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HomeMy WebLinkAbout0068 GUIMQUISSETT ROAD CZ%YY-X ' . Town of Barnstable Building nei PostThisCardSo•T,hat rt is Visible FromtheStreet Approved Plans Must be Retainedon'Job andthis Card Must besKept MAWL Posted Until Final Inspection Has<Been Made. : Where a Certificate of Occupancy is Required;such Bwlding shall Not be Occup�ed;until a Final Inspection has been made Permit ._ -. �.,�.._��.-...�_- Permit NO. B-20-97 Applicant Name: McGRATH POST& BEAM CO. PINE HARBOR WOOD Approvals PRODUCTS Structure Date Issued: 01/28/2020 Current Use: Foundation: Permit Type: Building.-Detached Accessory Structure- Expiration Date: 07/28/2020 Residential Sheathing: Map/lot 019 109 Zoning District: RF Location: 68 GUIMQUISSETT ROAD,COTUIT " Framing: 1 Contractor Narne_: 'JAMES R MCGRATH 2 Owner on Record: ANDERSON,CHRISTINE Contractor,License CSFA-073865 .. ,. � - Address: 68 GUIMQUISSETT RD Chimney: - Est Project Cost:. $27,685.00 COTUIT, MA 02635 I Insulation: Permit Fee: $241.19 Description. consstruct 14x24 studio-no utilities-no insulation=outdoor seasonal storage&workshop Fee Paid: $241.19 Final: Date::, 1/28/2020 Project Review Req: UNHABITABLE SPACE. (UNHEATED) Plumbing/Gas Rough Plumbing: - Building Official final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz.months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application,and the,apprnverl construction documents-for which this permit has been granted. All construction,alterations and changes of use of any building and st!uctures shall be in compliance with the local zoning by-laws and codes. Final Gas This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for'public inspection for the entire duration of the work until the completion of the same. , ram - " Electrical. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are;provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel— I b A Application # �- Health Division Date Issued 2_6 Conservation Division Application Fee /00 c Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board c2yl, Historic - OKH _ Preservation/ Hyannis , S E'.✓T Project Street Address GU rY\%u, Village L OtV`'— Owner A11dec'5e>:'1 Address (S (Su a mw s5err RU Telephone 77�— '1(37—a S 3 q SCANNED Permit Request COA SK-UC-C- NX a� i QI C� Uf A%�ie S JAN 3 0 2020 0 1143 (ft- P- 70-3 -- (YU7V,6-VrC_ Square feet: 1 st floor: existing proposed3(0 2nd floor: existing propose! gtal n. �31c Zoning District Flood Plain Groundwater OverlayJP , Project Valuation ) G18T Construction Type Lot Size -Li� c-Cfe— Grandfathered: ❑Yes ❑ No If yes, attach si ipportinowdocLaentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) No , v Age of Existing Structure ��_h�j� Historic House: ❑Yes ®//No On Old King' Highw ❑Gs �o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new O Half: existing new Number of Bedrooms: a existing 0 new Total Room Count (not including baths): existing 5- new 0 First Floor Room Count Heat Type and Fuel: ((Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes E(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: 4 isting gnew size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 2(No If yes, site plan review # Current Use Proposed Use < r�t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name��es Telephone Number Address Q.� Ark- Q- License # CSFk _5-73ax— r 111,h ���° .