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Y76 �ct�- L �' ��vd o� ��a� �?/a /'��Ott �T' l*r � ��� j r �.� __ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Map ZJ� Parcel( Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �174J Village G 7Z6S 0 G,�itJ6JG ✓T Owner /� Address i(✓���it�l �o�oO Telephone 4AZ2 ®2-7-7 Permit Request 14�6U46vE Square feet: 1 st floor: existin rproposedA&)L 2nd floor: existing proposed !Total new Zoning District /ZOO Flood Plain Groundwater Overlay Project Valuation ©®-edConstruction TypeAX1* Lot Size,�fv 0 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: YYes ❑ No On Old King's Highway: ❑Yes Qlo Basement Type: Full 2-Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) `7L� Number of Baths: Full: existing new Half: existing l new Number of Bedrooms: existing io new ` Total Room Count (not including baths): existing /® new o First Floor Room Count Heat Type and Fuel: UtGas ❑ Oil . ❑ Electric ❑ Other Central Air: U"'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: EYes C'No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ BarM existingS ❑ rvgw� size_ Attached garage: JKexisting ❑ new size _Shed: ❑ existing ❑ new size — Othe'n E«1 . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ . F= Commercial ❑Yes ❑ No If yes, site plan review# .3.. Current Use Proposed Use r APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 6l--Z Selo i** -;om- Telephone Number ��e Address /��/ X ?06&?.1 C477L-,i, AAY 0105' License # �,5 �5• Home Improvement Contractor# 1016 067 ma' Worker's Compensation `r "+����y �?'� n N ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE-ISSUED, 'a - MAP/PARCEL NO. r j6. 4 " i ADDRESS VILLAGE OWNER DATE OF INSPECTION: I JAFO.UNDATJ.O.Nr :, : FRAME M�fflo'1'/ f2oj, FIREPLACE ELECTRICAL:.. .ROUGH FINAL ,k PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING ® I 0 • DATE CLOSED OUT ASSOCIATION PLAN NO. e t ?lie Conn monwealth of Massaclfrusetts Department of Indirsoial Accirients Offire o,f'Investigations 600 Washington Street Boston,MA 02111 w mK vtass:gosldia Workers' Compensation Insurance Affidavit Baders/Conh-achws/ElectriciansOumbers A1313licant InformatFan Please Print Wb]y Dame(Bosmessiorgsnhzion%oiddnal): Address: City/Sta&Zip: ��T�/� aZf� S Phone# 0e,- � 6 —�IAI Are you an employer?Cbeck the appropriate box: Type of project(required): 1.[X I am a employer with 4. ❑ I am a general ccmtractor and I 6_ ❑New oomsfrttction employees(full and/or part-time).* have hired the sub-camtrachrrs 2.❑ I am a sole proprietor or partner- listed an the attached sheet. 7_ [ 'Remodeling ship and have no employees These sub-contractors have 8./❑Demolition working for mein any capacity. employees and have wotoers 9_ Build-mg addition [No woticers'comp.inammre c'�p. �-insurz , � 10_❑Electrical repairs or additions required-] 5.•❑ We are a corporation and its 3_❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself[No workers'cctimp- right of exemption per MGL, 12-❑Roof repairs insurance requited.].T c-152,§1(4),and we have no emp�es-[No workers' 13.E]Other comp-insurance required.] *Any appTD=lhat cheda box#1 must"fill oui"the section below showing ibeir wadcere compP++mfim policy information 1 Homeowners who submit It&affidavit indicating they tie doing all trot amd then hut:outside contractors I submit a new affidavit indicating such 1Coatmcmrs that chest this box must attached an additional sheet showing the name or&a sub-comux-tm and state whether or not those entities brio employees. Ifthe svbtnauactors hale employees,they mustprvvide their workers'comp.policy mm3ber. lam au employer iliatis providing tt orkers'compensation insurance for nay employees. Belotr is file polls}*and job sits h forrnaliart. Insurance Company Name:�p .t/�.��j1 (-�'f r//CJ/ �✓ Policy 4 or Self-ins:Lie.# f y��3'D1+7�'�1�f� -.2- raj Expiration Date. 71(e Job Site Address: e '�'� CitylStatelZtp: �'�v��l�t Attack a copy of the workers'compensation policy declaration page(showing the policy number and expo ation date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of au" z nal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as wen as civil penalties in the fonn of a STOP WORK ORDER and a fine of up to S250-00 a.day against the violator' Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification- _ .. ..... _. .. . .._ _ .._ . . ...... _. ..... ..............-- --- _......___ _ _ _.. I do hereby certify the 't andpenaWas ofperjury that the iiformiation proWded aboveis bw and correct Signature: Date: 70/ l Phone Oliiciat um milt Do not write in this area,to be completed by city bljiciat City or Towa PermitUcer se-9 Issuing Authority(cirde one): 1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plnmhing Inspector 6.Other Contact Person: Phone#: 6 Righti" .C.3-1: 8/28/2018. Wo-OZ:3.5 .AM PALE 2/002 Fax Server :,�•�.w'1 CERTIFICATE OF LIABILITY INSURANCE'. BATE nuaawM ICATSIS IF ED MAIAATTE§tOF 1NFO RS NO RIG E C CERTIFICATL DOES Md7 AFFIRlrlA11VF[.Y QR NEGATIVELY AMEN11.EX7BID 4R ALTER THE COVERAGE NFFQRDED®Y THE PdLIG1ES,BFdW: PHIS CERTIFICATE OF INSURANCE D08E3 NOT C'ONSTffUM A CONTRACT BEWiEEN-rkE;issume`UISLIREp4S) .AUTIIOR¢EO EORPRODUCEFLANDniECEMIMMM' MPORTANfi K��sort>licaEa hoidoris:an ADDR10NAi,, N51iREp.thb pc►licy(ths}:.must br ondorAed. Lt SUBROC�UITIQN 18 VIfANED;aub�CtEo e terms And oandRions oitRe POULA cermn'Poadw may repine and eiMormOr n4• A staI rosM an this'certl kah dow not confir righh c s.cmi a cogs holdi:in liw*I saaA endors s CONTACT PRODUC�id ,.._ HOROAWW.S'AGCYTMC. PHONE FAX . FO.BOX 250 IAIC'Na.Eapr WG:Nok: SIYW 'AYAXMS,MA:02601 AOOREM IMF NISURER(S�;AFOVG ODVHiAOE IiIYG A'` ENS Ac':CONIIIV&PIAL CASOALTY OQ�AN'Y INSUREP: A I ENTERMSBS INC-.ENsuRERS IIV9UR8t D' _ . .O HOkC 2056 00TUM.34A.02635: F: COVERA4ES CEIRMCATENUMOM 11EVIbiOrV NtIAABBR M0IWMWAMDMAWfOlnWdWA8ff.7Qr11 OR Comuff 011 O.AW CONTRACT OR OTMR DOC�1mff.mm RBVir=TO WNCN TM CM FrATE iM%Y BE SSM OR IMY Y�TAML"M AWORDIZDBYTHEPPUCMS I �1,�t�Wsu& rrTOALLTNmT��EJ LUMDMSAfN1CONDfTWitSOFSUCJIPgfvN?S Ii�slldl�If1LY ryAyE gEBr�41C�s1R faAO CLAM'J. POLWEW DATE. MW CAMm LIR: T1�PE[1FOIN<HIAAC� SL R p01JCY;N11Me8l: tir>rYYI nsent»w tarns gB�1EFrALL1ABILJtIY OCGUR}IEAiCE, ,8'. COh4@IIERC�AL;t�AL I.IABffili'Y' EYAWMAL TOMtm ci.Awas nenoE " 19Es't1=a vcumai+oa? E W{Are':aoa v~): S &ADV INJURY' S �AGG IRMAT6 uM(T APPI lE6 PER l3�BtAL AGGREGATE a POLICY �f'Ro.IECr�L)cc GOIf'A?PA(it3 : S AUTOMOBLEUABE M:: MBNED.$norLE S, ANY.AUf4' NAR(Eaaodrierltl N OWN�,AVfOS: ILY IN;R/ Y i SCHMLE.,AUT1d"a. v lr iwy s: H6tE31 AVf09; _ I�o OYVhrEQ SOB TY'OV1iAAIGE: S - academe. UMBPaIA LIAB _: .00CEAT H ©oES$UAB'. ,CLAIM&MADE: GI2EGATE 2 .. EE)l)G11OLE 5 rL ) LQY8t7S f11B . u AM c.ir..r OTHERA L A 0744 X .a78M7a13 071180s: 1' YIN UB 01rwwE= ® E L �AC�aOFNI S b00 tH10` aftoYEE S 500.Wo Yyad,4iaoWotinOv.. EL DISEASE-POGa.YUMif .s.> .500AOD DE CfW-TION OF OPERATICN8+I:OCAi10 I7FIR4: T�988EI:AC9?9ANY PBIc "MTrniCA2B iOT�C9RTII+tCATB HOd.D1�,AFFSG1II1C3:W0�RS.CBbIpVsaAt3$; CANCELLATION CERTIF[CAZE OLDER. ,_ , SMO=A5(OFrTMASUMD .POUdESBECANCELLM TOWN O}?BA2XSTABLE:. BEFORE Z101V DAiE ll .NOTICE W8L ME D91MM 20D MA ST IM. EMM Tim P0UCY ATNE`. HYAN=MA 02601 RD ZS 10I06}' Me A name arr ma _ I jbsemed- r f oFEr Town of Barnstable Regulatory Services • B MSTAB A 9 MASS. $, Thomas F. Geiler,Director 9. Building Division Tom Perry, g Buildin Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize • "� to act on my behalf, in all matters relative to work authorized by this building permit (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. Signature of Owner Signature of Applicant �-5;1 e- 1 ?0/6 e6 7 7-1- Print Name Print Name to 13 1 Date °F Town of Barnstable Regulatory Services M Thomas F.Geiler,Director 1619. Building Division F Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.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 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. DEFWMON OF HOMEOWNER Persons)who owns a parcel of land on which be/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"shaU 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 Iast 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 C.\Users\decolltldAppDatalLocalWcrosoMVmdows\Temporary Intemet Files\ContentOudook\QRE6ZUBN\I2RESS.doc Revised 053012 Massachusetts -Department Board of Building Re Of Public gulatio Safety Construction ns and Standards SuPe'n-i-so r License: CS-O50457 'a PETER MPOi►7E� COTUIT 2056 �. MA 02&35 c � _ °a Commissioner Expiration 04/19/2014 Office of Consumer Affairs&.Busihes Regulation eCTa i License or registration valid for indmdul use Only: OME IMPROVEMENT CONTRACTOR + before the expiration date. If found return to:. l egistration 109606 ! Type Office of Consumer Affairs and Business Regulation xpiration 9/21/2014, 10 Park Plaza-Suite 5170 Private Corporatio,i- A I E ERPRISES B :µ INC_ f oston,MA 02116 t PETER POMETTI 140 LITTLE RIVER RD i COTUIT. MA 02635 t-- -- Undersecretary ANOtva lid wi t0 ut signat ur e I A WC Guide to Wood Coiisti uetiou ill High Whid Ai-ease 1.10 mph.Mud Zoize Massachusetts usetts Checklist for Compliance (780 CMR 5301.2.1.1)1 ^T _ [0 Check I WC� .jet-, (T� Compliance 1.1 SCOPE WindSpeed(3-sec.gust)...................................................................................................................110 mph Wind Exposure Category 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) sto 5 2 stories _1G Roof Pitch .... .......