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4742 FALMOUTH ROAD/RTE 28
�/ �� ��}�7ou� i I`� PROJECT�� NAME: f'.e Ael— ADDRESS: PERMIT# PERMIT DATE: I S S y C—IL M/P:_ LARGE ROLLED PLANS,ARE IN: BOX I � SLOT 3 Data entered in MAPS program on: BY: q/wpfiles/forms/archive �1NE Town of Barnstable Regulatory.Services * BARNSfABLE, v MAss. �, Thomas F. Geiler,Director �A 1639. �0 �Fn +a Building Division Thomas Perry;Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us .Office: 508-862-403 8 Fax: 508-790-6230 September 3, 2013 Mary Ann Gilmore PO BOX 1181 Osterville, MA. 02655 RE: 4742 Falmouth Rd., Cotuit, Map 010 Parcel 001 001 Dear Property Owner, This letter is in response to application number 201305538 to add a three season porch.., Unfortunately, this office is can not approve the application for the following reasons: 1) Incomplete construction documents. Plot plan showing location of addition needed. 2) Additional information needed to use existing patio for support of addition. 3) Complete floor plans needed with insulation if needed. Please do not hesitate to contact this office with any questions. Respectfully, J r L. u- Local Inspector 508-862-4034 jeffrey.lauzon@town.barnstable.ma.us TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 601 QD 1 Application #slo t 3 y`D Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address / ry . i . ; . illage GcVOl`7_ AMA , Owner �/ I✓ (0V. Address .,_Telephone -�_6C�1+" ,V-7 9q l� Permit Request fv2 "D Mo O N rim 1�X 3 o Square feet: 1 st floor: existing 6WI06 proposed �Xv 2nd Ifflor: e x i proposed Total new ..Zoning District Flood Plain rou water Overlay Project Valuation SO wo Construction Type W 0-0— Lot Sizo Br 46 Grandfathere Ye ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ulti-Family (# units) _ Age of Existing Structure 1 ONO Historic ouse: Yes �o On Old King's Highway: ❑ IV Yes VO Basement Type: ❑ Full Crawl ❑Walk ther Basement Finished Area (sq.ft.) 41A Basement Unfinished Area (sq.ft) 0 A l ! Number of Baths: Full: existing ew Half: existing new Number of Bedrooms: xis i _new w o Total Room Count (not including bath. : e isti g new First Floor F#oo:m Counf s _ _n Heat Type and Fuel: > Gas ❑ Oil El tric ❑ Other Central Air: 'Yes ❑ No Fireplaces: xi, JNew Existing wood/coal stove ❑Y �'No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 4 newsize_ Attached garage: ❑ existing ❑ new size —Shed: &'existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) � � s f Name YA-1-ZV i 1 ('-11- ` o Telephone Number 1160 , Address #V 6?y `-1 'P. License # C D l . Iri : Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Z,44D r-, SIGNATURES DATE �a FOR OFFICIAL USE ONLY i APPLICATION# f -,JDATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i•. OWNER DATE OF INSPECTION: Fq_UNDATION FRAME ' INSULATION IT FIREPLACE k ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL FINAL BUILDING Y DATE CLOSED OUT t ASSOCIATION PLAN NO. J TOWN OF.ARNSTABLE BUILDING PERMIT APPLICATION Map I(0 Parcel d 16D i Application # Health Division Date Issued 'Sonservation Division Application Fee Y", , i ,Planning Dept. _ Permit Fee "E)qte.Definitive Plan Approved-.by Planning Board Iistor=ic - OKH k a Preservation/Hyannis P o§�t Street Address � A Viiiage-J C OT r i J'''q o7lner MA 1114d., 011-110RE Address phone ` Z/ -7 8 '9 { -...,,:.�`..,.� a,; Pe mitRequest \ A o L)m o 0 3 S ir--'AS o 130 aw Sq a ey,feet: 1 st floorexisting loCa proposed ` C) 2nd flo r. exi proposed Total new Zon ng®fistrict t Flood Plain �rou d water Overlay Project hIuation. 1 - Construction Type W 00I Lit= izee 0,of 1 Grandfathere Ye ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ulti-Family (# units) gf,:Existing Structure j C1 40 !:;,,, Historic ouse:' Yes a°No On Old King's Highway: ❑Yes No � ,� \ Basement Type: ❑ Full II�Crawl 0 Walk ther Baement Finished Are (sq.ft.) t l A Basement Unfinished Area(sq.ft) i V N�m6er-of Baths: Fullaexisting�_ ew Half: existing new Number•=ofj Bedrooms: c ,existin —new :; —Total Room Count (not ipcluding bath. : e isti g new First Floor Room Count - Heat-ZT, nd Fuel s ❑ Oil El ctric ❑ Other Q ,•Centrai4Air:•:1 ®"Yes- 0 No VIrepI ces: xisting i+ New Existing wood/coal stove: ❑Yes b,No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing q new ?size= Attached garage: ❑ existing ❑ new size _Shed: ©'existing ❑ new size a" Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # y Current Use Proposed Use APPLICANT INFORMATION r - ;(BUILDER OR IIOMEOWNER) Name M/%Z�A 1✓/� l�C/`'I0 Telephone Number SCE$-311 359� Address -; -1 0 , License # �0 o l l MA , Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO rBAd�,)STA tC SIGNATURE "d��/�,�I/I //�% ayri` r�{ DATE XV, • A i `\ FOR OFFICIAL USE ONLY APPLICATION# t -..._DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. = The Commonwealth of Massachusetts Department of IndustfialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Aimlicant Information Please Print Legibly Nam (Business/Organization/IndividuaI): Address City'/_Sta Z p:.