� Home Improvement Contractor# [3a j e3 S Email �h :n��a�j���C c�r,� Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � Xc:J SIGNATURE C/ - DATE Iizz FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. SCANNED JAN 3 0 2020 OG �Q G s� moo, L O0 �• 'pO TANK -7 WELLING �s•i PROPOSED `�'• i GARAGE , i� tip` • ,� lool l 6b SEPTIC FROM ASBUILT ON FILE AT THE TOWN HEALTH DEPARTMENT BUILDER TO CONFIRM CER TIFIED PL 0 T PLAN 68 GUIMQUISSETT ROAD. OF k4s. MBLU. 19-109 I CER7IFY THAT THE IMPROVEMENTS SHOWN ice`` °yam COTUIT, MA HAVE BEEN LOCATED BY A FIELD SURVEY. ROBE DATE. 12-17-2019 DRAWN: RBS 0 SYKES y SCALE: 1"=40� JOB A S642 No. 35418 DWG. CPP EASTBOUND �Ss�C�STE�S *LAND SURVEYING, INC. 12-23-19 " P.O. Box 442 FORESTDALE, MA 02644 ROBB SYKES RLS DATE 508-477-4511 Office of Consumer Affairs and Blusiness-Regulation 10 Park Plaza"- Suite 5170 Boston, Massac setts 02116 Home Improvement for Registration.., Commonwealth of Massachusetts n Division of Professional Licensure �+ + Board of Building Regulations and Standards McGRATH POST & BEAM CO. ^' Construction 9i*1 2 Famil JAMES MCGRATH r- Y 259 QUEEN ANNE RD. HARWICH, 'NIA 02645ires:o3/1a/2o2o JAMES R Mee ty �� BREWSTER Commissioner AL Office of Consumer Affairs and Business Regulation 1000 Washing n Street- Suite 710 Boston, M husetts 02118 Home Improve tractor Registration Type: Corporation y Registration: 132935 MCGRATH POST&BEAM CO. „ Expiration: 10/30/2020 D/B/A PINE HARBOR WOOD PRODUCTS/ 259 QUEEN ANNE RD. { c HARW ICH,MA 02645 w 1 O 20M-05/17 Update Address and Return Card. T/�e office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only omoratlon before the expiration date. If found return to: €�gl� Office of Consumer Affairs and Business Regulation a ,,,10/302020 1000 Washington Street-Suite 710 MCGRATH P ;. sF- Boston,MA 02118 D/B/A PINE HAq i�MODUCTS JAMES R.MCGF7Yt 259 QUEEN ANNE C J HARWICH,MA 02645 Undersecretary Not valid without signature The Commonwealth of Massachuisetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/din R'orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Mr &alht Address: n IPP.n Anne_ City/State/Zip.—Ha l i ,IM A W l Phone#: ,S019 <10 0?800 Are you an employer?Check the appropriate bon: . : Type Of project(required): l:[:]I am a employer with employees(full and/or part=time). 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me a 8. Remodeling any capacity.[No workers'comp,insurance required.] 3.[—]I am a homeowner doing all work myself:[No workers'comp.insurance required]' 9,0 Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.o I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.a We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 pp Insurance Company Name NN/ 1"1Arlr vlowe-ts-I CB ra nt c Cornwni+.l Policy#or Self--ins. Lic. #`E -C- tang _!J 0MQ5 J —dD 1 AA Expiration Date: Job Site.Address' U- YG City/State/Zip: �0 � Attach a copy of the workers' compen.ation.policy declaration page(showing the policy number and expiration date). Failure to secure coverage as_required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine,of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver i atton. I do hereby certify.0 er the pains an e s o erjury t a t e information provided above is a and correct Signature: Date: LA Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MCGRPOS-01 THORNE ACORU` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrrmm �►� 7/8/2019 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(les)must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER IACT Rogers&Gray Insurance Agency,Inc. PNONE Fax 434 Rte 134 Arc,No,Ext: 800 553-1801 C,No:(877 816-2156 South Dennis,MA 02660 ' :mail@rogemgray.com INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A:Travelers Indemnity Company 25658 INSURED INSURER B:New Ham shire Employers Insurance Compan 13083 McGrath Pos Co INSURER C: dba Pine ood 259 Qu Rd INSURER0: Harwi 2 INSURER E: INSURER F 1 COVERAGES C 1 MBER: REVISION NUMBER: THIS IS TO CERTIFY THAiYHE PO D BELOW HAVE BEEN)SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ENT �t ONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR AIN, T .AFFORDED::�gYY,THE':POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF ICIES.LI. -, HO HAVE BEM REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE } DDL BER POCK Y'EFF POLICY