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0610 MAIN STREET (CENT.)
n"^a Te fj 01, J ll w a .x. •. .° :� ', ,.- ,.s, ..t` ..: .. ?n., .:4y,,' .ki'.a ;..,: ,. .'-' + t:it�.. ..'cy _ i '. s a 1..��yf,�,t [.e- '`'' g�. -R� .. t I "' , i,' 3.!� i. .°�.�., :a. � ';A•t�' a 4�'.:.:'�y�, 1 -k..;�wx. �'y 4 y S lj� , 7 tf Y� •vh Y ! ��U ♦1:ry 41 1 Si�� � � M1. V t �A 44 a r. rr A :y V f . q e - $ •✓ ; 4 as � - a w : a. .. ',, y _ .: , .�� ' ,. a .. ,•, '., a s� . o a � ., .. v _ � - tee'• ,� .. d a ' a . C 0 a . 4 � ^ F ' e A� y y 5 4 f- v , ' e q 'k r a a•� , 0 Town of Barnstable llilClln g . t � s Post This Caard So That'it�s Visible From_t'heStr.-eet ApproveeJ Plans Must be:Retained on Joband_this Card Must be Kept jPosted Until';Final:lns ection Has Been Made _ 3: 1 - Permit �Where�a Certificate'of Occupancy is Req;u�red;such-Bui,dmg;"shall Not be Occupietl until a Final Inspection has been made Permit No: B-20-268 Applicant Name: RetroFit Insulation Approvals Date Issued: 01/30/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/30/2020 Foundation: Location: 610 MAIN STREET(CENT.),CENTERVILLE Map/Lot: 207-013 Zoning District: RD-1 Sheathing: Owner on Record: RAPAUE, ROBERT A&CASEY L Contractor Name',RETROFIT INSULATION INC. Framing: 1 Address: 610 MAIN STREET ' ` Contractor License 1-60461 2 CENTERVILLE, MA 02632w, Est,.,.Project Cost: $ 1,847.00 Chimney: Description:. Air Sealing,-Door Kits&Sweeps,Crawlspace Wall -R10 Rigid Board, Permit Fee: , $85.00 Overhang 5" Dense R-18 Cellulose, Insulate Crawlspace,Door, Insulation: r Fee Paid` $85.00 Project Review Req: i Date 1/30/2020 Final Plumbing/Gas Rough Plumbing: fficial This permit shall be deemed abandoned and invalid unless the work authorized by this permit is—commenced within sixtmonths afieNMR&O Final Plumbing: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterationsand changes of use of any building and structures shall be in compliance with the local zoning by-laws,and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or,road and shall be maintained open for public.inspection for the entire duration of the work until the completion of the same. JI - Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the&bilding.and.Fire-Officials,are`provided on this,permit._ Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed, �. .„ Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:5.Prior to Covering Structural Members(Frame Inspection) • 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ,n dC.c� �1 . : l Y ^y - �'WE Town of Barnstable *Permit#T it'd Tres 6 months from issue date ' Regulatory Services fee BARNST16 � Richard V.Scali,Director � ra rFD'"p` Building Division Paul Roma,Building Commissioner ocr 1 200 Main Street,Hyannis,MAr,IT60j1�A Y ZQ16 www.town.barnstable.ma.us t/I►J Office: 508-862-4038 OF �V8��Ft08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY, Not Valid without Red X-Press Imprint Map/parcel Number 20 7101-3 / . Property Address ��© //Y %! (e`�/=`,/I2_—, ZLG C� 2a Z Residential Value of Work a,and Minimum fee of$35.00 for work under'$6000.00 Owner's Name&Address & Z'Z,11"g2 Contractor's Name C=/7liL.Pi��� �5' C'�l�'+'�� Telephone Number Home Improvement Contractor License#(if applicable) Email: '�'�,� CP Construction Supervisor's License# if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner r ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 C>e. 27 (maximum,32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: � ��� . Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 r The Commornrealth rx,f Maswd iusetfs Deparoneut cr,f 1'udusbial Acciders f},frce of IMPEM,9miom. 600 Washing m Street Boston,MA 021.111. ' tdrvxt��rra�gapfi�ia . " Wurlors' Campensatian Insurance Affidavit:BTdMi rs/CantracturslEIe°ctricians/Pbnmhers AppHcaut In fk-matinu Please Print Larne 4B gm S' L�: ,V ep , Address.- tSfatel ��A�11 phone Are you an employer?.Ofeckthe apprag to bay. Type of project(reguieq_ I am a getxl t era contractor d I or an I.❑ I ant a employer uitT1 El . 6. ❑New oasssfrucEiori emp1ayee3(fish andfor part-fiime).* have 1vredifie sub-contractors � I am a sole proprietor orpsrtner- Tisfed Uzi the attached sheet , ?. ❑Remodetiug 27 shFp and have no employees , These sub-contractors have g_ ❑Demolition ' wor3d icng for rae in any capacity- employees 1 and haveworzrs' 9_.El S,0i1�ad�ifion [No a�s'Comp-iom rm C comp.insurar�vr require-] 5_ ❑ We are a wrpomfi m and ifs to-❑Electrical repairs ar a,c&E= officers have exercised f 3_❑ I am.a homeowner doing all wont _ 1L❑Plumbing repairs or$ddiiians myself[No workers'gip- riot of e$empfioa per UGL 13_❑Roofrepairs. insurance regait ed j f c_152, §1(4h andwe have no employees_[No woffi=' 1 €7t11e[ W I�DIJ��� cam-ksurance roqaked-] 'dap applicasd:�at ched3bas�i mast also fiIlo�the sectioabeIowshosdag tbeirwa�en:'cn®peasafiaapaycgiafoemaaa� - . �p�feppraQS whp Shc7�t ibis�d2Cit they 9i2�T�4 Sll WUR�Bad lea hiIE CFIItSidf�1P¢tLa�^*zmast Submit a new affidsvft mdieatiag sadL rCaat xctms Sit rbwl tWs boat neust attached=additimal sheet shown-ig the nee of the sah-cuitwaam and stye whedw or not ibme ea ides l.we employees.I€thesub-c shZ;M emgloYWs,tbeyamstpmvide their zs0dMM'C=R.PGHCF a1er- I am an euip sr Heat is prauidircg�yarkets�s azttlreresrdiajz h=zrarzw f br my earplajwex ffetoty it tfta paficy and job site ircforzaathms. Insurance company Name: Porlry or Self-ins-Zic_:` f iiratiou Iyafe: Job Re Address: C41State7V_ ,. Attach a'-copy of the workers'compensation p olicy declaration Page(showing the poficy member and expiration date). Failure to secure coverage as required under Section 25A o€MCL cL 1572 can lead to the imposition of criminal penalties of a flue up to$UOO.OU ar d f'or mein-yea-r impdso=ent,as well as cif penalties is the fo=of m ST OP WORIK ORDER and a fry of up.to 0-00 a day against the violator. Be ad%ised&at a copy ofthis statement maybe hrwarded to the office of IsvesEigations offhe DIA for insurance coverage uredfrta3in - I'do tterelsy tlrs pantZanZ,aItcss ofpedkq thatthe infbn affw;pm.ided abmv is true ar'id correct �rp�atrtr•� Date: 08kiai use aajly: Do just writs in filb area,to be cv&zp&ted by c*p rjrtatcn afjrctz:t Coy or Tama.: PeruatfLicense ii Issaing Auflority(c rck flue): L Sward of$ealtfi I wag Depart 3.Ci y rovm aerk dy Electrical Inspector S.,,Plimbiag Empector 6.Other CAMt2ct Person: Phone 41- Tafoarm�atioan � ns efioxas �. Massaclinseft Ge-aeral Laws ffiepter 152 req=m all=ploy=to In M&workers'compensation for fig emmployees. p -m jhy sty,an anpIoyw is dsfined ss .every person in the service of another u der any n„mrt_ofhile., � express or>mplied,oral orwlit� An fznPIaym_is defined as°`aa individual,pmtnjersbzp,assocfitian,anporaiion or other legal ea�.y,or any two or more is a joint eo�se,and including file legalrepreseDta&m of deceased employer,or ilae 0 1� J f fi3regnmg eng� erl loyees. Howeverfhe receiver or trustee of an per,association or.oth egal entity',employing�P eats and-who residestharem,or the occupant of the - owner of a.dweIIing hose having not mutes than threeaparen . dwnMag house of another who employs pesons to do maintartan ce,constrrac-ti on or repair work.an such dwelling House or on the grounds or bmldmg appzafenazzt thereto shallnotbecause of such employment be deemedto b(-,,as employer_" MM Cbaptrr 152,§25C(6)also sfatm that"every sta a or local licensing agemcy shall wifjihoId the issuance or renewal of a license or permit to operate a Dusskess or to construct btuZdbzgs in the commonwealth for any n applicant Who has notprodnced acceptable evidence of cnmpfiamce with the imrance.coverage regttired_ shall _ . oIildcal snb&ViSions Addrt?onaIIy,MQ.cbaptnr L52,§25C(7}states al�Teit�r the nor any ofzEs p enter into any contract for theperfomtance ofpublicworkunia acceptable evidence of compliance,viith fhe msurmm.. m mts of this chapter have been presented in the caniradting aufhoaty_" Applic=-Is Please fill oht the Wod='compeasation affidavit completely,by dierl®.g to bones that apply to your sifnation and,if necessary,supply sob-contactor(s)name(s), address(es)and Phone nnmber(s) along with their cm tzicste(s) of assurance- Lmlit ed Liability Comparaes(LLC)or Limited Liabl-lity pmt3ers s(LIP)withno employees other than the members or partners,are not regtmed to carry workeas'c top nation msmmlce_ If as LLC or LLP does have employees, a policy is required. Be advisedthatthis affidaykmaybe snbmitted to the Department of Industrial Accidents for confirmation ofmSUl7HnDe coverage Also be sure to sign and date the affidavit The affidavitshould be retamned to the city or town that the application for the peanit or license is being request,not the Dapartmeid of hidnstrialAcaidents. should you have any questions regarding th a law or if you ate regoaed to obtam a wormers' compensation poliep,please call the Department at the n=.bea listed below. Self-fim red companies should ear their self_i �n ce license na ber on the apgrap - lim City or Town Of Ecials f - Please be sore fiat the affidavit is complete and pried legibly. The Department has provided a space at the born of the affidavit for you to fill out lathe event the Office ofInvestig4x s has to conbmt you reg-axHn g tie applicant Please be sure to fill in the,pen�ii/Iicease mmiber which will be used.as a reference number. Im addition,an applicant that must submit mvltiple pe�llicense appli-cations is any evea year,need only submit one affidavit indicating cunnt policy inforsuatian(if necessary)and under`Job Site Adds"tie applicant should�-all locationsin (may or town)_"A copy of the affidavit that has bey officially stamped.or maimed by the city or town may be provided to tie applicant as proofthat a valid affidavit is on file FDr furore P=lt6-or licenses_ Anew affidavitmust be filled out each year.Wheae a home owner ar citizen is obtaining a license ar permit not related in any business or commercial venture (fir_a dog license:or permit to bum leaves etc.)said person.is NOT required to complete this affidavit The Office of Ind would Itket to i-Iisnk you ia advance for your coopedion and should you have any questions, please do not hesitate to give to a caIL The Departxamfs address,telephone and fax number Tha CbmMOaWM1ffiE of Mussach Dew�f ludo Aor��nts Of ace of 1nVegtfffkti= Q MA Q11F Tf,-L 4 617 -4 ot4flf Q,r Fax 9 617-`27 7M B.evised 4.24-07 m g�ra ki re Sk },- i x .-ry ,� rt5 v /t 1� Y r �Rk �4` 4 k 3 k xe.' '/�y�c !T ar�,w�6'Y� i="ap��y�,{ryw fir' 3i' _ y +yam A JR .y # _ w R>T'WSW { i S y r. r Office~54��-$�2-4�38 °` , IaaG t St1FT9A"b231 , w a+• k-: hP d n �- .,� P �^ �_,dji Pi x� } � � OIIZS \ 111LD �5 s1 ' afo"Wom 09II4� , j - no s % x aft m r t'7a& an ou �S}*t11 ' pes t a�rofi £oz ' f,. $> r (tCss c�job) " `PO.Oi S ar+E the s sgo b of the ap�i�c�t e�yidols r il pt� ed_11- accep x �, � � . � �f . ..� T SP f ., .'',"! � � , � . ___ e�d of C�2fCyC O$j@0 dkt C " r A .1 jj) t f 4t ) fj Pit 2{1l3C �s1, use w . �- ` x F Y Y , +Yet a MMa'A�vsxµgr»eus. _ �W"ri.+M.mnwx+M:dAVCW:u uev xs.++ra ee .µh+v�MAru nrtrhaMk�Fw.MKa MIIMK wir-`EYIVaw1�It Y1�e^tpretR'wh%Mlw'�iAad u,�=Y49zav#h++sacalrf`tpdFx'S�.k:Yw4 b a +hwwiMb¢��Iw„k.,xms+ni�'�*.m+N?_ r ; ice"• .. -:,� a pluu2is;noq;l.b.pgvA;ou ,Cje;axaaslapun 109Z0'dW'SINI�i V nF:: a2j s=ijme 21082i`dH 3L cr ONVOVSId S371.:+'VHO 01dV�VSId 031eIVHO - - I' giizo VW`uo;sog :uol l OLTS a;mg-ezeld Ted Oi . IanplAipul 910.ZIZ119 ;eac'x- uol;sln2ag ssauisng pus squjjV iauinsuoji;o aag;p :ad�(1 £506LC' :uol;e�;st6a :o;ujn;aa punoj jj -a;ep uol;sndxa aq;ajo aq 2i01OtRi1N0O 1N3W3A02idWi 3W I eino asn lnpintput ao;pgsn not;eJ;si2ai.10 asuaatZ aopelunad ssa/ulsng V sip jj Y samnsao:j;o as6,0. ' W�'dvD W 002u/lUODI .