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HomeMy WebLinkAbout0024 KEELA ROADr � �d I i THE Town of Barnstable �pF BARNSTABLE. ' Regulatory Services * 7 MASS. g. °a 39. M Building Division pTFO A'S�� - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection I Location 2 q KEG--r-,4 A G 7 Permit Number Z o (D C> b ' ( 7 Owner k i C_6 h 15,0 n Builder c. `'CIA`eoc7' One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Cv 4ri�A IC- IA r--fi1 U al�Z� :r-- ��4-- - Z) Ck c 7-57 - O Ne5 v 2J S' 6 9 �� l��4 2'�C) a KA_ . f. Please call: 508-862- for re-ins ection. Inspected by i'� Date �GXo TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION n - • a y, Map Parcel Application #_C200 00(, Health Division Date Issued �� d Conservation Division Application Fee .. l Planning Dept. Permit Fee 35 / Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis R Project Street Address lc ai-.4 r Village cc) r-" Owner rR Z_� +J Cktr4 d ress Telephone o 9'1 `4 ' Z -7-1 Permit Request Z-z ,&v ft � I--, r—r 0�_r:,4 r4r_-3 Tyi-e--4 11; Zc.iL Pi1CO *L%>r 4 i>" f"Z n fib 1/\ .1 6 "'s cr-, 6`1E 7 r>-G-_ Square feet: 1 st floor: existing proposed 0 2nd floor: existing IR 00 proposed 6 Total new Zoning District Flood Plain Groundwater Overlay Project Valuation typ 'Construction Type r e a a-� Lot Size I 1.`1 47 Grandfathered: 06 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 0No On Old King's Highway: ❑Yes Of No Basement Type: ❑ Full ❑ Crawl ❑Walkout 4 Other "- C4 e- het c� Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) q Number of Baths: Full: existing 'r�7 new _� Half: existing ® new Number of Bedrooms: 3 existing © new Total Room Count (not including baths): existing S new 0 First Floor Room Count Heat Type and Fuel: �d Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing I New 0 Existing wood/coal stove: ❑Yes X No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial ❑Yes ❑ No If yes, site plan review # cn Current Use Proposed Use � rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 5';�� � w<<� � : . w i3����r.�.s L. 4 t. Telephone Number 5gl_ Address 31- vr� 4 6-c License# 6 4-7 C.q 3 M "- S r_6 5s' Home Improvement Contractor# S' Q Worker's Compensation # 9 0C.- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO • ' SIGNATURE DATE { FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAFW PARCEL NO. 4 ADDRESS VILLAGE OWNER 0 DATE OF INSPECTION: FOUNDATION SoNOS (o)1 3�o9�o ,QN��i�e FRAME US t INSULATION b� v FIREPLACE r. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING D ? v DATE CLOSED OUT ASSOCIATION PLAN NO. r - - 4 r Tow.n. of Barnstab e Regulatory 5eryices T homas F. Geiler, Director Bading Division Thonmas Perry, CBO,Building CoinMissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsfable.ma.us F Fax: 508-790.6230 Office( 508-862--4038PLAN REVEEW Owner: /(�i ao LSmeJ Map/Parcd. � 1 3S'C 7- ®foS it Project Address 2`/, � Builder: �__----� The following iteros were noted on reviewing:` , • / G UL LwTill A 12evieed by: Date:- T- Ix o Massachr s s The Commonwealth f Department of Industrial Accidents Office of Investigations I 600 Washington Street ' Boston, MA 02111 . � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): *rr';d7oa oyiC tE-E- `�� lam✓`{' �'� ' `may &' Address: �Q �T x f✓ City/State/Zip: G` `-- Are y u an employer? Check the appropriate box: Type of project(required): 4. 1 am a general contractor and I 1. � I am a employer with � - � 6. ❑New construc`ion employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ErRemodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers'comp E] Building addition [No workers' comp. insurance comp. insurance.$ required.] S. [] We are a corporation and its 10.