(Fig 2) ...........................................�:ries iZ 512:12 g JG Mean Roof Height .................................(Fig 2)................................�.............14 ft _<33' y Building Width,W ....._ .. ..........(Fig 3)..........:..................................... .ZQ ft <—80' JG Building Length,L ..............................................................(Fig 3)....................r.�.r...: .... 22,rit <80' �G . Building Aspect Ratio(L/W) 1�7.1- _3:1 4-1 (Fig 4)..................(..:. ...C1 . . .. .--.--- V_ ........(Fig 4 .... 'A .5 6'� Nominal Height of Tallest Opening2 ........................... ( 9 1............................................ 1.3 FRAMING CONNECTIONS �} A General compliance with framing connections....................(Table 2).........I...!.�..`. .. .•.•......•••••••••••••••••-•• y 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete .• . ............................................:........................................................ Concrete Mason ry.. ................................................................. ................................................................ u4A_ 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).................................. ..... 71 in. el . y Bolt Spacing from endroint of plate ............................(Fig 5)..................................... in.56"-12" Bolt Embedment—concrete.........................................(Fig 5 ..........................Z in.>_7" v Bolt Embedment—masonry..... ...............................(Fig 5)..............S11...�1�... li in.z 15" ! (Fig 5 .1�.. ..1�..�.!l........>3"x T x'A" Plate Washer.......................................................... ( 9 )................ . 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension...................................(Fig 6).................................................. 0 ft<_12' 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 <d -,Maximum Cantilevered Floor Joists ft <d .: Supporting Loadbearing Walls or Shearwall................(Fig 8)...................................................._ _ FloorBracing at Endwalls...................................................(Fig 9)......................................................... '. Floor Sheathing Type ..:..................................................... er 780 CMR Cha ter 55 .. . Floor Sheathing Thickness .................................................(per 780 CM( Chapter 55)....--..............._3 in. 1 Floor Sheathing Fastening..................................................(Table 2).._d nails at_6L _in edge/L in'field _( 4.1 WALLS Wall Height Q Loadbearing walls........................................................(fig 10 and Table 5). ....................... —J—ft <_10' (� - Non-Loadbearing walls .....(Fig 10 and Table 5).................... .....�ft <_20' y Wall Stud Spacing .....................(Fig 10 and Table 5)................... in.:::,24"o.c. t: WallStory Offsets .................................. .....................(Figs 7&8).............................................a ft 5 d 4.2 EXTERIOR WALLS' Wood Studs Loadbearing walls........................................................(Table 5)..............................2x_f._-_a ft in. r 5 2x�- ft in. Non-Loadbearing walls............................................ (Table ).............................. Gable End Wall Bracing Full Height Endwall Studs............................................(Fig 10)............. ............................................. ....... L. ''II� WSP Attic Floor length................................................(Fig 11)............:................................ ft>_W/3 AA�LAN, Gypsum Ceiling Length(if WSP not used)...................(Fig 11).............................................�.ft a0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11).............................................................. S)Ao . or 1 x 3 ceiling furring strips® 167.spacing min.with 2 x 4 blocking 0 4 ft.spacing in end joist or truss bays Double Top Plate /j� SpliceLength ........................................................(Fig 13 and Table 6)....................................._'I` ft Splice Connection(no.of 16d common nails)..............(Table 6)..........................................................� A WC Guide to Wood Coitstructioft Lit.ifigh Wind Areas: 110 inph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)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) Header Spans ..................(Table 9) .......-(#-ft Q in.:511' Sill Plate Spans ............................................. ......(Table 9).:..............................�ft�in.<-11' L Full Height Studs (no.of studs)...................................(Table 9)........................................................ .a i..., . Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................._ft_in.512' Sill Plate Spans...........................................................(Table 9).................................._ft—in.512" Full Height Studs(no.of studs)....................................(Table 9)........................................................ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W r Jf Nominal Height of Tallest Opening2 .........:.................................................... <_6'8° SheathingType.............................................. note 4 .................................... J� Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ in. r. Field Nail Spacing ....... able.10 in. Shear Connection(no.of 16d common nails)(Table 10)................................................... Percent Full-Height Sheathing......................(Table 10)................................................... /o 51%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... tA Maximum Building Dimension,L Nominal Height of Tallest Opening2........................................................................._<_6'8" SheathingType..............................................(note 4).:...................................................: Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Field Nail 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>W(Design Concepts)..................... Wall Cladding y Ratedfor Wind Speed?........................ ...................... .......................................................................... 5.1 ROOFS 4,.. Roof framing member spans checked?.......................(For Rafters use AWC S an Tool,see BBRS Website) y Roof Overhang ...................................................(Figure 19)..............� ,[ft<-smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U=M Pit Lateral.............................................(Table 12).............................................L=_17E pit Shear............................................... able 12 S= pit(T )............................................ Ridge Strap Connections,if collar ties not used per page 21...(Table 13)............... k pif Gable Rake Outlooker:........................................(Figure 20).............. ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors ;. Uplift................................................(Table 14)............................................U= lb. IL Lateral(no.of 16d common nails)...(Table 14)....................................... - 780 CMR Chapters 58 an 59 •fAl f. lb. LE Roof Sheathing Type.... (per p m. 7h WSP f.— Roof Sheathing Thickness...................................................... .... . . lt. - � t��"" P }I Roof SheathingFastening ....(Table 2)... ....... ' 1..— f� Notes: 1. This checklist shalt 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. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 50/o 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 02-grade. AWC Guide to Wood Corrstruedon iia High Wind Areas: I10 niph Whid Zorze 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 Ff• _._WtiE11�HBe��BlstAt mussed was ATOUr. u n . u n n u Y H 11 11 fl /1 M H it i1i If RRR � 11 LI QQQ... /1 •I d U v rf f/ II 11 II 11 k If fl See DoWl on Next Page Vertical and Horizontal Nailing for Panel Attachment . . s A WC wide to Wood Constr•itction irr High Wind Areas: 110 inph Wind Zone Massachusetts Checklist for Com llanee (78o CMR 5301.2.1.1)i r 1 ■ p � { T{ ■ ■ ■ ■ �I Il 1 1 1 1 , , F aAM " OOLfiU W L Mca WACM 8EML Detail Vertical and Horizontal Nailing fir Panel Attachment ■ r i; Table 2. General Nailing Schedule {t, fk9t�"'i x- ' c,3 i?r �' '4 y -'w"�"r31S C3j,FI� t, •.j e4 'fit^ 5r.`Y}� S �,, e �, Y :xr t ay �� .r � ... :1.,,.• ,i-....� ,a7k .•: �...:...- «l, i..,,:} >, '.,s�iT }.:`x�:t� i v; �i l''Y i 5 r.;. .,Z ,_�.