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0975 MAIN STREET (COTUIT)
q�s ,y�.,,✓ sT _ _ _ _ � � �\ a � -s Eu �T sor4os (29)2JIThip F#eA^^e � � c soe- �3 -�67V-� �v6� • } 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6 3 5 Parcel do$ Application # Health Division Date Issued 4114 hL Conservation Division Application Fee 1 6 Vo Planning Dept. Permit F 3�S/ _ Date Definitive Plan Approved b Planning Board ��� > pp Y 9 1-0. Historic - OKH _Preservation/ Hyannis— ^ Project Street Address _� 5 ^n---f -4 Village C0 Owner r����G� t4 %G C �s —Address 9 S h-. ns S� to �-' Telephone 0 6 - z >er -(. 4 59 f _ Permit Request 977L. A-r—r- 5 P-e 'Ce-t tA.)( 3��--� 8 u-� S ` d-r- rr- '55 O 4 Sonto a`6ZS — Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new o Zoning District 2yr Flood Plain_ #4o Groundwater Overlay Project Valuation to.ccv Construction Type 0oad rrZA- --: r Lot Size ' ''f Z_ Grandfathered: J0 Yes ❑ No If yes, ®h supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Farr&# ur ! _ Age of Existing Structure r 6-o Historic House: Yes ❑ Nop�On 1; c ing 4ighway: ❑Yes )WNo Basement Type: ❑ Full $Crawl ❑Walkout ❑ Other �9,� ®"� Basement Finished Area (sq.ft.) Basement Unfinished ,a (sq.ft) Number of Baths: Full: existing 1 new O Half: existing �� / new Number of Bedrooms: 3 existing Q new Total Room Count (not including baths): existing 0 _-new 6 First Floor.Room Count Heat Type and Fuel: 11 Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes 14 No Fireplaces: Existing New -0 Existing wood/coal stove: ❑Yes krNo Detached garage: Zexisting ❑ new size Pool.: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes YIN o A�No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name q- f-vZ+4 Telephone Number I'i-7-1 1 6-X- r.LC. Address ?t o • 7b oc 4(2o License # a t!-7 GS g C u .r 0-1 Q-"'s S _ Home Improvement Contractor# t !g-7 C4 A Worker's Compensation # S7-�-7 goo 416 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 6+;_t w 3 D Fo-Z77> w hz T€ � c SIGNATURE (` ✓v` DATE r o L G FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED { MAP/PARCEL NO. s ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f .S )((a s 1 S DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizetion/Individual):• ; ,4 C Address: r v . ISox &-�G o City/State/Zip: Co T1,. .� 3 S Phone A 50 k-- 4-7 -2-9 6 2- Are you an employer? Check the appropriate bog: -Type of project(required):. 1.E3 I am a employer with _ 4. ❑ I am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- r listed on the-attached sheet. 7. 2ITe-modeling ' ship and have no employees These sub-contractors have 8. ❑Demolition • working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$• required.] 5• ❑ We are a corporation and its 10•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself: [No workers' comp. right of exemption per MG!, 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. 1C6ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: r►IO 2 ✓��D Policy##or Self-ins.Lic.M S i 10 v e Expiration Date: % b j _ Job Site Address: �t"i 5 w. �!,r► S'i City/State/Zip: Co ;u r i M A A ZG %S 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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify:ender the pains-and penalties of perjury that the information provided above is true and correct: Signature: ` + w' Date: r Phone 4: 40e, OCT G 9— Official use only. Do not write in this area,'tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone M ' _ '• '1HE I 'Town of Barnstable f Regulatory Services • BARNSTABLE, v MAss. $ Thomas F.Geiler,Director �ATf1 M. A,4 BuildiIIg Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section if Using A Builder I, L A ct Z 777 , i/2 C, ,as Owner of the subject property hereby authorize 4;-r x 0 2 M w.C,T L-W d.61 y Fr I >r rE s' (tr(aet on my behalf, in all matters relative to work authorized by this building permit application for: . -1 S wt /t . M ST- co (Address of Job) Signature of Owner ' Date • L�..J r�L �C r �� u,,` • Print Name Q TO RM S:O W NERP ERM IS S ION CERTIFICATE OF LIABILITY.INSURANCE` o 01/2016"'r'"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER'THE COVERAGE AFFORDED BY THE.POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS,URER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder-is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require,an endorsement. A statement on this certificate does-not confer rights to the certificate holder in lieu,of such endorsements. PRODUCER _ CONTACT Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHONE D.EXIJ: 877-266-6850 NQ)FAX , 585-389-7426, ROCHESTER,NY 14620 E-MAIL Certs@paychex.com AD RESS6 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: NorGUARD Insurance Company- '31470 STEVEN MCELHENY BUILDER INC INSURER B: P.O.BOX 460 COTUIT,MA 02635 INSURER C. INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTERBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE DDL SUBR - ' POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR NSR, (MW/DDNYYY). (MMIDONYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE�OCCUR PREMISES(Fa am rrence)MED EXP(Anyone person). $ PERSONAL&ADV INJURY $ EN'L AGGREGATE LIMIT APPLIES PER: GEN ERALAGGREGATE $ _ POLICY =PROJECT=LOc - PRODUCTS-COMP/OP AGG $' - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO - - .. (Ea accident) $. ALLOW14ED SCHEDULED BODILY INJURY AUTOS AUTOS _ (Per person).. $ . HIRED AUTOS a$�0�ED BODILY INJURY (Peraccident) $ PROPERTY DAMAGE $ (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $' EXCESS 11A8 CLAIMS-MADE _ AGGREGATE' - $ DED RETENTION$ $ WORKERS COMPENSATION AND .. - X WC STATU OTH- - EMPLoYErtsLlABum STWC700048 a1/29/2016 01/29/2017 ■ ANY PROPRIETORIPARTNER1EXECUTIVE E.L.EACH ACCIDENT $ 100,000.00 OFFICER/MEMBER EXCLUDED? � - - - E.L.DISEASE-EA EMPLOYEE- $ -100,000.00 (M es,des y in NH) FYI N/A- E.L.,DISEASE-POLICY LIMIT $ 500,000.00 rc YES desrnbe under , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H,more space`is required) CERTIFICATE HOLDER CANCELLATION Steven McElheny Builder Inc, SHOULD ANY'OF THE ABOVE DESCRIBED POLICIES BE CANCELLED,BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,fTS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORp 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo aro'registered marks of ACORD i s . . ' x tt f W •,...'wT///"'1 l,.13..;'3 F 3 :'E' E Ef P1F.:� •mR� R E S y, .`.i93 '3.:. a :..5-- ,3a�3. A 3 3 � ���' ��"� },,..:;.,•�_ ...m .........., q „r � F�,lw',c� � - ...,s ..z.AY�ki.�'si..,....�.._G...u...x K..u✓...2"'.: �.aw i q it k., Y^ 'v • °l "•S .X Lim i ensee DetaEls F emo ra hic..].nformNPX r ull Name: .. S N MCELHENY ....... ......... ._._..... _ '., v k er Name: r _............__............. _ _........._................................... r _.......y cerise. _ n o m� „ ress., � dress 2: 0� d0 Ity Cotult / r�? y x rate MA r pc ode 02635'AN 3� c � ,.ount U ed tares ..........__............................... ....__.._ ......... ......... .... {. 1 �, cerise No: License Type:. Construction Supervisor 1&2.Family. 0 < kr ? a ✓F�r v F Professwn: Building Licenses Date of Last Renewal: 112112016 v Issue Date: Expiraoon:Date: 9/23/2017 y / tcense-Status: Active Today' 11282016 r � econdaryLicense: -.. ... - ��' �� a cr r r Doing Business As: x r s s ?,Rz, atus:Cha e: Lrc n enewal ....r..er..equis.� n arma. .a�] ...... .... .. - '` ' - a Prere ulsite InTormation � s s a r ............................................................. ....... ...........................:_No Disnpime Information . ._ '. i `✓ k .'x'" ocumentum � v '���ta�a Ctosi}"Wi d9vi•�',.. c �.� _� z � , '" 2011 Commonwealth of Massachusetts Ve. * Site Policies.Contact Wg a ✓teWO a �;_vt •rsx,".r°•�FFi�r Y,7 / �' b �, � .C '>• a3 ' �•'�, y i"`3 r dr.�` fi .r_F,✓' "�^.'. �. .v yx sr,`fy '}'sr';�`�; f�` zt'�.1' €start:gs� ,ice"... ® $��31a �.,.,-:. �,i,�. y".�•u,�,r � Hr:EE���' ��Ea��,. �z. __. -'� ���� ,e' ,,.;�431 E�1f j13EN31� : .... ..".., , ,.; �".,,�"_' MW ��5 ht r i eifi nse rFs state ma us/J Fes I n ea ...........hR IN' >.>xa-.. -. .,,..�F<,... A;,z � 33.� Y 1 ,�,. 3"_ J 3`31`39r3�.L1 � st .�} : S �'pY1 : `r�t�nf'9.iw re Scss. S �.s.. ,l:,1,33 33 or .13 >r'1t" r 3 s'..,, ram' ...... z=�..... i .1i u. z S� .. -- ___ 3 Mom% 3 ._a....� �...:...: ", i 5 Ij r .�F,, h Search Results x ,. �,� r�s Select the licensee name below for more information.(if your search.produced more than one page,you may Y .� ' -a `. i : fir` XW 5 select page numbers at the bottom of this screen.) r ' Select the Search for a.Person or Search fora Facil1V button to performs new;search. x h' '-. s Select the Preview Fife button to view a;sample of the eltls included in a file you can download_ r Select the Download File button to download a text file of your search results at no charge. Select Public information Request Form for a form to order a dala.file: r > % :5 Searcn,fora Pen Sea ehor afi ev ew'rte #aawnia F e: r ! me License Number License Type License Status Address uk skr r MCELNENY STEVEN PICSFA-0476937 iNnstruction:Supervisor.1 A 2 FamiIVIAcfivF -otuit MA 02635' - M �r t y �xx � 4 J � ®2011 Commonwealth of Massachusetts Site Policies Contact Us � � , r� ki OR low,r :5...... a� -..� �" :..r "�ti� • c "~\�1�� � - ab` �'. 1�`.:n X c�`�:_ �� :.:•`' 1�7 r.r 3 d'§ ' �:s ✓f 1 y -.�-` 3�� 3q 4; �'iyf s� H-.,£4 o-' ,;=4���' >,x stCia3r`e -�'v�s) n t C1/ee ai��naancu a aac ucaeC� • � - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 157699 Type: Office of Consumer Affairs and Business Regulation Expiration 10129L2017 Private Corporation 10 Park Plaza-Suite 5170 : Boston,MA 02116 ' os STEVEN MCELHENY UIL BDERS INC STEVEN MCELHENY 56 BOWDOIN RD MASHPEE, MA 02649 Undersecretary; Not valid without signature Town of Barnstable B u i n ,uensrns�e n M Post This Card So That`:it Is Visible From the StYreet Approved Plans Must be Retained on Job and'thls Card Must be Kept '.t MAb'S. 