❑ Electrical repairs or additit 3.Q I required.] a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additit myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152,§1(4);and we have no 13.0 Other employees. [No workers' comp. insurance required,] *Any applicant that checks box 41 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. Insurance Company Name: tA a'i--cz:�;, i r4 Policy#or Self-ins.Lie.#: 9rL, ,r ►7 �"71'3 IC Expiration Date: 1VZ� Job Site Address: ` iC`Z''s" � XP City/State/Zip: Cc.., 4 0 Z_C-s.S Attach a copy of the workers' compensation policy declaration page(shout ing 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 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 of up to$250.00 a day against the violator. Be advised that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the info rm ation provided above is trite and correct Si nature: i�'�c� Date: 2 t `a Phone# . So C.- 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 S. Plumbing lnspector 6. Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or 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 license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has notproduced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall,. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or 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 town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts 'Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia - E,NERG'Y CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ON - AND TWO-FAMMY DETACHED RESIDENTIAL*CONSTRUCTION (780 C .E 61.00) Applicant Name_ cir€✓�..1 e- .�tr� -,�t'I Site Address: :z�( � z� � )Z> print Town: Applicant Phone: I;ek- -SA (,"X- Applicant Signature; Date of Application: NEW CONSTRUCTION: choose ONE of the following.two'o Lions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMTONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS M MaTRA-UM Ceiling or Basement Slab ❑ Option 1: Fenestration exposed Wall Floor. Wall perimeter AFUE HSPF U-factor floors R-Value R-Value R Value R-Value R:Value and Depth Nations]Appliancc-acr 35 R-38 R-19 1Z 19 R-10 R-10) consut•ationAet.(NAE( 4 1987 as amrndrd,minim cater as tipplicablo Note: This form is not required ifyou choose either of the two Versions of REScheck as listed below. ❑ option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http--//www.cnntgyr-DdeS.gOV/rrscheck/ ADDZ' O1VS OR;ALT)1kiPXON8.TO EXISTING$TJLLD 1`dGS.0�?EI2 5 FEARS OLD* *auildings under 5 years old must use option#1 or#2 is New Construction section above. Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _SF 100 x `Z — Zv = o f>Y' %° of glazing (b) Glazing area equals Zc v SF b a If glazing is<40°to.ii�e the chart belpW. If glazing is > 40 % r6ctc•d to "SUNROOM"section 780 CA4R TABLE 6101.3 PRES CRIPTIT ENVELOPE COMP ONENT CRITERIA.ADDITIONS TO EXISTING. . LOW-RISE RESIDENTIAL BUILDINGS MAXI2vfUM h9Ti)Mtm Ceiling and Slab Peril. • Fenestration -wall Floor Basement Wall R-.vall U-factor Exposed floors R-Value R-value R-Value R-Value and De .39 R-37 a R-13 • R-19 R-10 R-10, 4 . a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls; and including any access o enin s SUNROOM—An addition or alteration to an existing building/dwelling unit where the tot glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of f addition. Note: Owner to fill out Consurner Information Forfn found in Apprndix 120,P �► r Tow U� of B a rnstable t Regulatory Services Thomas F Geiler,Director q' F1619L Building Division Tons Perry,Building commissioner 200 Main Strcct, Hyannis,"MA 0260.1 . ivwwJown.barnstable.ma.us Office: 508-862--4038 Fax: 508-79( Property OwrierMust Complete and Sign This Section If Using l x.Builder I, ff.C:+r(• fJ, C Fi e,iSv , as Owner of the subject.property hereby authorize S'; � .