ExP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE OCCUR -660-2 8-IND- 1/31/2019 1/31/2020 , DAMAGE TO RENTEDnce 100,000 MED EXP(Any one n 5,000 PERSONAL 6 ADV INJURY 1,000,000 GEN'LAGGREGATE _ �'^ GENERAL AGGREGATE 2'000'000 r X POLICY L F PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A AUTOMOBILE ITY , COMBINED SINGLE LIMB We accident $ ANY AUT BA-4487B686-1 19 020 BODILY INJURY Perperson) OWNED SC EDUCED ONL S BODILY INJURY Per accident ' ,1 00O 000 AURTEO�S fj-• - yy ' � R X AUTOS ONLY ON. ' 'Y,` ,NX Z PPerOPPcEQ AMAGE K UMBRELLA LIAB OC URRENCE $ _ « C EXCESS LIAR CLA E jai- Ik- B DED RETENTION$ _;WORKERS COMPENSATION e v°Y PER 4 OTft- AND EMPLOYERS'LIABILITY Y � tER ANY PROPRIEfORIPARTNER/EXECUTIVE CC 09 A 7/8/201 /2020 HACCID $ 500,000 aFCb EXCLUDED? NEnNR t. El iSEASE 500,000 H yes,describe under- 't:, _ DESCRIPTION OF OPERATIONS below - E.L.DIS `y L 500,000 a DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sc 1E re space Is required) +% ; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map i Parcel' Application # Health Division Date Issued l Conservation Division Application Fee Planning Dept. Permit Fee oa Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservaticn/ Hyannis t , I Project Street Address w (*Y\ V► fSSt� g— Village Owner C �S`z� � AA)V) L— .S°2 O A Address Telephone C. 1`1 1-f ) Q t.3 14 Permit Request �r C2) 0001— a,t( 2 7 S�lL1 �d S . iR,—� (� CIZ�J t(. xce Square feet: 1st fl r: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project'Valuation SS 9�onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ ached 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 • •�7y APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ```~y r Name n!; �A10�frcjii ,-r Telephone Number (J d') ! d Address `'P() � a s1 ( (1_� License # CSC L c� 02 7 TI C�Nk A da 7 ( Home Improvement Contractor# (o Iq Ll Email o� e,re, 0, Vqa; f, Ce wt Worker's Compensation # Q C, Q�N 160 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r s FOR OFFICIAL USE ONLY APPLICATION# F DATE ISSUED MAP/PARCELNO. k ADDRESS VILLAGE k`3 OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT. ASSOCIATION PLAN NO. TQ'4[ofbk 8L31Q Self 449 .40 14 - : - totlti��oa�a�ve�O��V.W�• O�J!!t�'�g'�S•• � • -��6oc' `t ` : e. evolm . iLs The Comntonivealth of Massachusetts .-Department of Industrial Accidents` n 1 Congress Street, Suite 100 Boston,MA 02114-2017 x RMW mass gov/dia 'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FIL ED WITH THE PERMT17ING AUTHORITY. Applicant Information L Please Print Le ibl' Name (Business/Organization/Individual): ej,,,,c;, T y��„�'a; -� i► Address: +P n 0.)c" 10 City/State/Zip: 63111 Phone#: /o j_0 Are you an employer?Check the appropriate box: -Type of project(required): I.�am a employer with /X:) employees(full and/or part-time).* 7. []New construction'` 2.❑1 am a sole proprietor or partnership and have no employees working for me in $. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition ,'- 3.Q I am a homeowner doing all work myself.[No workers'comp..insurance required.] ` 10 0 Building addition 4-❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will =, r ensure that all contractors either have workers'compensation insurance or are sole I I. Electrical repairs or additions - proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. _. ❑ 1SORpof re airs. These subcontractors have employees and have workers'comp.insurance:= � p Ic.c,_X tt�� L - Al® 6.0 We are a corporation and its officers have exercised their right 14. Other...W of exemption per MGL c. y tr^I Zc.ar , 152,§1(4),and we have no employees.[No workers'comp.insurance required:] *Any applicant that checks box#1.must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such: xContractors that check this boz must attached an additional sheet showing the name of the sub-contractors and state whither 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 find job site " information Insurance Company Name S��� �. -S Policy#or Self ins. Lic.