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HomeMy WebLinkAbout0025 PATRIOT WAY a _ o 0 r 5 d wn t�r To of Barnstable *�e met# Expires 6 months from issue Regulatory Services Fee Z * snxtasrABLE, MASS. Richard V.Scali,Director 1639. Al fp�,I a Building Division . 3lg Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL_ ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4446clml,- Ol esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address' � ( r < •IT <!v Lr/ Contractor's Name Telephone Number Home Improvement/ontractor License#(if applicable) /sr5��' Email: Construction Supervisor's License#(if applicable) O /`l3 - M a PT u et m a DV �rkman's Compensation Insurance Check one: MAR 0 5 2015 ❑ 1 am a sole proprietor TOWN OF BARNSTABLE ❑ lam the Homeowner [-I ave Worker's Compensation Insurance E Insurance Company Name S Workman's Comp.Policy# 6"1 IlaV Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ����✓�� �e-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 (maximum.35)#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 fsign Property Owner Letter of Permission. A copy of the Home Imp ement Contractors License&Construction Supervisors License is required- SIGNATURE: Q:\WPFILES\FORMS\buil mg permit f rms\EXP YS .doC7� Revised 061313 r r � o The Comvrcrirvve�of•Massachaseft e rr o rdr str �4ce'dent 0'07ce of rm esi%adans BOSta78y AM Q,2111 � WFG'11?7tILZS.i~.�o'FS�f�Il� Workers' Crrmpensat€anInsurance davit:LuEildersfContr-a:ctorslE-ectricians/Plumbers �r�cant Infarmation. Please Priaf Legibly Name er6' �ca Address: A®, fox IG City/Stagy _ Phone� n. .' fare you an employer. Check the appr priate bow: Ty. of project r _ ❑ I am a:general contractor and I { � - 4 I!_�aTn a�ployex tivitle 6_ ❑Neva caarE[�orf Toyees{fii11 andtor *,F hav ehiredthe mib-contractors. Listed on the attached sheet'; 7- ❑Modeling I El I�s?n a sore prup>iefor or partner- These srb-coafractor�x have strip and have no employees $_ ❑Demolition efl�ing �m e m an c cr r empla gees and have workers' Y 4_ ❑Building addition Wo urorke:rs' comp_rw�rance comp_mstuancce_ r�oiredl 5_❑ We are a corporation and its lf}_❑Electrical repairs or additions I❑ I mn a homt orn-m-e-doing all work oifr have exercised their 11_❑Plumbing repairs or additions ray �2do urcrlrers'consp- right.of 4'\�.tionper MGL I?❑Roof repairs �1(�c_ 152, and we ha s e no, i�,c�fnrnce r�uir�d_j F employees_(No worker' 1--.❑f?.ther comp_inKarance required.j. -Any appUumt Lu[checks boa-,I-mst slso fi oiA the section below chrrwnag Ybeiz wormers'[ompetzsati-I poiiEY itl l Homec-wn�s�rbo subz>=R this z�dxvit i�,r�a r�c they ace pia g�Ytcriic�-�t$en hire outside co�txaemrs mast s,�rit s�.:sydss>it m _'� �such_ C:�r�c�rs tivgi check ties b�c must silarhr3 sa sdriirinnscI sz£et shoumg the asm�of ilie srkt-ors�md stsb��-hetbe[pEnnr rL�sa Lies h3v� Emplayecs- If fl+>sr a con acftres I>sc a empIoyees,dfiey must plmaae tl-r u ocki--s'cotng.policy uwaber_ rrrr are s:rr�i�y�r chat is prox�idirrg tt�or>ferg'c-omp�turliv.n uu-ntrrrrtce�`or rrz� pnrpFoyees. ��tF is f3t�paTic}curd}ob srl� ir?,forma�o:z / J Insurance Compas{Z�ame: 1- - 1,114, Policy,-'-'-Of S If Lim b t j Exgiratibn ate_ Job Site Address: Cif-vj'5tatelTlp_ A taclz a copy of the workers'compensation poll . decI—ation page(shovdag the policy number and,Xg tAn date). Failure tX)secure caserage as required under Sectioa 25_4 o€MGL c 152 can lead to the impositioa of csimi>Dal penalties of a fine up t I,50a_Qa andtof one yearimpf so as well as civil penalties in fhe faun of a STOP N}QRK ORDER-and a find ofup.to$250-M a.day against the violator_ Be advised that a coyT of this statement maybe forwarded to the Office.of hn,edigatiom of ffie DIA far iias ce coverage verit ratios- I do her-ef cerfi} rtrrd tkspruns Ott panotYnsS of aty that-the incjornnationprcnidedffbove fs.flocs and correct Simsture. Bate.; Phone#'. f iczirl use an[y. Da nat writs in this area,to bs cawpleW by cii}y or loam o ciaL City-or Town: _Peruritff-acertse zE EssningAuthority(circle one): I.Board of Health Buff ug Departcaeat I CitOTi awa Qerk 4.Electrical