•( yi-c-r;_-o"I `5t c- , > s I 9.act on my behalf, in all matters relative to work authorized by this building permit application for (Address of job Signature of Owner Date /U d- els#4 - Print Name if property Owner is,applying foi-permitplease complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable N�of r�r�y� • Regulatory Services a�tuasr�at� Thomas F. Geiler,Director Building Division PrFO t`A� Tom Perry,Building Commissioner 200 Maiti•Stree.�.Hyannis,MA 026.01 wwwAown.barnstable.rna.us Office: 508-862--4038 Fax: 508-790-6230 HOMEOWNER LICFNSE EXEMPTION Please print DATE: JOB LOCAT)ON: number street • villa'ge name home phone# work pbonc# CURRENT MAILING ADDRESS: eity/tovm state rip code The current exemption for"homeowners" was extended to include owner-occupied dwellings of six units or less and to allow hQMrowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINl-17'ON OF HOMEOWNER Persons) who owns a parcel of land on which he/sbe resides or intends to reside, on which thcre is, or is intended to be, a one of 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 bomeovmcr. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 7hc undcrsigncd"Homeowner"assumes responsibility forzompliancc yr th the State Building Code and other applicable codes, bylaws,rules and regulations. The undcrsigued"homeowner"certifies that he/she understands the Town of Barnstable Building Dcpartrpcnt e m;r,;rrrum inspction procedures and requirements and that he/she will complywith said procedures and requixcments. Signature of Homeowner Approval of Building Official Note: Three-fanuly dwellings containing 35,000 cubic feet or larger will be rcquircd to comply with the State Building Code Section 127.0 Construction Control. HONMOwNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building perrdt is required shall be cxrmpl from the provisions of this seetion.(Section I og.1.1 -Licensing of construction Supervisors);provided that if the bomrowru r engages a pc sons)for hire to do such wort,..that such Homcowocr shall act as supervisor." Many homeo er wns who use this rxcmpddn are unaware that they art assuming the responstbi)ities of n supervisor(sec Appendix Q. Rules&Regulations for L;eauing Construction Supervisors,Section 11 S) This lack of awarrness bften icsulrs in serious problems,particularly when the homeowner hires unlicensed persons. In this cast,our Boaud cannot proceed against the unlic=sed parson as it would with a liecnsed Supervisar. The homcc mcr acting as Supervisor is u)timatcly responsible. To ensure that the homeowner is fully aware of hisAc.r resporinbilidcs,many communities require,m part of the permit application, that the homeowner certify thathdshe understands the respormbilitics 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 fonr)rcrtifiealion for use in your community. ire r a ;DATE(MM/DDIXY) ACORD "CERTIFICATE OF Li�\BILITY�INSURAN`CE� = 'ovz7ilo PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 150 SAWGRASS DRIVE ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. ROCHESTER,NY 14620 COMPANIES AFFORDING COVERAGE I COMPANY A GUARD INSURANCE GROUP INSURED COMPANY STEVEN MCELHENY BUILDER INC B P.O.BOX 460 COTUIT,MA 02635- COMr,PANY I COMPANY I COVERAGES � 3H 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. O TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS T DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $_ CLAIMS MADE[::::]OCCUR PERSONAL&ADV INJURY $ OWNER'S S CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ j MED EXP(Any one person) $ j AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ I4 ALL OWNED AUTOS - SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ { ElUMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND WC STATU- OTH- _xj TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000.00 THEPROETORI PAPARTNERS/EXECUTIVE �INCL STWC128738 01/29/10 01/29/11 EL DISEASE-POLICY LIMIT $ 500,000.00 OFFICERS ARE: ®EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS F CERT,IFI.CATE.HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE STEVEN MCELHENY BUILDER INC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PO BOX MA 02635 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE k: C�AGORDCOttPORATtON:1988; T.