--C�,M- I b'rl Phone##: 60 Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition. working forme in any capacity. employees and have workers' insrrrance.�' 9. E]Building addition [No workers comp.comp.insurance r required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.�1 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions ` , myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs inc;,ra„ce required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑ Other . comp.insurance required.] *Any applicant that checks box#1 must also fill cat the section below showing their workers'compensation policy information. t Homeowners who submit this dffida-M indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and d state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day-against the violatof. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby..certify under the pains and penalties of perjury that the information provided above is true and correct (r_. .. r �L --Si ahi e: dzl&�IR61� r 4km Date: / as 1,3 Phone#• A08'.31.7 gs"Y� Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: 4. Phone"#: Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ..' of the foregoingg engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing'employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on.such dwelling house.' or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be'an employer." MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a Iicense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no-employees other than the' members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial . Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the permit or license is being requested,not the;Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please.call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. _ Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant - that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city.or. ' tows)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the' . . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.-. a dog license or permit to.bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions;' please do.not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,`#617-727-4900 ext 406 or 1-877-NIASSAFE Fax# 617-727-7749 Zevised 4-24-07 . www.mass.gov/dia AT-YC-Guide to Wood Construction irr High Whrd Areas:II D rrrph Wirrd Zorre Massachusetts Checklist for Compliance (78o CNfR5301:2.1.1)' - Check Compliance 1.1 SCOPE WindSpeed(3-sec-gust)................................................................................................................. 110 mph WindExposure Category.................. ...........................................................................................................0 Wind Exposure Category................Engineering Required For Entire Project....................................... 12 APPLICABILITY Number of Stories(a roof which exceeds B in 12 slope shall be considered a story)-L-stories•5 2 stories RoofPitch...................:.........:............................................(Fig 2) ........................................ _<12:12; MeanRoof Height..............................................................(Fig 3)......-............._..•--....._..............._. -ft <33 BuildingWidth,W ............................................................:..( 9 ).................................:..:__..:.:._. . ft BuildingLength, L' ...................................................-..........(Fig 3).................................. ft.5 80' i Building Aspect Ratio(LAW) .......:.......................................(Fig 4)............................................... :1 <3 Ys � Nominal Height of Tallest Opening2 .............................:.....(Fig 4)................................................z s 6,BY 1.3 FRAMING CONNECTIONS General compliance vrith framing connections....................(Table 2)................................................................ . 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete..................`................................:........................................................................_. ConcreteMasonry.................................................................................................................:................ 22 ANCHORAGE TO FOUNDATION"' 5/8'Anchor Bolts•imbedded or 5/B"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ..........................................(Table 4).................:..................fX_.... ... in. Bolt Spacing from endtofnt of plate.............................(Fig 5)..................:.................-[ in.-<6 -12". Bolt Embedment-concrete.........................................(Fig 5).......................................:............ in.>_7" Bolt Embedment-masonry.................. (Fig 5)..................... Fi ......_....:............................... in.