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HomeMy WebLinkAbout0040 ELLIOTT ROAD _ _ u,... ., .� � � _ f . .: . � . � . L �. _ }'. .. - ."j �' � - � y .. .. �, s _ � 9 e ,. � � � t o - - 7 _ ° �. e o i 1 �; .. a �. � � - - � ° e �.. � � � .. � n a. .. Insulate.. Weatherization --& Insulation 410 Grave St Fall,River,W 02723 Insulatersave net --t UJ March 31, 2014 0 Town Of Barnstable ° Thomas Perry, CBO 200 Main Street Hyannis, MA 02601 RE: 40 Elliot Rd Dear Mr. hcrry, This Affidavit is to certify that all work completed at 40 Elliot Rd has been inspected by a certified BPI Inspector. R52 cellulose was added to open attic space, All Work Performed Meets ox exceeds Federal and State Requirements_ Sincerely, , Roland Langevin Insulate 2 Save,Inc President CSL 103861 , HIC 1663 11 . , r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r -7 Mi pp Parcel I 1 Application p Health Division Date Issued• � Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board c cZ h4 h3 Historic - OKH _ Preservation/ Hyannis Project Street Address QO i 6� Village _ �Y1�-p� Li Owner NIX-MCIIN 1(D V M(M Address Q6 FA I i C,I le J Telephone rs-p7zq WbEo Permit Request ln—�.a-ex la Ck `�-`� `��� �c.�-17 6-n �016W'b\ a-I l U Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tot'thew N) Zoning District Flood Plain Groundwater Overlay Project Valuatio f'Z_, I Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup rting do&meatation. Dwelling Type: Single Family 521/ 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 w — Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Aq*r: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No �. Detached garage: 0 existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name &O—Y-0 I_&J2rr Telephone Number CP- Address L410 ),( P License # 1 ( �.tlex,, r 0 Home Improvement Contractor 0 Worker's Compensation #TPV ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO-'- Q SIGNATURE DATE r. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED I MAP/PARCEL NO. s� + ADDRESS VILLAGE OWNER !"f s i P' h t DATE OF INSPECTION: FOUNDATION c FRAME INSULATION f E FIREPLACE f ELECTRICAL: ROUGH FINAL i t PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations s a 600 Washington Street Boston, MA 0:2111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 11�� Please Print Ledbly Name(Business/Organization/Individual): C"k Tc �� Address: L} 10 C--, 'Uf 0 `4— City/State/Zip: QA1J Phone #: / (p`7— (_q 7Q(_,o Are you an employer?Check the appropriate box: Type of project(required): 1.2"'I am a employer with I F-) 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ 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 11.0 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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:,t Ct_Y6 l r)15(_'Yzin C P C rcAj Policy#or Self-ins. Lic.#: -1 pi W Q_2)S 1 143 1 Expiration Date: 6 i Job Site Address. I l (S �111 City/State/Zip:(-p V)4cy-V\,i.� 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 insumnmmmerag tion. I do hereby certify under t to ins l unties of perjury that the information provided above is true and correct.