Enspector S.Plumbing Ewpec€or 6,tither CoM- tSrct Perzan.: Phone#: 6 Information and tH truc ons 1 i Massacusetts CTreneraI Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant o this statute, an employee is defined as"_..every person in the service of another under any contract of hire, express or itaplied, Drat or written-" An employer iklefined as"an individual partnership,ass ciation,corporation or other legal entity,or my two or more of the foregoing!eagaged in a joint enterprise,and inclu * g the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,associ on or other legal entity,employing employees. t-lowever the owner of a dwc"house having not more than three artments and who resides therein,or the occupant of the dwelling house of a other who employs persons to d aintenance,construction or repair work on such dwelling house or on the grounds or b -ding appu Tenant thereto sh not because of such employment be deemed io be an employer." MGL chapter 152, §25C also sues ghat"every to or local licensing agency shall withhold the issuance or renewal of a license or pe it to operate a busi ess or to const-T!ct buildings in the commoaweaitb for auy applicant who has not prod ced acceptable evi euce of cowpliauce w-it_h the insurance_coverage required." Additionally, MGL chapter 152, §25C(%)states` either the commonweal h r;or any of its political subdivisions shall enter into any contract for the pe i�=ance of p lic work until acceptablt eVdderice of compliance Zia the insurance requirements of this chapter have'D17K presente to the contracting authority_" Applicants — Please,fill out the workers'compensation davit completely,by checkl-rg he boxes that apply to your sita.atiOn and necessary,supply sub-contractors)names) .ddress(es) and phone mm-,b,-T(s)along with heu cert_uc`e(_) of insurance. Limited Liability Compaq es( C Or Limited Liability Parmerships(LLP)vain no employes other t_ha_n the members'or partners,are not requied to azry w kers' compensation Msir-once_ If an L"L.0 or LLP does have employees, a policy is required. Bead ,sed that t affidavit may be s, bmifted to ibe Departinent of Ilnduzcral Accidents for confirmation of in_s:u­2n P t ovei�e. Iso be sure to sign and date the affidavit "11e affica.v t shoulld be retuned to he city or town Lath applicadoa for e permit or 1 cause is beM' Qr reauesied,not the Department of Industrial Accidents. Should you Lha e any question re ding the law or if you are required to obtain a workers' compensation policy,please call the 1 epa,anent at the er listed belo';v. Self-insured comT,Jes slw ld enter their self-inctlrance license number oa tl:,. appropriate line, City or Town Officials Please be sure that the affidavit is mplete and printed legibly_ The e ar;ment has roFZded a ace at the bouom p P � of the affidavit for you to ill out i Le event the Office of Lavestiga�_o� has to contact you retarding she applicant Please be sure to fill in the permi` cerise number which will be used as a_efereace number. In addition,an applcant that must submit multiple pei�i` incense applications is any given year,nee only submit one aL�davit indicating current policy information (ifnecessa��) .nd u-nder"Job Site Address"the applicant sh uld vvgte"all locations i<z (city or town)."A copy Of the affidavit at has betin officially stamped or marked by to or town maybe provZded to the applicant as proof that a valid a davit is on file for fatz c permits or licenses_ A An affidavit must be filled out each year.Where a home owner or tizeu is obtaining a license or permit not related to any�usi-ness or commercial venture (i.e.a dog license or permit to urn leaves etc.)said person is NOT required to complete`,hs affida it. The Office of lnvestig:tions �ould Nce to th:mk you in advance for your cooperation and should you ha)>e any questions, please do not hesitate to giv us a call_ The Department's address, elephone and fax number: Tb_4 COmmonw�al&of Massac?ins-(�-ils Diapafmtnt of ladustr-ka1 AQci_dr-fs Q�zee oz�v�sfig��au� , GGG Washmgtoa g'tizQf_�L }Roston_TMA 02111 Tt L�617 727-49Q0 W 406 or I- r NLk SAFE Fax� 617-`27- :491 Revised 4-2�07 - �'��.Inas�go�lda ;HOME IMPROVEMENT CONTRACTOR ' F3e istration: 145954 Type: . :1=xpiration: 3/15/2015 Private Corporatior DOYLE+THOMAS CONST INC TROY THOMAS 499 NOTTINGHAM DR CENTERVILLE, MA 02632 Undersecretan Massachusetts - Department of Public Safety Board of Building Reguiations and Standards ;�.ii i:�gun >i�iii t-�7�nr'CI+,•re:f: License: CSSL-099913 TROY A THOMW ; 499 NOTTGH.