>15" PlateWasher..:.............................................................(Fig 5)..............................................>_3"x 3'x'/� 3.1 FLOORS Floor-framing member spans checked ...............................(per 780 CMR Chapter 55)................................... Maximum Floor Opening Dimension.................... . .. .. � Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)........................................ Maximrlm Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7)................. Oft 5........_...._.._....._.........._. d Maximum Cantilevered Floor Joists_ Supporting Loadbearing Walls or Shearwall................(Fig 8)........................................._...........Q ft s d FloorBracingat Endwalls....................................................(Fig 9).............._.................................................. Floor Sheathing Type .......................:..............................:(per 780 CMR Chapter 55)..... Floor Sheathing Thickness ...........................................:.....(per780 CMR Chapter 55 .�` ............in edge/...... in. Floor Sheathing Fastening..................................................(Table 2).. d nails at� eld 4.1 WALLS Wall Height Loadbearing walls................... (Fig 10 and Table 5 ft �j- Non-Loadbearing walls (Fig 10 and Table 5) Wall Stud Spacing ........................................................(Fig 10 and Table 5)_....._.......__...1 in.:5 24'o.c. Wall Story Offsets :..(Figs 7 8:8).......................... 5 6� ry ................................................ ft d 4.2 EXTERIOR-WALLS Wood Studs Loadbearing walls -........................................................(Table�)..............................�2x ft in. 4_ NDn-Loadbearing walls :(Table 5)..............................2x Gable End Wall Braang FullHeight Endwall Studs............................................(Fig 10)............................................... ........... WSP-Attic Floor Length................::...............................(Fig 11)............................................. ft W/3 Gypsum Ceiling Length(rf WSP not used)....:..............(Fig 11).............................................. ft>:0.9W - and 2 x 4 Continuous Literal Brace @ 6 ft.o.c-.. (Fig 11)............................................................. or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss baysjeoo� Double Top Plate Aff,'C Garde to Wood Construction in Hlgh [Kiid flreas: 110 mph 1Yind Zone Massachusetts Checklist for Compliance (7s0 Loadbearing Wall Connections ' Lateral (no.of 16d common nails)................................(Tables 7)..................................................... Nan-Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for Mr ptiance t Table 9) " HeaderSpans ........................................................(Table 9).................................. ft in.< 11' Sill Plate Spans ........................................................(Table 9)....._..............._......... aft in.s 11' Full Height Studs (no. of studs)....................................(Table 9).......................................................a Non-Load Bearing Wall Openings (record largest opening but check all openings for compy rice to Table 9) HeaderSpans.............................................................(Table 9).................................. ft�in.512' . Sill Plate Spans......................:....................................(Table 9)_._......._.......---.............�ft�in._ 12' Full Height Studs (no.of studs)....................................(Table 9)................................................. !' Exterior Wall Sheathing to Resist Uplift and Shear SimultanbousV Minimum Building Dimension, W Nominal Height of Tallest Opening Z ......................................................................... - SheathingType..............................................(note 4)............................................ —� Edge Nail Spacing.........................................(Table 10 or note 4 if less)......................:. in. FField Nail Spacing able 1 D ......................I................_......_... in. pg.................. (T ) Shear Connection (no. of 16d common nails)(Table 10)....................................................... ..�Percent Full-Height Sheathing....................:...(Table 10)................_.................................. 5%Additional Sheathing for Wall.with Opening>6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest OpeningZ SheathingType..............................................(note 4)......................---.........................:.. Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Feld Nail Spacing.......................................:..(Table 11)................,................................. in. Shear Connection(no. of 16d common nails)(Table 11)........................................:..............19, Percent Full-Height Sheathing........................