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o ., �� .. � . �� s � . . �: v � . ; o _ �.�_ ro . o o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2,01 Parcel : Application # �� Health Division Date Issued -4 Conservation Division 1 Application Fee Planning Dept. - Permit Fee "o ' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address d�T Village A,Vi`�r L Owner rL1 L (,/ ifyn S Address S/ Telephone _ �d F 41 C;- 2M 0 Permit Request CON w7yu C4- 6'1C 2-L( E(AA qL4 /0d AX1g_ TU FIL-0 h r L t-V o r1 Square feet: 1 st floor: existing proposed _�2nd floor: existing 616 proposed_Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 600 Construction Type Wd&0 JoVlwe, Lot Size r 2-3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family, Ef Two Family. ❑ Multi-Family units) Age of Existing Structure 2� S Historic House: ❑ L�f Yes No On Old King's Highway: ❑Yes &'No Basement Type: 41!�u II ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) d Basement Unfinished Area(sq.ft) 67 Number of Baths: Full: existing 2 new Cj Half: existing d new y Number of Bedrooms: LI . existing o new Ll Total Room Count (not including �il existingnew��First Floor Room Count Heat Type and Fuel: VNo O ❑ Electric ❑ Other Central Air: ❑Yes Fireplaces: Existing New 0 Existing wood/coal stove: /Yes"13 No p 9 9 Detached garage: ❑ existing ❑ new size—Pool: ❑ exis ' g ❑ 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 rLn)b e14JP u 1 Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name- VL 4AJ Telephone Number OF Address 62,0 A 4 <� i License '(3 Home Improvement Contractor# Worker's Compensation # d(.- (56 6T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / D FOR OFFICIAL USE ONLY APPLICATION# -E DATE ISSUED 4 k MAP/PARCEL NO. :t t k ADDRESS VILLAGE" t. OWNER, DATE OF INSPECTION: FOUNDATION S Sagas ��. FRAME INSULATION y t FIREPLACE Y r • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'Y GAS: ROUGH FINAL FINAL BUILDING r62 -7)2- t DATE CLOSED OUT ASSOCIATION PLAN NO. I The ComlttoriweIth of Massac�.Usetts Department oflrtdustrialAccidents Office ce o InVesdgazions .f 600 Washington Street Boseolx, AIL4 02111 . �� _ www.�nass.gav/din • om ensadon ln-snran.ce �da•vit: Builders/Colatractors/ Iectrzeians/�'Iulilbers Workers C p Applicant kdonnadQ)ri Prease Pant Z egz . ) Ccley cltt uw �T'G�1 Neu c>9�.y�.rti Nnnn (BusLncss/Organization/Zndividuel CP���v►� 'ddress: 20 (M rJ City/State/Zip: cri vt t Phone Arc yo employer? Ctieck the appropriate box; Type or project(required): 1. am a cmploycr with ,.Lt 4. ❑ 1�am a general contractor and I 6. ❑24rw construction employees (full and/or part-tune).* have hired the stab-contractors 7; Rcmo deling listed on the attached sheet ❑ 2.❑ I un a'sole proprietor orparincr- 'These sub-contractors have g• ❑ Demohi on ship and have no employees employees and have ivorkeis' working for me in any capacity. 9. Building addition comp. insurance.$ [No workers' comp.-msurancc 10.[� Electrical repairs or add-itioi r6quirDd] 5. [] We are a corporation and its 3, ❑ I ant a homeowner doing all work' officers have exercised their ,. I I_[]Pl=bing repairs or additiol myself [No workers' comp. right of exemption per MC 12.0 Roof repairs 1(4),,and we have no • ins,�ranceTequired.]t I3.[] O.ther �M��' �t�0�JtTIO,�J employees. [14o workcrs' comp, insurance required.] ''Any applicant that ehecla box ttl must also fill out the acc6o13 below showing their workers' compcn+�hon policy bTA m nrw t ITomcowncrC who svbraif this s$davit indicating tiicq arc doing all work and.thrn hire outside contmetor5 must submit a new a davitindi�ting such. tConlr�ctnrs !fiat chock thin box truest attached an additional ihect showing the name of the sub�ontraLtors and state whether nr not those entities have crrcployccs. Lfthc sub contractnra have cmploycc�,they must providb their wor)ccrs'`comp.policy number.. 1am art employer litrd isprovidingworkers'eompeUsaf!DH irtsurartcefor my employees Befo�v Gs thepolicy andjob.site Insurance Company lTamc: Policy# or Self-ins, Lie.#: �L 6®6" �� Expiration Dafc:. I (� Job Site A•ddre.es: City/StatdZip: CtAjVUt t/i'A G Attach a copy or the workers' compensation policy declaration page (shov�iag the policy number and expiraiiorx date. Failure to sacure covcrago as irequircd under Section 25A of MGL c. 152 can Iead to-the imposition of crimirial penaltics of a fine up to �1,500,00 and/or one-yearprisonrnent, as well as civil penalties in the form of a STOP WORK ORDER and a fir. of up to $250.00 a day against tho violator. Be advistd that a copy of this statcmerit may be forwarded to the Office of Investigations of the bIA for insurance covers c verification. X do hereby certify un e e h psi penalties ofperjury tAut the information Provided shave is true ancCcoi rest Date: Si store: l / Phofic # C'60 v Offuial use only, Do not write in LhLr,area, to be cornvLeled by city or town official City or Towa:: Permit/License # Issuing Autbority (circle one): 1. Board ofl7ealth 2, Building Department 3. CitylTown Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other n i Information and 111st U ���� �t Mass chusetts Gcncral Laws chapter 152 requires all employers to pro c d cc of anotmpr nsatoa'nyocontract Oflhirces: Purs-dart to this statute, an eflytoyee is defined as ...every person m th express or implied, oral or written-" artricrshi association corporation or other Icgal.entt , or any two or more An amployer is defined as "an individual p P of the forcgoing,cngagcd ja a joint cntcrprisc, and including the legal representatives of a g Io ec;s.lHow vcr the zeceI . I or trustee of an individual, P�ncrshdP, association or other Icgal entity, employing Y o er of a dwelling house having not more than three apartments and who resides therein, o the occupant of the wn dwelling house;of another who employs persons to do rnaintcnanec, construction or rcpau ork on such dwelling ouse or on the o inds,or butld'ug appurt-nant thereto shaLl not because of such employrmnt deemed to be an employer." ency sh )T-ithhold the issuance or MGL chapter 152,'z5e(6) also states that` every state or local licensing ag for reaeTy2j.of a ueens 11 permit to operate a bus arcs Oy of to co Rance wi ldthes ill ins t anceno coverage requiredY applicant who has nAproduced•acceptable rvz P AdditionaIly,MGL obaptc�r 152, §25C(7) states 'Neither the `eonnonbleevide c of co�Jiznwcalth nor of its ee RZthdrthe insurance f pub enter.into any contract for,thc performance olic workil P requirements of this chapter Kaye been prescatcd to the contracting authority. Applicants compe anon a�dayit completely, by chcc the boxes that;apply to your situation a-nd, i Please fill oirf the workers' recess supply sub-contractors) c(s), address(cs) and phono u z(s) along with their ccrtificate(s) of insurance. Limited Liability Compardc .