�VI D '4 CENTERVILLE MA x Commissioner 04/13/2016 i AC:bR R 09/02/02/2014 Y) CERTIFICATE OF LIABILITY INSURANCE DATE CERTIFICATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.­THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kristine Fernandez Mark Sylvia Insurance Agency,LLC BONEEXt 508 957-2125 (FAX,AIC No:508 957-2781 404 Main Street Centerville,MA 02632 EA DRRESS:kdstin marks Iviainsurance.com INSURERlSl AFFORDING COVERAGE NAIC# INSURERA:Farm Family Casualty Insurance INSURED INSURER B: D$T Construction,Inc. INSURER C PO BOX 168 Centerville,MA 02632-0168 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER ID LIMITSCY EFF POLICY fDD LIMITS LTR A X COMMERCIAL GENERAL LIABILITY 2001X0485 7/21/20 4 7/21/2 15 EACH OCCURRENCE $ 1,000,000 DAMAGET CLAIMS-MADE �X OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PO- X POLICY1:1 R4 LOC PRODUCTS-COMPIOPAGG $ 2,000,000 MOTHER: $ AUTOMOBILE LIABILITY C BINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED. I RETENTION$ $ A WORKERS COMPENSATION 2001 W7501 7/25/2014 7/25/2015 PER OTH- AND EMPLOYERS'LIABILITY YIN STAT;E ER ANY PROPRIErORIPARTNERIEXECUTIVE NIA E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? Y❑ (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more space Is required) Carpentry I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA M32 AUTHORIZED REPRESENTATIVE - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract . price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$75.00 for a carpenter and$45.00 for a carpenter's laborer, plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment,and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) . -All new 8" drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -A 5 yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the. homeowner..The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at-the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument.on this date: Date: Homeowner __ Con ctG9V Town of Barnstable Regulatory Services T ''Ij off: , ;f Thomas F.Geiler,Director Ste, r�tr iT y( �ijf< Building Division `x v� 5 , ►� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ,�' _ atµ"'i - Office: 508-862-4038 Fax: 508-790-6230 -� PERMIT# �'�O� '. FEE: $ � SHED REGISTRATION .200 square feet or less S ?A+r,ol Wckv ce4e—rVI, 1 Location of shed(address) Village 2( Z 0 1 Property owner's name Telephone number Size of Shed Map/Parcel# Signa Date Hyannis Main Street Waterfront Historic District? ' Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature�is-r-equired) Sign off hours for Conservation-8:00-9 30-&-3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. 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J! .`i al �,,ff .lj-I r '. _, ,� ll" 5 a 4. t" an .i '..v,r .. .� r w I f' 2 L _ U ' I t •, q C 9 Ilk ' t _ Y d: III ti.,. S. - _ t x �) 1 R Y 9 �ql¢T v - .� { ..,t �' ,1 M.. .,�jp r�, tl fi S J "r4. a �1 1 �V �,- t �. �� S3 .b p (.' I: '1 ` M F, - t' 11 y n 1 5F 1 1 N 1 �y I'>.:.:.c{ '� l rt- �- '` il. . n1r 1 w .+r. 1 sQ- - . 1,_ _ `, ^ 4 N e '-a t. ' .r ..(V AoUAWATI.ON v-1 .'� s,. 1 z 32 Z s«{ —z Y ,i - .. f .. / N �,�� OF Mq `d _ /(7' �� R08ENT ,: y4F „N::. 1 -' r ._ I-.�� 1' BtIN-IKi3 r'i , ,. f C - q � a✓ No.8420 z. `t l , . . .. .. . . .-.