[1,3 Si nature: Date: l 0 Phone#: `� ��ZQ_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): 1.Board of Health 2.Building Department _3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: _ J`Nte &MMVWav" Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166311 Type: DBA Expiration: 5/11/2014 Tr## 222532 INSULATE 2 SAVE ROLAND LANGEVIN --- ------ -------=--- 536 EASTERN AVE. ------- ------- - FALLRIVER; MA 02723 . - --------=— — -- -- Update Address and return card.Mark reason for change. n Address Renewal 17 Employment El Lost Card DPS-CA1 is SOM-04/04-G101216 `X `e License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y ' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: G Registration: ;-166311 Type: Office of Consumer Affairs and Business Regulation Expiration 5/11/2014 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 INS- TE 2 SAVE ROLAND LANGEVIN //f� 536 EASTERN AVE (4 FALLRIVER, MA 02723 Undersecretary Not valid without signature Massa chusetts -Department of Public Safety. Board of Building Reguiations-and Standards Con+truction Supervisor License: CS-103861 ROLAND LANGE IN , f 536 EASTERN ACEt �� Fall River MA 01723 =XPiration 08/24/2015 Commissioner A� CERTIFICATE OF LIABILITY IN N DATE(MM/DDYYYY) 16....-_ _ SURD. CE 6/13/13 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 NAME: ......_..,, ....---- .-...... ), (508) 677-0407 -- Anthony F. Cordeiro Insurance PHONE -`_......___ FAC No) 508) 677-0409 1A!C„�� C(A/G 171 Pleasant Street E-MAIL Fall River, MA 02721 ADDRESS: lbrizido@cordeiroirisurance.com INSURER(S)AFFORDING COVERAGE NAIC k _ INSURER A-,Atlantic Casualty Ins. Co. INSURED INSURERB:TorI15_-Svecialty Ins. Co. Insulate 2 Save, Inc. INSURER C:Great American Ins. 410 Grove St. INSURER D_Guard Insurance Grou _ Fall River, MA 02720 INSURERE: INSURERF:— - u---- -^�-.-- — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR 1 TYPE OF INSURANCE IADOC SUER POUCY NUMBER M DO EY pMN�lYYY LIMITS A GENERALLIABILITY Y Y M081000174-1 6/12/13 6/12/14 EACHOCCURRENCE $ 1 000. 000 „X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISESLEa�xkn�nae)- $ --100,000- CLAIMS-MADE I X OCCUR ME EXP(Anyone person) $_ 5�000 _ _ - _. PERSONAL&ADVINJURY $__1 OOQ,000— t--- ----- ----.--.._. - ; ---.� -_----. GENERAL AGGREGATE _ $ 2 -000 000 _ ..GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOP AGG $ _2,.00O,000-_ X POLICY ,__1 PRO- .-.1 LOG -'-- ---__.-- -- T _.. -$ ( AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT' LEa accidert I_-____.----- $-----._�-_--....--- ANY AUTO BODILY INJURY(Per person) Is ...................._..........._........................_-..)_'_._-.,_....... ....-...-...-.._-._...._...--- ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS _..-----....._....-..-____., ...---_...._ •_-_..........-_._.___.--,..-__._....._ NON-OWNED PROPERTY DAMAGE HIREDAU70S AUTOS {Peracc lent)_---_ $ $ B X UNBRELLALIAB X OCCUR i78264D131ALI 6/12/13:1:2 /12/14 ._... .— EACH OCCURRENCE $ EXCESS LIAB I AGGREGATE - _- _$ 2 r O00,000 I CLAIMS-MADE DED X RETENTION$ 10.000 $ - D WORKERS COMPENSATION INWC311431 12/l /10/13 �[ WCSTATU- OTH- ANDEMPLOYERS'LIABILITY Y/N IO E MLTB. -ER,.. _ ANY PROPRIETOR/PARTNER/EXECU17 E EL EACH-ACGDENT.,.-___ _.--_$_ 5OO OOO OFFICER/MEMBER EXCLUDED? I N I A 0 ,_ (Mandatory in NH) j E.L_DISEASE-EA EMPLOYEE $ 500 tOOO Des _ Cdescribe under RIPTION OF OPERATIONS below I E,L DISEASE-POLICY LIMIT $ 500,000 C Equipment Floater IMP 375-99-76-01 6/12/13 6/12/14 Shop Storage 75,350 Veh Storage 76,250 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renarks Schedule,If more space Is required) Proof of Insurance. Residential Insulation Contractor. 