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0552 MAIN STREET (COTUIT)
� _ `5..�� j���-era/ S� �� � i l yIA t rs.�� �.��,� S� Town of Barnstable Bli11C1I1 . # ; .� g P.ostThis°Card So That rt is U�s�ble,Fro,,m theStreet Approved Plans Must,be Retained on Job andahis Card Mustsbe Kept RARNf3TAB3i.:• .rr .�� ,��3 µ ,:, xk a, '- z. s. M P,�ostei UntilFinal Inspection Has 13eenMade' r; � ; r i619. �A :. ' mow,. -� E ,y a ;. of• ., , - ° W,heiea Certificate of Occu ancisRe, u�red;such Bu�ldmshallNotbe Occupied until aF�nal lnspectionhasbeen made Permit Permit No. B-19-2050 Applicant Name: DINARDO,JEFFREY FRANK&APSE, MARIA IDA Approvals Date Issued: 06/24/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 12/24/2019 Foundation: Location: 552 MAIN STREET(COTUIT),COTUIT Map/Lot: 037 015 Zoning District: RF Sheathing: f •, » Owner on Record: DINARDO,JEFFREY FRANK&APSE,MARIA 4Contractor Name Framing: 1 Address: 552 MAIN STREET i' Contractor license: 2 as - "� Est P COTUIT, MA 02635 ro JectCost: $0.00 Chimney: £ Permit Fee: Description: 5x4 Shed $35.00 Insulation: Fee Paid: S 35.00 Project Review Req: Date 6/24/2019 Final: . 01 Plumbing/Gas i ry JM Rough Plumbing: Building Official s<:.. Final Plumbing: This permit shall be deemed abandoned and invalid unless the work au.thonzed by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved applica 0 and the approved construction documents$for:which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and strures shalt be in with the local zoning by-laws\and codes.. uct This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Offic lai s a p ovided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work r � Service: 1.Foundation or Footing ' �. Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is`installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Pers ing with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: ' Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable Building Post This�Card-,So That�rtrs:V,isible From°�the�Street-:A , .,;roved Plans Must;be,Retamedon J.ob andth�s,Card Must be,Ke t� ��� - -x SAR*WABM :R Mom. �PostedUnt�I�Finalrt ln'spection Has-Been=Made � � ;� � � � ,���� � x.: � ,� � ° °Where�aF.Certificateof�Occu .anc :ISRe ured�such 8uldm shall�Not�be4'Occu red�<unttl a Final�lns;,eetlo,n�has�beenmade�� 1 ei jjllt - AI Permit NO. B-19-2050 Applicant Name: DINARDO,JEFFREY FRANK&APSE, MARIA IDA Approvals Date Issued: 06/24/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Dater 12/24/2019 Foundation: Location: 552 MAIN STREET(COTUIT),COTUIT Map/Lot: 037-015 Zoning District: RF Sheathing: Owner on Record: DINARDO,JEFFREY FRANK&APSE, MARIA Contractor.Name 4 Framing: 1 Address: 552 MAIN STREET Contractor License A z3� 2 COTUIT, MA 02635 :. Est Project Cost: $0.00 Chimney: Description: 5x4 Shed 4 Perrnrt Fee: $35.00 ,. <. Insulation: Fee Paid;- $35.00 Project Review Req: Date 6/24/2019 Final: � zXu Plumbing/Gas , F • ., e�l3 ,- Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed;bythis permit is commenced within six months-a#ter issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zonirig by-laws:and codes. This permit shall be displayed in a location clearly visible from access street or road an d shall be maintained open for public inspec tion for the entire duration of the Final Gas: work until the completion of the same. F k Electrical The Certificate of Occupancy will not be issued until all applicable signatus b rey the B, a i&rire Officials are,provided on this permit. Minimum of Five Call Inspections Required for All Construction Work Q:' s Service: , 1.Foundation or Footing Rou h: 2.Sheathing Inspection g � fir. - 3.All Fireplaces must be inspected at the throat level before firest flue linin�.�g is installed. 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Pers ing with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final ' 1<111 11� Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable �pFTHETo Building.Department Services . °s Brian Florence,CBO * sAtuvsrABLE, Building Commissioner v� 1 MASS.. ,0� 200 Main Street, Hyannis,MA 02601 ATF�Mp'�A www.town.barnstable.ma.us Office: 508-862-4038 Fag: 508 7906230 PERMIT# Iq 60 FEE: $35.00 a SHED REGISTRATION RESIDENTIAL ONLY ry M 200 square feet or less S a / IN S-r/L�FT rL) 7 Location of shed(address) Village Property owner's name Telephone.number Size of Shed Map/Parcel# ~ E-Mail_7y(W 5"bi ly q-R 90—0 F3/6/v <o/y w 17, zo/y Signa�K Date Hyannis Main Street Waterfront Historic District? /V° Old King's Highway Historic District Commission jurisdiction? /1�a You must file with Old King's Highway Conservation Commission(signature is required) Al/V Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION . FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg O REV:08/6/17 --�. _ - • _ s _ tom..—.._..-__.. ... �.a�-.•..v•..ram µrr ... - ,.. f LOT 2 c CB FND CB S32'44'25"E FND / 122.28' F L , 12.1' d r_1 , 1 17,i LJ APPROXIMATE II-1 p v, -= LOCATION OF L J : EXISTING SEPTIC z� I SYSTEM BASED ON r m G TITLE 5 INSPECTION I I REPORT AS—BUILT L J W DATED 10/12/13 26.5 Z Z ao 0 CU . W W - z I Q r _ p N J i!� o DECK' SCREENED o rn N I , PORCH . to as .- �. —— z In EXISTING 36:8 -.DWELLING n� #552. 38.9' y LOT 1 CHIMNEY. 20I S.F.` o M :ai C6 'PORCH N N 120.83' ' CB N32'45'20"W MD C8 MAIN STREET FND ( PUBLIC 40 FT. WIDE 1"E r°�� Town of Barnstable d BAIMSTABLF, Building Department= 200 Main Street + s6 9. Hyannis, MA 02601 � �+�q �'°TED MAC 6 Tel. (508) 862-4038 - Certificate Of Occupancy Permit Number: . B-17-4045 CO Issue Date: 6/25/2018 Parcel ID: 037-015 Zoning Classification: RF Location: 552 MAIN STREET (COTUIT), COTUIT Proposed Use: Name of Tenant: Sprinklers Provided: Gen Contractor: A I ENTERPRISES INC. Permit Type: Residential -Single Family Type of Construction: A Design Occupant Load: 0 Comments: Living room,Sleeping Loft and full Bath Building Official Date: A Certificate of Occupancy is Required Prior to Occupying Space Building Code: 780 CMR 8th Edition r" d TOWN OF BARNSTABLE BUILDING PLRMIT•APPLICATION 44 Map Parcel � Application # 1 I Health Division Date Issued , Conservation Division w Applications Planning Dept. -Permit Fee Date Definitive Plan Approved by Planning Board a r gvI1- Historic - OKH _ Preservation/ Hyannis Project Street Address � Village 67/-viT Owner ,/ 4<6,V Address � AJ& 0177P Telephone f` ' 7/ ®!�� Permit Request ✓ mac- A 4-t 0 • ,rr- /'© S-754Y 4 �4$ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new �� Zoning District. Flood Plain Groundwater Overlay Project Valuation /�P �l3 _Construction Type Lot Size o 1/(0 . Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On gYQ Id i �Kiin(.g's_High_way: ❑Yes ❑ No 8 ILLJ��°d vr: . i. 5 "; Basement Type: gFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement UnfinishehlR'e9(sg4 ,j -3A45® Number of Baths: Full: existing new Half:TeS�i$y n,# F RAPt\, new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new � First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ®'Electric ❑ Other Central Air: WYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � � l�• Telephone Number Address 6jC 'S� License # ILe* ® Home Improvement Contractor# `d 5�l496 Email Doiwl-!d 6J— ref' Worker's Compensation 0119X- 600 4*017&22-,?Z'V2�f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AI IS;-?7e- - SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED a MAP/PARCEL NO. ADDRESS VILLAGE OWNER � T DATE OF INSPECTION: FOUNDATION �� �'� FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING v DATE CLOSED OUT ASSOCIATION PLAN NO. , t REScheck Software Version 4.6.2 C:omplience Certificate Project Architectural Innovations Energy Code: 2015 IECC ,f Location: Falmouth, Massachusetts Construction Type: single-family ' Project Type: New Construction orientation: Bldg. faces 0 deg. from North Conditioned Floor Area: 384 ft2 Glazing Area 7% Climate Zone: 5 (5916 HDD) Permit Date: Permit Number: Construction 51te: Owner/Agent; Designer/Contractor: Dinardo Barn Architectudl Innovations Colony Insulation, Inc 552 Main Street PO BOX 200 28 Jonathan Bourne Drive Cotuit,MA Cotult.MA(12635 Pocasset, MA 025.59 Compliance: 1.7%Better Then Code nvel ! Ass mblleri cavity cont. -Fact or UA' Ceiling 1:Cath.edral Ceiling 410 49.0 0.0 0,022 9 Wall 1:Wood Frame, 16"o.c. 256 20.0 0.0 0,059 1S Orientation:front Wall 2:Wood Frame,16"o.c. 256 20.0 0.0 0.059 14 Orientation:lAack Window 1:Wcod Frame:Doubie Pane with Low•E' 15 0.280 4 SHGC:0.50 Orientation. Sack Wall 3:Wood =rame,16"ox. 288 20.0 0.0 0.059 14 Orientation: Left side Window 2:Wood Frame:Double Pane with Law-E 28 0,280 8 SHGC:0.50 Orientation: Left side Door 1:Solid 18 0.280 5 Orlentation:Left side Wall 4:Wood Frame,16"o-C. 288 20.0 0.0 0.059 15 Orlentation: Right side Window 3:Wood Frame:Double Pane with low-E 32 0.280 9. SHGC:0.50 Orientation:Right side Floor 1:All-Wood joist/TruSs:Over Unconditioned Space 384 30.0 0.0 0.033 13 Project Title:Architectural Innovations Report date: 10/17/17 Data filenarre-\NCOLONYI\Server Documents\COI.ONY\REScheck\Arch inn-10-17-17-Dina rdoRes- Page 1 of 9 552MalnSt-00T.rck Compliance Statement: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements In REScheck Versioi 4.6.2 and to Comply with the mandatory require t listed in the RESchga Inspection ec . t. �5i �a (P� (N o JJ Nam -Title nat a Date J Project Title:Architectural Innovations Report date: 10/17/17 Data filename:\\COLONYl\Server Documents\COL.ONY\REScheck\Archlnn-10-17-17-DinardoRes- Page 2 of 9 552Main5t•COT.rck • REScheck Software Version 4.6.2 inspection Checklist Energy Code: 2015 IECC Requirement!;: 0.0% were addressed directly in the REScheck software Text in the"Ccmrnents/Assumptions column is provided by the user In the REScheck Requirements screen.For each requirement,tie user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. 103.1, (Construction drawings and ❑Complies 103.2documentation demonstrate ❑Does Not (PRL)t energy code compliance for the ❑Not Observable ; �builcIng envelope.Thermal ❑Not Applicable lenve:lope represented on construction documents. 103.1, Comtructlon drawings and QComplies 103.2. (documentation demonstrate ❑Does Not ; 403.7 energy code compliance for ❑Not Observable EMU]' IIlghting and mechanical systems. ❑Not Applicable (Systems serving multiple dwelling units must demonstrate compliance with the IECC 'gaipp,oved mercial Provisions. Jng and cooling equipment Is; Heating: Heating: ,❑Complies )per ACCA Manual S based Btu/hr__ i Btu/hr� IQDoes Not oads calculated per ACCA ; Cooling: Cooling: ;QNot Observable ual)or other methods BtuJhr ; Btu/hr� ![]Not Applicable by the code official. ; Additional C-3mments/Assumptions: 1 Nigh►mpact(Tier 1) Medium Impact(Tier 2) uow Impact(Tier 3) Report date: 10/17/17 project Title: Architectural Innovations Data filename:\\COLONYJ\Server DocumentsNCOLONY\REScheck\Archlnn 10 17 17 DinardoRes Page 3 of 9 5521V1alnSt•C:0T.rck r FA otective covering Is installed to ❑Complies � 1 r insulation :❑ .ct ex osed exter oDoe.>Not Pextends a minimum of 6 in.below ;QNot Observable; e. ❑Not Applicable w-and ice-melting system controls:❑COm.plles Instilled. ❑Does Not ❑Not Observable; ❑Not Applicable Additional Ccimments/Assumptions: 1 1HIgh Impact(Tier 1) JUMedium Impact(Tier 2) Low Impact(Tier 3) Project Title:i�rchitectural Innovations Report date: 10/17/17 Data filename::\\COLONYI\Server Documents\COLiDNY\REScheck\Archlnn-10-17-17-DinardoRes- Page 4 of 9 552MaInSt-COT.rck 402.1.1, ;Door U factor. U U•_ ;OComplies ;See the Envelope Assemblies 402.3.4 ❑Does Not ;table for values. [FR111 i ; � ;QNot Observable 1 ❑Not Applicable ; 402.1.1. ,Glazing U-factor(area-welghted U U ;❑Complies ;5ee the Envelope Assemblies 402.3.1, average). ;❑Does Not ;table for values. 402.3.3, lQNot Observable 402.3.6, I 402.5 VNot Applicable [FR211 I 1 303.1.3 jU-fa.:tors of fenestration products' ❑Complies 1 [FR4J1 [are determined In accordance ❑Does Not Iwith the NFRC test procedure or QNot Observable 1 taken from the default table. ❑Not Applicable 402.4.1.1 i Air harrier and thermal barrier ❑Complies [FR23]1 iinstulled per manufacturer's ❑Does Not (Instructions. QNot Observable ' ❑Not Applicable 402.4.3 i Fernastration that is not site built ❑Complies [FR20]1 ;is Ilixed and labeled as meeting ❑Does Not :AARIA IWDMA/CSA 101/I.S.2/A440 ❑Npt Observable ; or has infiltration rates per NFRC i400 that do not exceed code ❑Not Applicable :llmics. IC-r)ted recessed lighting fixtures ❑Complies ; sea.ed at housing/interior flnlsh ❑Does Not and labeled to Indlcate s2.0 cfm ❑Not Observable ; leakage at 75 Pa. ❑Not Applicable j 405.2 IAII ducts in unconditioned spaces ': R R-_ :❑Complies ; (FR25]1 :or outside the building envelope : ;❑Does Not are Insulated to aR 6. QNot Observable ; ;❑Not Applicable Building cavities are not used as ❑Complies ducts or plenums. ❑Does Not QNot Observable ❑Not Applicable HVAC piping conveying fluids R•_ R I❑Complies lino above 105 of or chilled fluids ; Does Not below 55 OF are insulated to�•R- I ;QNot Observable ; 3. ;❑Not Applicable ; 403.4.1 ;Protection of insulation on HVAC ❑Compiles ; [FR24)1 (piping. ❑Does Not ❑Not Observable j ❑Not Applicable ; Automatic or gravity dampers are ❑Complies ; installed on all outdoor air ©Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable Additional I:omments/Assumptions: 1 Nigh Impact(Tier 1) _Nf Medium Impact(Tier 2) _[Low Impact(Tier 3) Project Title- Architectural Innovations Report date: 10/17/17 Data filename:\\COLONY(\Server Documents\COLONY\REScheck\Archlnn-10-17-17-DlnardoRes- Page 5 of 9 552Main5t-COT.rck 11111[CCompliesrAirloin;talled insulatl n islbeledo orth,:Installed R- Does Not ded. Not Observable Not Applicable 402.1.1, Floor insulation R value. R ___ i R-_ ❑Compiles See the Envelope Assemblies 402.2.6 ❑ Wood ;ElWood ❑Does Not table for values: tIN111 ❑ Steel ;E.,) Steel j❑Not Observable 1 ;❑Not Applicable I i 303.2. (Floor insulation Installed per Ik ❑Complies 402.2.7 manufacturer's instructions and Y []Does Not (IN211 f In substantial contact with the []Not Observable 1 ;underside of the subfloor,or floor ❑Not Applicable ,framing cavity insulation Is in !contact with the top side of 1 sheathing,or continuous insu ation is Installed on the underside of floor framing and extends from the bottom to the ; top I)f all perimeter floor framing I members. 402.1.1, I Wall Insulation R-value.If this is a; R ' R-_ '❑Complies ;see the Envelope Assemblies 402.2.5, mass wall with at least'/:of the ;❑ Wood ;❑ Wood ![]Does Not ;table for values. 402.2.E wall insulation on the wall ❑ Mass ;❑ Mass ;❑Not Observable (IN3)1 'exterior,the exterior Insulation Steel ❑ Steel (❑Not Applicable .requirement applies(FR10). 303.2 !Wall insulation is installed per ❑Complies IIN411 (manufacturer's instructions. El Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) ZjMediUrn Impact(Tier 2) Low Impact(Tier 3) Project Title; Archltectural Innovations Report date: 10/17/17 Data filename:\\COLONY(\Server Documents\COLONY\REScheck\ArchInn-10-17-17-Dina rdoRes- Page 6 of 9 552MaInSt-C:OT.rck r 402.1.1, ;Ceilir9 Insulation R-value. R- ; R-_ ;❑Compiles ;See the Envelope Assemblies Wood ❑ Wood j❑DOe5 Not ;tab►e for values. 402.2.2, '❑ Steel ;❑ Steel ;QNot Observable 402.2.E :QNot Applicable (fllll ; 1 , 303.1,1.1, Ceiling Insulation Installed per 111[Does ompI'es 303.2 manufacturer's instructions. Not IF1211 :Blown insulation marked every ot Observable ;300 t=. ot ApplicableVented attics with air permeable ompilesInsulation Include baffle adjacent oes Not to soffit and eave vents that ot Observableextends over insulation. ot Applicable 402.4.1.2 ;Blower door test @ 50 Pa. <�,5 ACH 50= ACH 50 =_ ;QComplies ; (FI1711 ;ach In Climate zones 1-2, and CDoes Not ach in Climate Zones 3-8. ;❑Not Observable I t ;DNot Applicable 403.2.3 ;Duc:tightness test result of<=4 ; cfmi100 _cfm/10o ;dComplies (F1411 cfm,1100 ft2 across the system or ; ;QDoes Not <�;i cfm/100 ft2 without air ; ;❑Not Observable ' 1hanJIer @ 25 Pa.For rough-in : :❑Not Applicable , ;tests,Verification may need to ;occur during Framing Inspection. 403.3.2 Ducts are pressure tested to _cfm.1100 ; cfm/100 ;❑Complies ; (F12711 �det!rmine air leakage with ! hs I R' Opoes Not either Rough-in test.Total ;[]Not Observable ileac:age measured with a ;❑Not Applicable ; :pre;sure differential of 0.1 inch �w.g.across the system Including ithe manufacturer's air handier enclosure If installed at time of ; ;tes:.Postconstruction test:Total 'lea<age measured with a i ;pressure differential of 0,1 Inch w,g:across the entire system ' Iinc.uding the manufacturer's air I !handler enclosure. 403.3.2.1 ;Air handler leakage designated ❑Complies [F12411 I by manufacturer at<=2%of ❑Does Not !cie:;ign air flow. ❑Not Observable ; ! ❑Not Applicable Programmable thermostats ❑Compiles installed for control of primary ❑Does Not heating and cooling systems and [3Not Observable ' ini:lally set by manufacturer to ❑Not Applicable coje specificatlons. Heat pump thermostat installed ❑Compiles on heat pumps. ❑Does Not []Not Observable ❑Not Applicable Ci culating service hot water ❑Complies systems have automatic or ❑p0es Not ' accessible manual controls. ❑Not Observable ❑Not Applicable All mechanical ventilation system ❑Complies fans not part of tested and listed ❑Does Not H MC equipment meet efflCacy ❑Not Observable and air flow limits. ❑Not Applicable 1 Hlgh Impact(Tier 1) in Medium Impact(Tier 2) Low Impact(Tier 3) Report date; 10/17/17 Project Title: Architectural Innovations Data filenarne:\\COLONYI\5enrer Documents\COLONY\RbScheckWrchlnn-10 17-17-PinardoRes Page 7 of 9 552MainSt-i=0'T.rck Hot Ntater boilers supplying heat ❑Complies through one-or two-pipe heating ❑Does Not systems have outdoor Setback ❑Not Observable ; control to lower boiler water ❑Not Applicable temperature based on outdoor temK erature. ' Heat?d water circulation systems ❑Complies have a circulation pump.The ❑Does Not systc+m return pipe is a dedicated ❑Not Observable return pipe or a cold water supply ❑Not Applicable pipe, Gravity and thermos- syphon circulation systems are not present.Controls for ; circLlating hot water system pumps start the pump with signal for hot water demand within the ' occcpancy.Controls automatically turn off the pump whet water is In circulation loop Is at set-point temperature and ; no demand for hot water exists. Electric heat trace systems ❑Complies comply with IEEE 515.1 or UL ❑Does Not 515 Controls automatically QNot Observable ; adjLSt the energy input to the QNot Applicable hea:tracing to maintain the ; desired water temperature In the ; piplig. Water distribution systems that ❑Complies have recirculation pumps that Oboes Not pump water from a heated water ❑Not Observable ' supply pipe back to the heated ❑Not Applicable water source through a cold water Supply pipe have a demand recirculation water ' Syscem.Pumps have controls ; that manage operation of the purnp and lirnit the temperature of the water entering the cold water piping to 1049F. Drain water heat recovery units ❑Complies tested In accordance with CSA I2Does Not B55,1.Potable water-side ❑Not Observable ' pressure loss of drain water heat ❑Not Applicable ' recovery units< 3 psi for Incilviclual units connected to one or:wo showers.Potable water- side pressure loss of drain water heat recovery units< 2 psi for Individual units connected to three or more showers. 404.1 175%of lamps In permanent ❑Compiles ; [FI6]1 jflxtureS or 75%of permanent ❑Does Not 'fixtures have high efficacy lamps. ❑Nat Observable ' IDres not apply to low-voltage ❑Not Applicable , ;lighting. + Fuel gas lighting systems have ❑Compiles Inc continuous pilot light. ❑Does Not ❑Not Observable I ❑Not Applicable Ceimpliance certificate posted. ❑Compiles ❑Does Not DNot Observable ; ❑Not Applicable 1 Hlgh impact(Tier l EMediurn Impact(Tier 2) Low Impact(Tier 3) Protect Title:Architectural Innovations Report date: 10117/17 Data filenarie:\\COLONY1\Server Documents\COLONY\REScheck\Archlnn-10-17-17-Dinardoaes- Page 8 of 9 552Main5t4.0T.rck I Manufacturer manuals for [,complies mechanical and water heating ❑Does Not systems have been provided. ❑Not Observable ❑Not Applicable ; Additional Comments/Assumptions: 11 High Impact(Tier 1) Medium Impact(Tier 2) Low impact(Tier 3) Project Title:Architectural Innovations Report date: 10/17/17 Data filenar.ie:\1COLONYI\Server Documents\CGLO"REScheck\Archlnn-10-17-17-DlnardoRes• Page 9 of 9 552MainSt-(:OT.rck 2015 IECC Energy Efficiency Certificate Above-Grad:Well 20.00 Below-Grad►Wall 0.00 Floor 30.00. Ceiling /Roof 49.00 Ductwork (unconditioned spaces): Window 0..28 0.50 Door 0..28 .6: .. ® •� Heating Sy!item; Cooling Syfitem: - Water Heater; - Name: Date: Comments AC40RIDO® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE. 10/25/2017 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 policy(ies) must be endorsed.,If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Heidi Wellman NAME: Risk Strategies Company PHONE (781)986-4400 ac No:(7e1)963-4420 15 Pacella Park Drive ADDRESS:hwellman@risk-strategies.com Suite 240 INSURE S AFFORDING COVERAGE NAIL# Randolph MA 02368 INSURERAAIM Mutual Insurance Company INSURED - INSURER B: A I Enterprises Inc INSURERC: P. O BOX 2056 INSURERD INSURER E: Cotuit MA 02635 INSURERF: COVERAGES' CERTIFICATE NUMBER:CL1772439565 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 CONTRACTOR 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. 1 TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY POLICY M DD�YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADEOCCUR DA I O RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY_ $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH-. AND EMPLOYERS'LIABILITY YIN S STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 506,000 OFFICER/MA (Mandatory in H)EXCLUDED? WCC-500-5017622-2017A 7/18/2017 7/18/2018 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500;000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE R Ins. Brokerage/HEIW ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onlanli fr Massachusetts Department of Public Safety r Board of Building Regulations and Standards K. License: CS-050457 Construction Supervisor � Yy -: PETER M POMETT, PO•BOX 2066 COTUIT MA 02635 Expiration: 1 Commissioner 04/19/2018 _... _�--r°�r 4�t.1?�se�s�t�•rz�d`.f�°r� C'l��r.t�..rf�Po. zw' �:: _.., Offcc.of Consamer Affairs&Bnstness ItevalaU IMPROVEMENT COK CTOft w :' Regstratton"`,9096f#5 Tyge ExpraLon9121f0€8 4rateCsaitaraii A I ENTERPRISESINCi PETER POMETTI ' r 140 LITTLE RIVER RD �.,r' i ., COTUIT,MA 02635 Undersecretary ; i s i I • rra.;. it,,° q nt•License or registration valid fit individual use only 3t -before the.expiration date. 1f found return to: _.:Office of Consumer Affairs and Business Regulation "40 Park Plaza=Suite 5170 Boston;NIA'02116 F(s,1. f f S' 'pt:t r, , N,Not valid without signature ET. License.or registration valid fyir individual use only --before the expiration date. If found return to: • Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston;MA 02116 t Not valid without signature The Coma oTnreafth of-Mxssadrusdts. �•`4 .�e,�t�rfi�erzt a,�'� triall�cc�c�eFrts 600 Washington i�freet - Boston,,M4 0Z111 -- wnnv t=gav1dia Warimrs? Campensafian Insx - ce Affidavit Bn ltlers/ContractarsMecftk n A hmzhers, AppUitmildmmatkn Pieaseprint E.ee�xly no Are pu an emplayer?Checkthe appropriate bay T of (required)-- project r . L I a a 1 v:3th 4. ❑I am;a'gen�eral confractor and I d} am employees&41 amdfor patt-time * Iiave l iretltfie subs conktactom 6_ era c cEi 2.❑ lam a sole propdetor orpmtuT- tided onthe,attached sheep 7_ ❑RemodeHn ship and have no employees Thwe sub-conisactars have $_ Dema}ifioa worig for m ir ary its em3pla and wodmrs' 9. S,uildizig adT3iiiosr. INo vvpdna s' comp,rnsurmce comp.union+??I reTIired_l. - - 5. [] We are a corporafi-an and its 10❑Electrcal repairs or a,dclifinns 3-❑ I am a homeovm w doing alb woda officers have exRrcised tl:ar 1 L Q Plumbiagrepaim or additiom. rgl of MG n per L 7 L- Rnafrepai myself[No vunikers'Wig_ ibf exemption 1{� ❑ rs ` imm�a=e reTaiFed][ t~152, andwe;have na employees-Lwo wodoers' 13_❑Other camp_iamrzcce required_I #$nYaPp A n2melsboxiKmn Elsa fMVQtthe5MIiontr5awshmdndiekwoaer compenmCwupoTicpiafarmsriaa Sameoaraetstr}m sabot rFris�da<u i g tl�vy ode dain� w amdtSeaLse o-ut9decoataictarsamd so�aiitaaew�daeyt 9 sacML fCaaftvc{�o[s3�xtcheckt�sbaxa�asta2larhed�saaddiGanals�xeetshnticmgthen�.eofthesnb-caa�asmdsf�ewhetherarantthaseenti4rsha� employem ifthesaar ontxctmsR=e employee%9iepamsipm ide&eir wad Een gyp.policy nU mber- I am mi emplgw dial is pm id b workers'camp safiate h=raace for my*enW&pem- $ebb is fhe policy and jvb sit* infomaiiatL ImuranceCompanyName: 40flA-1 /�46li-74- Po-ficy;x or S&-i s-Zic. 6VW-"5'&) $'01'746,X4 201.2 FbpiratknDate: . . Job Re Addre= 6J� /A/ • City/State p: Attach a copy of the workerrs'compensationpolrcy-declara4 on page((showing the poficp number and expiration&ate). Failure to secure coverage as r equtredunder Section 25A of Mtn,c-157-can lead to the imposition of ainninai penalties of a E=up to$UOa.Oa andfar one-year imprisonment,as Knit as civil penalties in the fozm of a STOP WORD ORDER and a foe of up to$250-00 a dap against the violator_ Be adcdsed that a copy of this statement.maybe forwarded to the Of of Inestigaffim ofthe DI&for insurance coverage veriffCa ion. •T din hereby c �ud�r thin med�PsriaRies aflmrj ury ff dflte ircfarma6=prmuled abotre f tam acid correct Date_ mom ik 0.&W axe anry Da aiot tart*iti f zb area,to be cmnp&ad by rify arfotr7i offi ut City or Town: Permiff kense:9 Issuin Auffi&r4(dude once): L Board of.Ueal& `Builffing Deparfinemtt 3.Cify town Clerk 4.Electrical Inspector S.Phimbmg buPecter fi.Other Contact Person: Phone#: — -- - 6 information and Instruct ns ' Masszc��Ge'=al Laws 152 regones all MIgloyeas to Mr Mde worms'�e�on for their employees. Pmsaa��this fie,an eU57Ta7ee is definedeverypeasonin�e service of auoffim under any cmft of ofh$e, MqRIC:ss or inxPli ell,oral or vniffz » An_Mayer is d freed as-a m judividna],paxfnersbip,assocB on,coiporatton or athei legal edify,or aay two or mare of the foregoing is a joint uprise,and including die legal represe aiives of a deceased emplapra,or receiver or trustee;of an indiyidmd,p ip,association or other Iegal entity,maploying CU3pmy=S- However fhe owner of a d weir howl having not more than thee r apartments andv?no resides ,or the occ�t el the- dweIIing house an of on who employs Pem�tD do mahteum=,constr cdOn or repair v,�o$c on sock dweIIing house: or on the grounds or build"mg app�a�iherefo shallnotbmanse of such employmeE±be d=nedfn be an employer." MGL cbapt :r 152,§25C(6)also sues that"every state or Io ca l Hcensiug agency shall wirtlihold•Sze jzUnce ar rmew2l of a f c— r—or permit to operate a business or to con.sfru�bttrldings the commonwealtT:L for=P applicautwho has notprod'aced acceptable evidenm of cdmpH=ce witIx tare;,=-ance.cov'ez-age requireel- Addifionally,M TC`L chapfE:r 152,§25dM stairs WiT jher fhe corm aawealft nor;Ly ofifs political sobdivisions shall CMterinto any con ractfix-thepm-ffxmunto,ofpublicwmkuntlacceptableevidenceofcompli4a=T?ith•$emsux-ance. of this dupter have Been presented to fhe ca*�-anf ozify." A.gphcxuts PIease fill o± the wo3ers'compeasafifln affidavit completely,by chug�boxes that apply to pour situation and,if nary, Ply sob_contractm(s)name(s), address(es)andphone namber(s)aIongwifttheir cectficafets)of I, dLiabilrtY Carapames(LLC)or Limited Liability Pa s(LU)wiffmo maployees other than tb.e ice members or paztac s,are not rtq imd to�y workers compensation insurance If an LLC or LLP does have employees,apolicy is required- Be advisedt Affiis of idayitmaybe snhm�ed to fife Depa-fineat of Industrial Accidents for confirmation of i =mce coverage. Also be sure to siga and date the a'frdaviE The affidavit should be-rztm:aed to$e city or town that f3ie applica5.ou for the pew or license is being requested,not the D epement of Tip efi i l A�:� Sh6uldyou have any questions regardmg$ie law or if-you are req•aird to obtain a worm' compemsationpoliey,please call the DepartmeDt at fhe number listedbelOW' Self-msraed companies slienId� r their self-m crrr�n ce license nnmbe r on the appropr hue. City or Town Officials . r Please ba sore that tho affidavit is camplefe andprirted legibly. The Deparfm.enthas provided a space at the bottom of the affidavit for you to fib out in.tho event the Office oflnves gafr.�has in Contact egardi.g The applicant Pleas a be svr�fn f17I in the pe�itllicCUR riuinbea which ve>7I be used as a reference rmmber- In addition,an applicant davit indicatiag cruet thst must submit 3nubtiple pe�ftcense appEtsfions in any given year,need only sabmit one affi aoliey info=oatian(if necessmy)and under"lob She H ess"the applicant shouldwrite-aU ldeOr �ns in town).-A copy of the afhdavitthat has bey officially stmmped or mucked hythe city or�wu may be provided to�e applicant as pmofthat a valid affidavit is on file for fatiae'pmmits or licenses A new affidavhmznt be fIled Oi t each year.Where a home owner or c ti l is obtaining a license or peamit not relai--d{D any business or comet ercaal venfum a dog lice me,or permit to burn leaves etc.)said person is NOT regrrized complefe this affidavit The Office of rnvestigaiians would lib--to thank you m;&a=for your cooperation and should Yon have any questions, please do nothesifate to give us a mZ Ilze I}eparfinenf'S address,telephone anti fax number: + Thu-CDMMMTMIIE of Chu ' � I�egaz���flzrd�d�Accld�nfi�, • fie r��e�g�tio� Tf,-1.4 617-' -49W cat 406 car 1477 IM&AFR Fax#a7`27 774 xevised¢24 07 mgd Town of Barnstable Building Department Services Brian Florence;CBO 163q. �� Building Commissioner tc ram'' 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ` Fax: 508-790-6230 Property Owner Must. Complete and Sign This Section If Usin-aA Builder as Owner of the subject ro I l P pe�t9 hereby authorize 1 n 6A l to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and'alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. ,Siga tore of Owner Signature of Applicant Fay 9 IN41to-0 ?�6 rrl Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOIS I Rev:09/16/17 i , : l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION "1'OWI(i OF B IA,1A L ®�� p Parcel �`•� r1 "z Application # Ma Health Division Date Issued !1 f C Conservation Division Application Fee Planning Dept. ,' t ' _ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 5; A /4,4VAf _7a Village eO IV-'- 4A44— Owner 7�64r Address OL Telephone Permit Request &_ "49 dr& �G C/� �X %/��� /'� •�!� ° a, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District /�� Flood Plain Groundwater Overlay d0 •rw Project Valuation W Construction TypeJ� Lot Size 4�p *44LF Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Al 90 � Historic House: ❑Yes XNo On Old King's Highway: ❑Yes �V(No Basement Type: *Full ❑.Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.). Basement Unfinished Area (sq.ft) 3 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing / new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil Electric ❑Other Central Air: p(Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size= Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - '(BUILDER OR HOMEOWNER) 777 Name 6J&T � �' � Telephone Number Address ,!7D �1e + License # 66 -06'0'/-6 7 l *02.4 Home Improvement Contractor# Email Worker's Compensation #60UL-041-017*22'2-alAll ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED . MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. The CaasrrrarrtveaWt gjfMaYsadrusd&. Depart neat rr, rud-rrstrid A&ide7rts fa ce af gad&= _ 6DO WaskhW- ton&beet Boston,CIA OZ11� t Fow atass_gar/dirt War lm& Cwnpensafimt lnsn-mce Affidavit BuiIder-JCuntractursMecbicLmmThaphers tipper Informafian Please Print E.e�'bIy Address: PIWD6 %3 � Are u an employer?fheckthe appropriate bo= ' Type of project(retlnaed}_ I_ I a a employes�fi AA 4 ❑I am a general contractor and I employees(f z andfor pad-time).** 1mve Hredthe sab-coatcados . 6. Ides coasbr�Eiog 2.0 I am a sole proprietor or par tner- Tisfed e>z the attached sheet.. F. ❑Remodeling nme sib-contractors have strip and bane na employees. $..0 Demalifion: worSdag forme in any 10 andhhave wormrs', capacity �P . 0 S.uiFding addifi oa [NO UP&35& comp.*inst— 0 comp.inanran required] 5. ❑ re We a a�corporafion and its 1 0 Electrical repo&=,or a,dditi n officers have eYR�ed giek 3.El am a bomeovmer doing all'work 1 L 0 Plutabingrepairs or additions - Mysaf No vrozkecs' ,- ugbt of==Pfiou per MGL 12 0 Roofrgmim fr�enranre iecluired [ C.152,§1(4).and We haven* employees.�LVO WQT S' i3_D Ofher 'Anyapp &atcheftboa#1 alsofMouttheswdcmbgowshuvdngdieavia&ei camp®sat apoikyiuff=MU-a3- E nmeownem who submit sizis of uLwff Indira�g tb--y sm•doing RUwan$sitmoI&e owtmdecoahsctors—st sah=a new affida&mdicstna sack fCannactp f=chea Thi rant m=attached mt ad3itionsl skeet sbawiagthemmne of the sub-con=scto-a,and stile arhedm ornot i�hnse eotidesbwe employees.if thek&-Comiactaesbave empIaftes,theymmstpmvide&ek WndkeW amp-13QHU numbM I arrc all $eloov is tfie pottcy=d jolt site Fn�arrarrtrbrs Insurance company iLlame: Pof cy 4 or Serf-im Iic---flk- I-WeZ— � �//` Q�t 2 2, 1P Aylep , Job Site Addre= 51549 AIM415r, cify/St9&ziP: (/eT Mach a copy ofthe waders'caompensation.policj•dectara4ion page(showing the pofiry,number and espu-lion dale). Faihtre to secure coverage as regdiredvnder Section 25A of MGL c.157-can lead to the imposit im of criminal penalties of a fl=up to$"Oa OG anNar one-year imprisonment as wa U as civil penalties im the farm of a STOP WORK ORDERand a frme of up to$250-00 a dap against fhe violator. Be advised drat a copy of this sbdement maybe forwarded tia thB Office of InvesEgafi ons of the DIA for iflsurance coverage sm ion .1do kereby car*r the perraiXi�zs�F thatflts fnjbrma€mRrat�d abot�i g bars tad carrect Sigaatnre: Date Phone Irc. QjqMd use anly. Da not write in dds Axed be winpkisd by eify artoinj m�acrht My or Town: PermiffIcense;ff Issuing Auffi-or€ty(drde one): L Board of Elwl fi I Building Department I fifyfEowa Clerk 4.Electrical Fnspector S.Phunbmg hupector 6.Other C'aatact Person: Phone 9: Taformatio)a and Tastxact iWas . hfasmc G,il Laws chaptEr M Vie.aU emplogers fn provide woIkeas'C0113PeUSRton far their employees. PursUM3f`O this sib,an avkg ew is deed as 6:e4'e2y person m.hie sea vi ce of another ceder aoy cow ct of lam, =q=-,;s or implied oral or wrWmn." - asso�oa,corporation or other 1egaI enllly,or any two or rye 1�n employer is defined as"axt inidnal,pazfnersbip,go se�alives of a deceased employes,or$ie oof tie foreing nz a Joint e�pIIse,and mcln�g the Legal aepre f.Ih a trustee of an individual,pmt=ship,association or ofher Iegal entity,employing employees- HovQeYer the r=C• such dwelling owner of a dweIIiilghonsehavmgnotmorefiaathree apartments aadwho residestherem,Or the'occ oft3�e- dwemag house of aaA�WhO=3PI ys pe�sans to do m =,r.,nch�rfiT cIl or repair wo�C o71 house urfona�ibe sballnotbmanse of such�ploymentbe deemedto be an eazployer." or on.the grounds ar bmldmg app • MGL chapter 152,§25CC6)also sirs that¢eve9 sfate-or loc 2I Ticensmg agency shaII wrFIih oIa ffie Dance ar renews-A of a tic— a or permit to operate a lm-dnes.s or to constmct bmldi>zgs za the commonwealth for arrp applicantwho has notprod'uced acceptable evidence of compliance with tbr-bism-once coverage requ>red- 152,§25dMs Ltrs'N itherf]iec nor;; ofitspoliticalsobdivisiensshall Ad onaIIy,M TC2,�r fable evidence of camplian=WM fbe ftl=mc.. enter into any conlra ct for the p ce ofpublic vPa�un aocep regr==eaEs of dais rIIxptm have been presented ��� ufb ed.to the mift .a Duty:' AppHcaaLs ensafi on affidavit completely,by checiia g�boxes�apply to your situation and,if Please fEI out the Wogs'comp t Ceres)of necessary,Supply s)name(s)' address es)�Ph°nemmmber(s)aIongwiffi ammes or LimitedLiab�ityPa-Lmmhigs CLEF)wi-�no employees oilier Than the ;mstarmce. Limited Liability Comp (LL� members or parts,ale not rbquimd to tiny works'c�npensafron>asorance. If as L LC or LLP dDes have empIoyees,apolicyisregmred. Beadvisedthat this affi -vitmaybesohmrt�dtothoDepar(mentoflndusftia1 ffin of meta.M=coverage. Also be sure to sign and date the affidavit. The affidavit should Accide�s far co be-ret=ed to he city or town that the application for thin Permitor license IS being requested, nottheDepartme t of jr�1 Asci i fs. Shmayou ha t any questions iega die law or ifyon are requ>i ed in obtain a worlOrs' Lease call fh o D a tneEt at fhe n=l rr lisi�d below: Self-ins��d�aM'es sb ould eater ti�eir compeusationpoliey,p eP self i �ce liccnseamber on the appr line. City or Town Of i als _ Please be sm e that the affidavit is complete aodprhted.IegllY- The Department has provided a sp lfic� of the affida for you to till orb in event the Office oflnvmf fi�nc has to comactyou regarding applicant. Please b s to fln lithe pe�WHcense number whichvM be used as a reference x¢onber. In addition,an applicant etore that must submit I nultiple,permibUcense applications in awry given year,need.only submit ane affidavit mdicalm;co�.t and under."Tob 1��di�ress"lie applicantshould write"all locaiscns n (city or poker��rnatian Cifn ) be provided,to$ic town)-A_copy of the affidavitt3�has ben officially sfmnped or madced bythD city or tnvm may, pro applicant as proof that a valid affidavit is on file for foiure pity or Licenses_ Anew affidavit must be fella$ortf earls year.�i here a home o�vnes or cifi�o is obtaa>ning a license or permit not ielated:to any business or comm�ial Yee Cie.adoglicenseorpmmittobmn.Ieavese#c•)saidpemmisl`TOTx tDC°mple#eti�isaffidavit Office ofln. s+ gzfi _ns would Ie to thank you m advance for your coope�on and should you have any qn�os. he Tem please do nothe*�to givens a call 'Ihe 7?eparfineafs address,i-lephone and faxnumber: 1 fja=MjOat3j of hfassachnssx De2axtnmt of I�dustdak Acci&entE floe of TIL f=% v an. sM&oil II -Tf,-I< '617-' -4 *kt 406.gar Fax#617`27 7M I ' A WC Guide,to Wood Construedon in High Wind Areas:110 mph Wind Zane Massachusetts Checklist for Compliance(780 CAIR 5301.2.1.1)t Q Check 1.1 SCOPE Compliance ' WindSpeed(3-sec.gust).................................................................. ...................................,.............110 mph Wind Exposure Category..:.................................:............................. .............................................................B 11.2..APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story). stories 5 2 stories RoofPitch ..........................................................................(Fig 2)........................................... 512.12 MeanRoof Height ..............................................................(Fig 2).............................................. _ft 5 33' Building Width,W.............................: .(Fig 3).......,......:.....................:...::...... _ft s 80' ................................ BuildingLength,L ..............................................................(Fg 3).....:......... ............. ft <80' Building Aspect Ratio(LNV) .(Fig 4)............................ 5 3:1 Nominal Height of Tallest Opening ......(Fig 4)................................................... ' " •. ................... . 5 6 8 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2)................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.........:..............................................................................................:..............::..... ConcreteMasonry................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION 3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general ..........................:...... ........(Table 4)............................................... in. Bolt Spacing from endfjoint of plate ............................(Fig 5)...........:.............::......:... in.:5 6"—12" - Bolt Embedment—concrete........................................(Fig 5)................................................. in.a 7" Bolt Embedment—masonry........................................(Fig 5):............................................ in.>15" Plate Washer.................... ..........:z 3"x 3"x%" ...........................................(Fig 5).................................... 3.1 FLOORS Floor framing member spans checked ..........................`.....(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension................................ .(Fig 6). ..........................................:..... ft 512' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)........................... ......... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).....,................................................. ft s d Maximum Cantilevered Floor Joists — Supporting Loadbearing Walls or Shearwall................(Fig 8)............:,....................................... ft 5 d Floor Bracing at Endwalls...................................................(Fig 9).............................................I......... ......... Floor Sheathing Type .........................................................(per 780 CMR Chapter 55).................................... Floor Sheathing Thickness ............. ...............:..........(per 780 CMR Chapter 55):.................. in. ' Floor Sheathing Fastening. ................................................(Table 2)...__A nails at in edge/ in field 4.1 .WALLS Wall Height Loadbearing walls....................................... . ....(Fig 10 and Table 5).....................:.....—ft 510, Non-Loadbearing walls................................................(Fig 10 and Table 5)...........................—ft 5 20' Wall Stud Spacing .......(Fig 10 and Table 5)..................._in.5 24"o.c. Wall Story Offsets . ............................... ................... .(Figs 7&8) ....... . ........................... ft 5 d 4.2 :EXTERIOR WALLS Wood Studs Loadbearing walls........ ......................... . .... .. .(Table 5).... ....................2x+ _ft in. Non-Loadbearing walls................................................. (Table 5)....:.........................2x - ft in.a Gable End Wall Bracing 1 _ Full Height Endwall Studs:...........................................(Fig 10)...........:............::............................:.......... WSP Attic Floor Length.............................................:.(Fig 11).............................................. ft zW/3 Gypsum Ceiling Length(if WSP not used)..................(Fig 11)............................................ ft a 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. . (Fig 11). ............................ ............ or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length .............:..........................................(Fig 13 and Table 6)................................... —ft Splice Connection(no.of 16d common nails).............(Table 6).......................................................... AWC Guide to Wood Construction in Hight end Areas:110 inph Wind Zone Massachusetts Checklist for Compliance(780 CYIR 5301.2.1.1)' Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Tables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).................................._ft_in.511' Sill Plate Spans ........................................................(Table 9)......................... . . _ft_in.511' Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9)............................... _ft_in.512' Sill Plate Spans..........................:................................(Table 9).................................. ft_in.512" Full Height Studs(no.of studs)....................................(Table 9)........................................I............... Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest Opening2 ..............................................................................._5 618" SheathingType.............................................(note 4)...................................................... Edge Nail Spacing.................................:.......(Table 10 or note 4 if less)....................... in. FieldNail Spacing.........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)..................................................... _ Percent Full-Height Sheathing.......................(Table 10)................................................... _% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,L . Nominal Height of Tallest OpeningZ.... ..................................................................... 5 6'8" SheathingType.............................................(note 4)...................................................... Edge Nail Spacing..........................................(Table 11 or note 4 if less)....................... in. FieldNail Spacing.........................................(Table 11)...............:................................. in. Shear Connection(no.of 16d common nails)(Table 11). .................................................... _ Percent Full-Height Sheathing.......................(Table 11)................................................... _% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?................................ ............................................................................................ 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) RoofOverhang ...................................................(Figure 19)............._ft 5 smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift..........................................:.....(Table 12)............................................U= plf Lateral.............................................(Table 12).............................................L= plf Shear..............................................(Table 12)..............................................S= pif Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker.........................................(Figure 20).............. ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................ able 14 Lateral(no.of 16d common nails). .(Table 14).......................................L= lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) ............ RoofSheathing Thickness........................................... .............................................._in.z 7/16"WSP RoofSheathing Fastening...........................................(Table 2)...................................................... _ Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guidd to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist,for Compliance(780 CMR 5301.2.1.1)t 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16'and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment MEN THIS EDGE RESM ON FRAMING UMed NAU 44 ' JI IL 11 t u II r 11 ` 11 I f 1 It 11 . . 11 11 11 r 91 11 N II I I Q 11 0 ' I I •rs i i i i � i id Jo Ir Q lu r It 1 I1 rr yj 1 I1IJ ,rcc � 1 U F- 1 IJ II II 11 NAILSPACM — 1 . r PAAiE1_ vy See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in Sigh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7go Cmx 5301.2.1.1)1 r t� r r r = . i FRAMING�I MEMBERS r r+E M'FAhAEDUITE t r r l r � r t s Sw r r i - S-MIN. I i r r --3_�t�----------L- ----- -i--- SSAGGERM• 3•M UJA FATIERN PANEL PANOML EDGE DOUEU FLAIL EDGE SPAW G DEML Detail Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 inph Wind Zone Massachusetts Checklist for Compliance (7so CMR 5361.2.1.1)1 FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a no mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM 1 oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further,.if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the. ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has. been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. ' Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. Town of Barnstable Building Department Services r • " KAS& Brian Florence,CBO 16"3 ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www:town.barnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230` Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the ro subject l property hereby authorize /� / v/� � to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) _ **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S' ature of Owner Signature of Applicant ��F�QFy �aN�2oo i i� ucr7-� Print Name Print Name Oo Date Q:FORMS:OWNERPOMOSIONPOOIS Ree 09/16/17 Town of Barnstable Building Department"Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 ssARNEMe13M awes � www.town.barnstable.ma.us t659. Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print - DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual.for hire who does not possess a license,provided that the owner acts as supervisor. DEFINPITON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of.Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q.\WPFHM\FORMS\building permit fomn\EXPRESS.doc 09/16/17 To: Town of Barnstable Building Department From: Peltier Electric Inc. Date: 10/28/2017 Re: 552 Main st. Cotuit Ma As of 10/28/2017, the power has been disconnected to the unattached barn on the property of 552 Main Street Cotuit, Ma 02635. If you have any questions or concerns please contact me at +15083265216. Thank you, Joseph Peltier License#A14912 10/31/2017 08:03 5087759135 KEN DUARTE PAGE 01/01 KEN DUA.RTE PLUMBING AND HEATING CORP 37 Collins Ave Centerville,Ma 02632 508-250-2763 Fax;508-775-9135 Lic.# 11012 November 1,2017 A I Enterprises P 0 Box 2056 Cotult,Ma Dinardo bam 552 main 5t Cotuit,Ma The existing bam on this property►that Is beingtom down has no plumbing or gas connected to IL Kenneth Ouarte,president u-2017 08:18 - +12408235549 p.1 To:.Tonof w Barnstable Building Department From: Peltier Electric Inc Date: 10128f2017 Re: 552 Main St. COtuit Ma As of 1.Of2gl20.i.7, the power has been disconnected to the unattached:barn on the property of 552 Main Street Cotuit, Ma 02635. ff y.ou'have any questions ox concerns please contact me at +15083265216. Thank you; Joseph Peltier License.#A14912 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-050457 M, • Construction Supervisor PETER M POMETTIF- PO BOX 2066 COTUIT MA 02636 Expiration: commissioner 04/19/2018 ��� °"�naaxcueallL G Office of Consumer HO Affairs a�3ac/zua� . ME IMPROVEME &Business Re Registration NT CON, gulad`� Expiration 109606 R,4CTt)R 9/211201g TYpe: A 1 ENT 1' Private Co ERPRISES INC �� rporat'" PETER pOA4ETTl 140 LITTLE RIVER RD COTUIT,MA 025'3 ,..., Undersecretary , Town of Barnstable B R _ . 13ARMWA��s.1•f _Post This Card So That it is Visible From the Street-Approved Plans*Must be Retained,on Job and this Card Must be Kept 1g Posted Until Final Inspection Has BeenMade.- Where a Certificate of Occupancy is Required, such Building shall Not be'Occupied until a Final lnspection has been made: Permit Permit No. B-17-4036 Applicant Name: NICHOLAS BRADY Approvals Date Issued: 11/26/2017 Current Use: Structure Permit Type:' Building-Siding/Windows/Roof/Doors Expiration Date: 05/20/2018 Foundation: Location: 605 MAIN STREET(HYANNIS), HYANNIS Map/Lot: 308-.119 Zoning District: HVB Sheathing: Owner on Record: JEFFRIES,WILLIAM E JR& KATHLEEN TRS Contractor Name: NICHOLAS BRADY Framing: 1 Address: 595 MAIN STREET Contractor License: CS-108927 2 HYANNIS, MA 02601 Est; Project Cost: $ 2,000.00 Chimney: Description: replace existing rotted eliptical window with an all vngy new Permit Fee: $ 160.00 construction window Insulation: Fee Paid: $ 160.00 Project Review Req: Date: 11/20/2017 Final: f Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythis permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 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: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: � tt♦E AppIieatioa rr,� �J �....y�.:.�..:?...-...�............................... o� � Pecmrt Fee..............L6 ..............other Fee........................ MASS. 145 p Total Fee Paid TOWN OF BARNSTABLE / J BUILDING PERMIT Permit Appi oval by... ........................on.... Map........................................�.................... APPLICATION Section 1 -Owners Information and Project Location Project Address -� i S y' T e � Owners Name �D,+, � � e, r i PiS W o Owners Legal Address 8 V Ldl!4±C'i n Yz City a6 L 11► s State MA- Zip (D4 41 Owners Cell# E-mail Section 2—Structural Use ❑ Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet Section 3—Type of Permit ❑ New Construction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire.Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify L-)2Q, w i toLe w Section 4—Detail Cost of Proposed Construction, -o p Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated.10/2017 - j i Section 5 -Work Description { - .�. �.�� Re- �� �( �P�� V►hd Q w w r`�-h gym, �,t a Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage . ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ET Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal Municipal ❑ On Site Historic District ] Hyannis Historic District ❑ Old Kings HigJNo y Debris Disposal Facility:11 fl lJ TY1,� I am using a crane C Yes Section 7—Flood Zone Flood Zone Designation J Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) j Setbacks Front Yard Required Proposed l Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No Lscupdatc&IInt2017 r Section 9—Construction Supervisor Name /y i Gh�D�r�S f1`r�.Q�Nl/ Telephone Number So 3 6 41-- $ Address g�f Co PTg.,l N P h e City uth Va rN hState Zip o"G C License Number a—lo Ss 1)--7 License Type 1 Expiration Date Contractors Emall tip e `�6 q�C01r'1.�,�t F� f- Cell# A 6(f-S 3 11 I understand my responsibilities under the rules and regulations for Licensed Construction Supe-visor in accordance with 780 CMR the Massachusetts State Building Code. I understand the constr'yct'on inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Baunstabl t#ach a copy of your license. 'E Signatme Qlzz i Daze Section 10—Home Improvement Contractor Name N`LLJOS lot ' „4.p.y/ Telephone Number 50-1 364-53 7 Address 91f UnPtaa VUAej lef^'f CitySCv-t�Vol f h.uUt 11 State MJ� — Zip 69,J6 C� Registration Number 3 Expiration Daze -Vo I understand my responsibilities under the rules and regulations for Home Improvement Contractors m accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation requited by 780 CMR and the Town of B le.Attach a copy of your FLI.C... r Signature _ 10 Daze 7 Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CUR and the Town of Barnstable. a Signature Date r APPLICANT SIGNATURE Signature Date Print Name A.1 i.�,S Telephone Number 'jd� —�64:13 12 E-mail permit to: G p'h?���% (A, f{- Last updated:1117r2017 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ r Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire depwftent for approval Section 13— Owner's Authorization I, L � lei in, ( '1 rV AS , as Owner of the subject property hereby authorize OC4 ix J to.act on my behalf, in all matters relative to work authorized by th&building permit application for: (Addy s of job) 6271, - - Signature o er - to -L ir Print Name I Last updated:11/7/2017 f Massachusetts Department of Public Safety I Board of Building'Regulations and.Standards License: CS-108927 Construction Supervisor _1 NICHOLAS BRADY \ 84 CAPTAIN WEILERO SOUTH YARMOUTH,IN'. Cnn ,, -- n A Expiration: Commissioner O7/17l2019 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters).of enclosed space. - Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation, DPS Li of this license.censin g information visit; VvVM•PdASS.GOYIDPS r the Commonwealth of M arsWI MM s Depatonext of In�4cci 1 Congress S3tree,Sttite.3B0 . Workers'CompeusWon Insuurance Affidavit Ceaeral Businesses. TD ST FHZD WITH THE PMETTING AIITEK)RTTY. Anylicant Information -Please Print Le II" Business/Organization Name' Address: City/State/Zip: Phone#: �jg$ Are you an employer?Check the appropriate box: Business Type(requirad): 1.❑ I am a employer with employees(full and/ 5. ❑Retail �[ or parmime).' 6. []Restacuant/BanSating Establishment 2.10 I.am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any opacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c.152,§1(4),and we have 10.[]Menn'aataring no employees..[M workers'romp.insurance requIred] . 1LQ I Care 4.❑ We are a non-profit cm,sty by volunteers, - •wrt�i�no en�aloyees.[No workers'�P,msu�cei?eq.] � � :•• - - •Any8W#eant.that checks bmc#1.=st 6"M mtthe seddwbd'o*ftrwingtibi.vwW. saM apaticy iaaamatfam. "the coT=ft officas tiaye==aid tbemsglves,batrtz awpandmho other emptoyee,•a�rcu�eas'odmipeirsgticm�liey is n end each an osgadndon shmad chackbox#I: I mn an employer that 1s providing workers'compensationi InsurizaceforoW erapIrrpees. Below is Ehe pa�ey i jennu$aa. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure ooverage as required cinder Section 25A of MOL 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 ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of thus statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebyy c�a f under thepains andpenddes of pedgry that the information provided above is true and correct Sienature�I "9�y Date: Phone# OfjIcial use only. Do not write in this area,tobit compl by."City ertawn official City or Town: Permit/Lkae# Issuing Authority(circle one): 1.Board of-Health 2.IW9& ,D0Mtrssrt.3.•City/T6wn Clark 4.I;,fcensing.-Bo ti°d•s.Selectmen's Office 6.Other Contact Person: Phone#: www.scML3D 4rM Information and Instructions Massachusetts General Laws chaps 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an gaplayee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An epleyer 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 them three apt and who resides therein,or the occupant of the dwelling house of another who employs persons to do mice,suction or repair work on such dwelling house or on the grounds or building 11 thereto shall not bec anse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"a0ary state or local agency sW withhold*issaanee or' renewal of a Nome or pert b epera#e a btrsiness4w to constrict`. ulldinga in the.eommezwalth for any applicant who has-not piodac ed acceptable 6Mehne d cRmp&mc—c- vith-the insurance coverage regirired a =' Additionally,MGL chapter 152,§25CM states"Neither thacommonwealth nor any wits political subdivisiems shall* . enter into any contract for the pm fmmance of public work u dil acceptable evidence of compliance with the insa ance requirements of this chapter have been presented to the'coatractkj sidhority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your m ance company's name,address and phone number along with a certificate-of insurance. Limited Liability Companies(L LQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cry 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 fbr confirmation of insu ence coverage. Also be sure to sign and date the affidavit. The affidavit shDald be retarned 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 JM out in the event.1he Office of lnvestigations has to contact you regarding the applicant. Please be sure to fill is the.penniti!license number whiclz.yq be used agiz6fereiu:e number.d#ddi#cn,an appliani drat must submit multiple permit/licene appiiiioas in ady giver year,'need'only sukimit one affidavit:inclicatingturrent polky informa#ion.(if rie ). A cop�rditlie:affii t �been offi•c�allystamptd'or maiked-tiyth6 city orto�ari maybe provided to the applicant as pioof diat:a vAd•affidisvk is oa'filt for f nitre"permit ior gceases... new sffidavrt . must be filled out escli yew.Where a'.homd dwnpr or iS:ObtBIIIing.a license or permit not-related td any business or commercial venture(re.a dug license or permit to buin leaves etc.)said person is NOT required to complete this- affidavit The Department's address,telephone and fart number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston,MA 02114-2017 Tel.#617-7274900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 www.rnass.gov/dia Form Revised M-23-1$ �, ® DATE(MWDDIYYYY) .4COJev CERTIFICATE O1F LIABILITY INSURANCE �./ 1 10/25/2017 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Heidi Wellman NAME: Risk Strategies Company PHONE " (781)986-4400 NC No:(781)963-4420 15 Pacella Park Drive AIL ADDRESS:hwellman@risk-strategies.com Spite 240 INSURERS)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERAAIM Mutual Insurance Company INSURED INSURER B: A I Enterprises Inc INSURERC: P. O Box 2056 INSURER D: INSURER E COtuit MA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1772439565 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A POLICY NUMBER MWDDDLSUBR ICDfYEYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F—IOCCUR A D PREMISSES Ea occurrence $ i MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JE OT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS ' (Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIEDRETENTION $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY P OFFICER(MEMBER EXARLUDE�D'>XECUnVE N�N 1 A E.L.EACH ACCIDENT $ 500,000 A (Mandatory in NH) TACC-500-5017622-2017A 7/18/2017 7/18/2018 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE R Ins. Brokerage/HEIW 1 .. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rent anti TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma %� 7 Parcel Applicati P on l` f �IJv Health Division Date Issued Ll Conservation Division Application Fe > p Planning Dept. Permit Fee ( 7-.5 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Villagele 1�6 Owner Address C;,V7-vL7�- Telephone Permit Request ��� �- / �(� /f�C. /r�T[dY�©2 �'7ti/ % y��► �� Square feet: 1 st floor: existing6 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4�5V,4Cl�"wConstruction Type/�'`'f,6 Lot Size © � � s Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Z" Two Family ❑ Multi-Family (# ,_nits) Age of Existing Structure �`�� AK • Historic House: 2 es ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: m'Full U-6rawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) /2-o 46 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing - new Total Room Count (not including bath--,): existing new First Floor Room Count Heat Type and Fuel: A Gas ❑ Oil ❑ Electric ❑ Other s f,�i ,f/,-;c r' Central Air: W'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes gNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: (existing ❑ new sizO�60 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# a C) Current Use Proposed Use '= APPLICANT INFORMATION _ , - (BUILDER OR HOMEOWNER) Name Telephone Number 4W% Address License # G,5-�S��S 7 C0/�,T, A/X 49� 9 Home Improvement Contractor# Worker's Compensation # //J���CoM7�fa'�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ✓- DATE 3�a/ ' f I..a FOR OFFICIAL USE ONLY '4 APPLICATION# !a DATE ISSUED MAP/PARCEL NO. ,w ' ADDRESS VILLAGE OWNER ` # DATE OF INSPECTION: FOUNDATION t FRAME Y11012 INSULATION D V `t E FIREPLACE y e ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } GAS: ROUGH FINAL ? FINAL BUILDING D ?.a o DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth ofMassachusetts Department of lndustrial Accidents Office of Investigations 600 Washington Street . Boston,MA 02111 - wwwmass gov/diu Workers' Compensation Insurance-Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): �� GS'Z//� �Qi/�rS! �-/✓� Address: 27� City/State/Zip: 1411-0.2 Phone.#: Are you an employer? Check the appropriate box: Type of project(required):. 1 XI am a employer with 4. .❑ I am a general contractor and I. employees(full and/or part time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a'sole proprietor or partner- IL d ou the'attached sheet 7. Remodeling ship and have no employees These sub-contcactors`have "8, ❑Demolition working forme in any capacity: employees and have workers' [No workers comp.insurance comp.tnSrrrance 9. ❑Building addition ❑ We are a corporation and its 10.❑Electrical�epaus or additions required-] 5. officers have exercised their i 1. Plumbin repairs or additions.. 3.❑ I am a homeowner doing all work � `❑ g P Myself. [No workers' comp. right of exemption per MGL a - 12:❑Roof repairs ` insurance required.]t c. 152,§1(4),and we have no employees.[No workers' . 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill 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 entitics have ` 4 employees. if the sub-contactors have employees,they must providb their workers'comp.policy number.. ` 'I aria an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: C:k.�'cJ /�•/G��� d'�— rJJ(� Ci�+��' Policy#or Self-ins.Lic.#: U1✓'d2e7/Y-7ZIa Expiration Date: Job Site Address: 5 '� City/State/Zip: 1/ZGd�lLji� Attach a 'copy of the workers compensation policy declaration page(showing the policy number an expiration date). P ' d gP . . 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 u the pain •an penalties of perjury that the information provided abov is true d correc>: /✓ S• e• ii�, . � D vz Date: ./r tar . `yam Phone Okrad 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#: Rightfax N1-1 2/27/2013 5 : 49: 58 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(r�M/DD/Y1rYv� T d TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HORGAN INS AGCY INC PHONE FAX PO BOX 250 (A/C,No,Ezt): (AIC,No): E-MAIL HYAN IS,MA 02601 ADDRESS: 28XBF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: CONTINENTAL CASUALTY COMPANY A I ENTERPRISES INC INSURER B: INSURER C: INSURER D: PO BOX 2056 INSURER E: COTUIT,MA 02635 • INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY- . ° PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MIMOD\YYYY) (MmDD1YYYY) LIMITS , GENERAL LIABILITY aACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY, DAMAGE TO RENTED CLAIMS MADE OCCUR. REMISES(Ea occurrence) f ED EXP(Any one person) $ ERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER' EPIERAL AGGREGATE $ POLICY ❑PROJECT ❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ 1 DEDUCTIBLE $ t RETENTION $ A WORKER'S COMPENSATION AND x wC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-0270M742-12 07/18/2012 07/18/2013 LIMITS ANY PROPER ITOR/PARTNER/EXE CUT IVE N N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED 7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ° DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $': "`500,000.` - DESCRIPTION OF OPERATION S/LOCATIONS/VEHIGLESIRESTRIGTIONS/SPECIAL ITEMS - -y THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WOR1,ERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 MAIN ST BEFORE TH EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORD E WITH THE POLICY PR0181ON . AUTHOR E R RESENTATIVE jr HYANNIS,MA 02601 - .;. i,� •'.. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rig eserved.; t DaIHET - Town of Barnstable Regulatory Services &UNSTABLE9 $ Thomas F.Geiler,Director 039. �m 'OrFn,,,�,�► Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax:.508-790-6230 Property Owner Must Complete and Sign.This Section `If Using A Builder as Owner of the subject property hereby authorize � ��- Z>t4E to act on my rbehalf, in all matters relative to work authorized by this building permit (Address of Job) *Pool fences and alarms are the responsibility of the applicant.`- Pools are not to be filled or utilized'before fence is installed and all final} v inspections are performed and accepted. Signature of Owner Signature of Applicant Aue-m AC4,44 /ETA Print Name Print Name r . 2Ix + 13 Dat Q:FORMS:OWNERPEFMISSIONPOOLS 6/2012 Town. of Barnstable . �,. Regulatory Services * &ARNSrasc.E. Thomas F.Geiler,Director MASS. 639. Building Division . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sic units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building pemut (Section 109.1.ly- The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department ;n;mum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner tn, Approval of Building Official " t Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. - HOMEOWNER'S EXEMPTION. F The Code states that: "Any homeowner performing work for which a building pemlot' gdirt "hall be<g pmpt�,o0tWp4�s of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the h' ..11 engages a}4erson(S? h re't�o such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly 5 when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it,%p jd with,a hsewnsed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the ermit',application that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form curi4ntly used bX several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r .._ Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-050457 I IN PETER M POMET TI PO BOX 2056 . COTUIT MA 026:35 I'. .. Expiration 04/19/2014 • j commissioner. • Ulae�porrurrcaruaetc`C�a��laaaac�ccaeG� Office of Consumer Affairs&Busi ess Regulation License or registration valid for tndividul use only OME IMPROVEMENT CONTRACTOR' before the expiration date. If found return to: egistration ,1'09606 Type: ; ~' Office of Consumer Affairs and Business Regulation Y xpiration 9/21/2614 Private:Corporatiw'i 10 Park Plaza-Suite 5170 �- rr• Boston,MA 02116 -A I ENTERPRISES I'NC PETER PC METTI €� x� 140 LITTLE RIVER RD ' r COTUIT, MA 02635 Undersecretary " Not valid without signature . L - l1 - z CARBON MONOXIDE � F�@ MUST BE iNSTA.LLEIy F'=ry" � - '- MASSACHUSETIS1kl Dn'_.C."d: ----- zE 3 �SMOKE DETECTORS REVIEWED , I I 1 < BARNSTABLE BUILDING DEPT. DATE CLOS LIVING ROOM BEDROOM FIRE DEPARTMENT DATE - I I I I I BOTH SIGNATURES ARE REQUIRED FOR PERMITTING SITn NG RM. e BATH. DINING ROOM BATH --- ---- e I C❑9 L---- .. I O MUD RM. LOFT O 11 CuiJ LAUN Z I , wu um omrtr.as . ie m�ro ma.wu,. KITCHEN ` WALK-IN CLDS. U--- SCRE FOUNDATION PLAN emaooMBmRooM 2 O F EC OENED IN PORCH DECK W MUDROOM ,.+�. �e+ir - - . ROOF DECK W a m.omuva wu. Z• --- - : D- C: 00 swruromanmr - - - - r Z S LL `llST/l.0 g W n CROSS SECTION FIRST FLOOR PLAN SECOND FLOOR PLAN 61 :8 INi S1 i 'i EV jo . l7 $ 3 ® ® ® — FE REAR ELEVATION 4 LEFT SIDE ELEVATION Q z C H V a z 17 o: W a t7� W° O PulMEE __— W tl w SRFIG 5[PIa1 FRONT ELEVATION RIGHT SIDE ELEVATION 7 - 2 47 Tp f t FOR OFFICIAL USE ONLY i e APPLICATION# I DATE ISSUED } i MAP/PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: E. -FOUNDATION { FRAME ,i "t -INSULATION: x FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: 1 ROUGH, FINAL- -FINAL BUILDING — DAT..E CLOSED OUT y• ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 03 7 Parcel 0/S Application #€0o/,Z®6, Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation /Hyannis Project Street Address J J` VWMN SZ� Village Owner TN&&FSR EC71q/U Address P O L70 6 y a G®rveT Telephone Permit Request t/"1a-rLIayt aLrT'�vN o i- S11f2rFA0c1< T 1/U S u L/+T?o PtJ 7 A r w%_ /}ivd FGvo tZ i rV C, t) v E 1'O ri A Er t- (c,,g- 7'&W— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District F Flood Plain Groundwater Overlay ?O 0 O ®o Project Valuation Construction Type ��' � Lot Size Li 6 Ae01 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure I q 3 Historic House: ❑Yes X No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing a new Half: existing new Number of Bedrooms: q existing _new 1� Total Room Count (not including baths): existing ?, new First Floor Room Count T Heat Type and Fuel: *Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ***No Fireplaces: Existing A- New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name o-A "o,�.1_1rJ Telephone Number S�� 60 19l Address 1 as P30A (� BR.(�s rcyV License # CS - 07 V 2 a S� ke7--r6r A-`jPN s-muCe-e3 — Home Improvement Contractor# 49 9 a y - 30l i-7 T Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO K I ,o wz Ler� SIGNATURE_� �`�`' U DATE J �-\ The Commonwealth of Massachusetts Department of-Industrial Accidents 0 Office of Invesiig,tions 600lCashing1on Silreet Boston, MA 02111 www.mass.gov/dit, Workers' Compensation Insurance Affidavit: Builders/Clntractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/tndividual):Whalen Restoration Services Address: 22AmPriea.n wad _ -- City/State/Zip: Dennig- Phone #: 508 760 1911 Are you an employer?Check the appropriate box: Type of project{required): 1.® 1 am a employer with 25 4.' ❑ I am a general contractor and 1 employees(full and/or pan-time). * have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7. ❑ Remodeling shipand have no employees These sub-contractors have 3. ❑ 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.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGI. 12 ❑ Roof repairs insurance required.] r c. 152, §'1(4), and we have no employees. [No workers' 13-0 Other comp. insurance required.] 'Anv applicantthat checks box N 1 must also till out the section below showi,ni their compensation policv information. t Homcowners who submit this affidavit indicating they are doing all work and then hire out de contractors must submit a new aff idavit indicating such. Contractors that check this box must attached an additional sheet the name elf she sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees;they must provide their workers'.comp.policypnumber. 1 am an employer that is providing workers'connpensatioin nisuraince for my employees. Below is the police and job site information. Insurance Company Name: Arbella Policy.4 or Self-ins. Lic: 9091320411 Expiration Date: 4/1/13 Job Site Address:_55~a f1k<4 5 r Cit y/State/Zi � p:_ e d ry r l 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 tine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of 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 Off ice of Investigations of the DIA for insurance coverage verification. a 1 do hereby certify under the pains and penalties of perjury that the innformationn provided above is true and correct. Si,-,nature: Date: _13 Phone#: 508 760 .1911 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#: (:Theresa Cahalane-Norkus To:Ronnie Gutowski, Whalen Restoration Services, I (1508768M) 08:50 01/10/13 EST Pg 2-2 Client#:245206 WHALENREST ACORD,. CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYVYI)111012013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: HUB International New England . HUB International New England PHONE 508-945-0446 FAX 508-945 9136 AIC No Exl: AIC No 265 Orleans Road EMAIL Aooaess: North Chatham,MA 02650 508 945-0446 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Arbella Protection Ins Co. INSURED INSURER B: Whalen Restoration Services Inc.; IN6URERC: Whalen Services Inc. INSURERD: 22 American Way South Dennis,MA 02660 INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED;OR MAY.PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIODIYYY A GENERAL LIABILITY 8500040398 D410112012 04101/20U EACH OCCURRENCE' $11,000,000 X COMMERCIAL GENERAL LIABILITY - PREMISESOE®ocicu'en.) n. $100 000 . CLAIMS-MADE D OCCUR MED EXP(Any one person) $5 000 PERSONAL&AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOPAGG $2,000,000 POLICY PE 0 LOC $ A AUTOMOBILE LIABILITY 58243400004 410112012 04/01/201 (CEO,e'C10eOtSINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X .SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AlIT05 X NON-OWNED PROPERTY DAMAGE $ AUTOS ` Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS'LIAB CLAIMS-MADE AGGREGATE $ ' DED RETENTION$ $ A WORKERS COMPENSATION 9091320411 410112012 04/01/201 WC sTATu. OTH- AND EMPLOYERS'LIABILITY TORY IMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $500 000 OFPCERIMEMBEREXCLUDED? a NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under - DESCRIPTION OF OPERATIONS beIDW E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - RE: 552 Main Street,Cotuit,MA 02635 CERTIFICATE HOLDER CANCELLATION Theresa Egan SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 552 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Cotuit,MA 02635 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S848979IM703151 TC002 4f I 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-i or v License: CS-074928 W 1LLUM WHALEN "�" .122 POND STREET BREWSTER MA70263 ' Expiration Commissioner 08/16/2014 I Consumer mer Affairs e Business Regulation 4 License or registration valid for individul use only _�.. Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR before4he expiration date. If found return to: 0 egistration: 129244 Type: Office of Consumer Affairs aud'Business Regulation 10 Park Plaza-Suite 5170 - xpiration 7/30/2011 Private Corporat"' Boston,MA 02116 . Whalen Restoration Services I no. William Whale n 22 American Way South Dennis,MA 02660 Undersecretary Not valid without signature I �a s Restoration Services Inc. .a Fire, Smoke, Soot,Water Damage&Mold Remediation Services Cleaning Deodorization Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and`Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work at property located at S 1— 60 r-U/T to repair damage caused by 6i 2,5' on As owner(s) of this property; I (we) understand that J (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for .payment upon completion. (we) authorize nd direct my Insurance Company Policy No. 01 to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists;'for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. 1 (we) acknowledge receipt of a.copy hereof: : tl/0 3 OWNER DATED # SI OWNER WHALEN RESTORA ION REP. SIGNED 22 American Way,South Dennis,MA 02660 Phone: (508)760-191 Fax: (508)760-9995 • t-800-244-2598•E-Mail:-restore@whalenrestorations.com. Web Page: http://www.whalenrestorations.com OFFICE COPY TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 9 Parcel Application # Zo(o � I Health Division Date Issuer I C O Conservation Division '. Application Fee Planning Dept. ,Permit Fee Date Definitive Plan Approved by Planning Board s to Historic - OKH _ Preservation/ Hyannis � L Project Street Addressi� ` Village Owner Address Telephone SY � Permit Request % G t�KJ��dOz :;, % G✓/� �J�/�, �-IJ,� '� ;C�-�+/�5 :i7D ,G— i✓i�/'�'�e'�-�itx�G2 S.quare feet: 1 st floor: existing/proposed M 2nd,floor: existing/000 proposed/DOV Total new o Zoning District Flood Plain Groundwater Overlay Project Valuation%✓�i o®o Construction Type 11� xie Lot Size o Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 147YO . Historic House: 6dYes ❑ No On Old King's Highway: ❑Yes W/No Basement Type: ❑ Full YCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) d Basement Unfinished Area(sq.ft) O Number of Baths: Full: existing new ® Half: existing O new Number of Bedrooms: J existing t newi��fs Total Room Count (not including baths): existing- new First Floor Room Count Heat Type and Fuel: lGas ❑ Oil ❑ Electric ❑ Other i Central Air: Af Yes ❑ No Fireplaces: Existing / New 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 ❑ Commercial ❑Yes ❑ No If yes, site plan review# � s: Current Use Proposed Use Flo u APPLICANT INFORMATION Cl (BUILDER OR HOMEOWNER) A6TZ-Z Names � ' �'����. �° Telephone Number �" �" � Address PAX License # �Ol21��i Home Improvement Contractor# Worker's Compensation # 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t ; i ; r y FOR OFFICIAL USE ONLY r APPLICATION# _DATE'ISSUED -:_MAP:/,PARCEL N0. . _. t ADDRESSi VILLAGE OWNER DATE OF INSPECTION: FRAME rG G , f LA�1NSULATIONJ,- ` FIREPLACE ELECTRICAL: ROUGH FINAL - } 1 PLUMBING: ROUGH FINAL e OAS: GC-lF: TROUGH -R�,T + FINAL c ,�sz¢FI:NWBUILDINGM lto'��RLirc,�� ly/Ihh o cet o v Fr1e.Z't� �T oN Pc,nw —pro �e-sk�Gcyl'SS. �p DATE'CL'OSED..OUT ,_..e; r ASSOCIATION PLAN NO.. s \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i-. 600.Washington Street _i Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Build.ers/Contractors/Electricians/Plumbers Applicant Information Please Print Lellibly Name (Business/Organization/Individual):,� iU� "'.�.Q/ � 4E;nx' Address: �C� /�jC '2cJS� City/State/Zip: 0(07VG7- IW* 0Uo;X' Phone #: 4629 4A0~ 4A111 Are you an employer?Check the appropriate box: Type of project(required): l. I am a employer with 4. ❑ I am a general contractor and-I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner listed on the`attached sheet. $ 7. Wemodeling ship and have no employees These sub-contractors have 8. ❑,Demolition working for me in any capacity. . workers' comp. insurance, 9. ❑ Building addition 5. ❑ We are a corporation and its No workers comp.'insurance rP [ 10.❑ Electrical repairs or additions required.] � officers have exercised their 3:❑ I am a homeowner doing all work right of exemption per MG.L l l-El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' t comp. insurance required.]_ 13.❑Other *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 ate 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �� C Policy#or Self-ins. Lic. #: $ ��� r�Z��,c1 �a"�® Expiration Date: Job Site Address: � City/State/Zip: ©�Ul 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 and a pains penalties of perjury that the information provided above is true and correct. Signature: L Date: Phone#: l �(,� U 'l�L� f 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#: 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 not produced 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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.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 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia Town of_Bar-a-stable ,Y Regulatory.Services y u�ss Thomas F. Geiler,Director ;. Building Division . Tom Perry, Building Commissioner .200 Main Street, Hyannis, MA 02601 www.town.b arnstab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must 3 Complete and Sign-This Section IfUsin_g ABuilder` r, 1z 5A A k 4�4d , as Owner of the subject property_ hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application,for ; (Address of job) Signature of Owner. Date' Print Name If Property Owner is applying for permit please complete the;" Homeowners License Exemption Form on the reverse side.' Q:FORMS:O WNER 1ERMISSION 1 j woe Y�try Town of Barnstable • o Regulatory Services t" SrAB Thomas R Geiler, Director '"rFo µay a ,�� Building Division Tom Perry, Building Commissioner 200 Main-Street, Hyannis, MA.02601 www.town.barnstable.ma.us Office: S08-862-4039 Fax: 508-790-6230 HOl\,EEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phanc# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellinlrs of six units or less and to allow homeowners to engage an individual for hire wvfiri 4dMs"nbt posse's "cei?se p d that the owner acts as supervisor. DEFIJA'ITTON OF HONQ-MWNER Persoa(s)who owns a parcel of land on which he/she resides or intends•to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department . rninimum.inspection procedures and requirements and that he/she will comply with said pmcedure:l.and requirements. ,r�,� '.. .� ��},fix•_,, •.w Signature of Homeowner Approval of Building Official Note: Three-family dwelliags-containiag 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constriction ControI.. HOMEOWNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building pcmvt is required shall be exempt from the provisions of this scction.(scctivn 109.1.1 -Licensing of construction Supernrisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rulcs&Regulations for Licensing Construction Super re Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fonnlccr-bfication for use in your community. Q:forms:homccxcrnpt r x-aR-o� ,ram ACCRD. CERTIFICATE OF LIABILITY INSURANCE DATE(MU/DD(YYYY) NM902010 TRIM WITIFICATE 15ISSUMO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CEItTF CATS DOESAOTAFRRMAMVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tfff93 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR FWDUCIK AND THE CERTIFICATE MOLDER. INPORIANT:If the oertHiaate Iloldsr to an ADD11fONA1.INSU RED,the podoy(iss)must be srmlorsed. If SUBROGATION IS WAIVED,sub)oot tc the tsrrree acd oondHiom of fhs poloy,owbM FoOcim msy requim and andormmsnt A statement on We certlUosts does not oonfw rights to tho 5 cerllflob hoMw In Isu of such ems), PROClt CONTACT NAME: PHONE FAX HORGAN INS AGCY INC (IVC,No,Ext): FAX (AIC,Mop 44 BARNSTABIE RD B E-MAIL ADDRESS: PO BOX 2*-. PRODUCER HYARNIS,MA 02601 CUSTOMER lbNI: 28XBF INSURCR(S)AFFORDING COVERAGE NAIC4 INSURED INSURER A. CONTINENTAL CASUALTY COMPANY INSURER 9: A I ENTERPRISES INC INSURER C: INSURER D: PO BOX 2056 INSURER E: COTUIT,MA 02635 INSURER F. COVERAGES L'ERTIRCATE NUMBER:. REVISION NUMBER:. THS M TOCOMFY THAT TH EVOLXM OF MMANCE LWb BELOW'HAVE ob*lgsM TO IM MM NAMED ABOVE FOIE THE IAGWY PERIOD wo"TEIL. NDTWffWANDW ANY RSOIMMME Mr TERM OR CONDMT M OF ANY OONTRACT OR OTHER OOCtOW WITH REBPECT TO WIACH THB CERTIFICATE MAYBE ISWW OR MAY PERTAIL THE xMIIRANCE AFFORDED BY THE POWES DESCRIBED HEREN III BUBJECTTO ALL THE TERMS,ECCLUBIOHB AWN CdNDIfTONB CIF&NCH POJCIEL LIMITS SHMN WAY HAVE BEEN REDUCED BY PAID CLAIML s R POLICYA"...9ATIi,COLIC PW GATE. TYPEOFMBtAtANCE ..'i ?" c Aq lf�I;l1G(YYYY) 1 Y 7 LYTS LTR GOdERAL W1B11�TY ;r. t'r' R. ar,ra rtr,. a,;;:.. ( :COMMERCIA(GEJLUAB1LIfY TrA EACH OCCURRENCE $ DAMAGE I Q RENTED CLAIMSMAOE- OCCUR. ' PREMISES(Ea occumonoa) :..:. MED EXP(Any ono Perron) $ . . .PERSONAL$$'ADV INJURY $ GE?NI.'AGGREGAT'E LIMITAPPLIES PERM' GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMPIOP AGO $ AUTOMDDLE LIABIITY COMBINED SNVGLE $ ANYAUTn tJM1T(Ea aaddent) ALL OYVHED AUTOS `SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS; . (Per person) BODILY INJURY $ .r::er.... . (PeraWdm t) - I�[OiV{1WNEDALfTOS PROPERTY DAMAGE $ (Per aadd-9 UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENFlON$ E. WOEKER'S OOMPENSATION AND we sTATuroRv uLxTs OTHER. EMPLOYER'S LIABILITY YIN UB-M76M742-10_ O71i8P1Q10 07118 011 E.L.EACH ACCIDENT $ 500,000 ANY PROPERIIUWR� N E.L.DISEASE-EA EMPLOYEE $ 500.000 OFFWASR MUBER ExCLU)®9 ;,;.c iyes�d�smribs0. tL-DISEASE POLICYLor $ 50%000 DESCRIP�1011 DESORIPTION OF OPERA !TK1WS/L OCATJONS/VEHICLESI WMIC71ONS1SPEC1AL ITEMS TI[!S REPLACES ANY PRIOR CMtT[FICATE LSSUBIT6 TNEtMTIPICATENOLDER APAECIIINO WORK W COMP COVIMAOR CERTIRCATE HOLDER CANCELLATION ' DENNIS.Bt SUSAN AUSIELI,A SHOULD ANY OF THE ABOVE DESCRINED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF;NOTICE WILL BE DELIVERED IN ACCORDANCE 80 CROSS'ST WITH THE POLICY PROVISIONS.' �::• AUTHORIZED REPRESENTATIVE COTUM MA 02635 Dennis Chookaszis I ACORD ZS . . .. 19ti X09'ACORD CORPORATION. Ali rights reserved. ); UI00?'�Og�IIgl��?1i.III 4 : Niassachus�tt5 D(pa`rt at nns and Standards Board Of Bu►Id+n�ReI , ' Co struction Supervisor License n. , License.: CS 50457. Restricted to'. 00 PETER M POMETTI. r _. PO BOX 2056 COTUIT, MA 02635 Expiration: 4/19/2012 21436 ('uminisiuner Office onsumer , ``" HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only. x Registration 109606 before the expiration date. If found return to: Expiration: 9/212012 Type' Office of Consumer Affairs and Business Regulation Private Corporation 10 Park Plaza-Suite 5170 A ERPRISES INCH = Boston,MA02116 PETER POMETTI k 14a LITTLE RIVER i= COTUIT,MA 02635 Undersecretary Not valid without signature O • >m N c I I I - - CLOS r � U � ^ W II t BEDROOM LIVING ROOM I 1 1 ' C Q I ' uqy SITTING RM. DINING ROOM s BAT BATH LOFr $ _ _ MUD RM. ------------- i Y _I'r' : WALK IN CLOS. ol ca IIw.n o F _ _ ''-- s gg O © KITCHEN u a' '� .. S- BEDROOM • Q' r ' r� . BEDROOM m •r .m„.xe - .. d r r.a ., g O BATH � �• E nF II 0 W, a;. — R Z— s 4 SCREENED IN PORCH DECK r _ O '- F ROOF DECK �.F I IMPORTANT ° •� �°"' ANY CONSTRUCTION THAT INCREASES LIVING.SPACE �y BEYOND 1200 SQ.FT.PER LEVEL MAY REQUIRE THE Z INSTALLATION OF ADDITIONAL SMOKE DETECTORS. r NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE a' 0- INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL a 0 'a PERMIT DOES NOT SATISFY THIS REQUIREMENT. n 0 W LL FIRST FLOOR PLAN SECOND FLOOR PLAN u..l'a v.•.r'r ore:,,,o�,m,o �r.u.. -:• �� xev,w,� DRAWING a: Al - 4 e% o L[ of = t CRAWL SPACE C k N y u m pI t<o it I Q -------------- I 1 m m -----` 1 nary�Ero.a. W I an°nor,uuwer.�u ee..'o 1 _ ' �,rm..�,•m.�.�.w 1 1---- 4 I 'I v .enmrm,wowrxw.ev.eu•.°.e.ee,rr. $_ . B EwsnNG aooF I r e'-lv c.la eouu z•x /`t�"�r' r---- II El(IGTING EFEF To sEc,a[EOF¢u[0-.T.T R..S ROOF E%STING ROOF ' -FOUNDATION PLAN D MAL Art� — — rumuuv O I I 13w , I I Sa 1 nuuw,w rtNndexixo.m - - nr.nmOm.no.eroauw• n .. - artewxISO . e—TINGROOF '� �R a g e,annuc arson[ cr.lmo e R z E - UMTIW a.z SECOND ROOF JOISTS 0 W O.C.TO REWIN Lu a ui Q o K je EI p• LL O SECOND FLOOR FRAMING PLAN = IS NEW axe ROOF RMTERS®1CO.C. 3 I/d'=1'O' 0 O ROOF FRAMING PLAN wo,ra... N. s< E -TED , A2 - 4 ,r mB o f DIo ' wra u5un rwm� ® ••"r U omR- F E DFOE NEw Roof DfcR e+.row e5- . it I g I ,�i,.aro k . REAR ELEVATION LEFT SIDE ELEVATION " I Ire . Y i I le- Qu NFw SHED DORMER ' 1 1 cNmmey - ' I 1 I wra...xRxrRwroR�Rx. W U a s u ri-Ip 2 W = o H u .wm,D.wavu5 W 1- Of! Ell' 5 0 ® © �' r 1. aroN.rN a W . LLI RIGHT SIDE ELEVATION NOTED vr.ro DRAWSNG P. A3 - 4 =ems l MI R 5" - • I 11 1 1 - II I o.m h.-W - cv uxomowlms umm•e�! �avwz N .ov=s x.c <. �z.m LOFT ` rw/x wu.rcancva ,� BEDROOM r�mx vu.•vc.vnrw . w o.c sF^t� Ate wumwzs mewrnnc l =comnow \ •coxoaoa•H.a xwee I §� Bco.c Wrar•eonau /-gx'�4 ��`.\'� ncam��\\ \\\\N .mm,.w•�,a o - - - ItITCHEN SCREENED IN PORCH Sz SECTION THRU NEW SIDE SHED DORMERS ST f� \ CRAWL SPACE yg ceu0 o.c r���t/ 13'-i0 SECTION THRU NEW REAR DORMER&SCREENED IN PORCH- .t ..Lu \ Z WINDOW&EXTERIOR DOOR SCHEDULE W_ ;....� aEY R FEHWG W•H I1EHc eTVtf - _ w Q F W _ J A ® s mas. © W� LU o W Z M 1 O Q e H INTERIOR DOOR SCHEDULE W W m o a � IroTED = DRAWANG 0: A4 - 4 Assessor's offioe Ost floor): Assessor's map and lot number ....... .-�.�:....d�,S .,,. �QOFTNETo``� Board of Health (3rd floor): Se_ � e Permit number ..........dF.,.....l .t�Q.. ..�!?r!!4k?iQ. �n.y,ig ... � g 6 SEPTIC SYSTEM 1AUMP 'TABLE. Engineering Department (3rd floor): _ g48,TALLED IN CO �o rasa House number ......................................................................... u WITH TITLE 5 ° s639.,�e APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00 2:00 P.M. only r °�IiRON�IEN'Tp► �®�S TOWN 'OF BARN f LE S BUILDING 'INSPECTOR APPLICATION FOR PERMIT TO ..�.C!!' L►.s. ...-..��'t6V)�� B ''I � O�64............................................................................ TYPEOF CONSTRUCTION ...........WP..1D........... M f.--............ .............................................................................. 07 �!1! C ....Z ................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: -z-? ^ �,"j 'sI �?7-u �Location ...... .............. .......................j. ....... .......... ............................................................................................... Proposed Use .......S'rD/ y�- ..................................................... ............ ..................................... Zoning District ..............................................Fire District ................ � Name of Owner ...M42 L�........ } .S&.....................Address ...5',7.Z..... �`'/ C . l ............51..................eT-V........ .................... Name of-,ui er �E 79 .� J..:LJ j4fVWD.A........Address ..�J?�x...30 . } ..........�.�a.l�- .. .... . ............................ Name of Architect ......:...........................................................Address Number of Rooms ............................................... Foundation ...Cd�.lCt2 �a� P6s� ................. .. .................................................................... Exlerio. .cS ?.J.6`C. ? r .................................. ............................Roofing .................................................................................... Floors GJDD-b ..Interior -�_ Heating ............................................................................Plumbing .................................................................................. Fireplace ......... pp �� ae . ......................................................................Approximate Cost .......7� ......* Definitive Plan Approved by Planning Board ________________________________19________ - Area .:3Y.............. .................. OC Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH : a l OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ..1' '... '- ................... Construction Supervisor's License . 1 �iALr. iON, HAROLD d 0.1' 7 DEMOLISH /REBU'.iLD No ....... ...... Permit for .................................... Barn ...................................................... Location .....�. �.e;`..................... .........................C.OtUlt.............................. Owner ......Haroid j aCK .Q�?...................... Type of Construction ......Frame...................... K ............:'................................................................. Plot ............................ Lot ................................ r. Permit Granted .....Mdreh....23..............19 87 Date of Inspection ....................................19 '.......... �?y ...............19 Date Completed tr . s r Assessor's, ffioe (1st floor): 3 O`THEtO� Y Assessor's map and"lot number .......C".................... ......... �. Board of Health (3rd floor): Sewage Permit number ........... ...! .rvla Q..Igy!! 1�1� i►ti Z NAUSTSDLE, : �ineering Department (3rd floor): ( 1 '�o 1639• eta House number ...................................................... t ,�oypYd� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M: only ° TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT-TO .. Cr U�I J Jf „12 s�vl L -1 �r).?�1 S 't t 61 J„L�_✓� .......................................................................................... TYPE OF CONSTRUCTION ...........G`�U� i� �1 .f ....................................................................................................................... ...� .. r{....z3................19.V TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......SS CG-Tv 1 .............................................. .�. .......... ............................................................................................................... S'n)12A 6 f' - ProposedUse ..................... .................................................................................. .. ..................................................... Zoning District Fire District ............................ .�.,. �� ` --.............. : ...L... viName of Owner ...1GA. ...........? .........Address ....S ........ .�-j.....5. .........0 ..J................. Name of Builder ... .~....�.....`........,..`�tv�.6...........Address ../�30� ✓�?qj ......................................................... Nameof Architect .................................................................Address .................................................................................... Number of Rooms ......... :........................................Foundation C�G�JCPQ F 4`t ► O .................... ...................................... Exterior Cam ) j-Z S �'.1£� (.. ...........................Roofing ......../n�E?,Llj�. ....... ................................ . .................................... Floors lJOL}� Interior `_ Heating ........................................................................Plumbing ............. .......................... Fireplace ................. ...............................................................Approximate Cost;... .7.5� .... �... ......A. ...cy#%z Definitive Plan Approved by Planning Board _____________________19__z_ . Area ......... a . .................. Diagram of Lot and Building with- Dimensions, Fee. .:... ,...�1...0.................. SUBJECT TO APPROVAL OF BOARD OF HEALTH } v 5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... .............................................................. '• 0 Construction Supervisor's License .. t: n ...'.......... ACKSON, HAROLD A=037-015 ` No 3037 permit for .Demolish/ Rebuild ................... Barn .......................................................................... Location ...552 Main Street ................................................ Cotuit .....................................................................I......... Owner Ho 'ackso ........ ar .............ld.......................n...................... Type of Construction .......F.rame... ............................. ............................................................................... Plot ............................ Lot ................................ Permit Granted .....,March 23, ..19 87 Date of Inspection ....................................19 Date Completed .............................:........19 1 , � I Do i(./ Y -wasold m.„ `' w F eepp Commonwealth of Massachusetts Sheet-Metal Permit Map V_;"'4`Par6el Date: X-PRESS PE,RWemt#OL Estimated Job Cost: $ Permit Fee: $ APR 17 2013 Plans Submitted: YES NO Plans-Reviewed: YES NO T OWN OF N ELE Business License# Applicant License Business Information: Property Owner/Job Location Information: Name:. 6'070 In C_GLeG�/tc'C4.! Name: 77� c/ � Street: Street: City/Town: zie OL 66 b' lul City/Town:: C 1�7� a � Telephone:S��-"S SG Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES N x Staff Initial J-1/ unrestricted license J-2/.M-2-restricted to dwellings 3-stories or,less an.commercial up to-10 000 sq.ft./2-stories or less Residential: 1-2 family Multi- Condo/Townhouses Other . Commercial: Office Retail. ''' Industrial Educational Fire Dept. Approval Institutional,_ Other Square Footage: under 10,000 sq. ft. i over 10,000 sq. ft.: Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney l Vents Air Balancing Provide detailed description of work to be done: ell � 7D e— doalvU'a- !� -, I e , NSURANCE COVERAGE: - have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes V No ❑ f you have checked Y&, indicate the type of coverage by checking the appropriate box below: k liability insurance policy Other type of indemnity ❑ Bond ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Oassachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent , 3y checking this box❑, I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and iccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: y ❑ Master itle - . ❑ Master-Restricted ity/Town ❑Joumeyperson Signature of Licensee ermit# ❑Joumeyperson-Restricted License Number. y-�- Be ❑ Check at www.mass.govldpl Spector Signature of Permit Approval r - -COMMONWEALTH OF MASSA'CHUSETTS SHEET METAL WORKERS AS A MASTER—UNRESTRICTED ISSUES .THE ABOVE LICENSE TO R0. NEY N TAVANO 201 CAPES TRAIL W BARNSTABIE . MA 02668 137.3 3449 12/28/13 94294 a �OMM®WEALTH OF MASSACHUSETTS SHEET METAL WpRKERS s AIS A BUS ANOESSVE CENSETO RODNEY N .TAVANO TAVANO MECHANiCAL S YSTEMS 201 GAPES°:.TRAIL \�s �. W. BARNS TAB LE MA: 02668 00.00 s 3 233 J V 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 SEI,.OW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the eartl9cate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and ounditions or the policy,certain policies may require an endorsement.A statement on this cerilltcate does not confer rights to the certificate holder In lieu of such endorcernenl(s). PRODUCER U.N?CT Anne SanzD HUB Inl9 New England ONE .888.2244 A><. 508433-0680 c N at),508 125 Route 8A E4INLAD ES.. anne.sanzo@hubiriternationat.com Sandwich,O11A 02563 INSURER($)AFFORDING COVERAGE RAIC 508 088-2244 INSURERA,Hartford Insurance Co INSURED INSURERS:Safety Indemnity Insurance Co Tavano Mechanical Systems LLC 201 Capes Trail . INSURER : Di W Sametable,MA 02668 INSURER INBURER E INSURE P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING.ANY REQUIREMIINT, PERM 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. W R fYi'fiOfINBURAT/CE ADOLSUB POLICYNUMBER MMlDOWYfA MF 0 P LIMITS A GENERAL LIAeIIITY. 08SBMzQ6456 8/14/2012 08/1412013 GACH OCCURRENCE a 1 OOO 000 DAMAGE TO RFJJTEO COMMERCIAL GENERAL LIABILITY M S IEa accurc n e E300 O00 CLAJW-MADE ®OCCUR MEOW An onePerson) $10.000 PERSONAL&ADVNJURY 61000000 GENERAL AGGREGATE S 000 000 GEN'LAGGREGATELIMtTAPPUESPER PRODUCTS-COMPIOPAGG $1.000.000 POLICY PRO. LOC a B AUTOMOBILE LIAMLItY 6210665 812612012 05/261201 CO M9�1 aEo sINOLE uMIT ANY AUTO BODILY INJURY(Per Parton) $250,000 ALL OWNED Fv SCHEDULED BODILY INJURY(Per seddent) S500,000 AUTOS AUTOS X MAEO AUTOS X NON-OWNED PROPERTYOAnMGE a500,000 AUTOS ra d a UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR • CLAIMS-MADE AGGREGATE a DED RETENTION S a A WORKERS COMPENSATION OBWECLG5272 0611412012 01111412012 1 WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETpR/PARTNP.RIESECUTIVE YIN EL FAcm ACCIDENT $100 000 OFFICERIMEMBER QOCIUDED? ® NIA (Mandatory to NN) E.L.DISEASE.EA EMPLOY $100 000 Ir yes,daacrm under DESCRIPTION OF OPERATION8 below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach AGORD 101,Addhlonai Rememe schedule,If more apace Is required) CERTIFICATE HOLD CANCELLATION T ownOf�dTnStable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED J0. ain St ACCORDANCE WITH THE POLICY PROVISIONS. is,MA 02601 AUTHORIZED REPRESENTATIVE 01889-201 O ACORD CORPORATION.All rights oeserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S8004131M768520 AS004 r • The Cammonweah of Massachusetts Department?flndusitr a Accidents Office of Investigations. . •600 Washington Sitreet s_ Bostun,MA 02I1I www.mass.govldhz Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/plumbers .Applicant Information Plea a Print Ley Name(Baseness/Organization/Individnal):- Z, ac, City/State/Zip(_,- /� Irn:51z�1i1,---A I .Phone.#: Are you an employer? Check the appropriate bow Type of project(require;, a 1 I am a 1 -4-• I am a general contactor and T emp Oyer wnh--�� 0 6•[]New cstracfian" employees(full and/or paittimel.* ' have hired file snb=co�antoLs an 2.0 I am a•sole proprietor of partner- ;listed on the'aitached sheet 7. : Remodeling ship andhave no to es Tliese sub-c acta s have . Ye 8. ❑Demolition working for me nr any capacity, employees and have orkem'w 9 []Building addiiion [No workers' comp.msurance c�.,in;urance$ reguned-] $. [],'We are a corporafion'and'ifs 10.[]'Electd alrepa s or additions officen have ��ed their 3. I am a homeowner drug aIL work 11.0Plumbing repairs or a.dditi aryself [No wor]ers' camp. right 6f exemption per MGL' 12. Ito°f repairs in�nranne regtined-]t c.152, §1(4), and we have no . employees. [No workers' :13.0 Other comp Insurance r,,-q=d.] *Amy applicant that checks box#1 MMMt also fill out 6u scciion bclnw showing$users'compcasation policy infolmation. t Homeowners who submitfiris affidavitnrdicaiing they arc doing an work and they hire outside contractom-m Lstsuboutanew aindavitiadicaimg such. $Contractors drat obeck fhis boa m 2 t 2ft2r}hrd all additiffial sheet showing the name"of the sub coatracirns and state whe13ur ormt those eutiiies have ; empll oyees. If the sob-conbmcbm havo cmpl y.,ihey mnstprpvide thcir 4mrkzrs'comp.,poHcynumber. ' I am an employer that is providing workers'compensruian insurance for,my employees Belofv is the policy acid job site ' information Insarancc Company Name: ➢` �j Policy#or:Self-ins:Lic.# / � .n. Exp ration Date, J. Job Sit--Address:- Chy/Sta&7np: Attach a copy of the workers' compensation policy declaradonpage-(showing the policy miser and expiration date). FaiI=.to.sec=coverage as requi ed uader Section 95A of MGL C. 152 can lead to the imposition of annual penalties'of a fine uP to $1,500.D0 and/or one-year mzFuiso�eni `as well as civllpenalties in the form of a STOP W. o=ORDER and a fine- of tip to$250.00 a day against file violator: Be advised that a copy of,this stab merif maybe Ruwaided to the Office of, Iavesttgations of the I?IA for msur=e coyera�e.yeriticafinn I.do hereby cy under fhe pains-and enahYes o e7J that the infurvuVon prgvided above is true and correct Date phhne Official use only. Do not write&this area,tb be couzpleted by city err-tower affuial EJIju�jjjg City or Town: Permitlhicense-Issuing Anfhority(circle one): .•1.Bbard of Health 2.Bwldiiig Department 3.City/Town Clerk 4.Electrical Insspector b. Other � � Contact Person: Phone i#: I&HE Town of BAi ' s bye RegulatQiT'Services ar.+a9 Thomas F.Geiler,Director o Bonding • -.Tom Perry;Buildvig Commissioner 200 Main Street Hyannis,MA 02601.y wwwAowu.barustabie:ma.ns Office: 508-862-4038 �" W Fax: 508-790-6230 � - Property'Owrier M .fit" F + +.U-l7t Completeat?d'S1gr%This SectYori If Us'rrigA.Builder Ownet of the sub'eet. Y a 1't°petY hereby authorize Ct V, At W to act on my behal� In all matters relattve to work anthonzed by this builduig pxermtt (Address of.Job)p " - x Rp'r A Pool fences and alarms are the responsibility.of the applicant Pools:r, are not to be filled-before fence 1s installed and pools-are not to be utilized until aU final inspections are perfotm e'd aiid accepted. r, Ignat=e of Owner Signature of Applicant Print Name Print Name ,; o i r < '* & tr u Date d WORMS:OWATERPERMISSIONP00LS .y . „ �Y"E rgy, Town of Barnstable `I Regulatory Services * lARNsrABrZ, * Thomas F.Geiler,Director MAss �+ 1639. ►. � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,Na 02601 www.town.barnstable.nia.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street I_ village "HOMEOWNER i�-- name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as Sliper y sor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co mpfiance wit h the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109,1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,'that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexerript Assessor's offioe (1st floor): �FTNEtO Assessor's map and lot number ...........//. Board of Health (3rd floor): Sewage Permit number f!.. .���. .�.. .. .. .�'.. 2 Baaa9TsnLE, ! .............. Engineering Department (3rd floor): ,^A 'o MAOa �J D O t639. �00� House number ............................. ............... ...:..l.Cl. '°�cMara APPLICATIONS PROCESSED 8:30-9:30' A.M.,.and 1:00-2:00 P.M. only TOWN OF BARNSTABLE- BUILDINS INSPECTOR - APPLICATION FOR PERMIT TO ....�C ...... .....`'� ......1:.... !7��1.n:. :........................................... TYPE OF CONSTRUCTION G•14a ............... f}J 3�----------.19 / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �3 /✓Y?i,J S i 1 CvV''tJ i T' S ............................... Proposed Use r' � .a.6`^ �.....�.........�.....ycv 1'�r........ 1'� .......... ....... :`:::.:...:........: :J.'..;=�..{�........... .................... Zoning District ................. . ...�.et.....!.......................................Fire District ............... ......a........................... Name of Owner .Address ... Z �'J.."� C iS i V i T ........................ ... ..................................... Name of Builder -J :^'1� ......Hf.YWp�*..........Address '�a�.:k....-30� .W/j 4�/Dl Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......Z........................................................Foundation l�yC t $ ]'7, Exterior ...... lr '2..... �"' '.C..g5............................Roofing ..... ................................................... Floors ...... 'T?E'? ..��D.U..�l...................................................Interior .....�.y.. ............... ................................ i Heating .�? Ana......��Q..... .'.,/!. .!..�'�........................Plumbing .............. .............................�... _ .......... Fireplace 7d D 0 G p ..................................................................................Approximate Cost ............�. :................./.../ .. ..........4" Definitive Plan Approved by Planning Board -------19-------- . Area .......... :.... Diagram of Lot and Building with Dimensions Fee & SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's license ..D` 6' �............ t JACKSON, HAROLD A=037-015 , 31138 ADD 2nd STORY No ...........:.... Permit for .................................... Single Family Dwelling Location . 552 Main Street Cotuit ............................................................................... Owner ....Harold Jackson , ............................................................. Type of Construction Frame ....................:........................................................... a Plot ............................ Lot ................................ Permit Granted ....Augu;0;...U.,..........19 87 Date of Inspection ....................................19 Date Completed ......................................19 n J Assessor's offioe Ost floor): F'11Cf� °I� i�� � � �7 F THE T Assessor's map and lot number ...0. 7..����.....H.:... -,'� n�� 9N COMPL'" Board of Health (3rd floor): �e fO Sewage Permit number .............�..^..��".�..7.. �...... - �tl��� ����.� � Engineering Department (3rd floor): j � ' ���' �°®®� �'�� 'o L 0� t House number v �* k.`� ������'6� 3 0,,�t639. a�a ............................... ..................... ........ ... YP APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....�1.4�........... .... .�..�:�........��...I.n�....................................... TYPE OF CONSTRUCTION .....PJ ....... 26' '1. ..................................................................................... 3/............ t9�7. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ t� d'1 C4T* JI 'r .. ....... ................................................�........ 5........................................................................... Proposed Use .........I......... ¢.... ..... ........� .......... ....................................................... .. Zoning District .... Fire District ............... .. .................................................. Name of Owner ..... $ ..................Address ...r ...... .. 6111-1-'VIA. Name of Builder ....................... /.J.....!I`.. Wp6.J..........Address .304 G✓19 ��/OT..j.....�Il��.�...�?s 3` Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation Xx 1 S�"f& .............................................. EXlerlor ...... � � .�✓r9 ...Roofing .....'.�.e� ...................................:............... ........................................................................ Floors ..... ...................................................Interior ..... . Heating ... L�%Y:1..... ....t-j^-1/z ......................Plumbing ............. ............................ Z 6Bd ov 6 Fireplace ..................................................................................Approximate Cost ............/. Definitive Plan Approved by Planning Board --------------------------------t 9-------- . Area V1201... ...... ...................... �..... Diagram of Lot and Building with Dimensions Fee ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. -- --.. ... ............................ Construction Supervisor's License .® `lr� L.......'... r JACKSON, HAROLD 31138 ADD 2nd Stor-, No ................. Permit for ..................................7� Single Family Dwelling ......................................................................... 552 Main Street Location ..................�L...................L-:...................... Cotuit ............................................................................... Owner ....H.ar.o.ld....Jackson. . . ......................... .. .... .. .... .... .. .... ..... Type of Construction - ....F.r.ame........................... . .. ..... .................. ..................... Plot ............................. Lot ................................ Permit Gra6;ed ...AqgA.5t... .........19 87 Date of Inspection ................19 Date Completed ........... . ....................19 7 ' t • I 'I GENERAL NOTES ZONING DISTRICTS: 1. RF (RESIDENCE F DISTRICT) LOT 2 2. RPOD (RESOURCE PROTECTION OVERLAY DISTRICT)3. WP (WELLHEAD PROTECTION OVERLAY DISTRICT) THE PROPERTY IS ALSO LOCATED IN A ZONE II(WELLHEAD PROTECTION �d4 4Pj�a AREA)AND A 2ONE OF CONTRIBUTION TO SALTWATER ESTUARIES CB S3244'25-E C9 PROPERTY IS LOCATED WITHIN AN AREA HAVING A ZONE DESIGNATION OF CUS FIND122.28' T FND X (NON HAZARD) BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA). ON FLOOD INSURANCE RATE MAP NO. 25OO10O539J,WITH A MAP ar•, EFFECTIVE DATE OF JULY 16.2014. LOCUS MAP NOT TO SCALE I I' LOT AREA= 20,054 S.F. LJ EXISTING DWELLING,BARN,PORCHES,SHED&DECK 2.392 S.F.(11.910 APPROXIMATE DEED-REFERENCE: BK.29172 PG.148 . - LOCATION OF � _ EXISTING SEPTIC L J SYSTEM BASED ON r-T' PLAN REFERENCE: BK 235 PG.77, LOT 1 < TITLE 5 INSPECTION 1-1 o REPORT AS-BUILT L J DATED 10/12/13- 26.5 _ C Z C a U W � W � Q tO• J h 0 F, _ Q 38:8' ` 36.B �. �fl�i[S 14AM09�p�WtllW�4 M�IG�ram•A Kll1®N Ill1 Mi!Y IMVd[OIIGI 38.9' I.AE4 wo blil acr nre a w 01dtaYL IIRII A NHNo YI T6 RM W R16Y1 M PE.—A YUMOVI Ort RIaC arR¢et uA'Ilh uoON n4�/m,mW Cnm� - �e II,9 116 MM ImYla M PWGfI P r.VE uO 9lll UaN�Nl4 eG LOT t F CHIMNEY 20.054 S.F.. • Eavcnaw ara nlrsaeaprmn .� APPe • G.;� _ omAa d xs2nxlz n n N PORCH, JEFFREY FRAhX.DIYA_RDO AND HARM IDA APSE in seas 61Nd y I nnurA.ru or77s 12O.83• Avruux7: CB N32'45'2OV C9 - JEFFREY FRANK DI ARDO AND!YARM IDA APSE - coFIND FND t6P��uwa MAIN STREET .ATLAA m NA AA > PUBLIC ^'- 40 FT. WIDE �., CERTIFIED PLOT PLAN - 552 MAIN STREET - - d . - COT UIT. :YASSACRL"SETTS - - snrrY xa:r ar r ats-r r a I_EG:END - EXISTING DESCRIPTION - Paaurao ePr o CONCRETE BOUND CAPE&�ISLANDS GENGINEERING ■ STONE BOUND „�wou,eo I HEREBY CERTIFY THAT THE ABOVE INSPECTION IS S PERFORMED THE GROUND AS SUNMERR®.D PAAE TSOE1en-7272 • IRON ROD - - SHOWN AND THAT THIS MORTGAGE INSPECTION WAS PERFORMED IN ACCORDANCE EooPAEHoo7x Eono,wrre 2mc �.a Q. Es= WITH THE.TECHNICAL STANDARDS FOR MORTGAGE LOAN INSPECTIONS AS MAtEPEE,Wozsav eman:mre�.ertxr..®n ADOPTED BY THE MASSACHUSETIS ASSOCIATION OF LAND SURVEYORS AND CIVIL 7ar2xe mcr• O IRON PIPE - 0 20 50 100 ENGINEERS,INCORPORATED. • - IRON ROD W/CAP CERTIFIED PLOT PLAN SCALE: 1" = 20' MATTHEW C.COSTA P.L.S. DATE PROPERTY LINE AJ36950R9 WIORYAr10M:YM W.PARCEL 11 Town of Barnstable BARNSTABLE. - Regulatory Services V MASS. 0 i639• �0 Building Division prFO"MPS A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection N `�A Location J . .2- A *-rti S`- C-r Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Q K- &- L N G?4z57 AJ o� y � F f r Please call: 508-862-4038 for re-inspection. Inspected by Date 3/ i - Srnce 1955 GAco WEsTERN r,lnsulation Certificate } ' Y Date installation completed , :. Building address C City/State/Zip 4au 'Application Contractor(company name) Address City/State/Zip Phone X o F=ram r Areas Insulated . Exterior stud wall Average _ e thickness G r R-Value Average thickness R-Value 39 . x Average thickness R-Value s Crawl space/basement' Average thickness R-Value Additional areas insulated w w . I(print name) as an independent contractor;certi that the GacoWestern insulation fV atlon installed on this project was applied in a rdance with the GacoWestem r ecommendations and specifications as stated on the product data sheet and the GacoWestern Ap li Specifications in the amount as indicated'on this certification. 01_ (signed) Date .� : ' = GacoWestern Aged R-Value(hart, sti bhl a copal lumber a 1„ 2n 3"` 4n 5n 6„ 7„ S.5" L25" GacoGreen 4.2 8 12 16 r 20 24 28 32: 36 14: 32 `.29 . GacoFirestop 3.7 7 11 15 19 22 26 30 •:33 13 ZO 21 183 6.4 13 20 27 33 40 47 53 60 23; 31 48. . 184- 6.1. 13 20 27 34 40 47 54 60 24': 31 49 SU{A 193 6.2 w 13 20 21 34 41 41; 54 ' 61 24;' 37 49 'Based in initial measured K-values. - - - l .GacoWal. IFoam,j SPRAY POLYURETHANE FOAM INSULATION' www.gacowaltfgam.com 1 800.456..4226 PRODUCT DATA A Gaco Waffoam System , i Gaco Western WaliFoam 183M is an HFC-blown(zero ozone-depleting)liquid spray system that cures to a medium-density rigid polyurethane insulation material.Gaco Wallfoam 183M contains polyols derived.from naturally renewable oils,post-consumer recycled plastics,and pre-consumer recycled materials.Gaco Wallfoam 183M does not contain CFCs, . HCFC's or other gases harmful to the environment.This system can be sprayed on clean,dry substrates down to 35 F(2°C).Gaco Wallfoam 183M is a class l fire rated foam that meets the requirements of ICC-ES AC377 Acceptance Criteria for Foam Plastic Insulation.Gaco WallFoam183M meets the requirements of AC377 Appendix for use in attic and crawl spaces without an additional ignition barrier. r TECHNICAL INFORMATION , optimum performance, I. 13/4" recommended 1 1 exceed per pass.For typical1 1settings, 1 1 Gacofoam Spray Guide. .. PROPERTY TEST TEMPERATURE _ ASTM TEST UNIT; VALUE Nominal Density(Sprayed In Place) 77°F(25°C) D 1G12 03 Ibs/ftj 18 1 Z R Value see rote Belori 15°F(23 9°Q , C 518 h .ttz °F/Btu: R 6:4 at 1 ft= °F/Btu R 23 3 at 3 5 (ompresslve Strength(Patatlel to Rlse) 71°F(25°� D 16Z1 04a psi! 3Z Tensile Strength ,.:, T - °11°F(25°C) � ` D 1623 Psl 64`. _ . Water Absorption 3' 17°F(26°C) Water VaporTransmISSlon 17°F(25°E) E 96;05 perm m 112 Dimensional Stabdlty(]Days) 158°F 17D°q/95%RH D 1126 99 %linear change L 6% W 5%.T 3% 200'E(4Q.0 to 93°q Recommended:set vue'Temperature Range zs 77°F(15 C) x Closed(ell Content 71°F(15°q D 6Z26 05 % 9T8 ArrPermean(e;@ 15Pa(Inilitratlon/Ezfiltrat►on) 17°F(15°O E 283 04 Us/mZ 0 607 0 000(@ 1"thickness) .c> SURFACE BURNING CHARACTERISTICS i (Alsoknown , ..,. SYSTEM THICKNESS• FLAME SPREAD INDEX SMOKE DEVELOPED INDEX Wallfoam 183M u 4' (101 cm) 10 400n. ROOM CORNERFIRE Appen, LOCATION FOAM THICKNESS Walls F y r Up tb 9 5 (Z413 cm) coo } 5 4 Ceiling _ T 4 r ist � Up tb 11a(2194.cm)1 : r TYPICAL LIQUID CHEMICAL PROPERTIES Component 11 1 Component 1 1catalysts and blowing agents. PROPERTY TEST TEMPERATURE ASTM TEST UNIT VALUE Viscosity A.Component 17°F(25°q D Z196 68 r cps 180+20 Viscosity `B fompanerit ° 0*50 15 Specific Gravity °A"(omponent 17°F(25°O D 1638 70 S Gs 122 Speafu Gravity B"Component y 120 ' WeightJGallon A Etimponent '- 77°F(35°E) Ibs%gal 10..Z , Mixing Ratio ' A & B .Co mponent 77°F(25°(} By;yolume Stability When.Stored at 50°f to 10°F 3 M Months "A"(omponent 1 year, ` Component 6 months EQUIPMENT PRODUCT CHARACTERISTICS SETTING VALUE' CHARACTERISTIC VALUE Pre=Heat Iso(A) 115°f4 130°Fr(461"C 54 4°O„ (ream Tlme 0 1 sec _ at ea f115°F l30°F(4fi 1°( 54 4"C) Rlse Time 3 5 sec Nose Heat Y 115°f 130°F(461°f 54 4°E), Tack free Tlme 3 5 sec Re commended'Sprayfressure 80t0 1000 psl'(dynamlc) Core:Tlme 4 hours The infanuden herein Is believed to be reliable but unknown risks may he present ALLWARRAIMES OF ANY laND,EXPRESSED OR IMPLIED,INCWDIN6 WARRANTIES OF frolESS FOR A PARTICULAR PURPOSE AND THAT GOODS ARE OF MERCHANTABLE QUALITY,ARE SPECIFICALLY DISCLAIMED,see 6am western for inf°r®U°n concerning its Undfed warranty and its avnlabiNtg. . T � rfr;�,. .`�d�.`�zr'��•+#i^��'—�� a �•�a`'h,`4'Xnct"•v.:.s} «3 �"x r.",�4 �'�Sr- x.'yr y. ���• ��� ICC ter. v �` &CO WESTERN .. . ENERGY STAR I G din A y..CJ fth NdSb wdSdwi-6abad 4f � PARTNER �a i: nury bade.Goeed laoeee+ke q"-0k+1'm o,:z}w` F F 5' ,��" M W •^*�ir'{v'd"— n S# Toll-Free:877-699-4226 www.gaco.com Product=GWFD51 02/12 • CI W. Springfield, MA z Pittsfield, MA (413) 781-2897 (888)881-4598 Quincy, MA Worcester, MA (617)479-2619 ` � -(888)881-4598 Mattapoisett, Akdt'! Cape Cod&Islands (508) 758-6633 (888)881-4598 Rhode Island _ Hartford, CT (888)881-4598BUTLER (888)881-4598 Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen Town of Barnstable Town of Barnstable 200 Main Street 200 Main Street Hyannis, MA 02601 Hyannis, MA 02601 Attention: Records Attention: Records COMPANY: Certain Underwriters at Lloyd's c/o XS Brokers POLICY NUMBER: XSV 1962 CLAIM NUMBER: XSV 1962 INSURED: Theresa A. Egan LOSS LOCATION: 552 Main Street, Cotuit, MA , , DATE OF LOSS: 08/29/2012 ' DESCRIPTION: Fire : CLAIMANT: , ~'I OUR FILE NUMBER: CCI12-5433 Gentlemen: ,.., Claim has been made involving loss, damage, or destruction of the above captioned properq wh ch may either exceed $1,000, or cause Massachusetts General Law, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313, is appropriate, please direct it to the attention of the writer and.include a reference to the captioned insured, location, policy number, company claim number, date of loss, and claim or file number, ry trul y u at ag ino Adjuster P—617-479-2619 F—617-479-1740 paulb@georgebutleradjusters.com On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above, by first class mail. Secretary September 14, 2012 P.O. Box 710120,Quincy, MA 02171 0 _- fie �arim,aruvea� a�' etla HOME IMPROVEMENT CONTRACTORS REGISTRATION Hoard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 100740 Expiration 06/23/94 Type - PRIVATE CORPORATION ` - HOME IMPROVEMENT CONTRAL Registration IN740 Cap i z z i Home Improvement, Inc. Type - PRIVATE CORPORAL Thomas Cap i z z i , Sr. Expiration .YW23/94 1645 Newton Rd. Cotui t MA 02635 �e ' Capizzi Home Ieproveaent .ram .Thaws Gpizzi, Sr. `IM Nwton Rd. Cotuit M 02b3i t Assessor's office(Ist;Floor): �.. Assessor's map andylot number � /� v:• :' Hof TM�c To` Board of Health(3rd.floor): # i .? s d'�P wp� y^ 'q ow Sewagei Permit number Ci c rS Z IMUSTAXLL i Engineering Department(3rd floor) ,< I i r;ua House number i µ € I °o 'aso. Definitive Plan.Approved byi.Planning Board t I k. APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-.2:00 P.M.only TOWN OF , B.ARNSTABLE BU [LDING INSPECTOR APPLICATION FOR PERMIT TO /r%//1��i?J Gl/Tj6S TYPE OF CONSTRUCTION ; 19 jP3 t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following in/formation: Location r��02 14/xl� Proposed Use Zoning District Fire District Name of Owner Address �/�i"n/y/' Name of Builder�i2-21 /�/�6���/>/1D7�1�D,r Address Name of Architect Address Number of Rooms Foundation Exterior Roofing r r t Floors Interior Heating Plumbing Fireplace Approximate Cost OD Area Diagram of Lot and Building with Dimensions Fee J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the ab construction. Name Construction Supervisor's License JACKSON, HAROLD 36176 t Re-Roof F` 't NoPermit For p% 'Singlet Family Dwelling ` 1 a ` Location t s 5 5 2 'Ma i n Street J P i Cotuit } ` Owner. I n Harold .Jackson a' Type of Construction - Frame , ' -Plot Lot UL � R. Permit Granted ept. 17 , ` 9 93 Date of Inspection 119 F ` Date Completed _ 19 " s � r r _ • ;' t zti .fi .`' f I I.��1 I..".�� � I . . .� � I . I , �_� :'.'I, . �. .'-I . - ...�I .�_ 11 . 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PATIO 25001C0539J,WITH A MAP EFFECTIVE DATE OF JULY 16,2014. Z 55.3 Q PROPOSED SEPTIC OUTLET DEED REFERENCE: DB 29174 PG 148 t cn W TO BE CONNECTED TO 0 3 CD EXISTING TANK. STONE PLAN REFERENCE:PB 235 PG 77 in PARCEL A Tn WALK DECK SCREENED MIN.2%SLOPE PORCH p rn I MIN. 1'OF COVER OVER PIPE ELEVATIONS OF EXISTING TANK LOT 1 v cl) AND LOCATION OF UTILITIES SHALL BE CONFIRMED PRIOR TO \ 20,054 S.F. CONSTRUCTION NOTICE THIS PLAN MAY NOT BE ADDED TO,DELETED FROM,OR ALTERED IN ANY WAY BY ANYONE OTHER THAN CAPE& � N/F HELEN M. RENNIE ISLANDS ENGINEERING,INC.� UNLESS AND UNTIL SUCH TIME AS AN ORIGINAL(RED)STAMP APPEARS ON THIS PLAN NO PERSON OR PERSONS, 56.1 V MUNICIPAL OR PUBLIC OFFICIAL MAY RELY UPON THE INFORMATION CONTAINED HEREIN;AND THIS PLAN \ I REMAINS THE PROPERTY OF CAPE AND ISLANDS ENGINEERING,INC. 36.8' EXISTING \ DWELLING a 38.9' \ DATE DESCRIPTION BY APPR #552 OWNER OF RECORD: JEFFREY DINARDO& CHIMNEY MARIA APSE 55.11 552 MAIN STREET COTUIT,MA 02635 APPLICANT: JEFFREY DINARDO& STONE DRIVEWAY MARIA APSE 552 MAIN STREET 55.2 COBBLESTONE EDGE COTUIT,MA 02635 54.9 PROJECT: ai CB/DH N CB/DH RAZE BARN & CONSTRUCT GUEST HOUSE FOUND / 120.83' - FOUND CB/DH 552 MAIN STREET 55.4 N47001'17"W FOUND IN 55.4 COTUIT MA 02635 MAIN STREET SHEET NO.: 1 OF 1 DATE: NOVEMBER 17,2017 ( PUBLIC 40 FT. WIDE ) DRAWING FILE NAME: MAIN-552—DINARDO—SS DRAWN BY: JB CHECKED BY:MC PREPARED BY: CAPE & ISLANDS ENGINEERING OFF CIVIL ENGINEERING-LAND SURVEYING-ENVIRONMENTAL PERMITTING INCORPORATE/' WATTWEW C. +j' SUMMERFIELD PARK a COSTA 800 FALMOUTH ROAD SUITE , 508,477.7272 PHONE0C ^` No. 52282 MASHPEE,MA 02649 508.477.9072 FAX O 20 50 1 000r msj0**\' DRAWING TITLE: SCALE: 1" — 20' sur+v� CERTIFIED PLOT PLAN ASSESSORS INFORMATION: 037/015