WrTnd Zotce
Massachusetts Checklist for COMPIjaUce(M CMRs3012-1_1)I
Loadbearing Wall Connecfions
Lateral (no-of 16d common naffs)__--___--__ (Tables 7) --_--_—__---_
Non-Luadbearing Wall Connections
Lateral(no.of 16d common marls}--- -•--(Table 8) --
Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)
Header Spans - __-- _(Table 9).._ z_. _ft_in. 11,
Sill Plate Spans _. ---(Table 9
—R )----------------—dui.-11
FuA Height Studs (no. of st(1ds)___— --_(fable 9)
Non-Lmd Bearing Wall Openings(record largest opening bi�'check an openings for compliance in Table 9)
Header Spans.._..._._-..-__�.---------(Table 9)_-_-__-- __ft'_in•_<1z
Sin Plate Spans.__.
Full Height Studs(no.of studs)_-- (Table 9)-------_--.____. ---
Edarior Wall &hewing to Resist Uplift and Shear.Simultaneously{
Minimum SwIding Dimension,W
Nominal Height of Tallest Opening? .................
Sheathing Type_- _-- _-__--(note 4)
Edge Mail Spacing--- r - (Table 10 or note 4 if
Feld Nail Sparing.--- ___ -__.(Table 10) in.
Shear Connection (no-of 16d common nails)(Tab)e 10)__
Percent FuMeight Sheathing-__' ___.-(fable 10)-___-----_-_- ---.---__-_—%
5%Additional Sheathing for Wall with Opening>•6'8(Design Concepts)-_-.--_-.-_
Maximum Building Dimension,L
Nominal Height of Tallest OpeningZ--—-------------•---.--------•-•------------------ ,.-__._56'8
Sheathing (note 4)__-_ -------
Edge Nall Spacing--_--__ --- _--(Table 11 or note 4 if less)_-:--_-_---
Feld
Shear Connection(no. of 16d common nails)(Table 11)_-----
Percent Full-Height Sheathing--- (fable 11)--- -- _ --%
5%Addifionaf Sheathing for Wall wrlh'Opening>SW(Design Concepts)----_-_-_---'
Wafi Cladding
Rated for Wind Speed?---__ ___ �_--__-_-- ---� --- ----
5.1 P,OOFS
Roof framing member.spans chac:kad7_ _—.(For Ratters use AWC Span Tool,see BBRS Website)
Roof Overhang - -----.----------(Figure 19)___-:- ---_f1_<smaller of 2'or L13
Truss or Ratter Connections at Lnadbearing Walls
Proprietary Connectors _
Ups --- ---- ---.(Table 12)_-_—_---- U= pif
Lateral__---------------- •----(Table 12}___--_ -_L= pif
- Shear_______-•---------(Table 12)_-__-- __--- --S= 'P�_ '
Ridge Strap Connections, if collar ties not used per page 21_-. (Table 13)--------- ____--T= plf
Gable Rake Outlooker-----------------_.-------- _----(Figure 20) .------ ft-smaller oft`orL12 '
Truss or Ratter Connectons at Nork oadbearing Walls
Proprietary Connectors
------.(Table,14)•— -- --- --U- ib-
Lateial(no.of 16d common nails)...(Table 14)------------------------------------1 = lb.
Roof Sheathing Type r_-_:_----------(per 7B0 CMR Chapters 58 and 59)
Roof'Sheathing Thidmess----_-.-- - - ---------- ----- _in?7116-WSP
Roof Sheathing Fastening—_._____ __-.(fable 2)_-�--
Notes:
-1. _ This chadclist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of
TSD GMR-53D12 1.1 Item 1. If the checldist is met in rls entirety then the foifowing metal straps and hold downs ara not
required per the WFCM 110 mph Guide: -
a. 5e1 Straps per Figure 5
b. 2b Gage Straps per Fgura 11
c. Uplift Straps per Figure 14
d_ Ali Straps per Figure 17
e= Comer Stud Hold Downs per Figura 18a and Figure 18b _
2 'Exception:Opening heights ofup io a ft_shall be permed when 5%is added to the percent fu"eight sheathing
nequrrrxnents shown in Tables 10 and 11.
