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0218 LITTLE RIVER ROAD
OF/ .� Town of Barnstable uidi Post This Card So That,itpis VisibleFrom"`the Street 'Approved�Plans°Must beRetamedonJob and this Card Must be Kept EACtN$'fACtt.E. 15, • M" " Posted Until Final Inspection HasBeen Made , ' , 1634 ♦ ;'. q ...� . ,mow. ,< - � n '�. .'a< :•. �R Where a Ce�ficate of}Occu�pan�cy�s Required��su�chtl�Bildg s�hallgNot,be Occupied until a Finalln,sptection�tas be�en,made Per t Permit No. B-18-1191 Applicant Name: JONES, PHILIP B& PROVENZANO,JACQUELINE . Approvals Date Issued: 05/14/2018 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 11/14/2018 Foundation: ` Location: 218 LITTLE RIVER ROAD,COTUIT Map/Lot 054-006 004 Zoning District: RF Sheathing: Owner on Record: JONES, PHILIP B& PROVENZANO, 1,--, Contractor Name Framing: 1 1.r §Contractor License Address: 218 LITTLE RIVER ROAD E� x, z 2 COTUIT, MA 02635 v x Este Project Cost: $0.00 k Chimney: Description: install a 12x16 shed Permit�Fee: $35.00 Insulation: Fee Paid $35.00 Project Review Req: � Date 5/14/2018 Final: a � r Plumbing/Gas x Rough Plumbing: Building Official �q Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzeiitiby this permit is commenced within six months�after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicatidn;a d tl%e approved construction documents f r which thiss permit has been granted. All construction,alterations and changes of use of any building and structures shall b'e 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 rod[Irrid shall be maintained open for publi crospection for the entire duration of the work until the completion of the same. E s Electrical. The Certificate of Occupancy will not be issued until all applicable signatures bythe Building antl Fire Officials are,proded 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: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final Terpns contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department 4 Building plans are to be available on site Final' All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f =, Town of Barnstable THE t Building Department Services Fmkri— �,G Brian Florence,CBO ®� Building Commissioner O n 039. � 200 Main Street, Hyannis,MA 02601 a www.town.barnstable.ma.us `9 r' tF-9 f �p,� Office: 508-862-4038 Fax: 508';790-6230 PEWMT# -/�- ,�/ FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less 21 L �' f1Q /L�✓� cu-fc�l Location of shed(address) Village Property ownowner's name Telephone number l2, X �LI� G�- Qay Size of Shed Map/Parcel# 4igennAature Date Hyannis Main Street Waterfront Historic District? �1[) Old King's Highway Historic District Commission jurisdiction? /70 _ You must file with Old King's Highway Conservation Commission(signature is required) Sign off bours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMNIISSIONS,THERE MAY BE A REITIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMNIISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:08/6/17 t k, \ LOCUS INFORMATION WRISHf oWNm: oouaAs c.a PAm�vouNm owwr DISIWx:n, IiPfID lme tcrmOlcE: eooK tams.PAGE u wmaml� Nm w�zoNE e PUN BOOR mt,PME 7e zaxE�rmt�w�. x.arm 7/te/li "°W'W NAP a Wln 43 �ssm,asw LOCUS'MAP vwtcia: coe-oDi wun s im lse as.Bm zoNwc msmlcr: a omtwa tnr slm m.taaiss. m ro°pi11 sElBw,s % DDsnrm mammD m„•wx ,Wm/ea,tao-xas REAR 15' (HOUBE r.A1E1)) � C'EFflir TO THE BEST oP NY PROP6510N/iL KNOWIETM C INf9FNATON 11,w D BFL6 TINT E lDI CORNETS, /, dND190Ne D oEffllCl6 TD ME - � SfRUDIYRE .l5 EIEWWwm BY , � N9IRUWFM SUINEY wID Ag 6NOWN ON ro A3 lN6 PUN APE cDB g. � " /0 / PWDfi551dU1 t/im sUINEMR Rti-C'y{t - PLAN OF LAND • .�' / M 218 LITTLE RIVER RD IN COTUR MASSACHUSEM / - (BARNSEABRE COUNTY) EXISTING CONDITIONS i I AUGUST25,2017 I I \A 41 MATT YORK s - I I / YORK CONSTRUCTION.INC. P.O.BOX-B26 SANDWICH,MA 02537 O&W GROUP 349 Rou 28.Unit D ' W.Ya mocth,Meeswhue 02673 ' _ • 508 77B 8919 : ®m an wew.en " PlE xtis-CVP.on A Dwo.No:eras-ot snEEY t or t .. .PUB.H0:6-OtiJ.00 ,•� -ssr.1 'SINE FAmw R K ZA&E PI-A oN BAGIL 4&ZWF �� GARI3A�G Gr�fi�L VML•y FWW USA. 1500 6At-• n L.r.ACµ1WP SYsrt-A �s�N ��XpA►J sI DN TI �} Amu cATtoN AWA O'D• PAo GPD s O,`1¢ Sp=44&SF APP UUITGN. .AWA �•�ili"!J E X P A N S i D N y 5tt-:WALL A aFA--3o xz 44=240sF of �I �}Es �-o►l� LEAS oTroM AMA = -5e x A•'x-Z-24o sF r-.&, -row- AWA P AeoSF 3' MAX. � pEaLoGA►TIojJ �E �.S'K��rNa� Z. '/8_�s +. "L. cif T- N OF sTows OF ' FETER CAXMRNOA. v�ii ''` -tcrt AL llla O � - S_ FG g i8++ FS1 flu tMt ZS o z4 24 fm q L M SAj PLAT PLAtJ l LOB- TIOW C&TO 17' 2 (o 1 t 111�Y ;:T1riAT'.:jtt1E `D�t�M.0 �t4awN RAW Z 4MMIM :FL`1S WtTK. 'Irt4E SIDELat3E A� LOT g 5�ST8AGK. Du DF 'NGA 'm WW OF MAP - PAP=4- -� aAL ftwry. t'i�i►?..aer� zo e. mAk Nye iNc • i � LAI�ID Sv�V�Ytt�S •ala�rts�f OF 'L Piet. W.L.L. Ev en m-r JP ram, ?C L 6,4 ZONE ZF /�S� 15i t . oe f JM Weil, ior Ali N NO.ISM OF � Cpa A ML y/ i U1T1T,w` Y�iM• , .IN Nwwr ,,, �.! _ + . C Wit" vo xsow tt, I Eli q-- 1 -7 Town of Barnstable t TTI�l • rAaivsraae.�. • 200 Main Street, Hyannis MA 02601 508-862-4038 saJSt•0� Application for Building Permit Application No: TB-17-3637 Date Recieved: 10/19/2017 Job Location: 218 LITTLE RIVER ROAD,COTUIT Permit For: Building-Insulation-Residential Contractor's Name: Craig P Bishop State Lic. No: CS-109777 Address: Sandwich, MA 02563 Applicant Phone: (774) 20572001 (Home)Owner's Name: Philip Jones Phone: (978)875-0892 (Home)Owner's Address: 218 LITTLE RIVER ROAD, COTUIT, MA 02635 g -t Work Description: 10 hours air sealing Install 7" layer R-26 cellulose to 1546 square feet open attic `--; Install 1 thermadome with plywood surface Install 96 ventilation chutes trp - Y per... Total Value Of Work To Be Performed: $3,506.