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1365 MAIN STREET (COTUIT)
� f „T 1 i i, FAQ /6•- 33 - 7 3 _ U014A Town of Barnstable *Permit +� Tres 6 mo hs r issue date Building Department Services ° fee r r 9,,m,,, r,�,�: � .� Brian Florence,CBO i ASSL �0 Building Commissioner .19 �iOrEc t�r►r" 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY , Not Valid without Red X-Press Imprint Map/parcel Numbe - r ^ ^ l Property Address /` 3�S. �I� 1 f Residential . Value of Work$ , 8 a Ott Minimum fee of$35.00 for work u�ry�t QO¢{QO 1 �,J�r�iU dJrWNSTABLE Owner's Name&Address Contractor's Name `U Telephone Number S40-p— � r j 7�p r Home Improvement Contractor Licens (if applicable) '125 7 Email: Construction Supervisor's License#(if applicable) e's 6 G G /Y / ❑Workman's Compensation Insurance Check one: Q ` I am a sole proprietor '� 00 ❑ P .P -. I am the.Homeowner, S+ I have Worker's Compensation Insurance E ©�l T Insurance Company Name 84 H�?&/-, 6 q c' `�p LE Workman's Comp.Policy# , Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping.'Going over existing layers of roof) FI/Re-side Replacement Windows/doors/ iders..U-Value ,00 - aximum.32)#of windows ' #of doors: *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 Improv ment Contractors License&Construction Supervisors License is 7re ,red. SIGNATURE: Q:\WPFILES\FORMS\building permit fomrs\EXPRESS.doc 08/16/17 Me Comniomrealth ofMaysadlimetts . De�r�tnrent of`1'rrdrrsir, Accident Offwe ofrntwigadons ' h00 FP'ashbigton Street Boston,MA 02111 ttrrinu mas gmMia Workers' Campensat an InsnranceAffidavit:B•cedersiContracWrsMectdcians/Plumbers AppUcantlufarzaafiGn Please Print Led Nam(Bu6MMKk3aaizahon�adividnal). Address: Ci Statel Phone� = . 70 e u an employer. eck appropriate bon: ' Type of project(required)_ 4. I am a general contractor and I I. . I am a employer with ❑ g ta_ employs(full andfor part-timed* have lured the sob'-caa�ac-tors ❑New construction 2.❑ I am a sale proprietor orpa.1 - listed on the attached sheet. �- ❑Remodeling ship and have no.amployees These sub-contractars have 8_ Q Demolition forme in anycapacity. employees andhave wodoers'[No n?rsmrs,comp_insurance Comp_Msurance$ 9. E]Building addition` regaimd] 5- ❑ We are a corporation and its 14❑Electrical repairs or addlitions 3_❑ I am a homemmer doing all work officers have eseraised timer 1 L❑Plumb ngrepairs or additions.. of eSemgtibn per MGI 11.0=Yzex[&o vores insurance require&]] C.152,§1(4)6 andyve have no y .. employees_LW6 works' 13.❑'Other comp-insurance mqui ed_) 'Awaywlice d-atcbedMbasP1mast also filloutthesectionbeTawsbnstiugtii&voickereca®penm npeTiU2n5=lion_ I Samem mers who snbmnt this affidatdt MgBcating they axe doing RU wank and tbaa hie antside cnatrimim maw submit a nesv affidavit indicatab sacTL fCM=U=ts dLst cIwI this boa must attached sa sdditirmsil stet dwwhg thename of&a sus-camtrscma anei state whets ar not those a2ideslizve emptuyees.I€tbesub-cont=mliace ezziptofee%Mey=tsrpzuvl&their warkeW camp.policy,number- I am an emplayer tlta#is pr4nVing workers'compensdiont fimirancefor ury*eirrphny ees Betvt is the paficy and jo b site inrfor madon. Insurance Company Name: Policy tt,or Self-ins.Luc_11'. % auDate: Job Site A&fiess t6tatelyrp: Attach 2 copy of the workers'coanpensationpolicydeclarationpage(ShoWlllg 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 aiming penalties of a fine up to$UOa Oa aniVor one-year imprisonment,its well as civil peualties.in the form of a STOP WORK ORDERand a Elie of up to O_tltl a day agaiast the sriolator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations.oftihe DIA,far iflsur ance coverage immdfrcanon- Irl'o hereby aerhfyas thepaut dpen awe. 1dU9Vhzt the niformaignprmi1wabal d correct Sit�tatvre: - Date: Phone ik 00 Cp — (3,o'rcial we only. Do not unite is this area,to be completed by dky artown ofjreiat City or Town: PermitlI.i,cense# Issniog Authority(cirde one): 1.Board of Health Z.RwI ing Department 3.City Town Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Conbct Person: Phone#: -- - 6 laformation, and 11astructioJas �. h assaic mcetfs Geheaal Laws chapter 152 rmpirm all cmployas 70 provide wozln'as'compensatic n free their eoployees. ; Porsuaafto this sib,an arVIoyee is defined as.'_.evm7 person m the service of another under any confront ofhire, express or implied,oral or written.." An ernsloye-r is defined as"ar mchvidnal,parts=ship,association,cxnporafion or oiiher legal eatify,or my two or more of the foregoing engaged in a Joint entrprisq,and mcbmg the legal representatives of a deceased employer,or f ac receiver or tustee 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 pm m to do Ce,construction or repair work on such dwelling house. or on the grounds or bmlding app thereto shaIl not becanse of such employmzut be deemed to be an employer." MGL chapter 152,§25C 6)also states thhat'every state or local li eosin agency shall withhold the issnance or renewal of a license or permit to operate EL business or to construct buuTdings in the commonwealth for any applicant Who Ihas not produced acceptable evidences of cdarplrance wuh.the ffism n cu coveJrage req aired" ' ofids oIifical sub divisions shall Additionally,MGL chapter ISZ, §25C(n slates'Neither the nor any p . enter intD any contract for the performance ofpubho,work until acceptable evidence of compliance va h the msm-dace._ rtTlirl ieuts of this chaFterhave been presenIMd.to the contacting authority." = Applicants Please fill ohf the workers'compensation affidavit completely,by checking the boxes that apply to your sifnation and,if aecessary,supply Snbcomhwt°r(s)name(s), address(es)andPhonenzmmber(s)alongwiththeir cmtficate(s)of mma rance. Lmuted Lnbi ity Companies(LLC)or Lmmited Liability Pmtaeabigs(LLP)withno employees other than the members or partners,are not regrmed to cant'workers'compensation fiamn7ance. If an LLC or=does have employees, a policy is rmpfttd. Be advised that this affidayh maybe snbmified to the Depa-tment of Industrial Accidents for confirmation of insm-ance coverages Also be sure to sign and date the affidavit The affidavit should be-retumed to the city or town that the application for the permit or license is being requested,not the DePattmeat of k Accidents. Shouldyou have any questions regardmg the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter t acir self-h =a ce license nuruber on fhe appropriate line.. City or Town Officials t Please be sore that the affidavit is complete and priated legibly. The Department has provided a space at the bottom of the affidavit for you tD fM out in the event the Office of Investigations has to contact you regarding the applicant Pleas a be sure to fill in.the permit/license nimaber which will be used as a reference number. In.addition,an applicant that must submit multiple peunitlliceas5 applka ions is amy giveuyear,need only submit one affidavit indicafing cnsent policy informhation(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 to may be provided to the applicant as proof that a valid affidavit is on file for fvtnie permits or licenses_ A new affidavit must be fml d oiht each year.Where a home owner or citizen is obtaining a license or pe zrak not relate-d.:b any business or commercial v&atae (Le. a dog license or permit to bum'leaves etc.)said person is NOT recpm-ed to complete this.affidavit The Of of Investiga Toms would hke tD thank you in.advance for your cooperation and should you have any questions, please do not hesitate tD give us a caIL The Dep ailment!s address,telephone and fax nmnbMr.. - Depadmmt cif Ti�ak Awidenft ice of�•�e�zg�tia� -Tf,-1.4 617' -4900,�xt 4€6 ter i-,a77-MASSAM Fax 0 617 727-'749 Revised4-24-•D7 p W zma S9.gagIdia T wn of Barnstable, Regulatory Services s Thomas F.GeRer,1&"for. Building DlY�S10II Tom?