�d'!j ., Massachusetts Department of Public Safety Board of Building Regulations and Standards ; a License: CS-086733 Construction Supervisor • CHARLES PISACAI�O PO BOX 126 ' HYANNIS PORT JVIA CA— Expiration: Commissioner 07/29/2017 'F s Construction Supervisor = Restricted to: ° Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. a Failure to possess a current edition of the Massachusetts _ State Building Code is cause for rgvocation of this license. DPS Licensing information visit:WWW.MASS.GOV/DPS Town of Barnstable Regulatory Services FTHE , do Richard.V. Scali,Director BMWSPABLE. ; Building Division BARNSTABLE MASS. P wan hs uEm •ii 039• 10 Thomas Perry,'CBO ... - 1639-2014 �FD1A°�A Building Commissioner �Dg 200 Main Street, Hyannis, MA 02601 wwwaown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 June 3, 2015 Bradford Inkley 33 Lake Road W Yarmouth, MA. 02679 RE: 610 Main St., Centerville, Map: 207 Parcel: 013 Dear Mr. Inkley, This letter is in response'to application number.201502493 submitted to install a wet bar and 201502495 submitted to a kitchen.Unfortunately,the applications can not be approved at this time because of the following: 1) Construction documents submitted are unclear as to,the scope of the project and compliance with the Zoning of the Town of Barnstable as well as the State Building Code. Please do not hesitate to contact this office with any questions. - r Respectfully, 4 L. Lauzon Local Inspector Jeffrey.lauzonntown.barnstable.ma.us (508) 862-4034 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CiTyl C e nZ P r up MA DATE 3 f PERMIT# JOBSITE ADDRESS I!p 6 M aW n s— OWNER'S NAME�i I\ l3 rp tW 11 P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:Ej REPLACEMENT:® PLANS SUBMITTED: YES NO® FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET I URINAL I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING ' OTHER 1 i INSURANCE COVERAGE:' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY[ BOND [� OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. r CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliant with al ertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. . PLUMBER'S NAME 11 i +1 2r[ r LICENSE# SIGNATURE MPP JP® CORPORATION(]# PARTNERSHIP®# LLC®# COMPANY NAME ju — Q,i r ADDRESS 3 Lt/ i Ae S7 CITY L���1 f v �\P . STATE ZIP ®a(a3 TEL ���o— b' 3 FAX CELL I EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No . THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 Owl • M . J Cod?Age, 1 n .9eA(Z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BARNSTABLE MAP PARCEL MA DATE PERMIT# JOBSITEADDRESSI 6 628 il CPniei^uhP OWNER'S NAME GOWNER ADDRESS I TEq FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL[ ' PRINT CLEARLY NEW: RENOVATION:ff REPLACEMENT:,S• PLANS SUBMITTED: YES NO[j APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7. 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATERI DRYER FIREPLACE _ FRYOLATOR FURNACE _ GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT _ OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST { UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER OTHER .INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 .YES &]NO E I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianceswith all ertine t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. S PLUMBER-GASFITTER NAME ,, a p,K , e p LICENSE# 1 /a SIGNATURE MP[Z MGF[3 JP® JGF® LPGI® CORPORATION[]# PARTNERSHIP®# LLC[J# COMPANY NAME: ? M�J 2:1 P ADDRESS 3 i IMP s CITY Cel��—�/ U Vw STATE ZIP � ]TEL 5L �(o79P a FAX _._._.. 1!CELL j EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes. No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES PERMIT PAYMENT RECEIPT x ,S TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 ' DATE: 05/04/15 TIME: 16:01 -----------------TOTALS----------------- PERMIT $ PAID 50.00 ANT TENDERED: 50.00 ANT APP LIED: 50.00 CHANGE: .00 APPLICATION NUMBER: 201502494 PAYMENT METH: CHECK PAYMENT REF: 2609 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Divisions Application F&�fl Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address "0WA 5/- Village Owner Adctess Telephone r Permit Request 6 _64ZW 7V /6C,-,�1V( VCA 0 Square feet: 1 st floor: existing proposed oor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation onstructio Ty e Lot Size Gran athered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Fa ily ❑ Two amily ❑ 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: V) Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ —> Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use D Y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address Z,_, License # Home Improvement Contractor# Email a0a6rd. - Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ° N SIGNATURE DATE lor �; FOR OFFICIAL USE'ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS - ' VILLAGE ` OWNER DATE OF INSPECTION: I ; h i F FOUNDATIONt .. g FRAME ,� 3 INSULATION FIREPLACE ELECTRICAL: ROUGH ""--,:.FINAL } PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i t ASSOCIATION PLAN NO. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel L 3 Application # So 1-/ Health Division Date Issued f Conservation Division Application Fee 2 Planning Dept. - Permit'Fee Date Definitive Plan Approved by Planning Board p 'rP Historic - OKH _ Preservation/ Hyannis , Project Street Address 6 LO U-1 S1YL,E�"1� Village Celt2:)M&M q LLLC Owner1?R1 tPS1RG,W+LX-� 110Nw> Address «7 046?Z(,ALGE�t_ lDc.ct ire, t17- Telephone Permit'Request '9C^.MoV E . K l TCt•{- J : �72s` l Ca TMC-Z (C671ACRE (UI(,�, J�pw THE A5 A Sup K � CAR ?C.0 k P Square feet: 1 st floor: existing' proposed 2nd floor: existing '—proposed Total new 'Zoning District " Flood Plain `Groundwater Overlay Project Valuation t5a6.M Construction Type ^ Lot Size t .5zs7 Aef6— Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 21"' Two Family ❑ Multi-Family(# units) Age of Existing Structure CC140 Historic House: ❑Yes UIo On Old King's Highway: ❑Yes A-Mb Basement Type: 2--r'ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 70 O 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 4 Heat Type and Fuel: ❑ Gas 2-61 ❑ Electric ❑ Other Central Air: ❑Yes Colo Fireplaces: Existing L New Existing wool al stoves ❑Y U-NO -• .J, co Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: LE9. fisting 0 newize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 0 cao Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w rn � n� Commercial ❑Yes _C�J'No If yes, site plan review # _ Current Use T�E3t��N't7A& Proposed Use t3tyet a'Il/}z APPLICANT INFORMATION C (BUILDER OR HOMEOWNER) Name JI6VeN �O(,L Telephone Number ZZ3_0-7T' Add rDA;> License # C5 _0C?CM62_ Home Improvement Contractor# Email �7Z�tL�C( �Tg/4Yw�lr . C Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C$� SIGNATURE 1-.-) DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED F ' MAP/PARCEL NO. ADDRESS "- - -VILLAGE . OWNER - DATE OF INSPECTION: = = FOUNDATION ' `{ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL--" w " PLUMBING: ROUGH FINAL ` GAS: ROUGH - FINAL FINAL BUILDING . DATCLOSED OUT ASSCfpIATION PLAN NO. �: �TFIET Town of Barnstable o� ' Regulatory Services • �asxsr�►au�. cress. $ Richard V.Scali,Interim Director s639. �e ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete.and Siam This Section If Using A Builder l L L L- asOwner of the subject property hereby authorize ^ -&J et3 to act on my behalf in all inattets relative to work authorized by this building permit to PA c� S (Address of Job) a 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 r inspections are performed and accepted. Signature of Owner e of Applicant Print Name Print Name VQ Ig3 Date Office of Consumer Affairs and Business Regulation -_ 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration' 176576 Type: LLC Expiration: 9/3/2015 Tr# 244445 COTUIT BAY DESIGN, LLC. - STEVEN COOK 43 BREWSTER ROAD MASHPEE, MA 02649 Update Address and return card.Mark reason for change. SCA 1 0 26M-Wil � Address [] Renewal Employment Lost Card J --- ----- �c �Lo��ciirorrufeall�o��CYllcu�rcc�aach; Office of Consumer Affairs&Business Regulation License or registration valid for individul use only kWME IMPROVEMENTCONTRACTOR before the expiration date. If found return to: gistration: 17�6Type: Office of Consumer Affairs and Business Regulation piration: 9[3/2015 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 COTUIT BAY DESIGN LLC. STEVEN COOK 43 BREWSTER ROAD - MASHPEE,MA 02649 Undersecretary of valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards {..1111�t1,ti1L11111 JUIIGI Y'11111 License: CS4)9W2 ````�r'is �!A STEVEN H COOJC'z 43 BREWSTER RBA1l./,-LJ' Mashpee MA 026 9 •y Expiration /ems=• Commissioner 07/16/2017 i � J 28'0" Cl• ; Bedroom #2 Bedroom #1 C1. . 8'-2"x 12'-4" 11'-6" x 12'-6" z Lin. 4 Bathroom f 5� x 9� f tm . l � 3 � i ipN _-— t ! � E s t t Living Room # 13'-6" x 18'-6" b Mud Room 8'-4" x 8'-io" r Y ■ ■ c 20�-� C5'n4GE mu t T is A MovkoD , Brown Cottage EXISTING CONDITION FLOOR PLAN 610 Main Street Centerville, MA Note:All Dimensions are approximate and are not to be used for construction. r �► r ` � _� ....■� '<, �. 3;:. '. ; - ,k ` f d � - — 07/2�2/2�014 r • �"', � - �. . _ . �� � � _ � ,1 -.�� � T;i �� _ _-- '�,. .' I 07/22/20 Cc,U-A C, o r� C��o�� tir •;� i. • O7/2"2/2014 Y;. 1111111 1 ----� -1111ll1 1 111IIII 1 i CC) l . 1 _� i 7-4 I& i i i s i r t� { i �t A I r I i j,. l � cQ t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel Application # Health Division Date Issued idI /S' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (-6 PC--ri' Historic - OKH _ Preservation/ Hyannis Project Street Address �, MAItj S Village (.����I-L .0 LLLG Owner WtLL1P5T:ko 1J}D6V,6RAH b�&J Address W 7 0Va&MMVK GALCH65T&k. V Telephone .Q ZE" 1 to Permit Request IDS-MLL. NCB KIIZH-L� (FIZe 1looscY lms-,At4aL 6A0 F&gkr;�\ l 0-M .err% G e d-6 05F, W 14 t o4 (A -u- RE 7AF ?&(AAAx KEs I ewc& Square feet: 1st floor: existing proposed 2nd floor: existing 16� proposed Total newer .Zoning District Flood Plain MA Groundwater Overlay Project Valuation V 10,000.00 Construction Type Lot Size Ao2z Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family kr' Two Family ❑ Multi-Family (# units) Age of Existing Structure lq`70 S Historic House: ❑Yes CAI o On Old King's Highway: ❑Yes �Jo Basement Type: ❑ Full awl ❑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 3 new First Floor Rao Count Heat Type and Fuel: M-6as ❑ Oil ❑ Electric ❑ Other 0 Central Air: ❑Yes l�No Fireplaces: Existing New Existing wood/ oal stove ❑'16M ®-No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ xisting ne y size_ �ro a Attached garage: Crexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: UJ A� ry rn Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes alo If yes, site plan review # Current Use IZ6;5t*P6J�A-L Proposed Use ��I I•ff1/�L APPLICANT INFORMATION ; ,(BUILDER OR HOMEOWNER) Name 6Tay&,.S Telephone Number (:io Address 4'5 FDREWST&V_ License # 4(;;Z Home Improvement Contractor# 5�1� Email 67b IT�Y �N-CGN+ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE '' DATE a FOR OFFICIAL USE ONLY r z APPLICATION# DATE ISSUED MAP f PARCEL N0. <" i ,r ADDRESS •. . :�m ' , +�. .. E.-_ 'VILLAGE- o _ •' ••� ,: 'w' OWNERf DATE OF INSPECTION: FOUNDATION FRAME ,.. 4 •. ' _. .. _- �, -•. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH -• FINAL GAS: ROUGH = FINAL FINAL BUILDING D*TS2CLOSED OUT ; As-s-o-GRATION PLAN NO. C r FROM THE DESK 0= 928.710-3973 L. PHILLIPS BROWN, DWI September 25, 2015 Thomas Perry, Building Commissioner Town of Barnstable Building Division 200 Main Street Hyannis, Massachusetts 02601 Re: 610 Main Street, Centerville, MA Dear Mr. Perry: My wife Deb and I are the owners of the above-referenced property. Approximately five years ago we began a renovation project in the carriage house located in the garage. As the project progressed, we realized we liked the space in the carriage house more that the cape style house located on our property. We decided to make the carriage house our main living area and added a kitchen. We are now trying to bring the property into compliance with Build- r ing Code requirements and the Town of Barnstable Zoning Ordi- nance. We are removing the kitchen from the cape-style house so there will only be one kitchen on the property. Our electrician has been issued a permit for the electrical work. Our plumber has ap- plied for a permit for removal of the kitchen and is waiting for it to be issued. M We have been working with Assistant Building Inspector Jeff Lau- zon in connection with our project. Mr. Lauzon has asked us to submit this signed, notarized letter stating our intentions for future use of the property. We intent to occupy the carriage house as our main living area. The cape style house will be used for family and guests. We recognize and acknowledge that the property is located in a single-family residential district. We agree that when rented, SUMMER:167 OVERLAKE DR.,COLCHESTER,VT 05446 WINTER:34638 N.93D PLACE,SCOTTSDALE,AZ 85262 PPAROWNDVMSGMAILCOM f IJ• r `1 FROM THE DESK OF L. PHILLIPS BROWN, DVM the property will be rented as one single-family residence and.not. as a two-family residence. Thank you for your consideration and assistance with this matter. If you need any additional documentation, please do not hesitate.to contact me directly. In the alternative, you may contact our attor-' ney, John Kenney, at his office in Centerville. Very truly.yours, L. Phillips Brown Cc: John W. Kenney STATE OF VERMONT County, ss. On this day of September, 2015, before me, the undersigned notary public, personally appeared L. Phillips Brown, and proved to me through satisfactory evidence of identification, which was to be the person whose name is signed on the preceding or attached document, and acknowledged tome that,he signed it voluntarily for its stated pur- pose. NotWy ublic: My commission expires: I %- PAGE 2 Town of Barnstable Regulatory Services °FINE Tn, �1- Richard V. Scali Director " Buil din Division iz;��sTA6 ARN TABI,�. g S E ;639 � Thomas Perry, CBO 139V20 4xs a¢xsrsazs Building Commissioner 575 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 _ September 21, 2015 Steven Cook 43 Brewster Rd. Mashpee, MA. 02649 RE: 610 Main St., Centerville, Map:207 Parcel: 013 Dear Mr. Cook, This letter is in response to application number 201504995 and 201504996 submitted to ' obtain a permit for work previously done without the proper permits. Unfortunately; as discussed on the phone previously,the application can not be approved at this time because of the following: 1) A notarized letter by the owner stating the purpose for the work and the'intended use of the property is needed to confirm compliance with the Zoning Ordinance for the Town of Barnstable. To date,this office has not received the above requested letter; therefore, can not proceed with the issuance of the building permit. Please do not hesitate to contact this office with any questions. Respectfully; hG�� 1 e . Lauzon Local Inspector jeffrey.lauzon@town.bamstable.md.us (508) 862-4034 y , n r. Town-of Barnstable 'AM& Py a" Assessing Division IF fir's sARNSTABLK 367 Main Street,Hyannis MA 02601 Office: 508-862-4022 Jeffrey A.Rudziak FAX: 508-862-4722 Director of Assessing October 4, 2010 L Phillips Brown& Deborah B. T. Donovan Brown Family Revocable Trust 1920 Harrison Blvd Boise, ID 83702 Re: Parcel#207/013 &207/010 610 & 612 Main Street, Centerville, MA Dear Mr. Brown&Ms. Donovan: Please be advised that for taxpayer convenience and efficiency of departmental records this office will be combining your FY2012 taxable parcels into one parcel for assessing purposes. You should start receiving one single tax bill starting with-the Fiscal Year 2012 Tax Bill that will be issued in December of 2011. This bill will be referenced as parcel number R207/013 and the remaining parcel (R207/010)will be cancelled. If you have any questions regarding this matter please-feel free to contact me at the number listed above. Respectfully, ken' e aey Property Transfer,Assistant QA—An—'t New Da4a—lSplits%ComhineLtnFY13.Joa 16,0„ 1 4 Brown—__ Living Room �Carriage�House _I 14'-6"x 15'-4" C10 Main Street Centerville, MA _ s, s. 24'0'1 E k _ -TCV Kitchen GAiZZIA(Sif 9'_4„x 15,_4„ I }: T0" H UP k I r 1 w I � 7. 2 Car Garage 24'0" 24'0" 23-4 x 23-io" f Y p Stor. F � } I 24'6" EXISTING CONDITION FIRST FLOOR PLAN COTOIT�ily1�.1 Note:All Dimensions are approximate -)1z-7 I,S and are not to be used for construction. 1 6'0" m, r Brown h Sleeping Area Carriage House 12'-8"x 15'-4" 610 Main Street Centerville, MA 24'0" Q f� F� Dressing Area 8-10 x15-4 TO„ � E; F. _t Bathroom Roof' t - 7'-4"x 9'-2" .Below } 3,Xs v Shower Lin. �DN £ ti d 24'0" ' 24'0" 5 Loft �r Storage 10'-0"x 11'-4„ 11'-8"x 13'-4" 'Y f eRoofLBelow, ,z 'L 24'6' EXISTING CONDITION SECOND FLOOR PLAN Note:All Dimensions are approximate (fOTU PT EAyDE%I6P and are not to be used for construction. �TME Town of Barnstable Regulatory Services Mz6;Z Richard V.Scab,Interim Director q. �0 63 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete.and Sign. This Section If Using A Builder yk ,as Owner of the subject property hereby authorize -t I b*!hJ eO CQQ(G to act on my behalf, in all matters relative to work authorized by this building permit (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. 7 ff V� Z Signature of Owner e of A licant pP VIA It �t lC-�-lpS (1�u.N Print Name Print Name Date E � dmjeffu Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176576 Type: LLC Expiration: 9/3/2015 Tr# 244445 COTUIT BAY DESIGN, LLC. STEVEN COOK 43 BREWSTER ROAD MASHPEE, MA 02649 Update Address and return card.Mark reason for change. SCA 1 0 loan-osni Address Renewal [I Employment (] Lost Card C/�c rlo��a»ta�rracall�o/C/llriSrcc�rrJe�t Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date If found return to: Pt.gi.tr. ... 176576Type: Office of Consumer Affairs and Business Regulation piration: -,.91 3/2015_, LLC 10 Park Plaza-Suite 5170 COTUIT BAY DESIGN LLC:, Boston,MA 02116 STEVEN COOK 43 BREWSTER ROAD MASHPEE,MA 02649 ��— Undersecretary lot valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards CDnstr uction C'iinei Ji-or License: CS4*W2 ter•:ris STEVEN H COOK-" �,^^�, 43 BREWSTER RUA10 a Mashpee MA 02C49 Expiration Commissioner 07/16/2017 f, r 07/29/2014 Till •rk.;, w 07/29/2014 M ♦ T, r art+,,�`� a. a. I � r a 07;224%'2014 07/2•2/2014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Vu Health Division Date Issued Conservation Division 1y Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1401a r! Village �� ��frl Owner � �," , J k Address Telephone Permit Request ;&- _1X_ \;�z Square feet: 1 st floor: existing propose 2nd flo r: isti proposed . Total new 0 Zoning District od Pla' undwater Overlay Project Valuation onstr ction Type Lot Size randfather ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family r 1 Two mily ❑ Multi-Family (# units) Age of Existing Structure _ His ric H se: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: °Full Crawl ❑Walko ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 4e-" S'Sr 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: X Gas Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood'/coal stove ❑Yes ❑.No Detached garage:X existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: gexisting Ll news size_ 4 m.. C.1) -Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ` . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 5.1 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use I I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a ' a _ _ Telephone Number , cy c I Address l License # Home Improvement Contractor# Email If s ` „ Worker's Compensation # y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE t i - r — FOR OFFICIAL USE ONLY �-- - �p F APPLICATION# DATE ISSUED ; E MAP/PARCEL N0. r ADDRESS ' VILLAGE ` OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 4 J Sawa "_ FIREPLACE ' ELECTRICAL: ROUGH FINAL s � 't. PLUMBING: ROUGH RNA L�� GAS: ROUGH FINAL ' ' FINAL BUILDING s; DATE CLOSED OUT r ASSOCIATION PLAN NO. 1 COASTAL ENGINEERING COMPANY, INC. 260 Cranberry Highway, Orleans, MA 02653 a 508.255.6511 a Fax 508.255.6700 a coastalengineeringcompany.com April 24, 2012 Project No. C17709.00 Mr. Brad Inkley 33 Lake Road West Yarmouth, MA 02673 Re: Condition Evaluation for Existing CMU (Concrete Masonry Unit) Foundation Wall at Garage (610 Mair Street;Centerville;MAI Dear Mr. Inkley: As requested, Coastal Engineering Company, Inc. (CEC) performed a structural condition assessment of the existing CMU (concrete masonry unit)garage foundation wall at the above referenced site. Based upon CEC's visual conditional assessment, the following observations were made: • The north"foundation wall of the garage retains soils from 1'-6" at front to 3'-9"at.back of garage. The CMU wallf is assumed un-reinforced and un-grouted. 0 There are three noticeable_vertical cracks along the entire height of.the foundation wall. One located 6' 0 +'fro m garage'opening`onnorth wall (crack"A!'), one located 13'-6"±from garage opening on north wall (crack B')`and'one`I;oeated'at:.the>back wall of.garage 1 0 ±from face of north wall of main house (crack"C ) ; :o • Crack-`A vanes from 3/4"to'/2'wide. The wall to the west of crack rotated '/2`out-of=plane;on top, which,`- b' used by footing settlement on north-west corner of the garage due to inadequate -compaction'''of'filled.material's at-the.time'of construction..,.The surcharge load from vehicles in the- garage may,also have contributed to crack and rotation of the wall. • Crack`"B' is a '/< wide vertical crack adjacent to post supporting the main floor girder. From the proximity of the crack location to post;'we can conclude that the crack,was.caused byexcess shear stress"in block's due-to high.point load`.from=;th:e..girder. ., • Crack"'C varies fr'orri '/2 to''f4"wide`Thejop:of.the wall.is pulling away slightly toward north which may be caused 13 f' oting settlement on`north-west corner of the garage due to inadequate compaction`of fill materials at the time of construction. • . .There is a i+ gap between the garage slab--on-grade and foundation Wall on the north side,which is caused by the foundation wall.pulling away at the north-west corner due to footing settlement. All three cracks appear to have been there for a long period of time based on the smooth_edges and efflo`r'escencealongside of cracks: Therefore; it is possible that;the;footing at the north west corner of ,the garageYmay have already settled land-reached its bearing capacity. • :Aside from the tnree`c"racks,the overall condition of the CMU foundation wall appears to.be i,n good :. .. condition , As a result of the--above''observatio:ns, CEC recommends the following repair.for cracks on the existing CMU fou'n'datiori'wall:' - • Prepare surface