(Table 11)............................................:....... 'no 5%Additional Sheathing for Wail wfth•Opening>6'8".(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... ' 5.1 ROOFS Roof framing member spans checked?.........................(For Rafters use AWC Span Tool,see BBRS Webslte) Roof Overhang ...................................................(Figure 19)............._a ft.s smaller of 2'-or L/3 � Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift.....................:...........................(Table 12)................................_...........U= ►f —L Lateral .............................................(Table 12)............................................. '.........._.........L= plf Shear................................................(Table 12)............................................S=77.ptf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............... = pif Gable Rake OUdDDker............................................(Figure 2D) ..............0 ft s smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= b. Lateral (no. of 16d common nails)...(fable 14)............................ .........L= , b. Roof Sheathing Type....................................................(per 780 CMR Chapters 53 and.59) ........... Roof Sheathing Thickness.....................................:..................................................6700 in. 7/16'WSP Roof Sheathing Fastening............................................(Table 2)--.._...................._.................�........... Notes: -1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 7B0 CMR-53D1.2.1.1 Item 1. if the checklist is met in its entirety then the following metal straps and hold downs ara not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20.Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1Ba and Figure 18b 2. Exception:Opening heights of up to 8 ft shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. he bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated 92-grade. i Y -1 � • AFYC Gnide fo Wood Collsiriictloii in high fVindAreas: 110 mph Wind Zone Massachusetts Cheddist for Compliance (7so CNIR 53012.1:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a) new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte. 28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first floor c) replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH,Exposure B may be obtained from the American Wood Council (AWC)website. —WrMN-niS EDGE FEM ON FfiA1dIF tG USE Sd FdAit-S • •ATbbr. 11 II / IL II 1 • 11 11 1 w 1 u u 1 :EAt q c c I i•1 H I � N e 11 o 1 as I It It T I 1 I I o x rl 1 I I t a. 1 1 i L m if 1 1 I It •Q !L II 1 ,Z I 1 1 m n rl 2 I t to I II t u`Qt 'i i t : i CL t 1 CL rh d I l 11 FRAMING MSMSER S i EDGE F:drEF{ MMTE 1+ [k ' LLF pp I 1— I IL . 2 t -11 t 1 t 3B I t t u tc J I i r I' p ii ii ti ' 1 I •C ` + i It it1 i - ---- ` i - II -�_; STAGGIN:ED 3`MSwI NAIL SPAGING t TlVL pATTE7l1J PA!! PANL ED sE !X?U13LE MA>L HUGE sP,4CdVG DETAIL See Datail on Next Page Vertical and Horizontal Nailing Detail Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment I�T Town of Barnstable ,Regulatory Services , * RARNS-4ZLE, Thomas F. Geiler,Director 1q .��a Building Division �Fo Mp`t ,ti Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print rDATa _cit- zw'l d-Ol JOB-LOCATION: b- r} V CT(— number street village "HOMEOWNER" HKAYW &l4P1a�/ 508-3 0, 8 691 name ! home phone# work phone# CURRENT MAILING ADDRESS: ps:T1MVIt LLE K A, (00a& city/town state zip code The current exemption for"homeowners"was extended to include own occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildinjz permit (Section 109.1.1) -. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require eats. Sign re o omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control v HOMEOWNER'S EXEMPTION j The Code states that "Any homeowner performing work for which a building permit is required shall be exem pt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This-lack of awareness often results in serious problems,particularly When the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. i Q:fo=:homeexempt j Town of Barnstable ti °E Regulatory Services SAMNSM&BLEF MASS. ' ` Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Sectio If Using A Builder I, , as er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this uildi.ng t (Address f Job) *Pool fences and alarms ar the responsibility of the applicant. Pools are not to be filled or utilized efore fence is installed and all final inspections are performed an accepted. Signature of Owner Signature of Applicant f Print Name Print Name Date QFORMS:OWNERPERMISSIONPOOLS 612.012 J• t�,, 1 1 I ® These products are available with additional corrosion protection.Additional products on. �-These products are approved for installation:with the Strong-Drive SD this page may also be available with this option check with Simpson Strong Tie for details: Structural Connector screw.See page 27 for more information. Fasteners - pF/SP,AIIowablefLoaUs xUphft with; SPF/HFAIIowahle Loadsn ntiUphtt with ; No Ga To Rafters/6 T* �_ "l)plfft Lateral(160) 8dx1'/Naiis`i Upldt t',Uteral ailsi � Code ,. 