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proofof workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Craig Bishop 10/19/2017 (774)20572001 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,506.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 10/19/2017 $35.00 X)M-XXXx-XXXX-! Credit Card _ 3464 —_ Total Permit Fee Paid: $85.00 10/P9/2017 _$50 00 XXXX-XXXX-XXXX-i Credit Card 3464 I ,„�..„�,,,�.,.„ �, �•"�,.",'�" e° ems �� a "�""� z� "` � �°' " r �zr�v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q-Mht � 1 Map Parcel 0 Application *.9 Health Division Date Issued Conservation DivisionUILDI11� E Application Fee �-- Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board APR 2-7 2017 oHistoric - OKH _ Preservation/ Hya`nniV���a r. Project Street Address d 1 /e XivE-jq -kcA0 o Village 04U; .� ✓tom S Owner ®N 5 Address r Telephone Permit Request RE#Ode L Kji ri kiF q (A111V r.40ldeT5 0100-e!v, Xe wells! 117- a4rYyaay 1 ��✓, Tv��l6�worP✓ 3 Square feet: 1 st floor: existing proposed 0 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 'AiA/117 Lot Size 1, 3 ci U G Uz Grandfathered: ❑Yes 2(No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 6 Historic House: ❑Yes LY//No On Old King's Highway: ❑Yes M//No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 .Z 31 Number of Baths: Full: existing new 0 Half: existing new O 1 Number of Bedrooms: existing Vnew 0 Total Room Count (not including baths): existing So newFirst Floor Room Count Heat Type and Fuel: L7/Gas ❑ Oil ❑ Electric ❑ Other Central Air: S/Yes ❑ No Fireplaces: Existing New 0 Existing wood/coal stove: ❑Yes d/No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Uk/existing ❑ new size _Shed: ❑existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # N14 Recorded ❑ Commercial ❑Yes Ao If yes, site plan review# Current Use ��S i d Q�fA•I J�iNbIe- *A�r�1 r Proposed Use `l.4y e APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number p!J K Address :? 0 License# p 71 Z- E , S.4IUdueiL 14 % M� Home Improvement Contractor# , Vo Email Y®��`�UB� iN �N9�fl�1. Oaly Worker's Compensation # YV CV 00 ? 57 eF®V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0.0 ® � Ali/lj Y.4 SIGNATURE DATE FOR OFFICIAL USE ONLY a APPLICATION # 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. I �I E � Town of Barnstable Regulatory Services BARNBTABLB, MAE& Richard V.Scali,Director a679 �c MA'S Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towii.barnstaI3Ie.nn.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize � (Zo'vsv ( to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fen es and alarms are the responsibility of the applicant. Pools are not be filled or utilized before fence is installed and all final re jn speE 'ons are performed and accepted. gnatu f Owner Signature Applicant V ��� t tL �d►J� 1�t OE?►C Print Name Print Name ZQl-9 Da F 1 - The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): GDt-- T' Address: PO OX QCD City/State/Zip: E Sir-4QKzIKAHI Miq Phone# —i-1L — lSei- t Are you an employer?Check the appropriate box: Type of project(required): 1. 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. �construcotion. 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building 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 11. Plumbing 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 Llltt�dcty� employees. [No workers' 13. Other 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. $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. .44 L et ivr/c 6,lg4/?'Tf✓ —T it/, , Cu/y Insurance Company Name: �N_`x)�r�t�i� c t Cyr �Qt✓ �c) Policy#or Self-ins.Lic.#: l3xy C )CI-99 QjOL+ Expiration Date;Z IZ 2IZC�l 8 Job Site Address: Zlb 1 L-4 'R1Vf_r___Pn City/State/Zip:COc)rr,rY11=� 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 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 d penalties of perjury that the information provided above is true and correct. Signature: Date: L46-(, 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#: V ' 1 ® DATE(MMMDIYYYY) E A��o CERTIFICATE OF LIABILITY INSURANCE F03/03/2017 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 pollcy(ies)must be endorsed. If SUBROGATION IS WANED,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. NTACT___ _...--..-._....-_..-._-....-.._..__...._.-......_... ......._. NAME. Eltysla Morels- __.............._.__.._....._............___...__......__....._... ...............�.._ THE INSURANCE AGENCY OF CAPE CODE INC. Morels— PHONE E t 508)888-2766 C No: ADORE • ellysia@insuranceofcapecod.com P.O.BOX 960 INSURERS AFFORDING COVERAGE NAIC 0 EAST SANDWICH MA 02537 INSURERA: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: MATT YORK CONSTRUCTION INC INSURERC: tNSURER D: PO BOX 826 INSURER E: EAST SANDWICH MA 02537 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 131703 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 !L 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.M1DCYEXPADD S B j INSR TYPE F INSURANCE OUCYNUME M LIMITST M COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S E TO RENTED CLAIMS-MADE OCCUR PRE ISES Eaoccurrence) $ MED EXP(Any one person) $. N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICYD jECT LOC PRODUCTS•COMPIOPAGG $ i $ I OTHER' COMBINED SINGLE LIMIT $ AUTOMOBILEUABILRY Ma accident) _ 1 ANY AUTO + BODILY INJURY(Per person) $ ALL AUTOS OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS P AUTOS Per accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ i EXCESS LIAB CLAIMS-MAOE NIA AGGREGATE $ DED RETENTION$ $WORKERS COMPENSATION X SEA T R _ E AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNERIEXECUTIVE YIN E.C.EACHACGDENT $ 100.00E A OFFICERIMEMBEREXCLUDEDI NIA NIA NIA WCV00999805 02/22/2017 02/22/2018(Mandatory In NH) E,L.DISEASE-EA EMPLOYEE $ 100,00E "Yes,describeunder E.L.DISEASE-POLICY LIMIT s 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts'if the insured hires,or has hired those employees,outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification j Search tool at www.mass.govRwd/workers-compensationfinvestigationst. {i CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i Jackie 8t Phil JonesACCORDANCE WITH THE POLICY PROVISIONS. _ 218 Little River Road AUTHORIZED REPRESENTATIVE { Cotuit MA 02635 Daniel M.Crow ey,CPCU,Vice President—Residual Market—WCRIBMA 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and Logo are registered marks of ACORD I I ,yam ✓VlG6�d41?AI24%21116CG(�{L d�.V4GCL61CCC�lI�C�Q Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before theexpiration date. If found return,to: —`Registration Ex iration Office of Consumer Affairs and Business Regulation cj 16264Q1T� 04/02/2010 10 Park Plaza-Suite 5170 i1 Boston MA 02116 MATTHEW YORK I OTt ' MATTHEW YOR 29 Crestview Dry �`n E,Sandwich,MA'02537 ! � 1 } Undersecretary t valid withou ature ' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-097162 . -Construction Supervisor A �' MATTHEW G YORIC P.O.BOX 826 l : .:EAST SANDWICH MIa2537 Expiration f Commissioner 10106/2018 OF Ill om -.1-------------- .Y L- � �I�1• - —s -•--era.:..w:.w.rr - e1 ram.AwV T(- ILD 'L P49r SIDE View �MUM ` BLLEN U.uauuu I - ar.a�. r��w rnn.srtavr"•��eem�+uumam.we \ - ��.� w..s.w.r urn a►rr.na�.w��.s-w.wwwhr.�r .. 5rndrltA,MA 02563 sararr,srr..e+..o�-.-,�.,rw•a.r r.v.rrr - ..• ..+M w r�.sr rw.ua tr w.n.ms.ermr+•sw ao.vmw - ,r M 1 S*'�; , y .. " �"1• �i— Ncr.:rr—' . art Kiry. �i••i�-•G1 FA1�• 'All 0 ly�vy IYv 1<is 19< ISs �r - .Lei � � ! I'"" -- ---- - •,.{�.�•`.- , .y..o « � �vre•ejv ht..wu�. � ' pmN•0 � � y Y � f�RrNG Z r 1 e• _. pINi.ILrFM. O I ^ n•a..«o ! ins,«. �<II' � � sy'c Sf i �f+�r.ns } -EC (st♦:stq O Y �„ nrm u..� < I IN..a+L. pf/'1' wMV. •M•#r•1 irry i4' 1.�. p4. � s' ty-✓ y-a• i•. O!• .p M 1'4' dsni tl'f' N 1 � 1 1 J}�.,Ili.�J t t.e +•-P r� W'i Vi" 5 n �------'- I Nr..r r rxw _ • _ —� 1 I � I - r- ;-c _ I sue" -�,, � a -�— r-� i.�• fir. —tom_-?_4' pro �Y' 4 • h�COt 1D Ft l PtAr�t �zPa Es Via.=1'—O' F K F • .r ZEQOl1�f H M - -- n....o`�a.me�.....nee.....e...+.m.,a.e s,+.••mom.a - - S..d.l.h.Mk 02563 J It • y H41-LCS. to—orm 11 re 104 fv m.ol' wOo e,Irro�an kl,iq mk+na '" ^ ma,�.wilh,r nlrn B,CW-a DYt1C�OM IM Orgvt w�ro lrW rTW,rior lQ l,Y n - m.n�nn.0 ix uxa u,ez trartr,as ar�roan:V�ct�„rP.d �+1, mm—collar., .n,A,.�i.we..rw.a n.,•.rwv inr ec.,T.enre�v. '- ------ I �''r gf'raw!o.r t!eS a t'i�•'f��r,«,n; --------------- I ..e. -v I _ r r•� c F L - � — - gh ran.-- i I I� I I a.11 rrm 04 b.usL-*Wm- �� r�a j'D'•PY•ta 4Y..3Ro�Mi.L II Lyw uti•J'+/i•A'. •ltthtP-.� I p _ _ r a-it -I-I Lj— —BLLEN B:BSS000, C.P.B-0- PO Box 73S-10 Charles Street w'or 7-z- Sandwich,KA 02S63 (508)-833-1820 r MOTES: ine purchaser of tnese olans is resoonsible for Como IM08 wltn all local ouildina cones am ordrwxes. Nelther Allen B.Osgood or participating designers may to held responsible for site condltions,or th?use of these drawings during construction. Purchaser is responsible to verify all elements of these Dlans for desion,accuracy,and size Drior to actual construction. ZX12glow", •HLLEN ®. OSi60009 E.P.®.®.. PO Box 735 - 10 Charles Street ly Sandwich, MA 02563 ' LIoR� �yc�w"o� (508)-833-1820 O - � •-• �p(�Q-IU°QL-' .�" ,� �•?� I�I - _ `tuTE OFR -- �1�qN(rIIrTE� re'i/`� y0efYP•Gt..4 t.(nlbh FC i t • f�?h1E� T _�. i � U:. U'-1 �7 k Li'q� I OG h}h IUh- P-13 w'Gair PILER E.C_ ODD -f.{,�}y.iJl«� • P.P.^.'' ir ZN��t g 1-0- 1.�{.ufA �biu� F:L� 2xlGe Im11DL gPVIC- nr�, v1c� - ,/r°cf'(A L GL. ��'cfYP.Gt-•�W�> 5t'�L 6EAM r.!Io,c 3 3 rror�Es�Bs ` 2V f1(--r- r 4 C�fi1c•a rb W - j 1 4 W F +rl�-rGL 4> r4 H- �T i sE• _'.k-�•�X _ I, �'I i' I � I 1F+tcK-Erl <nr�£•L4..EOfi�S _ _ � ., _ 1r.'JI'L6riG•FI,tE't� e {.41,:=r�i. � G� V<1/f f'F-�CL'F�.F�•+-� Gr'-Aa 1 "t Icy"rriWr0 r:wW- F 'F r�YwA RS _ 1 f � � 3"H,' i VC, oln'K',� r,��, qAe 1 ` ' e 4. ._. F ,....� 11 .. .r..r i. .T _�. 1__ _ ._.,..{ ..r_. _LL !. -�� • , .- . �w �i R d .:,y ,f, , _!.. x 17 r OF r — ! ;_r I .._;-, -}- :•� 1_j_", ., .may ...-f- . . � - , .... . r w A-4 (��;�/ �-,�QrT/.c'y� .T,. �IT�4T/•�E �v�rr�aTiQ�J. a , I. . _ ,: . . , _ . . '_ f. : . . , . , .� ; /r ! -7`",U ;si~ E.C'�it/Eo SErai H7 , -�. t E�'E.2EtiG'E R.C: 4Al� .2 E4U E�JE i OF L4 7A tWVT /.t/ TyE ✓.Lo+aaP c L � t3AX7:=_ ae .VYE /XACc, _ 7A' ,l.A' /S !/ T BASE' Oit/Ai!/ i2EG/STE.2F� L.4�/O SU.el�6yb USED TO C✓�aZiT T iA III J Parcel 0 . . Permit#; a ; -- // Conservation Office(4th floor)(8:30- 9:30/1:00 2:00) t� � Date-Issued or''8, Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Feed_ Engineering Dept. (3rd floor) House# _ �tME Planning Dept.(1st floor/School Admin.Bldg.) • �� �' '+ RNSTARLE. Definitive n roved by Planning Board + f . 19 g!�o G�_ TOWN OF'BARNSs,TABLE,` °�Uf �, t Building•PermitApplication Qp a Project Street Address pG( Village cc `l) ` ti .Owner Klk' -o'-he-mot Ljecx-eSj;�' Address 1", 1374 do-/y/y- Ald 40 35 'Telephone -013 962 -33 2_3 ; -Permit Request 'btfJ�L-[.r®Cllr- 02 �z. ' P�T yy L F 2Z` x ZZ- a►2 Gf} ' lf.