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 St. AUTHORIZED REPRESENTATIVE f Hyannis, Ma 02601 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: A OWNER AUTHORIZATION FORM ( wner's Name) owner of the property located at Yo F /I ce-41-kf V . -� (Property A Tess) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature . Date r RISE;ENGINEERING Federal ID 4 05-0405629 RI Contractor Registration No 8186 division of'T'hicisch Enginccrin. MA Contractor Registration No 120979 - CT Contractor Registration No 620120 — 1341 Elmwood Avenue,Cranston,RI 02910 ;.. (401)784-3700 FAX(401)784-3710 CONTRACT i S E Page 1 !l PRO(iR��1 THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING C L.C-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER ._..........._-........___ __.......... .. ..., PHONE DATE Client C Edith.Romano (S08)274-4059 03/08/2013 141779 SERVICE STREET _._.�.._._..�.. ._._.._,......- _._,_,. BILLING STREET 40 Elliot Road 78-0 S Qunsiganlnd Av _ _._ SERVICE CITY.STATE.ZIP .-....... ,_. ._ _........_,_,,....._. . ..,..,, .._._. BILLING CITY,STATE,ZIP Centerville, MA 02632 Shrewsbury, Ma 01545 V-_ _ _.. . .... ... . JOB DESCRIPTION a Provide labor and materials to seal areas ol'your home against wasteful,excess air leakage. This work will be fL ed ini'o>S�ert L L] with the use of special tools and diagnostic tests to assure that your home will he]eft with a healthful Ievcl of x nge and indoor air quality.Materials to he used to seal your home can include caulks,foams,weatherstripping and oth r ts. Primary areas for scaling include air leakage to attics,basements.attached garages and other unheated areas(windows re not encritty addressed) (12)man hours. $924.00 Provide labor and materials to instal]ventilation chutes in(77)rafter bays to maintain air flow. $268.73 Provide labor and materials to install a 15"layer of R-52 Class I Cellulose added to(1240)square feet of operi attic space. SL971.60 Provide labor and materials to insulate the back off I)attic hatch with 2"rigid'Themiax board.Weatherstrip the perimeter. $35.12 Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper Vent to exhaust existing bathroom fan(s). $116.10 Provide labor and materials to install(12)6"X 16"rectangular aluminum sotlit vents to increase ventilation in attic areas. t7 the age of your home we anticipate the need to use lead-safe remodeling practices in the course oPthis work. Specify color: Nhite or Ciray. $456.00 Total: $3,771.55 Utility Incentive: $3,059.66 Customer Total: $711.89 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Seven Hundred Eleven &891100 Dollars $711.89 UPON FINAL INSPECTION WAPPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALING FT 30 AY9 S REVERSE FOR IMPORTANT INFORr1ATION ON GUARANTEES,RIGHTS OF RECISION SCHEDULING AND CONTRACTOR REGISTRATION DO NOT SIGN THIS CONTRACT IF THERE ARE A Y BLANK SPACES ptrFHo DEIGN RE-RISE ENGINEERING .. .._.._-,... ...,._.._....... „__ ._....._..., .., -,.._....., CUSTOMER ACCEPTANCE i 13 I N E:i IS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE :..,,,_._.... /...,,,..(1�.,...(�... ......... ._,..._. . ..,_,.__.... ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE Y )D SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK __..._._.....