#: L d �J�ad�`Gfl \ Expiration Date: Job Site Address: _ City/State/Zir): D` (03 r� Attach a copy of the workers' compenidtion policy declaration page(showing the policy number and a iration date): Failure to secure coverage as'required under MGL-c. 152,§25A is a criminal violation punishable by'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$25.0.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DI.A for insurance coverage verification. I do hereby certify under the pains andpenaldes ofperjury that the infornwtion provided aAAbov is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,{o be completed by city or town official y 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#: Client#: 317787 •RETROFITINI ACORDTM CERTIFICATE OF, LIABILITY INSURANCE DATE(MM/DD"YYY) R 810 512 01 5 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 suds.endorsement(s). PRODUCER ,.. .._,. - CONTACT . .NAME: HUB International New England PHONE 97 Fax 222 Milliken Blvd A/C No Ext: - A/C;No 978-988-0038' EMAIL Fall River,MA 02722 ADDRESS: 508 235-2200 INSURER(S)AFFORDING COVERAGE NAIC# Star ar Insurance Company 18023 INSURED INSURER B: - RetroFit Insulation, Inc. INSURER c PO Box 105 - Seekonk, MA 02771 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 UBR POLICY EFF POLICY EXP - LTR INSR WVD POLICY NUMBER c. MM/DD MWDD LIMITS GENERAL LIABILITY _., EACH OCCURRENCE $ AGE? RE ' COMMERCIAL GENERAL LIABILITY. - PRE DAM NTED' MISES Ea ocwnence $ CLAIMS-MADE F OCCUR t - MED EXP(Any one person). $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $< GEN'L AGGREGATE LIMIT APPLIES PER: - - - -PRODUCTS=COMP/OP AGG- $ POLICY JE Q LOC a •: . . $' .. AUTOMOBILE LIABILITY : COMBINED SINGLE LIMIT Ea accident ' • ANY AUTO - - BODILY INJURY(Per person) $ - - ALL OWNED SCHEDULED • BODILYaccident AUTOS AUTOS. INJURY(Per ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR- - EACH OCCURRENCE - $ ' EXCESS LIAB CLAIMS-MAIDE w AGGREGATE $ DED RETENTION$ - $ A WORKERS COMPENSATION „ WC084520100 8/02/2015 08/02/201 X WC STATU OTH- AND EMPLOYERS'LIABILITY •Y.1 N .. MITS ' IER - ANY PROPRIETOR/PARTNER/EXECUTIVE - - ^ E.L.EACH ACCIDENT • '$1 OOO OOO OFFICER/MEMBER EXCLUDED? ®. N/A F - - (Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $1 000 000 -' ` - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ` AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION.All rights reserved.' ACORD 25(2010/05) 1 'of 1 The ACORD name and logo are re I tered marks of ACORD #S1432002/M1432001 R6004= .. S !. - _ • ... • ire (p Q� la X Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massac setts 02116 �, Home-Improvement Colcytor Registration Registration: 160461 m TVpe: Private Corporation Expiration: I/2s�2016RETROFIT IN ION, INC: Tre JOSEPH REILLY 252915 � - P.O. BOX 105 '�� SEEKONK MA`02771 a ------------ Update Address and return card.Mark reason for nge:che scn, a zoM:ostit �' J [] Address El-Renewal Employment ❑ Lost Card eammroraruda/f�o�UNGaa4crc%Ud`ells Office of consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: tb81 • Type: Office'of Consumer Affairs and Business Regulation xpiration:t:.�I f' p18 'Private Corporation 10 Park Plaza-Suite 5170 RETROFIT INS ULATI 1Ns,:_• ',;. Boston,MA 02116 IN JOSEPW REILLY' , 644 RODMAN ST ,t FALLRIVER,MA 0272t Undersecretary+ of slid R without signature. of PubiiC; Ida �"kfitg'04011 Boeta and Btaettla,� ' ,4 d-Onstr�acMn Svpereiwr Spe L cialte is sot :CSS -40 1 . ��� Seetiounk 3ti1A 02T�1_ I� AID � 3 • - • i � �•� �,,�,.� rye S Aa'.�, � - � � �* .. •.,. • Exg�lrailon siore�r. 08IOS�I2017 /?