'k•` a* x.r r.; s.,, a t. a * 3 ,' t ::;: § iA "`i _ Permit . ..;." i 'Where a Certificate of Occu anc is Re utred;:such.6 u rq wldmgahall Not be Occupied until a;Final Inspectlon;has been made:. Permit No. TB-15-14 Applicant Name: Doug Askew Structure Current Use: } Date issued: 05/11/2015 Excavation. Permit Type: Addition/Alteration—Residential Expiration Date: 05/11/2015 Foundation Map/Lot: ` 035_008 Location: 975 MAIN STREET(COTUIT),COTUIT Framing Zoning District: RF Owner on Record: PEIRSON,ELIZABETH L TR Insulation Address: 975 MAIN STREET a a ;Contra actor Name • Garage Drywall COTUIT,MA 02635 _ Contractor License i x Est Project Cost $15 600 00 Final Description: Test Historic Sign Off , # r� - �. ,�� .:. Permit Fee $.647 80 Plumbing/Gas L Fee Paid: $0:00 t i Rough:Plumbing Building Official` <Date Final:Plumbing A This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permd has been granted. Rough:Gas A!w All construction,alterations and changes of use of any building and structures shall.be n compliance with the local zoning by laws and codes Final:Gas This permit shall be displayed in a location clearly visible from access street or road and shall be maintained.open for public inspection for the entire duration of the . work until the completion of the same. `� � a a ,• - ._ ,' - - Electrical ' k `"° The Certificate of Occupancy will not be issued until all applicable signatures by`the Building and Fire Officials are provided on this perint r n t Service Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing , *j Rough _ 2.Sheathing Inspection ti 4 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final , 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection +*%' 5.Prior to Covering Structural Members(Frame Inspection) 1, ,�� ��_. __ low Voltage Rough 6.Insulation . , 7.Final Inspection before Occupancy r i « Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations Work shall not proceed until the Inspector has approved the various stages of construction. 7 +� Health Final "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site. 00 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT. Preliminary Final TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Y Parcel 03 rce1 00 Application # "� 1� S a pp Health Division n Date Issued C:5) Conservation Division Application Fe Zo Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board qE) /Y /3 Historic - OKH _ Preservation / Hyannis Project Street Address q S 4 Village ,— r- Owner 5 �6 f t-L& $ �. Address '�� A^4- � S i Co 1 Telephone Permit Request 'G�,-1 iZr r%D V f1 04 F r t C L P1:- C K&t -� Square feet: 1 st floor: existing Vn7-proposed 2nd floor: existing 681 _proposed Total new Zoning District X- Flood Plain 6 Groundwater Overlay Project Valuation Zo, c t v Construction Type Laoo r 2-Ao^V-F Lot Size Z / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family WL Two Family ❑ Multi-Family (# units)' Age of Existing Structure ® Historic House: *Yes ❑ No, On Old King's Highway: ❑Yes )&No Basement Type: ❑ Full ❑ Crawl ❑Walkout J&Other fA(Vj� &-L Fuc VA-Z CJZ,+L--Jl. Basement Finished Area (sq.ft.)� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 1 new _ Half: existing / new Number of Bedrooms: 3 existing f new L Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other =� �_" ZE Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stole: kyles ❑ No Detached garage: ❑ existing ❑ new size_P21: ❑ existing ❑ new size _ Barn UJ existing`-"b nev size_ Attached garage: existing ❑ new size Shed: Aexisting ❑ new size ether: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ h gam" Commercial ❑Yes ❑ No If yes, site plan review.# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name (;T't0Z--L V(--CL-HF91) Telephone Number 94 ,-7 Address !ry 'Zo y- 40 License# 04-1 G i 3 Cy rz, - -T- �^ 4�`SS Home Improvement Contractor# c 5-1 Gctq Worker's Compensation # OCT0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE V" DATE `��S 113 r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t ; ADDRESS VILLAGE '} OWNER- DATE OF INSPECTION: w FOUNDATI.ONa FRAME INSULATION L PKs"•) FIREPLACE r ELECTRICAL: ROUGH FINAL g PLUMBING: ROUGH FINAL GAS: ROUGH FINAL j ti FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. r. r t The Commonwealth of Massachusetts Department of Indus d Accidents ` N Office of Investigations y 600.Washington Street" Boston,MA 02111 _ t www.mass gov1i is Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians//Plumbers . Applicant Information Please Print Legibly Name.(Business/Organizarion/3ndividvaI): �i' Ey7• w►C;Eir"E-44 iG t Address: iTa foxf!o6 City/State/Zip: CA 7u T- 4 6Z`4owe#: 571v9`` -77 -eci<oy . Are you an employer? Check the appropriate box: Type of project(required): 1.�4 I am a employer with 4. I am a general contractor and I employees(fall and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. [�Remodeling ship and have no employees 'These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' . [No workers'comp.insurance comp. insuance.# 9.. E]Building addition required] 5. We are a corporation and its 10.❑Electrical repairs or additions ' 3.0 I am a homeowner doing all work ' officers have exercised their 11.[],plumbing repairs or additions myself [No workers' comp. right of exemption per MGL- 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other . employees. [No workers' comp.insurance required_] *Any applicant that checks box#l•must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such" :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that is providing workers'compensation insurance for n y employees. Below is the'po&7 and job site information. Insurance Company Name: NO-m.G t-c Policy#,or Self-ins. Lic.-#: �T-WG 4`o 6 bor O Expiration Date: ' 11'7-41"14 Job Site Address: T-7 S '01-,A7- 4 . City/State/Zip: �'v 4 o^A- O 2-4-5S _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$1,50D.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 cerfifyyunder the pains and penalties of perjury that the information provided a boveis true and correct -Si e: ?X� c Date: Phone#: 509-- 4-1 q 6 Z- Official use only. Do not writein this area to be completed by city or town official City or Town: Perm_it/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: t. Phone-#: Information and .Instructions Massachusetts General Laws chapter 1.52 requires all employers to provide workers' compensation for their employees. Pursuant tin 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 ori such dwelling house:' . or on the grounds or building appurtenant thereto shall not because of sucli.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-contractors)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 mquired 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-insur•ed.companies should entertheir self-insurance license number on the appropriate line: City.or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill,out in'the event the Office of Investigations has to contact you regarding the applicant. .. Please be sure.to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit gone affidavit indicating current. policy information(if necessary)and under`Job Site Address"the applicant should write"all locationsn. (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 conm'ercial 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 sliould you have any questiotls;- please do not hesitate to give us a call, t i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-1VLASSAFE Fax# 617-727-7749 wised 4-24-07 www.mass.gov/din f CERTIFICATE OF LIABILITY INSURANCE 04/01/2013 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHONE , 877-266-6850 AIC . 585-389-7426 ROCHESTER,NY 14620 E-MAIL Certs@paychex.com AD RESSffi INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NorGUARD Insurance Company 31470 STEVEN MCELHENY BUILDER INC INSURER B: P.O.BOX 460 COTUIT,MA_02635 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS TYPE.OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS TR NSR D (MM/DDIYYYY) (MM/DD/YYYY) GENERACLIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ - =4AIMS-MADEE=OCCUR MED EXP(Any one person) PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ' POLICY =PROJECT=LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY $ AUTOS O AUTOS (Per person) HIRED AUTOS NON—OWNED BODILY INJURY $ AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND X WC STATU- OTH-TORY LIMITS ER ' EMPLOYERS'LIABILITY STWC466090 01/29/2013 01/29/2014 E.L.EACH ACCIDENT $ 100,000.00 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? yy�/NN E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory In NH) YI N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yea,describe under 7- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION STEVEN MCELHENY BUILDER INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION P.O.BOX 460 DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY COTUIT,MA 02635 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A TYC-Gidde to Wood Construction hi High Wind Areas:110 aiph Wind Zorze Massachusetts Checklist for CompJiance (780 CNTIZ 5301:2.1.1)' Check Complian= 1.1 SCOPE Wind Speed(3-sec gust)............................................... 110 mph Wind Exposure Category.............................................. ...... ....... ........ .............................B Wind Exposure Category................Engineering Required For Entire Project .......................................C 12 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) 1 '17- stories s 2 stories RoofPitch...........................................................................