=7, Building Commissioner 201D MWn Suet, HYa=*MA M601 _ www.tawnbarns#ableaa�a.ns •. . office: 508-8624038 Fax: 508- 79ab 2 34 F peYty Owner Must Complete and sign This Section - It Using A Builder as Owner of the subjegt property h mbyatrthoaze ` to act on my behalf, in all q2twm relative to_work ati d bythis building permi application.for. (.Address of Job) S of Owner ate Pant Name -Q•FOAI�S:01��5ION - v ACC> CERTIFICATE OF LIABILITY INSURANC"E- DATE(MMDDmyY) 64. � 09/20/2017. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Linda Sullivan - - - DOWLING &O'NEIL INSURANCE AGENCY AHCNE,E�d, (508)775-1620 FAX No: AoliIL sS: Sullivan@doins.com 973 IYANNOUGH RO - _ INSURERS AFFORDING.COVERAGE NAIC# HYANNIS MA 02601 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED - INSURER B: - C J RILEY BUILDER INC INSURERC: . - INSURER D.: .. PO BOX 382 INSURER E OSTERVILLE MA 02655 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 194138 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL-THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LICY EXP LTR TYPE OF INSURANCE N DL SU D ,POLICY NUMBER. MM/LDIDY/YEYrr MM DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ .. ., - CLAIMS-MADE~ OCCUR DAMAGE TO RENTED , PREMISES Eaoccurrence $ • - MED EXP(Any one person) $ - N/A - PERSONAL&ADV INJURY $ - GEN'L AGGREGATE LIMIT APPLIES PER: - _ GENERALAGGREGATE $ -POLICY PET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT $ - Ea accident - - ANYAUTO r . ,BODILY INJURY(Per person) $ -ALL OWNED SCHEDULED -AUTOS AUTOS N/A - BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ - AUTOS - - - Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE 4 $ EXCESS LIAR CLAIMS-MADE N/A - AGGREGATE $ DED. I RETENTION$ - - $ WORKERS COMPENSATION /�- SPER TATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN ' - - - E.L.EACH ACCIDENT $ 500,000 - A OFFICER/MEMBEREXCLUDED? N/A NIA N/A 6S62UB2E89906917,, 05/05/2017 05/05/2018 - • - 'Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe underDESCRIPTION OF OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will'be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.' This certificate of insurance shows the policy in force on the date that this certificate was,issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govPwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE.WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street _ - AUTHORIZED REPRESENTATIVE - Hyannis MA 02601 �"'r Daniel M.C y,CPCU,Vice President—Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrtct14r�fSiirvisor - CS-06614.7 y Eat Tr es: 02/05/2019 CRAIG RILEY;`J r PO BOX 38' -, OSTERVILLE MA 02 w \66 c(301� Commissioner,. . V he�oo�a�riao�ruueaCCl a��aaaacf tcaelta� , Office of Consumer Affairs&Business Regulation License or.registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 125799 Type:. Office of Consumer.Affairs and Business Regulation r xpiration: 0130/20'.�8 Private Corporatior` 10 Park Plaza-Suite 5170 �- Boston,MA 02116 C.J. RILEY BUILDER)NC _ CRAIG RILEY y r � 10 B WIANNO AVE. s OSTERVILLE;MA 02655 Undersecretary Not ali it out signat e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATI01*--�' (0- : �Map Parcel RN1)TAp,LE Application # 0 Health Division ,� �, i ,', .; - r Date Issued ® l � Conservation Division Application Fee Planning Dept. �, mo Permit Fee __6 3 f`S-0 Date Definitive Plan Approved by Planning Board ` 713 Historic - OKH _ Preservation/ Hyannis Project Street Addresp Village Owner Address Telephone s76 Permit Request X I-dw& �- Square feet: 1st floor:VeAtin9 prop ed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new .--- First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric . ❑ Other Central Air: ❑Yes )(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool:Yexisting ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number a -:Rtf I-ldg -lo 17 Address License # :7�4 A16 Home Improvement Contractor# Z711 Email Worker's Compensation # � ALL CONSTRUCTION 7RIS R LILTING F S PROJECT WILL BE TAKEN TO r / - 15 SIGNATURE DATE f t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED I MAP/PARCEL NO. r I ADDRESS VILLAGE OWNER I DATE OF INSPECTION: i t FOUNDATION i ab FRAME � JO J9 15 s INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. • ; . ' Dept afli�w�-1�.'�icc�itr - 08Z=a,flrtvesf kafiang 600 WTaghiagtan Sfreet $astnr4 HA 0?11I - WWWL=rs 90-VAYa - Workers' Compemafion lnai r-anm AfWzy t:Btnlders/Cont acbrs/IIectdciam/Plum bars A-PpRe.-adInformation Please Print Le i •Nine( �. � - Address- © ' ;jdAl 1, Pho. Are VdanempI • . Check appropriate.boxv. Type ofprnJert(regtar4; 1. I am a eo=ploper wi h .. 4_ Q I am a g=mml camtracinr and I * havehandflie sob-coz�racE 6 El New com*=tiom• eatplapxs(Ell.and/or part time)_ . 12.01 am a sole proopgdeimr or parftw- listed am Ibm emhed sheet 7. ❑RcmodcImg ship and have no employers These sob-cad act[=bavm g, []Dc�ohdian working forme in'my capaaiiy cmipIPY=m dhm woa3rcrs . g. B ,7,,, additi [90 W013 S'comp,mcitranrr_ =P-incm-anrr.t ElrnZ V LJ18 � . 5. Q We are a cotparai on and its `IO_[]Rlr,Ecalrepajm or ad�iims 3.Q I am a homca c r doing aU wu6c j afficras have ezerciscd their IL Q Pl�mgmpaas or addi = mpsdf[90workes'cdtap. . tight of �„�n, o��1 t c.'L52,§1(4),and we have no 12-Q Roof rcpaim [Z,Ta vnl±=+ 13.❑Other rmup.bsmmnm regaicd_] *A3rpsppIi=atf5n1.fi c box#l=stzhafIIa�tbei abcteWsSas�iagt�cawor 'caa�rnsdinapeIi�yss���. t]3nmeawaca who svbmit�fs a fEda-Yit fiug-fmg they a=doing aII w�and thm hum=*;a Ia Est snhmsit dncpr a�dapit indics�sncti �Can�s&at rbccJcfhis bmc most attached ea eddidmmI ehatshowiaoPthe nn:ane of fhe suh-�dnzs emd close whrthcr or notthnse e�tirs hope i =mpIcTcm rttl�.snb-mn�a bM=3phryas,thg nmstpmvidm r wrniaa' P.p�=Mbcc I am arz err�lnyer is providing workers'cnmpazsation Rzrarzrnrr far my eV�gIayeu .9d5W ie the pa q and job shz u formation, Tnsurm=Com2my Name: Policy#or Self-ins.Lie.#: f„ rob Shr,Addrrss: c ytst rrp: Atfarh a copy of the workers'campeusatian policy declaration page(sliowmg tTie po&cy n er and e4&xdan date). Fame to socum coverage es requi-cd v oder Sec[im25A ofMCsL c.M L--M l d to the imposiiian of ct�al penalties of a EM 13P to$1,500.00 and/or mr-year h3prds—cut;as well as civil penaii m is the fmn of a STOP WORK ORDER and a f= of mP to$250-00 a day against the violator- Bm advised that a copy of ffils sWmac..otmay be forwarded to the Ofa=of FnVc:s;;ems of•(ire DIA fir insmmce covQage vmfficz&m I do hareby cert)ry WeAer Diu=and n perfmy that the b1formnt�aa pro'vzded above' and correct S' SpAsdc Fwa Date: / Phone#: 007dW use uldy. Do not write in thi s area,to be canPldtd by city ar town 017daL City or Town: Permi'ff(.ice=5-M Iss�Authority(circle one): L Board of Healfh 2.Biu1dmgDepartmeaat 3.UdYffmm Clerk 4:Elect=i 1twpector S.Phanbinglnspertor 6 Of cer Cont cf p=on: Phpnc nform.ation and Instructions Massachusetts General Laws ch%lrr M rmgwm all=q layers to provide wa&='compeosafimn for mein a¢VIoyees. Pmso=-in this smote,an mphyre is deed as a.every personm the service of another under mry cordract ofhirr, esprrss or implied,oral or writir L- Ammp&y,!