-. _. ;. ., }.. r _ 0 ; a.: a. 1. - _ +,:. a s r : :.J (� ... : -.1. Y ^ - .... : ,:. CER TIF a E D P L 0 T ..: PLAN ... .: NEW CONSTRUCTION ONLY = CC^/7` :1�' ✓/t—C._,E 14,. TOP OF "`FOUNDATION . IS_ FEET . A.80VE 'LOW POINT OF. ADJACENT - IN ` k ' 1 '< : . . .. r( i'. .: 6., SCALE / - gv DATE_ ( : 1, :7 0 EDGE ENG/NEERING CO.IN `—"� CLIENT bV�2n/�� J CERTIFY. THAT THE`f"ouwvA7n EOISTERED REGISTERED SHOWN, ON THIS PLAN IS LOCH :ED CIVIL LAND JOB NO.: /O�. ENGINEER - ON THE GROUND AS INDICATE DID SURVEYOR DR. By. �1 CONFORMS TO ,THE ZONING LAW 'TY —'' ' ' OF BARNST LE MAS 33 1N0. MAIN ST CH:BY R I? :.f3 712 MAIN S T. __________ 4"` ,a� 30 ,YARMOUTN uece _. /�7: l l r��' / %1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, • 1- Y _ w. ty^ .. • • � 0 Map Parcel Application # HealthyDivision Date Issued aa.log Conservation'Division Application Fee. Planning Dept. :: Permit Fee Date Definitive Plan`Approved by Planning Board C/ pF PL Historic - OKH Preservation/Hyannis fi Project Street.Address QA- Lt_) Village Owner LLZo% Address Telephone Permit RequestAEw�-J C tl k'&-Z E elwefo r ehe00SA S GeeATSav C,- I k °> i fie s¢f■v``e� Square feet: 1 st floor:existing&CX) proposed 400 2nd floor: existing &C0 proposed ( 00 Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation"_3 00 Construction Type Lot Size I U. 111 sra PT_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family J9 Two Family ❑ Multi-Family(# units) Age of Existing Structure �aq ors Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes &No Basement Type: 0 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: existina new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: gGas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes �No Fireplaces: Existing New Existing wood/coial stove:.,❑Yes )a No Detached garage: ❑existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing P�hewF�Asize_ RAtached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' v� cn > Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )&No If yes, site plan review# cn Current Use Use Proposed Use ' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r k Telephone Number Address 10 CCHv Q 7 License# CS `75S og81 l� Y&.A&t,UT)i M .7?) Home Improvement Contractor# i k Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YtQ�p.74 SIGNATURE DATE 4 1 ,- `? t FOR OFFICIAL USE ONLY APPLICATION.# DATE ISSUED MAP/PARCEL NO. o t , ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION } FRAME _ �1?Y`�£ INSULATION FIREPLACE - 'ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0 lz7w� — k DATE CLOSED OUT ASSOCIATION PLAN,NO. I The Commonwealth of Massachusetts Department of Industrid Accidents 0. Office of Investigations 600 Washington Street Boston, AM OZIIY k9iwww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIlectricians/P.lumbers Applicant Information Please Print LegiblY NaD1e (Business/Or-gstization/Individu.1): >". CA&&2� = V Address: Os �- City/State/Z_ : W �CFt M11 ®i3G`73 Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a cmploycr with 4. ❑ I am a general contractor and I . 6. ❑New contraction employers(full and/or part-time)-* havc hued the nib-contractors listed on the attached shoot 7. R-cmodeling 2.❑ I am a'sole proprietor or partner- These sub contractors havo ship and have no employees 8. ❑Demolition employees and have workers' working for me in any capacity. 9. []Building addition [No workers' comp.-iusuranCC Comp-inerrranGe. 5. Vdc are a corporation and its 10_0 Electrical repairs or additions rt qu�red] officers bavc cxcrcised their lLE]Plumbing repairs or additions 3.❑ I am a ho=owner doing all work right of exemption per MGI: myscl.f.[No work�crs comp. 12.0 Roo frcpairs incnranCC rCquIIed_]t .c. 152, §1(4), and we hayt no •13.❑Other employees. [No workers' comp.insurance regtured.] *Any applicant fiat ebeclu box#1 must also fill out the section blow showing thcir ,workers'compensation policy infonrmtim-L t Homcownca who submit this affidavit indicating they arc doing all work and then hirc outside wnb-art rs must submit a new affidavit indicating such. $contractors that cbmk this box trust attacbcd an additional short xbowing the namc of the sub--eanti-a t and stain wbetba ur not thost mtilits bave cniployecs. if the sub-contractors have crr,ployccs,tbey nn ustpravidt their workcm,comp.pobey number. I a arc employer thaf is providing workers' camp instcrance for my employees Below is[he policy and job site m information jusuranGe