(Fig 2) .........................................111_Lai�. 5 12:12 MeanRoof Height.............................................................(Fig 2)..................._ .7.7,ft �5'331 BuildingWidth,W ...........................................................:.(Fig 3).......7.............................. ft :5 go, %001 BuildingLength, L .............................................................(Fig 3)................................................._12:-ft.!g B0, • Building Aspect Ratio(L/W) ...............................:�..............(Fig 4)............................................. 3:1 Nominal Height of Tallest Opening2 .............................:.....(Fig 4).................................................L�L:5 6,8, 1-3 FRAMING CONNECTIONS General compliance with frarnin'g o6nnectlDns...................(Table 2)..................................... ........................... 2.1 FOUNDATION Foundation Walls meeting requirements of 78D CMR 54D4.1 Concrete................................................... . ......... .............. Concrete Masonry............................................................ ....................................................................... 22 ANCHORAGE TO FOUNDATION"" 5/3'AnchDr Boltsvimbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ........................_"-------------"(Table 4)............................................... in. Bolt Spacin"g from endr)oInt of plate.............................(Fig 5)......,...._......:................. Bolt Embedment-concrete.........................................(Fig 5)...... ........................ ......... in. T' Bolt Embedment-masonry....................................:....(Fig .................................. in.�:15" PlateWasher..*..............................................................(Fig 5)............................................ 3'x 3"x 3.1 FLOORS FloDrftaming member spans checked ...............................(per 7BD CMR Chapter 55).............................. Maximum F1DDF Opening Dimension.....;.............................(Fig 6).................................................. ft:�12' ✓ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..*.................................... MtWmUrri Floor Joist Setbacks Suppoiting Loadbearing Waifs or Shearwall...._...._.....(Fig 7)................................................... ft 5 d Maximum Cantilevered Floor Joists ' Supporting Loadbearing Walls or Shearwall.......:........(Fig 8)..................................................... ft 58 t4A Floo .B 'rracing-at Endwalls...................................................(Fig'9)................................................................ t4 iN Floor Sheathing type .................t......................................(per 7130 CMR Chapter 55).......................... Floor Sheathing Thickness ........................................._.:.....(per 780 CMR Chapter 55).......................5W in. Floor Sheathing Fa'staffing..................................................(Table 2).. d nails s_.L at in edge I 1-.4- in field' ✓ 4.1 WALLS Wall-Height Loadbearing walls.......... .............................................(Fig 10 and Table 5).................:.........I It :g 10', Non-Loadbearing 'walls.................................................(Fig 10 and Table 5)........................... 1 ft'_520' Wall Stud Spacing ..... ................................_......_.........(Fig 10 and Table 5)................... 16 in.<24*o.c. WallSbry Offsets ........... .........................................(Figs 7&8)............................................. ft !9 d 4-2 tD=PJOR-WALLS' Wood Stid's Loadbearing walls......................................................(Table�r)...........................-..2x 1 'ftin.t Non-Loadbearing walls................................................(Table 5)........................ ... 2 x_ - -i ftoin. ✓ Gable End Wall Bracing' Full Height Endwall Studs...........................................(Fig I D)......................T...................... ............ 4A -W13 WSP-Atfic Floor Length................................................ Fig 11) ..................................��ft?_ Gypsum Ceiling Length(if WSP not used)....................(Fig 11)............................................. ft�:c.9W and 2 x 4 Dbritinuous'Lateral Bra&e @ 6 ft o.c... (Fig 11)...... ...............*................. or I x 3 ceiling furring strips @ I Vspacing min.with 2 x 4 blocking @ 4 ft spacing in end joist or truss bays ✓ Double Top Plate : . Splice Length ................:.....................................(Fig 13 and Table 6)................................I ft t4 A AFYC GFride to Wood Corrstructiorr ill Hi�[t {.Yind Areas: 110 mph f-ind Zon! Massachusetts Checklist for Compfiance (7s0 CtIAR5301.Z.1.0 Loadbearing Wall Connections 2.. v ' Lateral (no.of 16d common Wads)...............................(Tables 7 ............................................••--•-.. i Non-L-aadbearing Wall Connections Lateral (no.of 16d common nails)..... ......_........(Table B)..---•-----........................................... � Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table in Header Spans (Table 9).......:....................�_... 'Z ft L in.<_ 11' ✓ .....................•........_._.------...__........... able 9 ....�ft in.s 11' ✓. Sill Plate Spans )....._....................... Fun Height Studs (no.of surds)•-•••-•-----------•-•.....:.........(Table g).....................__:.................. ... Non-Load Bearing Wall Openings (record largest opening bill check all openings for compliance to Table 9) (Table 9 ...............•----•........_ft_in.<_12' i.A HeaderSpans............................................................ }..... � Sill Plate Spans..•. (Table 9).................................. I ft_in.s 12` P_ .... Full Height Studs (no.of studs)....................................(Table g)................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneousiy4 Minimum Building Dimension, W 3' < __..�Nominal Height of Tallest Opening 2 ........................................................................ i. T . SheathingType..............................................(note 4)...................................................... Edge Nail Spacing----------..................... ••....(Table 10 or note 4 if less)......................:.in. o/ Field Nail Spacing............................... ...........(Table 1D).........._......._---------•........._.......... i in. . Shear Connection (no. of 16d common nails)(Table 10).......7................................... ... 3 - a/ ..... O 9 9--•................... able 10 ........................................... Oo 0 Percent Full-Height Sheathing (f ) 5%Additional Sheathing for Wall with Opening>6'B' (Design Concepts)...--_--•--.•-••-•• Maximum Building Dimension, L " q Nominal Height of Tallest Opening2 ..._....® 6 B' 0 Sheathing Type.........:..:.. ............(note 4).....................................................(z .................. 9...................... Edge Nail Spacing .. _..._..(Table 11 or note 4 if less)........................�( _in: P FeldNail Spacing..........................................(Table 11).._--•-----•----_--••-...................._...... in. ✓ Shear Connection (no. of i 6d common nails)(fable 11)..................................•-----%.....-_.. ... .IL Percent Full-Height Sheathing........................ able 11 ......................................:............aoV !o 5%Additional Sheathing for Wall with'Opening>6'8'.(Design Concepts)..................... Wall Cladding ............................................. Rated for Wind Speed? ....................... .................. 5.1 ROOFS ✓ Roof framing member spans checked?...........:............(For Rafters use AWC Span Tool, see BBRS Webs'ite) 19 S ft 5 smaller of 2'or Ll3 Roof Overhang (Figure ) ............._ Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors able12 ......................:.....................U= i'lo plf ,r ... able 12 .....•••---•-•--•--•.........................L= 6pff Lateral-•-•.................•--.._..__.._........ (T ) S= °Z"t.pff .._. .---...•-- •. -- •............. able 12 Shear............................................... ..-- •- .._ (T ............................................ Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= pif 1`4-19. Gable Rake Outlooker............:....:................. (Fgure 20)........_. _._ ft s smaller of 2'or Lf2 14 Pr Truss br Rafter Connections at Non-Loadbearing Walls, Proprietary Connectors U= �"I ib. Uplift ..................(Table 14)............ Lateral(no.of 15d common nails).-.(Table 14).......................................L=t`firlb. J Roof Sheathing Type------------------------_..--•-----•---•---- (per 780 CMR Chapters 5B and 59)............ Roaf Sheathing Thickness - ........................................ ° z in.?7/16"WSP _..(fable 2) ..............•--_.. �' ✓ Roof Sheathing Fastening ............ _................................... — Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR-5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 2b Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Ba and Figure 18b ?. ' Exception:Opening heights of up to B fL shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. ure treated#2-grade. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness press . I OFTFiE ,� Town of Barnstable of Regulatory Services ! RARN•CI•ART=,R f ' MAE& Thomas F.Geiler,Director ATE k Building Division Tom Perry,Building Commissioner 200 Main Street,FIyannis,MA 02601 - www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must u Complete and Sign This Section If Using A Builder I as Owner of the subject property herebyatithonze � y > C ^� 1 � act my behalf, c V� �.E l dry `��,�t. in all ma.ttets relative to work authorized by this building permit, R75 � &-I� 5 (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_ Stgtiatute of Owner Signature of Applicant Print Name Print Name 1'3 Date QTORMS:OV4MMPERMISSIONPOOLS 62012 a. THF T Town of Barnstable .. .. Regulatory Services } R6RNCfA�r ,.R : Thomas F. Geiler,Director . Building Division Tom Perry, g Buildin Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: j 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. DEFIN11 ON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed tin nEr perm der the buildi it. (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 : zz Approval of Building Of5cia] Note: Thee-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 constructian Supervisors);provided that if the homeowner engages a persons)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 ultimates Supervisor. The homeowner acting as Supervisor is y responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit.application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t.amend and adapt such a form/certification.for use in your community. Q-forms:homeexempt ; I Office of Consumer Affairs&B m' d ess Regulation g License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 5 Registration: ,.,F .57699 Type: Office of Consumer Affairs and Business Regulation . Expiration: 4,0129/2013 Private Corporation 10 Park Plaza-Suite 5170 µ 0 Boston,MA 02116 STE N MCELHE'NY BUILDERS;INC an E - -STEVEN MCELHENY.._-.{.,"__ C 56 BOWDOIN RD. ��, •._�,�; :_ g��,-�-��„2 (��1 MASHPEE, MA 02649 - Undersecretary Not valid without signature -- R .Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 &2 Family " a License: CSFA-047693 STEVEN P MckmEA_ M PO BOX 460� , ` Cotuit MA d635 Expiration Commissioner Q9/23/2013 ' C-o O El V-L Roo— • �`�' " 6Eb'zoDk� HA ,y t 1 ,s — I. aTCNoED . /I __—�—_.. � �� I�u—^_ iI � 9�� •+F Ec. Wwee.d � -e f E<. ' 11 � • 1 I Ec scc ., �o:�,N �' h•�TLMEi{ ZC :6 i'a` i C &J"I GIG Hwsws ,n-f1 £x. F—It 1.n.t 3"OUSIN`U JO NM Q1 •r�-w, �zxro �roaG ' i L " }4^ IN Exit•1��cp ne.." _ '� 7.f.o J°mow, \ $Thal$3E7,�no•-� GE��.r+!G NE L£—^If S°•5:5 G" lL" o.G. C! SE` IY E� 2 C '� •,/o£cS E..( WaH L°j(, tL I _. w ,L i LI.l.YGwirl\. J^A - . - ---r--7 I A - 3l I NIC-61"s 84�1 TG£.J OYAZJ 7�AeC co oEIM r Town of Barnstable *Permit# PC ti EYpires 6 nrorrths jr nr issue date Regulatory Services ' Feet', w BARNSTABLE,.MA + - v� 6 9 `�0 Thomas F. Geiler,Director - prF�MP't A Building Division Tom Perry,CBO, Building Commissioner 0 200 Main Street,Hyannis,MA 02601 1 www.town.barnstable.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION RESIDENTI� Not.Valid without.Red X-Press Imprint JAN 2_7 2010 Map/parcel Number 1✓y.S yo 9' TOWN OF BARNSTABLE Property Address 5—r Cc [✓]Residential Value of Work ,v rac, Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address r R2I �•� 5 wLr4 . wt ��. Ca Contractor's Name S E.y`t A -TT LJ-1 Z•r.L' 7;1 Q,S 1 Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 4'1 G 4 3 ❑Workman's Compensation Insurance Check one: , ❑ I am a sole proprietor ❑ I am the Homeowner' [41 have Worker's Compensation Insurance i Insurance Company Name rn&,t rr-M 5 I I-L S, (`•i ✓2 nv�P Workman's Comp.Policy# S T--)e— OZ 6 S 3 Copy of Insurance Compliance Certificate must accompany each permit, Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side #of doors 1 .. Replacement Windows/doors/sliders.U-Value 1 (maximum.44) of windows S *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must.sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required.' SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 The Co_rnmo nwealth o Massachusetts Department of Industrial Accidents !; -ij Office of Investigations I' 600 Washington Street Boston, MA 02111 ` Z s wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Pleage Print Legibly Name (Bus iness/0rganizati on/Ind ividual): Cj JPV fi" IM C_CLN,F-L j LA Address: 'fie b o y 4 G o City/State/Zip: g e, rt, i t /R b Z G 3 S Phone #: S 1 e' L-i— Are you an employer? Check the appropriate box: Type of project(required):. 1.[4'I am a employer with 3 4. 'I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.El.I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have g. U Demolition Workingfor mein an capacity. employees and have workers' Y P Y• 9. F] Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its ME Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] 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' 13.❑ Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are,doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below-is thepolicy andjob site information. Insurance Company Name: �.H /� tz t, Policy# or Self-ins.Lic.#: s i w C_ a Z e Sss""s Expiration Date: 2 a it 6, Job Site Address: Z-S N S T City/State/Zip:_Co i 4 I T VA_40 L4-3S 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 we11 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 D1A for insurance coverage verification. I do hereby certify under thepains(and�penalties ofperjury that the information provided above is true and correct. Signature. 7"'L �n'c `'�`""�1 Date t ' 2-� t Phone#: 0 - of"7'1 Official use only. Do not write in this area, id be completed by city or town official.. City or Town: Permit/License# Issuing Authority (circle one); I. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector S. 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-contractors)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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia ��HErc Town of Barnstable Regulatory Services 9BARNhi esBLE,g' Thomas F. Geiler,Director 039;.� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:_ 5087790-6230 Property Owne> Must . Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize 5 c mil. ..-. L_►-( 2.y I cat-DRS l 4aCact on mybehalf, in all matters relative to work authorized by this building permit application for. P4 7- (Address of Job) Signature of Owner Die G � Print name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. OTORMS:OWNERPERMISSION Town of Barnstable it F'(HE Tp� Regulatory Services Thomas F. Geiler,Director BARNSTABLE, MASS. 16J9 Building Division 9� ��� pTBa �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ' number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or Iess and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. , Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cyrbic`feet or 1'arger 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 dp 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 helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILF-S\FORMS\homrexempt.DOC ACORn r }=GERTIFIjC"ATE OF LABILITY ;INSl1RANCEx � r D"TE ""° ry e:,�. ._...,.,;�,.-,.—,. �. ....Y.S,.�..,..�,;e.X> .__.x .�s_ a �" ,.F r.�' '` .., -✓ . 1..,, - .�a�. .:z 4. ^i 3 .u,1? ,i'-r, DIYY}` PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 150 SAWGRASS DRIVE ALTER THE COVERAGE AFFORDED RY THE POLICIES RELOW, ROCHESTER,NY 14620 COMPANIES AFFORDING COVERAGE . _ COMPANY . A GUARD INSURANCE GROUP' _ INSURED COr,+,+PANY STEVEN MCELHENY BUILDER INC B' P.O.BOX 460 COTUIT,MA 02635- COMPANY COMPANY - D .v::�.� °:,is..�..wm.-.z::.,wAi_.....s._.�:yG..s .,c.._,b... �••..+z:w ,.::`.zr.>.�,..;3�__. ..�cS.,.; 2.. .'3:, , � .. r.s.�_. ...�+i.. .... ...........�.w.,.'�A._. ..0 ....-_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ' INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS - - - LTR DATE(MMlDDIYY) DATE(MMIDDIM GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADEOCCUR PERSONAL&ADV INJURY $. OWNER'S&CONTRACTORS PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY, $ (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $. GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT - $ AGGREGATE EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM. AGGREGATE $ - OTHER THAN UMBRELLA FORM $ ---WORKER'S-COMPENSATION-AND-- WCSTATU- Ono- —_ EMPLOYERS'LIABILITY --— — — EL EACH ACCIDENT $ 100,000.00 THE PROPRIETOR/ INCL PARTNERSIDCECUTNE 0 - STWC128738. 01/29/10 01/29/11 - EL DISEASE-POLICY LIMIT $. 500,000.00 - OFFICERS ARE: ®EXCL - - - EL DISEASE-EA EMPLOYEE $ 1001000,00 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS y....- -.:' �. - .�i�x 4, t 4 s z� i �}' :.;�`� 8� :4,+t � �'�� �[ . j x.+. f� `��...,....i x.;l.k�,...•...,..::. v �'� .sr 4 r� ,CERTiFi_CATE,.HOL®�R�=,� .,_,...�x.��_.zs,,.,,_b az._wu.,, � �.r ,..-3.,`.y:•CA�ICELLAgiONx_.,.>'( . o.... ,.....�....__ ��` SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE. STEVEN MCELHENY BUILDER INC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAILPO . COTBUOX 460 MA 02635 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -7 � �t�` . ar C 'TI :•t w`'a', r:-� d „�.-, �.�.. .� -. .,_,_ .. .,,,..,....--. I *-` Nlassachuse'tts-Department of Public Safety . Board of Building Regulations and Standards •� —Constructidn Supervisor License L nse .CS 47693 , Restricted to 1 G a a � STEVEN P MCELHENY --PO BOX 46l)_., COTUIT MA 02635 . tk Expiration: 9/23/2011 C'onmiissimiei _ Tr#: 6192 .: dividul use only � acella License or registration•vand for m iebefore the expiration date: if found return to Office of Consumer Affairs& usinessRegulation HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulatron 10 Park Plaza--Suite 5170 Registration 57699. Tr# 288175 - Boston,MA 02116 ; Expiration, Li12912011 TYpei� va Cor arrEaUon - STEVEN MCEL ," 3UhD� 5 INC STEVEN MCELH s 56 BOWDOIN R _ Not valid without signature . S 6 Undersecretary i MASHP.EE,MA 026 :- J. _l TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #0/-QQ: I 6 Health Division 'Date Issued Conservation Division `� App'lication Fee I Planning.Dept; Permit Fee r Date Definitive Plan Approved by Planning Board 0)Gn`: Historic - OKH Preservation/Hyannis ft Project Street Address w- h • s.