� is defined as'an individual,partnership,associafiam,carporahion or other legal may,or any two or more of the foregoing aogagcd in a joint Bon se,and inclndmg the legal rep=seutaiivas of a d=ased employer,or the receiver or trustee of an mcfividual,p ,asso©ation or other legal cx tY,employing employees. However fhe owner of a dwcIIinghouse kringnot more fl=f from aj;artinmab and who resides f==ir,err the occupant of fhe- dweIImg house of anotier who crrplvys persons to do matntemancq rn-reh-n_r-d m err repair work om such dweltmg homer or on the gr nu ds or bml&g app�aot therein sbaIlnat becrose of sash employmr.Rat be ydeemed to be an employer." i r , ti fM MM chapiar 152,§25C(6)also states that'every siafe or Ioca.I 1ICGIISIIrg agencyshall withhold ffie issuance or . renewal of a license or perms to in operate a business or constructbung d"mgsk the commonwealth for any applicant who bss not produced acceptable evidence of cdmplrance with the iasmranm coverage required." GL I5Z 25 slates wNeithar the camunonwealth nor Ely of its political subdivisions shall. M ,§ �Add��aIIy, �P� __... eofer into arry roatract for theperfannaam ofyoblio wmkuutil acceptable evidence of complian.crveRh the kx -R,r6. re atremerts of this chapter have been p=c n tcd to the cozAacdmg authority." Appliesnrt3 Please fill otrt me veoriaers'compmmfion affidavit complefrly,by chmking the bates that apply to yopr siinaiion and,if necessary,supply sub-coufzactor()nam s , address(es)and phonenomber(s)along wiihtfics cedificate(s)of .�s) insurance. Limited Liability Companies(LLC)os Li ni rdLiabilRy Partnerships(LU)wiano ea�layees other than the members or parties,are notregtmed to carry wod=e compeasafian insnammcm If an LLC or LLP does have =ployees,apolicy is impi=ed. Be adviszdthsttus affidghmaybe smbmitfed to the Dep_aztmeat of Indastr al Accidents for corffimafiam m�ofinsco coveaagm Also be sure to sign and date the affidavit. 'Ibc affidavit should be ret orurd to the city or town that the applicairm for the permit or license is being requested,not the Deparimeof of Tndustd;;l Ar Eels. Shouldyon have any gnestiom regarding the law or if you are regained to obtain a woda=s' compensaticmpoTicy,Please call tine Deparimeot at me number listed below. Self-fi sored cm agar ie•c should enter their srlf-kmrmce license number on the appropriate line. City or Town Of id2h Please be sore that the affidavitis enmpletm and printed Iegl)ly:-The Departmemthas pc'-ovided a spare at the bottom of the affidavit fur you to fill mrt m the evert tine Office of_nyw6gafions has to code4 you regarding the sgpIicant • Please be a4nre tri fill in the pc �Wfi icrose mamber wh chk�wffi be used as a reference number In addition,an applicant that must submit multiple p©mw ic=se applit*dons in any given year;need.only submit one affidavit indicating emrent policy fi foram mien(if necessary)and under'gob Site Address"the applicant should write"all lacafions is (may or town)."A copy of tine•affidavit that has be=ofGciaIIy stamped or mrariced bythe cry or town may be provided to tie - applicant as proof that a valid affidavit is on file fur fuse pemzifs or licenses A new affidavit must be fffied out each is o alicense or eroitnnotrelatzdin anybmsinrss orbommeacial ve:�uB year.Where a home owner or btaasng p (i.m a dog license or peamh to bum leaves etc.)said person is NOT regtftcd to complete this affidavit The Office of knve:s 1Ea ms womldlike to thaokym is advzmae foryomr coopm-aiimu and sbnoldyoa have nay T sdms, please do nothesifato`to give us a call R; •�, The Depaztncmfs address,tolephamo and;&x mmbm- commmwed&Of MLSMOILUSeng - DepEd mmt 01n a1 AcDidmts Q-Mtca Q.f vestkatio= 6m Vahan Sk,=t; $osb093.M&Oil11 Tel.#617' -49W eat 4€16 or I 477 M&WWAM FaX9 617 727-7M }Zevise142407 p, - VIdk I � 77 AH IC Guide to Wood Construction in High W nd Areas: 110 faph )find Zone Massachusetts Cheddist for Compliance (780'C,MRs�ol.�.l.l)r Loadliearing Wall Connections ' ' Lateral(no.of 16d common nails).............................._(Tables 7.,)............................................... . Non-L'oadbearing Wall Connections Lateral(no.of 16d common nails)................_........._-.(Table B),_......_.............._............ ........__ 11' Load Bearing Well Openings(record largest opening but check all openings`for compliance"to Table 9) r Header Spans -------------_-------_ _,_ (fable 9).1............. .......... _ft___.in.77 5 Sill Plate Spans _.. .. ...: .(Table 9)... ...._....._.... . . _ft _in.511 Full Height Studs (no.of studs).:..._..._.-_-_..................(fable S).................._._....._..........;....._.,.... ) Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9 HeaderSpans........................................:........._...._...(Table g).................._.............. ft_rn.51Z' Sill Plate Spans......."....._....... ................._......_.......(Table 9)...............,._..............._ft_in.s 12' Full Height Studs(no.of studs).......................__-._....(fable 9}. ..._._........_..............__....._. Exterior Wall Sheathing to Resist Uplift and Sbear Sirnultaneously4. - Minimum Building Dimension,W � . Nominal Height of Tallest Opening.. ..............................................:_. .........._.............__. SheathingType............... .......................(note 4):,............................ ..__. Edge Nail Spacing...................................(fable 10 or note 4 if less)__----......_._....:. Feld Nail Spacing. ...(fable 10)........._ ....... ....-.__.. in. Shear Connection(no.of 16d common nails)(fable 10)... - ...__.._..............................._ Percent Full-Height Sheathing..._._:_.......:...(Table 10)......_........._...:......................... M Additional Sheathing for Wall with Opening>S'B'(Design Concepts)._..__....._._.. Maximum Building Dimension,L Nominal Height of Tallest Openin92.. ..................... 5 6'B" Sheathing Type..... ......._.......................(note 4)....................------------------ Edge Nail Spacing ... .. ._.__..(Table i 1 or note 4 if less) _............. Feld Nall Spacing. -.(fable 11).. ...:_ ._...__ .. _,_... in. Shear.Connection(no.of 16d common nails)(Table 11)........................... . ..••-••.... Percent Full-Height Sheathing...__...._.- 11)........................ -_ 5%Additional Sheathing.for Wall wrth'Opening>6'B'(Design Concepts):-_-..._-._..... Wall Cladding Ratedfor Wind Speed7. _.._.---._._..........__......._...._. ... ......._.......__......—___.�_... ._._..._ 5.1 ROOFS Roof framing member spans checked?................._.....(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang .......................... _-_•_.•--•_•.._. . .:.•..............(Figure 19).-- ........._ft smaller of 2:-or L13 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors ' i. U rift.. .r._.._....-:.__..(fable 12)_............._......... ... U' pif:-: Lateral. ._� -.._._......__.__........(fable 12}- ....... plf Shear-Y._....:..:.._.....�_e::._..........:.(Table 12)........_....._.............__.._._....S= p� Ridge Strap Connections,if collar ties not used per page 21... (fable 13)...._.........._.........._T= pif. Gable Rake Oudooker................:............._-(Figure 20 ft s smaller of 2'or Lf ' Truss or Rafter Connections at Non-Loadbearing Walls' Proprietary Connecbrs Uplift.__._..:...........:..._._.._.__.._..