�?; eyo�ra✓ First Floor 1-23(d square feet Second Floor k 5 S 13 square feet Estimated Project Cost $ --5�,- �- f , Zoning District R�= Flood Plain A11A Water Protection Lot Size (©®, 500 Sq.VL5Z-. Grandfathered ? N/`,4 Zoning Board of Appeals Authorization A114- Recorded AIA Current Use tkovz- y.fi11 Proposed Use Nc- W AvPY6- Construction Type A)00,6 f=kfi-rwar Commercial Nl�4 Residential Dwelling Type: Single Family V/- Two Family Al* Multi-Family "(1/d Age of Existing Structure ► )e U13 Basement Type: Finished 'VIA ` Historic House NIA Unfinished Old King's Highway 'fnf Number of Baths 2 �Z No.of Bedrooms 3 Total Room Count(not including baths) 7 First Floor 3 Heat Type and Fuel T IT'A - GAS Central Air x)14- Fireplaces Garage: Detached Ail- Garage: Detached Structures: Pool �h Attached ,2 9AR 2Z X Z7` Barn None All Sheds Other Builder Information Name k -V E''Ot l'� �' Telephone Number 29 8 Address _10-)c 1-F>Lk0 License# © 1'2- "t SS _ ' e-, o ry' t R At ©zGa5 Home Improvement Contractor# /D /fo L15 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 3 - FOR OFFICIAL USE ONLY PERMIT NO. D "TE ISSUED M I P/PARCEL NO. - r _ r ADDRESS VILLAGE , OWNER , t DATE OF INSPECTION: — — FOUNDATION fi ` FRAME t ,. .. INSULATION FIREPLACEi ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL # FINAL BUILDING L I I DATE CLOSED OUT ' ASSOCIATION PLAN NO. I ,f t f , i s { a F i Town of Barnstable *Permit# e d-,201 F�Tres 6 months r m iss a date � Regulatory Servlces FeeRAWM , y� Mass`mI'E� Richard V.Scali,Director 039.Arm h Building Division A, MESS PENN Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 2 3 2016 www.town.barnstable.ma.us Office: 508-862-4038 TOWN OFF�a��a�$� 9 (� EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Imprint Map/parcel Number z�46 Property Address �l �e k tj c ` (2anL 174�' esidential Value of Work$ oj�.cx1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name 1,219r/rr!I �^r.' Telephone Number 5_0 1?--300 5 4801 Home Improvement Contractor License#(if applicable) ' � �'i�S� Email: Construction Supervisor's License#(if applicable) D 5 yy� r GW_ orkman's Compensation Insurance Chec one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Coom}pensation Insurance Insurance Company Name ' / /to G/Y�-5 Workman's Comp.Policy# . �-�G _ 236AJ 3/-- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request eck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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 required. C SIGNATURE` S Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC 06/20/16 owl The Cezumormeakh of Marsadt?.rrtsdts Dewtmeut cff1hd=hia1Accidenty 1Offikecf 600 Washfize in Street ` Boston,MA 02111 a - tvrvIV.t aMgMldia Workers' Gmipensa#iffn I ce AffidiA B4ilde�-dCont ractGrs/ElectdcianslPhunhers APPEcaut Informatku Please Pr n Ni= C :c i Ci,/St..tel 6U d Ph...,- Are YOU an employer?t .ckthe appropriate b T of ect r L❑ I ant a 1 with 4.'❑I am a general contractor and I Yl� a °] { . �P� ° 6_ ❑New oonstxuctiorx- , oyeez(full andfor part-time).* have hired the sub•-captors fisted au the attached sheet 7. ❑RPox+ndeliag 2. I am a sale groprietmr arpastaer- t sh£p and have no employees 2kese sub-co atractors have 9- ❑Demolition fix me in eraFtlayees amdhave Wodcers' c�ng �capacity- 1 9. .❑Building addition [No iwodnn s'camp_fimmance COMP-insurance r ] 5. ❑ We area corporation and its 10-❑Electrical repairs or a&rld ions 3_❑ I am a homeowner doing all Work � o$cers have eYa* ised their 1L❑Plnnbingrepairs or adclitions of on per MGL myself[No work='comp- . � e have mo 13.❑Roof'repairs insurance required-]i i. c.F52,§ {4}, employees.[No i ads' 13_❑Other camp.insurance -] •Axpapg&csatChatcbeftbaxffl—st also Mooitfiesecbioabdow--&uvdnde!rvi 1eiecmmPeum +=paTs3riu5M=mL ��ameoaraen rho sabmit dtis�daeit i+�r�R dozy e�chin;sg srad�smd eheal�e uumd��rt+rs�SuTo-mic a nem affiaa�mdicatino saw fC ffist c'hk7r t is box mast aftriv as additimal dtad dwwlug the—of the sob-cam and Ole wbethet ar natthnse w ities hsm ampbyees.Iftbem -c==dashave empTa s,they=srptvuide&e!r wodEe&vmp.pGUu-1 m jam an euipioyer flint is pros id&g it orkers'cou perisrdian i?rssirat wfbr my em.V&yem Below is thapaUcy and jobs szfe irz,jormatibm - Ia=mince Company Names. Po-ficy 41 or^pelf--ins.Iio_ e A& S , 0 2 S 4 A/ 3 1 F—T=tiouDate. 2 Job Site A,ddre V4' e ttfy-1(#I CitylState 2l p: Attach a�wpy ofthe warkers'compensatioapoRcl declaration page(showing the policy number and e=piration date). FaRnre to semen coverage as required under Sw iaa 25A of MGL c�157 can lead to the imposition of criminal penalties of a fine up to$UOD:00 inWor orie=geirimpusoumenf,as well as rim penalties is the fb=of a STOP WORK O DER-and a fame of up#r -00 a dap aggainst the viohdar. Be adsised that a copy of this statement way be faded to the Office.of Isves#gations ofttte DL4€or ibsumace coverage verifrcafim I do h e nrlyegE W ander des pains andpmahiees ofperjury ihatfha info rm a dwi pm-i&d a bMW 15 h7W and carrect i � Date: 0?3 J Phase TO o — 02kid ass only. Do net wri&in this ama,itr be campfeted by city srtown ojoi al Cky or Town: Ferrudt Ucense 9 I A &WrftY(carte one): . L Bamd of Health 3.BuMiag Depm meat 3.Cltyfrowit aerk 4.Electrical Fir S.PIrmbing Inspecter 6.Other Coact Person Phone#: 6 E h&&sar]r mft Ge:beaal Laws chaff 152 regtmrs all employers'to Xavide WMTM 'compensation fur them=Ac�". parmza=vw this stye,an enphyee is of anothcrunder any contract ofhna, aV express or iuplied,oral or writ" An enpkyer is defmtd