+ Village Cd' r" Owner _sr �� .r L N,&I Address Telephone S v r= - L _-f, •- C 4 S q Permit Request C jr c e mac eta , -S C� Square feet: 1 st floor: existing i c a& proposed a 2nd floor: existing &`o proposed 3 v Total new 3091 Zoning District Flood Plain Groundwater Overlay Project Valuation I a , c Type_ L,� 0e t> Lot Size Grandfathered: P Yes' ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure i S o Y(es Historic House: Yes ❑ No On Old King's Highway: ❑Yes )&No Basement Type: ❑ Full ❑ Crawl ❑Walkout 0 Other C Vt-p-;r-r C c J> C X�-`- Basement Finished Area (sq.ft.) 0 Basement Unfinished Area(sq.ft) 40 Number of Baths: Full: existing -I- new 0 Half: existing new '6 Number of Bedrooms: 3 existing 0 new Total Room Count (not including baths): existing 9' new ® First Floor Room Count Heat Type and Fuel: A Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing_ i New 0 Existing wood/coal stove: ❑Yes;WNo Detached garagelp xisting 0 new size—Pool: ❑ existing ❑ new size _ Barn: existing ❑ new size R'OOP Attached garage: 94 existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' Commercial_ ❑Yes ;WNo If yes, site plan review# f Current Use Proposed Use w - APPLICANT INFORMATION . f.a (BUILDER OR HOMEOWNER) Q' Name i&v Z-4 on�;r t-H !`� 3L- Telephone Number �O P, Ot(y Address f c- 73 v-x Il G e License# 104-7 e Ca a- C&1-u Home Improvement Contractor# Worker's Compensation # S &OC'-b`z-c►E?5;3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO T2.4 e:'M- S—, A71C*-i SIGNATURE DATE S 1Zd o') FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0: ADDRESS VILLAGE OWNER j S. 9 DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL x x FINAL BUILDING ����� / � DATE CLOSED OUT - ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston, AIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Si'Z� Address: 7o 'J c) City/State/Zip: Cn1-c--t s+^ A 3 hone.#: L7 , 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. 0 New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7.. ba Remodeling [] I am a sole proprietor or-partner- ship and have no employees These sub-contractors have 8.'0 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'•comp.-insurance comp. insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required] t c. 152, §1(4),and we have no employees. [No workers' 13.[:1 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: N A-rL t nl J�U,re C z pn% — Policy#or Self-ins.Lic.#: 1�_"i'uD Cc 7_X1 ¢9% Expiration Date: Job Site Address: Ct."'1 S vv%�h.•�t S-T' City/State/Zip: ev`7---j 7- 2-6-SS Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirigl penalties of a fine.tip 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 Ida hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Si ature: C Date: Pr, Phone#: S y k 4 Official use only. Do not write in this area,tb'be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 04 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 Iocal 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-con6actor(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 pernut/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town):'.A copy of the affidavit,that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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 Intvestigatlons. 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 4.06 ar 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFVICICIENCY FOR ONE- AND TWO-FAMILY DETACIIED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: Print Town: Applicant Phone: Applicant Signature: Date of Application: NEVI CONSTRUCTION: choose ONE of the followin two'o tions 780 CKR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA. FOR NEW ONE- AND TWO-FANIILY BUILDINGS hCA-M MUM MINIMUM Ceiling or Basement Slab QOption 1: Fenestration exposed Wall Floor Perimeter AFUE U-factor floors R R Value Value R-Value wall R-Value HSPF SEEI R-Value and Depth National Appliance-Energy 3 5 R-3 8 R-19 R 19 R-10 R-10, Conscrvati°h Act(NAECA)of 4 ft.- 1987 as amended,minimums or cater as a licable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http•//www.energycodes.goy/rescheck/ ADDT•TIQT ALT�NS.OR RATXONS.TO EXISTING$UILb* "E 5 YEAR3.OLD* *)Buildings under S years old must use option#1 or#2 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) �.3 SF 100 x 7 q % of glazing (b) Glazing area equals `L SF h a If glazing 0%.uge the chart below. - . If gla2ing is >40 %prQce6d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter LLLJJJ Fenestration Wall Floor Basement Watl R_value U-factor Exposed floors R-Value R-value R-Value R-Value and Depth .39 R-3 7 a R-13 . R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form found in Appendix 120T i Town of Barnstable Regulatory Services. $axxAM aces. ' Thomas F.Geiler,Director 9�'�eoNa�►``� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize S';—W-o z " -r F-L- yl 2T-,.t Y `T"I c-Z>'S:i?sto act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) f Owner Date Print ame cju If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O W N E RPERM IS S I ON Town of Barnstable 1 '1 , o Regulatory Services ` Thomas.F.Geiler,Director BARNMBLE, utnss. 9� 1e39. ,�� Building Division pTFo rya Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B 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. t DEFIMTION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC �arr ryze'uea ��/ Board of Building Regulatiods and Standard HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only Registratio' n` 157699 before the expiration date. If found return to: Expiration: Board of Building Regulations and Standards t �r i,. . 10)29/2009 Tr# 260819 One Ashburton Place Rm 1361 ype;_ Pnvate Corporation Boston,Ma.02108 STEVEN MCELHENY BUILDERS,INC STEVEN MCELHENY s - y-% 56 BOWDOIN RD. 4 ,� / MASHPEE,MA 02649 L� Administrator Not valid without signature BV'afWAffWWWfM 86a� �}k s a i n frY r a Construction Supervisor License License: CS 4M93 i i ExP►at[pn 91/23/2009 Tr# 4549 '�Resfr'ic ton —1 G� R �t STEVEN P MCELHENY = 33' PO BOX 460 �,.� �y i COTUIT,MA 02635 Commissioner j I ' AOORP. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY) 01/28/200 9 PRODUCFR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Paychex Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE. HOLDER. THIS CERTIFICATE DOES-NOT AMEND, EXTEND OR 150 Sawgrass Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rochester, NY 14620 INSURERS AFFORDING COVERAGE INSURED INSURERA: NorGuard Insurance Group - Steven Mcelheny Builder, Inc. INSURERB: P O Box 460 INSURER C: ----- ------------- - COtult, MA 02635 INSURERD: INSURER E: -------------------_.__._.__...-- - COVERAGES FHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LIMITS LIRTYPE OF INSURANCE POLICY NUMBER — GENERAL LIABILITY I I EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY i I _ — _-_- -- - �FIRE DAMAGE(Any one fire) i.$ .CLAIMS MADE � I OCCUR ! i MED EXP(Any one person) _.-_----- i PERSONAL I--_—8 A -_-_DV INJURY $ ' GENERALAGGREGAIE j$ GEN'I.AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGE, 1$ - PRO- i� -- ----- -I---- --'--- • POLICY 1JECTLOC 1 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AU 10 (Ea accident) AI_I.OWNED AUTOS BO ID iY INJURY -- $--- _------ SCHEDULED AUTOS ( (Peon) --------------_---_-_ -- I IIRI:D AUTOS - BODILY INJURY !$ NON-OWNED AUTOS ! (Per accident) -------- i. PROPERTY DAMAGE $ (Per accident). GARAGE LIABILITY - AUTO ONLY-!EA ACCIDENT- ANY AUTO - - I.A ACC $ OTfiER THAN. - - AUTO ONLY: AGG..$ - EXCESS LIABILITY I I - - _I-EACH OCCURRENCE - $ - - OCCUR - _.CLAIMS MADE - - -!AGGREGATE E --_$ _-_ --— ----_- IN DUCic"..r RF'T-ENTION S $ A EMLYWORKERS COMPENSAI u1f FNti STWCO20853 01/29/200 O1/29/2010 u `AC ETA! cTl. EMPLOYERS'LIABILITY �� I ,, TOR TORY LtMr1$ - j L E.L.EACH ACCIDENT $ 100,000 1 I E.L._DISEAS_E-EA EMPLOYEES_$ 100,000 I j E.L.DISEASE_-POLICY LIMII�i$ 500,000 OTHER I ' I I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED!!" k.JJFSEMENTISPECIAL PROVISIONS t CERTIFICATE HOLDER j ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Steven Mcelheny Builder, Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30— DAYS WRITTEN P O pox 460 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Cotult, MA 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA V ACORD 25-9(7197) 0 ACORD CORPORATION 1988 Convert to natural gas heating-and together we can save YOU money and,irrmproive our environment, !till iP, ' � ) ', � � r " '4,'�'t�'.+•;a �} +, 6�,rt•i 1',rvR I Fl :r' }, a bbb 4 w' bP to; r:a t, •.,r; ,' S'JI �U 'r;R N t•?\ii,r µ.'s uy1: dh „ • !' 1, ry I :c.., ,.i, •' r4 a.� ,'b� p^ - 1'i' ..i,:l "'T+ 1v,y,2Ld .M,,,;�'�tl, o)' .',i i�'• a, M" `�S �Y9'i"iV� _. �M'4"de.. t;t. n^'a'ti ,, .a ° w.a+•s-iRx• , r,�.W,,,•, kR+ i s r: .•T;r7;•r >J ,.i9 '�kl , 1 I` •.T: +°- �,},yyS. ^' r ea I iY•yt l4�! a, :,$,a,,s�' �'��`� dig"rrat,L ?, , 'y�� `t{ :>;. 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SCALE: 1 I t-_u•' DRAWN BY It'GL- 1. - DATE: y 1 S(D`� REVISED el,z-[.g - 1 " _ LF t TI C1 f 4 F Ciro / i f a a F (:F06 hrl as vy ;�". -a,s,�a•"' t€±,s"lh.. �*.ryc.�.,�.«-.•s..>.,y„<,�.•^�....,» ,!q«��. '� a:n3«.�+��+`"""• ''ma's t�5 :' °�" - �` '-�.�r'"�-` c A ila rZ L-I` LTin'E� . II ! , y y"f � - I �/✓It1 LC. �+. 