��.; f �lze �o7.vmaruuea� ����� �\ Office of Consumer Affairs& usiness Regulation License or registration valid for individul use-only HOME IMPROVEMENT CONTRACTOR Registrati before the expiration date. If found return-to: �. Office of Consumer Affairs and Business Regulation u on: '`�157699 0 10 Park Plaza-Suite 5170 Expiration 10/29/2011. Tr# 288175 }Eq 1vv to C pogation Boston,MA 02116 Type STEVEN MCELHENY BUILDE S;INC STEVEN MCELHENY ; _. 56 BOWDOIN RD MASHPEE, MA 02949 .. -- Undersecretary Not valid without signature I"- Massachusetts- Department of Public SitfetN Board of Building Regrulations and Standards gConsfructibn Supervisor License License: CS 47693 RestYicted loin#1 G ,.STEVEN P`€,MCELHEN Y ' "a .PO BOX 460i; 4T , „ :!COTUIT M't 1 Z _ A 02635��� t� Expiration: 9/23/2011 Conunissioner,' Tr#: 6192 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, bit- -'Parcel O S Permit# '�9 yp C�� 3� II )� � hRNgTA8I, E Date Issued Health Division " Conservation Division 'o o /! ►t� t� g; 3 F&EPTIC caSTEM MUST 041,ST-LLFD IN C0rulPLI CE Tax Collector WITH TITLE 5 Treasurer E IVI �PMMENTAL CODE .., 1 BIVISION SIN I���C�lLATIO Planning Dept. Checked in y Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis I Project Street Address Village L'a _IIA 1 r 4 Owner . . jZ= C i-I pi r G i-1 n L c, o^4 Address Z 4 .�c��� �� �'a� i �''�•� Telephone V_7 Lt_11 P 2 Permit)Request Z 7.,4d.r ✓1 'r>ezU u e,v ITz 4- e f 2 k Lf 1. C�►'�'T�5 1A, o7, 0-o o Q E,_Cr t r45, S h4isZ77E7J I Square' feet: 1 st floor: existing ke o proposed 2nd floor: existing proposed — Total new Valuation 10 . v coo Zoning District Flood Plain Groundwater Overlay Construction Type a era P tz 4—e- Lot Size t 1. 5va Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. I f Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure S Historic House: ❑Yes A�No On Old King's Highway: ❑Yes J6 No., Basement Type: A Full ❑Crawl O Walkout ❑Other Basement Finished Area(sq.ft.) _ Basement Unfinished Area(sq.ft) i Number of Baths: Full: existing new Half: existing new Numf er of Bedrooms: existing L4 new TotallRoom Count(not including baths): existing new. T' First Floor Room Count i } HeatlType and Fuel: P Gas 0 Oil ❑ Electric ❑Other Central Air: ❑Yes X No Fireplaces: Existing New Existing wood/coal stove: ❑Yes X No Detached garage:❑existing O new size Pool:❑existing ❑new size Barn:❑existing 0 new size Attached garage: ❑existing ❑new size Shed:❑existing ❑new size Other: t Zoning Board B r f Appeals Authorization ❑ A ❑Zo o ppe Appeal# Recorded Com i mercial ❑Yes ❑ No If yes,site plan review# Cur r{nt Use Proposed Use - BUILDER INFORMATION Name S�� -E�*! ,✓.eft-L ! %J`) 5�LA r '1>;ER:sTelephone Number Sa g- - o-� Address 75G K 4 G C? License# 6 41 O 43 C'a 77L4 < ✓'^ Home Improvement Contractor# i o ffS } Worker's Compensation# L-0 C q i - ALLfCONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A-a I S:�-i; GQ F T-a 6 3 roE dz s fl't SIG#NATURE DATE 4 t FOR OFFICIAL USE ONLY t • c PERMIT NO. DATE-ISSUED ` MAP/PARCEL NO. f ADDRESS ' VILLAGE OWNER - DATE OF INSPECTION: , FOUNDATION FRAME Cy JI Os 8S _ E INSULATION w' FIREPLACE ELECTRICAL: ROUGH FINAL III PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING- DATE CLOSED OUT®' ^ ASSOCIATION PL_"AN NO. t ---_—__ The Commonwealth of Massachusetts Department of Industrial Accidents 600:Washington Street J Boston,Mass. .02111 Workers' Com eiisation.•Insurance davit-General Businesses a 'X<-��.�.5a:•� -. 'r.S.: •.;t�ya.