as"am mdiQidnal,pasbzersbip,assoc�ian,corporation or other legal eatiL or airy two or more of the foregoing=apged is aJoint Vie,and inchrding the legal repzeseafafrves of a.deceased employer,or the, receiver or t UStee of an mdividaal,par ship,associafion or ofheSlegal entity,employing employees. However the ownet of a.dwelling house having not mare tbaa$tree apmimeots and who resides therein,or the occmpamt of the - dwmMng house of mxd er who employs persons to do mafi eamm,canstrwtion or repair wow on such dwelling house or on the grounds or building appurien ant therein shall notbmanse of such employment be deemed to be an employer-" MGL chapter 152,§25C(6)also stairs that¢everystate or local licensing agency shallwiEhhold the issuance or renewal of a license or permit to operate a business or to construct bufldb:gs io the commonwealth for auy applicantwho has not produced acceptable evidence of compliance whli the bnmrance.coverage required:" Additionally,M(H chapter 152,§25CM stLtns-N=ffierthe ca mncmwealthnor;�ny ofifss political subdivisions shall cuter iotD any contract for the performance ofpublic work until acceptable evidence of compliance with$ze msm2ce.- requn ements of this chapter have been p=e nfe or���d to the C MthO .tyf, 4 A PPIican-t-s Please fill out the worlo'as'compensation affidavit completely,by Ong$e bones flat apply to your siination anp,if necessary,supply sob-contractor(s)names), addresses)and pl=e rr— e(s) along with their certificate(s) of s wrEno Io ofEer fhan.the ;�crn�ce_ Limited Liability Companies(LLC)or LimitedLiabRity�Parfne�bip (LIP). e�p yew members or p are not required to cagy works&compensation iusoxancz- If an LLC or LLP does have employeas,apolicyisrmjah-ed. Beadvisedthatfhisaffda:vrtmaybesnbmiCindtotheDeparfmcutofTndustrial Accidents for conf mn,6oa of i ce coverage:. Also be sure to sign and date tare afu daYit The affidavit should be retied to!he city or town that the applicaf;.on for the permit or license is being requested,not the Department of badastrial t+,r-f-; e+fie_ Should you have any gnzstians regarding the law or if you are regcared to obtam a wow' compensation policy,please call the:Department at the amber listed below: Self-fiMnrd eonpanies should eu,`er their self ins�ce Iicrose.mmzber on the appropdade line City ar Town Officials t Please be sine that the affidavit is co3nple4a end.priardlegibly. The Depar(menthas provided a space at the botbom of the affidavit for you to fill out in the event the Office of 3nves$gations has to cozdact you.regarding the applicant- Please b e sure to f illia the petmtllicease m— er which will be used as a m5re ace amber. Im-addition,an applicant that must submit muhiple pe�licease applir aiicns in.any given year,need only submit one affidavit indicating curt p olicy infu ►ation(if necessary)Emd under`Job bite A.ddrm&*the applicant should write"all locations in (city- or: A copy of the-affidavit that has been.officially stamped or ma6ced by the city or to maybe provided to the applicant as#oo-fthat a valid affidavit is on file for firfm permits or licenses Anew affidavitminA be frIled oitf each yew.Whew a home owner or citizen is obtaining a license or pmmitnotrelated to any bnsin=or commercial (Le.a dog license or permit to bran leaves etr-.)said person is NOT regahrd to complete fh;s affidavit The Of=of Ines would him to ti>ank you is advance for your cooperation and should you.have any questions, please do not hesitate to give us a call The I?eparimert's address,telephone and faxnu>abea: C--o rf tbE of llmclhn-se-tts . IIegat�ae�c}f did Acc�c�ts face of Inve&tkkfio= B MA 0�111 Tel.#617' -4 =ft4-06 car 1477-MA 9AFF- Fax 4 617 727 7749 WW Revised 4-24-07 �� I MID CAPE ROOFING 11 RUSSO ROAD WEST YARMOUTH, MA 02673 508-775-3799/508-385-8801 Barry Merrill & Paul Merrill Job Site Address 1 Mailing Address Name: ��Tl y Name: Street: 9/ �e �" r- Street: City: �' 4- City: Telephone: Telephone: We hereby propose to furnish all the materials and all the labor necessary for the completion of: roof replacement of the dwelling at the above address. .Mid Cape Roofing proposed to remove and dispose of the existing roof. The roof will be replaced with CertainTeed Landmark shingles. Aluminum drip edge will be.installed alongthe gutter line. Ice&Water Shield installed on bottom edges to° protect ice back-up. 15 pound felt paper will also be applied. The shingles will be installed using 1% inch roofing nails. New pipe vent collars will be installed: Ridge vent will be installed along the ridgeline of the roof to provide proper venting'of the attic space. Mid Cape Roofing'guarantees the workmanship for a period of 10 years. All walls and landscaping will.be'protected from damage;'the property will be raked and cleaned of all'debris.. All material is guaranteed to be as specified and the above work is to be performed in accordance with specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: 93-6.00-All discounts have been applied. Payment made as follows: Deposit of: 00 the day job is started and remainder paid on completion. Any alteration or deviation from the above specifications involving extra costs will become an additional charge over and above the estimate and will be discussed with the homeowner. Respectively Submitted by Mid Cape Roofing NOTE: This proposal may be withdrawn by Mid Cape Roofing if not accepted within 30 days. Acceptance of Proposal The above prices, specifications and conditions are satisfactory and`are hereby accepted. Mid Cape Roofing is