(LLC) or Limited Liability P crships (LLP)with no empuiEmcc. ifloyees other than c mombors or partners, are not xcquircd to workers,' compensation submitted to the Department f olndustrial employees, a policy is required Bc advise that this affidavit may b s Accidents for coMfumation of insuraMcc cov age. Also be sure to igu and datta thGuc ted, not the p enthof d bo rotamod to the city or town that the applica . . for.the ding o licensers ou arc rbcingraq uimd to obtain.a workers' Indus trial Accidents. Should you have any qucs 'ors regarding law or i f y olic lease call the Department a the nurAber ' tcd below. Self insured companies should enter their compcnsahonp y,p self insurauGc)liccnsc number on the a ropziatc lin City or TowP O;fticlals Please be suxo e bottDM that the affidavit is complete and printed 1c ly. T'hc Dapartrncnt has pro udre arding the applicant of tho affidavit for you to fill out iM the event the Office o a cstigations has to contact y n applicant Pleaso be sure to fill:in the permivhccnsc numbcr wbi�hh ll h give ydars n cdconly submit affidavit indicating current that must submitmultiplc permi4censc applic t7 Y olic'y inf-ormmation(if Accessary) and under"lob Site ddress" lh ap kcd byic tshould cca worttown lznay b provided to the or l? . town),"A cbpy of the affidavit that has been bfficiall stamped or applscant as proof that a valid affidavit is on file fox taro permits t n t related o anybusiness or coming aoyC°�c year.'Whcro a home owner or citizen is obtaining a 'ccns e or pezml i e. a dog Jicensc or'permit to bum leaves etc.) said persoA is NOT rcq ed to cozrrplcte this affidavit ( u in advance for your c peration and should you bavc any questions, Tho Office of Invcstigadons would bier to thank y plcasc do not hcsitatc to give us a call. The Department's address, tcicphone,and fax number; Thrt CbIfMonW(,- th o I assaGhustr� Off�ce of Jj�yP3t.ptx.6as 600 Was-hulgton Street Bosun; MA 02111 Tel; # 617-727-4WQ ext 406 Qr 1-877-MASSAFE Fax# 617-7,27-7749 Rcyiscd 11-22-06 ww.mass..gov/dia Of THEr� ` 'own o Barasta le Regulatory Services w .�svrszAnce Thomas K Geiler, Director .hASS �* t6J9 �`m - BuildingDivision rFo naa� Torn Perry, Building commissioner 200 Main Street,, 14yannis, MA 02601 www.town.barnsta ble.ma.us Fax: 508-790-623 Office: 508-86-2-403 8 Property Owner Must Coz plete and. Sign This 5ectiot, ff Usilig .A` Builder as Owner of the subject property heteby authorize S In C N - to act on my behalf, in all matters relative to work authorized by this building permit application for: . e. ':(Address of Job) ho Siratu e-of Owner Date �1��1 L��O 11�11 � .11�a�� • Print Name If Property Owner is applying for permit pIcase complete the Homeownets License Exemption Porn-i on th`e reverse side. T0w)a 0f Barnstable y�v of YHE Ip�yo RegulatoxY Services. .. Thomas F. Geiler, Director f / BARNSV,BLE, MISS. � Building Division s67P• �� �jfo hta�` Tom Ferry,B uilding.Co mmissi ones 200 Main Street, Hyannis., MA 02601 v,lyly•toA,n.b2rustable.ma.us Fax; 50S-790-6230 Office; 508-862 4038 --A— Ho jEoWNER LICENSE EKEAIPTf 0 -- PJcnse Print DATE: 10J3 LOCATION: street villago- numbcie "HOMBOWNER": home phone N work phone# name CURRENT MAILING ADDRESS: slate city/town zip code llings of exam lion for"home_o_rs''was extended to in ude owner occupied dwiovided that the zowner act na The current p to allow homeowners to engage an in idual for hire who d es not possess a rcens 7, superyisor. DEFINITION 0B OgEOlVNIER who owns a arcel of land on'whi he/she resid s or intends to reside on which farm shvctu.res•intended A to Person(s) w P be, a one ox two-family dwelling, attached or detached s ctures accessory to sue use person who constructs more than one home in a 0-Ye,I. ar period shall letobthe Bulding official,ered a hat he/she e/he shall be er P ' "homeowner"shall submit. the Building Offcia on.a form acceptable res onsible for all such work erformed under the ild>'n ermif, (Section 109,1.l) The undersigned "homeowner" assumes zesponsibility� r compliance with the State Building Code and other applicable codes, bylaws, rules.and regulations. I I Th'e undersigned "homeowner" certifies that . .she understaeds the to wn y Bly arnstable said procedureing s ant min.iznum inspection procedures and requirements an`d that h P requirements, Signature of Homeowner ------------- Approval of Building Official , Note; Three-family dwellings containing 315,0o00 cubic feet or larger w�11 be required.to comply with the l. State Building Code Section 177.0 ConstrucEh0 0 I ERIS ExEi KF1ION ` The Code s talcs that: "Any homeowner performing worl�for which a building permit is requir`cd shall be exempt from the provisions ecnsin of con strvefor ing woSuperyuoro);provided Thal if the homeowner engages a prrson(s)for-hire to do such i of this section(Section 109,1,l -U g work, that such Homcotimcr shall act as supervisor. the articularly Many homeowners who use this c oc Susoervisorsr Section 2aware t 1t5)yThis lack-of awarcncSooftenlresultsf in seriousspr(blems,partic Q, &Rc ulalions for Licensing construction P not proceed against the unlicensed person as it would Hrith a licensed Rules g when the homeowner hires unlicensed persons. In this case,our Boatd can p actin as Supervisor is ultimately responsible. unifies rc vire,as part of the permit application, supervisor, The homeowner g s'bilitics many comet 9 b P omcowncr is fully aware of hISthCr respon y To ensure that the h at he/she understands the responsibilities of a Supervisor: On the las'page of this issue is a form eurrcntly used that the homcowncr ccrtifyth u t"" /cc i,ficalion for use in Your commun ty I ' - Ntassachusetts-Department of Public Safety Board of Building-Re!-ulations and Standards Construction Supervisor, License License: CS 4 47993 Restricted to: 00 N STEPHEN J DEVLIN" 820 MAIN ST COTU IT, MA 02635 Expiration: 2/4/2012 Commissioner Tr#: 15633 + �a, Bo��o�ixTt&i�rFttidy>os����ta _ License or registr,ticn valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiraVon date. If found return to: Board of Building Regulations and Standards x Registration: 131841 B it Expiration g/2g/2010 Tr# 274186 One Ashburton Place Rtr 1301 :, xType Private Corporation Boston,Ma.02108 CENTRAL CAP CO. INC. STEPHEN DEVLINL r ; /,lid 820 MAIN ST �����COTUIT,MA 02635 Administrator lYoiwithout signature AM MWgqk/#19/0 �M One As iburton Place - Room 1301 QM Boston, Massachusetts 02108 Home Imprt-vementContractor'Registration Registration: 131841 z Type. Private Corporation ~'° } Expiration: 9/26/2010 Tr# 274186 1a t y fi= CENTRAL CAPE CON STRUCTIOIVGO'IN-C STEPHEN DEVLIN 820 MAIN ST. COTUIT, MA 02535 va. t 3 Update Address and rett rn card.Mark reason for change. -' Address Renew:I Employment Lost Card N Ap z7 ........... " ► o T - s sU- Zs -,ow 1 4 ;7- ?. ¢ ,B Sc ' /AiL4 AA5.7 0/7> Of IAMES sc LIOOpE No 33253 '�fCi 1 P 4 � 0 C��T/F/ i r Sd }` ',5 `. - Y-1 ° 'i E*� rwq -,x r rl .� v i'' > '' A F 7✓ ,`#�x2. t.. td.,{. r y t re..£ C r''%' ,� i - # .I r ,'. 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SAC RRENG g 'rc > `� r COMMERGAL GENERAL LIABILITY ' s x R C'� r r EM aacwrr8 $ f G .a ` -,T y .. ^"irLaIMS MAD>= }:OCCUR +. - MEJ�E CP(Arty of>Q P�tsoh) a'$ a ti 4 ;7' 4 b -Z 4 S�3 r o �, ♦ } �:° > t' n PBtSEHdAL$ADH INJURE` "$ a '� �' t r e _ ,� r f 'SEfdERALAFrGREt-11 i $'' t' ,"t*. , F. f ' GENIAG�REGATE'l1MITAPPLIESR>=R v.':; `„ ,a.; r ' Pf3CDUC7S.'COMPIORAGG'� b �- 3 s _ r* t :elt0- -'� P c r �, c E a r 4 r. Pa4r,;r LOC :: F rAUTOM4�U.ELkgSA:,STY , `r ' r ; +.i_ - a ,, f " 't COMBIN SINGLE LIMIT 1 � '<1 t ANYAUTO W c\ t k (E?acac#er}tJ - r r$ w f, 3 r x ,: ,'.. NE4AUTOS ' "� } ! HODSLY UR,Y r t- s a�-C. t } r"i +SCHEC)iN-®AUTOS 1 S 1 �iq Y" t 1, 1p� pRl ' S 'h.i� k. L Kyv. l? I HIRJ AUTO$ , r �- 2 , r - , r- > t� BODILYfPLIURY $ y, as '` 7 N01Y-0WNED AU7`OSc ° t i "'r s 5 f i f_v' S- d s. -;r :: v -;: (Fer aocider¢j AMA a i,Q GE, ' r $ GARAGELiABILRY < ' 7 `r, a 1 .s-,,. t x e AUTaONfY;EAAGCIDENT $ AM AUTO C S r c !: : , •.i ACITII ONLY A P ;, 3, ,44/3 EA: Si :. EXCESSLU�REIJ:'i"l #Lli l c OCCURRENCE ;e ' - 1:'-,",_.,,�l.-.�;:.!4,:_..�"'.,_,�,,*�,lt-�1;_-,,"�,.'-*..-,i��,`�..:lAJ�":.;*%".-.!..r,.,i"'..�-,`"1,�-���.-.,"�::-�.-���qq,11'��!�,.�'1��-,,,�,,,!�,,V��".,���.'i,�,-e��,:'-i�-�,',i2��:�-,,li�i'.,,,'.�.l,_;z;,�1���.,�!I��::��i�i��_-.1�"�r:�'IL_:..,.�I--"I-.'�,-,__,---I-).,_iiI,I���.,�",m�',":�:�:�,:,,,,,-�—-"i�-it OCCUR - CLR{A33 MADE t _ '�r' AGGREGATE' $ i DEDUCTI-LE i $ ` 1 L T REfFM10N t $ r, ng� r ->` $ s - , )k .A 1NORKERS Cv.+..tiNS+#110N ` V g; WC3TA�S QfH E F'� :Y' 3: . AND ENIPSAYERS All. r:. ANY pROPRIETOR/PARTNERIDSECUTtVE YIN * : E-IL EACHAGCIDENT $ 1,00 OOO' OFFICER/AAEMBER EaCttli ? (AAandatory7nNH) r C 006 ZB 6 .: 'S/id/200 5fi41201t3 EcDISEASES FAEanPLOY $ ' 100 , : '1: !€yess-`tlescdb�irrMer "A = .-. sFEe1A..- o.�DNs> , .EL ptSEAS <POLrcr"uMrr $, :. .,. , ;BOO OQ"0 OTHER t .rs s D �,..._:—-,:�,-�;E"::- b ^ '.9 1 - d.. .:;`-.-,.,.1.�..:!-..',�..�--%T�.1m,-,-.,��i1i.!_.._--.1!.,,.;1._,11.���.�.�i:,��-�1.,,.k1:,;,1i-�.i..4,-,,,..,1.",%.,:::--�.'I..:..`...,;._.—,k_;�.,��1.-,._w;r;,,.���-.,.��,,�-,`,-.��_� ,,SC,RiION OF OPE1. I M3 S1 L`DCA3lOA251'L E}iK if I�CCL� SY ENt RSEM i3i SPECU�i!PROV�IONS , u n F F r .( 1F A i `t t �y , . y', r 1. . CERTIFICATE LDI*¢2,• :t C 4�1#G i°J�I AI - - ` a i i - r f -.,SHL)ULli' Y",60. E.i480ifEflESCRIB$DPQLICI£SBECA�•ICEL.I.EDSEFORETHE XRiRATIOt� r r .. > i 1�3e1J.s Craxa r t DpTt:THEREOF THE�su>sdts'te+suRERENNDEAVORTO DAYS vi+R1jTEN e t `� . Z73Vl.s''F1.1.��xRC� ) "NOTiCE70THECEFtTBWCATEHOLDERIVAIYIEDTO'IHELEKT6,OT-FAB..URE70pOSOSHALL tj -' East Faltlmou , ,, 1rIA 021 6 s 4 s :' c iMPO$E fJ0 O)9CtGATEO.d1 QR IJABRj1;Y Of 61NY i( I[i UPO[d 7tlE IPISURER 1jS�`AGF31T.-AIF t '; �' r i xt REPAESIITATWES-= v k -,,oIV.,-i u�D RESEN7'AY7Vf- ter- ,,r ,,^. - a a. ;,.,��-�4�:��-�.Y�i,�i,,;.,,!�j,�T-..11,,,'-.'',4,...::�i.��>;..1:l.�-,i�.",,,1:..,-,l'i,,i;��.��.i�i,.;,rrr�r-�.t,,�:,..,,--;;�'�"I�..,--�.,i-.,I,..�.,,�:'�,i�,��.�I,�.-,,-�.,;',�v.,���i�,,�1?"Jjl,:,�.,�i.�E.-��!c',,,.',,,,,.m2—I11:1��I�,,,.,--�!�-,,���.ti-.1I.`.11�711I:i�i.;-.,J,.t,-�,��":."',,�;.�;��,,,,�'',..',��,.":.,_�,":,,,:�'I"..'�.,.��:�,',-,.-� �.?;.."..._,.:z�i,,...,S,',�-1._-.�.-�m�L-`�=�A2�"-i1--.,",M:,�;1.�;..-,1��,I_�..�,.-,'�,:��1 1.,.,.: "C ]} ` :v 1 !r �Ol1V'23c'I.s'/e�L�ipp�. n: �q,�+�9'""' `a4�",�"�' - --a�S- r AX _ , ,_t HCOISI�2.f1 i �oi �+ t C��.71DDr� `���'4Fe, �.� iO�f t '�9MI� ,e5 a YLv e._ "*z. INso251zoo9oI) a The}�CC3R[?naers�and la,®ate reglstaeed rr►ar8s o$ a OFtD S i Z S- FDF creafiedswlth ptlfiFactory trlai uersion�, df�ator� r� r ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �)01 Parcel OV Application #_06696 UK Health Division Date Issued Conservation Division Application Fee Planning Dept. = Permit Fee -� Date Definitive Plan Approved by Planning Board Oak- Historic " - OKH _ Preservation/Hyannis UQ Project Street Address OL4 Py ST W. Village Owner Wi T I IAvn.S Address 1 Q u (z(rv- Ril) Telephone Permit Request C6WSg7wc1- 2�/�0 � ) �� -' /dw pni 65u67-1N S IP a(A-fl ?1(k S . (V SM n)eW VZ (t!/"A) Square feet: 1 st floor: existing PZ-N proposed 02nd floor: existing 0 proposed M Total new gEF Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 6V )00 Vla-.6ft<, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Sell, Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 9'No On Old King's Highway: ❑Yes YNo Basement Type: Lei Full ❑ Crawl - Aga"11_ ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new Half: existing b new 0 Number of Bedrooms: 3 existing I new 41 r3(L f o Total Room Count (not including baths): existing new First Floor Roomd Cou o �/ U1 co'' Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other n Central Air: ❑Yes lr No Fireplaces: Existing New Existing wood/coal stoy.�: des ❑ No Detached garage: ❑ existing )4VAw size—Pool: ❑ existing ❑ size _ Barn: existingM- n(R size_ Attached garage: ❑ existing ❑ nkk&ize _Shed: ❑ existing/V raw size _ Other: �`•� ''JJ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use •PS(h 6V na Proposed Use S -C_ - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name STt vi,) �i1��-V'/�1 Telephone Number 6—C C6 0 Address U h1 q, S T- License # �� C• Gd ti i r 2 3 S Home Improvement Contractor# 1 i Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO VI � SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER y " DATE OF INSPECTION: ` FOUNDATION ' FRAME 5f+aAT4-%rJ I84 INSULATION I,* ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1' o AL- 3 " ° r DATE CLOSED OUT ASSOCIATION PLAN NO. . i c t J I . The Commonwealth of Massachtisetts Department of Industrial Accidents Office of Investigations' 600 Washingfon Street Boston, MA 02111 w WWlV.m ass.gov/dia Workers' Compenisation Insurance M#idavit: Build ers/Colntractors/Electricians/Plumbers Applicant Information Please Print Legibly Maine (Business/Organization/Individual): r,h.Q Ctl w spj zU Cri au Address: �• City/State/Zip: r((�1 T D 1 3! Phone.#: �d�—77 �•—C Cco Arse y�an employer? Check the appropriate box: Type of piroj Act(required): 1.L�I I am a employer with �f 4 ❑ X a general contractor and I 6. ❑New construction . have hired the sab-contractors employees (full and/or part.fim.e).* T. listed on the attached sheet. ❑Rcmodelin 7 .2.[] I am a'soleproprietor or•partner These sub-contractors have ship and have no employees 8. []Demolition employees and have workers' 9 ❑BuildinctJ g addition working for mein any capacity. . [No workers'•comp. insurance comp• a corporation ors5, � We are a corporation and its 10.0_Electrical repairs or addition required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.0•Plunnbing repairs or addition myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs c. 152, §1(4), and we have no . insurance required-] t 13 [] Other employees. [No workers' comp:insurance required. - *Any applicant•that checks box#1 must also fill out the section below showing their workers'eompcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and thcn hire outside contractors must submit an,cw affidavit indicating such, tContiaetors that check this box must attached an additional shoot showing the name of the sub-contractors and state whetheror not those entities have employees. If the sub-contractors have employers,they must providb their workers'comp.policy number. lam an employer that 1sproviding workers' compensation insurance for my employees Below is t/te policy andjob site information. fiisurance Company Name: Policy#or Self-ins. Lic.#: 6 G Expiration Date: '/ 2 D �. Job Site Address: S� 0L4 1 CeVrXV if (C 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 cri niri4l penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the of Office Investigations of the DIA for insurance coverage verification. 1 do hereby certify under t e pains•and penalties ofper' ry that the information provided above is true and correct. Si attire: Date: Phone# UX— )`1 b' C o p 0 Official use only. Do not write in this area, tb be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of health '2.Building Department 3. City/Town Clerk .4.Electrical Inspector S. Plumbing Inspector formation and Insttue 'OHS Massachusetts General Laws chapter 152 requires all employ rsonrs provide s �ce of anoth r under o any contract o Drees. Pursuant to this statute, an employee is defined as ...every person m th eicpress or implied, oral or written." o or An employer is defmcd as "an individual,partnership, associ e legal representatives nt tiveon or shof legaler deceased employe,or the ore of the foregoing engaged in a joint enterprise;and including g p employ ers. However the receiver or tiustee of an individual,partnership, association or other legal entity,employing p y owner of a dweling house having not more than three apartmen ant of the ts and who resides therein, or the occup n such welling dwelling house of another who employs persons to do maintenanc of succonstruction iti nor rep pt be deemair work ed to be an employers" o'r on the grounds or building appurtenant thereto shall not becauseP 25C(6) also states that"every state or local licensing agency shall withhold the issuance or MGL chapter 152, § uildings in the commonwealth for any renewal of a-licenser permit to operate a business or to construct b nce.with th6 insurance cover applicant who has notaproduced25C(7table evidence t co oP�onwealth nor any of its political subdirequired." sions'shall . Additionally,MGL.ohapter 152, §25C(7) states Neither the . enter into any contract for,the performance of public work until acceptable evidence of compliance�dth the insurance requirements of this chapter h v"been presented to the contracting authority. Applicants l Please fill out the workers' compensa on affidavit completely,by checking the b es that apply to cats(our situation and, if necessary, supply sub-contiactor(s)Hain s),;ddrcss(cs)and.phone numbcr(s) ong with their certificates)thinsurance. Limited Liability Companiies( or Limited Liability Pa.rtne Ps(LLP)it o DEEP doesloycehaveer than the members or partners, are not required to c workers'compensatio urance. If an L employees,a policy is required. Be advised the this affidavit may e submitted to the Department of Industrial coverage. Also be Sur to sign and date the affidavit. The affidavit should Accidents for confirmation of insurance be returned to the city or town that the application fo e Pe the law or if y u it or license is arc required d to obtain aewoakers't of Industrial Accidents. Should.you have any questions re g compensation policy,please call the Department at the er listed below. Self-insured companies should enter their self-insurance license number on the appropriate lin ' City or Town officials artment has ed a space at .Please be sure that the affidavit is comp ete'and printed legibly. lionss to contact yo uregarding theapPlo antra of the affidavit for you to fill out in the event the Office of Investig Please be sure to fill in the pex�itlhcense number which will be used as a re ence number. Ixi addition, an applicant np affidavit that must submit multiple perxnit/license applications in any given year, neetshou suwnIne call locations to eating currentc ty or policy information(if necessary)and undet"Job 5ile Address PP be provided to the town);".A copy of the affidavit,that has been officially stamped or marked by the ci r town may be applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new a davit must m filled out each year. Where a home owner or citizen is obtaining a license or permit not related fo any bus ss or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this a vit The Office of Investigations would like to.thank you in advance for your cooperation and should you h any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts l epariznent of Industrial Accidents Office of layestigations. 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NTAS.SAFE Fax# 617-727-7749 Revised 11-22-06 ww,v.mass.pov/dia r ) I,NERGY CONSERVATION APPLICATION FORM FOR ENERGY EFVZCZCZENCY FOR ONE; AND TWO-FAMILV DETACHED RESIDENTIAL CONSTRUCTION (7so CMR 61.00) Applicant Name: ST�� � (,VL4 Site Address: Q L,� 1pI�T- print Town: Cc yj--o v �f e, Applicant Phone: TC) —=72 Applicant Signature: Date of Application: Al . l/ (!�/ NEW CONSTRUCTION: choose ONE of the followin two`o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMTONENT CRITERXA. FOR NEW ONE- AND TWO-FA-M11Y BUILDINGS ncrMuty> MZNXMUM Ceiling or B Slab asement a Option 1: Fenestration exposed Wall Floor Wall Perimeter AFUB 1-1SPf U-factor floors R-Value, R-Value R-V-alue R-Valua P,value and De fh National Appiian°o-E R-10, conscrYaGon Act(N. 3 S R•-3 8 R�19 R-19 R-10 4 ft. 1987 as amcndcd,mi cattr a4 applirablc Note: This form is not required if you choose either of the two versions ofREScheck as listed below. Opfibn 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 Ma 6107.3.2 REScheck VJeb which can be accessed at htt '//www.enrr codes. ov/reschecl ADT3XX' O1V5'bl A `p RAxI S.TO MUS`XTNG B=DNQS,.O ER'S FEARS OLD* *buildings under S years old must use option#1 or 42 in New Construction section above. Complete the €ollowin9 formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b a) SF 100 x . % of glazing (b) Glazing area equals SF If glazing 0%.uge the chart below. If glazJmg is } 40 % rgcee,'d to "SUNROOM" section 780 ClYM TABLE 6101.3 PRESCRZPTWE ENVELOPE COMTONENT CRITERIA ADDITIONS TO E�STINO LOW.-RISE RESTDENTLA.L BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Pei .0 Fenestration Floor Basement Wall R_Va Exposed floorsLil; R-value R-Value and D U-factor R-Value.39 R-3 7 a R-19 R-10 R-10, 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 Compressed over exterior walls, andjricluding any access o enin s). ENROOM—An addition•or alteration to an existing building/dwelling unit where the tc El glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of additior<. Note: Owner to fill out Consumer Information Form(found in Appendix 120iP) r A IYC Guide to 1•Yootl Co»s-ti'tr.ctioif ill Fli,lr 141ircd Ai,ects: 1.10 rrcp/i 1'Yirid Zofre Massachusetts Checklist fm Colup`1zanCe (78lo CN111530f:2.1.1) � Co 1.1 SCOPE 110 mph Wind Speed (3-sec, gust) ......................... ............ Wind Exposure Category ...................... .............. .. ..En Engineering Required For Entire Project .............. . Wind Exposure Category...:.......... 9 - .•. 1.2 APPLICABILr1Y - stories s 2 stories Number of Stories(a roof which exceeds 8 in 12 slope shall be 2)consldered a story ....._ s 12.1 ' RoofPitch ...................................................:......................... (Fig. (Fig 2).......................I....................:.... Z eft s 33 Height ............... S BO BuildinMean Roof (Fig 3 ZFff ( 9 )........................................_........ Building Ledlh W .....:.....................................:................:.. N f} s 80' ' Fig 3 .................... Building ngth, L ....:........:................. i.z.� s 3:1 g Aspect Ratio (UW) (Fig 4).................................................. Nominal Height of Tallest OpeningZ .........................•.• (Fig 4).................._.. ......................... 1.3 FRAMING CONNECTIONS V General compliance with framing connections............... ....... 2) 2.1 FOUNDATION Foundation Walls meeting requirements of7B0 CMR 5404.1 Concrete.:.:... :...:............ .............:.....:............................ 'li�l*1�� Concrete Masonry 1'3 2.2.ANCHORAGE TO FOUNDATION , . 5/8"Anchor Bolts<lmbedded.or 5/B"'Proprietary Mechanical Anchors as an alternative m concrete only Bolt Spacing,-general ......... (Table 4) - . in i (Fig 5)..... ... ... ...... n 5 6" - 12" .Bolt Spacing from end/Dint of late ••-••-•p In z 7 .....(Fig 5)...... ..... . .. .. .. .............:....... .. Bolt Embedment-concrete..................:................. in.z 15" (Fig.5)............ .... ....:..............:...... Bolt Embedment-masonry.............................:..... .....:.>3" x 3" x'/<" PlateWasher..:................ .............................................(Fig 5)..........:....... ......... 3.1 FLOORS (per 780 CMR Chapter 55)................... ••• :.......................:... 3 ft s 12' Floor framing member spans checked P Fig 6 ................... .. .... .... . . Maximum Floor Opening Dimension - Full Height WaII Studs at Floor Openings less than 2' from Exterior Wall (Flg,6)..1.....••••...• Maximum Floor Joist Setbacks s d (Fig 7)......... .........I................. .......:... . :... ft Supporting Loadbearing Wail's or Shearwall.......:.:...... .Fi Maximum Cantilevered Floor Joists s d (� 5upportintg Loadbearing Walls br Shearwall................ (Fig B).................................................... Fig 9).......................... ............... . .......................... FloorBracing at Endwails............:...............................•• "(per780 CMR Chapter 55)........................I.......:.. i Floor Sheathing Type ......................I.........,..... . .. er780 CMR Chapter 55)....:.................. m. Floor Sheathing thickness ................ .............................. (p Floor Sheathing Fasteriin ..................... Floor 2)..�d nails at_� in edge/ in field g ................. 4.1 WALLS Wall Height (Fig 10 and Table 5).. - .,....... �ft s20 Loadbearing walls..................................................... - . _ , .. ..(Fig 10 and Table 5)........................j2�ft s Non-Loadbearin walls _ ' (Fig 10 and Table 5)........:.......... I/ Wall Stud Spacing ...................................:..... s d............... ' Wall Story Offsets ................................................... ......(Figs 7 &8).... .............................. ....... ft 4.2 EXTERIOR•WALLS' Wood Studs 2x -�ft • Loadbea in ringwalls _ .......,..............-.. — —....................................................... S ft Non-Laadbearing walls . Gable End Wall Bracing' (Fig 10 — FuII,Helbht Endwall Studs ' ................'... (Fig 11)............,......,.........................�ft . WSP�Attic Floor Length ............... ... ft>_0.9W .. . ,.. ,:.%Al[ r7 o�� .......(Flo 11): ..:.:................................. — ATVC Guide /u 1'Yood Colfffl•r1cli0/r iii. Hi,�Il/r Gllirid Areas: I10 litph WijId Tolle Massachusetts Checldist for Compliance (780 CtAllR5301.2.1.1)! J Loadbearing Wall Connections Lateral (no. of 16d common nails).......................'.........(Tables 7)....................,................................ —/ Non-Loadbearing Wall Connections V Lateral(no. of 16d common nails)....... ... ...........: . ..........(Table 8)................ ...:.................................. Z Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) / Header Spans (Table 9).......•...........................�ft 12 in.511 V Sill Plate.Spans Table 9 3 ft O in.511 Full Height Studs (no. of studs)...........................•........(Table 9)..............................I........................ Non-Load Bearing Wall Openings (record largest opening bUt check all openings for compliance to Table 9) HeaderSpans............................................... .........(Table 0)..............................:... ff v in.S 12 SillPlate 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 OpeningZ SAS 6'8" -Sheathing Type..............................................(note 4).................................. /A........0.SS- Edge Nail Spacing (Table 10 or note 4 if less)........................ 6 in. Field Nail Spacing ..........................;.............. Table 10)............................................... IZin. �1 Shear Connection (no. of 16d common nails)(Table 10).............................................I.........— Percent Full-Helght Sheathing.......................(Table 10).................................:...............�% 5%Additional Sheathing for Wall with Opening>-6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Openingz....... ....... .....................•.................................... s 6 B Sheathing Type..............................................(note 4).....................I............... ....... O.S,S Edge Nail Spacing (Table 11 or note 4 if less).................•...... 6 in. ✓ Field Nail Spacing......, tn. ................................:..(Table 11)................,...........:.................•.._.-I.L- --� Shear Connection(no,of 16d common nails)(Table 11) Percent Full-Height Sheathing— .. Table 11 ............................................:.......2') 56/o Additional Sheathing for Wall with'Opening>6'8"(Design Concepts)...............:..•. Wall Cladding Ratedfor Wind Speed?.............................................................. ..........................................•.................... V 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Websile) Roof Overhang ...................................................(Figure 19) .............Q ft s smaller of 2'or V3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors U-2Q3p If l� 6-v Uplift................ .......................(fable 12)............................................. •,,C �0 t� Lateralt ha ......................... (Table 12).............................:................L= plf �f Shear............................:...............:..(Table 12)....:............•.•........................ • •p � If• i trap Connections, if collar ties not used per page 21... (fable 13}......GN1�P -....Lv.4(.Sr� _ Gable Rake Outlooker..............•..'. (Figure 20) ............. 0 ft s smaile1r of 2'or V2 ✓ Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors � Uplift.......................:........................(fable 14)............................................U=_t 111 lb. —�{ Lateral (no. of 16d common nails)...(Table 14).......................................L-�Tb. Roof Sheathing Type....................0_4. 13......2,?........(per 780 CMR Chapters 58 and 59) ............• Roof Sheathing Thickness........................................... .............................................I&In.?:7/16"WSP, Roof Sheathing Fastening............................................(Table 2).:..............(..�l�b�.....••••rV.•• r Notes: 1. . This checklist shall be met in its entirety, excluding the specific exception noted In 2, to comply with the requirements of 78D 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. 2b Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. ' Exception:Opening heights of up to B 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, License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 131841 Board of Building Regula x �tions and Standards Expiry fbn,. .9/26/2010 Tr# 274186 One Ashburton Place Rtn 1301 - Boston Ma. 0210$ T�� P ' to Corporation ' `x CENTRAL CAP 3 EONtRI C-TI6NCO. INC. STEPHEN DEVIIIN �? . ' 820 MAIN ST " COTU IT, MA 02635'4= Administr ator of slid without signature L F 1 s a i One Ashburton Place Room 1301 Bost6n. Massachusetts 02108 Nome Impro vement'Contractor Registration Registration: 131841 Type: Private Corporation 4 Expiration,. 9J:.6J2010 Tr# 274186 CENTRAL CAPE C,O.NST.RIlCTION'QQr_ =a STEPHEN DEVLIN 820-MAIN ST. .; t , COTUIT, MA 02635 4 a '_:. --- , „. Update Address and rett r•n card. Mark reason for change. _ Address Renew-i Employment Lost Card DPS-CAT %6 50M-07/07-PC8490 - ..._...:. � _- -- a, - �• ''�' �+ ✓�6-U/OOs�i/�7.P9ZlUe�U/L ��� .JOQ.CILLldC�6 Boardtof Bu iding Regulahods.and�tand"aids ConstructforirSupervisor License License CS: 47403 ct en IIff 2010 .Tr# 15334 r FZ ST,EPHEN J DEVQN BLACKTHORN DRY MARSTONS MILLS`4MA 02648 }} Commissioner t . a t x ACORD, CERTIFICATEDF ;LIABILITY INSUI�NCE. x `:' ` 5 19 20 o PRODucER,:-1508.)656-1400.�FAX•-.,;-(508)656-14.99 THIS:'CERTIF_ICATE;.18:,ISSUED-.AS:A'-MATTER OF",INFORMATION.' ONLY AND,`CONFERS NO;`.RIGHTS UPON THE,'CERTIFICATE`.' Charles River:Ins Brokerage, Inc HOLDER.-'THIS'CERTIFICATE DOES NOT AMEND, EXTEND.OR.- 5`Whittier. Street `ALTER THE°COVERAGE AFFORDED,BY THE POLICIES:BELOW. 4th''Floor- 1 Framingham MA 01701 INSURERS AFFORDINGCOVERAGE NAICr# INSURED s ` � ;.': INSURER A AIG'' .. ' .. ; .: �32220 Central Construction C0,` 'InC. INSURER B TrdYelers',Ins.-.CO-.- 820 Main Street INSURER'C 'INSURER D' . COtuit MA 02635 ' INSURER S OVERAGES 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;,WJTK.RESPE-CT-TCU-- WC41-k -CERTIEtATE.MAY9rBE ISSUED.OR MAY'PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO,.ALL THE:TERMS,'EXCLUSIONS AND CONDMON" OF SUCH POLICIES: A_GGREGA!E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-, _ I lNSRADD'L`' POLICY EFFECTIVE I POLICY EXPIRATIONI -- --- - - 1 r r_i,r l;vaz.Istu:gwE Yt�Lt,;y N mrimrc --(...DATE WIDD/YY I DATE IMWDDNYI ; EACH OCCURR vim_ _ 1,.00a 0 f�� I DAvr.� TORENiED 1 ?LI OPifFRCAICFNFRAItiAF,ll'TYI ��GcEA saR '. 11%e4j2008+ 11Ji�3I2009 oREMISES(Ea cttr..nce: i 303,000 I M WIED EX? "a,e uerson PERSChA'.'E ACb'lPtJ R a-;000 r C001 GENERAL AGGREGATE $ 2..,000 r t3f 01 - ` U_r:L f�vr 2rvA,c L RIT APPL LS cL"R�:, - ' f ,�' - ` '�. 000 R!`:0ii_ '. P%Ou CTS- Gl w/0: AGu r -� 1 POLICY I SRO i LC ( d l i�'- ANY A t Tr �. {i'_L 14YI�Ct:<.l1 i t v • BODI ILY I^i.JLlk 1 EFn {Perperscr! I' ^ f _ 1 HIRED AUTOS gnu i v IN-inlay - raperclle.anzry - I- I �A, ANY -E -A^Cl ENT - - I, -- ANY AUTO ! i :OTHER THAN EA ACC $ 1 I l AUTO ONLY: AGG S EXCESS(UMBRELLALIABILITY i EACH OCCURRENCE .AGGREGATE !$' . 1 DEDUG L fiLE RETE•lTiON a �. A WORKERS COMPENSATION AND i` vV STATJ O i H- Ewiv (jiER&LiAri'LiVi £ ri ..I. ( �ANY PRUPRIETURIPAk7NtR/EXECUTIVE '��� _ .� E.L EACH ACCiDEN S'!>. �'�`e '. ' '' - UrriLEw/nEivi3tk t xi LuiiEur I wr. nna-'1t Fgna 5/14/2009. 5/14/2010 c L cicE,eSE �4 EP a:OYcc S 100,000 ff yes,desaibe under E' SPECIALPROVISIONS below E:L:-DISEASE-PULICY'LINIIT $ 500.,000 'OTHER t { �UtSCRIKIUN OF OPERA 1lUNSILfX.A I tUNS/VEHILLES*AGLUSiONS ADDED kly EADORSEMFNrj lSPELULL PRO'ISIONS y S r CERTIFICATE HOLDER CANCELLATION AVi - Al A-- UL.5VI1.ULe1 YV1.�l.LJ Lf:. 1 LLL YJ i/IV-. if _I- 4ir TI�Qri /1F FiaZ1 l012t�' Y FYDIRATIAAI n&TF TLIFdp6r. THE ICCI 11 Nl IA Rii0FIR Wit/ FA1T1 AV(LQ Tt1 klSil I 59-Tciwn a-. eariCTHE a n ^� ti* II.fEN NOPIGE 10 THE;GER IFIGATE HULOERRNAMAED.O J"E.LEi=i BUT � Y Falmouth, ;MA , 02540 ,, _ _ _ " INSURER,ITS AGENTS OR REPRsSEENTATNES i ,�'- i't x "�` ".wl Inxnonen aeooceealrwra;-e Y'i}-'yT KeATtEC4� �f t3RP9 9 d'fltlliCsSS y n Y pn r.npP RATIrW 1QAS' w=ljr k;!4jc91cu4VVi[II I IP �l LcFI�J c 'ar• :.t�e�all'VUWW:OffadorVCOt11 ; R x -"09/21/2009 00:59 5087785731 CAPE COD INSULATION PAGE 02 ter/ REScheck Software Version 4.2.2 Compliance Certificate Project Title: New Second Floor Energy Code: 2W MCC Location: Carlterville(Barnslable),Massachusett3 Construction Type: Single FaMillyy Project Type: A] on n9 m9ree mw 8137 Climate ZM*-, S Construction Site: Owner/Agent: Designer/Contractor: 59 Oki Post Road Matt&Almee Garthee Stw mn Devlin Centwvlfe.MA 026M 59 Old Post Road Contrail Conswudkah Carrhpany Cantarvlllo.MA 02632 820 Main Street Cotuit.MA 02635 50S 420-1340 Compliance;1.0%Better Than Cade Maximum UA:120 Your UA:119 Calling 1:Flat Calling or Soasar Thaw M X0 0.0 26 Ceiling 2:Cathedral Calling(no attic) 60 $0.0 0.0 2 Floor 1:Afl-Wood JoistTn=0ver Unconditioned Space — — — Exemption.Framing cavity fiflad with Insulation. Wel 1:Wood Frame.16'o c. 957. 19.0 0-0 $1 Window 1:Wood Frams,13ouble Pere with! 118 0,340 40 r War 1:fter(Except Gas-Fired Steam)922 AFUE CWPbrm.57atemant The W*pDsed burktg design described here Is Lrnhslstent with the bulkiing plarm,sW iriwfioK and odW caticulatlons milted with the Permit t c9lio0.The proposed Willing has been designed to nXW the 20M IECC regtriremerb in RESchadr Version 4,21 and to comply with the mandatory requiramentg list ire the RESaxwk inspecction chemist S 14,CAJ GVLI r 11.swf Q 0 Name- _.._ + a r Project Notes: RESdheck by Cape Cod lnsula5m,Inc 455 Yamrouth R*d Hyannis,Ma_ 01 1-800-B9B-6671 #t3035 "Out Title:New Second Fk)or 4ata filename:C:1PMgram Flles\CNack\RESoheckW3035.rck Report 48tB:09114l09 Page 1 of 3 .09/21/2009 00:59 5087785731 CAPE COD INSULATION PAGE 05 200 6 I CC Energy Efficiency Certificate Calling 1 Roo/ 98A0 Wall 1li.00 Floor!Foundation 0.00 Ouctwork uncwwmoned spmas): Wlnd4w >, t Door CMW Non-Gas-Fired 130ft "I APUE Water Heater. ilimm- Namm 441Dabs • 09/21/2009 00:59 5087785731 CAPE COD INSULATION PAGE 03 ►f REScheck Software Version 4.2.2 Inspection Checklist Ceilings: Q Ceiling 1:Flat Coiling or Sdssor Tniss,R-W.0 cavity insulation Commernts: ❑Ceiling 2:Calhadmi Ceiling(no attic),Rr30.0 cavity inmdation Carnmems: Above4rade Walls: ❑ Wall 1:Woad Frame,fir o.c.,R-1U cavity insulation Commonts- 11OWOWS: ❑ Window i s Wood FrarmDoubie Pone with L,ow-E,U-Iector 0.340 For windows without labeled IJ-factors,describe features: #Panes Frame Type Thermal Break? Yes No Con nests: Note:Up to 15 sq.R of glazed fenestration per dwelling is exempt from L 41actor and SHGC requirements. Floars: Q Floor 1:Ail-Wood JolsVrnlss:Over Unconditioned Space. Exemption:Framing cavity fined wnh ineatsW. Gontrrrernts: Heating and Cooing Equipment ❑ Sailer 1;OUW(Except Gas-Fred$team):92.2 AFUE or higher Make and Model Number: Air leakage: p Joints,penetrations,and all onion such openings in the building envelope that are sources of air leakage are Sealed. ❑ Reid fights are either 1)Type iC fund wish endlosuras seawgasketed against ioak5 to the cegng,or a)Type iC rated and ASTM E293 lea WW.or 3)installed Inside an airtight aeaemlalt with a 0.5"clearance torn combustible matidgis and a 3•d*rattae from Insulation. sunroma. O Sunroonw that are thermally isolated from the building eanvelo"Have a nwww,um%nestrartion L142cmr of 0.50 amp the wa mum skylight 1.14actor of 0.75.New windows and doors separating the sunn:om from condilioned Space meet the building thermal envelope requirements. VAW Retaedar q Vapor intender is insured on the wamn-Irw�aide of an nort-venled tanned oefiings,WOOD,snd flouts;or It has been determined plot moisture or Its freezing win not damage the mah ials;or other approved means to avoid condensation are provided, Comments: Materials khmUffeetion and hu"liadon: ❑ Mks and egi4xment are iderdiriod so tl*ot►n*wrs can be dater iced, © Manufacturer marwals for all installed heating and Cooling equipment and service wilier heaffrng equipment hive been MvAded. ❑ insulation R vales,glazing U-factors,and heating equipment efficiency are dearly marked on the building plans or epeCrlrcatiorls. Duct Insarlation: ❑ MiltA in undandi6ored spaces or outside the buing are krr;uWW to at least R4. Prged Title:New Second Floor Report date;09/14109 Data illeneme:OVrogmin FGes\ChadclRP,SChe* S.rck Pegs 2 of 3 1 t, . • 09/21/2009 00:59 5087785731 CAPE CUD INSULATION PAGE 04 vF 0 Ducts in floor t uses above unconditioned spaces or above the outdoors are insulated to at leM R-5_ Duct Construction: 0 Air handlers,filter boxes,and duct connedions to fiange8 of air dlshibufiW system equipment or shout new fittings are sealed and mothanhxdly fastened_ AN joints,seams,and Contractions are made buy airtight with tapes,ga*eting,mastics(adhesives)or other approved dcoore systems.Tapes and mastics are rated UL i 81 A at UL 1191 B, Building framing cevltles are riot used as supply duM. ® Atftmatic or gravity dampers are installed on all outdoor air fntalae9 and exhausts. Add'raortat requirements for tape sealing and metal duct aftMg are included by an Inspection for compliance v4th the l0arnationd Mechanical Code. Ton Tatum Corftls: Them>ostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the hoofing and/or cooling input to each zone or floor is provided. Heath and Cooling P Sbdng: Additional reqitettterds for equipment sMng are wftoed by on Inspedivn for cw9limwe with the Irderrefim PteddenflalCode. C1mulating,erviae Hot Water systems: a Circulating service hot water pipes are Insulated to R-2. C3 Cdreu a ng service toot water systems Include an ate or accessible manual swrXh to rum off the drradating pump whet Ise system is not in use. Heating and Cooling Piping Insulation: Q I4VAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F am Insulated to R-2- Gerf�fca�: . A permanent eerffflcate is provided on cr in the olecWteed dishfbutimt panel frstirtg the predotninartt insulation R valtm;wwfndow U-factors;type and efficiency of space-oondltloning and water hesbing equipment. NOTES TO FIELD-(Building Depattrwt Use Only) ti project-rft;New Second Floor Repart'date:09/14/09 Data filename:C:)Program Filez%ChecMRE$dWkWM$.rck tie 3 of 3 Town of Barnstable Regulatory Services k 7ARNEUAD Thomas F. Geiler,Director MAes. 039. 3y h � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www,town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790 Property Owner Must Complete and Sign This Section. ; If Using A Builder as Owner of the`subject property hereby authorize u ,J 0, to act on my behalf, in all matters relativeto`work authorized by this building permit_application for (Address of job) 9r) g Signature f --vrier ry raY. L ).J �t/tiV�cd Print Name If Propelly Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Town of Barnstable F�l rp� Regulatory Services Thomas F. Geiler,Director sinxcr�er.�, � Building Division Arlo Mpy a Tom Perry,Buifding Commissioner 200 Main Street, Hyannis,MA 02601 ww ,town.barnstable.ma.us Fax: 508-790-6230 Officer 508-862-4038 — HOMEOWNER LICENSE EXEMPTION Please Print DATE: J 10B LOCATION: street village number ..HOMEOWNER!': home phone# work phone# name CURRENT MAILING ADDRESS: city own state zip code -ss and lin of six The current exemptio for"homeowne s"was extended to include own ocaclpteed dwrlovided that the towner acts as to allow homeowners to ngage an indi idual for hire who does not possess supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel land o which he/she resides or in tends r�solduch usehand/orich efarni re is,structures.r is dA ed to be,a one or two-family dwellin atta ed or detached structures accessory person who constructs more than o e ome in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the But ing Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work erfo e under the building ermit. (Section 109.1.1) The undersigned"homeowner" ass mes X�onsibility for compliance with the State Building Code and other applicable codes,bylaws,rules an regulatlhse�he The undersigned"homeowner"GP-rtifies th understands the Town of Barnstable Building Department minimum inspection procedures and requiremen and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings contairting 35,000 c bic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S E MPTION The Code states that: "Any homeowner performing work for which building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provid that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act s supervisor." Many homeowners who use this exemption are unaware that they are s uming the responsibilities of a supervisor(see Appendix Q, cn results in Rules&Regulations rfor Licensing unlicensed Construction Is this supervisors, ase,our Board caSection snno proceed against the un) This lac of awareness licensed person snit wous ruld with aalicensed ' y when the horneowne Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,aspart of the permit application, that the homeowner certify that he/she understands the responsibilities on for use in yourO ommunityn the last age of this issue is a form currently used by several towns. You may care t amend and adopt such a fomr/ r ' 1 NN i 51 � 7r Of ,LAMEST r MAOORE E No 332 SECOND FLOOR BEAM b,Weyerh.,u , -_ 3 PCs of 1 3/4".x 9 .1/4" 1.9E Microllam@-LVL TJ-Beam@ 6.35 Serial Number. - - User:1 9/1412009 11:29:18 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page t Engine Version:6.35.0 CONTROLS FOR THE APPLICATION AND LOADS LISTED r G° c V C S pto it- Product 049rarn is Conceptual. LOADS: h+`�'� ` Analysis is for a Header(Flush Beam)Member. Trutary Load Width: 12'6" Primary Load Group-Residential-Sleeping Areas(psf):30.0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application. Comment Uniform(plf) Floor(1.00) 250.0 125.0 0 To 10'6" Adds To ceiling SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 2.15" 3281 /1514/0/4795 Al: Blocking 1 Ply 1 3/4"x 9 1/4"1.9E Microllam®LVL 2 Stud wall 3.50" 2.15" 3281 /1514/0/4795 Al: Blocking 1 Ply 1 3/4"x 9 1/4"1.9E Microllam®LVL -See iLevel®Specifier's/Builder's.Guide for detail(s):Al: Blocking DESIGN CONTROLS: Maximum Design Control Result Location Shear(Ibs) 4643 -3825 9227 Passed(41%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 11801 11801 16806 Passed(70%) MID Span 1 under Floor loading Live Load Defl(in) 0.249 0.254 • Passed(L/491) MID Span 1 under Floor loading Total Load Defl(in) 0.363 0.508 Passed(L/336) MID Span 1 under Floor loading -Deflection Criteria:STANDARD(LL:L/480,TL:L/240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 10'.6"o/c unless detailed otherwise. Proper attachment and positioning of lateral"bracing is required to achieve member stability. ADDITIONAL NOTES: `s -IMPORTANT! The analysis presented is output from software developed by iLevel®. iLevel®warrants the sizing of its products by this software 'will be accomplished in accordance with iLevel®product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel®Associate. -Not all products are readily available. Check with your supplier or iLevel®technical representative for product availability. -THIS ANALYSIS FOR iLevel®PRODUCTS ONLY!. PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevel®Distribution product listed above. -Note:See iLevel®Specifier's/Builder's Guide for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: 59 OLD POST ROAD David McLean CENTERVILLE, MA Falmouth Lumber 670 Teaticket Hwy East Falmouth, MA 02536 Phone:5085486868' Fax :5084570649 davem@falmouthlumber.com Copyright @ 2009 by iLevel@, Federal Way, WA. Microllam@ is a registered trademark of iLevel®. - _ i Assessor's map and lot number .............. .... .. .. :/�:.......... - oFINETo - ewage Permit number ...��... .5�.1'............................ �C S .y . C Z S3WSTADLE, i SEPT YS House number .... I�S� .ED S6V NOMb 0 0� TOWN OF •BARNR �;� RU 1�t 0 1 N G, INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION - ' O G �1 Gt .. ....... .... 1... ............... .......... .............. ... ......... C...�:L J..... ..............19...0.:! TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..5.(1.......(3...!j... CJ��"� ... .0�... lob . ' ...11..1..1..1.�'..n...C�.'..f.,�....... Proposed Use ....�... .n�..!..d. ....... .. .0. ....... .... ........ .... .!^. .�` �1.............. 1 I ` Zoning District District ....cr t:4: Name of Owner�7.[E'!�I1...�..��. 1 !.` �'1.."".��L.1 !?nSAddress ... ....G.. ....!..Q .r.. ....CeP1.�-CV . .. ...... ..... .. . c 1l L /I Nameof Builder ..............................................................'....Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation �O ti C�� � 'V C ........................... ..................... Exterior ...C. . '!�.G.!!.....1.. ..1.. ..�. .5........................Roofing ....��_. .7. '`. ................. ... 4. Y.�.... . ............ ............. V Floors `^!. . ..... ............................................................Interior .....5�...�.�.e..�...�.�.C.��............................,...... Heating '" ........Plumbing..... ...... Fireplace ......no....................................................................A`Pproximate Cost.... .... W. .... .......................... .................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ...�/�..... ...................... Diagram of Lot and Building with Dimensions Fee SUBJECT�9- PROVAL OF BOARD OF HEALTH ,,, T6� t r >i dew Vv- s b® 6.+�s�i®aeims��an++iwt.nwe rV` V I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above d construction. ' . ............ Name !� .1..:.w..1.K�. ^..� —WILLIAMS, GLEN & MARILYN `4 ' � .- fNO .2a3.aD- hermit for .. ...........�................Single Family welli Qzg ............................................ .............. ...****............. Location ...Lot......#. 5.9.....O..d 'st Road .................. Centerville . .................................................. . .......................... Owner ...Glen...&...Ma.r i.1 y n...Williams.. . . ... fyr .... .. .. .. ...... .... ....... ..... .. . .. ....... T ei�" I Frame Type of Construction ........................................... ................................ ............................ Plot .............................. Lot.................I................. July 21 81 ..................19 Permit Granted ........................................19 19 Date of Inspection { / Date Completed ..................... PERMIT REFUSE6 ............ 19 . ...............4. ........................................... .............................................................. ............... -:... .. ........ -� ...... ......................................... ............. .................................................................. • Approved ................................................ 19 . ............................................................................... ................................7............................... ........... II I ' � 1 1 �Io, , ;)Q • Lt) "SMOKE DETECTORS REVIEWED a _ I SUEDI G DEPT. DATE MTt'ZE _ FIRE DEPARTMENT DATE f BOTH SIGNATURES ARE REQUIRED FOR PERMITTING enw tixt 41, r - _ i + d= , s II tj s t E r . + r fin--`S 'n(v� _.-_ PREPARED FOR _ P � _..__-... ._ _. .. : 1 .• I.it i _ — f .I -_-- - f � I - ':' is t j ' r Central Construcfion Company, Inc. Steve Devlin •President Y I'. _ - n r .' he Excitement is Building" .a $ .j 820 Main Street-Cotuit, MA•508-420-1340 - _ SCALE IL ri--1p Orv` -L- V�i J�-' �l �1 . DATE DWG NO.. DESfGNip.uL,- HECK. DRAWN �i' JGB NO. SHEET' OF : - •I _ PROJECT TITLE l� a S e_. . 1 'pi�-0�° — �s i r i , 6 i j 1� • P.._ t • + {{{ '.' _.. — -3 .t o J�!�r ti. , P>3E ABED FOR j ' _ I _ 7n?"fi�-- (✓he-G :�i--Tn:,/l� c AL 4 .€.J i _ f _ F j 1 - Central Construction Company, Inc i _.. I Steve Devlin•President _ _ «The Excifement is Building" / / i' ' Main Street•Cotuit,MA•508-420-1340 82e-mail:centralconstructionco@gmail.com, ; ?5 t s�r,L :iet f �\ . . �i-• 1 . i Weldsite.www.centralcapeconstruction.com SCALE c s-'ua'Z 0 DATE .: '. D.WG NO DESIGN STuK,' CHECK DRAWN - ?` n .ice SHFFT OF _ - r. 4 - - i L i7. V C h.o(J i rt : E ry I f J � � G r _ l E } PREPARED FOR } U 7 13v t�i3 i v j - - - -- = -- - Central Construction Company, Inc. 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