(Table 14)........._ ..............._r....:... U= lb. .. Lateral(no.of i 6d common nalls)...(fable 14)................................. L= Ib. - ....._._....:......_.._..........__......(per T80 CMR Chapters 58 and 59 .... ..... . Roof Sheathing Type Roof Sheathing Thickness............... in.>_7116'W5P Roof Sheathing Fastening.......... ....-.._..........(Table 2)_............... .. _.._....... ___, Notes. •1. , This checklist shall be met in its entirety,excluding the sperrf'is exception noted In 2,to comply with the requirements of 780 CMR-5301.Z1.1 Item 1.if the checklist is met in Its entiraty then the following metal straps and hold downs am not required per the WFCM 110 mph Guide: - a. Steel Straps per F1gurE 5 b. 20 Gage Straps per Figum 11 - - c Uplift Straps per Figure 14 d. Ail Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1Ba and Figure 1Bb - 2 'Exception:Opening heights of up b 8 ft shall be permitted when 6%is added to the percent full-height sheathing 'requ'urerrients shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a'minimum 2 in.nominal thicimess pressure heated#2-grade. ' AFDC Gtcide to Wood Construction irr High Wind Ar eas:110 rnph Arad Zorie • Massachusetts Checklist for Compliance(780 0TR5301 2.1.1)' - - - Check Compliance 1.1 SCOPE Wind Speed(3-sec. ------- _..___._-_---___-----:......._,......_._.110 mph WindExposure Category.._......... .__......_.__._---.._._................„...._......._..........._......._......_..._:_B Wind Exposure Category................Engin6ering,11equired For Entire Project........................................0 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shad be considered a story) stories S 2 stories RoofPitch..:..._.__..„....:........_....._.-__-..._.....__............--.(Fig 2) .......... ......._................. 512:12 Mean'Roof Height _..__._......_.... _ ...... .-_(Fig 2)..._._............_._.............. ft !9'33' Building Width.W..........__-......_._._........_.._:._.... ..(Flg 3)_.._._.._......:._............__:.-. ft S so, Bulding Length,L (Fig 3 _ ' Bulding Aspect Ratio(L M ........................._...._._..._...(Fig 4)......... •s 3:1 Nominal Height of Tallest D enin Fl 4 ' 1.3 FRAMING CONNECTIONS General compliance with framing connections_...__...... .(Table 2)....................................................... . 7-1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrat�.............................:.......................:........................:................................................. ConcreteMasonry........___._.__.:...............................................:_.._....:........-----__............... 22 ANCHORAGE TO FOUNDATION" 5/8'Anchor Solts•imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only • Solt Spacing-general..................................... .(Table 4).:__....._.. ...._..._._.„._..__ in. " Bolt Spacing from endroint of plate.......... (Fig 5).......___..:................. In.5 6"-12'. Bolt Embedment-concrete._-._...__.._:..-_-__--.._.._...(Flg 5).......--.........__.....:._...;...__.._in.i 7' ' Bolt Embedment-masonry... ....._..... -......... 5)_......._.r_....................___ in.z 15' . PlateWasher..:.__:_......_..._...._.____......._...._...(Flg 5).._..._.,._-------------------------_>3'x 3-x%' 3.1 FLOORS Flow framing member spans checked ...(per T80 CMR Chapter 55)_..-._.._..__.._.. ' Maximum Floor Opening P 9 Dimension ........................._....._............... ft 512 • Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall 6 ..................................... MWdmr.1m Floor Joist Setbacks Supporting Loadbearing Wallis or Shearwall...._.._...._(Fig 7)........_......:_... ft s d Maximum Cantlevered Floor Joists ~-�-�•„ ��••�~ T Supporting Loadbeanng Wals or Shearwad........_......Fig 8)_................................................. ft s d FioorBracing at Fsdwads__..„.._........„...._._..._...........„_(Fig 9)___._._.._.._.._.._._._...„_..._._.._. ...._. Floor Sheathing Type ___...._.._.._.......:..-. ..._._._...._(per 780 CMR Chapter 55)........ Floor Sheathing Wckness_........_.„.._..._.._„...._...._.:.__(per 780 CMR Chapter 55)..... in. Floor Sheathing Fgsterfmg_:.„............... .:..(Table 2)__d nails at in edge/ rn field 4.1 WALLS Wad Height Loadbearing wails._._.--. ...... (Fig 10 and Table 5)„.....-..__--__._--_---_ft s 10' Non-Loodbearing wails.._...„...:._.._.„._. _• (Fig 1 D and Table ft's 20' • Wall Stud Spacing .„........_..._.„._..:........„....._......._._(Fig 10 and Table 5)..____........._—in.:;24 o.c. WadStory Offsets ...._.__.._...._....._....._.........„._.„.(Figs 7&8)_.........„....................__....—ft s d ' 4-2 1:7Ci•ERIOR•WALLS' . Wood Strids Loadbearing►tracts---_._.--:........_....„._........_._.._....„(Table 5)........_........._.._.....2x ft in. Non-Loadbearing wa!!s.__._........_. ...„-' able 5 Gable End Wall Bracing Full Heldht Endwall Studs--------------- __.___.- •(Fig 1 D)_...... _. ....___....... _..._. ...�:._ WSP-Attic Floor Length---_'.--_ '..„_._....._(Flg 11)_�.._..._...:„._.._.......„_.. ftzW/3 sum Cardin Len (If WSP not used~___-_-_..__ r 11 .._„....._.:._._........._..„ _z - _GYP 9 9�( )•- ' -(F9 )• —ft 0.9W and 2 x 4 Continuous Lateral Brace @ B ft.o.r~_Fig 11)....................................... .. or 1 x 3 ceiling furring strips @ 1 T spacing min.valh 2 x 4 blocking @ 4 fL spacing in end joist or truss bays Double Top Plays Space Length ..._.__._.-........_.._Y ....(Fg 13 and Table 6)................ —ft e , AWC Gicirle to Wood Corrrtruction hi High 14f1ndAi-eas: 110 nigh lKnd zone Massachusetts Chec.1dist for. Compliance(780 CZAR 5301?.l:l)' 4. a. From Tables 10 and 11 and location of wall sheathing and Bul7ding Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: I. Panels shall be installed With strength ands parallel to studs. I All horizontal joints shall occur over and be nailed to framing. til. On single story construction,panels shall be attached to bottom plates and top member,of the double top plate. iv. On two story construction,upper panels shall be attached to the top•member of the upper double top plate and to band joist at bothm of panel.Upper attachment of lowerpanel shall be made to band joist and lower attachment made to lowest plate at first tloorframing. V. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of ad staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment S. Glazing protection:a)new house or horizontal addition—required if project Is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition not required unless there is extensive renovation to the firsffloor c)replacement Whidows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH,Exposure B maybe obtained from the American Wood Council (AWC)website. YVF�fI}1SIDGERESrSON _ }$AMM MEW mas If • I, 1 , it „ y9 • ii ii` i• I �CI Z� I 1 •l a� u i b ii Ii G It to c i I i , I I FAAhII�[a 1wTateats R •r I I r iu I ID6EMFAIA@I�TE I, tl ii W . Ili ii ii So ► + . i _ 11a ,1 � 1 1 � r o II 11 l7 11 1 i fH� it DDLr$r E$)GF STAGS 31 m t tAII�S?AGkJG NSA PATTERN - �^ PAW EDU 0011KENA1LIDGES?ACMDEML See Detail on Next Page - Vertical and HDrrzonlal Nailing Detail •' Ve far Panel Attachment � rfical acid Hotizanfal Nailing for Panel Attachment aFTHE r Town of Barnstable Regulatory-Services Thomas F. Geiler,Director �A 1639. �t� " rEo,u..c Building Division _ Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstabl e.ma.us' Office: 509-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorizeA to act on my behalf, IZ2 in all matters relative to work autho Zid ythis building permit application for. l 3 G 6- IYL41Al Sr, Cv t-m►-r A4,�- (Address of Job)Signature of Owner Date Print Name If Property Owner is applying for permit please complete. the Homeowners Lic.ens.