1'�7Woo7 III i P�pptME ip�p� ' The Town of Barnstable . BAE. Department of Health Safety and Environmental Services MASS. �A s63q• s�e� iE0 MP+ Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location J 7� MAtAJ Permit Num*r' !,�2 E Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: `7 �. NE45 s7'tF��R7l�1G Mft!Cr row or,f G!K��iL e-ez6Z E:,e w,-s 6-;6 1IJC- -ro' 6-o). h�i C"?'o e CZ 1 P6 F©k 79-e-4- K#-P7�E-Rd 7 P4-A-rr Co,u/J &<--77®A1 t Please call: 508-862- for re-mspec ' Inspected by G Date /�� ��(f1 `gyp IKE 1pk The Town of Barnstable - - BARNSTABLE. • Department of Health.Safety and Environmental Services MASS. PrEO MPS Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection �� � Location 75 M'Orlu S� �`�� Permit Numb�r� �o �6�-3 Owner Builder c- d 'te One notice to remain on job site,one notice on file in Building Department. The following items need correcting: /7 S� CL4 OAS L�nri�Cr- /C� u r o� A>2GcJr� � � s�iF�7l�JG. /"00 s� � �n -r- /�Jc-��s o Lzs �a ���� ircaG L/Yo//W � ,P16 cRe Cz- i Fo �� K� Crz 7' s to to R_�I-7'� ©rU �-T/mAJ ? Please call: 508-862- for re-inspec ' Inspected by ► '"�'/ ° is Date_ /07 Ds THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM A DATA BLE I 2007 JAIL► 17 PM 12: 09 °r n�.; i 1 V �'�•T T� �•X SST%�� J4�al �uCrJ/y� /�� — Gz Z4f-," 7 f" o ME- MOORE E��FCISTER�`��� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# Health Division -r, nr r "`. f " Conservation Division Permit# Tax Collector _--------Date Issued' Treasurer 7 Application Fee a&7— �/ Planning Dept. Permit Fee r c� 7 Date Definitive Plan Approved by Planning Board R` Historic-OKH � Wpeservation/Hyannis Project Street Address q"1 S A q , ,4 5-F. Village r-u-� e Owner '3-f E F F L A cta(F- J i C>C� ,.(s Address q 1 �^^ q-., ,J S T • Ca�-K, '� Telephone S c lb 4 Z1- - C. -4 5 S Permit RequestZ �-- x Y Square feet: 1st floor:existing proposed �5 fo 2nd floor:existing 5v0 proposed Total new 6 Zoning District fZ Flood Plain N o Groundwater Overlay Project Valuation 14 19,w" Construction Type a o 2 rt f-- Lot Size ` z- 4c- Grandfathered: �11 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Y Two Family ❑ Multi-Family(#units) Age of Existing Stru re o Historic House: Yes ❑No n Old King's Highway: ❑Yes XNo Basement Type: ❑ Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) , Basement Unfinished Area(sq.ft) 5Number of Baths: Full:existing new Half:existing new - Number of Bedrooms: e ' new Total Room Count(not including baths):existing First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other C,6ntral Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing Nnew size 4�G Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ►%AtfLEt r 4y Telephone Number S-o-I„- 77 - Ss07 G °z- Address (Po iS cx 4& o License#. -- d -T 3 t?0 • "� , ,�.� A o ZG-5-5 Home Improvement Contractor# i to 4 g Worker's Compensation# ©8 i to e_t l --7 -os ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,a,; 4;7 rz ✓z S SIGNATURE r DATE I FOR OFFICIAL USE ONLY i 1 PERMIT NO. ► DAT, ISSUED > i r r MAP/PARCEL NO. ` ADDRESS' VILLAGE OWNER - t DATE OF INSPECTION: f FOUNDATIONo D 67 W)o.L 110.7� , FRAME � if p�a INSULATION i } FIREPLACE i ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL FINAL BUILDING O(G 7/�1�8 R��G DATE CLOSED OUT ASSOCIATION PLAN NO. k r f Town of Barnstable ` Regulatory Services iAEA1$TAB ,,sAM . Thomas F.Geiler,Director AEEp :A10 Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW `/ �3S Uo Owner: ✓off'`��/!Q/F �t7ti6WS Map/Parcel:- Project Address 94T 1 AIW S�. C-7- Builder: AA'cCEQ-1-1415'jy The following items were noted on reviewing: 6 >ti G- S-r'&-E� /36wm 5 AAA V Ci) -41 L-5-6 4k rat 13 e-x- ry&'s e4�� /A)S PEr—Tr o Al Reviewed by: Date: 107 Q:Forms:Plnrvw k f r C 06 e� r The Commonwealth-of Massachusetts Department of Industrial Accidents" t i Office of Investigations ` ski / 600 Washington Street Boston, MA 02111 -3a www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): t I-f �� �k ` 7 �s C . Address: �o ?orX 46 Q City/State/Zip: C9 r-Lc r �— H-%- 0 ZG 3Sphone #:_ S q 7 - ,�i G-z- A,re�an employer?Check the appropriate box: Type of project(required): 1.FJ I am a employer with 7i 4. ❑ I am a general contractor and I 6 ,,Tew construction employees(full and/or part-time).* have hired the*sub-contractors v n 2,❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp.insurance. 9, ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] Officers have exercised their 10.El Electrical repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11.0 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.] OAny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. kContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. t am an employer that is providing workers'compensation insurance for my.employees. Below is the policy and job site information. Insurance Company Name: H vo-R I F o,2, Policy#or Self-ins.Lic.#:__ b Q� c,L o 1 —''7 s® _S Expiration Date:__ 01"►5 �^ d4 S-T% fob Site Address: C a 1'.4 r City/State/Zip: ✓-^ 09 Z(o Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :ine 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 )f 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. - f do hereby certify under the pains and pens ' of perjury that the information provided above is true and correct 3i ature: � c� Date: 'hone#: d r 14-7 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): L1. oard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ther tact 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 pf 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s),of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy-information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Commonwealth of Massachusetts Department of lndustdal Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-49GO ext 406 or 1-8,77-MASSAFE Fax#6�17-727-7749 Revised 5-26-OS wwwmass.gov/dia E � 1 V TyJ.I V1 Alp alJ.la7L"LFAVL+ Regulatory Services s�xNs rla Thomas F,Geller,Director Fa39. Building Division _ Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Rce: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME EYIPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL a 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement;removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which'are adjacent to such residence or building be done by registered contractors,with cerkain exceptions,along with other requirements. Type of work: W T ! Estimated Cost_ Address of work: 91 G Sr �-P �` ' `� c^"'A ® Z G.S Owner's Name: - —: g7" 1-( c ��,c ►.t s l— .J4Z jr P�l 2 S o-mil Date of Application: I b C I hereby certify that: Registration is not required for the fonowing reason(s): ❑Work excluded by law ❑'Job Under$1,000 Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. OR Date Owner's Signature Q.wpMes.fomu:homeaffi day Rev: 060606 A VE T( ti • .snarrarastE, + Town of Barnstable X` ' Regulatory Services Thomas F. Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Dffice: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Tf US.. ,g Aiu- R ; der I, L—A "0� '� �� ��a rl , as Owner of the subject property hereby authorize LJ-F—aJ V--o:L-M to act on my behalf, in all matters relative to work authorized by this building permit application for: 01 `1 5 VV-, 19 , 14 S i C o 7 i t IF (Address of Job) T Signature of Owner Date fit•+ e �. Print Name Q:Fomis:expmtrg Revise071405 i 1 g l� d ✓lie toamnzaoUwe o�✓UCaa6ac�ivae Board of Building Regulations and Standards License or registration valid for individul use only �a HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Regis t on, 5 One Ashburton Place Rm 1301 piration: 10/20/2008 Boston,Ma.02108 Type: DBA GROVER&MCELHENY BUILDERS STEVEN McELHENYrj o 523 MAIN ST C COTUIT, MA 02635 Deputy Administrator Not valid without signat e _..__I "�e i�anvnwouueal� ✓llaad¢cliccaea $ BOARD OF BUILDING.REGULATIONS [ j License: CONSTRUCTION SUPERVISOR �. Number: CS O47693 r Expires: 09/23/2007 Tr.no: 6108.0 Restricted ST P 'h PO BOX 460 _ C7) I §. .3 COTUIT, MA 02635 Commissioner r ii �p ij } 3'3d 9♦1}.. t��1..,.. .',.:.E .. .. a .. i .. _ _ 5 ..i. t A SfI,SA /YMM/DDYYY) ACORa CERTIFICATE OF LIABILITY INSURANCE 9/DATE(MMfD Ny 6 PRODUCER _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mc Shea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 508-420-9011 INSURERS AFFORDING COVERAGE NAIC# INSURED Steven P. McElheny Builders,Inc. INSURER A: The Hartford Insurance company P.O. Box 460 INSURERS: The Hartford P.O. BOX 460 INSURER C COtult, Ma 02635 INSURERD: 508-364-1926 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 50,000 CLAIMSMADE �OCCUR MED EXP(Anyone person) $ 5,000 A NPP916772 09/22/0.6 09/22/07 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYF_j JECOT PR El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILYINJURY $ NON-OWNED AUTOS (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT S ANYAUTO OTHERTHAN EA ACC $ _ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CICLAIMSMADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION AND WCSTATU- OTH- EMPLOYERS'LIABILITY X TORYLIMITS ER ANV PROM ETORIPARTNERIEXECUTIVE - E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? 0 816 C 17-7-0 5 0 9/0 4/0 6 0 9/0 4/0 7 E.L.DISEASE-EA EMPLOYE1 $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONSADDEDBYENDORSEMENTlSPECIALPROVISIONS a ' I I , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1151 main st COtuit, Ma 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 5 0 8-7 9 0-6 2 3 0 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001/08) ©ACORD CORPORATION 1988 - a 6 T v 15.5 480 .P z ,y Jla.4iERS � 4 / C. OORE ,. 33253 Tt 2B'd 26a' z VERIFY SIZE&MATERIAL OF PLATFORM IN THE T 6 FIELDWIOWHER 14'd' 14'd P., >< POSTS ON IZ DIA LONG. SONOTUSEST04'Q' �-r BELOW GRADE I I I I I I I I H�N �.UP B oN. ¢ L' A4 I I I I I I A mW�c ti F 3 L N 0 LADDER&ACCESSI HATCH TO S.F, I n ACGES& O M C= b L----'� $ $ I XATCX I U $ I I I � I ANDERSEN I I VELUX I M 24a6 I ABOVE- I I U L__J 3V'z6B' I I $ I I STEEL BEAM(FLUSH FRAMED•)__—-—-—_-- ANDERSEN AXW 13 I ' r -] I I STORAGE I ACCESS IT I STORAGE ACCESS HATCH I H $ $ $ I HATCH T.I ANDERSEN - ° I I I I �J l�1CZi6 I I q I I L——J ANDERSEN I I AXW 13 I I I _ - - - STEEL BEAM(FLUSH FRAME D_------- I -I ANDERSEN I 1 VELV% I I 2446 - I I SKYLG XT I I LBOVE_J A4 m A4 A4 I A4 b b I I 5V"s 96' I CUSTOM DOOR U 5V'x 9'6 5't1'r 9'6 5V"x9'6' 57.9'6' bra - ... CUSTOM CUSTOM CUSTOM CUSTOM a Oo O DOOR B DOOR DOOR DOOR B f d'd 14'a 2Bd 28'd FIRST FLOOR PLAN � SECOND FLOOR PLAN w � NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS SCALE &DIMENSIONS IN THE FIELD 1/4"= 1'-0" 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER DATE: 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT THE DESIGNER SMALL BENOnFIEDIFAN' 10/11/2006 FIRST FLOOR TO BE 7'•0"ABOVE CONCRETE SLAB ERRORSOR THESE DRAWINGS RIORT.ARE sTOARTCP 4J ALL CONSTRUCTION TO CONFORM TO780CMRMASSACHUSETTS WILL BE RESPONSIBLEFORING THECONTENTOR DRAWING NO.: .STATE BUILDING CODE IN THESE DRAWINGSIF CONSTRUCTION COMMENCES WITHOUT RE 60LE NOTIFYING LY FOR TH 6J PROVIDE UTILITY INSTALLATIONS FROM STREET TO NEW GARAGE DES(GNER OF ANY MIRRORS OR OMISSIONS. VIA UNDERGROUND CONNECTIONS TO COMPLY W/AIL LOCAL CODES ONTTHESE DRAWINGSPROPERTY NOTED.ANY0 ER USE USE ON THE PROPERTY NOTED.ANY OTHER USE OF 6.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OFWINGS TO BE 3000 PSI ARE PROTECTED UNDERNTHETARGNHESE ITETHE CTURAI COPYRIGHT PROTECTION ACT OF 1990. z N 0 QCG_m . 1z m Lo 2 cifi t0 1 x 6 RAKE BOARDS CT]N W/I x 3 DRIP BOARD CV m BOTTOMOF CEILING JOISTS b TOP OF U b OP E IL tv SECOND ROOK SUBFLOOR TOP OF PLATE / W.C.SHINGLE SIDING TO WEATHER b //j % Ix6lIx6 CORNERBOARDG TOP OF FOUND. CUSTOM DOORS FRONT ELEVATION MA EFALANLTHEFIELO) CONT.RIDGE VENT BEAM FOR CHAIN BLOCK (VERILY SIZE WIOWNER) ttPICAI ASPHALT BOTTOM OF ROOF SHINGLES O CEILING JOISTS U 0 � � Ix6 FASCIAb r� FRIEZE 00 DS TOP OF ✓\.K/ KNE_EWALL /'A� b SECOND FLOOR SUBFLOOR J �1 TOP OFFLATE M I L.I.n LTJ 4 F-1 SCALE: t;-Vlo-O . DATE: 10/11/2006 RIGHT SIDE ELEVATION DRAWING NO.: FINISHED GRADE VARIES (VERIFY INFIELD) A2 z 1.B RAKE BOARDS E N N WI I.G DRIP BOARD >„C)0 a, I Q ¢_ �to m F2tiu�i BOTTOM OF L(n[y]N^, CEILING JOISTS - C� E-m< �U< ot b TOP OF KNEEWALL M b SECOND FLOOR!: SUBFLOOR TOP OF PLATE TII1 SIDING to S'1v6 4 CORNERBOARDS TOP OF FOUND. P.T.6.6 POSTS CROSS BRACE - AS REQUIRED CONT.RIDGE VENT F-+ REAR ELEVATION BEAM FOR CHAIN BLOCK (VERIFY SIZE W/OWNER) TYPICAL ASPHALT ROOF SHINGLES O SOTTOM OF CEILING JOISTSEl � ,^ fF lO�N" o f 1.B FA$CIAB b '� FRIEZE BOARDS Z TOP OF of. `J KNEEWAU. 2 V/ b SECOND FLOOR N SUBFLOOR TOP OF PLATE W b SCALE: 1/4 = Y-0" TOP OF DATE: FOUND. 10/11/2006 DRAWING NO.: FINISHED GRADE VARIES (VERIFY IN FIELDI A LEFT SIDE ELEVATION 1///y```i CONT.RIDGE VENT TYP.ROOF CONST. <7 .2 x 1D ROOF RAFTERS @ 16'o.c. -Ifr CDX PLYWOOD ROOF SHEATHING ¢cLt S N -ASPHALT ROOF SHINGLES }OR Q 2B'd -16LB.FELT PAPER -]v12RIDG2.5 UR -AT ALL RAFTER HURRICANE CUPS m G V OO IC ALL RAFTER END N - -ICE/ HIELD AT BOTTOM 12 J'P OFF ROOF ROOF wi OM OF w a DODO 10 CEILING p 11'b- B'd I1'd __ 2s 10s 16 o.c. TLTING JOISTS CL'x g CL1 �V �_X B I P.T.1.6POS15 Aa b I ONtz'DIA,CONC. UNFINISHED S SONOTUBES TO dD' 11 I I BELOW GRADE STORAGE F: M TOP OF `J ------ ---- ————— ———————————— ]/d'TSG KNEEWALL PLYWOOD SUB FLOOR. b t�I _____________________ GLUED S NAILED CONT.ALUMINUM N SECOND FLOOR 1 I b 60FFIT VENTS SUBFLOOR I 21 tas®16'o.c. TOP OF PLATE I I I I I I I I I I II I I II I I I III I o r I I AT SIDE DOORS UN I a I I II I STORAGE I d I I I I TYP.WALL CONST. 2.2ft PLYWOODSHEATHING I (d-DOND.SLAB TYP.112'OIA ANCHOR 3.W.C.SHINGLESIDING I I I SLOPE Z TOWARDS BOLTS®dB'Pc. A.TYVEK VAPOR BARRIER DOOR$) TOP OF FOUN I CONC. I I ti 1 V CONC.FOudD.wus STORAGE FOUND.W ALL$ 4 A @ - .SLAB PITCHzroo.H oasr 44I . ot.}—,T.wco TYP.ROOF CONST. FOOTINGS FOOTINGS b S =2 z 6 KEY I I I I I I I 1 a I I I I I I I I 0 I. I I BOTTOM v I I I I CEILING JOISTS A A I I A4 , I I A4 O A �, T�pYPI'. �L, Z I I DROP TOP OF FOUND. , I V L R N I FRONT DOORS AT LLI I I I CONST. I L____________ —J I UNFINISHED I --- ------ -- _______= I STORAGE Q = -- --- ------- — ----------- -- SECONOFLOOR Z CONC. SUBFLOOR �+ APRON' 2,IOe IT y 2vfOs 16'a.c. TOP OF PLATE Si EEL BEAMS B (FLUSH FRAMED) MULTI LVL HEADER A4 AT DOORS.(FLUSH FRAMED) �J 2.5 t0'.6 t'.6' tDd - 2'-4 y LJ I- 2B'd j, STORAGE c SCALE: 1/4"= F-0„ FOUNDATION PLAN DATE: TOP OF FOUND. 10/1 1/2006 SECTION @ STORAGE , DRAWING NO.: b A4 A4 z U zB•a' P.T.2 v lO LEOGER BOARD LAC BOLTED TO [S.� SOLID BLOCKING WI(2)LEDGERLOK BOLTS 16'o,c.WI JOISTS HANGERS AT BOTH ENDS Q p t 1'z 5'-G t t'JT 2&f C p V Q ,-, � F�LI P.T. p B h 211A'x911d'LVL B IL T ILTI AQ AT ACCESS HATCH A m ¢_ b B 11-7 I u I 7 s•.v r-v =I I sl - � 14L RAM FLUSH iRAMED — — 2 x 10 FLOOR JOISTS 1E'O.c, 4'CIA.STEEL COLUMNS AT FACH ENO OF STEEL BEAM I .h b Q — — STEEL BEAM(FLUSH FRAMED) i I A A A I A p A4 A4 A4 I A4 C" II I I v MULTI LVL HEADER MULTI LVL HEAD lUTI- • Li AT DOORI HEADER --J LTJ 2B U zBa � �] L" LC� SECOND FLOOR FRAMING PLAN ROOF FRAMING PLAN SC SCALE: NOTES: 1/4"= Y-0" 1.) ALL ROOF RAFTERS TO BE 2 x 10's UNLESS OTHERWISE NOTED DATE, 2.) USE SIMPSON H 2.5 HURRICANE CLIPS 10/1 1/2006 . AT ALL RAFTERS ENDS 3.)VERIFY GUTTER TYPE/LAYOUT DRAWING NO.: W1 OWNERS A5 Daniel E. Braman.'P.E. 189 Harbor Poini Rd Cunur squid,WA 02647-0361 1:4 2. �t - r� 1t2 G= Pow 2.S` x 3 2 e; 2. 1 � t.4.� �2. .„�J 0 l o �- ,� �' �2►cam t� t..rco.a. L ,0 00Z14MV�L CLZ�Ml.t:�, �Oe-LC:L ,oc�a OF RANI .e c ( —� _ D,6 RAMSBEAM V2 . 0 - Gravity Beam Design Licensed to: Dan Braman, P.E. Job: Higgins 975 Main,Cotuit Steel Code: AISC 9th Ed. SPAN INFORMATION Beam Size (User Selected) = W14X30 Fy = 36. 0 ksi CTotal Beam Length (ft) = 28. 00 Top Flange Braced By Decking LOADS: Self Weight = 0 . 030 k/ft Line Loads (k/ft) : z Distl Dist2 DL1 DL2 . Pre DL1 Pre DL2 LL1 LL2 0.00 28 . 00 0. 161 0. 161'' • '0. 000 ` 0. 000 0. 428 0. 428 SHEAR: Max V (kips) = 8 .67 fv, (ksi) = 2 . 32 Fv 14 . 40 MOMENTS: Span Cond Moment V Lb Cb Tension Flange Comp Flange kip-ft ft ft fb Fb fb Fb Center Max + 60. 7 14 . 0 .0. 0 - 1'. 00 17 . 34 24. 00 17 .34 24 . 00 Controlling 60 .7 14 . 0 0. 0 1. 00 17 . 34' -24. 00 --- --- REACTIONS (kips) : Left Right = DL reaction 2 . 68 2. 68 Max + LL reaction 5. 99 _ 5. 99 Max + total reaction 8 . 67 8 . 67 DEFLECTIONS: Dead load (in) at 14 . 00 ft = 0 . 313 L/D = 1073 Live load (in) at 14 '00 ft = -0.701 L/D = -479 Total load (in). at 14 . 00 ft = -1. 015 L/D = 331 RAMSBEAM V2 . 0 - Gravity Beam_ Design Licensed to: Dan Braman, P.E. Job: Higgins 975 Main,Cotuit Steel Code: AISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W14X30 Fy = 36. 0 ksi Total Beam Length (ft) = 28 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 030 k/ft Point Loads (kips) : Flange Bracing Dist DL Pre DL LL ,, ,, Top Bottom 14 . 00 0 . 00 0. 00 1. 00 Yes Yes Line Loads (k/ft) Dist1 Dist2 DLl DL2 Pre DLl Pre DL2 - LL1 LL2 0. 00 28 . 00 0. 161 0. 161 0 . 000 0. 000 0. 428 0. 428 SHEAR: Max V (kips) = 9. 17 fv (ksi) = 2. 45 Fv = `14 . 40 MOMENTS: Span Cond Moment @ Lb Cb Tension Flange Comp Flange kip-ft ft ft I fb y Fb _ fb Fb Center Max + 67 . 7 14 . 0 0 .0 1 .00 19.34 24 . 00 19. 34 24 . 00 Controlling 67. 7 14 . 0 j ., 0. 0 1. 00 19. 34 --- REACTIONS (kips) : Left Right DL reaction 2 . 68 2 . 68 Max + LL reaction 6. 49 6. 49 ; Max + total reaction 9. 17 9. 17 . DEFLECTIONS: Dead load (in) at 14 . 00 ft = -0. 313 L/D = 1073 Live load (in) at ' 14. 00 ft 0 . 795 L/D 423 Total load (in) at- 14 . 00 ft = -1. 108 L/D = 303 RAMSBEAM V2 . 0 - Gravity Beam Design Licensed to: Dan Braman, P.E. Job: Higgins 975 Main,Cotuit Steel Code: AISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W14X30 Fy 36. 0 ksi 3Total Beam Length (ft) = 28 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 030 k/ft Point Loads (kips) : Flange Bracing Dist DL Pre DL LL Top Bottom 14 . 00 0. 00 0. 00 .2 . 00 Yes Yes Line Loads (k/ft) : Distl Dist2 DL1 DL2 Pre DL1 Pre DL2 LL1 LL2 0. 00 28 . 00 0. 161 0. 161 0.000 0 . 000 0. 428 0. 428 SHEAR: Max V (kips) = 9. 67 fv (ksi) 2. 59" Fv = 14.. 40 , MOMENTS: Span Cond Moment @ Lb . Cb Tension Flange _ Comp Flange kip-ft ft ft - fb Fb fb -Fb Center Max + 74 . 7 14 . 0 0. 0 1. 00 21. 34 24 . 00: -21.34 24 .00 Controlling 74 .7 14 . 0 0. 0 .: 1.00 21. 34 24. 00. -- --- REACTIONS (kips) : Left Right DL reaction 2 . 68 2. 68- Max + LL reaction 6. 99 6. 99 ' Max + total reaction 9. 67 9. 67' DEFLECTIONS: x Dead load (in) at` 14 . 00 ft = -0. 313 L/D - 1073 Live load (in) at, 14 . 00 ft = -0. 889 L/D ,_ 378 Total load (in) at. 14- 00 ft = -1.202 L/D 280 , _ . f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 Parcel t7C7V i Permit# S l(.0(o q - li�g Health Division � Date Issued I f OS Conservation Division [ /Cofer 6'S �Q�� Application Fee Tax Collector Permit Fee Treasurer SEPTIC SYSTEM MUST BE 650 ON/Oy N S TALLED IN COMPUAM Planning Dept. "T"WLES Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address CI"7 S VA&A- ST. Village Cv 7-1.I —, Owner 1-t f %-t%C,C,I NLS I LA-0"GE -pr- Z44Address 1-7 S 1- sen)v, i Telephone ZS_ Permit Request 70 't�K, '� ;CAZL--4 70 0CH e cal S'o—f-•c IT,ZS Square feet: 1st floor: existing I o ® proposed � 2nd floor: existing G c o proposed Total new 3ea Zoning District Flood Plain tl® Groundwater Overlay Project Valuation t S .000 Construction Type wad b F-s2+4.--Z Lot Size T 0 a a Grandfathered: 6Yes ❑ No If yes, attach supporting documentation. = Dwelling Type: Single Family XTwo Family ❑ Multi-Family(#units) j cr - Age of Existing Structure l cc n Y Xs Historic House: ❑Yes &No On Old King's Highway: ❑Yes W"No Basement Type: ❑ Full ❑Crawl ❑Walkout 7 Other e®A Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �o� � r" Number of Baths: Full: existing 2 new Half: existing /— new Number of Bedrooms: existing sS new Total Room Count(not including baths):existing new First Floor Room Count 7 Heat Type and Fuel: R(Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes O No Fireplaces: Existing -> New Existing wood/coal stove: ❑Yes Po Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:R existing ❑new size Shed:id existing ❑new size e_Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name <37-c-i`ems 1 i-el Telephone Number 5-o 4- if Za -53 GJ Address '(7 ors 146 o License# 041(,;3 C $ •: v~ �+ Home Improvement Contractor# t r a ° es Worker's Compensation# 3 co 0 t Sw 2.�$-C,4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t i!A PCSfy;r- S',r�, &-0-1 SIGNATURE C DATE 1 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION CVV f(A'(4 _ 19 I-N-K(& f�FF FRAME INSULATION FIREPLACE wat ELECTRICAL: ROUGH FINAL PLUMBING: ROU fH"-i; Z FINAL } �= m GAS: ROUI� FINAL FINAL BUILDING I a C7 C ` DATE CLOSED OUT ASSOCIATION PLAN NO. 00 •4 pFTHE To�N Town of Barnstable Regulatory Services sANWABcA Thomas F.Geiler,Director '4p 1 a`�� Building Division jEa r�►a'� i .Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Officer 508-862-4038 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142Arequires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �ti;�e� a .���'—+� S� ��e•.�• �rr�timated Cost Address of Work: l S ` A :" 5 . Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ,[]Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMP CUTY ORKUNDERMGL c 142A. ACCESS TO THE ARBITRATION PROGRAM SIGNED UNDERPENALTIES OF PER7URY t I hereby apply for a permit as the agent of the owner: i I Contractor Name Registration No. Date OR Date Owner's Name Qh ms:homeaffidav The Commonwealth of Massachusetts r - - Department of Industrial Accidents 600 Washington Street Boston,Mass. .02111 Workers' Co ensation.•Insurance Affidavit-General Businesses ' �:"•es:�5ae� ir• w`S.:`i-+5:;'¢5at�. ". :.a..r.-.w,Fti.., `gr-c '' .. - _ � '�:.a,,:%5 • name: . nI address.- city state: On d� av e Z(,-3 S phone# work site location(full address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Bating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,.Autos etc.) ®I am an ism to er with '� ism to ex (full& art time.): ❑ Other %/ %/,�� 11ll/%%%///%///O//�/�%%%/�%%/�%%/O/O//G�%%�%%��% Iaam.an employer providing workers' compensation for my employees working on this job.. comyany iiaIIiet.. r'�• address:'�''�`•: '��• i' 5 T 4.3 msurance.co::::..,,.;•�f .: •�...:.:c,. ,. ......",.;...:.::;,•..;:• _''.:>:i _ of - #f.� fo:�':1��".:�•7��@< I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: comyany natiter eaaresse `lion city: U insurance co.... :..:...::...::.�_.:•,_�.: ,• _ e e;_ company n � - address. . .. city... Y: J.. •C 011 insuranc_co - v}}�. OWN Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that 0 copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains and p allies of perjury that the information provided above is true and correct simature �c Date Print name -IFi'.ir P•t V%,,C`Z t_1-17-;J3 Phone# 410 S 3(o official use only do not write In this area to be completed by city or town official city or town: permit/license# []Building Department _ ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: __ __ phone#; []Other ' (revised Sept 2003) Information and Instructions Massachusetts General I;aws chapter 152 section 25.requires all employers.to provide workers'compensation for their.. employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied; oral or written. An 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 enferprise, 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 bean employer. MGL chapter 152 section 25 also states that every.state or local licensing agency.shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. y Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you Have any questions regarding the"law"or if you are required to obtain a workers'compensation policy,please call the Departrnent at the number listed.below. City or Towns . Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill.in the permit/license number.which will be used as a reference number. The.affidavits maybe returned to the Department by mail or FAX.wiless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you Have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department.of Industrial Accidents . @tttce of Investl®atlons 600 Washington Street Boston,Ma. 02111 fag#: (617) 727-7749 phone#: (617) 727-4900 ext.406 °FTME l Town of Barnstable Regulatory Services * snnxmum, Thomas F.Geiler,Director 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 ABuilder I, L-A W Z"E 7-, N'aS v, as Owner of the subject property hereby authorize ry e.R VIM`( �-�RCS to act on my behalf, in all matters relative to work authorized by this building permit application for: 01-7 S on-• lot • tis (Address of Job) Signature of Owner Date S Print Fume N ---- fie �oon�� cr�ivaelta Board of Building Regulations and Standards License or registration valid for individul use only HOME IM OVEMENT CONTRACTOR before the expiration date. If found return to: lug Board of Building Regulations and Standards Re istrati 1 0485 One Ashburton Place Rm 1301 /2006 Boston,Ma.02108 GROVER&MC S STEVEN McELHc- 523 MAIN ST ,�44 -_-.,°�� C.G-e-«�rX/"" � ot valid without signs re COTUIT,MA 02635 Administrator N BEARD-OF-B.UIILDINtG'REGULATIO',NS r . License C14STRTUCTION.SURERVIS6R Numbe!l11— : 6998.0 047693 �� = (�05 Tr.no , Re-r3c�te AN STEVEN P MCEL k PO B®X 282 Administrator COTUIT, MA 02635 LOCATION OF P0,®PER-FY L WES MAY N®T BE ACCui2ATE STANDARDLEGEND MAPAv^��n � _ NOTE:not all symbols will appear on a map P �� GOLF COURSE FAIRWAY OO � EDGE OF DECIDUOUS TREES PEDGE OF BRUSH 24 I ORCHARD OR NURSERY O V—V—V—v EDGE OF CONIFEROUS TREES J' _ MARSH AREA r , —• • •— EDGE OF WATER DIRT ROAD DRIVEWAY IE_PARKING LOT . PAVED ROAD — - — DRAINAGE DITCH PATH/TRAIL PARCEL LINE** MAP 326�-MAP# #367—PARCEL NUMBER HOUSENUMBER#367 E- 975 , / 1 FOOT CONTOUR LINE 10 FOOT CONTOUR LINE Elevation based on NGVD29 >/4.9 SPOT ELEVATION o0o STONE WALL \ -X—X- FENCE \ RETAINING WALL M I� 03 4 \ \ ;,— RAIL ROAD TRACK 29 \ � STONE JETTY SWIMMING POOL 989 \ / PORCH/DECK ] 0 BUILDING/STRUCTURE F4+L DOCK/PIER HYDRANT e VALVE o MANHOLE 0 POST O'p FLAG POLE T O W N O F B A R N S T A B L E G E O O R A P N 1 G 1 N F O R M A T 1 O N S Y S T E M S U N 1 T or SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This ma is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetrics(man-made features were interpreted from 1995 aerialphotographs b The James P 9 P VA P ) Y w ;;.� e — 1"=100'scale map and may NOT meet of property boundaries.They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE TOWER 0 20 40 National Mop Accuracy Standards of this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards ¢ LIGHT POLE o ELECTRIC BOX � 1 INCH=40 FEET* enlarged scale. an the map. of a scale of 1°=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax maps. s-� ell v i i . � � I�I�'III��1I1��II1,I ��-"Se�+on.b:s 4B"oa m•J. .. %w c.R .es+sT II'''I1I —II IIf �. e.rb. 7 r-d n. n a Fl-1 i IY•s z w .r. iv o . ser NA • � �: «Esr r - - ' S�nwcb�p R+6T �. PmF FCII�n•.J� e SEGTOJ A•A 'Ii cl'•o• . H�uc.'.+s Pe ecN THE FOLLOWING IS/ARE THE - BEST, IMAGES FROM . PoOR QUALITY ORIGINALS) I m Nc(:7 L DAT A oy. OFIKE Town of Barnstable *Permit# �Ile O Expires 6 months from issue date Regulatory Services Fee NAM ^ oa 1639. ,m'g Thomas F.Geiler,Director Building Division ® IT Tom Perry, Building Commissioner 200 Main street, Hyannis,MA 02601 S E P 2. 3 2004 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number b 3 S OJ U Property Address Q 7 5 vi I . +S 5 C (Residential Value of Work etc)ri a Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address T t T r t1 i 9 6I S °) S m A ...4 Q T-_ Contractor's Name S TV J Z --A V�- EL H ) I t 1? (Z Telephone Number_` q'L v - Home Improvement Contractor License#(if applicable) 1 t 6 Ll8 Construction Supervisor's License#(if applicable) _ 0 4-1 G 1)3 - p - ' _ ✓fze TDom�irr�yuieact� p��i�tiu�a - PWorkman's Compensation Insurance Check one: Board of Building Regulations and Standards ❑ I am a sole proprietor .HOME IMP;*VEMENT CON T RACTOR !a ❑ I am the Homeowner < ` Re i�4tatit�rt �P485 [ I have Worker's Compensation Insurance - 0nj2004 yp6 - di +dual Insurance Company Name P}tZ i 5c.1 Z.-I> worktnan's comp.Policy# N -7' Copy of Insurance Compliance Ce cate• ust be on file. x1{ NrAV.fityy d.4rc:... Permit Request(check box) A� 'r Re-roof(stripping old shingles) All'construction debris will be taken to 1i H Q�S i-A 3 El Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Signature �"@ r Tow. of B arAstable 04�" tOk�F r�ces F.eguXatoxy Se Thomas F,oeiler,Director $ � ldiug Division Building Commissioner' TomPerry, 2,00 Main Street, Eya=js,MA 02601 •. __ �,{a�,barnstablesnaus ,-• 508-790-6230 office; 508:g62-4038 Property Owne Must -Complete ana Sign TMS section If Using A.Budder as owner of the subject property Y' •��� � . . ' �,� s .'to pact on naybe�alf;. . . . .:_ _.. • '. . hereby authorize • . . .. . • . .:._ .. o work authorized by this bu�ldmg pest application for. -- • ��,matters relative t . . ..�_._.. 9�s ��•, � Cam.:#' - -- (Address of Job} - Date. gignature of er printName t� LI ` -}'1 • I >v c...i ____-- I � PO!CL r i u N ri r'Re`['s� i Pow . T b i I (-� C i^� •!5 i'O G rf mod-!+14 j-�c. 1-O l. DRAWN !4 DATE: •.� REVISED - DRAWING NUMBER 1 uar Raaa19AMmwpPJp . 4r 5I I ,1 00 ,w } - i ! N g.,..i ,r_G v ra r, A.Tr, 111 _. 14a � �, -r--- �b••sotto;�.-��.. a T'D _...__ 1 � SCALE: APPROVED BV: MAWN BY. DATE: ri Jr' REVISED DRAW NG NUMBER qll� 1g1m B11�O.�0001 CIPAELR1Lt• 1 i ,I . I I k_ r � T � ------ I , T, a iL r_,•.ev SD _-.____.__ _ __ — - 5o.>T s c T'D I 9CA1.E: APPROVED er: '1.--•,,��_. ��-o� DRAWN BY r4VW DATE: +) fry REvrgQp DRAW DIO NUMBER ux. NBRIDMA.�OOPI QPApgMf♦