2 The bottom sib plate in exterior walls shall be a minimum 2 in-nominal Uckness pressure treated#{2-gr ode_ '
ATVC Ga de ra Xbod CarrstrucL o u ur RF r [t Hlzi dAreas_ 110 rrZplr ;7dZ76rxe
Massachusetts CheckIist,far.•CompIiance(790 CrrfRs3.ol,?r_I)t
4.
a_ From Tables 10 and 11 and location of vial[shieathing and Balding Aspect RaSo,determine Percent FW-Height.
Sheathing and Mail Spacing requirements
b. Wood Structural Panels shall be minimum thickness of 7116'and'be installed as follows:
L Panels shall be installed With strength axis parallel to studs.
I All horizontal joints shall occur over and be nailed,to framing.
tn_ Dn single stniy MnstrudSon,panels shag be attached to bottom plates and top inembei-of the double
top plate.
iv- Dn two story construction,upper panels shag be attached to the top member of the upper double top
plate and to band joist at bottom of paneL Upper atfad rent of lower panel shall be made to band joist
and lower attachment made to lowest plate at first floor framing.
v. Horbmntal nail spacing at double top plates, band joists,and girders shall'be a double rote of ad
staggered at 3 inches on cenfai-per figures below:Vertical and Horizontal Nailing for Panel Attachment
b- Glazing protector a),new house or horizontal addition required if pplar-f•is 1 mile or closer-to shore(generally,south of
Rte.28 or llor,i of Rte 6).
_ b)vertical addrtion—not required unless there is extE�renovation to the first fiaor
c)replar�rnentvriridows—needs energy conservation compffati�only(chap 93)
6_Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B maybe obtained from the American Wood Council
(AWC)website
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See❑alail on Next Page -
Vertical and Ho1vorrlal Nailing Detail.
for Panel Attachment Verfi�:al ar4 HorTzantal Nailing
fDr Panel Aftachrnent
Town of Barnstable Goo `iaphic Information System Juno 28,2015
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Sel®Gtad Pxfoel L.:,.J
Wu�+ry dole-*04W or r ciAtory hkorprglatlen, Crtaig waft bnwA a go*of . O.v W,,GARLAND.ADAM T&LISA C Total An"u d Value,$266300 +
I"' I -91ajPa9
1000'"..rrol irtcai eMbWhod map acoitrWV Mand*do,.Tho 04ra0IkOs on this mmp
" pro onty grmiyhlo twowntadonm of Amooaor'a tw.o lk,They orc not ouo Pvgw1y Co Qlyt+or; ACrtt�9o:4, 9 atxQp - Abutters .
t wndarEaoand da no/r"oont WxWr*o rotadanmhipm to PMitrkal fcoRDem on Una mitp `; Location,88 LONGFELLOW DRIVE • ' ; °
ouch as bulldkre 1xht3zm, SiJ(19r
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 1 Parcel U t Application# c,204 74
Health Division
Conservation Division Permit#
Tax Collector Date Issued 1
Treasurer Application Fee ]]�
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address 0 c qe
Village ( -4f l-I/At
Owner Address
Telephone Iva 51(4
Permit Request ITZ` I k1 I�I 14 k) D {_d
a O&- G w✓la Al
4eSquare feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new✓ J
Zoning District Flood Plain Groundwater Overlay �j�l�& pl�')
Project Valuation 6, 01) Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) -�
Age of ExistingStructure Historic House: ❑Yes ❑ No On Old Kin 's Highway: ❑Yes ❑No
9
-4; Basement Type: 14 Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) y56
Number of Baths: Full:existing oZ new Half:existing new
Number of Bedrooms: existing new �iMGi�l,
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:❑exist' g ❑new size
Attached garage:4BXisting ❑new size Shed:❑existing ❑new size Other:
bE
Zoning Board of Appeals-Authorization -Q-Appeal# Recorded❑ °f -
Commercial ❑Yes ❑No If yes, site plan review# ,
Current Use Proposed Use
BUILDER INFORMATION C� WOOr
Name 06( Yjj �.rl-J Telephone Number tiU b tL�
Address L"G d4,5 442,1 License# GS �� [J
G� I Home Improvement Contractor#
Worker's Compensation# �-�r-���a�
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I�(A.i� ;�j I OU,)
SIGNAT E JDATE ® ��
FOR OFFICIAL USE ONLY
J, 6
PERMIT NO.
y it
DATE(fISSUED
MAP/PARCEL NO.