1 . ,Truss a Plates To Studs` :]60 F w 1 .. ,r 160 1 �f n Ref (_ s... F2 _ ,) ..:rL(160)-�,',�' F2"�., H1 18 6 8dx1/z 4 8d — 585 485 165 455 400 415 140 370 117,L6,F16 H2A - 18 5 8dx1'/2 tt2 8dz1Yz 5 8dx1Yz 'S75, ,130 ,55^ r 4 a 495 130r' 55 `� , , �r IP1,'L18,F25 H2ASS?; 18 ,; 5 SS8D _kt 2.SS8D 5=SS8D ,.,`,4p0 _;1:30 ,. 55A,ron '400 345 a* 130 55:r ' 345 ; 170 H2.5A 18 5.8d I 5 8d 600 110 110 575 535 110 110 495 I17,F16 ® H2.5ASS 18 5-SS8d 5-SSBd — 440 75 70 365 386 75 70 310 170 H2 5T 18 5 8d 5 8d — 545 135 145 425 545 135 145 425 IP1,L18,F25 ® `'HU 18 4 8d 4-8(] — 455 125 " 60 K-�,I5 32D z t105'r 140 929D ® H4 20 4 8d 4 8d — 360 165 160 360 235 140 135 235 117,L6,F16 ® H5"� ��"�' 18 >,r 4,8tl x� + 4=88"'�;�� — r_Z4557 �_ 115 �...,k200,�,�•"•+455. `" 265 .,:�100,�; 170�M;,�„265 ,_��� ' ® H6 16 8-8d 8-8d 950 — 820 ® :H7Z 16 4 8tl 2 8tlz1'/z 8 8tl 4f `985 t�`480 " _ f "�I ,"5 345°k t.� � - 117,F16 H8 18 510dx11/2 5 10dx11/2 745 75 630 565 75 510 L10,F26 H10A Sloped 18 "`910dx1Y; 910dx11/2,-, 4J90G 2853 ® H10A _"w 18 '910dx11/2 9,10dx11/2 ° 114011 590 n 285 1015 '�05 x s 285 117,L18,F25 ;H10ASS 18_ ,y9 SSN10 9,SSN10} s s; 970 .565 1;70 A_"k 835 ,1,485 170 s H1 18 910dx1 Yz� '9106X M2 = r 1050 '.490� t`285 �� � "a 905 K�420 � 285 *� ��; 170- PAR H10S970 18 +8 8dx1% <8 8dx(1/z10 r 8 8tl 1,010 s 660« 21,5 �, 550 s - 870 r 570 185 3„ } 475_" t.; IP1,L18,F25 H1OA 2 18 `P9 jOdx1Yz' 9-10dx1'/z " 47 1245 8 5 "260 u r: ,1070 �700 x F25 ® H10 2 18 �l610d 1 _ 6.10d 760 _,455 +_r 395, , ;� ,,; 655 h 390 IRE � 117,F16 ® H11Z 18 6 16dx2/ 6 16dx2/ 830 525 760 715 450 655 170 H14 18 12 8dx1?/ 13 8d 1350'I �'515 265 1050 480 245 ' - 4 }, , 13012 8tlx1'%z 1 r IP1,L18,F258t TSP 18 9-10dx1'/2. 6-10dx11/z . — 740 310 190 — 635 265 160 — 910dx1Y2 6-10tl — 7f 890" 310 190 - 765 265 160 — F26 1.Loads have been increased for wind or earthquake loading with no For uplift Continuous.Load Path,connections in the same area(i.e.truss to plate connector further increase allowed:reduce where other loads govern. and plate to stud connector)must be on the same side of the wall. 2.Allowable loads are for one anchor:A minimum rafter thickness of 21/2" 7.Southern Pine allowable uplift loads for H10A=1340 lbs.and for the H14=1465 lbs. must be used when framing anchors are used on each side of the joist.and 8.Refer to Simpson Strong-Tie®technical bulletin T-HTIEBEARING for allowable bearing on the same side of the plate(exe bon:,connectors installed such that enhancement loads. nails on.o pposite side don't inte ere): 9.H10S can have the stud offset a maximum of 1".from rafter.(center to center)for a reduced 3.Allowable'F/SP uplift load for stud to bottom plate installation((see detail uplift of 890 lbs.(DF/SP)and 765 lbs.(SPF). 15)is 390 lbs.(H2.5A);265 lbs.(H2:5ASS);360 lbs.(H4)and 310 lbs.(H8). 10.H10S nails to plates are optional for uplift but required for lateral loads. For SPF/HF values multiply these values by 0.86. 11.Some load values for-the stainless-steel connectors shown here are lower than those far 4.Allowable loads in the.Ft direction are not intended to replace diaphragm the carbon-steel versions.Ongoing test programs have shown this to also be the case with boundry members or cross grain bending of the truss or rafter members. other stainless-steel connectors in the product line that are installed with nails.Visit 5.When cross-grain bending or cross-grain tension cannot be.avoided in the wirmstrongtie.com/corrosionJor updated information. members,mechanical reinforcement to resist such forces may be considered. 12.NAILS:16dx2'/z=0:162"dia.x 21/2"long;10d=0.148'dia.x 3"long, 6.Hurricane Ties are shown on the outside of the wall for clarity and assume 10dx11/2=0.148"dia.x 1'/2"long,8d=0:131"dia.x 21/2"long,8dx1 Y2=0.131"dia.x 11/z long. a minimum overhang of 3/2".Installation on the inside of the wall is See page 22-23 for other nail sizes and information. acceptable(see General Instructions for the-installer notes u on page 17). 13.SCREWS:Strong-Drive®SO#9x11/2"(model SD9112)=0.131"dia.x 11/2'long(forthe models marked with the orange flag only).Full table loads apply. F2 , N F y .. C3 Fi H1 Installation H2A Installation H2.5A Installation o ' TSP Installation H2.5T Installation (Nails into both top plates) (Nails into both top plates) 17 � o c II N - '. ��( ► '"' use aminimum of two 8tl nails w 1 ` this j side of truss i a (total four 8d s � o OH4 _.�„ °ot nails into H3Installation Installation ' -truss) M F (Nails into upper top plate) (see footnote 3) sA o O H2.5T Installation a Two 8d nails 2< into plates. Eight 8d tA°a t nails into studs 0 H6 Stud H4 Installation to Top Plate ® H6 Stud to Band ® H7Z Installation. 