offthe area around cracks by scrubbing with wire brush to remove°an'`'loosened Y materials and clean,it with high-ptessure;hose:.Let.the.surface,and area dry, completely before' attempting.,to`patch or s'eal�cracks. Providing solutions for the benefit of our clients and community a I Mr. Brad 101ey Page 2 April 26, 2012 • Cracks"A"and "C"can be filled with Quikrete Hydraulic Water-Stop Cement. Fill the crack as tightly and completely as possible and trowel smooth the surface. See attached product data for additional application procedure. • Crack"B" and smaller cracks along the wall can be sealed with Quikrete Concrete Repair. Apply the Concrete Repair by pushing cartridge tip over surface and forcing the fill material deep into the crack then tool smooth the surface. See attached product data for additional application procedure. • Fill gap between slab and foundation wall with concrete and seal joints with flexible sealant. Assuming that no additional load is added to the garage structure, at this time, we do not believe additional measures are required other than crack repair remedies listed above, however, the owner of the property must periodically inspect the repaired area for new cracks. If new cracks reappear in the same area, the owner must commission a licensed structural engineer for further evaluation of the foundation walls and footings. Please note that this evaluation does not include structural analysis or capacity verification of the original structural system design. Please do not hesitate to contact us if you require additional assistance regarding this matter. Very truly yours, COAST L ENGINEERING CO., INC. OF P`SH Mq� ANDAEW H. y� A ew Lin, P.E. c ��N V CIVIL y No.48909 AHL/jak dO9o,�9Fcrs TEA��Enclosures: Photographs,Product Data Sheets SS�O .AL E D:I DOCI C 1 7 70011 77091reportllnkleyLet ter-2012-04-24.doc Front View of Garage m P@ I Good Overall Wall Condition e 1 u ¢ N y Crack „A„ Crack „B„ 11 w� M4�111v ..., ,.>.. ,._ .._. Crack "C" = _ —= Smaller Cracks - 77 m m .. .`. - - M2,,3 r - HYDRAULIC WATER-STOP CEMENT DIVISION 7 Cementitious Damp- PRODUCT DESCRIPTION Proofing 07 11 16 QUIKRETE Hydraulic Water-Stop Cement is a rapid setting, high strength repair material designed to plug leaks instantly in concrete and masonry. 0y PRODUCT USE ' QUIKRETE®Hydraulic Water-Stop Cement will block running water when application is made to masonry or concrete surfaces.This special formulation allows the product to obtain high strength and rapid setting while repelling water. - _ QUIKRETE®Hydraulic Water-Stop Cement solves leakage problems wherever active water is present,in all masonry and concrete above and below grade. Use QUIKRETE®Hydraulic Water-Stop Cement for sealing around Curing time concrete pipes and for plugging leaks in: Compressive strength •Foundation and retaining walls 2 hours 1000 psi(6.9 MPa) •Chimneys 24 hours 2500 psi(17.3 MPa) •Swimming pools,fountains and cisterns 7 days 4500 psi(31.1 MPa) 28 days 5500 psi 38.0 MPa SIZES Final set time Less than 5 min •QUIKRETE'Hydraulic Water-Stop Cement- - 10 lb(4.5 kg)pails INSTALLATION •20 lb(9.1 kg)pails SURFACE PREPARATION •50 lb(22.7 kg)pails All patch areas should be free of loose material,dirt,dust,algae and mildew. Preparation should include enlarging small cracks and holes YIELD and avoiding V-shape cuts. •Each 50 lb(22.7 kg)pail of QUIKRETE Hydraulic Water-Stop Cement will yield 0.42 cu ft(12 L). METHODS Starting at the top and working down,apply Water-Stop Cement while TECHNICAL DATA maintaining light pressure on the patch. Maintain pressure until initial APPLICABLE STANDARDS set begins and the leaking is stopped. ASTM International •ASTM C109/C109M Standard Test Method for Compressive MIXING Strength of Hydraulic Cement Mortars(Using 2-in. or[50-mm) Blend 4-41/2 parts Water-Stop Cement to 1 part water,by weight. Cube Specimens) Ingredients should be mixed to form a heavy putty consistency. Do •ASTM C191 Standard Test Method for Time of Setting of Hydraulic not mix more material than can be used in 2-3 minutes. In most Cement by Vicat Needle cases,limit batch size to 4—6 oz(113-170 g)of powder. Using 41/2 oz(128 g)of powder and 1 oz(28 g)of water will provide a golf ball PHYSICAUCHEMICAL PROPERTIES size mix,which is appropriate for most applications. QUIKRETE®Hydraulic Water-Stop Cement provides typical physical properties as shown in Table 1,when tested in accordance with CURING ASTM C191 and ASTM C109. No curing membranes or compounds are required. PRECAUTIONS •Mix no more than can be used in 3 minutes �'`'_ �" f -Hot temperatures will reduce the setting time.At colder companies' option, to refund the purchase price. In the event of a temperatures,below 50 degrees F(10 degrees C),use warm water. claim under this warranty, notice must be given to The QUIKRETE® Companies in writing. This limited warranty is issued and accepted in WARRANTY lieu of all other express warranties and expressly excludes liability for The QUIKRETE® Companies warrant this product to be of consequential damages. merchantable quality when used or applied in accordance with the instructions herein. The product is not warranted as suitable for any The QUIKRETE®Companies One Securities Centre purpose or use other than the general purpose for which it is intended. Liability under this warranty is limited to the replacement of (4 4 Piedmont Rd.,NE,Suite 1300,Atlanta,GA 30305 404)634-9100•Fax:(404)842-1425 its product (as purchased) found to be defective, or at the shipping Refer to www.quikrete.com for the most current technical data,MSDS,and guide specifications - ah - - - ,•g, �; ^i ..-, �a ,. <sus-,;.��=- cEMEmr& cosrcRErE~Ducrs— CONCRETE REPAIR • FRO.DDCT N S,%,862E�1�h 1 Concrete Materials & PRODUCT DESCRIPTION Methods 03 05 00 QUIKRETE® Concrete Repair is a superior acrylic latex formulation for crack repair in concrete, including concrete, stucco or masonry walls, sidewalks, patios and driveways. R, PRODUCT USE QUIKRETE Concrete Repair fills and repairs cracks up to%2"(13 mm)wide in concrete, masonry,stucco,sidewalks,patios and driveways. Benefits include: -Dries quickly to a tough and flexible finish •Helps prevent water and ice damage to concrete surfaces Weather resistant •Excellent adhesion Textured to blend with concrete surfaces (4)Excess Concrete Repair can be wiped off with a damp cloth. •Easy clean up with water before product dries (5)Wait at least 24 hours before painting. Use latex paints only.Air and surface temperature should be above 40°F(40C)for proper SIZES application. QUIKRETE& Concrete Repair is available in 5.5-fl.oz. (163 ml) (6)Do not apply if rain threatens or is predicted within 12 hours squeeze tubes and 104oz.(296 ml)standard caulking tubes PRECAUTIONS YIELD May cause eye,skin and respiratory irritation.Avoid contact with •5.5-fl.oz(163 ml)tubes will yield about 12 lineal feet(3.7 M)at a'/" eyes,skin and clothing.Avoid breathing vapor. Use only with (6 mm)diameter bead adequate ventilation. Ingestion may cause irritation.Store between 35 • 10.1-fl.oz(296 ml)tubes will yield about 24 lineal feet(7.3 M)at a'/ °F(2(,C)and 100°F(38°C). (6 mm)diameter bead or 12 lineal feet(3.7 M)for a 3/8"(9mm) WARRANTY diameter bead The QUIKRETE@ Companies warrant this product to be of merchantable quality when used or applied in accordance with the INSTALLATION instructions herein. The product is not warranted as suitable for any SURFACE PREPARATION purpose or use other than the general purpose for which it is Clean all loose dirt,dust and gravel from the crack. Surfaces to intended. Liability under this warranty is limited to the replacement of receive Concrete Repair should be dry and free of oil and grease. its product (as purchased) found to be defective, or at the shipping companies' option, to refund the purchase price. In the event of a APPLICATION claim under this warranty, notice must be given to The QUIKRETE® (1)Cut tip of spout on angle to make a (6 mm)to 3/8"(9 mm)hole. Companies in writing.This limited warranty is issued and accepted in (2)Use cartridge in standard caulking gun.Apply by pushing cartridge lieu of all other express warranties and expressly excludes liability for tip over surface and forcing bead of Concrete Repair deep into the consequential damages. crack.Apply no thicker than 3/8"(9 mm)at a time.On horizontal The QUIKRETEO Companies surfaces,deep cracks can be partially filled with sand prior to One Securities Centre application. 3490 Piedmont Rd.,NE,Suite 1300,Atlanta,GA 30305 (3)Concrete Repair can be tooled to smooth the surface. (404)634-9100•Fax:(404)842-1425 'Refer to www.quikrefe.com for the most current technical data,MOS,and guide specifications TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0 Map `2-o-7 Parcel L�0n qr 'A `lication ` `�°�`� Health Division Date Issued (L Conservation Division Application 4ed Planning Dept. Y' Perm. it Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address '?f j Village- .,ry Owner All&I r? Cao w,?l Address Telephone 472 _ 7le ~ 3 9 7 3 Permit Request 1-5�� if Jft4f � A/� tjV<� eys7d-�_7 14,v �_� I?v, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay oject•Valuationv I cli 2F1,dO 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) C> 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' w, Heat Type and Fuel: A Gas ❑ Oil ❑ Electric ❑ Other Central Air: 51 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 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 v_--Addres`s N License-4, q Home Improvement Contractor# I Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE-"- DATE,.•.. ,ohsbl 5 ,r E' s FOR OFFICIAL USE ONLY F v APPLICATION# F � { DATE ISSUED r MAP/PARCEL NO. h ADDRESS VILLAGE } OWNER DATE OF INSPECTION: FOUNDATION v FRAME INSULATION' �a7.G 7� o re e Z t FIREPLACE 9 t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ., -GAS: r ROUGH FINAL :: FINAL BUILDING . _ DATE CLOSED OUT ASSOCIATION PLAN NO F The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv ' 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 7A T J., Address: J o2, ► City/State/Zip: :&4 Phone #: -T 7,q 2l Z-2—9Z� Are you an employer?Check the appropriate box: Type of project(required): 1.[4 I am a employer with I _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 5g Remodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' insurance.$' 9. ❑ Building addition [No workers' comp. insurance comp. 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 I LF]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: W G 7 Q j' j q Expiration Date: o# /as/1 r l 2 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer fy u der the pains and penalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: BOARD A MASTER UNRESTRICT EDERS , :: ;ABOVE LICENSE T& JAMES M JACKSON JMJ'HE_ATING & COOLING 106 ELIZABETH LN DENNIS MA 02660-2606 642 02/28/12 797237 YVA SACHUSGT-i.