. t F
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION '
FRAME W -�3I 161
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
ti. The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111' T.
w>*.mass.gov/dia '
Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers
Applicant Information .Please Print Legibly .
Name(Business/Orgauization/In(iividual,): Dk& TY
•Address•_ �I
City/State/Zip: I�j J66 Phone.#:
Are you an employer?Check the appropriate box: :Type of project(required):•
general co a I a. m gntractor and I
1;❑ I am a employer with 4 � 6. ❑New construction .
employees (full and/or part-time).* • have hired the sub-contractors
listed on the'attached sheet. 7. Z Remodeling
2.❑ I am a'sole proprietor or partner- b These sub-contractors Have •
ship and have no employees 8, ❑Demolition
�yorkin for me m an capacity. employees and have workers'
g y p t5'• $. 9. ❑Building addition
[No workers' comp,insurance comp. insurance, 10.❑$lectricalrepaas or additions
required.] 5. We are a corporation and its
3.❑ I am a homeowner doing ill-work . _ officers have exercised then 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 Nye have no 13.❑ Other
employees, [No workers'
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 anew 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.
Tam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site,
information.
Insurance CompanyNazne:
_ u
Policy#or Self-ins.Lic,#: xpiration Date: U
lob Site Address: r, City/State/Zip- tt
Attach a copy of the workers' C,619p6nsation policy.declaration page'(showing the policy number and expiration d ).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the.Office of
Investi ations of the bIA for insurance covers e verification.
I do hereby certify under the pains and penalties of perjury that the information provided above•is true and correct.
S'oftore: Date Y^b
Phone#:
Offccial 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):
I.Board of Health 2,Building Department 3,City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone#:
information anti instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of bite,
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 ofthe
tion or repair work on such dwelling house
t do maintenance construction g
dwelling house of another who employs persons o p
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."
AdditionaIly,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 acceptably eviderree of compliatife g+ith 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-contiactor(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 pemut.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 maybe provided to the
vit must be filled out each
applicant. roof that a valid affidavit is on file for future permits or licenses. A new affida
PP P
• year.Where a home owner or citizen is obtaining a license or emut not related to an business or commercial venture
Y g P Y
(i.e.a dog license or permit to bum leaves-etc.)said persoi 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.-.
ae CQ.mmQnwWth of Mar rhus4tts
D%artmMt dladustdW A.rXi&llts
Offalce of fnvest gaums
600 W'as iingteii Stmd
B.WQ4,AMA 02111
TeJ.#f l7-727 000 ext 40,6 or 1-877-MASS
Fax#617-' 7-'�749
Revised 11-22.A6 www.mass.govAua
J I •
Town of Barnstable
Regulatory Services
* sARNs'SSGeller,
� .MASS. " Thomas F.Geiler Director
�
� $APEc N►v+�' Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax; 508-790-6230
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.
4 - Type of Work: Estimated Cost C�"� 06
Address of Work: 4aroIFUA00
Owner's Name: 60
Date of Application
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
❑Job Under$1,000
OBuilding 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 WORD 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-
P 11.-,P;> 00)_�T6
Date Contractor e Registration No.
OR
Date Owner's Name
f
Q:forms:homeaf6dav
Ti01!dSZ3D(CODthtAe� ^ .
p'maiptiv!Psdmges far due and Two-FamDy Residential EaildingsUH ated wii1b FvX4'FPfh (/
r
• 148.AXffAiLlhf iK11VIMUM '
Glazing Glazing Ceiling Wall Floor I9a=tw Slab HeatinglCooling
Ares1(7o) U-valuul R-value' ' R-value' R•Yslue° Wall Porimcw Eopmcm Mcilcyy
Paa'cage R-valuer R-Yaluet
5701 to 6500 Pleating Degree Days'
0.40 38 13 19 10 6 Normal
R i2°!a 0S2 30 t9 19 I0. 6 Normal
$ I2% OSO 38 13 19 10 6 '85-AFUE
T I5% 036 38 13 24 NIA NIA. Normal
u I5% 0.46 38 19 19 10 6 Normal
}Y 15°l. 0.44 311 13 23 N/A N/A 113 AFUE
p� 15% 0.32 30 19 19 10 6 U AFUE
�g . I il'le 032 38 13 25 NIA NA Normal
y 13%. M'l 38 19 23 N/A NIA` Nanstal
Z 13% G.47 38. 13 19 10 6 90 AFUE
AA 10/. 0.30 30 19 19 10 6 90 AFUE
1, ADDRESS OF PROPERTY:
2, SQUARE FOOTAGE OF ALL EXTERIOR WALLS:
3, SQUARE FOOTAGE OF ALL GLAZING:
4, %GLAZING AREA_(#3 DIVIDED BY 02):
5. SELECT PACKAGE(Q--AA-see chart above): i
NOTE: OTHER MORE INVOLVED NIETHODS OF DETERMINING ENERGY REQUIRM ENTS
ARE AVAILABLE. ASK.US FOR T1U,S INFORMATION.
• � ��
BMDING INSPECTOR APPROVAL:
YES:. NO:
q-fauns-f3SQ303a
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ACOR® ry CER a lFlCAT ' lA T THONG :104/23/2007
PROD�R 11M)Il�I�TG _ ���Y T t AS A ?TER H INFORMATION
SCBLEGIEL INSURANCE 11 Y v a IOHTB UPON THE CERTIFICATE
LD ES NOT AMEND. EXTEND OR
34 19►IN ST 17 CIRCLE DRIVE • $ I W BY THE POLICES BELOW.
WEST.
508_ 11 15 1(Q ERB AFFORDIND COVERA08 NAIL 0
MUM IMBURERA:COLONY IMSURA=
.7=05 MC$40Y7COTF
INSURERS:ZOFdC$
17 Circle Drive INSURERC:
INmtm.O:
gymnis, NA, 02601 RH)UR9iE
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN tMED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOING
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 Oi SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTA pmo TYPE woultuC FOLJ6VNULlO! � CAMISM LYRTB
A aBNWALNMILRY =3326473 04/27/2006 04/27/2007 EAuKOCCUMENCE 61,009,000
]L CON M.RCOLL GENERAL LM MAY PFtEmms Me o fir— $100,000
CLMMS MADE aocom MEDEVwnaspemn) 83,000
PERSONAL A AOVINJlJW $1,000,000
OZNV0LAaMQATE o2,000,000
aEMLAWREGATS LINRAPPU®PIA: PRO0UCY8-COMPIOPA00 •2,000,000
POLIeY � we
AUTomm"LON)MJN MOLE LOT ICI
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EUI PROPS'LwHm EL EACH ACCIDENT 8100,000
JETORIPARTNERAMCVM ANYPRCP -
OiYXNRAMUMEXCLUDED? FA,0L4EASE•EAEMPLOYEE 8100,000
sP gAtouv6DWo,7-® EL DISEASE•POLICYtwIT o 500,000
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THIS VORIMRS CGWSNSATION POLICY DOSS NOT VAOVZDE COVZRRM FOR JAMS 10CMRROW
CERTIFICATE HOLDER 'CANCELLATION
TOM OF DARNSTAWA - 3HOULD AM OP TILE ABOW) OSBCRIAED POLICIES RE CAUCII++E+ SEPORE THE EIMATION ..