�.vs:.... ..Mr_ r �� 7; Roof Framing Blocking to Rafter(Toe-nailed) 2- 8d 2-10d each end Rim Board to Rafter(End-nailed) 2-16d 3-16d each end Wall Framing - Top Plates at Intersections (Face-nailed) 4-16d 5-16d at joints Stud to Stud (Face-nailed) 2-16d 2-16d 24" o.c. Header to Header(Face-nailed) 16d 16d 16"o.c. along edges Floor Framing Joist to Sill, Top Plate or Girder(Toe-nailed) (Fig. 14) 4- 8d 4-10d per joist Blocking to Joist (Toe-nailed) 2- 8d 2-10d each end Blocking to Sill or Top Plate (Toe-nailed) 3-16d 4-16d each block Ledger Strip to Beam or Girder (Face-nailed) 3-16d 4-16d each joist Joist on Ledger to Beam (Toe-nailed) 3- 8d 3-10d per joist Band Joist to Joist (End-nailed) (Fig. 14) 3-16d 4-16d per joist Band Joist to Sill or Top Plate (Toe-nailed) (Fig. 14) 2-16d 3-16d per foot. Roof Sheathing Wood Structural Panels rafters or trusses spaced up to 16" o.c. 8d 10d 6" edge/6" field rafters or trusses spaced over 16" o.c. 8d 10d 4" edge/4"field gable endwall rake or rake truss w/o gable overhang 8d 10d 6" edge/6",field gable endwall rake or rake truss w/structural 8d 10d 6" edge,/6" field. outlookers gable endwall rake or rake truss w/lookout blocks 8d 10d 4" edge/4" field Ceiling Sheathing Gypsum Wallboard 5d coolers - 7" edge/10" field Wall Sheathing Wood Structural Panels studs spaced up to 24" o_c. 8d 10d 6" edge 112 field. 1/2" and 25/32" Fiberboard Panels 8d — 3" edge/6" field 1/2" Gypsum Wallboard 5d coolers — 7" edge/ 10" field Floor Sheathing Wood Structural Panels 1" or less 8d 10d 6" edge 1 12".field greater than 1" 10d 16d _0" edge:4.6",field 1 Corrosion resistant 11 gage roofing nails and 16 gage staples are permitted,check IBC for additional requirements. Unless otherwise stated,sizes given for nails are common wire sizes. Box and pneumatic nails of equivalent diameter and equal or greater length to the specified common nails may be substituted unless otherwise prohibited. AMERICAN FOREST & PAPER ASSOCIATION TO'NIN yr , T?^.f i Pv 0/• 1,14 Pi Fr ------- --------- --------- �bR COVERED PORCH DDxwuxXsis) �I`:e f � I x DQ (X6Pvtt msrwc op iDvtnKS e�rR.we 6+•rq.cR i PtevtC m^NtNc I - PICIL -T 8 3'1• 6'-p STUDY zo. g (axrD(wxoow.Ns wnrtDfiDX vecD � - uNEwmsnND ew PAssirau DININ RM. gEIs FAMILY ROOM N T— L3� I <$i i SUNROOM II HALL I _ A T� II` r-----------------------------�3;15� ---zl 9KITCHEN�' '0BXDN r�2 2/6 1 Posy D L-__- i %-ip .r-z i¢ -(i2• COVERED ENTRY 4 - _ q.p 20-5'(+N yip IX6 POST 51 - (NGNVAm msNNc wALL AT 4IIA6 � ; _ _ FIRST FLOOR PLAN GARAGmsi'NG H E - - ph _ h � J G. a � O ; O a a O g J LL W r F ANDERSEN WINDOW&EXTERIOR DOOR SCHEDULE o rn RDUw OPENlW WXN REY6 STTIE Naffs h �_ o A PgiO1 DOOM SEE aMEA t - IL y LL B Y06R•X3.O6R' Ot] AwNINOKbN W6EA6?e C TW]6610 p011&E NUNO NDII �OOfiER�B TLT NN6X D HM1Wltt FlffNLMyOoo CAIDWO PATIO D.]Oi E 6' x-fa PNN61611 —NONWDODRXED TIO DODR 4— F '41A'X.+�.)9' DDUBLE HUNO N9tY 666ERIE8 TLTYOISN _ DATE t0(]6(mtz ] G 6KX8-0' Rm1m66 FRENONKUDD 0.mWG PATODOtli .OD8EI6E9 LE:A6 NatED H ]'81N'%.'11s' TW3.X] OOUOLE XIINC NAN �OOBEAIE6 A--....eediNWXTpI.DOU81E NUNGSTO�TRTNG91 Al - 5 Fv z � o f Hdge rs-b.Dd cri ket be12 yon to align rith ekieth &:,: 13 .�5(+ Adersen St—WATCH 12 seconddouble hung wdws.® rdr and door trim ® c cto match exi (}(� Da' o man Haase � PROPOSED PROPOSED ADDITION PROPOSED COVERED POR COVERED PORCH E7aSRNG HOUSE TO RDAAIN AS IS s'-v I«i.l zD.r t+n iG:iv EXISTING GARAGE AND HOUSE TO REMAIN.AS IS _ Ming and Lia•ct1-I 6X6 structural to match edat - FRONT ELEVATION " 1/4'a 1-O' t Vl Z a O • t z a Q � J = D- C a ¢ C O a a O LL ANDERSEN WINDOW&EXTERIOR DOOR SCHEDULE NEl' RCUGIIGPEMNG W%H —E NatEe ` • F O PORClI C00R BFE UNNEA d Y LL B ZONCk ZLbTC12 BOeERUM r - C 2'd-10•k.—* D—LEHUNO WpY —RiEenLTWABH FltENCHWOOa¢®WO PPTIODDQi E S-t•ke-11• FVM91811 mErCHNa MEOPXnODCaR 4006EMEe - - F —1I6'X4—' DOUBLE HUNG NOW bU eER�EeTLT Yl46N DNTE:t01111A1] G 6'dXed FltENCHVAODGLmWO PATICOOOR ug6ER�3 BGIE:A6 NafEp Z M'%lLLTlO' TM421R DOUBLE HUNG Wpv OD 6FN�E8 • " - DRAWING e. AU-WNDOWBT0BEANOERBENBTCRYWAT01,DdI NUNO4TOM A2 - 5 .7 of Z z - plate ht— root ridge ® !a align with axlatinq - � , roof-Ingle. eldlny and Mm - eecond floor to match axlat. e.Hhg ht. Aw Ed AL G G existing.flat fl 5 ehdY floc . kNrhen fl er 5'elidera to replace existin {'french doors kitchen floc EXISTING MAIN HOUSE exlet.dining PROPOSED ADDITION 10 REPLACE E1gSTING EXISTING CABOOSE STRUCTURE TO REAMAIN AS IS - TO REMAIN AS IS(tales to align Ith kltch ) 2a-0'ffF/ new Andersen Storm WATCH french doors .. PARTIAL REAR ELEVATION 12 Q73 _ .. eilt.nrldwge dqe wlpoint u .. . \ N Q13 - edst.iryaricket ® z ® soffit t! *, . - 12 H O 12 �..In h. xletlnq- ( F Q4(+/—) In house +/12i �� Z Q j \ 0 f > eve kitchen plate ht: eve kitchen Plate h w W 6x8 eWdural pool of Pot, I D Q 0 _b a o N b F—IIInxle�fwalle I reVlace Q a p �"I ex aUnq D ra wdw stud floor Q d'Iwok porch (to be remove I 2 Z etudX_floar I I Y—— kitMan new kitchen Moor I I W F PROPOSED dininatm floor Q COVERm (exi q) II. [vex ewu IL EXISTING CABOOSE STRUCTJR L w DUSTING CABOOSE STRUCTURE TO REAMAIN AS IS colfra Pwa LEFT SIDE ELEVATION RIGHT SIDE ELEVATION SCALE:As xarEa owAvnrme: '. A3 - 5 4 1 , <v j ------ ----------- ------- �. 3 I c rorcd.eort l I _ I 2 I b xt ensnx I � ee>nxe rouse ena1v ��R 1 i _ �.. 12 12 so*ro,•«nv.roee Axe v�+•w"�, ' —— —————1——— exist.second flow Ro ew Mitchen plat —eexnwa m s—w es (align.IB existing atfii). is rr,.A,,.M,NT _— — — rwdw h—adw— Z r K 1 T C H LN CRAWL5PACE a x la FULL BA.5EMENT fll tl In B caw fl t fl w_ xsoo m w kitchen floor ,m.v"`.ca01v ce°R e+x i Un9 .¢'is*'w ne CRAWL SPACE I� _ uu�wyy woo^ . tinny a«n (mlyn.Itn exeeny) rveam � LJenswe qce I -' >i,r uu rizcaxx.rle. runxw deewexr CRAWL 5PACe rcw•c. 4 o-nosrw.0 L J •wvsmm. z ?II .eauu eauu eauu z 1? mmuu w ' in u xemmm�����y�.w�uue�.ax eonou« axq . § I vmmuraxev oo�c� 1 § CROSS SECTION O KITCHEN a<aDx a. e'MexuM Arun�.°Na`eseM! — •. 50 a Awe w208.1+/-) xM•CO CMM' /�11�J wzx wonen>me Snor uL wxxL w,Dsal T--- 7 .. _r___ __r 10 OI? FOUNDATION PLAN _ existtny a o� '' wcu - aecand flow caning - N - 12 existing(+/-$ ® 12 a5(+/_) wnx>o�c•oc Z eeaamsmncu�°vv'`auswe 0 m eaaR1OO - B M na..w n"roiea on Z 12 I ting F' Q v S avxcmnA .xlstin9 1 m.u,a lu waona flaw ATTIC _ ate heyht = a s Z o °�� oe> I ® �O I ® ® i w.,°�o•a a'•'m nw i 1 n...on a a existing PORCH Q STUDY D renowted new 6 I HALL IMUD/ PORCH W ► � j - L A U N >m,x.uuL ras. j xew eoa>m �O azlatiny_etudy floor Wtdlen floor ~ O IL u LL ex>,welr„wwe eonwroeeLownxar rveanm>nxe wmwxw lur..a >nrC rlmie .xo w.0 : mxlawnvarl.a d 4 I f Ioo ' for so oA�Iv/a/mu �aunDx xxo wmr0 6GlE:A6 x101ED CROSS SECTION o n CROSS SECTION \ENTRY PORCH 1/4'-V-O• 1/4•-1•_0. A4 we 5 I Z J 6 2 b at ------------------- ----- rc U I I I -I �- N[W 2X�0 ROOrRMCi5 .9.C. I • I mow^ - '. I .. I I bm I I. r7---------------- - ----------------- I I i ♦ I - - - - I - - I I j j w:murmwicr® i i wnNc wwa - .- I I 1 I 1 3@ I I 1 I I o V 1 I I I 1 1 I I I x • a . r utW 2xl0 ROO�RPFIEw9®ICO.O. ---- PROPOSED p z ROOF FRAMING PLAN < � - g a a a • LL W LL O ~ O ' d u ""� onre ioimraoa� sum:ns Ro>Ev ownvaRcc A5 - 5 i kq mail: ; -P PERMIT Commonwealth of Massachusetts- . APR 18 2014 �5heetMetal Permit MagJ Pardel TOWN F SA IN T ALE Date: / l�/ Permit#1Z Estimated Job Cost: $ Permit Fee: $ Plans Submitted: YES NO Plans'Reviewed: YES NO Business License# - Applicant License# 3 V �,'*4 Business Information: Property Owner/Job Locatioli ldfomsation: Name: la,14ytp _yh cG� wit/`�� Name: C6,r<s ikf_ Street: G 5 �{-ui Street: M5 ' Ci frown.: �- G!'n�S�(�� Cityfl'own: �y'i Telephone:� LS�'-7�z. �c �� Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES_yeNO J 1/lN&unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. fL/2-stories or less Residential: 1-2 family :��Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other Square Footage: under 10,000 sq.ft. mover 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/Vents Air Balancing Provide detailed description of work to be done: NSURANCE COVERAGE: have a current jj il' insurance policy or its equivalent which meets the requirements of M.G.L Ch. 112 Yeso ❑ fi you have checked Yes• indicate the'type of coverage by checidng the appropriate box below: k liability insurance policy Other type of indemnity ❑ Bond ❑ )WNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Caws,and that my signature on this permit application waives this requirement Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent y checking this bo�ereby certify that all of the details and information I have submitted(or entered)regarding this application are true and ccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be i 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 Insneetions Date Comments Final Inspection Date Comments Type of License: Master le ❑ Master-Restricted y/Town , ❑Joumeyperson Signature of Licensee rmit# `� ❑Joumeypersan-Restricted License Number7/ �$ ❑ Check at www.mass.govldnl Zie Commonwealth of dlassaclzusetts UW Departmmt of-EndusW&A r dents Office fice o f�isvestig atiorrs -600 TWashingtoa IS`freet ' Boston,MA 0..ZIII wrurt�,mass:grrv/dia Workers' Compensation Insur-gnce Affidavit:BVMderslContractors/IIectridans/Pbaabers Applicant Informaiaon Please Print Lego Nye(Busmessl c%�L�Y1.