✓✓✓._._. DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ll dap J 9, 49 W Parcel/71 �t3L Permit# v2 a Health'15ivsion IOL�" � :aiJ Date Issued Conservation Division c �` ! !�� ;, "' ' Z3 Application Fee Tax Collector ..r !©3 02PermitIO� � �t Fee Treasurer SEPTIC 1;V%-,TEINI ,UST ESE O Planning Dept. WSTA:f`ED IN CC#UPUANCV,/ i TITLE� ��31®Zi Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANO Historic-OKH 41,a Preservation/Hyannis TOWN REGUUT101433 Project Street Address 4o E I I -L& &4.p Village CekJr�e y u I M 11. 8/gapa STa h f-e— Owner E D e w el InA N 0 Address 40 E ll 1 ®E& Rmp Telephone ( 568 `775 4 d P q Permit Request t t9 & ¢.c/ bo u ' , fir' ffij w Square feet: 1 st floor: existing proposed_d-46 2nd floor: existing proposed d Total new Zoning District Fleod`Plain Groundwater Overlay Project Valuation__43,460.9a Construction Type t,( W Q Lot Size YS -ki-e- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family &10'- Two Family ❑ Multi-Family(#units) Mo Age of Existing Structure 31 V_em-5 Historic House: ❑Yes C Pdo On Old King's Highway: 0 Yes 2olTo Basement Type: ❑ Full ❑Crawl ❑Walkout Wither li _,S JA6 Basement Finished Area(sq.ft.) 4/&- Basement Unfinished Area(sq.ft) Number of Baths: Full: existing / new ! Half: existing G' • new _ Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Off'Gas ❑Oil ❑ Electric 0 Other Central Air: ❑Yes &'I�lo Fireplaces: Existing L New er Existing wood/coal stove: ❑Yes t�lo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing lfnew size k 4 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use G' BUILDER INFORMATION Name RUM tq[D �P_C..e-nu Telephone Number ( 6-09) Oe- gobg Address I T9 Tim Tmk l nN License# 6 9-3 6(Z- zAA.-tZ sT-n&ts _m i (1 MA- O 1&49 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO V n 1z.macc� Dt s nose I SIGNATU E DATE pp- . . ` FOR OFFICIAL USE ONLY PERMIT NO. DATKISSUED MAP/_.PARCEL NO. 'r _7` r , ti •` _ 42 ADDRESS ;. VILLAGE OWNER DATE OF INSPECTION: '� - - f• ''� FOUNDATION FRAME INSULATION FIREPLACE �� r- • ; - w ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH ., FINAL-= GAS: ROUGY-I� = FINAL--a FINAL BUILDING DATE CLOSED OUT } •r r ASSOCIATION PLAN NO.' �P`oFTHE Tpk�� The Town of Barnstable N BARNSTABLE. • Department of Health Safety and Environmental Services �L' TSMASS. O �p t639. A 0 Tfo Mp{ Building Division 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: 4a/7/ir Ka M ANO Map/Parcel: -2 II- P/r 7/ Project Address: i70 -/-T 1?0,,' er-k T• 'Builder: (?o/yi.c-p The following items were noted on reviewing: 11 l) at Al. /-o-C, P g-r o,•t W�I 413o" 4' fit'"/Y 13o vlf- r- D J/f Sr,4Z-t. //// ..-1. / �C,LY UACDAL l2 54,4S 3 5'T/, t l o ��R �1r��2 �.r�n-roc ��n 1�v r F L�v�v�� - 3�wl/Z why -7-s / ar A6-�IV-77&Z YrNfrzw,I-y ✓r'�r�/r„z�.o r.�E �u ems-+ /;/�-` P3 le- Reviewed by: - Date /Z' . 1 q:building:forms:review r ' °FTHE P° Town of Barnstable Regulatory Services r sa MASS. " Thomas F.Geiler,Director y nss. $ Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOk LAW SUPPLEMENT TO PERMIT APPLICATION i MGL c. 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 certain exceptions,along with other requirements. A Type of Work:��Aiq "r C9l�rt4Ge 4b2YJl riot l 7I1 A Estimated Cost 4Gc Address of Work: 40 E`l t 6'b %An Catunet-o dLe, Ma 6v<.3;- Owner's Name: 1�D(NI B M Kl Ai 6 Date of Application:S j awl 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 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 agen owner: Date " ntra or N e Registration No. OR Date Owner's Name Q:forms:homeaffidav ` _...... . The Commonwealth of Massachusetts n� . 