/ A/e- 5 -� OFtNIe Tn Town of Barnsta a *Permit# Expires 6 months jro } Regulatory Services Fee * BAMSTABLL • ' X.P v "1639.A�' Richard V.Scali Director ��� ������ RFD Mp'�A . Building Division Tom Perry,CBO,Building Commissioner MAY 04 2015 200 Main Street,Hyannis,MA 02601 TOWN OF BARNST www.town.barnstable.ma.us (ABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number � d� IQ 'b Not Valid without Red X-Press Imprint 1/� Property Address U 14,1 ) S�fi -j7— 7tJ�• [],R,6/sidential Value of work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressc�wJsd c� C,f I !V7 =� Contractor's Name � I//" / Telephone Number,' Home Improvement Contractor License#(if applicable)J� �/ Email: ����u(���2Q 7.•�'�f°✓ Construction Supervisor's License#(if applicable) C,3-0 7 3JI' ❑Workman's Compensation Insurance Chec one: am a sole proprietor ❑ I am the Homeowner - ❑ I have Worker's Compensation Insurance Insurance Company Name Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ---- _ ❑ Re=roof(hurricane-nailed)(stripping-old shingles)'All-construction debris'will-betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) rplacement -side ,3a Windows/doors/sliders.U-Value __(maximum 2Z)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: QAWPFILESTORWbuilding permit fonnsNEXPRESS.doc Revised 06.1313 t Massachusetts -Department of Public Safety Board of Building Regulations and Standards k-onstr uction SuperYisror - License: CS-073547 DAVID W COLLI 4S , 20 PICCADILLY-tD IM¢ SANDWICH MA7025 T Expiration Commissioner 12/07/2016 Department of Public Safety Massachusetts - Re ulations and Standards Board of Building Reg � I V orjstl 111 LlV fl JuY C IslJl ..µ.. License: CS-p737 DAB W COXD SAND 2025$3 ' Expiration 1210712016 commissioner -- � � �lze tPomrimancoecc Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR ` egistration: 2 q Type: i Expiration:=='5/201-31Z. Individual David Collins —, David Collins 20 PICCADILLY RD :;: .Sandwich,MA 02563 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Boston,MA 02116 !' Not va d without signature .... ,,_ 4s _r 5 { , A e}� 7 t Ae Commoffiv altfi ofmassackuseft Department oflndustrialAccidwts Dgwi ofInvestigcrtions 600 Washington Street Boston,MA 02111 nimasmimA vw: is Workers' Compensation Insurame.Affidavit Builders/Contractor&TJmtricianstPlumbers Applicant Information Please PrintLegibly Address- )/c CityfStae - < � t I C, 9 p1me Are you an employer?Check lire appropriate box: "am.a 1 with 4- ❑ I am a general contractor and I 6.[ of project construction : '��` �- 6. ❑Dery�n employees(fun andfor Vie}* have hired the sub-�ors 2 I am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling. ship and have no employees, Thee sub-contractors have 8. ❑Demolition working forme in any capacity. employees and have workers' 9- ❑Building addition [NO workers, comp-insurance comp.insura w. 5. ❑ We are a corporatimand its 10..❑Electrical repairs or additions' officers have exercised titeir 3.❑ I am a homeowner doing all work ME]Plumbing repairs or additims myself[No workers'camp_ right of exemption.per MGL 12.❑Roof repass inSUrance required.]1 c-152,§1(4�and we have no employees-[No workers' 13.❑Other cam-ffiSQianm wed-] *Piny applicant that checks box*I test also fill our the section belaw showing ffi&vockers'coaupeu�tioupolicg inhumma m- t Firms wbo submit this affidavit-umficstmg they an doing all worm and diem hue outside coutmclors mms'wRos it a new*affidavit indicatia such- Contwtou dw cited[this box must attached an additional sheet showing the rant often smb-comscos and state whether ernot those entities bawe employ If the sub-coutaactom have employees,they ntmstp mde tab workers'comp.policy maabm I arm an empIoy'sr that is prm,fng workers'compensation insurance for my empl yem Below is flee pantry arad job.sits informatiML Insurance Company Name: Policy* or Self-ins-Uc.