hereby authorized'to perform work as specified with payments made as outlined above. Accepted: lam` a �•�, ;x �� us-ru �- I f Yan*rner Aff I T CON RAC��OR rt l C?1EMEN. Type tien:: :i61458 Partners." ' ;fra f- �pira 1C.60 = �, > 4 CAP � r ', t NERRI I ` Y i ' u$SG RD nders� l� 0- 73 d ' MOUTFI,MA , R _ t r1 �• t""bi`'r6i v)ri valid for individui ,. .icense.j, tja�io edate. Iffoued return-tc;: _ram before t` *F me, Affairs and Business 12e9ulati%,j ! Oil a f,inS� Saito 5170 Boston, p211i i P{(-L.L r* Notlwithoutsignature ---- -- � r- Massachusetts Department of Public Safety Ivif Board of Building Regulations and Standards License: CS-054428 Construction Supervisor BARRY B MERRILL 'f i �i 312 SKUNNKETT RD CENTERVILLE MA 02632.7;;',; Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain ess than 35,000 cubic feet(991 cubic meters)of ^^^ Expiration: inclosed space. Commissioner 05/21/2018 t i Failure to possess a current edition of the Massachusetts hate Building Code is cause for revocation of this license. IPS Licensing information visit: WWW.MASS.GOV/DPS TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY ( PARCEL ID 054 006. 004 GEOBASE ID 42566 ADDRESS 218 LITTLE RIVER ROAD PHONE (508)862-3323 COTUIT, MA ZIP 02635- LOT 8 BLOCK LOT SIZE IDBA DEVELOPMENT DISTRICT CT PERMIT 17697 DESCRIPTION BLDG PMT #05025 PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: Im BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE P:. BTABI.E. 039. OWNER LECCESE, MIKE & DEBRAFG A ADDRESS P.O.BOX'-1374 BYILI�.[ G IVIS COTUIT, MA /1111 DATE ISSUED 09/06/1996 EXPIRATION DATE TOWN OF. :BARNSTA1311 BUILDING PERMIT 2 ROB 99- :ID`,.,,.,`4 566 A PARCEL ID Ob4 OOC 4' G ADDRESS 218 r T ITTLER VER" ROAD ZIP 02635--- COTUTT, RA DBA DISTRICT (7, WT 8 BLOCK E. DEVELOPMENT 'LLING -179) PERMIT 15025 DESCRIPTION SINGLE FAM I L" DWE P14�SEW_PMT_#96 BT 1ZM I T TYPE BUILD LE NEWRESIDENT TITLE IIAL LDG Department of Health, Safety CONTRACTORS: 1E V E Rrr, W I L L I AM T_ and d Environmental Services $481-49 TOTAL FRES. $.00 BAND CONSTRI.IC77TON COST. $155 3201.0.0 P 1.01 -SINGLE RAM 14 0,ME DETACHO, 1 ...PRIVATE 03 DEBPA. OWNIER LECCESr_., MIKE & ADDRESS P.O.BOX 1274 :BUILD ION BLUILI)ING COTUIT, MA . ... .. -7 DATE 18 SURD 05/08/199'6 FYP-f RATION. DATE., PERMANENTLY.EN- THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR TED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR EN- CROACHMENTS ON PUBLIC PROPERTY.NOT SPECIFICALLY PERMIT ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS. PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED lit FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED.ON JOB AND WHERE APPLICABLE, SEPARATE THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU_ PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 3.INSULATION. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ov,(,I .671 16. Tat" 0 'Aar 2 2 L IWGINEERINgPEPA ENT HEATING INSPECTION APPROVALS 3 0(1 BOARD 2 '1 71(. SITEPLAN REVIEW APPROVAL OTHER: g7 z �6T z Fo KInN !2tm WORK SHALL NO Y PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS,NOT STARTED WITHIN SIX CARD CAN:BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. ` The Commonwealth of Massachusetts Department of Industrial Accidents oxceol/oyesfflodons 600 Washinqton Street Boston.Mass. 02111 `- Workers' Compensation Insurance.ARdavit -77 Am--c �nr m Mi'nn•_.nt m _ Please M NT'le bl� •�•�r'•' loc.tion• 1?0X `c3y t �f''✓ d �O 6 L) ( tom... tl,�A phone#vrc7R 7 ®9 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. comply nime• -- . address• cih• phone#• insuranceco. , 11i li'# .... I.i Ind: I am a a roprieto general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following wo •ers' compensation polices: comp,Bgl n•tmc srQUtJ f )4L,rn 46*��a- address• ®2. phone#• J®�— "Z�7� nsurnnee co. ,l�L>�O,JS kU FO/Q L i'=...."'�:. w,•- -•- _ • �+rmu:..•o:.:.•x vs�s-^rr-:•;^7'�e'pr.."5'Fb•,v•. ., _ ��7YEA�J►ei�i•�=7t:?*rs�e�?F,�4?^".9_s'�4"�'"•�S �cimpanvnamc• 1 i�� ��- adslr_ess / -2— /,/Wez— cit 5 1,ui C-(4 14W ®2,�6 E phone m—'Ok 8� in------ce�n`�lr�/1 �+�.el/�L (/N(�®N� ►�[^� �K-6riL�.�'-�IlpttcY#"/� J 7 _ :Atiachadditional'sheitifiieeessa �... y 7<-.+�^+"± '?Q;�`.c. :"<►`'. ��.,. " Failure to secure coverage as required under Section 25A of hIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OILce of Investigations of the DIA for coverage verification. I do herebt•eertifj•tint/•r the•pants and pens! ' o pe 'u a infornwtion provided above is true co d Signature �-- Print name VJ t.L•-l^•t ,�-o"i 'C�- C�t VT et Phone# official use oniv do not write in this area to be completed by city or town official • i�11',' city or torn. permit/license# tnBuilding Department C3Ltcensing Board^= ` O check if immediate response is required OSelectmen's Office �Ilealth Department contact person: phone!{; nOther r Ires-iised 3 95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employces: As quoted from the "law", an empliti ee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emplm+er is defined as an individual, partnership, association. corporation or other :::gal entity, or any two or more of tine foregoing engaged in a joint enterprise, and including;the legal representatives of a deceased emplover, 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; grouse or on the grounds or building;appurtenant thereto shall riot because of such employment be deemed to be an employer. MGL chap1er452 section 25 also states that even,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. �...�r.�+.e--�• • ^w.`^�'!.