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I understand tliat a' copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. . ... Tdo hereby"c hepai -and-penalties-of-perjury that -information-provided-above_issr_ue_annd-correct Date 'Signature .. .. - .,. ,. . .. •. .:Phone# �� ' Print name oMcial we only do not mite in this area to be completed by city or town offictal city or town: permit/license# CIBuilding Department ❑Licensing Board ❑Selecti=32s OMcce ❑checkif immediate response is required ❑HealthDepartment contact person: phone#; ❑Other____ (revised 9/95 PItU Information and Instructions Massachusetts General Laws 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 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 b g appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance ar 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. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation arid' supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tlie 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'.of if you are required.to obtain a workers' compensation policy,please call the Department at the number listed below:. City or.Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom�o '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.pe mrtTlicense number which will..be used as a reference number. Tlie affidavits may lie'r t� l 41. .r .. .. the Department by�maiT FAX unless other ements have been made; The Office of Investigations would like to thank you in advance for you cooperation and should you have any�uesttons, . please do not hesitate to give us:a call. ddress tel hone and fax number: ICI. The Department s a•.... ..: ..... . .. .:..,:... ... . . .-. .. ,:-.... .::.,... .. The Commonwealth Of Massachusetts � Ac cidents Industrial-A .-Department of Indus G Mce of Investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 i t RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Q� square feet x$961sq.foot= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE ' square feet x$64/sq.foot= 1767 x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f , >120 sf-500 sf )/?v fo C-MIN $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit; x.0031= square feet x$961sq.foot= :k STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee r projcost J57 9+Alm f+ '�toccctt� �F St�.irw��, 7=CUR Appeadk J Table JS2-lb(eoatiaoed) boa pdm Packaps for One Sad Two-Family Residential Buildup Rued with F"W Fu&b MAXIMUM MINIMUM t3laalmg O1aaaBEqwpmm Ca1im6 Will Floor. BasementLawwr liaAm'('N�) U-value= R vatud R•vaiue' R vaiu2 Wa nwalues ST01 to 6500 Heating Degree Days' Q 12% 0.40. 