• " •",,:e""�Ay+ '•e.,�,.".. '• - '•` � :. � .::tta�ros , name' L t1- may lZiurt_r{7zS• i address: /17G city- Co state: oM_ zip: phone# ' SO$— -(Zo S-563 work site location(full address): Z`7 L'� 14 ,``� _6 S57 . ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.)' I am an em to er with 2 em •lo ees full& art time.: ❑Other I aIIi anemployer providing vtorkers' compensation for my employees working on this job.. r: ,..• ,,+�,r s /• t COI1IAanV•IIBIIIe... t": t•�• 1,:.•• ':' �-j' (AJ'�'{a.��;��•a:;'�':.�!':•.,::�•��;'.�;. rl• �{r e8�r'essd' '. city ,(l•@�T�.:e••r `-� '.•[',.�0•� �' .phone:.#:�;� �'•���5:'�` �•T'�'C!• `•��''.'�•'�•�:. Irisiir3nce.c�'` o:�...���.� •:1;:/C.=`:, ...�•<. .�, Oh .#i :�.. .'S`:; t. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' - compmsation polices: com�envaariie= �t• •'•'•` addaessi. city�.. - phone'#a _ 1!• ,' :(t+'- 1,e�i`•e:.•.• .•"1'°�•:,•'••• insurance co.'.•.':•'•:�• - "o7ic #�:• •��•��'. c op V-ne •arr• ...�.;n an ke. ':>•:`_ • .. , • ••, - ter': ,t). _ 'rTi1 r CltV: '• :>_ msurancelso:•�:• :a''. ::olic.'-:#;;.:-:;`'.::',::,'; Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a dine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that p copy of this statement may be forwarded to the Office of Investigations of the DI:A for coverage verification. I do hereby certify under thepains an penalties ofperjury that the inf ormationprovided above is true and correct 1 Signature v"d," Date Print name VVN C T�Vf z tL Phone# official use only . do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ~ ❑-check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: __ phone#; ❑Other (mused SepC 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers.to provide workers'.compensation for their.. employees.. As quoted from.the 4'law", 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 mqre 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.oceupant of the.dwelling house of another who.employspersons 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 section 25 also'siaies 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 applicant.who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, 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 in .the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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 lists below. City or Towns . 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 0. Jn the permit/license number.which will be used as a reference number. The:affidavits may.be:returned to the Department by.mail or FAX unless other'arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. . The Departrnent's;address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Mestli mRs 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext:406 oF� r Town of Barnstable h Regulatory Services saruvsrasLJE, Thomas F.Geiler,Director crass. A 1639' p•`� Building Division lED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT _ HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, . improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �[U U Estimated Cost Address of Work: 2 L� �`�L cq C v' •► } Oyvner's Name: C'�l d -r's� P ( Date of Application: I hereby certify that: Registration is not required for the following reason(s): (]Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FORAPPLIC PROGRAM OR GUARANTY FUND UNDERMGE HOME IMPROVEMENT WORK DO NOT HAVE*142A. ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No: OR Date Owner's Name []:forms:homeaffidav oFj"E roh, ... . . . Town of.Barnstable °;. Regulatory Services ' uomasEGeiler,Director . _.. -.. . . N. Building Division TomPerry; Building Commissioner 200 Main Street, $yannis,.MA 02601 wpvyy.toyyn.barustable.ma.us office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder rC I c j 01_Su e4,as Owner of the subject property hereby authorize:'. @,.i-, va�LC LF-[ to act on mybehalf, in all matters relative to work authorized bytIL binding permit application for: (Address of Job) Signature of Owner Date T i C vm zo tJ c L i-(6 `Sc7 Print Name 1 s � BpARp.OF BV T � License ;.ILDIN.G REG(LLA,rIONS INSTRUCTION SUP. - NurnberSS ERVISOR a _ 047693 d 8 �.r Q05" g STE,VEN P Re§t no: 6998.0 PC)BOx 28 MCEL , r COTVI-T, MA Administrator ".. I Board of Building Regulations and Standards HOMEIM ,OVEMENTCONT „ Re istra�tiorP. RACTOR ..]10485 " P /2006 GROVER&MC STEVEN MCELH 523 MAIN ST COTUIT,MA 02635 --K Administrator I • 1 I MAR.24.2005 1_ *20AM SHEPLEY SALES NO.287 P. i/2 ® �- BC CALCE 2003 DESIGN REPORT - US Thursday,March,14,2005 09:58 BO Double 1 3/4" x 9 1/2a'VERSA-LAM(g)3100 SP File Name: BC CALC Project:R601 Job Name: Nicholson Renovation oeseription:Structural Ridge Adcress: Specifier: City,State,Zip:Corit,Ma Designer: Bill Campbell Customer. Steven MoElheny Company: Shepley Wood Products Code reports: ICS0 5512,NER 629 Nlisc: o 12 17 IStandard Load-30 Psf i 15 pst TrlhuWry !�L . 90 81 2260 flas LL 2260 lbs LL 1376 lbs pL 137e Ibs i]L Total Horizontal Length-12.00-00 General Data Load Summary Version: US Impeelai ID Description Load Type Ref. Start End Type Value `l"rib. Dur. S Standard Load Unf.Area left 00-400-00 12.00-00 Live 30 pet 12.00-00 115% Member Type: Roof Beam Dead 15 psf 524040 90% Number of Spans: 1 1 ceiling Unf.Area Left 00-Da00 12.00-00 Live 5 psf 04-0OwcO 100% Left Cantilever No Dead 10 psf 04.0U-Co 90% Right Cantilever, No Controls Summary Slope: Ohl Control type Valve %Allowable Duration r Loud Case Sparc Location Tributary: 12-00-00 Moment 109e6 ft-Ibs 68.3% 115% 3 1 -Internal Neg,Moment 0 ft-Ws n/a 100% End Shear 3174 lbs 42.9% 116% 3 1 -Left Live Load: 3U psf Total Load Defl. U253(0.568") 71.1% 3 1 Doad: 15 psf Live Load Deft. U406(0.355") 59.1% 3 1 Dead L ead Load: 0 psf Max Dsfi 0.568" 56.8% 3 1 Duration: 115 Notes DISCIoSur6 Design meets Code minimum(LI180)Total load deflection criteria. The cam,Disclosure, and accuracy of Design meets Cods min1murn(L/240)Live load deflection criteria. the input moat be verified by anyone Design meets arbitrary(1 )Maximum load detection Criteria. who would rely a the au ut n Minimum bearing length for B0 is Y ko Minimum bearing length for 61 Is 1-1/2' evidence of suitability for a Member Slope=0,consider drainage. particular application. The output Entered/Displeyed Forizontal Span Length(s)=Clear Span+112 min.end bearing+1/2 intermediate 0earing above is based upon building code-a=Aplod design prcpejes Connection Diagram and analysis methods. Installation Consult project design professional of record or BOISE technical representative for connection design of 1301S5 arlgirleered wood Botts are assumed to be Grade 5 or higher, products roust be in accordance Member has no side loads. with the current Installation Guide and tha applu-nable building codes. Connectors are:112 in.Staggered Through Bolt Tc obtain an Installation Guide or if you have)232 any Qbefore b,beginning CBII „ �_ {b00}282-07Et8 before beginning b 2-1/21' � I Product installation, c=2-3/4" a 60 CALCit,PC FRAMER6,9CIZ, d 24" _..r 0 --� ® r "`H1 9C RIM BOARD'"',SC OSB RIM T ; BOARI]r' 8,CIS�GLULAM-, VERSkLAMS,VERSA-RIM®. VERSA-RIM PLUSS, VEP.SA-STRANDTM, VERSA STUDS,ALLJOISTS and AJSTM are trladem8rks of J 13olse Cascade Corporation.. J Page 1 of 1 MAR.24.29t35 11:20AM Si-IEPLEY SALES N0,287 P.2/2 0 BC CALCO 2003 DESIGN REPORT-US Thursday,March.t4,2005 09:58 Double 1 31411 x 9 112"VERSA-LA►N10 3100 SP File Name' BC CALL Project:R502 Job Name. Nicholson Renovation 131scription Address: Specifier: City, State,Zip:Couit,tea Designer. Bill Campbell Cautoler. Steven McElheny Company: Shepley Wood Products Code reports: ICS0 5512,NER 629 IVlisc: �o �12 starda�rc Load•so ps(I 1,5 psf TrlUurery 12-00-00 -�� BO 91 1800 Ibs Ll. 1900 The ILL 1147 lbs DL 1147 ibs DL Total Horizontal Length-10-00-00 General Data Load Summary Versiol.. US Imperial ID Description Load Type Ref. Start End Type Value Trib. Dur. S Standard Load Unf.Area Left 00.O9•00 1 MO-00 Live 30 psf 12.00-03 115% Member Type: Roof Beam Dead 19 psf 12.00-03 90% Number of Spans: 1 1 ceiling Unf.Area Left 00-00-00 10.00.00 Live 5 psf 04-00-OD 100%, Laft Cantilever: No Dead 10 psf 04-00.00 90% Right Cantilever: No Controls Summary Slope; 0/12 Control Type Value %Allovvablo Duration Load Caae Sparc LDcation Tributary: 12-00-00 Moment 7817 ft-lbs 47,5% 115% 3 1 -Internal Neg,Moment 0 ft-lbs I n/a 100% End Sheer 2564lbs , 4.7% 115% Total Load Dell. U436(0.27411) 41.1% 3 1 Live Lord: 30 psf Live Load Deft. 1.1702(0.171") D4.2ao 3 1 Dead Load: 15 psf Max Defl, 0,274" 3 t Partition Load: 0 psf Duration: 115 Notes - Disclosure Design meets Coda minimum(L1180)Total load deflection criteria. Di Di c leteiiess and accur&c of Design meets Code minimum(IJ240)Live lead dieflec6on criteria. The P Y Design meets arbitrary(1")Maximum load defection criteria. the input must be verified by anyone Minimum bearing length for 80 is 1-112". who would rely on the output as Minimum bearing length for B1 Is 1-1/2", evidence of suitability,for a Member Slope c 0,consider drainage. particular application. The output Entered/Displayed Horizontal Span Length(s)-Clear Span+1/2 min,end bearing+1/2 intermediate trearing above is based upon building code-accepted design properties Connection Diagram and analysis methods. Installation Consult.project design professional of record or POISE t—echnical representative for connection design of BOISE engineered Wood Dolts are assumed to be Grade 5 or higher. products must be in accordance Member has no side loads, with the current Installation Guide and the apptie:abia building codes. Connedors are:V2 in.Staggered Through Bolt To obtain an tnstalletion Guide or if you have any questions,plesise call a=z„ Lbil (800)232-0788 before beginning b 2-1/2" r Product installation. i BC CALCO,00 FRAMEI A, MOD, d=24" a—i� 8C RIM S 167OARD 8C OSS RIM a •._. HOARD'w,BOISE GLULAMY" VERSA-LAMS,VERSA-RIM0 i f VERSA-RIM PLUS®, VERSA•STRAND'''N', VERSA STUDG,ALLJ01ST@ and AJSTM'are trademarks of Boise Cascade Corporation, Page 1 of 1 .. - - /% NET•�5 bit _ - �L� EAcA 2TFr£R �. px-cCl�•tJCY ABED �� 7msrS ro +L Ec..3 rT•I v E .-wh" rarg'- A - - To.S iS.r M T-FI•S Qo.O•:n i _ - „: -_, .. `- .:� I — - -.__ ___..-- c r8• - -1+.5 a... _ ,. - TI.IT TO i Oae R.r.I A`I I! CLOSE— [!LAW"QC h ho•iCT • wr3�� - APPROVED BY: �.. BCALE: • ♦ '.-p.. BY DATE: I .'Ips REVISED DRAWING NUMBER i i IMPORTANT ANY CONSTRUCTION THAT INCREASES LIVING SPACE -� .�w..wK-.nw�l..+M.nwHrv...w..w�ww.w•�wrxs+rw.•n•rtw..MV.MUT.!•�wYMKK.wKI.•••Y.J.ii.+rYa'!v.'I••..A..1•.m..J•..:Oil.Yt'.t::u'v:.Vh�+.:w,.w.•S•v.t.M•R•M'Y^.•�MTXr.1uM:. BEYOND 1200 SQ. FT, PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS, NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. j 4 Y• raC,mz-:C.J C td j . i t Ca;;ccal2 : .. -'A�1 e �•�r-�i..'�. �"i � +�� F '-••ti^_+_+�....-�.-�-._...+ww_..w�..�.��r+rrr•.w.._....:.•.r'. n+......w. ......w.r..r._.r.r.......... j {�,�,r.�GJ�:.ta � � (.t..lbc.f- Si A•.;� �_ r # j"_ ._._...._ ��.�... i , t t CA, 'T- yjt4O.Mt uh __..._.. . 0 .{ ! ' . E vl Ta t t r S t'74�Z ................................... .... . i'os; ra � � • rGNUt cl 2tMOV.J••i lot 17L_rl4 �t.r-u 'SCALE:'/r'-p.. APPROVED BY: DRAWN BY i. DATE: Zbe..f+0 REVISED .• DRAWING NUMBER i i f , 1� • f /,' N I j L 1"7�•CGM � SC.r f . } r � r t � • v1�r.t C4 �{. 7Init10 {7 • -_..�}�f Ci L.� 1�lit .__.1 C'W\.1 1'� �: t..C,"�..� ��1{ �r f�`......_._. K i G M o t--Go 4 T .1c.1��i+ +�C� t�i M•i7 �'�-t o ►,i,S APPROVED BY: DRAWN BY DATES I 0 Fo REVISED • I . i • i DRAWING NUMBER