#_ ExpirationDate: -Job-&Add GitS�IS�tet p 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 OD anVor one-year imgris as Rq-ll as civil penalties in the form.of a STOP WORK ORDER and a fine. of up to$250-00 a day against the violator- Be advised that a copy of this statement may be forwarded to the Office of lavestigatioms of the DIA for iusumnce coverage verificatiom. Ida hereby verrct,�, the 'ns rand naiiies ofpeditry fl at tloe infotmatwi protide d abme is true and correct .psi Date: Phone !?,07rial use only. Do not.wrke in dais area,to be completed by c4 or totm o,f J�acbti City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Biding Department 3.CityNown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone g: 6. r r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Parmiant-to this statute,an m ployee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or wriftea" An vnployiu-is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do mainteaance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho has not produced acceptable evidence of compIiance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfomlance ofpublic work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contrasting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of amnance. 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 as LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 Deparmeat<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 lime. 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 ermit/license number which will be used as a reference number. In addition, an applicant P e e e e eed o submit one affidavit indicating current that must submit multiple p rmmtllrceuse apphr:ahons m any given year,n my rating policy information(if necessary)and under"Job Site Address"time applicant should write"all locations in (city or town)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the ' applicant as proof that a valid affidavit is on file for firture 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 (Le. a do license or permit to bum leaves etc. said person is NOT ed to complete thus affidavit ( g P , ) P regmT mP The Office of Investigations would like to thammk you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Depar iacat's address,telephone and fax number. The CQumaawealth-of Massachusetts Department of Industrial Accidents Office of kyesfrgatiow Q Strut 604 Washu� n S $Qstcn,MA 02 111 lei,#617 727-4900 e�xt 406 or 1--977 MASSAFE Revised 4-24-07 Fax.##617-727-7749 www-mass_govfdia" F IHE ri * fARNSPABM • ' MASS. ,. 7Cown of Barnstable - { Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, f Ct► AubE1Q�� Y` -+ e�µ, as Owner of the subject property hereby authorize �i�� ��/ h. f- to act on my behalf, in all matters relative to work authorized by this building permit application for: r ur ► 3� (Address of Job)__,_ I Signature of Owner Da Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. • Q:\WHILESTORMS\building permit forms\smokecarbondetectors.doc Revised 040714 f n ��pTHE Tay, Town of Barnstable Regulatory Services rt BARNSTABLE. • ems. $ Richard V.Scali,Director �p 1659. �0 rEDMA.t0. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5 - -08 790 6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: - - - - - - JOB LOCATION: number street village . "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 building 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 requirements. , Signature of Homeowner 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. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often . results in serious problems, particularly when the homeowner hires unlicensed persons. In this case 6ur.Board canno t of proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\smokecarbondetectors.doc Revised 040714 e _ w Town of BarnstablePermit: 7 3 c (o Regulatory Services at :- I2,li of o p�1K Thomas F.Geiler,Director Building Division I, BARNSTAOM : Tom Perry, Building Commissioner y MASS. sb#9. 