2 (Nails into upper to H5 Installation p plate) Installation Joist Installation (Nails into both top plates) - Caps&Bases .;. R ` ii �ir■ LCB/CBC-0/umn MATERIAL:See table 15Ge"for'A'Botts FINISH:LCB,CB44,CB46,CB48,CB66,CB68,CB610—galvanized; Y t'/z°for3i4°Bolts `I all other CB—Simpson Strong Tie®gray paint or HDG. Some models available in HDG or stainless steel INSTALLATION: Use all specified fasteners.See-General Notes. •For full loads,minimum side cover required is 3"for CB,2"for LCB. �6 •Install all models with bottom of base plate flush 4 ' with concrete. a h w 4a/, 5y; •Post bases do not provide adequate resistance to �lr . '` r prevent members from rotating about the base and ytherefore are not recommended for non top-supported p installations(such as fences or unbraced carports). OPTIONS:at y •LCB and CB are available in rough size.Other sizes ; .. available for CB specify W1 and W2 dimensions.Consult W- Oil v Simpson Strong-Tie for bolt sizes and allowable loads. CB44 Z CODES:See page 13 for Code Reference Key Chart. (CB46, C848,CB64,CB66,CB68, Configuration of all CB86,CB88, CB610 similar) other CB sizes ®These products are available with additional corrosion protection.Additional products on this page may also be available with this option,check with Simpson Strong-Tie for details. k. Dimensi - Column Allowable lift Loads ons+�, � >Model Nominal :Y . TFast (DF/SP,)kr ,. mn c + M achine Code` No Sae Strap Base 1 Bolts Narls r B01ts C01u Ref Ga x Width (Ga),_W1 y�WZ'a DNads 0 1,� cox,- LCB44 _„ 44 12gax.2 1.6 39/6. 3Yz -6Yz 1216d 2 '/z 2705 4250= - CB44 44 7 ga x 2 .7 39/e 39/e 8 — 2 5e — 4200 LCB46 46• 12 ga x 2 16 39/,6 51/z 61/z 12-16d 2 Yz 2705 4240 ® C646 46 7 ga x 2 7 39/s 5'/z ,8 — 2 5/8 — 4200 - CB48 48' 7 ga x 2 7 3'/16 7'/z 8 — 2 %6 4200 IL8 2Side ,, u 2"Min. Side ® CB545 GLULAM 7gax.3 7 4'/z 5'/e, 8 = 2 5/e P � x4200' Cover Q T Cover ® CB5 6 ;`GLULAM; ,7 ga x 3, ,7„ ? 6 5Ye 8' "— 2 5/6 4200 r _; � I• 4 LCB66 6x6 12 ga x 2 16 5'/z .51/z 5'/z 12-16d o2 t Yz 2705 4230 CB64 6x4 7 ga x 3 7 51/2 3Y16 8 — 2 5/e — 4200 170 ® CB66 6x6 7 ga x 3 7 5'/z 5'/z 8 1 2 % — 4200 C66-7 6x 7 ga x 3 7 5Yz 7 8 — 2 5/e — 4200 LCB ® CB68 6x8 7 ga x 3 7 51/z 7Yz 8 — 2 5/e — 4200 IL8 ® CB610 6x8 7 ga x 3 - 7 51/z 91/2 8 — 2 % — 4200 w CB612 6x12 7 ga x 3 7 51/2 111/z 8 — 2 5/e 4200 mc% - C6T/e 4 PSL� := 3 ga X3 7 7'/e 31/z. 8 2 C871/6 6' PSL 3 a x;.3 7 x ,7'/e 5'/ 8 2 3/4 x.;.' %g® 9 z s- t 6650 170 C671/s 7 ' b�PSL a 3 g3X;$, 7.' :71/a _7, $ '- 2=: 3/a '? g t 6650a q 9 q3� a CB76 GLULAM 3 ax3 7 K6 63/<<; 8x a 9 k 2,: /4 ry 6650 s. t <CB775 GLULAM 3gax,3 7I .;7Yz •63/4.. ® C67 9 GLFILAM' 3 ga x 3 7 -9'/s 63/a 8 = 2 3/a 050�`" f r " 8 .: �J6� 0 C67.10 5�GLULAM''y 3 ga x 3 7 i1-0s/6 63/4' 8 ' = 2�= 3/a „' .P16650 3"Min. 18�"i P, Side CB86 8x6 3 ga x 3 7 7Yz 51/z 8 — 2 3/a — 6650 170 Cover ° % 3"Min o CB88 8x8 .3 ga x 3 7 7Yz 71/z 8 - — 2 3/ — 6650 - Side W fi 9T Cover G I AM ��3 a x 3 7, , 6 r 83/ 8',.9. a,z _ � 2•"�:t3/a - "C69 9 GLULAM: 3gax3x7 a9 83/ 38 2=�3/4 6650 IL8® CB ' 0 CB99 5 o TM (CB5, CB7 similar). CB1010 10x10. 3 ga x 3 3 9Yz 9'/z 8 — 2 3/< — 6650 for Glulam Column S CB1012 10x12 3-ga x 3 3 91/z 111z 8 — 2 '14 — 6650 ® C61212 12x12 3 ga x 3 3 11'/z F11 Yz 8 — 2 M44 — 6650 1.Uplift loads have been increased for wind or earthquake with no Values in the tables reflect installation into the wide face.See technical bulletin _ further increase allowed;reduce where other loads govern. T-SCLCOLUMN for values on the narrow face(edge)(see page 232 for details). 2.PSL is parallel strand lumber. l LCB bases installed with nails must be installed into the wide face. 3.LCB products may be installed with either bolts OR nails 5.Designer is responsible for concrete design. (not both)to achieve table loads. 6.See pages 226-227 for common post allowable loads. 4.Structural composite lumber columns have sides that show 7.NAILS:16d=0.162"dia.x 3'/z"long. 60 either the wide face or the edges of the lumber strands/veneers. See page 22-23 for other nail sizes and information. T 3 HOIdOWIIS&Tensitin Tes:� i ". e . ;' - 1 LWHTT-Tension Ties OD Tension ties offer a solution for resisting tension loads that is fastened with nails. j The entire line of tension ties has been tested and evaluated to the requirements of AC155.. ( i6 ;€. Z The HTT4 and HTT5 are the latest generation of tension ties.They feature an 1, ". 'I W optimized nailing pattern which results in better performance with less deflection. o is Designed to meet new code standards,the HTT4 and HTT5 offer higher loads than R their predecessors. The LTT19 Light Tension Tie is designed for 2x joists or purlins and the LTT20B E 6" Ro is for nail or bolt-on applications.The 3"nail spacing makes the LTT20B suitable for wood[-joists with 1Odx1'/2.The LTTI31 is designed for wood chord open web truss 6 F + i• attachments 1— to concrete or masonry walls and may also be installed vertically on a 1 minimum 2x6 stud. i 3 MATERIAL:See table FINISH:Galvanized.May be ordered HDG;contact Simpson Strong-Tie. INSTALLATION: •Use all specified fasteners.See General Notes. ;. t.