31 13 19 10 6 Normal R i' 12% 0.52 30 19 19 10 6 Normal S I 12% O30 31 13 19 10 6 1S AFUE T 1511i 036 31 13 23 N/A . N/A Normal U i 13'1i 0.46 38L 19 19 10 6 Normal v t 15% 0.44 31 13 23 N/A N/A 85 AFtJE W ` 15% 032 30 19 19 10 6 1S AFUE X .19% 032 31 13 25 N/A N/A Normal Y 12% 0.42 31 19 21 MA f N/A Normal Z 13% 0.42 31 13 19 10 / 6 90 AFUE AA 11Y. O.SO 30 19 19 10 6 90 AFVE c 1. ADDRESS OF PROPERTY: ZAD o 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: Sy 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-form-080303a I 780 CMR Appendix J Footnotes to Table J5.Mb: ' Glazing area is the ratio of the area.of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fts of decorative glass may be excluded from a building design with 300 fl of glazing area. . =After January 1, 1999,glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.53L U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 . insulation and R 38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the root 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding,structural sheathing,and interior drywall. For example,an R 19 requirement could be met EITHER by R 19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling.requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. Q A 'The R-value requirements are for unheated slabs.Add an additional'R-2 for heated slabs. 'If the building utilizes electric resistance heating�use compliance approach 3;,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J52.la NOTES: a)Glazing area and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable.levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door.contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value.to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). PE azw LANES i%AAV NCaD �2Ar STANDARD LEGEND NOTE:not all symbols will appear on a map # GOLF COURSE FAIRWAY `� EDGE OF DECIDUOUS TREES ^--�---^ EDGE OF BRUSH 248 ORCHARD OR NURSERY r — 3 . 8 V—V—v V EDGE OF CONIFEROUS TREES \ MAP 2 4$ MARSH AREA 2 — • — EDGE OF WATER _ = DIRT ROAD ----- --- -- # �O X M P ` DRIVEWAYPARKING LOT t::L,0� PAVED ROAD 1 — — DRAINAGE DITCH # 49. . — — — " PATH/TRAIL o � — — PARCEL LINE / r mecca .*—----MAP# t 21 a PARCEL NUMBER t #leeo HOUSE NUMBER r 2 FOOT CONTOUR LINE 37 f f— _ —18— 10 FOOT CONTOUR LINE — — Elevation based on NGV029 MAP 2 .V /\ i/4.9 SPOT ELEVATION +_ .fir. ~ ---- -- --- - MAP 48: 000 STONEWALL - _---- - -X—X— FENCE RETAINING 4 # WALL RAIL ROAD TRACK 4 © STONE JETTY ---------------------- SWIMMING POOL PORCH/DECK �] 0 BUILDING/STRUCTURE DOCK/PIER .t} HYDRANT 248 \./ AP 24 6 VALVE ® MANHOLE / \ 54 . 9 0 POST 0" FLAG POLE T O W N O- F B A R N 5. T A B L E -O E O O R A P H 1 C. 1 N F O R M A T 1 O N ' S Y S T E M S U N I T Q SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is on enlargement of a ENOTE., arcel lines are only graphic representations DATA SOURCES: Planimetiics(man-made features)were interpreted from 1995 aerial photographs by The lamesd TOWER 1-100'scale map and may NOT meet daries.They are not true locations,and W.Sewall'am� Y.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD UTILITYPOLE" -10 . 20 40 National Map Accuracy Standards at this actual relationships to physical objects Corporation. P anlmetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards p LIGHT POLE O ELECTRIC BOX 1 INCH=M FEET* enlarged stole. at a scale of 1"=100'. Parcel lines were digitized from FY2002 Town of Barnstable Assessor's tax maps. r T �✓Ga� BOARD OF BUILDING REGULATIONS License:,,P91SISTRUCTION SUPERVISOR Nu[nbe�'CS 023665 • Bird Sia�e 3%2§11110 . � :,a lw 04 Tr.no: 1332 �w - � tom-.;C' 0 RONALD C FREOi 18-•8.TIMBER LN � � L•� � :' . . _ . MARSTONS MILLS, Md2648 Administrator �. n;••Y hi ._•� O 9- � t .• 1': ��r' P gIdPLMill R A' 1 99-9 e) 137 IL i 1 ^j� I I , t� :j Try `�'Mt''A^,�,r�+.+w....�mnmumvn.an� ��{d e n�meee,.m�v,oar.om��•n,.a+>e,��.�,.,•.,.,.,•,.,.�.. ismsr�nmx.rmmwasmmmnm+m��n....mn,�m'rv�... mm �l•k er>4 .�574.4n1¢5Pk7 P�fi� , 1 -- 7r� ;x c U I sT-nDill c T 3 oPrio"1 � /. I SECOND FLOOR BEAM VAATJ-Beam(TM)6.02Serial �m er: 0360 3 PCs of 1 3/4" x 16" 1.9E Microllam@ LVL User:t Engine Versio42 n: . THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page 1 Engine Version:1.2.1 CONTROLS FOR THE APPLICATION AND LOADS LISTED Fil, 2❑ 20' a' Product Diagram is Conceptual LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 12' Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 360.0 120.0 0 To 20' Replaces FLOOR LOAD 30/1012'0 SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplitt/Total 1 Stud wall 3.50" 3.50" 3600/1432/015032 A3: Rim Board 1 Ply 1 1/4"0.8E TJ-Strand Rim Board@ 2 Stud wall 3.50" 3.50" 3600/1432/0/5032 A3: Rim Board 1 Ply 1 1/4"0.8E TJ-Strand Rim Board@ -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):A3: Rim Board DESIGN CONTROLS- Maximum Design Control Control Location Shear(Ibs) 4948 -4214 15960 Passed(26%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 24328 24328 46671 Passed(52%) MID Span 1 under Floor loading Live Load Defl(in) 0.381 0.492 Passed(U619) MID Span 1 under Floor loading ; Total Load Defl(in) 0.533 0.983 Passed(U443) MID Span 1 under Floor loading -Deflection Criteria:STAN DARD(LL:U480,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: RONALD FREGEAU Andy Shakliks ROMANO GAR. Mid-Cape Home Centers 40 ELLIOT RD Route 134 CENTERVILLE MA PO Box1418 So Dennis, MA 02660 Phone:508-398-6071 ext4987 Fax :508-398-4559 brubel@midcape.net. Copyright © 2001 by Trus Joist, a Weyerhaeuser Business Microllam6^ is a registered trademark of Trus Joist. - _ _ `n Y , ` ,�2rrG�x Ply Roo. � Al- 1 , 1 t 2 K l o C.F-t I W C. jotsTs 144 or 2��"1-1ea0err ,. �a THOUF: ri¢tllNi., i t (� l i -3o th15u�4tivt�e Via" �eiwiS�trDk • llix"Cor, Pt sub 1- oil ��;�"Sh�-ro��, .,�,� _ �..`.. � r3/•�°°xt2" � t��s�,n ` ��,.s2.�cl�a ad�srs ien'r >�_�.�h��r��s r 12 S PT 1 _._..,._.._,�.,..� 77 1 ti 49' ,. ' ouev (r3CG la;6bC sroN� _ - r« r. f241 _ RA-6 Gr-Ak' Class Secs oN %eAenfdI 10. r Min, -- y /ucr� d F� �f/�6�7q Aryl ® 4fi�G` �Cf�SN�/FG f. Fiat hiq Zol 1 -'R`"�k� /r'0-/ 7 41 av$ �40 /y ! r f i r" i ..� 1 � (rr V/• �i��fv I.e"A� '/.yam 4*lG e / '�✓sy^fl�r .�I�. U; tt 7 , I } Tk ..: } .q- _ 140 // y 7"R j- -- SCALE/ /I� APPROVED BY: DRAWN gY G .. DATE:- '�` r ` REVISED bK,4WING,NUA4BER Lon/�i'►c.�C[,+$'• /� G GP!'+F°' l /r f'�l+b/' f ro /ne' Oeex oroawox i f I'Z4F�MN9 . .._- a3 ( _ ke , _ .... ,, 40 , tys D t .� '.� � ' .. _ � ,dam✓r �i5 �� S 91/i tc fro I ( r y lJj tt i ( 1 t; I i F � _,.._- , r ,1uC►'� �'' sY# : - _ f •� SCALE: APPROVED BY: - DKAV/N BY DATE: REVISED ORaWlNG:NUMBER _ I .. I I 4 , ; I , i } 07 I i f F i 60 ti I 5 t I ; 1 ' } q a I { / \: � ' •�:' II'. �, I f... I i I � I { �.� . � 1. - . 1 y S � ' i. LJ lj k , { 3 } 1 ° 1 , SCALE: APPROVED BY; DRAWN$Y G DATE: REVISED _ DRAWING.NUMBER ---_._..._...- -- WAI - y)" Dr x 1prj JQrr `°�:9� soc on 'lov�- ��ea o,� N� g'�tr� 7`0 /r,��c�'n,� flaninQ coin �v �'p ,f'� off .2nGI �lJr•- 14,31 { O•r /O X oe1 T 1 � f 3f cx 1 i ` i log14 Ions i x y AP 14', n� _ n' O!e �/IPO/ !D ; 3� �� {�,� j �- Ufa//J " /»a7`G{► 1' - - o 9f` Of �r�efivr�l F a o I Q/)4w ! 1'n o/t ff j o" to to o/i vy i SCAIE// , A PROVED BY DRAWN BY DATE: REVISED DRAWING NUMBER