Company Names: Policy#or Self-ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip. Attach a copy ofthe workers' compensation policy declaration page(showing the policy number anal expiration date). Failurc to sccurc coveragc as requircdtmdcr Section 25A of MGL c: 152 can lead to tho imposition of criminal penalties of a f=tip to $1,5DO.D0 and/or one-year inprisonment, 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. Bc advised tbat a copy of this statemciit may be forwarded to the Office of Invcsti atians of the DIA for ingurancc coverer c verification. I do hereby certify nder the pains-and penalties of perjury th,af the inforrmadon provided above is true and correct Si afore: _ _ Data: Phone# � � "A2 Ll'1910 Ofj,-C l use only. Do not write in this area, to be completed by city or fawn of7cLaL City or Town: Permcense# Issuing Authority(circle.one): 1.Board of Health 2.Buildiag Department. 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector. 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute, an empLoyee is dcfmcd as "._.evcry.pcison in the service of another under any contract of hirc, express or implied, oral or written_" An employer is defined as"an individual, partacrship, association, corporation o�oer legal entity, or any two or more of the foregoing eng�in a joint enterprise, and including the legal represcn yes th of a deceased croploycr, or the cccciver or trustee ol%m individual,partnership, association or other legal m fi employing employees. Ffowevcr the owner of a dwelling houschaving not more than three apartments and who rc ' cs therein, or the occupant of the iwclliag house of.anotber who empIoys persons to do maintenance, construe ' n or repair work on such dwelling house )r on tba grounds or Wilding appurtenant thereto shall not because of such e loymcut be deemed to be an employei." a viGL chapter 152, §25C('0 also states that"every state or local licensing ency shall withhold the issuance or ,riewal of a license or permit to operate a business or to construct b ings in the commonwealth for any applicant who has notproduced•acceptable evidence of compliance the insurance coverage required-" Vdditionally,MGL ohaptcr 1�-2, §25C(7) states`Neither the commonw th nor any of its political subdivisions shall Inter into any contract for The pe�r,f-ormancc of public work until acccp lc cvidcacc of compliance arith the m--nacc L cquircmnts of this chapttr baveVbcenprescatcd to the contracting an ority. ,pplicants lease fill out the workers' compensation davit completely,by eking the boxes that apply to your situation and, if � �: sary,supply subonfra.ctor(s)name(s), address(cs) and phon numbers) along with their eertificafe(s) of rsurance. Limited Liability Cornpanics(1, or Limited Liabili Partnerships(LLP)with no-employees other than the rembers or partnczs, are not rcquirod to carry workers' comperes on finance. If an LLC or 1 I.P does have mployr,es, a policy is required. Be advised that affidavit ma be submitted to the Department of Industrial ccidents for confirmation of insurance coverage. o be sure to sign and date the affidavit The a$tdavit should returned to the city or town that the application for QIC pc=t r license is being requcstcd, not the Department of iduzstrial Accidents. Should you have any questions rearding 'claw or if you are required to obtain a workers' )mppensat on policy,please call the Department at the n> er ' tcd below. Self-insured companies should enter their df-kmuanrc liecmc mmaber on the appropriate line. ity or Tow-A Officials case be sure that the affidavit is complete and printed Icgil ly. Th D cputmcnt has provided a space at the bottom 'f3�e affidavit for you to fill out in the event the Office ofvestigati has to contact you regarding the applicant case be sure to fill in the permit/license number which will be used as efercnce number. In addition, an applicant at must submit multiple permit/liccnse applications in any given year,nc only submit onp a$davit indicating eurrerlt ,licy information(if necessary) and under`Job Site Addrtess" the applicants