& Exemption Form on the reverse -side. - !�•IInoA.fC-nVJIJT.APti:RhdT.CCT(lN Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-066147 CRAIG J RILEY PO BOX 382 ;� Osterville MA 02955 %�Vj� ill )Flit,. Expiration Commissioner 02105/2017 T11, � parrunwozureal a�C>/�aavac�zuaPlt�+ Office of Consumer Affairs&Busihess Regulation MMIM OME IMPROVEMENT CONTRACTOR egistration: 125799 Type- xpiration: 1130/2016: Private Corporatic ns C.J.RILEY BUILDER]4 F CRAIG RILEY a. 10 B WIANNO AVE OSTERVILLE,MA 02655 Undersecretary f VDAC ace group WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-2E89906-9-15) NEW-1 5 INSURER: ACE AMERICAN INSURANCE COMPANY 1. NCCI CO CODE: 12165 INSURED: PRODUCER: C J RILEY BUILDER INC DOWLING & ONEIL INS PO BOX 382 973 IYANNOUGH RD OSTERVILLE MA 02655 HYANNIS MA 02601 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 05-05-15 to 05-05-16 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA ` B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in o� item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B �r-- D. This policy includes these endorsements and schedules: o� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o� 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 05-21 -15 RG ST ASSIGN: MA OFFICE: ORLANDO DA ACE 24M PRODUCER: DOWLING & ONEIL INS 22LGR 020116 Client#:10798 2RILEYCJ RDTM CERTIFICATE OF LIABILITY INSURANCE ' DATE(MM/DD/YYYY) 05/14/2015 TINS 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(les)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 endorsemengs). PRODUCER CONTACT NAME: Dowling&O'Neil Pac°,"o,Exi,508 775-1620 Fax Insurance Agency E-MAIL ac,No: 5087781218 ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC! Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B: C.J:Riley Builder,Inc. INSURER C P.0. Box 382 Osterville, MA 02655 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY MP059664 5/02/2015 05/0212016 EACH �OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurr nce $500 000 CLAIMS-MADE F OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000 000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY RO P LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY Y/N CRY T IER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Certificate of insurance for workers compensation will be Issued by the carrier. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Lawrence Hurwitz SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 8 Horizons Road ACCORDANCE WITH THE POLICY PROVISIONS. Sharon,MA 02067 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S151055/M151054 LS1 ®Boisedascede, Double 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP Roof Beam\13601 Dry 2 spans No cantilevers 1 0/12 slope September 23,2015 10:43:06 BC CALC®Design Report Build 4137 File Name: CJ Riley_1365 Main Job Name: Russell Description: RIDGE Address: 1365 Main Street Specifier: J Madera City, State,Zip: Cotuit, MA Designer: Customer: CJ RILEY Company: Shepley Wood Products Code reports: ESR-1040 Misc: �0 12 08-02-00 20-02-00 BO 131 62 Total Horizontal Product Length=28-04-00 Reaction Summary(Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 0/84 453/680 B1, 3-1/2" 3,072/0 5,560/0 B2, 3-1/2" 11239/0 2,257/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area (lb/ft^2) L 00-00-00 28-04-00 15 30 09-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 13,785 ft-Ibs 41.3% 115% 8 19-1-1-14 Neg. Moment 15,838 ft-Ibs 47.4% 115% 9 08-02-00 End Shear 2,884 Ibs 26.9% 115% 8 09-05-12 Cont. Shear 4,423 Ibs 41.3% 115% 9 09-05-12 Uplift 764lbs n/a 115% 8 00-00-00 Total Load Defl. U459(0.521") 39.2% n/a. 8 19-01-03 Live Load Defl. U707(0.338") 34% n/a 11 19-01-03 Total Neg. Defl. U999(-0.053") n/a n/a 8 05-00-00 Max Defl. 0.521 52.1% n/a 8 19-01-03 Span/Depth 17.1 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2 764 lbs n/a 8.3% Unspecified 131 Post 3-1/2"x 3-1/2" 8,632 Ibs n/a 94% Unspecified B2 Post 3-1/2"x 3-1/2" 3,496 Ibs n/a 38% Unspecified Cautions Uplift of-764 Ibs found at span 1 -Left. For roof members with slope(1/4)/12 or less final design must.ensure that ponding instability will not occur. For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow surcharge load. Notes Page 1 of 2 ®Boise Cascade, Double 1-3/4" x 14" VERSA-LAMO 2.0 3100 SP Roof Beam\111301 Dry 12 spans I No cantilevers 1 0/12 slope September 23, 2015 10:43:06 BC CALC®Design Report Build 4137 File Name: CJ Riley_1365 Main Job Name: Russell Description: RIDGE Address: 1365 Main Street Specifier: J Madera City, State,Zip: Cotuit, MA Designer: Customer: CJ RILEY Company: Shepley Wood Products Code reports: ESR-1040 Misc: Design meets Code minimum (L/180)Total load deflection criteria. Disclosure Design meets Code minimum (L/240)Live load deflection criteria. Completeness and accuracy of input must Design meets arbitrary(1") Maximum total load deflection criteria. be verified by anyone who would rely on Calculations assume Member is Fully Braced. output as evidence of suitability for particular application.Output here based Design based on Dry Service Condition. on building code-accepted design Deflections less than 1/8"were ignored in the results. properties and analysis methods. Fastener Manufacturer: TrussLok(tm) Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable Connection Diagram building codes.To obtain Installation Guide �I b d — or ask questions,please call LI (800)232-0788 before installation. a • • • BC CALC®,BC FRAMER®,AJSTM ALLJOISTS,BC RIM BOARD'TM,BCIS, BOISE GLULAMTM SIMPLE FRAMING • • • SYSTEMS,VERSA-LAMS,VERSA-RIM PLUS@,VERSA-RIMS, VERSA-STRANDS,VERSA-STUDS are e trademarks of Boise Cascade Wood Products L.L.C. a minimum=2" c= 10" b minimum=4" d=24" e minimum= 1" All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. All TrussLok screws may be installed from one side of multiply Versa-Lam beams. Member has no side loads. Connectors are: FMTSL338 ®Boise Cascade, Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 Sp Roof Beam\111303 Dry 3 spans No cantilevers 1 0/12 slope September 23, 2015 10:43:06 BC CALCO Design Report Build 4137 File Name: CJ Riley_1365 Main Job Name: Russell Description: Designs\RB03 Address: 1365 Main Street Specifier: J Madera City, State,Zip:Cotuit, MA Designer: Customer: CJ RILEY Company: Shepley Wood Products Code reports: ESR-1040 Misc: 12 1111111111111111111111111111111I 1 BO 03-00-00 06-00-00 03-00-00 B1 B2 63 Total Horizontal Product Length= 12-00-00 Reaction Summary(Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 14" 0/386 0/753 B1, 3-1/2" 1,208/0 2,042/0 B2, 3-1/2" 1,151 /0 1,940/0 B3, 12" 0/338 0/667 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 900/0 115% 160% 125% 1 Standard Load Unf. Area (lb/ft^2) L 00-00-00 12-00-00 15 30 01-00-00 2 Reaction from Desi... Conc. Pt. (Ibs) R 06-00-00 06-00-00 1,239 2,257 n/a Controls Summary Value %Allowable Duration Case Location Pos. Moment 3,217 ft-Ibs 8.8% 115% 9 06-00-00 Neg. Moment -2,349 ft-Ibs 6.4% 115% 9 03-00-00 End Shear 1,147 Ibs 8.4% 115% 8 02-01-14 Cont. Shear 1,880lbs 13.8% 115% 9 04-01-10 Uplift -1,139 Ibs n/a 115% 8 00-00-00 Uplift 1,006lbs n/a 115% 9 12-00-00 Total Load