�!: .c.. y, ;fir....ya.p•°o:. ::. �,...� ` :YMs .,p�)4_,.. .;,. •ka'. - , Applicants Please fill in the workers' compensation affidavit completely, by checking;the box that applies to your situation and supplying company names. address and phone numbers 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 affrdav it. 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. .......,w.. .wraar�ifi^Fs�r" �..,,..a,•�•e�w•wrr!a.!`.q _. 1..,e� ii �,r.. rN��".r�'i J�!Ln {� ,� .,y: 's`'...M :;�. .. .... 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 fill in 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 an),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 Washinaton Street -- Boston,Z. 02111 fax#: (617) 727-7749 •, phone#: (617) 7274900 ext. 406, 409 or 375 44 u..o�c..fr� 0 �i���-i.�l.lv�G.tVI.•."75.. �!4TVl I � 4EET NO f'...I.OF.. CHKD. BY ..........DATE...----- ---- ...6T.15 .......LJf..fR�L-....-�PIJAIP,C:r.((?X4 JOB NO... .IG�'1� Eo ;._v�til .. .>✓>✓ru.�rro TiH� R.. Ft �1r1L�_....- Z . . 4 12 X 5� � >PR4 ' zZ - (o fit-) L�P Floo J o aL, coNr44tlo�:, I i i I I �A 5 or 2- V/ B�.T CAP Gam. c'i1^�tir�lv�t1�.> vlRt��, �o0'ril.! !• s7 _tK--N� i- sr L JID e*5 S fM A t , r4 for .,;A' owT> rv:7- io1 i&nve Ow Tc' 510- hsTtl A 307 (vgi.v.) � I�'L•" , cPA ylo►-4 - ffPa x 4` Mir►. 10 5!1 TJ T-P' of- .57e=- - r taj-STn-tL.T 1 orl Ar-J D HA 5"S LA`T`E:�T b Dt Tl o^4 IPEQvl" Au- Wei-�b s -tom r> r,-- ?o SA Gh-P 'OzDIIJAiYc ALA A-eZH 1T1b(T"L �P� Assq D Fi ,D- 3 ,/ff4F-f WHP,1�8 MICHELEC. CyG MICHELE C . TUDOR, P. E . o NoU3407774 p4 ConsultingStructural Engineer STRUCTURAL o 1� �o �EGISTERt` � ' 4/ [VAL E 6 CJ 123 Cottonwood Lone•.CenterAle.Mosmhusetts 02632•(5W)771-7601 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im ^�C- C DATA I 1 170 Safe Loadr (Beams) Safe Loads(Beams) i i 1 �` 1 I is W SHAPES (WIDE FLANGE BEAMS), Cont'd '.W SHAPES (WIDE FLANGE BEAMS), Cont'd Allowable .Uniform Loads in KIPS ( Allowable Uniform Loads in KIPS For Beams Laterally Supported i For Beams Laterally Supported 285 ' - I i, Span ,W16 x Defl. ! Span W14 x Den. ' in in in in Feet 96 88 8 71 64 58 50 45 40 36 31 26 Inches Feet 53 48 43 38 34 .*30 26 22 Inches 7 ...... ...... ...... ..... 179 162 14 129 1 88 0.8 ' 1 __ 125 111 �5 t 0.09 _.. 8 ZU 228 � UZ 162 14i 113 94 77 0.10 �. 8 ]]5p 109 97 83 70 58 0.11 , v !I 9 228 TO 185 168 144 129 115 100 84 68 0.13 9 138 111 97 86 74 62 51 0.14 10 253 236 205 186 166 151 129 116 103 90 76 61 0.16 11 241 220 186 169 151 137 118 105 94 82 69 56 0.19 10 124 112 100 88 78 6b 56 460.18 i f12 221 201 171 155 139 126 108 97 86 75 63 51 0.22 I I1 113 102 91 80 71 60 51 42 0.21 i� 13 204 186 158 143 128 116• 99 89 80 70 58 47 0.26 12 1 13 96 96 94 84 73 65 55 47 39/86 77 67 60 51 43 0.35 0.260 .30 .: 14 190 173 146 133 119 108 92 83 74 65 54 44 0.30 f I 15 177 161 137 124 Ill 101 85 77 69 60 50 41 0.35 14 89 80 72 63 56 47 40 33 \., 0.35 f i 16 166 151 128 116 104 94 81 73 65 57 47 38 0.40 15 83 75 67 58 52 44 37 31 0.40 17 156 142 120 109 98 89 76 68 61 53 44 36 0.45 15 78 70 63 55 49 41 35 29 0.45 18 148 134 114 103 92 84 72 64 57 50 42 34 0.50 17 73 65 59 51 46 39 33 27 0.51 19 140 127 108 . 98 88 79 68 61 54 48 40 32 0.56 18 69 62 55 49 43 37 31 26 0.57 �• �._ 20 133 121 102 93 83 76 65 58 52 45 38 31 0.62 19 66 59 53 46 41 35 30 'Id 0.64 ; 21 126 115 98 88 79 72 62 55 49 43 36 29 0.68 22 121 110 93 84 60.7520 62 55 SO 44 39 ® 28 23= 0.71 7 69 59 53 '47 41 34 28 w, (,( 21 59 53 48 42 37 '32 27 22 0.78 ( 23 115 105 89 81 72 G6 56 50 45 39 33 27 0.82 22 57 51 46 40 35' 30 26 21 0 = k 24 111 101 85' 77 69 63 54 48 43 �-3$ 31w 26 �0.89 i. 23 54 49' 44' 38 34 21 24 20 0.9 - ( 25 '106 97 82 74 67 60 52 46 41 366 30 25" 0.97 24 - '52 47 42 36 92 •idr l 2.3 .[19 1.02 s 26 102 93 79 71 •64 58 50 45 40 35 29 24•1.05 27 98 89 76 69 62 56 48 43 38 33 28 23 1.13 I; 25 50 45 40 35 31 27' 22- 18 1.11Ar:_; 28 95 86 73 66 59 54 - 46 41 37 32 27 22 1.22 1 26. 43 39 34 7 25 22• 18 1.20 s<P J I 29 92 83 71 64 57 52 45 40 36 31 26 21 1.31 27 46 -42 37. 32 23 2S 21- 17 1.29', q. `d Z 30 89 81 68 62 55 50 43 39 34 30 20 1.40. 28. 44 40 35 32. 28 24 17 1.39 31 86 78 66 60 54 49 2 /37 33 29 20 1.49 2q 43 35 30 27 23� T9 I6 1.49 w r 32 83 76 64 58 52 47•CAS 13356/ 32 28 24 19 1.59 y 30 41 33 29 26 22, 19 15 1.60 ! 33 80 73 62 56 50 46 39 31 '27 23 19 1.69 (23.7J e f 34 78 71 60 55 49 44 38 34 30 27 22 18 1.79 - i Span W12 x Defl -- f Span W14 x Defl• In in -v tt in in I Feet 85 79 •72 '65 58 53 50 45 40 Inches p; 1 i Feet 119 Ill '103 '95 '87 84 78 74 68 61 Inches _ -- - - -_ _ ]��Q1 � 7 13 I188 ]� 0.10 r! „ 10 _ - _.... 165 148 0.18 i B -- -- -_ -- -j -����-�� 115 103 'E 0.17 11 85 1 5 163 150 134 0.21 10 7 JU 1Q 3 125 11i 104 93 83 0.21 ( 7 �__y _ �. 12 240 55 �0� ;9Q 1I1 M N6 149 137 123 0 26 11 1�J6 156 140 125 114 103 94 85 75 0.25 : r 13 233 217 199 182 164 161 149 138 127 113 0.30 12 155 143 128 114 104 94 86 78 69 0.30 F 1: 14 216 201 185 169 153 150 138 128 118 105 0.35 1 t I 15 202 188 173 157 142 140 129 119 110 98 0.40 13 143 132 �118 106 96 87 80 72 64 0.3514 133 122 •110 98 89 81 74 67 59 0.41 R 16 189 176 162 148 133 131 121 112 103 92 0.45 15 124 114 103 91 83 75 69 62 55 0.41 17 178 166 152 139 126 123 114 105 97 87 0.51 (, : 18 168 156 144 131 119 116 108 100 92 82 0.57 16 116 107 96 86 78 71 65 58 52 0.53 19 159 148 136 124 112 110 102 94 87 78 0.64 17 109 101 91 81 74 67 61 55 49 0.60 r 20 151 141 129 118 107 105 97 90 82 74 0.71 , 18 103 95 85 76 69 63 58 52 46 0.67 21 144 134 123 172 102 100 92 85 78 70 0.78 19 98 90 81 72 66 60 54 49 44 0.75 k 22 137 128 118 107 97 95 88 81 75 67 0.86 20 93 86 77 69 62 57 52 47 42 0.83 23 131 122 113 103 93 91 84 78 72 64 0.94 21 88 82 73 65 60 54 49 44 40 0.91 I� 24 126 117 108 98 89 87 81 75 69 61 1.02 ' �22 84 78 70 . 62 57` 51 47 42 38 1.00 I 25 121 113 104 94 85 84 77 72 66 59 1.11 i' 23 81 74 67 60 54- 49 45 40 36 1.09 �I { 26 116 108 100 91 82 81 74 69 63 57 1.20 24 77 71 64 57 52 47 39. 3y 1.19 27 112 104 96 87 79 78 72 66 61 55 1.29 25 74 68 62 55 50 45 41 371. M 1.29 u c 28 108 101 92 84 76 75 69 64 59 53 1.39 I 26. 71 66 59 53y- 29 104 .97 89 81' 74 72 67 62 57 51 1. �^ 1( 27 69 63 57 -51. 30 101 94 86 79 71 70 65 60 55 49 1.6060, ! 28 66 61 55 =' 31 98 91 84 76 69r 29 64 59 53 32 95 88 81 74 67 _._ _ _ - 30 62 57 51 ( 33 92 85 78 72 65 _._ _._ _._ __ __ 31 60 55 I 34 89 83 76 69 __ 32 58 54 35 86 80 74 67 _._ ___ _._ __ - -.- ] 33 56 52 zj 36 84 78 7234 55 80 74 68 - 39 53 _r17 \ (23.7) (23.4) (23.2) ...... _� -._ (23.4) \ s Nate: Load above heavy line is limited-by maximum allowable web shear. y heavy line is limited by maximum allowable web shear. i 'Tabulated loads for this shape ay computed with the allowable stress (ksi) shown ? 'j \this shape are computed with the allowable stress (ksi) shown in �e Note: 'gym of the allowable load column. •� parentheses at the bottom of the allowable load column. x.. •�"-� Tltc• CunrntunN•calt/r of AtassacliuSells • :� '�.b '' ' Department of Industrial Accidems aw i t 61111 Mrxhinglon Sired • :; #" Bbsion.Maw•02111 �-� Workers' Compensation insurance-AtRdavit _ :A icnnt a{orm••r 1"cationion"_—. PIe�Se pRilV'i",e t�ly ••:� O �LTT 1_E �tQa-P-- �v' `� - cttt• (�o T"C'1 T "hone 1! �—�Zg'7gD 9 13 1 am a homeowner performing all work:myself. I am a sole proprietor and have no one working in any capacity lam an employer providing workers compensation for my employees working on this job. address- ------- iniurnnee en, nnfies•# ® l.arn a o e ro netor genera!contractor,or homeowner(circle one)and have hired the contractors listed below who h the following workers' compensation polices: v comn•rm n•rmc add ress ® � , Y .city.: f){.� c�.;� D �S "hone#• SOBS " 7�9 �c•rr�rr•"con ` ���`� �-w 1 :'A•r r• noli # 6 A)o 7� �� company e• nddress- t, "hone#• c urnnee # liach additional'sheet ifoee ..... —•� - _ -ter. �.,z Failure to secure coverage as required under Section 3A of AWL 152 can lead to the Imposrgon of ertmroat penalties of a fine up to 51300A0 aad/, une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a one ofS100.00 a day agaiost me. I understand that cop}•of this statement may be forwarded to the Otnce of Investigations of the DIA for coverage veritkatioa. I do ltenbr cettif}}•and• t/ie pains and penaltl op at the iajornwtioa provided above is true correct Sienature a� 71f. Print name rM. T• C�' Lam'1 J'htme# SOB—J128 ®7909 Frimmedlate e only do not write in Ibis area to be completed by city or two otliciai permitAteeme q riBuildiug Department or town* (3L[censing Board response is required QSeleetmea's OBicc �tiealth Department phone#; m0tber_.� rson• f •Information and Instructions - t Massachusetts Gencral Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for the employees. As quoted from the "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 employ►er is defined as an individual, partnership, association, corporation or other :-gal entity. or any two or mo: the foregoink:engaged in a joint enterprise,and including the legal representatives of a deceased cmplover, or the receiver or trustee of an individual , partnership,association or other legal entity, employing employees. However tl' 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 he or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 1'52 section 25 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 common+•ealtb 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 evidence of compliance with the insurance requirements of this chapter performance of public wort: until acceptable been presented to the contracting authority. � '.. ,._.+_++Yw Yia`. .Ji!� '�•' r..; •.� y. yam.:r.::NY►:n:�.w�t�'•�; 'Y.':•.;.}'- .a. . . .h�.1T:. ':�a.� .�. •J�.,-..„K•1:�•.1:1 r•�.••ir. w»� `��11•r•• .w :11r 4rt,.� •Y•�::..�1,. :l• Applicants c: - Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names address and phone numbers 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 require to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pic y e used as a reference number. The affidavits may be returned be sure to fill in the permit/license number which will b • 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 questie please do not hesitate to give us a call. :. � i.�� �:.ii+%•..wad f .a-t -:ti..: 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 fax#: (617) 727-7749 �.... I/rlfn __- AAZ Ann -- ?7r DEPARTMENT OF PUBLIC SAFETY 48311 ONE ASHBURTON PLACE , RM 1301 MA 02108-1618 BOSTON , CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Restricted To: 00 WILLIAM T EVERITT Detach bottom, fold , sign on M t; POB% 1340 V back, and laminate license card. COTUIT MA 02635 .,Kee to for receipt and change - p p p g - of address notification. ,�,� ✓/ae �oo���aoneueaC�� a�✓�lizaaac�uoeC� � _ Restricted To, 0048311 ' L C I' DEPARTMENT OF PUB SAFETY I S � CONSTRUCTION SUPERVISOR LICENSE 00 - Hone :. Number: Expires: 1G - 1 & 2 Family Homes f Restricted To: 00 Failure to possess a current edition of the ! Massachusetts State Buiilding Code WILLIAM T EVERITT is cause for revocation of this license. POB% 1340 COTUIT, MA 02635 '.