200 Maip Street, Hyannis,MA 02601 A Lei www.town.barnstable.ma.us 4'� w Office"508`=862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLF SOLID FUEL STOVE PERMIT Owner: C kus--t Aymersw Pnon�-�+-*,q- ""2-1 J 9 _ Install at: WS lD01MQ015SC'[T- -f-D Village: C6TU Man/Parcel: B I OR Date: 2'51® • Stove A. New/Used_ B. Type: Radiant/Circulating C. Manufacturer: ` tU.S y smye QMYLS Lab.No. - D. Model No. Chimney A. New/Existing (If existing,please note date.,of last cleaning B. ,Flue Size X 12 ;'..{ _.` i C Ate other applianees'attached t6-Nue? f 1� , ;.• _ °'--i'°}t� D"=Pre=faby TYPe andNlanufacturet i' f _ .. E. Masonry:0 ' Lined/Unlined Hearth _. _ ... .... . A. Materials: EMU ICI -11 Lk= B. Sub Floor Construction: 11.4 1# xa� gr a Installer ° ; m' Name: Address: Phone: l �' Location of Installation: KI.0 Registration# Construction Supervisor# OR check V-H'omeowner Installing, no license r quired APPLICANTS SIGNATURTLLIAE APPROVED BY: Please make checks payable,to the Town o Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector , Q:forms:stove Rev 163107 j The Commonwealth of Massachusetts- Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information '1 ,t Please Print Legibly cNarile-( C�Business/Organization/Individual): V-6-ri1VE, CAddr-ess Lo R 9U11AaUtSS;-r- " VNn�\ cCi_ty/S.tate%Zi-p?c Phone #: - Wf-2_ 3 q Are you an employer?Check the appropriate box: r. Type of project(required): I.❑ I am a,employer with 4. Q I am-a general contractor and I 1. - - -6. ❑-New-construction - - - --employees`(full and/or pait=ttime):*' have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees 8. E] Demolition working for me in any capacity. employees and have workers' 9. � Building addition [No workers' comp. insurance comp. insurance. $ re officers have exercised their uired.] 5. We are a corporation and its 10.0 Electrical repairs or additions .}I�a�' m a homeowner doing all work - 11.0 Plumbing repairs or additions myself o workers' com right of exemption per MGL Y � P• 12.❑ Roof repairs insurance required.] t j c. 152,§1(4), and we have no employees.'[No workers' 13.❑ Other comp."insurance required.] *Any applicant that checks box#1 iriust 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 shcct 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 andjob site information. Insurance Company Name: Policy#or Self-ins.'Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a"co of the workers com ensation policy declaration aye showin the policy number and expiration date). -' PY P P Y P g (-'showing P Y P' ) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi i der the pains an en [ties of perjury that the information provided above is true and correct. Signature: Date: I �d r_hon Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable oFIME o Regulatory Services 11MINsiasLE Thomas F. Geiler,Director erase. 039. ,�� Building Division Atfp�,la . - Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 i www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER?L'I CENSE`EXEMPTI ON"---I Please'Print DATE.` Jlol 2,D JOB LOCATION:--..;, �V��1 u V�S��:.� 1 OAb number street village "HOMEOWNER . e 1AVUQ i "K_ /1 IU SVIV 14' `"l Y) 13'q ��11 home phone# work phone# T M CURRENAILING-ADDRESS:—� a- - mm 0.01sSeTr ROM owsA city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which tie/she resides 6r intends to reside,on which there is,or is intended to m .. „ , ehed or,detached'structures accessory tosuch use;and/orfarm'structures. A be a�one or two family dwelling,atfa person who constructs more than_one,home.in a two=year penod 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 building 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 'requirements.. Signer ,o o' owner 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. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)forhire 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. Q:\WPFILES\FORM S\homeexempt.DOC f " • ti THE, Town of Barnstable Regulatory Services sna AB& Maas. Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM SOWN ERPERM1SSION ju �VTOWN!, N\ fQvu� of ARNNAK SCANNED PINE . OR WOOD PRODUCTS 2020 t X 2. 1 AN 1D. 51 n nnq PINEHARBOR.COM JAN 3 U 23)LU 1-800-368 SHED 259 Queen Anne Road Harwich, MA 02645 p: (508) 430-2800 ,t f: (508)436-1115 nT- E-'.;1a barns@pineharboccom ENGINEER'S STAMP s PROJECT: 14' x 24' Barn CLIENT: < „ } of s k �1 Chri i st n An e a � d r e son-r d F v < 'i A DDRE SS: T y,. f� 5, 'P �e f' v t 6 6 i 8 Gu m i u sett R oad z. x A q 3 z' C )otu t. MA 02635 y so k' .Nx Y �r a i kv. PHONE: }a 8 �����x� rf f .r� 774 4 7 8 21 34 Y3 E-MAIL: 3 . _ s I co o' 6 Y= hr�s @gm eac 3 ail m ADDRESS OF PROPOSED WORK: 68 Guimquisett Road Cotuit, MA 02535 Barnstable Bldg.Dept. ApprOvedby: REVISION DATE: Permit#: 1/9/20 DRAWN BY: GB Scale: 1/4" = 1'-0" Unless otherwise noted Page A.1 C P1NE C R WOOD;PRODUCTS PINEHARBOR.COM 1-800-368-SHED O I ront Elevation Left Elevation 259 Queen Anne Road Harwich, MA 02645 SCALE: 1/4" = 1'-0" QSCALL 1/4" = 1'-0" p: (508) 430-2800 f: (508)430-1115 barns@pineharbor.com ENGINEER'S STAMP 10/12 Pitch Architectural Shingles PROJECT: To Match House 14' x 24' Barn CLIENT: Christine Anderson PVC Trim ADDRESS: 58 Guimquisett Road White Cedar Shingles Cot u i t, MA 02635 t PHONE: Board and Batten 774-487=2134 E-MAIL: LL- seachris33@gmail.com ADDRESS OF PROPOSED WORK: ' 68 Guimquisett Road Cotuit, MA 02535 14,_0„ �, 24,- 0 REVISION DATE: 1/9/20 DRAWN BY: GB Scale: 1/4" = 1'-0" Unless otherwise noted Page A.2 PIS OR WOOD PRODUCTS PINEHARBOR.COM 1-800-368-SHED Rear Elevation Right Elevation 259QueenAnneRoad 3 Harwich, MA 02645 SCALE: 1/4" = 1'-0" SCALE: 1/4" = 1"-0 p: (508)430-1115 f: (508)430-1115 barns®pineharbor.com ENGINEER'S STAMP ' I I 10/12 Pitch Architectural Shingles I I I I PROJECT: To Match House 14' x 24' Barn CLIENT: Christine Anderson o PVC Trim _ ADDRESS: 68 Guimquisett Road Board and Batten Cotult, MA 02635 PHONE: White Cedar Shingles a 774-487-2134 E-MAIL: seachris33@gmail.com ADDRESS OF PROPOSED WORK: 68 Guimquisett Road Cotuit, MA 02635 14'-0„ 24-0„ REVISION DATE: 1/9/20 DRAWN BY: GB Scale: 1/4" = 1'-0" Unless otherwise noted Page A.3 PINE4R WOOD:PRODUCTS. >=loor Plan AS PINEHARBOR.COM SCALE: l,' = 1'-0' 1-800-368-SHED 259 Queen Anne Road 3 Harwich, MA 02645 A3 p: (508)430-2800 f: (508)430-1115 barns®pineharbor.com (8) - 12" Sonotube Footings STHD10 @ all posts 40" below grade ENGINEER'S STAMP a 8'xl4' Storage Loft Y, s ----------------------- PROJECT: 14' x 24' Barn CLIENT: 2 0 4 Christine Anderson A2 N A3 ADDRESS: 68 Guimquisett Road Cotuit, MA 02635 O PHONE: 0 6 774-487-2134 A5 - E-MAIL: seachris33@gmail.com ADDRESS OF PROPOSED WORK: 68 Guimquisett Road Cotuit, MA 02635 REVISION DATE: 9'-0" 1/9/20 DRAWN BY: W-o" GB A2 Scale: 1/4 = 1'-0" Unless otherwise noted Page A.4 ' z S PINE OR TimberpanefTM Frame 7 L mberpanelTM Frame W°°DpR°puTs 6 PINEHARBOR.COM SCALE: 1/4" = 1'-0" SCALE: 1/4" = 1'-0 1-800-368-SHED 259 Queen Anne Road Harwich, MA 02645 p: (508)430-2800 f: (508) 430-1115 barns@pineharbor.com I ENGINEER'S STAMP 2"x10" Ridge 2"x6" Collar Ties 2"x8" C 24" OC Rafters C �� w/H2.5 A Rafter Clips I" Roof Boaro (4) Nails 8D PR ECT: I"x12" Loft Boards 14' x 24' Barn 4"x4" Loft Joists t 6"x6" Plate Beams CLIENT: 4" 4" Wind Bracing ing Christine derson 4"x6" Door Posts (Fir) ADDRESS: 1"xlZ Srieathing 68 Guimquisett Road 4"x4" Purlins (Fir) 0 7 Cotuit. MA 02535 6"xb"Posts (Fir) PHONE: 5/8" AdvanTech Floor 2"AO" Floor Joists 16" OC 774-487-2134 .1/A 2"x8" Sills (PT) ? E-MAIL: STHDIO Straps (all posts) - Y. seachris33@gmail.com ° w/ (1)#5 Rebar at Top of Wallbo ADDRESS OF PROPOSED WORK: a a a a a 68 Guimquisett Road Cotuit, MA 02635 12 REVISION DATE: 1/9/20 DRAWN BY: 1�1,_0.. 24,-0., GB Scale: 1/4" = 1'-0" Unless otherwise noted Page A.5