Defl. U999(0.008") n/a n/a 9 06-00-00 Live Load Defl. U999(0.005") n/a n/a 14 06-00-00 Total Neg. Defl. U999(-0.001") n/a n/a 9 09-10-07 Max Defl. 0.008" n/a n/a 9 06-00-00 Span/Depth 6.1 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(Lx W) Value Support Member Material BO Wall/Plate 14"x 5-1/4" 1,139 Ibs n/a 2.1% Unspecified B1 Post 3-1/2"x 5-1/4" 3,250 Ibs n/a 23.6% Unspecified B2 Post 3-1/2"x 5-1/4" 3,091 Ibs n/a 22.4% Unspecified B3 Wall/Plate 12"x 5-1/4" 1,006 Ibs n/a 2.1% Unspecified Cautions Uplift of-1,139 Ibs found at span 1 -Left. Uplift of-1,006 Ibs found at span 3-Right. For roof members with slope(1/4)/12 or less final design must ensure that ponding instability will not occur. For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow surcharge load. i ®Boise Cascade Triple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP' Roof Beam\111303 Dry 3 spans No cantilevers 1 0/12 slope September 23, 2015 10:43:06 BC CALC®Design Report Build 4137 File Name: CJ Riley_1365 Main Job Name: Russell Description: Designs\RB03 Address: 1365 Main Street Specifier: J Madera City, State,Zip: Cotuit, MA Designer: Customer: CJ RILEY Company: Shepley Wood Products Code reports: ESR-1040 Misc: Notes Disclosure Design meets Code minimum (L/180)Total load deflection criteria. Completeness and accuracy of input must Design meets Code minimum (L/240) Live load deflection criteria. be verified by anyone who would rely on output as evidence of suitability for Design meets arbitrary(1") Maximum total load deflection criteria. particular application.Output here based Calculations assume Member is Fully Braced. on building code-accepted design Design based on Dry Service Condition. properties and analysis methods. Deflections less than 1/8"were ignored in the results. Installation of BOISE engineered wood Fastener Manufacturer: TrussLok(tm) products must be in accordance withcurrent Installation Guide and applicable building codes.To obtain Installation Guide Connection Diagram or ask questions,please call b d (800)232-0788 before installation. a BC CALC®,BC FRAMER®,AJS-, ALLJOISTO,BC RIM BOARD- BCI®, BOISE GLULAMTm,SIMPLE FRAMING SYSTEM®,VERSA-LAM®,VERSA-RIM • • • PLUS®,VERSA-RIME), VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Cascade Wood a Products L.L.C. a minimum=2" c=7-7/8" b minimum=4" d=24" e minimum = 1" Connection design assumes point load is top-Loaded. For connection design of side-loaded point loads, please consult a technical representative or professional of Record. All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. All TrussLok screws may be installed from one side of multiply Versa-Lam beams. Member has no side loads. Connectors are: FMTSL005 r ISC 9P t5 Town of Barnstable *Permit# Expires 6 m tsfro issue di#e �T Regulatory Services Feed * BARNSTABLE, MA-Sv 639. $ Richard V. Scali,Interim Director �ArFO N1�A'I A,0 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number g Not Valid without Red X-Press Imprint � � � �lQ, /C Property Addressto .J a ❑Residential Val 7- A?o-rk$ Odd 60 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 44.e Contractor's Name Telephone Number -fog_ OM Home Improver7ient.Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) PER MIT ❑Workman's Compensation Insurance Check one: O C T 2 8 2013 ❑ I am a-sole proprietor I am the Homeowner I have Worker's Compensation Insurance TOW E3 r Insurance Company Name Workman's Comp.Policy# 142 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value c (maximum.35)#of windows C�2% iGy l #of doors: ` ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Impr vement Contractors License&Construction Supervisors License is r ire SIGNATURE: Q:\WPFILES\FORMS\buil permit RESS.doc Revised 061313 i j L Hie Cam7noirnfeakh of Vassaehmetts Department ofIndnstrid Accidents r Ojyke ofImestigations 600 Washington Street Boston,MA 02111 wtvm ntassgaiAdita Workers' Compensation Insurance Affidavit:Builders/ContractorsMectricianMumbers AppEcant Information Please Print i Name akmines orgw izafionl7ndividnal} Address: a ;X/�;0I CitylStatrlZip Phone 4 a D you an emp yer:'Check the appropriate box: Type of project(required): . contract I or and ❑ l.. h 4 I am a employes with ❑ I am a�� 6_ New oomsfruction employees(full and/or part-time)* have hired the sub-contractors. 2._❑ I am a sole proprietor or partner- listed on the attached sheet_ 7- ❑Remodeling slip.and have no employees These sub-contractors have g. ❑Demolition working forme in any capacity employees and have workers' 9. n Building addition [No workers' comp,insunnce comp.insurance.$ required-] 5. ❑ We area corporation and its 10..0 Electrical repairs or additions 3.❑ I am a homeowner doing all wort officers hm a exercised their 11..❑Plumbing repairs or additions myself [No workers'comp- right:of exemption per MGL 12.0 Roof repairs insurance required.]F c_152,§1(4),and we halm na employees-[No workers' 13.0 Other comp-insurance required.] *Auy applicmt that checks boa¥1 toast also fill out the sectioa beIow showing their workers'compensatiou polirp informatiem_ T HameDwners who submit this affidavit indicstiag they are doing aU work and then hire Outside contractors SUbMit a nen:affld3VR indjrRtinp,sorb ICAetractors that rhxlc this b=must attached an additional sheet showing the noose of the vabFcO n and state whether ocnot those entities have employees. If the mVcontractors have employees,the}must provide their works'comp.policy number. I am an employer that is protichir,g workers'compearstrtion iresrrrrrnct;f r nr} enzp7vyec�s Berate is t3ie paTic}and job site information. \ Insurance Company Name: Poltccy:ff.or Self-rus.Ltc-4: Expiration Date: ��t \ Job Site Address:�b�5 4145 P qg City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy num er�,nd e,pofirtion 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 unpnsamnent,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 It apron arty[ al de fperjurp that the in orrriation prin ide�d abm �fstan correct Siemture: Bate: 0 Phone#: . Qaki.at use ouFy. 11b not trri rn this area,to be completed by ciip or town gf)Sciat City or Town: Pern itUcense It Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing,Inspector 6.Other Contact Person: Phone#: 6 _ I Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursu.antto 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 Iegal 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 21zy 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 siivation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their cel 1.iicate(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 Indus'irial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. '11e afiida.vrit 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. Seli 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 bf 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 tilled 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 Depai$ment of Industrial Accidents Office of%vestigatims 600 Washington Strut Boston,MA 02111 Tel.#617-727-4940 ext 406 or 1-977 hIASSAFE Revised 4-24-07 Fax# 617-727-7749 www.inass-gov/dia BAMRMBEX MAM tNE, Town -of Barnstable Regulatory Services Thomas F. Ceiler, Director 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 Property Owner Must Complete and Sign This Section If Using A Builder 1, kATH-Wni . RUS.§jW as Owner of the subject property hereby authorize o act on my behalf,�A in all matters relative to wor authorized T this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. CAUserAdecolIik\AppData\Local\Microsoft\Windowffemporary Internet Files\ContentOutlook\DDV87AAZ.\EXPRESS.doc Revised 072110 Massachusetts -Department of Public Safety Board of Building Regulations and Standards C".%truction Supen ivar License: CS-066147 ,g CRAIG J RILEV PO BOX 3s2 5 N - OS'I'ERVILLE WA 026JC Expiration Commissioner 02/05/2015 Tor�ecr�Q�y� ®fice of Coasomer Affairs 8s 8d(siae a License or registration valid for indi yidul use only HOBNE anon: YERAEPR CONTRACTOR before the expiration-date. Er return to: Registration: 125799 Expiration: 1/30/2014 Type' Office of Consumer Affairs and Business Regulation Private Corporatia, 10]Park Plaza-Suite 5170 C. • ILEY BUILDER WC Boston,t+rlA 02116 CRAIG RILEY 10 8 WIANNO AVE. OSTERVILLE,MA 02655 / 4 Undersecretary a out signet Client#:10798 A CO CERTIFICATE (� "T'� [`. r f /�7!_(R�I�LIEV�CJ farERTIF"I�?JA1 F f7,. O UASPU 17 4i WW, �e-7ll�i1T'Z?L"2RILEvl;C DATE(IdM/DD/YYYY) H CEe�TiFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.05/06/2013 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED °RESEldTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ANT: It the certificate holder Is an ADDITIONAL INSURED,the poilcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the ms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certIfIcate holder In lieu of such endorsement(s). aoucER rWling 8, O'Neil NAME: -urance Agency PHONE No.E,:508 775-1620 yC po; 5087781218 3 Iyannough Rd., PO Box 1990 E-MA L ADDRESS: 'annls, MA 02601 INSURER(S)AFFORDING COVERAGE IJRED :INSURER A:National Grange Mutual Insuranc NAIL A C.J. Riley Builder,Inc. INSURERS: - P. O. Box 382 ;TSUR_ ER_; Ostervilie,MA 02655 'INSURERD: INSURER E VERAGES CERTIFICATE NUMBER: INSURER F: HIS IS TO CERTIFY THAT THE POLICIES OF REVISION NUMBER: INSURANCE LISTED BELOW HAVE TH REQUIRE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR E POLICY PERIOD IOICATED. NOTWITHSTANDING ANY MENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS !:RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE-AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. - TYPE OF INSURANCE ADOLSUBR i INSR WVD POLICY NUMBER POLICY EFF POLIC EXPY I GENERAL LIABILITY _. MM/p0/YYYY MM/DD LIMITS r MPOS9664 5/02J2013 05/02/201 EACH OCCURRENCE )t COMMERCIAL GENERAL LIABILITY I ACHO, T �pp $1 000 000 CLAIMS-MADE O OCCUR PREMISS Es occccurre $500 000 - II MED EXP(Any one person)__ $10,000 PERSONAL&ADV INJURY S 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2 000,000 POLICY jE� LOC f PRODUCTS-COMP/OP AGG S2'000,000 'f"MOBILE LIAO(UTY M9059664 Y Au7o I I 5COMBINED SINGLE LI rI /02/2013 05/02/?.01 OWNED SCHED acciden,___ 1'000,000 SCHEDULED rOS AUTOS BODILY INJURY(Per person) s X HIRED AUTOS X NON-OWNED I BODILY INJURY(Per acctdenq $ AUTOS PROPERTYDAMAGE Per accident S ( UMBRELLA LIAR X OCCUR ) S EXCESSLIAB BINDER359107 5/02/2013 05/02/P01 EACH OCCURRENCE CLAIMS-MADE $3 000 000 DED RETENTIONS AGGREGATE $3 000 OOO IRKERS COMPENSATION - D EMPLOYERS'LIABILITY �rVC059664 $ r PROPRIETOR/pARTNERIEXECUTIVE YEN 5/05/2013 05/05/201 X I WC STATU. : O7H- 'ICER/MEMBER EXCLUDED? I ndafury I and N/A LI E`L EACH ACCIDENT $500 000 s,describe under � CRIPTION OF OPERATIONS below E.L DISEASE-EA EMPLOYEE $500 000 IE.L.DISEASE•POLICY LIMIT S50()0Oo ON OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addhlonal Remarks Schedule,0 mare apace Is required) ce coverage.is limited to the terms,conditions,exclusions, other limitations and endorsements. contained In the certificate of insurance shall be deemed to have altered, Walved,or extended the e provided by the policy Provisions. ATE HOLDER GANGELLATION "� Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 II/ialn Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N Hyannis, MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7//11 2010/05) 1 of 1 The ACORD name and logo are registered marks Of ACORDB 2010 ACORD CORPORATION.All rights reser ed. )879/M110878 LS1 /}VI V \ Tov"n of Barnstable Expires 6 montlrs from issue date Regulatory Services Fee. 4�, RNSI - g MAC Thomas F. Geiler, Director fsnnwY" Building Division w Tom Perry, CBO, Building Commissioner 200'Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us y Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ❑ Residential Value of Work D® Minimum fee of$25.00 for work under$6000.00 r. Owner's Name&Address Telephone Number Contractors Name i 11 u(� Home Improvement Co ractor Licen #(if applicable) l�`S 7/ 0 Construction Supervisor's License#(if applicable) R PERM ❑Workman's Compensation Insurance SS Check one: 2009 - ❑ I am a sole proprietor ` .SUN 2 5 eIrnathe Homeowner TOWN OF BARNSTABI- . have Worker's Compensation Insurance A. Insurance Company Name �] (�JJ Workman's Comp. Policy# ' ®Jr7[�4 Copy of Insurance Compliance Certificate must be on file. 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 r000 .❑ 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. Vomeractors License&Construct Supervisors License is required. SIGNATURE:Q:\WPFIL:ES\FORMS\Exp Revise06O4O9 1 !Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: f'%�`( %'�/ 6i���.� Phone.#: Are 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 ":2.Q 1 am a sole proprietor or partner-' listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g• "0 Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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.[]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. Iam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA'for insurance coverage verification. I do hereby certify der the pains and naI *es of perjury that the information provided abov is tr a and correct. Signature: Date: UZ" Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 d employer,or the representatives of a decease � a joint enterprise,and including the legal of the foregoing engaged in � rp g a individual partnership,association or other legal entity,employing employees. However the receiver or trustee of n ,p p, owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of anotlier who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the,commonwealth for any, applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-conti•actor(s)name(s),address(es)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 g insurance coverage.e. Also be sure to sign and date the affidavit. The affidavit should . Accidents for confirmation of g of or town th at the application for the permit or license is being requested,not the Department be returned to the city pp Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each home owner or citizen is obtaining a license or permit not related to any business or commercial venture year.Where a h tntng (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 Common ealth w of Massachusetts w 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 11-22.06 www.mass.gov/dia Y Client#:10798 2RILEYCJ ACORD- CERTIFICATE OF LIABILITY INSURANCE 06/2412009 ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT.AMEND,EXTEND OR. g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 Iyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA National Grange Mutual Insuranc C.J.Riley Builder,Inc. INSURER B: P.0.Box 382 INSURER C: Osterville,MA 02655 INSURER D: 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. INS AD01 LTR NS TYPE OF INSURANCE POLICY NUMBER DATE IMMIDD EFFECTIVE DATE EXPIRATION M t D YYI LIMITS A GENERAL LIABILITY MPOS9664 05/02/09 05/02/10. EACH OCCURRENCE $1 000 000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES TO RENTED $50 000 CLAIMS MADE f OCCUR MED EXP(Any one person) $5 000 X BI Ded:500 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY PE O- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $. DEDUCTIBLE $ RETENTION $ $ TAT1TH- A WORKERS COMPENSATION AND WC059664 05/05/09 05/05/10. X WC SLIMIT 0ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500 000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ND EMENT I SPECIAL PROVISIONS RE: Richard Russell,1365 Main Street Cotuit,MA' Lqd a9 Operations performed by the named insured asprovided by the terms and conditions of the policies. Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 90_ DAYS WRITTEN 230 South Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S590271M59026 MAK 0 ACORD CORPORATION 1988 sllussachusetts Department of Public Safety Board of Building,, Re�oulations and Standards Construction Supervisor License License: CS 66147 Restricted to: CRAIG J RILEY PO BOX 382 ryt OSTERVILLE, MA 02655 Expiration: y512011 ('�annus�irmcr Tr#: 10398 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration �125799 Board of Building Regulations and Standards - - Exphatian- 0/2010 Tt# 262231 One Ashburton Place Rm 1301 7: Boston,Ma.02108 Type,Private Corporation C.J.RILEY 13UIL6ER,'INC CRAIG RILEY 10 B WIANNO OSTERVILLE,MA 02655- Administrator Ot id w gout signatur I� I U2509 10:20a C.J. RILEY BUILDER INC. 5084286076 p.1 rrAA RILEY ' . BUILDER, Inc. PV d 10B Wianno Ave. Osterville,MA 02655 508-428-6376 Fax 428-6076 cj@Cjrllev•com Proposal 5/09/09 Mr. Richard Russell 1365 Main Street Cotuit,MA 02635 Proposed work: Installation of four new windows in small cottage, includes materials, disposal, tabor, and painting. Please see spread sheet for cost break down. *Total cost........................................ $3,971.00 C J Riley Builder Inc. Thank you, All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or Authorized `• deviation from above specifications involving extra costs will be executed'only Signature upon written orders, and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our Note:This proposal may be 15 workers are fully covered by Workman's Compensation Insurance. withdrawn by us not accepted within days. t4 mce O�� ro�f�oiaf The above prices, and conditins ar�ti facto and are hereb acce ted. You ��=s factory Y P are authorized to do the work as specified. Payment will be made as outlined Signature r above. j\. Date of Acceptance: ~ l/ V Signature Op714E iow Town of Barnstable *Permit# 6 k Expires 6 months from issue date + BAxxsTABLE, : Regulatory Services Fee 7 7, 7� v� MASS. Thomas F.Geller,Director pTEDN1°�`a Building Division /'� � Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number4-7 Property Address V ❑Residential Value of Work C25, o®® 06 Owner's Name&Address Z14:d—az Contractor's Name Telephone Number Home Improvement Contr ctor Lice (if applicable) Co truction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor X-PRESS PERMIT ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance S 13 2002 Insurance Company Name ABLE Workman's Comp.Policy# A60 d Permit Request(check box) p 0&P �G tT 9• •t. . Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature 6f Q:Forms:expmtrg Revised121901 4. q 12, 12'-0• NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS &DIMENSIONS IN-I'HE I-IEL D POSTFROM RIDGE 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, - DOWN TOSLAB DETAILS,&FINISHES IN THE FIELD WITH OWNER 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT FIRST NS I-RUC I-I BE 6o CONFABOVORM TO 78 01'2 4.) ALL CONSI-I�UC'f"ION TO CONFORM TO 780 CMR MASSACHUSFI`fS STATE BUILDING CODE,8TI t EDITION AMENDEMENT&IRC2009 26"Doo EMOD. S.) 110 MPH EXPOSURE B WIND ZONE ATH I 6.) VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE OPOST FROM RIDGE DURING FRAMING CONSTRUCTION o DOWN TO SLAB o I 7.) ALL.L.VL LUMBER/BEAMS'TO BE 1.9e L/360 LOAD 0 8.) SEE CERTIFIED PLOT PLAN DEVELOPED BY RICK HOOD FOR ALL tt PROPOSED&EXISTING DETAILS ze DooR i 9.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSFAL.LATION OF 6 i .. LLLL � ALL SIMPSON COMPONENTS w1 10.)THIS SITE IS IN'THE 110 MPH WIND BORNE DEBRIS AREA, EXPOSURE"B" o &WITHIN ONE MILE OF NANTUCKET SOUND PER STATE OF >I MASSACHUSETTS WIND SPEED MAPS _ - - 2x 10RAFTERS@ 16"D.c o 11.) GLAZING PROTECTION PER 780 CMR 5301.2.1.2 TO BE PLYWOOD PANELS N (+ VERIFY ALL WIND BORNE DEBRIS PROTECTION REQUIREMENTS W/OWNERS PRIOR TO START OF CONSTRUCTION GAS x 12.)FOLLOW ALL REQUIREMENTS OF TI IE IECC2012 RESIDENTIAL ENERGY INSER1 REMOD. EFFICIENCY REQUIREMENTS&VERIFY ALL DETAILS WITH THE INSUt_A'TION GAMEROOM INSTALLER/CONTRACTOR. (VAULTED CEILING) - 1-------- I A N., Y A"., Y^A Al Al Al Al , EXIST.2 x 4 WALLS SISTER 6'-2" FRAMED W/2 x 6 STUDS I TYP. ROOF CONST. 3-1 3/4"X 11 7/8 LVL HEA ER TYP.WALL CONST. - -2.10 ROOF RAFTERS @16"o.c. 1.2 x 6 STUDS SISTER FRAMED .5/8"CDX PLYWOOD ROOF SHEATHING SEMI-CIRCLE DECK FRAMED POST FROM RIDGE 2.12"PLYWOOD SHEATHING -ASPHALT ROOF SHINGLES W/P.T.2 x 6 JOISTS @ 16"o.c. DOWN TO HOR. 3.6"(R=20)GATT INSULATION - FELT PAPER SUPPORTED BY(2)DIAMOND r SPR 4.12"GYPSUM BOARD -SPRAY FOAM INSULATION(R49) PIERS - 5.W.C.SHINGLE SIDING .2-1 3/4"X 11 7/8"LVL RIDGEBEAM -SIMPSON H 2.5 HURRICANE CLIPS 2'-9" T-5" 4'-9" 4'-9" 2'-5" 6.TYPAR EXTERIOR VAPOR BARRIER AT ALL RAFTER ENDS t - -ICE/WATER SHIELD AT BOTTOM 2 x 6's @ 16"o.c. TO"OF ROOF P LA N -WIND WASH BARRIERS RAFTERS -WIND WASH BARRIERS ROOF FRAMING ALUMINUM DRIP EDGE FLOOR PLAN 2 2 �10 7 S �a.. R�ve�WED K t��TECT � SMOKE IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS TOP OF PLATE CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION /LJn TABLE 402.1.1 MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS TOP OF PLATE ( ) TABLE BUILDING DEPT. DATE FENESTRATION ShYLIGNi CEILING WOOD FRAMED WPLI.FLOOR BASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL UFACTOR U-FACTOR R-VALUE R.VALUE R-VALUE VALUE RVALUE RVALUE - 032 0.60 I9 20 30 IRS"S 10(2FT.DEEPI 1.13 / REMOD. 22 NOTES: A `, I ` GAMEROOM 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. FIRE DEPARTMENT DATE 2.15/19 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR OF THE HOME OR R=15 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL BATH 51QN.ATURES ARE REQUGMEQ FOR PERMITTING EXIST.CONC.SLAB W/CONC.SKIM FOR 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS 1 FIRST FLOOR TILE FLOORING FIRSTSB LEGEND: FLOOR �5f � A 0 EXISTING WALLS QS SMOKE DETECTOR CONSTRUCTION TO BE REMOVED A SECTION @ GAMEROOM MM NEW CONSTRUCTION ©CARBON MONOXIDE DETECTOR Al COTU IT BAY DESIGN, LLC NEW REMODELING FOR: THE DESIGNER SHALL THEBUI NOTIFIED CONTRACTOR WILL SCALE : DRAWING NO. ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF 43 BREWSTER ROAD WILLCON TRUC BERESON.RESPONSIBLE FORDING CONTENTOR 1/4" = 11-011 WILL BE RESPONSIBLE FOR THE CONTENT IN THESE DRAWINGS IF CONSTRUCTION MASH PEE MA. 02649 _ GDSGGNER S ftTHOUT ANY ORFYING R U S S E L L RESIDENCE DESIGNER W ANY ARE ERRORS OR OMISSIONS DATE : PH. (508) 274-1166 V C C THESE DRAWINGS REQUIRES FOR HE ITTE. SE OF THE OWNER NOTED.ANY OTHER USE HE OF FAX (50$) 539-9402 T M n THESE NTOFTH DESIGNER UNDER THE 8/7/2015 1365 M U I 'M` CONSENT OF THE DESIGNERUNOERTHE Al MAIN O T ARCHITECTURAL COPYRIGHT PROTECTION N STREET C ACT OF 1990 I