ould write all locations in (city or wn)."A copy of the a$davit that has been officially sta�pcd or marked by th ity or town may be provided to the pliant as proof that a valid affidavit is on file for future permits or licenses. A n w affidavit must be filled out each ar.Wherc a bome owner or citizen is obtaining a licenscior par= not related fo an'1-usiness or commercial venture a dog li=se or permit to bum leaves etc.) said person is NOT required to complete f�s affidavit .r Office of Investigations would lu7rL to thank you in adv . ce for.your cooperation and shoo Jd�you have any questions, zse do not hcsitatc to give us a call. ti Department's ad.dress, tcicphonc•and fax number The C6mm.onw-,4th of Massachusetts DgaartMbnt of Ind�ustrial Accidents of m of LivVtigaticrns 600 Wsushington Street Boston, MA 02111 Tel. # 617-727-49-0.0 cxt 4.06 ax 1-U7-M.ASSAFF Fax 4 617-727-774 ( 11-22-06 wwW.mass.gov/di a '- • ` .. 00-35;000 of enclosed space • JA-Masonry only iG-1_2 Family Homes edition of the 'y �. ossess a current e f0o"'v"%°'�" � Failure top Code Re Cations and Standards State Building , Board of Building Sn Massachusettsi ervisor License is cause for revocation of this license. ;` Construction Sep 't icen'se: CS 75281 r L Tr# 11056 Expirations 2l2009 4 31100 s Res to ctlon. • "' � TODD J CANTARA � i 10 ECHO RD MA 02673 Commissioner W YARMOUTH, J License or registration valid for individ'ul use OWY before thGexpiration date. If found retw to: Board of Building Regulations and Standards One,Mhburton.Place Rm 1301 Boston,;.Ma.02108 ` Not valid without signature Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 159211 r Expiration 4/10/2010 Trig 266397 . Partnership ECHO CUSTOM CARPENTRY TODD CANTARA . 10 ECHO RD. W.YARMOUTH MA 02673 Administrator ti To W* n of Barnstable �. Regulatory Services . s $ Tliams F.Geller,I3ireetar, Tom Perry,Building Coxnmissiolice 200 Main 9tr� Hy nis,MA 02601 wwwAawu.barustable.,w n.tus Office- SOS-962-4038 Fay; 503-790�'6230 Fropertyr Ow her Must Complete and Sign This'Sec:'tion f Using A Builder j� a ¢..� ��I r• , U Ovmez of the subject property ' hetabp authorize Cua6s nlla C ig�� to sct ou iuy behalf, in a.ma.ttas•=clative to wozk authoxizod by dl is building pctaait apprtcatiaa For: eeevil�e- U, {Addxces f Jab) Pxint hla=e If Fxvpcdy Qvmn r is app!)riug for pczmitplcase Cou plete the 140MCO'W' Utts lr,.acense . Bxemptiou Fom on&i.t re^ =e side. 10/10 39Cd 3aI-10d SNV3180 PL8T0bZ805 Tti:80 800Z/10/80 REScheck Software Version 4.1.4 Compliance Certificate Report Date:07/15/08 Data filename:Untifted.rdc Energy Code: Massachusetts Energy Code Location: Bannstable,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type. Other(Non-Electric Resistance) Gla&V Area Percentage: 13% Heating Degree Days:. 6137 Construction Site. Owner/Agent: Designer/Contractor Compliance:7.7%Better Than Code Mapmum UA 39 Your UA:36 Ceiling 1:Flat Ceiling or Scissor Truss 150 30.0 0.0 5 a Ceiling 2:Cathedral Ceiling(no attic) 200 19.0 0.0 10 z Wall 1:Wood Frame,16"o.c., 240 11.0 0.0 19 Window 1:Metal Frame:Double Pane 16 0.075 1 Window 2:Metal Frame:Double Pane 16 0.075 .1 Compliance Statement The proposed building design described here is consistent with the Wilding plans.motions,and other calculations submitted with the permit application.The proposed buitding has been desUned to meet the Massadumetts Energy Code :requirements in REScheckl/ersion 4AA and to comply withthe mandatory:requirements:listed in the'RESchea nspection Cheddist The beaftioad ortliisbuilding,and-the�fingload 74fappmpriate,'hasbeen:determined,,using;#he.,awricable:Standard-Design Conditions found in the Code.The HVAC equipment se1_ecW to heat or cool the building shall be no greater than 125%of the-design load as specified in S 13 d4:4. Name-Title Signature 1}a g Project Title: �; Report date:07/15/08. Data filename Untitled.rdc Page 1 of 4 BOt,SE Triple 1-3/4" x 7-114" VERSA-LAM® 2.0'3100 SP Floor Beam1FB01 BC CALC®9.5 Design Report-US 1 span l'No cantilevers 1.0/12 slope Friday,August 15,2008 10:10 Build 91 File Name: Echo ElloitResidence.BCC Job Name: Elloit Residence Description:Girt replacing bearing Wall Address: 1 25-Pat�iots R . Specifier: Bill Campbell City,State,Zip:Centerville, Ma Designer: Customer: Echo Custom Carpentary Company:k Shepley Wood Products Code reports: ESR-1040 Misc: 11 NO - 10.00.00 BO,3-1/2„ B1,.3 1/Z" LL 2400lbs LL 2400 Ibs DL 654 Ibs DL 654 Ibs w .Total Horizontal Product Length=10-00-00 Load Summary Live Dead Snow Wind Roof Live. Tag Description Load Type Ref. Start End 100°% 90% 115% 133% 125% Trib. , 1 Standard Load Unf.Area(psf} Left 00-00-00 10-00-00 40 10 . 