� IN LICENSED AS A JOURNEYMAN PLUMBEP,, ISSUES THIS LICENSE TO JAMES M JACKSON 106 ELIZABETH LANE SOUTH DENNIS MA 0266.0-2606 25949 05/01/12 763034 ` i:. III e n c U 8/04/II Brad Inkley 33 Lake Rd West Yarmouth,MA 02673 ORe:Installation of a.new heating system for#610A Main Street,Osterville,MA - UOI will supply materials and labor to famish and install a new gas furnace and insulated v two zone duct system for the first and second floor of the existing building.All work will be performed in a neat workmanlike manner by licensed professionals in �J compliance with State and Local Codes.The following is included: I-Goodman gas furnace with an AFUE rating of 95%efficiency 4-j (t I-Goodman 16 SEER condenser' Insulated plenums Venting with schedule 40 PVC to the rear of the house FSK Insulated galvanized sheet metal duct work with insulated flex duct to the individual registers. Condensate pipmg'and drain 2-Digital thermostats - u 2-Honeywell zone dampersL$ �J I-Honeywell zone controller I-Barometric"dump zone" damper y Electrical wiring by others v Total: $16,920.00 tion A:If Amana equipment is desired for both heating and air conditioning, add: $2,002.00. tion B:If i'install an April Air media filter system add, $364.00(If installed at the time of installation of the heating system . Terms.One third due upon acceptance,one third due upon commencement of work and the balance due upon substantial completion..Afinance charge of 1 112%will be added to any balance over 30 days.Should collection be necessary,all r/pl.O.Box 42I attorney's fees,court costs and other collection costs incurred will be added to the outstmdinp amount. ProAosed Ae t by south Dennis,MA 02660 774-2I2-296I amon ACORD CERTIFICATE OF LIABILITY INSURANCE ' °ATE(MMIDDIYYYY) . 04/2Z/2Oil PRODUCER (800)666-0200 FAX (781)261-I111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Main ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 77 Accord Park Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Unit 81 ALTER THE COVERAGE AFFORDED BY THE P.OLIGIES%69% Norwe77, MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED JMJ HEATING AND COOLING INC INSURERA: Selective Insurance Co of SC 19259 106 ELIZABETH LN INSURERB: Selective Ins Co of Southeast 39926 SOUTH DENNIS, MA 02660-2606 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TRW XDD'L POLICY ERPTIUVrm LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DD/YYYY LIMITS GENERAL LIABILITY S 1928898 0410512011 0410512012 EACH OCCURRENCE $ 11000,0001 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,OO CLAIMS MADE rX OCCUR MED EXP(Any one person) $ 10,00( A PERSONAL&ADV INJURY $ 1 1 000 1 00 GENERAL AGGREGATE $ 3,000,00( GENT AGGREGATE LIMIT APPLIES PER:7X POLICYPRODUCTS-COMP/OP AGG $ 3,QQQ,QQ PRO- JECT LOC AUTOMOBILE LIABILITY A 9092892 0410512011 04/0S/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ -" EXCESS I UMBRELLA LIABILITY v EACH OCCURRENCE $ " OCCUR CLAIMS MADE + AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC 7938793 04 AND EMPLOYERS'LIABILITY Y/N /O5/2011 0410512012 X TORY LIMITSI IQTH ER ANY PROPRIETOR/PARTNER/EXECUTIVE� E.L.EACH ACCIDENT $ 5001 QQ B OFFICER/MEMBMBER EXCLUDED? (Mandatory in NH) z If yes,describe under E.L.DISEASE-EA EMPLOYE $ 5001 QQ SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 5001 QQ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS vidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR. REPRESENTATIVES. -- AUTHORIZED REPRESENTATIVE. ----- � v--- Donald Ri e11 Jr -- ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. - The ACORD name and logo are registered marks of ACORD r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ali .07 Parcel Application # O0 [ 6q `_77 Health Division Date Issued kk Conservation Division A' Application Fee 'y1 Planning Dept. . . - Permit Fee Date Definitive Plan Approved by Planning Board F ` "r'P Historic - OKH _ Preservation / Hyannis Project Street Address 12-7 a� Village e Z Owner Address 4�6�1,274 6:�6_P Telephone a773 — 4f�;'~_ Permit Request 7,-n "4-1i'IS& cieE� e�.eL5/'rl , l Square feet: 1 st floor: existing proposed 2nd floor: existingroposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation g ..��00,4V 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 �C'I ICJ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 1-:'-Z Ste' Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing �2' new First Floor Room Courts �fl, Heat Type and Fuel: 20as ❑Oil ❑ Electric ❑ Other € Central Air: Yes ❑ No Fireplaces: Existing New �_ Existing wood/'coal stogie,: LYY Ps 4No F� Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing =� new,;., size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: NO Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Qs�No If yes, site plan review# Current Use ez.,in)r4 �R5 Proposed Use f'A&gR APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 4 Named' ) � Telephone Number �J� �3 Address 4de- &o License# ' Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO12o®3�t�fC SIGNATURE G� DATE � �� s i FOR'OFFICIAL USE ONLY y APPLICATION# • ! r DATE ISSUED ' MAP/PARCELNO. ADDRESS j ' VILLAGE OWNER ` DATE OF INSPECTION: i k I FOUNDATION FRAME /s�lZ "1I7—if INSULATION � (oI ,w FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH »II FINAL" ' 1 GAS: ROUGH FINAL p i FINAL BUILDING y G a Vf3�/ DATE CLOSED OUT r r ASSOCIATION PLAN NO. i - t Town of Barnstable Regulatory Services i •" t Thomas F.Gefler,Director WAAL Building Division Tom Perry,Building Commissioner 200 Main Str=4 Hyannis,'MA 02601 www.town.barnstabUma.us Office: 508-8624038 Fax: 508-790-6230 Pro Owner Must e Own Property Complete and Sign This Section If Using A Builder I, jrt as Owner of the subject property hereby authorize 3� ',7 K`� to act on mybeW, in all matters relative to"work authorized bythis btkding permit application for. Ca �.�I Gar (Address of Job) Signature o er Daze Print None If Proper Owner is apply ng;for permit please complete the. Homeowners License Exeinption Form on the reverse side. Q:FORWOwNWERMiSSION t /�aaaaclz"elm reg►strat►omval►d for►nd►v►dul use only, f °"'moru License,or { Office o onsumer ffau s B mess Regulation HOME.IMPROVEMENT.CONTRACTOR before the expiration date If found return to: Type: Office of Consumer Affairs and Business Regulation p. i Registration 151420 Yp 10 Park Plaza-Suite 5170 Expiration: 5/26/2l)12 DBA Boston,MA 02116 B-, 8 HOME MAINTENANCE BRADFORD INKL` Y`- 33 LAKE ROAD W YARMOUTH, MA M679 Undersecretary of valid with nature' ; 0 Masslicilusetts- De ru•tn►c►it of Public Safety. Board of' Buildinl- Re-ulations,and Stand ►►d� `. Construction Supervisor License ,I Licensek'C9 .92159. Y ; BRADFORD N .INKLEY +a .3D LAKE RD x yi V�YARMOOT.H MA 02673 �-- - - Expiration: 11/15/2012IF yi f umiuissiuncr. Ti#:' 5642 t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/IndMdual): Address: City/State/Zip: ` ! Phone#: Are you an employer?C ck the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): �,� employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction I am a sole proprietor or partner- t 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 re uired. q ] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4),and we have no 12:❑Roof repairs employees. [No workers' 13.11 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, xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hav employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. e 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:_ n'l/ /1� �el�lft 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 certify under the pai d en ties f perjury that the information provided above is true and correct Signature, 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#: i �FTME r Town of Barnstable Regulatory Services BA"* M s& E Thomas F.Geiler,Director 9� 1639. ' �FDMp'lA Building Division, Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 October 19, 2011 Bradford Inkley 33 Lake Rd. W. Yarmouth, Ma. 02673 RE: 610 Main St., Centerville, Ma. Map: 207 Parcel: 013 Dear Mr. Inkley: - This letter is in pP response to application number 201104977 submitted to do work at the p above referenced address. The construction documents as submitted, show conflicting information and compliance with 780 CMR can not be verified. Specifically,the floor, plans do not match the information provided on the REScheck. Additionally, the locations of the life safety devices are not shown. Therefore, your application can not be approved at this time. If you have any questions regarding this matter, please do not hesitate to call this office. Respectfully, e L. Lauzon Local Inspector (508) 862-4034 I i Q:zoning5 Ok ��Ilalu Page 1 of 1 Lauzon, Jeffrey From: Dr Phil Brown [philbrowndvm@cableone.net] Sent: Monday, November 14, 2011 2:04 PM To: Lauzon, Jeffrey Subject: letter November 14, 2011 Jeff, Brad Inkley asked me to send a letter to you regarding use of 610 Main Street, Centerville, MA. Deb and I have owned the Centerville property for almost 15 years. When I decided to retire and move back to the Cape (I owned,a veterinary practice in South Yarmouth for 20 years); I wanted space to work on projects, such as sail making, woodworking, re-finishing antique furniture, etc. The main house is approximately 900 square feet, and it seemed only logical to re-build the dilapidated structure adjoining the garage as a work space capable of housing equipment, including my table saw,joiner, planer and assorted hand tools (too many, according to my wife). I have upgraded roofing, windows, insulation (none previously), heating (replaced a propane stove)to improve thermal efficiency and reduce waste. These changes were done to provide me a comfortable and large work area and improve the property- not to make it suitable as a rental. This will be place large enough for me to comfortably work. I feel a full bath is needed because the one in the main house is very small, and I can't drag sawdust and dirt into the small main house without getting in trouble. I also would like a washer/dryer for rags, work clothes, etc because the current one is in the basement of the main house and hard to access. A sitting area is helpful for design time and supply sourcing. feel that the upgrades will benefit the property and the neighborhood and am becoming frustrated that so many obstacles are being placed in the way of improvement. This drawn out process has also prevented me from returning to the Cape. L.Phillips Brown DVM x Corporate Veterinarian Newman's Own Organics email: philbrowndvm@cableone.net 11/30/2011 REScheck Software Version 4.4.2 Compliance Certificate Project Title: 2nd Floor Addition Energy Code: 2009 IECC Location: Barnstable,Massachusetts Construction Type: Single Family Project Type: Addition/Alteration Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 610 Main St. Brad Inkley Centerville,MA 02632 . 33 Lake Rd. W.Yarmouth,MA 02673 Compliance:5.2%Better Than Code Maximum UA:155 Your UA:147. The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. , It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. R9 OEM- Ceiling 1:Cathedral Ceiling(no attic) 792 40.5 0.0 21 Ceiling 2:Cathedral Ceiling(no attic) 154 35.0 0.0 5 Wall 1:Wood Frame, 16"D.C. 270 15.0,. 0.0 21 Wall 2:Wood Frame, 16"D.C. ,900 _ 15.0 6.0 39 Window 1:Vinyl Frame:Double Pane with Low-E 83 0.320 27 Door 1:Solid 40 0.280 11 Floor 1:All-Wood Joist/Truss:Over Outside Air 96• 38.0 0.0 2 Floor 2:All-Wood Joist/Tru ss:Over Unconditioned Space 636 30.0 0.0 21 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other• calculations submitted with the permit application.The proposed building has been designed to meet the 2009 IECC requirements in REScheck Version 4.4.2 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: 2nd Floor Addition � Report date: 11/02/11 Data filename:C:\Documents and Settings\Chris Legere\My Documents\REScheck\#8325 Brad Inkley.rck Page 1 of 4 REScheck Software Version 4.4.2 Inspection Checklist ' Ceilings: F� s ❑ Ceiling 1:Cathedral Ceiling(no attic),R-40.5 cavity insulation Comments: ❑ Ceiling 2:Cathedral Ceiling(no attic),R-35.0 cavity insulation Comments: ` Above-Grade Walls: ❑ Wall 1:Wood Frame, 16"o,c.,R-15.0 cavity insulation Comments: ❑ Wall 2:Wood Frame,16"o.c.,R-15.0 cavity+R-6.0 continuous insulation Continuous insulation specified for this above-grade wall has consistent R-value rating across full area of the wall. Comments: Windows- ❑ Window 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.320 T . For windows without labeled U-factors,describe features: , #Panes Frame Type Thermal Break? Yes No { Comments: Doors: ❑ Door 1:Solid,U-factor:0.280 , Comments: Floors: ❑ Floor 1:All-Wood J oist/Truss:Over Outside Air,R-38.0 cavity insulation Comments: I Floor insulation is installed in permanent contact with the underside of the subfloor decking, ❑ Floor 2:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation Comments: I Floor insulation is installed in permanent contact with the underside of the subfloor decking.. 