�2� r��GL,c�s0-<c ch-yotvzip A)eA- 1- Phone.# Are you an employer?Check the appropriate bow , 1.�am a with 4. ❑ I am a general c�tractar and I Z`9Fe�P�7�(regma•ed):, �o� b. New ccrnctrnr�f;rn, employees($iII and/or part tie).* have hired the gob-co�xact= ❑ 2.❑ I am a'sale proprietor orpadner- listed as$ie-atfached sheet 7. [4 odeling. ship and have no employees These snb-c(=ractM have 8, []DemoJi n warkmg for me i=any capacity, employees and have wo±=-' [No Workers' comp.rncmranre comp.lusmanre,$ 9• []B�g addifian rested.] 5• []'We are a corpohdim and'its 10.0 Electrical repaics or adcr±= 3.❑ I am.a homeowner damg all-work officsIa have eaErcised their 11-[]Plnmbmg repay or add ions myself [No wormers' comp. right df==Ftkm per MGL 12-0 RDafrepa� iu nce requaed.]t c•152, §1(4),and we have no employees. [No wo±s' . 1.3.❑Other coMr incn ranrr.mq�ed] *Auy applicant fhat ebeckv baz#t=st also fill oat fhe section bdow shoeing t isva&=e compmsabra poflcy moo. t Hameawners who sahmittlris sf davit mdicadng ticy are damg an wnrk and fisa bffe ontside canlr I mast snba t anm s:ffdavftmdica:Chg such. tConfractoc-s that chrrlc fhi bozmnst atfarhed an additional sheet showing See name aF thb sub—c.ntmnla.s and state whew M-Mt dm=entities have capioyces. If the sub-contoci=ha employ=;they tPruvide&cir wain;ems.pony mffihd I am an employer that is prop_ir g-workers'MrIVensatfvn insurmcce for my employees Below is the policy and job site irt}vrmafioa Iusnrance Company Name: 1-- 72 Po #or Self-ins.I,ic,#k_ J EgpaadflnDate:_ � Job Site Address: 24:�- c04 asp: t Attach a copy of the workers' campensation policyd=arz1&m page-(showing the policy amber and m#ration date). Fat-Eare to.secure coverage as regrdredunder Sectiaa25A ofMCH,C. 152 can lead to$ic imposition of�alpeoaliies ofa �up to $1,500.00 and/or one-pear nnim mmn=4 as well as civil.penalties in the fc=Of a STOP WORK ORDER and a fine of'op to$250.00 a day against the viol-f= Be advised that a copy of this statEmeot may be ftawarded to the Office of hivesri s of the DIA for msnrance coverage ve iEc:zt CM I'do hereby certify under the pahzs-and penalties a-fpm jwy that 1 bzfb�a provided abope is true and correct _ Vie: �.��—�,,/�-��5� - Date. � ��• l� y Pbrme offIC&I use only. Da not write in this area fn be cnazpleten*by city or.town oaiciaLE� �V City or Town: Permiflr.ir�,geLmimgA fhoritp(circle one): 1.Board of Hear 2.Bmlding Department I C�tp1 Toren M k 4.�icaI hOther Contact Person: Phone#: Town of Barnstable t Re to Se ry rvices $ Thomas F.Ge$er,D' u•ector • . . Building Division Tom Perry,Building Commissioner . 200 Main Street Hym mis,MA 02601 Www town.barnstable.ma.ns Office; 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A.Builder ,as Ownet of the subject ptppetty hereb7 authorize to act on tap behalf, in 0'=tt=ttl2ttve to work authorized by this btriIding pPrrnit (Address of Job) Pool fences and alarms ate the ons res ibili f th responsibility o e applicant. Pools are not-to be filled.before fetice is*installed and pools ate not to be utilized until all final inspections are performed anal accepted. Sigaatr of Owner et=e of Applicant 1111 t . Print NatLie Print Name Date Q•.FORNM.,OWIERPMUMsZOD4POCU VE Town of Barnstable 'f of . Regulatory Services anarrsc�prs, Thomas F.Geiler,Director o��,�� Building Division Tom Perry,Bmlding Commissioner 200 Main Street; Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LIC EKSE EXEMPTION Please Print DATE JOB LOCATION: number street vm7lage "HOMEOWNER": name home phone# work phone# CURRENT MAMMG ADDRESS: city/frown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sic routs 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. DEFINPTION 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 constricts 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",asm=es 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 ofBamstable Budding Deparbnent -rmunr„r inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Bw7ding Official ' • Note: Three-family dwellings cantainmg 35,000 cubic feet or larger will be required to comply with the State Budding Code Section 127.0 Construction CorztruL HOMEOWNJI IS EXEMPTION The Code states that Arty 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 I work,•that such Homeowner shall act as supervisor." Many'homeowners who use this exemption an unaware that they are assuming the responmbmlities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 215)_This lack of awam=ess 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 responsmble. To ensure that the homeowner is fully aware of his/ber t'esponsmbilities,many cornmunities regmre,as part of the permit application, that the homeowner certify that hclshe understands the responsibilities of a Supervisor. On the last page of this issue is a farm currently used by sang-Al towns. You may can t amend and adopt such a fmm/e tification fur use in your comrrnmity. Q forms:homeexempt Cilent#:281696 TAVANOMECH PATE(MWDD!YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/17/2014 E HOLDER.THIS -ERIWICATE DOES NOT AFFIRMATIVELYIOR NEGATIVELY AMENDONL,EXTEND OR A TER THE COVERAGE AFFORDED Y THE POLICIES CIESfS CERTIFICATE BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),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!S WAIVED,subject o 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). CC SanzO Anne PRODUCER k0 E:c 50ti-945-9136 PHONE 508 945.7863 arc No HUB International New England arc N0.0,1 265 Orleans Road EMAIL anne.sanzO@hubinternationai,com ADDRESS: N Chatham MA 02650 - INSURER(S)AFFORDINGCOVERAGE HAICN 508-945.7863 INsuRERAt Hartford Insurance Co INSURER B:Safety Indemnity Insurance Co INSURED Tavano Mechanical Systems LLC INSURER C: 201 Capes Trail INSURERD: W Barnstable,MA 02668 INSURER E: .. - INSURER F S ER CERTIFICATE NUMB : REVISION NUMBER: COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT 70 WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR I.!AY 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 BPOUCDDECL li4S LIMITS POLICYEFF NIA AODLSUBR POLICY NUMBER MMfDCyr D MMIDDIYYYY LTR TYPE OF INSURANCE 1 R _ ` A GENERAL LIABILITY OSSBMZQ6456 8/14/2013 081141201 EACH OCCURRENCE s1000000 DppIJAGFETORENTED $3OO OOO PREMIS S Ea occurrence X CO!d!.IERCIAL GENERAL LIABILITY -CLAIMS-MADE --I OCCUR - - 'LIED EXP(Any one person) $1 O OOO .PERSONALBADVINIURY $1,000,000 -- - GENERALAGGREGATE $2,000 000 • - PRODUCTS-CO''P, PAGG $2,000 00O GENT AGGREGATE LIMIT APPLIES PER: $ POLICY( (JEC I 1 LOC COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY . 6210665 3/28/2013 08/28/2014(Ea acciaentl S BODILY INJURY(Per person) $250,000 ANY AUTO - BODILY INJURY(Per occ;denI) $500,00() - X SOHEDULEDAUTOS PROPERTY DAMAGE $5t}O�OOONON-OtY\EO ` Per olden!MM X AUTOSOCCUR EACH OCCURRENCE $ CLAIhIS•ItADE .r. AGGREGATETION$ WC STAN• OTH-9 AND WORKERS v 08WECLG5272 8114/2013 08/14/201 A W ANY PROPMETOR!PARTNER/EXECUTNEYiN E.I.FACHACCIDENT - SIOOOOO OFFICEIRLIEMBEREXCLUDED? ® NIA E.L.DISEASE-EA EMPLOYEE $100 000 (Mandatory In NH) If yas,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS Wow DESCRIPTION OF OPERATIONS)LOCATIONS!VEHICLES(Attach ACORD 101.Additional Romarks Schedule,If more space is requlmd), - - - ,.- CERTIFICATE HOLDER _ CANCELLATION Town of Barnstable SHOULD ANY OF THE A86VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED.IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORO 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S10616841M978046 AS004 1-3 e� S M 000;0=.g99Z0. VW 3 lg tl1 S N tl S3 d tl 3` t 0Z llV2ii oNvnd..L � � SW31SAS 1t10NdAtll�N `h3,NQ08 5�2��wM � 3W 133NS e ®• a ® a o a .�cca�43�SSti�U d0 N1.�tl3fV1N®N�W®3 . _�OMMONiN EALTH OF a ® ® o o ® N1AS.Siq+ HUSE7TS Qf ' SHEEN"A. WORKERS SSt1ES _TNE =FOLtOWf R. -1 DENSE i {. s nAsrr:ft u�RSTR I CTE-0 { Pig R€If�1EY N TAVANQ:. 201 CAPI:S TRAIL ` ` >.BARNSTAB LE �fi'A 02668-1373 4t+g ]2 } 5 Telephone: 508/563-6049 COLONY INSULATION, INC. 28 Jonathan Bourne Drive, Pocasset, MA 02559 am CLOSED-CELL FOAM INSULATION SPEC SHEET CONTRACTOR: IA1 1 �1 2C-'�V �,\ JOB SITE ADD SS: y..�w J� DATE: THICKNE58 R.y�gl UE� AR•eA Ceiling Cathedral Ceiling Garage Ceiling 11asernent Ceiling Slopes Exterior Wall Gsrafglise-. Wall" W alkout W Ill. Cathedral Wall E•lockers Overhan Slalr/Risers All R-values and thiclmess'meas'urements are emed to be accurate by the following Installers: TECHNICAL DATA.FOR MATERIALS IS ATTACHED TO TIiIS FOB cc, �S - A inthal/�� ThermalGuard CC2 TECHNICAL DATA'SHEET' PRODUCT NAME PHYSICAL CBARACT MSTICS Property Value Test Method Arn than Dntssity(nominsl): 2A ASTM D-1622 `R-vales: 7/incchh . ASTM C-518 ThermalGuard CC2 . compressive Strength: 35 PSI ASTMD1621-94 Tensile Strength: 70 PSI ASTM D 1623-78 PRODUCT DFSCAWTION Dimensional Stability: -<4%A ASTM D 2126 Closed Call Content: •96% ASTM D 2856 .ThermalGuard CC2 is a fast set,closed- Air Permeability: .002 L/sm2(@ 75 Pa'@ 1") ASTM E283 celled,245fa-blown spray polyurethane Vapor Permeability: .8 Porms @ X, ASTM E96 foam(SPF)insulation designed for use Fungus Growth; None ASTM G21 in residential&commercial structures, Service Temperature: 250°17(120°C)* exterior foundation or perimeter insulation,below grade applications, IS-1-h-peroaaw will vary depending on application Contact yourArirthane ra rhnlcal lispresentoltveJbr recommendations and tNaattom Alwayty teat naomaI0wrd CC2for sultablllty foryourpm ocular opplicadon hr exterior tank/pipe insulation and etc. o safe manner, ThermalCruard CC2 is applied as a LIQUID PROPERTIES liquid and expands 25x in seconds to fill prnnerty Value Test Method and seal.building cavities of any shape' Viscosity(A) 200-250 CPS ASTM D-2196 and size. It.exhibits superior thermal Viscosity(B) 1100.1306 CPS ASTM D-21.96 insulatiowtr-barrier,and sound Weight Per Gallon(A) 10.25 lbs/gal ASTM D-1475 attenuation properties compared to Weight Per Gallon(B) 9.4 lbs/gal ASTM D-1475 conventional insulation materials.- 9 EACTIVITY PROPTY,E Once fully cured ThermalGuard CC2 Pronerty �e ` remains rigid maintaining significant Cream'Timc. 2-3 seconds @ 25°C(77°F) structural strength and thermal- Rise Time: 12-16 seconds @ 25'C(77'F): insulation properties in adverse conditions across a wide variety of COMBUSTION PROP,F,RTIES � applications. propry Value Test$viethod MANUFACTC7RER Flame Spread Index. <'25 ASTM E-84 . Smoke Development «150' ASTM 8-84 Thermal(luard CC2 is manufactured PACKAGING&STORAGE f exclusively by Drum Weight(A) 551 lbs Drum Weight(R) 500 lbs Arnthane Inc. Total Set Weight 1051-1bs 1002'West Main Street Storage Temperaturc Range(S1R) 60—go OF Richmond,MO 64685 >Shelf Life at STR 6 months P.81&776.3015 1F.816.776XIS rpo not ollow material ra freete.bo mat pre heat Or recirculate(B))natatial os It will cawsefrajhtng and loss of www.arnthame.com blowing ogent slarage atfemnperviurea above or below STR may shoran ihe(fift and cause degmdoria„arlave of blowitz agent. Cold material will develop higher viscosity which can camse during pnocrsrin such as pamp cavltarlon and poor mWwe of(A)and(B)c"ponewts.Foy best prvcsysingperfornvance during of pl(cadon(A) CORROSIONmid(B)abaon reoiperaturesshaurhlbe between 60 IP--80 F; ThermalGuard CC2 is clitmically& PROCESSING PA,RAMZTERS physically compatible with all common Processing Prossure'Range: 900-1400 PSI• building=Aerials including electrical Processing Temperature Range: its—145 T$ wiring,wood,matal,concrete,plastic Substrate Temperature Range. 35-105 OF (PVC),copper,vinyl,and glass. Anrbiont Temperature: 35—105°F Substrate Moisture Content. .519%' INSTALLATION Yield 3800 v 506013oard beet Pef Set* Maximum Litt Thickness., 4 inches" ThermalOuard CC2 must be spray applied using approved equipment Use 'tneeashryparometers&yields can v-y wide&aapendl'ngon substrate mnpvomre,ype&condi ion,amblem IA ratio proportioning system that can teapamtureelevadon,humfdity,equipment and otherfactors•burbwtrasiallalon the tvAanmrarmtobservethe! acbieve the speciRed temperature.and 9"°aliry.andcharad-u°a°fthefo=and a4lustegn;pms„ttemperaa;e,tpWpftesenb as needed to aco mmodale these V01'abldr in order to Mitre optimum yield PmPkzr acp ef"proper cell snm«rt u%and .I pressure.requirements. ofthefadm. "ALWAYStest rhentxtf t')f W CC2 at destlrrdlhiekweees in ajo manner prior to Insulating stnaetum to erasure that it can be safely iAst ailed at the deshad lift thieknwa whhout rink of ehawft or combustion It is the e�huive respaxslblUryoftheirpyRrotorroachieveprop�rlj/tlhlcknessforsgfeoppltcatlotc Sa#k1jr1 Wcknessmayvary from application to application Am. ane TherrnalGuard CC2 . TECHNICAL DATA SHEET appropriate PPE as required by OSHA, intended for use by nopprvfesafonal. ThermalGuard CC2 demonstrates NIOSA,and statc/local safety applicators,or those who do not excellent adhesion to various substrates regulatory agencies. purchase or utilize tl*.produet in the when installed according to . normal course of their liusihess,.The manufacturer specifications. It is the applicator's responsibility to potential user must perform any.. comply with all job site safety pertinent tests in ordci to determine the ThcrmalGuard CC2 resin(B)does not requirements set forth by OSHA, product's performance and suitability is require agitation. Do not prc-heat or. NIOSH,and statellocal safety the intended'application;since final recirculate resin(D)as doing so will regulatory agencies. determination of fitness of the'product result in the"boiling off of the 2456L for any particulat'use is the blowing agent which will result in poor LIMMATATIONS responsibility of tho buyer. yield and poor foam perfoonance. ThermalGuard CCZ should not be left All guarantees and warrantiei as to the ThermalGuard CC2 should be installed expos ad to sunlight,as U V light will products supplied by Arnthane shall at a maximum thickness of 4 inches per rapidly degrade foam. Do not use near have only those guarantees and pass with a minimum of 30 minutes high heat or open flame.• warranties expressed by the between passes. It is the applicator's manufacturer..The buyer's sole remedy responsibility to test lift thickness for a TheimalGuard CC2 must be covered• as to the material claims will be agaimt particular application prior to with an approved 15-minute thermal- the manufacturer of the product. The commencing installation to ensure that barrier when used as insulation for aforementioned data on this product is the product can be installed safely at the residential or commercial buildings. to be uacd as a guide and is subject to desired thicl�ess. Installation must comply with all change without tioti'M The infarmadon applicable building codes. herein is believed to be reliable,but SAFETY&ENVIRONMENT unknown risks may be present. Do not install ThcrmalGuard CC2 at a ThermalGuard CC2 is installed by thickness exceeding 3 inches per pass NO WARRANTIES,EXPRESSED OR ' independent SPF contractors. It is. and do not apply subsequent passes DaLWA INCLUDING PATENT rccvmmmded that building owners within 30 minutes of the previous pass. . WARRANTIES OR`GV'ARRANTIES verify that-the SPF insulation contractor In rare.cases doing so may cause OF WRCHANTABILITY OR maintains proper credentials,insuranoc, charring and combustion.: FITMESS FOR IfM ARE MADE,BY and licenses and is properly trained to APZFMNE INC.WTTH RESPECT. safely install SPF insulation products. It is the applicator's responsibility to TO PRODUCTS OR rWORMATION . t test lift thickness for a particular SET FORTH HER) & ThetmalGuiird CC2 achieves a Class I application prior to commencing Fire retardarlcy sating and meets or installation to ensure that-the product Nothing contained herein shall exceeds minimum building code . " can be installed safely at the desired constitute a permit m recommendation_' requirements for fire safety. thickness. to practice any invention covered by a patent without a license form the owner ThermalGuard CC2 has low odor during Please contact your tcchnical sales of the patent. Accordingly,buyer application and produces no toxic representative for recommended assumes all risks whatsoever•as to the vapors after application. equipment configurations and for use of these materials,'and buyer's recommendations for yourpsrticular exclusive-remedy as to any breach of Always read and follow all Material application, warranty,negligence,or other claim Safcty Data Sheets provided with all shall be limited to the purchase price of shipments:Additional copies are DISPOSAL&CLEAN UP the materials. Failure to adhesrex to any available upon request from Arathane recommended procedures shall rolieve Inc_or your technical sales Curcd/ceacted product may be disposed Amthai c Inc.,and the manufacturer of representative. of without restriction,Excess liquid W all liability with respect to the materials and'B'material should be mixed and their use thereof. Basic POE safety equipment is required togcther,aod allowed to cure,then for personal protection including,but disposed of in the normal manner. not limited to:long-sleeve chemically Product containers that are"drip free" resistant overalls,rubber,nitrile,or may be disposed of according to local, latex gloves,splash shield or safety. state and federal laws �. glasses with splash guards,rubber or leather boots w/covers,full-face air- WARRANTY&DISCLAMER purifying respiratory(APR)with appropriate cartridges or fun-face The data presented herein is subject to- ® Arnfhane supplied-air-respirator(SAR),and other change without-notice and is not Amtnane'tnsr= 1002 W Main Street RW mond,MO 64055 P 816.776.3016 F 816.776.3216 . WWW.amtMne.com THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I m ^ � DATA SPECIAL ORDER MATERIAL i C-0 NAME r SALESMAN DATE REC. a .. �� ST "RDER# P O' VENDOR ------------ DESC ool, NO.OF PIECES • f To Reorder Labels Call 1-800-828.4448 ! p`OF 1NE► � Town of Barnstable % BARNSTABLE. • Regulatory Services MASS. �p t6, a.9. ' Building Division rf0 MAy 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection �r^ Location < Permit Number V Owner Builder One notice to re ain o ob site, o e noti on file in Building Department. The following it e corr curl_. STOKE �7R5� Please call: 508-862-4038 for re-inspection. Inspected by Date i '! TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma r � p S Parcel Application # Health Division Date Issued �� D r Conservation Division Application Fee Planning Dept. Permit-Fee ' (D Date Definitive Plan Approved by Planning Board Historic.- OKH _ Preservation/Hyannis Project Street Address 87(a M rA in 5+r a-c±: Village C o v%•+ Owner LA hdl L<.e Address A Telephone C 1-7 •- A Permit Request AA a6 Le m6 a-e- a o%d c�sl 4 (:C A Il -PIP,t s4p r Y.% n C1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a coo Construction Type Lot Size 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 Old King's Highway: U4Yes ❑ No 0 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ca Basement Finished Area (sq.ft.) Basement Unfinished Are + .ft) C-' 1,�Il p7 Number of Baths: Full: existing new Half: existing ►r�'ew- Number of Bedrooms: existing —new w Total Room Count (not including baths): existing new First Floor Rrmcourdih Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ZI new size _Shed: ❑ existing ❑ new size _ Other: 2 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) e IS 4 Name G Telephone Number �/- No, ©O(� Address 4djol License # L t 2— Home Improvement Contractor# f 0 Z 46 5 Worker's Compensation # 146.5 G no ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE 2, 77 ®7' i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER a� DATE OF INSPECTION: FOUNDATION FRAMES l! 3a�Q.es-irk INSULATION mzS t o/0�' Rlvv FIREPLACE ELECTRICAL: ROUGH FINAL = r' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING rX DATE CLOSED OUT eT F; ASSOCIATION PLAN NO. r ,yam The Commonwealth of Massachusetts S11`X Department of industrial Accidents _ 0 ce of Investigations' 600 Nlashington Street Boston, MA 02111 wwiv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Licant Information Please Print Le ibl Marne(Bus" TA ' Address: • City/State/Zip: �.� Phone-.#:_� (� c�,�ra0 " ndQ� Are you an employer? Check the appropriate box: Type of project(required): 1. ( I am a em to er with 4. ❑ I am a general contractor and I 6. ❑New construction p y * have hired the sub-contractors employees (full and/or part-tim.e). listed on the T.'attached sheet. ❑Remodelin g . 2.❑ I am a soleprpprietor or'partrier-' These sub-contractors have ship and have no employees 8. •[]Demolition working for me in any capacity. employees and have workers'comp. insurance. 9 ❑wilding addition [No workers'.comp.•insurance ❑ rep Electrical airs or additions required) 5, [] We are a corporation and its 10. 3.❑ I a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance.required.] t c, 152, §1(f, and we have no employees. [No workers' 13.[] Other comp. insurance required.] *Any applicant.that checks box#1 must also fil out the section below showing their worke rs'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, if the sub-contractors have employers,they must prvvidt their workers'comp.policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CD C���" ��o c� Expiration Date: 9 Policy#or Self-ins.Lic.#: �, l � j. I Job Site Address: ��� _ City/State/Zip:�'tt 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 tip to 31,500,00 andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a find. of up to$250.00 a day against the violator. Be advised that a copy of ads.statemmit may be forwarded to the Office of Investigations of the D•'" r ins ce coverer e verification. I do hereby cert ^` er,the ins-and pertalties of perjury that(fie information provided above is true and correct t • /,�'' . Date: - — Si aturc:' r PhoX . � 6®� ®� j Offccial use only. o not write in this area, to be completed by city or town offcciaL City or Town:/ Permit/License# Issuing Author!ty.(circle one): I.Board of Health '2•Building Department 3. City/Town Clerk 4,Electrical.Inspector S, Plumbing Inspector 6. Other I �'®gat ® StIr ct ®ems mployers to provide workers' compensation for their employees. Massachusetts General Laws chapter 152 requires all e 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 deceased employer, or the receiver,or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelljng 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 uch employment be deemed to be an employer." or on the grounds or building appurtenant thereto shall not because of s 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 compliancewith the insurance coverage required." fldditionaIly,MGL chapter 152, §25C(7) states"Neither the commonwealth not any of its political subdivisions shall . enter into any contract for•the performance of public work until acceptable cvidence of compliance�dth 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 suh.cont�actor(s)name(s),'address(es)and.phone numbers) along with their certificates)of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no'employees other than the members or partners,axe 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 arc required to obtain a workers' compensation policy,please call the Department at the aurrtber listed below. Self-insured companies should enter their self-insuranpe 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 permiYlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit4icense 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 borne owner or pitizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit uld like to.thank you in advance for your cooperation and should you have any questions, The Office of Investigations wo please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Deepa.rtm=t of Iadustrial Accidents Office of Txt�estiga f ozzs 600 Washington Street Boston, MA 02111 Tel. # 617-727-490.0 ext 406 or 1-877-MASSAFB Fax# '617-727-7749 Revised 11-22-06 www.mass.gov/dia I ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFIMCIENCY FOR ONE- AND TWO-FAMILY DETACPIED RESIDENTIAL'CONSTR'UCTION (790 CMR 61.00) Applicant Name: - Site Address: 176 /�1a•N S prin! Tovm: Applicant Phone: (7 72 f 71 Applicant Signature: Date of Application: NEW CONSTRUCTION: ehoose ONE of the f0l1DWi11g two•o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPOl`IENT C r FOR NEW ONE- AND TWO-FAMILY B INGS 1NZMUM Ceiling or Slab Basement perimeter a Option 1: Fenestration exposed Wall loon Wall AFUE HSPF U-factor rs RV e R-Value R_Value R Value • R=Va and De th . National Appliancc�Enc C°nsCrYatl°il Act(NAE .35 8 R- R=19 R-10 4 ft. 1987 as amcndcd,minir cstcr as applicabIc Noto: This. m is not required if you choose either of o versions ofREScheckas listed below. ❑ Option 2: Scheck�Version 4.1.2 or later variant software ysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at htt :/lwww.cner co ow/rescheck/ ADDZ`X O1V5'OR AX,`� ZAXXOI�S.TO E [S zZNG b S.O PER 5 YEARS OLD *puildings under 5 years old must use option#1 or 42 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b= a) ' SF 100 x 2 , 3�/° of glazing b a (b) Glazing area equals SF If 'lazin �s<d0%.uSe the chart below. If lazing is > 40 % rocee••d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW.-RISE RESIDENTIA-L BUI:LDDNGS MAXIMUM M]NXMUM Ceiling and Slab Perir Fenestration -Wall Floor Basement Wall R_yalt Exposed floors R-Value R-value R-Value and De U-factor R-Value ,39 R-37 a R-13 • R-19 R-10 R-10, 4 . a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i,e. not com ressed over exterior walls, and including any access o enin s). ' SIJNROOM—An addition or alteration to an existing building/dwelling unit where the toti El glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of tl. addition. Note: owner to fll out Cons-urner Inf'artnation,Forth found in A endix 120.P �►,�„ Town of Barnstable Regulatory Services r • - BARNBrADLL, Thomas F. Geiler,Director F�AF Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 wvm,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62 Property Owner Must Complete and Sign This Section If Using A Builder X kjnds611 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for. a -VA MA (Address of Job) Oa(P-3s Signature of e Date Li v\d s T? 1 e Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. i . Town of Barnstable Regulatory Services f 'Thomas F. Geiler,Director )A NsTABLE, KA-9 Building Division prfD '� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 - HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER": hone# name home phone# workP CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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: Tlu'ee-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, man communities require,as part of the permit application, er responsibilities, y I aware of his/her , To ensure that the homeowner is fully P homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by that the homed fi' several towns. You may care t amend and adopt such a fom-Jcertification for use in your community, i (nt of public S!►fct} _p•i u�rr'' d Standards ' ��tts ��` �•tn uild►Pfi Rc`ulution License }v�assachu: Board of 6 Supervisor .` . Consttu�tion 42099 l • License: CS Restricted to: 00 r ` YE L. SCOT CK AVE #' 10 HANCO 02420 LEXINGT�N,MIA Expiration: 71412011 19690 v sinner ' )if cot°t P uhlic.Sato 'etts- ICI •►nd Standards Nlass<<chuguildin R�`elation License Of ervisor .� Bo.uc nstruction Sup : / CS 42099 w • License: r p t .. Restricted to: 0 COT-v KYLE S COCK AVE . 10 HA GTON,MA 02420 LEXIN 71412011 Expiration 19690 (.ununisiuncr • i , 4 ' e License or,registration valid for individul use only before tho expiration date.' If found return to $oard of Building Regulations and Standards One Ashburton Place Rm 1301 Bosttrn,Ma.02108 v \C 4— Not valid itho <;t signature � a. 671_tom .�__..,..: �-----•-- ��,�,,, ....,��.\ 6o�i � '�f€ tYfdt9ofid � wtl HOME IMPROVEMENT CONTRACTOR Registration, 102858 Expiration ;7.L3/2010 Tr# 0 ^ 4 » -• �, e P vote Corporation KYLE RESTORATION SCOTT KYLE J 10 HANCOCK AVENUE INC,� ` LEXINGTON,MA 02420�L Administrator 6 }. ' i � Licensebr'registrat;ion valid for individul use only before the expiration date. If found return to: I Board of Building Regulations and Standards One Ashburton Place Rm 1301 w 11 . A Boston Ma ,021 OS Not valid it signature - < HOME IMPROVEMENT CONTRACTOR Registration: 102858 Expiration ,7G3/2010 Tr# 0 . .Type Friyate Corporation KYLE RESTORATIONS; ' yT SCOTT KYLE 10 HANCOCK AVENUE LEXINGTON,MA 024 Administrator l 10/01/2009 13:42 E174845155 SI(10 ANL WALSH INSUR FACE 02 '° ^� �y /� g ^� DATE(anMrvDr�rY1 .�C � �R I�B�f^� ! aA� ��/"+► ILI Y Y INSURANCE IQ/1/2009 THIS CE62TIFIGAIM IS ISSUED AS A MATTt=it OF INFORMAT1tTE PRO*IJCER (517)46,-•a114 FAX. (617)484-51-55 ®NLy ANI7 CONF�tS Nfl RIGHTS upoN THE CfsR'TiFICl�Tt= HOI.i]E - THIS CERTIFICATE 00 NOT AMEN69, EXT9rN0 OR Sico s Walsh TnsuraPda Agency, ALri:Et TI4E COVERAGE AFFORDED BY THE PO[ICIES SEL+DVt�, 106 Concord Aua. —'— P.O.Box 136 i.iNStIR9ERS AFFORDING COVERAGE ji NAIL lH yA 02478 .. . . Belmont I INSLRERA Na�ion�al GzzLnge Mutual Iits s .. ..-. I o049 IN$L RED rE►noeomPnY Kyle Restoration 1NS1}REtS:Sti3� znsu -. 10 Hancock Strget IN SUPER 0: 4 MA 02420. INSURERS: �,ax�-ngtan COVERAGES I THE POLICIES OF INSURANCE LISTED BELOW HA11F_PEEN ISSUED TO THE jN$URED NAMED ASOVE FOR THIS POLICY H THIS PERIOD INDICATED.MAY BC ISTANDINR ANY PERTAIN,M HE INSERM OR U ONCE CONDITION BY rI1E POLiG E5 DESCRIBED!4ERE N S SUBJE DOCUMENT rT��ALLL THE TERMSE?C"LUSIONSPAND CONDITIONS bP SUCH R MAY POLICIES.AGREGATE 64'rAITS$HO§VN MAY HAVE SEEN EO`?vED 6Y PAID CLAIMS. -- � PbZICY EFFECTIVE IP-DLlCYExFIRAfiDN S IN$R�RO'Li I POLICY NUMBER �R9Y�LM141�: YY71 9A?F-�f11L01YYYY1 FACE OGCURFENCC I S 500 Q00 '���' TMa r.... L` n �-�• MGI E IP -0FIy o�i,e piencni- ....... QOA ' ! (GCNBRAL LIABILITY c p r-s occu�.... L 50 ..j oo. j t ppPJ,MCR<.:iAL GEtiER.4G LtARII_ITY .� c .. ars+;nV .... :.. ".10 RC11 ?..,'• $>zaezobs a/zGi Qzcl I > ,. p, �cLAln� MADE (7��OGCtIR�t2S0151� � � IS'RSONAL1 ACVIN-1, T 600,000 I GENERAL A0CR_GAiF .1,1 11d.900.t 000 I I j Prh S ... r i I _7UCT •GpMF,o?AUG i?,. I000 000 j CEN'L ACGREGATF OMIT APPLIES rF�.: j I y Pv"Llcv rt0 Low.G —_ ---�--- —a �I_ AUTOMOBILE LIABIu7Y MEINFD SINCLE $ LIMIT I CC j 1(E^acQld!3nl) ANY AUTO j I RCOILY IN iURY ALL CN'NED AU OS (anr persenl j SCI-161)ILEL"AUTOS I • HIR.EI)AUTC4 per ! vYINJUnY ... .....I � I Ire!rtr,rlcc:lt) � No-Q'MNED AUTOS j I I PRCrE-R7Y DAMA' F. (P"aceident) — Ir-- AUTO ONLY-EA ACCIDENT GARAG£LIABILITY j FA ACC F AN"AUTOCTN[N THAN ........ AU7CONLY; ,AGG•,..g . I EXCESS I I,IMBRELLA LIABILITY I i EACH OQCUNNENCE I AGGREGATE U ff 'OCCUR CLAIMS MADEIS .• .. .. ..I ( i IIIOEDI:CTIBLE R RETENT1GN B STnTU- eF ITS r' WORKERS COMPENSATION TORY LIMITS i ER AND Eh1PL0YERS'LIABILITY y;N t,L FP.CHACa!D;-NT 100,boo .4NY PRCPRIETORIPARTNEprFk:000TiVC ... OFFIGER;MEMOPP EXCLUC::2 �rCCA5264p I S/27i'2009 i 8/27d2010 6L.DISEASE-FaEI�aF;.aYC�QI. 100,.OQ IN'pndrtary In NH} , Ityym,deec•IbAunder E.L.DISEASE-POLICvLIMIT ,. 500,.000 A MA.L PR'OV19IONS b61- -I j OTHER I _ D[BCRIl'TION OF OPERATIoNs!LOCATIONS I VEHICI.13I EXCLUSIONS ADDED W ENCORSENIENT!SPECIAL PROVISIONS CERTIFICATE HOLDER _ CANCELLATION ATION 1WOULD ANY OFTHR ASDV£ITFSCRIBED POLICIES BECANCS.LLED BEFORE T!!F PXPIRATION B �C�nya BCE ("5tT11y'�' DAT$TNERECF.THE i$SQjNG INSURER 1VIL11-ENDEAVOR TO MAIL 10 DAYS WRITTEN AT :: )3UILDING• n0PT• I NOTICE TO T14_CERTIRCA70 HCLDER NA FD TO THE LFPT,BUT AI' .45 TO,eC 30 3NAI.- Mkl:NNT S r A1�a STRZET IMPOSE NO OBLIGATION OR LIABILITY F NY KIND LI IIWE IN ER,ITS id OR HYAN REFRESEyT.4. 11UTNORU EED P AT r ACORD 25(2409101) c 98$•:2,009 ACORO CCORPORA All rights reserved, INS025(24d9o1) Tlie ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,,,.. Applicatid # (0a Map P el Health Division 'Date Issued Conservation Division �:Application Fee ) Planning Dept. Perrnit Fee: Date Definitive.Plan Approved by Planning Board Historic _' OKH, Preservation Hyannis Project Street Address Mal Village C*4-1A Owner Ck v1_S; Address'ress L&Oi S Telephone 7 "e Permit Request J2 A-N Lf i-ALrD V Jf: Square feet: 1 st floor: existing—proposed 2nd floor: existing proposed Total new Zoning District, Flood Plain Groundwater Overlay Project Valuation 0 Construction Type Lot Size Grandfathered: EJ Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family L11 Multi-Family(# units) Age of Existing Structure Historic House: LJ Yes )rNo On Old King's Highway: LJ Yes )WNo Basement Type: XFull �I(CQrawl J Walkout LJ Other (2- 6&S1.e,vKz4^A-&) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing. new 0 Half: existing —new Number of Bedrooms: existing 0 new Total Room Count (not including baths): existing It new 0 First Floor Room Count-9 7 S2 Heat Type and Fuel: Ll Gas XOil L1 Electric LJ Other Central Air: L)Yes No Fireplaces: Existing—3—New Existing wood/Odall stove";'0 Y.6s )SrNo Detached garage: L3 existing U new size—Pool: Ll existing L3 new size Barn: LJ exi ting 5' ew usize Attached garage: co existing Li new size —Shed: U existing LJ new size Other: Zoning Board of Appeals Authorization L3 Appeal # Recorded LJ Commercial Ll Yes LJ No if yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) Name Telephone Number Address In 44Mt( CC License# A AL > Home improvement Contractor# Worker's Compensation # W-20 124- r8 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGN DATE 77!. r i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME Ege�g a S/-21 Z09 ko&C4 INSULATION aws FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0 t .. DATE CLOSED OUT ASSOCIATION PLAN NO. o- r w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' d 600 Washington Street -Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl —� Name(Business/Organization/Individual): 4 L Address: i t� 4n t,% r Q City/State/Zip: A ,b7,q Z DPhone.#: Q C) ` to o G Are you an employer? Check the appropriate box: Type of project(required): 1., I am a employer with 4. ❑ I am a general contractor and I —•�� 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or'partuer-' listed on the attached sheet 7.. ❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑ Building addition [No workers' comp.•insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P -.3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152, §1(4),and we have no employees. [No workers' 1311 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.afiidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.M ) .Z y- i Expiration Date: Job Site Address: 60 jp C •y v►, 'F. City/State/Zip: V I't 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 crimirial penalties of a fine tip to$1,500.00 and/or one-year' risonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a agains• e�_Oc r. Be advised that a copy of this statement may be forwarded to theOffice of Investi ations o e IA fo overs a verification. I do:hzreby erti fund the p s and penalties of perjury that the information provided above i true and �rrrr�ect Si : Date: C Official use only. Do not write in this area,tb be completed by city or town offlCW .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,conti actor(s)name(s),-address(es)andphone 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 . .l 1 Mass-_-r____..e n. - b-Cr I—_3AA;4;,,, annlicant Please be sure to fill in the permit)"license number which will oe uScu as a ioicicu�c.,�iu.�,,.. =u 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 of permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone-and fax number: The C6mmonweal.th of Massachusetts Department of Indu.striAl Accidents Qffitce of Iavestigatlans. 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727=770 Revised 11-22-06 s. www.ma.ss.gov/dia M Town of Barnstable -' Regulatory Services. • sAxivsreats. uAas. �, Thomas F.Geiler,Director �E1659- Building Division Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862.4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, li�►�"s-�-v,p�le►� �, �1�-�- , as Owner of the subject property hereby authorize K� to act on my behalf, in all matters relative to work authorized by this building permit application for: � _7 M d iPl 51.?-p- Ce (Address of Job) Ali� Signaturg of Owner Date e \ Print Name If Property Qwner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0W1dERPERMISS10N ' i ' Town of Barnstable m Regulatory Services ,. • Thomas F.Geiler,Director sAtaasrwsre. MA35. Building Division Tom Perry,Building Commissioner 200 Mairi.Street, Hyannis,MA 02601.. v WWAown.barnstable.ma.us Of5ce: 508-962-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB IACATION: - number street village "HOMEOWNER!'* name home phone# work phone# CURRENT MAULING ADDRESS: city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HONEOWNTR 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 botneowner performing work for which a building permit is raps d shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)fair hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they an 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 pannot 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 responsibilitiu,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 cornmunity. Q:forms:homccxcmpt - HOME IMPROVEMENT,CONTRACTOR Registration 102858 Epjratron�7/3/2010 Tr# 0 ~ $ Type ivpte Corporation \ KYLE RESTORATION SCOTT KYLE 10 HANCOCK AVENUE INC } LEXINGTON,MA 02420; Administrator i Board ml" IJ g Re Construction SU gutahons and St Pervisor License Lrcoe- CS ,42099 .;� B►rthaateY 7/4/1951 � ExPration 2009, i. ;Restr►ctio Tr#.543 SCOT KYLE t.r '!i 10 HANCO"K AVE ti + LEXINGT ON Mq 02420 Commissioner j 1 i rt r r � t 1 - aanleu�is ogli pgen lo(\l Rom 'uolsog a i 10£I w-d aaeld uolanggsd aup spaupuelS pue suoileln2aH 2uippng Jo paeog I . i :ol uanlaa puno3 JI -a.lep'Uoilejidxa aql aaoag, IR Sluo asn InpIA!pul aol.pyUA uoilealsiRaa ao asuaai I k; NOTICE NOTICE TO a TO w r EMPLOYEES a EMPLOYEES / V\ The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street; Boston, Massachusetts 02111 (617) 727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring Savers Property & Casualty Insurance Company NAME OF INSURANCE COMPANY WC0001248 07/01/2008 to 07/01/2009 POLICY NUMBER EFFECTIVE DATES Sico&Walsh Insurance Agency,Inc. 106 Concord Avenue,Belmont,MA 02478-4034 (617)484-4114 NAME OF INSURANCE AGENT ADDRESS PHONE - Kyle Restoration 10 Hancock Avenue Lexington ,MA 02420 EMPLOYER ADDRESS 06/16/2008 EMPLOYER'S WORKER'S COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to-furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Worker's Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are herby notified that the insurer has arranged for such attention at the. NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Building Detail Page 1 of 1 ji $t i 1�✓ bt S n 21 Logged In As: Building Deta i I Thursday,Ju Parcel Lookup Parcel Detail Error. LoadOBGrid: EXECUTE permission, denied on object 'gets ', databasi 'TOBI_Production_Property', owner 'dbo'. Building 1 of 1 BMT[d2�j± �tl • Me Code Code Description Gross Area Effective Area Living Are BAS First Floor .2268 2268 BMT Basement Area 420 76 FAT Attic, Finished 644 193 FEP Enclosed Porch 150 45 FOP Open Porch 196 39 FUS Upper Story 840 773 GAR Attached Garage 5501 193 Extra Features Code Description Units Unit Price Year Built Value Commen FPL2 Fireplace ~� 3.00 3,000.00 1987 $7,200 FPO Ext FP Opening 1.00 800.00 1987 $600 Out Buildings http://issgl2/intranet/propdata/BuildingDetail.aspx?PID=2283&BID=2367&N=1&NN=1 7/17/2008 �'owlg ®f far -�)) astable *Permit#,f a 0(03ac) Expires 6 months from 'sue date Regulatory Services IW x Ap Fee � 'T Thomas F.Geller,Director AUG 2006 Building Division TOWN OF BARN Tom Perry,CBO, Building Commissioner , F �' STi4BLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Ck EXPRESS PERMIT APPLICATION Not A - 0 YaifdwithoutRedXPmpSIDENTIA� ONLY I C�\ Map/parcel Number Property Address � N oo�l� 'Residential Value of Work_ ��j(�Q-®d Minimum fee of$25.00 for work under$6 000.00 Owner's Name&Address r. Contractor's Name Telephone Numberrt� 6 + Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance assurance Company Name Norkman's Comp.Policy# -opy of Insurance Compliance Certificate must be on file. 'ermit Request(check box) 95 Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. GNATURE; 'orms:expmtrg vise071405 o` ► 1 ne t,ommonweaizn uj lvlussucRuYeccs Department of Industrial Accidents Office of Investigations 600 Washington Street +yz Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Flu' Applicant Information Please Print Legibly ."-Name,(Business/Orga=ation/Individual): Address•._,_. 26 city tate/Zip: �PhoneT#:-�- �f� L1 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I 6• ❑New construction employees (faU and/or part-time).* have hired the sub-contractors 'c27E-I am a•sole proprietor or parer- listed on the attached sheet. $ 7• ❑ Remodeling 014.and Piave no ertaployees� These sub-contractors have S. F1 Demolition king-fo wor rme in'any'capaoity. workers' comp.insurance. 9• ❑ Building addition [No workers' con7p. insurance 5• ❑ We are a corporation and its required:] officers have exercised their 10•❑ Electrical repairs or additions 3 I am a homeowner doing all work right of exemption per MGL 11.❑ 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' 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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500;00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under.the pains and penalties of perjury that the information provided above is true and correct Si afore: "_ Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Binding Department 3.City/Town Clerk 4.Electricai Inspector 5.Plumbing lnspvstor � 6. Other Contact Person: . . Phone#: k Information and Instruct4o s , 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 orbuilding 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 requtements 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 permittlicense 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 0i 1-877-MA SSAFE raA 617-727-7749 Revised 5-26-05 w-w-v.mass,aov/aia TOWN OF BAR.NSTABLE • HAHHSTADLE, o 06 9 BUILDING INSPECTOR r r APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .......... LZ!K/ ......P.A0.l�'4L/./.il.0..................... .... . ...... .2.............94.0. TO THE INSPECTOR OF BUILDINGS: -The undersigned hereby applies for a' permit according to;the followingroinformation: Location .........Ore............41!� �.�.7. ................................................................................... ProposedUse ..... !.\... .�.�. `�.��.�� ................................................................................................................................. ZoningDistrict ......... .............................................Fire District ............4. .. ..1........................................... Nameof Owner ...... .. ............Address .......... .. . .Y'.w.)...........,.. ...................................... Name of Builder .... Address.�. . .aa: ....... r . ,. ?,�..arc.E.A....�..�.. ....�? .rr°1�.���.��. Name of Architect ...07.Ct-AAILME—.�.ft .. #w.rr.Address ......... Number of Rooms ......... ....................................................Foundation ...... .Q�x.......t .1•......................... Exterior ...........IN..®: ..�s....:s � *f.....................Roofing ..........!! ..C .0.�...... .l�l��°.t.�............ Floors ............. a�..........................................................Interior .......... 9 e! Heating ..... PAr..k4tg 'Plumbing ..........`.... 3..A.rr`1............................................... Fireplace ................... ...........................................::...............Type of Chimney ...... ................................ Diagram of Lot and Building with Dimensions �- Jo i � Evi axe s r-rr-�� l�►���►v �1 J -I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .l ..l...Q.. .��.. ..... ..! .�.. »....................... ,Bryan, Marcus No .200.Z�Permit for ........................................... .... A Z;�........ Location ------— ............ ......................................... Owner a eve ..................... V1% Type of Construction .............. ................................................................................ Plot ............................ Lot ................................ Permit Granted .......t?J?:�.z............19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ti ................................ ................................ 19 .................. ................ .. ...... .. ....... .............. .. ......... .............0...................... 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FLOOD PLAIN DATA FIRM PANEL #250001 0018 D Map J5 REVISED: JULY 2, 1992 Parcel 85 ;.9 ZONE A13 (EL 12) & ZONE C LEGEND PE T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 22 EXISTING CONTOUR Mc EE 876 MAIN STREET, COTUIT, MA x 24.25 EXISTING SPOT GRADE CIVIL 0. 35109 Prepared for: Dulce Bryan, 876 Main Street, Cotuit, MA 02635 PROPOSED CONTOUR V Engineering by: Surveying by-, SCALE DRAWN JOB. NO. ft fthiseWork #A' RNER SURVEYING 1"=20' P.T.M. 142-08 TEST PIT 12 West Cnl Road 22 Long Road DATE CHECKED SHEET NO. Forestdole, MA 026" Harwich, MA 02645 BENCHMARK 1 (61 1 (508) 477-5313 1(508) 432-8309 4/11/08 P.T.M. 1 of 2