# •For use in vertical and horizontal applications. Load 7# ' •To tie multiple 2x members together;the ! transfer ate Designer must determine the fasteners For tension ties,per ASTM test standards, :`R washer required to join members without splitting anchor bolt nut should be finger-tight plus is not required.. the wood. /3 to /2 turn with a hand wrench,with , 6'h •The Designer shall specify anchor bolt + consideration given to possible future I type,length and embedment.See SB and wood shrinkage.Care should be taken i to not over-tor t HTT5 he nut.Im act �'—�2Y,' SSTB anchor bolts on pages 33-37. � q p LTT20B (HTT4 similar) CODES:See page 13 for Code Reference Key Chart. I wrenches should not be used. l LTTI31 (LTT19 similar) U.S.Patent 5,467,570 . These products are available with additional corrosion protection.Additional products on ®These products are approved for installation with the Strong-Drive SD this page may also.be available with,this option,check with Simpson Strong-lie fof details. Structural-Connector screw.See page 27 for more information. Matenal(Ga) aDimensions � Seat; Fasteners'iAAllowable Tension Loads•(160) 'Detlechap x 'Code; Mpdel a�� Thick .sMc at�HlgheSt �tdosxc�. . Strap, xPlate °f Anchor 1361ts Fasteners DElSPB �SPF/HF Allowable Load L'TT191 16 3 ' ' 1%x- 19'/8 13/6 5/,e Yz,s/s or IK 8 10dx1'/2 1310 1125 0.180 8 10d 1340 1150 0157 x r r + 10 10dx1'/2 t n185w 4 LTT20B3 "12 T 3, 2 �2193/ 1'/}aY# %e '/zs/sorr3/ r <1:0 10d a1500 � 1290 r 0185 3 P2, ,,ys �` �.• * . 1625 '.'�` 1400.�';. pi0183 }a, F4 S LTTI316 18 3 33/a 31 13/e /4 5/s 18-10dx1'/z '1350 1160 0.193, 10dx1-1/2 3610' +4� 3105�•` a 0086 �t 41 *''/,6 5/s 18,.i6tlx2'h #10x1 r 3830 rf3 j,f�Hj, 014-2- ", 160 26-10d01/2 4350 3740 0.120 Ll ® HTT5 11 — 2'/2 16 1M6 '/16 '/s 26-10d 4670 4015 0.116 IP2, 26-16dx2'/2 50906 4375- 0.135, F4. N HTT5KT'. 11. '/4 2'/2 16 ' 15/6. :'/6 6/6 s 26-SD#10x2Yz 5445 5360 1 '.0.103 160. 1.Allowable loads have,been increased for wind or earthquake with no further increase z allowed.Reduce where other loads govern: o Hanger not shown a 2.Post.design by Specifier.Tabulated loads are based-on minimum 3"x3'h"(2-2x4)post(in 3%"wall). for clarity Post may.consist of multiple members provided they are connected independently of the holdown Q , z fasteners.See pages 226-227 for common post allowable loads. z 3.A standard cut washer is required under anchor nut for LTT19 and LTT20B when using''/2"or a 'A"anchor bolts.No additional washer is required when using a'1/4"anchor bolt. 0 4.Deflection at Highest Allowable Tension Load includes fastener slip holdown deformation, ` w and anchor bolt elongation for holdowns installed,up to.41/2"above top of concrete. HTT4 and HTT5 may be installed raised up:to 1'8"above a top of concrete with no load reduction provided that 'A additional elongation of the anchor rod is accounted for. ° s S.If the base of the-LTTI31 is installed flush with E o a concrete or masonry wall,the allowable load a is 2285 lbs.. 6.Allowable tension load-for HTT5 with a 0,0 . Horizontal HTT Installation o bearing plate washer'BP5/8-2(sold separately) 3" m o N installed:in the-seatof the holdown is 5295 Min• °® - for,DF/SP,and 4555 for SPF/HE m m Preservative- 7.HTT5KT is sold as a,kit with the holdown;BP%-2 m 0 treated o o barrier may,. 6 N bearing plate washer and 26-SD#10x2Y2 screws. .m be required a , 8.Structural composite lumber columns have sides that show either the wide face or the' xm _ ' edges of the lumber strands/veneers.Values in the tables reflect installation into the wide ^' face.See technical'bulletin-T-SCLCOLUMNr for values on.the nartow face(edge)(see page 232 for details). s � 9.HTT4:with SD#10x1'/2 screws achieves full load.on a single 2x6 stud or joist. 10.FASTENERS:10dx1'/2=0.148 dia.z 1'/2"long, 10d 0148"dia x 3"long, 16dx2'/z 0.162 dia.z 2'/2"long, 'SD#10x2'/2=0.161'dia.z 21i," Vertical HTT4' Horizontal LTT131 Horizontal LTT19 Installation SD'#10x1%i=0161"dia.x i'i2". : -installation Installation (LTT20B similar) 4c �oFt T Town of Barnstable *Permit# 6 -3 c��3 ~O„ Expires 6 mont ro 'sue M w Regulatory Services• Fee ♦ BAMSTABIA » Thomas F.Geiler,Director, Building Division "V Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 r_ www.town'.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not.Valid without Red X-Press Imprint Map/parcel Number Property Address Z v1�1 2� - ���� � Residential Value of Work�' Minimum.fee of$35.00 for work under$6000.00 Owner's Name&Address 20 . k p6c c Contractor's Name 7 Gephbne Number q2B''��� Home Improvement Contractor License#(if applicable) I S I BG kPRES 9- ®� �/�IT Supervisor's License#(if applicable) (,- Porkman's Compensation Insurance JUN 1 2012 Check one: ❑ 1 am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance Insurance `Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request,(check box) �J Re-roof(stripping old shingles) All construction debris will be taken to (((❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ' #of doors . ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows "Where rJ'� c e of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Notperty.Owner m s sign Property Owner Letter of Permission. opy of the H e mprovement Contractors License&Construction Supervisors License is uired.SIGNATURE: C:1UsersldecolliklAprosoftlWindowslTemporaryInternetFileslContent.OutlooklQKIH7J6E1EXPRESS.doc Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations h i ' 600 Washington Street: t — Boston, MA 02111 A www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization%Individuali: PLU fjMN I Address: lbqf0 City/State/Zip:�j J1 L M Phone #: qzB "r7(a 00 Are you an employer? Check the appropriate box: - . ' Type of project(required): l. I am a employer with 4. ❑`l an 6.i a general contractor and 1 ❑ � New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. .7. ❑Remodeling ship and have no employees . , ` These sub-contractors have g, ❑ Demolition workingfor mein an capacity. employees and have workers' Y P Y- � 9. ❑ Bolding addition' [No workers' comp. insurance comp. insurance.: required.] • 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑' lumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Roof repairs - insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp. insurancee required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I C `,, Insurance Company Name:' � Ui t Vl-1 f co l0�� %�t � � v1 Policy#or Self-ins. Lie. #: wC '150 . Expiration Date:, Job Site Address: qlq2— ��/(. Q �� Cit /State/ZiN/06 - Attach a copy of the workers' compensation policy declaration'page(showing the policy number and expiration date). Failure to secure coverage as required,ttnder Section 25A of MGL-c. 152 can lead to the imposition of criminal'penalties of fine up to $ ,-0 .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 $2 0.0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigati ns f the DIA for insura c coverage verification. I do here y ce oft der t p a dain penalties of perjury that the information provided above is true and correct. Si natu e: s; �.._- _ Date: Phone#: U' 7ipj" �000 Official use onh�. 'Do not write in this area, to be completed by city or town.q frcial. . - City or Town: Permit/License# Issuing Authority,(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector- 6.Other Contact Person: Phone#: r AieQR& CERTIFICATE OF LIABILITY INSURANCE DATE(06/2011 Y) 4'��- 07/O6/20„ 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: Germani Insurance Agency PHONE (508)428-9194 FAX 908 Main Street AIc No: 508 428-3068 E-MAIL ADDRESS: Osterville,MA 02655 PRODUCER C UST O E I INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A:: SAFETY INS CO ' • ' Scott Peacock Building&Remodelling, Inc. INSURERS: P.O.Box 171 Osterville,MA 02655 INSURER C: ' INSURER D: National Union fire Ins.Comp. ` Y 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYY - LIMITS A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2012 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY - AM RENTED PREMISES Ea occurrence $ _ CLAIMS-MADE OCCUR - MED EXP(Any one person) $ ' PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY F1 PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $SCHEDULED AUTOS --- BODILY INJURY(Per accident) $ ' PROPERTY DAMAGE $ HIRED AUTOS - r (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ D WORKERS COMPENSATION WC 5815464 6/22/2011 6/22/2012 WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under - DESCRIPTION OF OPERATIONS belowI E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION , Scott Peacock Building&:Remodeling,Inc. , : SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL ;BE, DELIVERED IN Fax#"568-428-7625 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ©1988-2009 ACORD CORPORATION. All rights reserved. ' ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Nlassachusetts- Department of Public Safety Board of Buildim- Re�ulations and Standards" � Construction Supervisor License License: CS 94500 JAMES S 'PEACOCK PO BOX 171Fr OSTEVILLE,'MA02632 Expiration: 7/22/2012 (Luunissi i�er Tr#: �29233 _ I �1O LE Z/JO/llillZfl'7t11,�2LCfL ��./�.!!.ddCZff2LGOeG66 Office of Consumer Affairs& B siness Regulation License or registration valid for individul use only I�— - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 151853 Type: Office of Consumer Affairs and Business Regulation ~ _ Expiration: 7/7/2012 Private Corporation, 10 Park Plaza-Suite 5170 a Boston,MA 02116 SC OTT PEACOCK BUILDING&REMODELING INC JAMES PEACOCK", x , 1046 MAIN STREET SUITE 7 OSTERVILLE,MA 02655 Undersecretary Not valid without signature Town of Barnstable Regulatory Services sn MASS. Thomas F.Geiler,Director y nss. �+. °lfD;9.��,0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner lust Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorze i to act on my behalf, in all matters relative to *brk authorized by this Tbuilding permit application for: . AT (Address of Job) VofOwner Date ;C: To cJ A Print Name r QTORMS:OWNERPERMISSION