4 Air Leakage: I (j Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or solid material. ❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,'and in openings between window/doorjambs and framing. Recessed lights in the building thermal envelope are 1)type[Grated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ' ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed to maintain insulation application. ❑ Wood-burning fireplaces have gasketed doors and outdoor combustion air. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Air Sealing and Insulation: ❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower door test result of less than 7 E ACH at 50 pascals OR 2)the following items have been satisfied: (a)Air barriers and thermal barrier: Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or repaired, Project Title: 2nd Floor Addition Report date: 11/02/11 ! Data filename:C:\Documents and Settings\Chris Legere\My Documents\REScheck\#8325 Brad Inkley.rck Page 2 of 4 (b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c)Above-grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d)Floors:Air barrier is installed at any exposed edge of insulation. . (e)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or sprayed/blown insulation extends behind piping and wiring. (>) Corners,headers,narrow framing cavities,and rim joists are insulated. (9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall. Sunrooms: Lj Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. Materials and equipment are identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation:. Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. , Duct Construction and Testing: ❑ Building framing cavities are not used as supply ducts.- - ❑ All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet-metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). ❑ Duct tightness test has been performed and meets one of the following test criteria: (1)Postconstruction leakage to outdoors test:Less than or equal to 8 cfm per 100 ft2 of conditioned floor area. (2)Postconstruction total leakage test(including air handler enclosure):Less than or equal to 12 cfm per 100 ft2. (3)Rough-in total leakage test with air handler installed:Less than or equal to 6 cfm per 100 ft2 of conditioned floor area. (4)Rough-in total leakage test without air handler installed:Less than orYequal to 4 cfm per 100 ft2 of conditioned floor area. Temperature Controls: rl Where the primary heating system is a forced air-furnace,at least one programmable thermostat is installed to control the primary heating system and has set-points initialized at 70 degree F for the heating cycle and 78 degree F for the cooling cycle. ❑ Heat pumps having supplementary electric-resistance heat have controls that prevent supplemental heat operation when the compressor can meet the heating load. Heating and Cooling Equipment Sizing: ❑ Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. Cj For systems serving multiple dwelling units-documehtation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). Circulating Service Hot Water Systems: Li Circulating service hot water pipes are insulated to R-2. Lj Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: Project Title: 2nd Floor Addition Report date: 11/02/11 Data filename:C:\Documents and Settings\Chris Legere\My Documents\REScheck\#8325 Brad Inkley.rck Page 3 of 4 r . ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: Heated swimming pools have an on/off heater switch. Pool heaters operating on natural gas or LPG have an electronic pilot light. Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems.' ❑ Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source Lighting Requirements: A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a)Compact fluorescent (b)T-8 or smaller diameter linear fluorescent ' (c)40 lumens per watt for lamp wattage<=15 ; (d)50 lumens per watt for lamp wattage>15 and<=40 (e)60 lumens per watt for lamp wattage>40 i Other Requirements: Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is. - above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement's'). Certificate: ❑ A permanent certificate is provided on or in the electrical'distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment:The certificate does not cover or obstruct the visibility' of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) 1 i Project Title: 2nd Floor Addition Report date: 11/02/11 Data filename:C:\Documents and Settings\Chris Legere\My Documents\REScheck\#8325 Brad Inkley.rck Page 4 of 4 2009 IECC Energy Efficiency Certificate k Ceiling/Roof 40.50 Wall 21.00 Floor/Foundation 30.00 Ductwork(unconditioned spaces): �.. Window 0.32 Door 0.28 NA Heating System: Cooling System: Water Heater: Name: Date: . Comments: f �•Forte MEMBER REPORT BEAM'A DORMER ROOF BM,Root.Flush Beam PASSED software 2 piece(s) 1 314" x 14"' 1.9E Microllam@LVL Overall Length:16' 0 0 12 0� 16, Iq 2❑ All Dimensions are Horizontal;Drawing is Conceptual Design Results Actual @ Location Allowed Result. LDF. System:Roof Member Reaction(Ibs) 5388 @ 2" _ 8881 Passed(61%) Member Type:Flush Beam Shear(Ibs) 4406 @ 1'5 1/2" 10707 Passed(41%) _ 1.15 Building Use:Residential Moment(Ft-Ibs) 20664 @ 8' 27897 Passed(74%) 1.15 Building Code:IBC Live Load Defl.(in) 0.406 @ 8' 0.522 Passed(U463) -- Design Methodology:ASD Total Load Defl.(in) 0.652 @ 8' 0.783 Passed(1-1289) Member Pitch:0112 • Deflection criteria:LL(L/360)and TL(U240). • Design results assume a fully braced condition where all compression edges(top and bottom)are properly braced to provide lateral stability. • Bracing(Lu):All compression edges(top and bottom)must be braced at 7'1 11/16"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Total Available Required Support Reactions(Ibs)Bearing Bearing Beoring Supports Dead/Floor/Roof/Snow/ Accessories r Wind/Seismic 1 -Column-Hem Fir 3.50" 3.50" 2.12" 2028/0/0/3360/0/0 None 2-Column-Hem Fir 3.50" 3.50 2.12" 2028/0/013360/0/0 None Tributary Floor Roof Loads Location Width Dead Live , Live ' Snow Wind, Seismic Comments (0.90) (1.00) (non-snovr.1.26) (1.15) (1.60) ._ _ (1.60). 1 Uniform(PLF) 0 to 16' N/A 240.0 0.0 0.0 420.0 0.0 0.0 Snow (LEVEL@ Notes- - - - n SUSTAINABLE FORESTRY INITIATIVE iLevel@ warrants that the sizing of its products will be in accordance with iLevel@ product design criteria and published design values. iLevel®expressly disclaims any other warranties related to the software.Refer to current iLevel@ literature for installation details. (www.iLevel.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,. builder or framer is responsible to assure that this calculation is compatible with the overall project.iLevel@ products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator ForteT"'Software Operator Job Notes 5/18/2011 1:45:53 PM William Rubel BRAD IniKLEY iLevel@ ForteTM v2.0,Design Engine:V5.1.0.3 Mid Cape Home Centers BROWN JOB (508)398-6071 x 4990 610 MA114 ST brubel@midcape.net CENTERVILLE MA Page 2 of 5 �•■ Fte or MEMBER REPORT BEAM B-2ND FLOOR AT BM A,Floor Flush Beam PASSED software 3 piece(s) 1 3/4"x 91/2"1.9E Microllam@LVL Overall Length:12' 0 0 12' . All Dimensions are Horizontal;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF System:Floor Member Reaction(Ibs) 5023 @ 11'10" 6674 Passed(75%) -- Member Type:Flush Beam Shear(Ibs) 4943 @ 10'11" 10898 Passed(45%) 1.15 Building Use:Residential Moment(Ft-Ibs) 9063 @ 10' 20312 Passed(45%) 1.15 °Building.Code:IBC Live Load Defl.(in) 0.167 @ 6'7 11/16" 0.292 Passed(L/838) -= Design Methodology:ASD Total Load Defl.(in) 0.265 @ 6'7 13/16" 0.583 Passed(L/528) • Deflection criteria:LL(U480)and TL(U240). • Design results assume a fully braced condition where all compression edges(top and bottom)are properly braced to providelateral stability. • Bracing(Lu):All compression edges(top and bottom)must be braced at 1 V 9 1/2"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Total Available • 'Required Support Reactions(Ibs) Supports Dead/Floor/Roof/Snow/ Accessories Bearing Bearing Bean ng Wind/Seismic 1 -Stud wall-Spruce Pine Fir 3.50" 2.25" 1.50" 484/324/0/528/0/0 1 1/4"Rim Board 2-Beam-Southern Pine 3.50" 2.25" 1.69 1875/324/0%2832/0/0 . 1 1/4"Rim Board' • Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Tributary Floor. Roof Loads Location Width Dead Live Live Snow Wind Seismic Comments (0.90) (1.00) (non-snow 1.25) (1.15) (1.60) (1.60), 1 -Uniform(PLF) 0 to 12' N/A 14.0 54.0 0.0 0.0 0.0 0.0 Residential-Living Areas 2-Point(lb) 10, N/A 2028 0: 0 3360 0 0 POINT LOAD FROM BM A (LEVEL®Notes (ZSJ SUSTAINABLE FORESTRY INITIATIVE iLevel®warrants that the sizing of its products will be in accordance with iLevel®product design criteria and published design values. l iLevel®expressly disclaims any other warranties related to the software.Refer to current iLevel®literature for installation details. (www.iLevel.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record, builder or framer is responsible to assure that this calculation is compatible with the overall project.iLevel®products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator ForteTm Software Operator Job Notes 5/18/2011 1:45:54 PM William Rubel BRAD INKLEY iLevel®ForteT""v2.0,Design Engine:V5:1.0.3 Mid Cape Home Centers BROWN JOB (508)398-6071 x 4990 610 MAIN ST brubel@midcape.net CENTERVILLE MA Page 3 of 5 r •� Fort@ MEMBER REPORT BEAM C-2ND FLOOR AT BM B,Floor.Flush Beam PASSED•software 2 piece(s) 1 3/4" x 9 1/2" 1.9E Microllam®LVL Overall Length:12' p U. 12' 2❑ All Dimensions are Horizontal;Drawing is Conceptual Design'Results Actual @ Location Allowed Result LDF System:Floor Member Reaction(Ibs) 2135 @ 2" 3347 Passed(64%). Member Type:.Flush Beam Shear(Ibs) 1781 @ 1'1" 7265 Passed(25%) 1.15 Building Use:Residential Moment(Ft-Ibs) 6162 @ 6' 13541 Passed(46%) 1.15 Building Code:IBC Live Load Defl.(in) 0.220 @ 6' 0.292 Passed'(U637) Design Methodology:ASD Total Load Defl.(in) 0.340 @ 6' 0.583 Passed(U411) -- • Deflection criteria:LL(L/480)and TL(L/240). • Design results assume a fully braced condition where all compression edges(top and bottom)are properly braced to provide lateral stability. Bracing(Lu):All compression edges(top and bottom)must be braced at 11'9 1/2"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Total Available Required Support Reactions(Ibs) pp Su ortS Dead/Floor/Roof/Snow/ Accessories , Bearing Bearing Bearing. Wind/Seismic $` 1 -Stud wall-Spruce Pine Fir 3.50" 2.25 1.50" 768/324/0/1080/010 1 1/4"Rim Board 2-Beam-Southern Pine 3.50" 2.25" ° 1.50 768/324/0/1080/0/0 1 1/4"Rim Board • Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Tributary_ Floor Roof Loads Location Width Dead =. Live Live Snow Wind.