12-00-00 Load Disclosure Controls Summary value %Allowable Duration Case Span Location Completeness and accuracy of input must Pos. Moment 6950 ft-Ibs' 55.3% `. 100% 1 1 -Internal be verified by anyone who would rely on End Shear 2506 Ibs 34.7% 100% 1 1 -Left output as evidence of suitability for Total Load Defl. L/335(0.342") 71.6% 1 1 particular application.Output here based on Live Load Deft U426(0.268") 84.4% 1 1 building code-accepted design properties . and analysis methods.Installation of BOISE Max Defl. 0.342" 34.2%` 1 -1 engineered wood products must be in Span 1 Depth 15.8 n/a 0 1 accordance with current Installation Guide and applicable building codes.To obtain %Allow. , %Allow Installation Guide or ask questions,please Bearing Supports Dim.(L x W) value Support Member Material call(888)234-0056 before installation. BO Post 3-1/2"x 5-1/4" 3054 Ibs .° n/a 22.2% Unspecified B1 Post 3-1/2",x 5-1/4"' 3054 Ibs n/a 22.2% Unspecified BC CALC®,BC FRAMER®,AJSTM ALLJOISTO,BC RIM BOARDTm,BCIS, Cautions BOISE GLULAMTm,SIMPLE FRAMING SYSColumn at Bearing BO analyzed for bearing only,columnP analysis has not been performed. LUSO,®,VERSA-LAMB,VERSA-RIM LUS® VERSA-RIM®, Column at Bearing B1 analyzed for bearing only,column analysis has not been performed. VERSA-STRANDS,,VERSA-STUD®are trademarks of Boise Wood Product's,L.L.C. Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1"}Maximum.load deflection criteria. User Notes 2nd floor loading Page 1 of 2 r Triple 1-3/4" x 1-1/4" VERSA-LAM®2.0 3100 SP Floor BeamtF1301 BC CALC®9.5 Design Report-US 1 span I No cantilevers 1 0/12 slope Friday,August 15,2008 10:10 Build 91 File Name: Echo Elloit Residence.BCC Job Name: Elloit Residence -Description:Girt replacing bearing wall Address 25 Patriots Way Specifier: " Bill Campbell City,State,Zip:Centerville, Ma Designer: Customer: Echo Custom Carpentary Company: Shepley Wood Products Code reports: ESR-1040 Misc.. Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on output as evidence of suitability for o o particular application.Output here based on c building code-accepted design properties and analysis methods.Installation of BOISE e o 0 0 ' engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,-please a minimum=2" C=2-1/4" call(888)234-0056 before installation. b minimum=3" d= 12", BC CALOV,BC FRAMERS,AJSTM, e minimum 3" ALLJOISTS',BC RIM BOARD-,BCI®, Connectors are:16d Box Nails r BOISE GLULAMTm 'SIMPLE FRAMING SYSTEMS,VERSA-LAM®,VERSA-RIM . PLUS®,VERSA-RIMS, VERSA-STRANDS,VERSA-STUD®are trademarks of Boise Wood Products,L.L.C. Page'2 of 2 I •.( _, •.I r ' 1 r 1 per' r r f r � i ' • j � � ' � j 1 a I � i } i r 1 f , . r , r, , o r- - ? f I' 1 j � - � , i mot_--•--,�- I • - - � I � t I f , u I Y ► 1 Y *It SMOKE DETECTORS R VILVVED I IMPORTANT _ UPGRADE REQUIr:EE:� r 1 I } i STATE' r CARBON MONOXIDE ALARMS E BUILDI DEPT. ! DATE BUILDING"'CODE REQUIRES THE UPGRADING'OF r MUST BE INSTALLED PER 1 � ! oWfSMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN r MASSACHUSETTS BUILDING CODE ! I ONE OR MORE SLEEPING AREAS ARE ADDE`7 OR CREATED. * y FIRE DEPARTMENT DATE -NOTE!:A SEPARATE PERMT1 IS REQUIRED FOR THE ' INSTALLATION OF,SMOKE DETECTORS-THE ELECTRICAL r BOTH SIGNATURES ARE REQUIRED FOR PERMITTING r { ` PERMIT DOES NOT SATISFY THIS REQUIREA4ENT; e TOWN OF BARNSTABLE Permit No. -----------_--_____ •A"IT,a s Building Inspector rua Cash — —- �O �0VA OCCUPANCY PERMIT Bond ----___--------_? - 1� No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to 3aCiY:l Y rJtLtE VOY'F•, Address "^ 25 Patriot Way, Centerville s^ Wiring Inspector �f f ,ice% j, Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. I9...... _ ....... . .............................m....__...._... .. ._._. Building Inspector '�'Y s. 3. r� - c1. •are f.y�? } 4 � r TI f fiZ E kit If ft j S ,e '`r k.. �. '•j r it �"a y i 7 ��_ o 'i� 4' .. ;. _�.,. �� •v KN�'r �tt F �F•r,� xy esi a�, 1. ` a •'t hd rC, tif b vIi Ij '� iL k M 1 f� h' F^ i•ry 'A^ 's, ry 1 `F 42 FOUA/OR.tIOr/ { f" i 1 r 1 a.. - F f, 43 1, ro £ to �, �;`. N �T��H '�'�'� � x-•r� r 16 1 'R08ERT ,ti ,.k _ r.,..,�,..r,o.:a-.-.,�,..irT.�'.f`^. r•s---.-•a++.w...:�""4 -'•+-.,•'t'� r'.�a`Ir.^..'^�"'__ r ,'�"'�x'�' !' i _ k +Ir.� �• � 4 T � s _ _. __ •+" 1 r > � `i',to i P,x�Hsi .t� '"J P. tI sup Ire. 4 CERTINED PLOT PLAN — G U 7- 3 T�A j"9 l 0 7 NEW CONSTRUCTION ONLY = V/° 'L E., TOP OF �FOUNDAT,fON : IS FEET RIN A.80VE _<:OW' POINT OF. ADJACENT < c° i.�A It, , tAA L Xjp �A SS,* M R4A0 c , SCALE•:. / - 4v DATE t ' (EL D RED GE.ENG/NEE'RING .CO.INC� WE'rN�2 10ERTIFY THAT THE0vwy.ar�n CLIENT SHOWN ON , THIS PLAN IS LOCATED LE ISTERED REGISTERED IVIL I LAND JOB NO.. �U ON THE GROUND AS INDICATED AND ` ,q CONFORMS TO .THE ZONING LAWS ep GINEER SURVEYOR DR. BY. OF BARNST_ LE MAS 33 NO. MAIN ST 712 MAIN ST. CH. By ��' .x: �" O " ;z SO. "YARMOUTH, MASSY H.YANNIS, =,IpAT.E, REO LAND SURVEYOR fs Asie's'lor's map and lot- number ./VJV TN E Tad Sewage Permit number .... ................................... Senc SYSTEM Mu I STADLE, AS& House number .................!.............. COM ................... R639 Mid. 5 0 r cot* T 0 W TN.. OF B AS N S ros BUILDING 4NIPECTOR ......... . . ... .... . .. . . ..... APPLICATION FOR PERMIT TO ......��Are*l TYPE OF CONSTRUCTION ................ .1,e11Z1V.dr1..... .................... -.......................................... ....................................... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a p;3it according to thb following inf mation- 2 following Location ...... e......................... ..... ProposedUse ............. ........................................... .............z.................. ... .........Fire District Zoning District .... . ................. ....... ...... . .... ....../Name of Owner .sAddress .... Nameof Builder ..............<- .............................Address ................................................................................. 'io Name of Architect ........................ ... .. ..................................Address ........................................ ... ... ................................... . ................... ....Number of Rooms .................... ....... .........................Foundation��✓� . .... Exierior ... . ..... ........ ...Roofing ........... ... ....... 7,lievl.............. Floors. ............ ... .... Interior ..... .•.................................... ... ..... . Heating ..../�64' ....... .e..I.0..Plumbing ....... ...... .................... Fireplace ......................... ................................Approximate Cost .............................v. ................. . Definitive Plan Approved,by Planning Board -------------------------------19--------- Area ......... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the To n of Barnstabll egardi n!g,)� e above construction. ,e4 Name ...... . . ............. Bam }�x�� Corn �+l ^ ---r^ —�92-3I4 ' ^. ~ . ^ . � ,'No ' - Permit for ..l��.-story. ' ��_ _.__- -~ _----.g . \ ` '-'-^-~~---^------'----------' Location ..... ot.#3....25..Patriot..WaY.......... . -----.~_. ^~-~.1~le------------- ' ' Owner --J�gzzoer..H�Voe..Corn......... .............. Type of Construction -.]�oad..Fzauoe............... / ` . ''---------^-----------~---- . . Plot ............................ Lot ................................ ` ^ ' . ' ^ ' 'Permit Granted ......... Date of Inspection ---lV "='= Completed / - � PERMIT REFUSED -' ' IF 19 . . ^= tv ~~ ' . ' . --..�- . ........................ in `- �^ ��-..��---------.�-.. lQ � `-,�-`= �� . . . . ^ -------.-------~.------...--.. � . / ��'. '��,���'���,�' ^