OATH THERSOP, THS MUM MMURER MARL ENDEAVOR To MAIL 21 DAYO WRITTEN
NOTICE TO THE CEIIRFIOATE HOWER NANO TO ?TIE LSPT.BUT FARDIE TO DO SO &HALL
RV ME RD OMUTHw Ow LU=M OF ANY UFON "a munEK n8 Aamm an
- RevMeaawrATnm. '
I ma
AUTHORIAeRLDREB
ACORD 2A 4IOB) 0 ACORD CORPORATION IWO
May . B. 2007 2:56PM E I MORSE LUMBER No-7616 P. 3
I
(9
BOARD OF BUILDING REGULATIONS
.. License: CONSTRUCTION SUPERVISOR
Number GCS, 024806
7/05/�1040
Birthdate 9W
4EzpiresQ?�05l2007 Tr.no: 29091
M 1 }
Restricted 7 00 i ,.
DAVID A BARRY( ; e�
68 CAPT ELLIS
HYANNIS, MA Commissioner I-40ME IMPROVEMENT CONTRACTOR
R®listrati9�'' 1,0714
Expi racial;?;:-°2/2/2008
i- fiype Parfnetship
i INE FINISH
�? :Y DAVID W-Lffi .
68
CAPTAIN ELLIS LN'. �'"/j ,�
-il iMll-NIS, MA 02601 \ 4 ,,,�'
�ti.,. Deputy Adpiinish•ator
} ij_
Town of Barnstable.
Regulatory Services
' sn �'MASS. � Thomas F.Geiler,Director
.� htnss. �.
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,NIA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8
Fax: 508-790-6230
Property Owner Must '
Complete and Sign This Section
If Using A Builder
I, A �S as Owner of the subject property
he authorize Q to act on my behalf,
in all matters relative to work authorized by this building permit application.for: .
L -
r
Address of Job)
'a' S J IlU IO}
SignatLU of Owner Date
Print Name
Q TORMS:OVJNERPERMIS S ION
Ll
16
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u
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02 N0� Poo
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88 Longfellow Dr. , Centerville 5/7/07
RR 1 nnnfalln\ni nr rr�
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88 Longfellow Dr. Centerville 5/7/07
P
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a
y
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•a.
Town of Barnstable *Permit# . Ool 6-.),L!! Cr
Expires 6 months from issue da
Regulatory Services Fee
Thomas F.Geiler,Director �.y
Building Division 1
Tom Perry, CBO, Building Commissioner
200 Main Street,Hyannis,ARIA 02601
wwvr.to)Nn.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
r Not Valid without Red X-Press Imprint
ip/parcel Number O`
operty Address
Residential Value of Work r��c5zAjinimurn fee of$25.00 fo work under$_6000.00
Nner's Name&Address [ P`J �(,
)ntractor's Name ���'rS ftma MON.-, . Telephone Number-
Me Improvement Contractor License#(if applicable) /
�-sfr -Z�sorls-Lzc�se-#-(�applieable-)
]Workman's Compensation Insurance. -PRESS PERMIT
Check one:
E�;_I am a sole proprietor APR 2 2007
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE
*
surance Company Name l�u/-i
.'orkman's.Co__ Polic # (j1 :Z 61C
opy of Insurance Compliance Certificate must be on file.
:rmit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to t
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
r❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Cons rvation,e;f�%
***Note: Property Owner must sign Property Owner Letter of Permission,
A copy of the Home Improvement Contractors License is required.
[GNATURE:
Forins:expmtrg
:vise061306
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations •
600 Washington Street
Boston,MA 02111'
www.mass.gov/dia '
Workers}Compensation Insurance davit: Builders/Contractors/Electridans/Plumbers
A licant Information Please Print Le ibl
Name(Business/Organizationadividual): . 7 t"
Address:
City/State/Zip:
/State/Zip: Phonet -71 160 l
'��/
tY
Are you an euiployer7 Check the agpropriatebox: :Type of project(required):.
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction .
'employees(full and/or part-time).* • have hired the sub-contractors
listed on the-attached sheet. 7. ❑Remodeling
2. Pl am a'sole proprietor or partner- These sub-contractors have g, ❑Demolition
ship and have no employees employee$and have workers'
working for me in any capacity. $. 9. ❑Building addition
[No workers' comp.insurance co insurance. 10.❑Electrical repairs or additions
required.] 5. ❑ We are a corporation and its
'3,❑ I am a homeowner doing ill"work . . _ officers have exercised their 11.❑Plumbing regains or additions '
myself.[No workers'comp. right 6f exemption per MGL 12,❑Roof repLairs
insurance.required]t c. 152, §1(4),and we have no 13.❑ Other '
employees. [No workers'
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 anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether ornat 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 maybe forwarded to the Office of .
Investigations of the WA for insurance coverage verification.
I'do hereby certify under the pains a�ndpenalties of perjury that the information provid�7;ls truan'd correct.
� — •
Sii, tore.
Phone r—7
official use only. Do not write in this area, to,be completed by.city or town official.
City or Town: " .Permit/License#
Issuing Authority(circle one):
:1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the
receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or,the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any
applicant who has not produced:acceptable evidence of compliance with the insurance coverage required."
AdditionaIly,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 evidenee-ofcompl%ani= with:lie insurance-
requirements of this chapter have been presentedto the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,it
necessary,supply sub-contiactor(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. Ia 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 (c*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 fo 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'co not hesitate to give us a call.
The Department's address,telephone.and fax number:.
The ComonwWth of Massa&usetts
Department of la trial A.ee dents "
Uffiee of InVOWIIPRO S
600 Wasliinateji Street
Boetan;_ILIA 02111 • -
Tel.#617-727-400 ext 406 or 1477 MASSAFE
Fax#617-727-7749
Revised 11-22.06 www gov/di&
r .
. Town of Barnstable.
�o�Tws r�ti
Regulatory Services
aA ' * Thomas
xsAss. �. F.Geiler,Director
e16 9a Building Division
Tom Perry, Building Commissioner
200 Main Street Hyannis,-MA 02601
www.town,barnstable..ma.us
Office: 508-862-403 8 Fax: 5 08-790-62 3 0
Property Owner Must
CoMplete and Sign This Section
If Using ABuildtr
as.Ovner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for; ,
(AOdiess -if—Job)
igna of,
r Date
l'I t'1641fe' 4d6i
Print Name
0•rORN5:0'W1rJERPI PJVMSSION
d-�� ��al
-,�
,\,
, _ � , , .
i
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.:�{
-:,..�.
t.
Board of Building Regulations and Standards Y
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home ImprovemeniL Contractor Registration
Registration: 133704 0
x Type: DBA
Ex iration: 7 3
p / 1/2007
JFM CONSTRUCTION
JAMES MCMORROW
17 CIRCLE DR.
HYANNISPORT, MA 02601 �
Update Address and return card.Mark reason for change.
�Ps-cai Co soon-oaioe-Pcassa Address Renewal Employment n Lost Card
Certified Plot .. Plan , in. Barnstable, MA
Address 88 Longfellow Drive Prepared For : Adam Garland
Assessor's Map: 188 Lot: 014 Baxter Nye Engineering & Surveying
Community Panel Number 250001 0563 J, Effective Date 07-16-2014 Registered Professional
F.I.R.M. Map Zone: X (un—shaded) Engineers and Land Surveyors
Plan Reference: Land Court Plan 24614—E N Sheet 3 Of 3 78 North Street, 3rd Floor
Certificate of Title: #189499 Hyannis, MA 02601
Phone (508) 771-7502 Fax — (508)-771-7622
Owner: Adam T. & Lisa C. Garland Job Number. 2016-016 Scale : 1 = 20 Date : 04-22-2016
ZONING DISTRICT: RD-1 JQ
OVERLAYS: .
RPOD, SALTWATER ESTUARY PROTECTION
p
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Aj L.C. CERT. 162296
PARCEL 188-013
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J N/F BARBARA ONEILL
L.C. CERT. 60092
PARCEL 188-015 ENG� _ _ . — —
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I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE-THE EXISTING STRUCTURES SHOWN HEREON ARE
LOCATED IN RELATION TO THE MONUMENTS SHOWN AND IS NOT LOCATED WITHIN A SPECIAL 6F-
FLOOD HAZARD AREA. SHANE
THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. M. -
MALLON
`. No.48607 CA
REGISTERED PROFESSIONAL LAND SURVEYOR N BAXTER NYE ENGINEERING & SURVEYING DATE