- Seismic Comments (0.90) (1.00) (non-snow.1.26) (1.15) (1.60) (1.60) 1 -Uniform(PLF) 0 to 12' N/A - 14.0 54.0 0.0 0.0 0.0. 0.0 Residential-Living Areas 2-Uniform(PLF) 0 to 12' N/A 45.0 0.0 0.0. 1 180.0 0.0 0.0 ROOF LOAD, 3-Uniform(PLF) 0 to 12' N/A 60.0 0.0 0.0 6.0 0.0 0.0 WALL LOAD iLEVEL®Notes ` 1 SUSTAINABLE FORESTRY INITIATIVE iLevel®warrants that the sizing of its products will be in accordance with iLevel@ product design criteria and published design values. 111 iLevel@ expressly disclaims any other warranties related to the software.Refer to current iLevel@ literature for installation details. (www.iLevel.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record, builder or framer is responsible to assure that this calculation is compatible with the overall project.iLevel@ products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator ForteTm Software Operator Job Notes 5/18/2011 1:45:54 PM William Rubel BRAD 114KLEY iLevel®ForteTM v2.0,Design Engine:V5.1.0.3 Mid Cape Home Centers BROWN JOB (508)398-6071 x 4990 610 MAIN ST brubel@midcape.net CENTERVILLE MA Page 4 of 5 , • Fort@ MEMBER REPORT BEAM D MAIN GARAGE BEAM,Floor:Drop Beam PASSED •software 4 piece(s) 1 3/4" x 18" 1.9E Microllam®LVL Overall Length:24' 0 0 24' 1❑ 2❑ All Dimensions are Horizontal;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF' System:Floor Member Reaction(Ibs) 12640 @ 23'8" 28875 Passed(44%) - Member Type:Drop Beam Shear(Ibs) 11397 @ 22'1/2" 23940 Passed(48%) 1.00 Building Use:Residential Moment(Ft-Ibs) 72386 @ 15'5 1/4" 77506 Passed(93%) 1.00" Building bode:IBC Live Load Defl.(in) 0:762 @ 12'4 3)16" 0.778 - Passed(U368) Design Methodology:ASD r- Total Load Defl.(in) 1.127@ 12'5 1/4" 1A67 Passed(U248) • Deflection criteria:LL(U360)and TL(U240). • Design results assume a fully braced condition where all compression edges(top and bottom)are properly braced to provide lateral stability. • Bracing(Lu):All compression edges(top and bottom)must be braced at 4'1 1/2"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. r t + • `. Total Available Required Support Reactions(Ibs) Supports Bearing Bearing Bearing Dead/Floor/Roof/Snow/ Accessories Wind/Seismic 1 -Column-Southern Pine 5.50" 5.50" 1.87 2845/6953/0/0/0/0 . None; 2-Column-Southern Pine 5.501, 5.50" 2.411, 4161 /8479/0/0/0/0 None Tributary Floor Roof Loads Location Width Dead Live - Live Snow Wind , Seismic Comments (0.90) (1.00) (non-snow.1.25) (1.15) (1.60) . (1.60) 1 Uniform(PLF) 0 to 24' N/A 120.0 480.0 0.0 0.0 0.0 0.0 Residential Living Areas 2-Point(lb) 16' N/A 2199 2832 0 0 0 0 POINT LOAD FROM BM L, B 3-Point(lb) 18' N/A 1092 1080 0 0 0 0 POINT LOAD FROM BM g , C� (LEVEL®Notes, ^SUSTAINABLE FORESTRY INITIATIVE { iLevel®warrants that the sizing of its products will be in accordance with iLevel®product design criteria and published design values. iLevel®expressly disclaims any other warranties related to the software.Refer to current iLevel®literature for installation details. (www.iLevel.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record, builder or framer is responsible to assure that this calculation is compatible with the overall project.iLevel®products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator t N Forten"Software Operator Job Notes 5/18/2011 1:45:54 PM William Rubel BRAD INKLEY iLevel®ForteTM v2.0,Design Engine:V5.1.0.3 Mid Cape Home Centers BROWN JOB (508)398-6071 x4990 610 MAIN ST brubel@midcape.net CENTERVILLE MA Page 5 of 5 r 'ZX y 071n 1414T��s !/, 3 � G . r } TOWN OF BARNSTABLE,BUILDING PERMIT,APPLICATION Map Parcel l� Application # L0015- 8 1 Health-Division Date Issued Conservation Division �11w Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis !I�z��lo — Y :V Project Street Address I`Yl Village G l Owner rO Q_A Address Telephone 10 C.f Permit Request I Sr' � ` �' 'ice Lr_ /W rn ltv ' r l� r F Square feet: 1 st floor: existing proposed '/660 2nd floor: existing-17 proposed: : Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3�,5'6v�o Construction Type , Lot Size Grandfathered: 0 Yes ❑ No If yes, attach orting cum%ation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure G Historic House: ❑Yes ❑ No On Old King's H hway: YeEW No ;o v' Basement Type: ❑ Full xrCrawlG` ❑Walkout ❑Other w cA `- 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 9, new First Floor Room Count Heat Type and Fuel: VG as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 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 P ,es site Ian review # J Y Current Use 01or a^�� Proposed Use Z it �S' S- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ir)gn ZUd tey/ Telephone Number Address 110 License #� � bendi'S Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE G DATE r ; FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED � ` € MAP/PARCEL NO. ADDRESS VILLAGE y f OWNER DATE OF INSPECTION: FRAME J 113111 b &V hle 1/ 4 A`INSULATION11l .`kl FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL H GAS: r: -ROUGH iWW -1 P-'- FINAL tiQ'IfFINAL BUILDING; C 7 ' Z =,.=SPATE CLOSED OUT .L, 1 ASSOCIATION PLAN NO. } a Town of Barnstable Assessing Division 1, COPY sA MST"M 367 Main Street,Hyannis MA 02601 MASS. a Office: 508-862-4022 Jeffrey A.Rudziak FAX: 508-862-4722 Director of Assessing October 4, 2010 f L Phillips Brown& Deborah B. T. Donovan Brown Family Revocable Trust l: " 1920 Harrison Blvd Boise, ID 83702 Re: Parcel#207/013 & 207/010 610 & 612 Main Street;Centerville,MA Dear Mr. Brown&Ms. Donovan: Please be advised that for taxpayer convenience and efficiency of departmental records this office will be combining your FY2012 taxable parcels into one parcel for assessing purposes. You should start receiving one .single tax bill starting with the Fiscal Year 2012 Tax Bill that will be issued in December of 2011. This bill will be referenced as parcel number R207/013 and the remaining parcel (R207/010) will be cancelled. If you have any questions_ regarding this matter please feel:free to contact me at the number listed above. Respectfully, � 1 i e ' e a ey Property Transfer Assistant QA-Assessor's Nm Date-15plits\CombineLtrsVY12.doc � * 4 INlassachusetts- Department of Public Sal-co' Board of Building Regulations and Standards Construction Supervisor License k i r License: CS, 92159 BRADFORD N INKLEY _ 33 LAKE RD W YARMOUTH, MA 02673 Expiration: 11/15/2012 ' Commis Tr#:.5642 in ome lm roe? ment C,ogtiktor Registration • } r Registration:. 151420 T e' 'DBA 7 yp Expiration: 5/26/2012 BRADS HOME MAINTENANCE �, 1w BRADF.ORD INKLEY ' i 33 LAKE ROAD t , V�I W YA i\IIO.UTH MA<,0�679 R / I >u J . Update Addiess and return card.Mark i t n Address Re, newal. Emplc�tl giDPS CA1 er 50iM 04/04 G101216 V.,�_�..__..•..sr..... 9 Office Aonsumer Affairs&Bdsi.ness Regulation License or registration valid for mdrvidul use only +- before the`expiration date. 1f found return to: HOME IMPROVEMENT.CONTRACTOR I!` Registration: _ 1,51420 - Type: Office of Consumer Affairs and Business Regulation Expiration 5/26/ 012 DBA 10 Park Plaza-Suite 5170' ' Boston,MA 02116 B S HOME MN MOTE l BRADFORD _ - 33 LAKE ROAD P ; W YARMOUTH, MA 02fi79> Undersecretary of valid with gnature j o A PVC Grr.ide to i-Vood Cons•trcictiorr:'in High )Mind rheas:4 niph 1Vind Zone. • Massachusetts Checklist fo> codinjiance (78o CrlR 5301 2.1.1)', ; LJ Check Compliance 1.1 SCOPE 4 '•�` ,. �� .. s 'r•• ,� a. Wind Speed (3-sec. gust)..: ...... . ........ ..... .:. :......::.- 110 mph' Wind Exposure Category...................................................... ......: .... B Wind Exposure Category.' ....En ineenn 'Re wired For Entire Project :.......................................... � r 1.2 APPLICABILITY Number of Stories(a roof which exceeds B in.12 slope shall be��co, idered a story) y stories <2 stories °' Roof Pitch .......... ........ .......(Fig'2) :....; 512:12 Mean Roof Height ....................................... ....... •... .: .(Fig 2)............................ ......................_AL ft'-' Building Width,W ...:.............I..........................................,..(Fig 3) .... ...... .. �. ....... ff-5 80' rs Building Length, L .:........... .(Fig 3) g 'ft s BO` v Building Aspect Ratio(UW) ............................ .... . ... .. (Fig ) '.... .. ........ < 18 Fi 4 Nominal Height of Tallest Opening ..... .:(Fig 4) r - <6 8" , 1.3 FRAMING CONNECTIONS „ n "a v General compliance with framing c6nnections....... ,,......(Table 2)............................... ............................ 2.1 FOUNDATION s € Foundation Walls meeting requirements of 780 CMR 540'4.1 a "y Concrete......::.......... Concrete Masonry...................... .. ................................................. .. .... ..... ..- ....- .4. 2.2 ANCHORAGE TO FOUNDATION " '• 5/8"Anchor Bolts,imbedded or 5/8"Proprietary Mechanical Anchors'as an altemabve in concrete only µ Bolt Spacing-general .....`.... y .....n.. ,... :.(Table 4) ..... ,n^`<6 in. Bolt Spacing from endrjoint of plate .,.. .: ....(Fig 5) Bolt Embedment-concrete...: •(Fig 5) Bolt Embedment-masonry..........................................(Fig 5) ...... ? in.>_15 Plate Washer................... :.:. ... ........ .. ,,(Fig 5) ...... .. ..._... ........ 3.1 FLOORS Floor-framing member spans checked ................................(per 780:CMR Chapter 55) .••• Maximum Floor Opening Dimension......:.. ..:.... .. .. ...(Fig 6) .... ft<12 Full Height Wall Studs at Floor Openings less than_ 2'from Exterior Wall(Fig 6)................... :. . ....... r . L Maximum Floor Joist Setbacks Supporting Loadbearing Wall's or Shearwall.... ........ (Fig 7).. .. ..:: ...;.... f.... ::.:: .. /ft <d y Maximum Cantilevered Floor Joists, Supporting Loadbearing Walls or Shearwall........ ... :(Fig 8) . R:...: .....1........................... ,.... 4 ft s d P/ Fi 9 ..................................i Floor Bracing at Endwalls.. { 9 ) •• Floor Sheathing Type. .....: .._.. ....................................... (per 78b CMR Chapter 55).;................................. ✓ (per 780 CMR Chapter 55 F Floor Sheathing Thickness .(p p ).•.• •• in. Floor Sheathing Fastening......... .......... ... . . .(Table✓2).._d nails at in edge I in field Y' 4.1 WALLS Wall Height • FI 10 and Table 5 9-ft s 10 !/ Loadbeanng walls......::. ....... ............ ( g ).. Non-Loadbearing walls ........... (Fig 10 and Table 5):: ::.fig ft 120 Wall Stud Spacing .I........... .(Fig 10 and Table 5) o• �in Wall StoryOffsets' .... ...................(Figs 7&.8).;•; ' !i 4.2 EXTERIOR WALLS' �.. Wood Studs Loadbearing walls................... . .(Table 51) 2x �ft ....(Table 5)n....... .. ' ....... 2x -�fLin.,Non-Loadbearin walls Gable End Wall Bracing' Full Height Endwall Studs .... .. ... :. ..... .(Fig 10),..' WSP•Attic Floor Length:.......:.. .(Fig 11} -6�ft zW/3 Gypsum Ceiling Length(if WSP not used)................... :.(Fig 11) -•�ft z 0 9W and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .-(Fig 11 or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft spacing in end joist or truss bays Double Top Plate �y t% Splice Length ;.. ... ...:. (Fig 13 and Table 6) --F Splice Connection (no.of 16d common nails).......::. .(Table 6) -......: ..t.L . ...... . ANC Guide to I-Vood Construction in High IVind{Areas: 110 niph IVind Zone Massachusetts Cllec1clist for Compliance (7s0 Cnr[R5301.2.1.1)' Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Tables 7)................. /d? Non-Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Table 8).......................................................� Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9)................................... ft © in.s 11' �- Sill Plate Spans ...........(Table 9).................................. ft—in.S 11. Full Height Studs (no. of studs).....................................(Table-9)....................................................... Non-Load Bearing Wall.Openings (record largest opening but check all openings for compliance to Table 9 — • Header Spans...... .......................................:.(Table 9) ................................. ft_t in.5 12' .............. Sill Plate Spans.............:.......::....................................(Table 9)..................................—ft—in.5 12' Full Height Studs (no, of studs)...................:................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension, W Nominal Height of Tallest Opening2 _Ls 6`8" Sheathing Type..............................................(note 4).......:............................................. .)r,Cox . v Edge Nail Spacing .. Table 10 or note 4 if less),....................... in. Field Nail Spacing..........................................(Table 10)................................................. in. Shear Connection (no. of 16d common nails)(Table 10)....................... v Percent Full-Height Sheathing........:..........:...(Table 10)..... ... ......................:.................... % 5%Additional Sheathing for Wall with Opening> 6V(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2...............................::........................................-5 6'8" SheathingType..............................................(note 4).........----........................................ cp Edge Nail Spacing .. Table 11 or note 4 if less ........................ in. . v Field Nail Spacing............................... •..(Table 11)................,. /#I- •in. lip, Shear Connection(no, of 16d common nails)(Table 11)....................................................... Y Percent Full-Height Sheathing.......................(Table 11)............................................:....... % G 5%Additional Sheathing for Wall with'Opening> 6'8'(Design Concepts).................:.. v Wall Cladding Rated for Wind Speed?............:..... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BB RS Website) Roof Overhang ...................................................(Figure 19).............J_ft:5 smaller of 2'or U3 C.- Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors - v Uplift.... ......................(Table 12)........................................:...U= plf Lateral..................... .. .....(Table 12)..................... - pif Shear...........::..................................(Table 12)............................................S= Of . L Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............... .. .... . ....T= plf ....(Figure 20 Pi ft 5 smaller of 2' or U2 ' Gable Rake Outlooker..:....'..........:.................... ( 9 ) .............� Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14).........................................:..U= lb. Lateral (no. of 16d common nails)...(Table 14).......................................L= . lb. Roof Sheathing Type...:............::.................................(per 780"CMR Chapters 58 and 59) ............ Roof Sheathing Thickness....................:...................... ............................. ...............✓Z in.>_7/16'WS Roof Sheathing Fastening............................................(Table 2)................................ Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Ba and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. ENERGY CONSERVATION APPLICATION FORM FOR ENERGY,EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION '(790 CMR 61.00) Applicant Name: Site Address: - print Town: Applicant Phone; 15' °. Applicant Signature, Date of Application. NEW CONSTRUCTI N choose ONE of following two o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR = NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Basement ; Il Option 1: Fenestration exposed Wall <>° Floor,. Wall Perimeter= AFUE HSPF. SEER U-factor floors R-Value R-Value- R-Value R-Value . R_Value and Depth. National Appliance Energy ' R-10, Conservation Act(NAECA)of .35 R-38 R-19 R-19 w. R-10 4 ft. 1987 as amended,'minimums or greater as applicable Note: This form is not required if you choose either-of the two versions of REScheck as listed below. El < Option 2: REScheck Version 4.1.2 or later variant software analysis must,be completed' 780 CMR 6i07.3.2 REScheck-Web which can be accessed at http<//www energyco des.goy/rescheck/ ADDITIONS OR:ALTERATIONS,TO EXISTING BUILDINGS OVER.5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2'in New Construction sec tionsabove. Complete the following formula to determine the % of glazing: w (a) Gross Wall & Ceiling Area,equals Formula: (100. x b.-, a) cod SF a I ? — e %.of glazing 100 x (b) Grazing area equals_ NSF If glazing is:< 40% use the chart below, If glazingYis >40.% roceed to "SIJNROOIv1" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE-COMPONENT GRIT_ ERIA ADDITIONS TO EXISTING' LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM .Ceiling and j ' R-Value Wall w_, Floor Basement Wall R=Valueeter Slab R=Val,ue Fenestration Exposed floors U-factor R-Value R-value and De th 39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compress d over exterior walls,'and including any access o enin s SUNROOM-An addition,or alteration to an existing building/dwelling unit wherethe total 0 glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P) Town of Barnstable Regulatory Services i = Thomas F.Geller,Director etwe� fbr Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Www.town.barustable ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ,as Owner of the subject property hereby authorize grY-1 1 J—X&C to as on my behalf, m aU mutters relative to work authorized bythis bu&6g permit application for. �.(� �-�Z. �Y1(,tG� .�C� �..E-, ►fit,� (Address of Job) Signature o Date Print Name If P=ea Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0WNEUMWSSJ0N l_ Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map. Abutters Map Size „ Zoom Out Parcel Viewer In y� 1 r R. - a..m I )PG Map: 207 2010211003 Location: tl,24 2070 1004 " 207016. Owner: 207150 aW. t�51 Location Ir 207015 Map & Parce a5ea Location 207022001 Acreage N41 207146 k _ 427 ' CUCrent �1A 207013 Mailing Addi 207010 `61D N 612- 207012 N 614 y Appraised ' Extra Featui .` Out Building 20710.5: 207111 Land N234 N- " Buildings ` 207009 Total Apprai . '406 Assesse" e . 0700 , 0 114 Fee'' 2t1418$ 2070614 Extra.Featui Out Building Land Set Scale 1" = 114 I Aenal Photos MAP DISCLAIMER Buildings Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comma BarnstableMA v1.2.3867 [Production] co http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=2070 0&M' pparback=+ 10/12/2010 � bra r���r� sT Cr�t� �� coD�� �'c� �i�� ire' �rq�_ ���. �t'��c) _ . /ST .��� - c31Gce _ _._ T� �� cue �%��� _C�/�yl . S�'e�>- ,mil __: The Cominonwealthof Massa chusetts �. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0111 L www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Leaibly Name(Business/Organization/Individual): 3-AD VSAb1Y;1e_— Address: !P': ez.) s oxiad 1 11 City/State/Zip: Cam; Dt-,-4pl �; if 5,12C76 Phone.# � 5 ' Are you an employer? Check the appropriate box: _Type of project(required) ` 1.❑ I am a employer with 4. D I am a general contractor and I employees(full and/or part-time).* have'hired the sub-contractors 6. 0 New construction 2. I am a sole proprietor or partner- listed on the attached sheet. �7.. ❑Remodeling and have no employees These sub-contractors have g. 0 Demolition P workingfor me in an ca aci employees and have workers' Y P tY• # 9. ❑ ldin Buig`addition [No workers'comp. insurance 'comp.insurance. required.] 5: Q We ate a coiporation and its 10.0 Electrical repairs or additions 3: I am a homeowner doing all work officers have exercised 0 their : 11. Plumbing repair's"or additions myself.[No workers'comp. right of exemption per MGLY 11D Roof repairs - insurance required.] t c. 152,§1(4),and we have no employees. [No workers' :13.D 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 contractoi 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 r 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 policyand job site g information. Insurance Company Name: "' 3 Policy#or Self-ins.Lic M 67-t` Expiration Date: 6 " Job Site Address:_ l� /?✓lYyl �T° �'e� ��r" 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 crimuial penalties of a fine up to$1,500.00 and/or one-year.imprisonrhent,as well'as civil penalties in ih6 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 statemerit may be forwarded to'the Office of E Investigations of the DIA for insurance coverage verification I do hereby certify under e p ' s a perjury that tile information provided above is'true and correct - Signature: Date.Phone#: 02 Official use only. Do not write in this area,to be completed by city or town official 41 City or Town: 'Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector'5.Pltimbigg Inspector, 6. Other Contact Person: Phone#: P . 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 tiustee.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,Iocal 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 LimitedLiability 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 thetaffidavit 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 ownefor citizen is obtaining a license.or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us,a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts ' Department of Industrial Accidents ' Office of Investigations ; { 600 Washington Street- Boston, MA 02.111:a, Tel. #617-727-4900 ext 406 or 1.877-NIASSAFE w Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia u _ d W Si R'non St _ , < r r 1 : < _ ------------- ; t - , *, x S" i x , : t i r D e < v n 1 S , 14 : x 3 r r , x f i i _ _ t CG!'1 �iG7��GYl , I - . , j,) Ta $E ,. i La r�/Z : . .......... ....... IWO I . I _ I , , k , , 6 t.. rr w. 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R _ •,r- r - e e °B a �a � gdgg - ® s Sip O Q r ay /y - - 9 a 0..0 c, s..�y®�•t�-^ :,Ly"�' -" ^ .a III 4ird ° s�a�a�s aa3�=rG 6s 5� P-4—n s SOSIFF Ib _.. v aa° � r L t 00. LA T C LO • v d 9. Filed wift Cent. of TItIa No- 3494 SssWssa' sa 'v Sxx@ai92 yak s1 on of Part or Lot CI -�--a Showr on Plan 1 06 H a 5 ? - $.i � -¢ Title No. 3494 � Fi ray tabl is Count f Registry District y May rssved tgr'tend rFePf�s a tots be isss��d i�sd , ate cortif�et�s e�title � be s esI-m*..S.: ------------ ---- m arplift .. the Cwt. a D> F _ s : ko Qj�; ti flp a l:c• ISo87F �tx t_oT 3 _ L!c C. .15021 cTF Ib,?-77 ?7? dr. B C,¢,G, isoB737 Cr-F S ' Al ez }. O I � f \ t'��, � :-ram• C��. • �j b 43 i 3 S KETC • • µ M -(-:�Iw N Lam' ►q eV C-r1S`T al'..c- t� t.14 FmgSk - sir Y ! V. .:`. X:Zoo r L � 1'O„ a FOSF ca. �� 4-1 } I K -2:1-Ac-70 1 4 / � Va> vi rA-5 a � z j4n, eAle W-C o71 4 7 o gff91 b t _ a ICI - co i C) co-A-1 l - - 5 uR T Po . 1 . .. T-c 5z ,f T I?It W . L O)C� I Froyl I- r , 0 F-pr lAot:?7- �z 1 ��,G-j���y� � -` ,}•'�Few s to" 61 a SAS r c � v T Wa 5�,Az CIA njewes µ Val, , 1A 1 - - -- ----- - ---- ---- -- - - ---- -- - --. __ _. - - --..._ x b r i vVIV r 7 h/ ol lie `c �t � it �I Iry � y 1W c . f � c- fSCp 4-1 �# NOoo z- SMOKE QEOR$ REVIEWED ` TECT N, �4 DEPT, DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING - - -