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0067 LAKESIDE DRIVE EAST
� �. ��� � � .� i ,,, E w 4 a I I ll� �y i UPC 12143 No.13LGN HASTI1109.ON j ,IA Ave. Town of Barnstable {Post This Card.So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept a BAkNYiCAlIS.LT. S MASS. Posted Until Final Inspection Has'BeenMade. IFIk eaa�° rermit Where a`Certificate of Occupancy is Required,such Building shall Not be Occupied untiha Final Inspection has been made Permit No. B-19-944 Applicant Name: STEPHEN DUFF Approvals Date Issued: 04/29/2019 - Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/29/2019 Foundation: . Residential Map/Lot: 252-096 Zoning District: RD-1 Sheathing: Location: 67 LAKESIDE DRIVE EAST,CENTERVILLE - = Contractor Name: " STEPHEN DUFF Framing: Owner on Record: FIELDGATE, DAMON& NATALIE ELIZABETH =1 Contractor License:. 188860 2 Address: 10 MORRIS ST ' -R Est. Project Cost: $40,000.00 Chimney: LEXINGTON, MA 02420 Permit Fee: $254.00 Description: Remove Kitchen ceiling and bearing wall. Creating Cathedral Ceiling I- Insulation: (new kitchen). ( , "° Fee Paid 5 254.00 Date. ' 4/29/2019 final: Project Review Req: SMOKE DETECTOR UPGRADE REQUIRED:NEW HFEADER- NEEDED AT SUNROOM ENTRANCE. Plumbing/Gas Rough Plumbing: _ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after rissuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas:. work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are,provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: d r Service: - 1.Foundation or Footing �'` Rough: 2.Sheathing Inspection _ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate per are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department• All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: s Application Numb.. .�. V.Y. ................. i ]MMSTABLY, • MAMA, Permit Fee.......................................Other Fee........................ 1� Totsl Fee Paid................... ... ...... .. ... ...... ...... 1T0'YVN OF BARNSTABLE Permit Approval oy... .......................On...:l!.4,, 4g14, ::... BUILDING PERNUT Map:.. X .i ..............Parcel........... ................. APPLICATION no Section I — Owner's Information and Project Location Project Address 62 ,0,A:&f.2dx. rd CA,= Village Owners Name r� It 1,4 Owners Legal Address City XA u-ta y\, State NL cL Zip 0 5C 6 Owners Cell# g 6 g `3 / E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet MAR 26 Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm. Rebuild ❑ Deck Apartment ® Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar Pool [; Insulation Renovation . Other,Specify Section 4 - Work Description CY t_a.4-t f a V-L,C d441 .i Last undated: 11/15/2018 Application Number...................................................... Section 5—Detail Cost of Proposed Construction O Y6,K Square Footage of Project Age of Structure 3 S -`-i o 42a� Dig Safe Number l� # Of Bedrooms Existing Total#Of Bedrooms(proposed) Ao r lk g�,. 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist Design Section 6—Project Specifics GJ Wiring ❑ Oil Tank Storage Smoke Detectors [�Plumbing [ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal FA On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility:Q I am using a crane ❑ Yes No Section 7 Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ ? 0 Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No - Last updated:1 1115n018 J6 `I Gval S� K Sunc,ou i C, uo& " 3 Coo - '`� �a r I g , Application Number.................. Section 9- Construction Supervisor Name v �, �_�o Telephone Number 5 a _ 3 Address City State zip O S _ License Number C S- a p 6 7gg License Type S Expiration Date /g Contractors Email Cell# 5 0 i6- CQo - .2 1Rt1 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor is accordance with 7E0 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 C an the Town of Barnstable.Attach a copy of your license. Signature Date h gt, -e Section 10—Home Improvement Contractor Telephone Number 5 O Fr - '7 3�1--t►'i l'1 Address 5 jt� City &ULafghze State Ae,,Zip 0 r0 3a Registration Number Z -,F60 Expiration Date 6—y /cJ I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required and Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License.Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CUR and the Town of Barnstable. Signature Dater APPLICANT SIGNATURE Signature Date Print Name Telephone Number E-mail permit to: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): JZ-,0 ,&4t') Address: City/State/Zip: Phone Are you an employer?Check the appropriate bow Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(fiill and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.[rI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.i 9. ❑Building addition ncnranCe t required_] 5. ❑ We are a corporation and its M❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised theirt 11.❑Plumbing repairs or additions myself. [No workers right gh ofexem tton p per MGL 12.❑Roof repairs insurance required]t, c. 152,§1(4),and we have no . employees. [No workers 13 ❑Other comp.insurance required.] *Any applicant that checks box#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 isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: Policy_ #or Self-ins.Lic. g 2 Expiration Date: /��(o 1;26 d S�01 orr Job Site Address:. �� e � City/State/Zip: ©Z 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Sig_nafiae: ��� Date: "Cza 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.EIectrical Inspector 5.Plumbing Inspector. ; 6.Other r Contact Person: Phone#: E` - 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." ion or other legal entity,or two or more an individual,partnership,association,corporate g iny, any An employer is defined as dual,p �P� of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced*acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 15.2,§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-contractar(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LI.C)or Limited Liability Partnerships(LU)with no employees other than the members or partners,are not required to cagy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of industrial Acciu�tr`s. Shroud you h4�e.=uf aa-stio::s re6..rd�g the flan?or if you are rernrrPd 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 permittlicense number which will be used as a reference number.,In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been.,officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Department's address,telephone and fax numrber. The Commonwealth ofMassachisdts Depm tFnent of Industrial Aoddent , Office ofInvesfigatiew 600 Washington Strut Bostan,MA 021 I1 TeL#617-7274900 ext 406 or 1-977-MASSAFF, Fax#617-727-7749 Revised 4-24-07 Www-m=,govrdia RENNIEJ002 MW LF ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE( 0'—V yDD 201919 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 n.ADDITIONAL INSURED,the po!!C•;(Ies).must have ADDIT!ONAL INSURED proviisiOns or be ^dorsed. 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 License#1780662 NTACT HUB International New England 600 Lonqwwater Drive P"ac°N No,W:(781)792.3200 ,No;(781)792-3400 Norwell,MA 02061-9146 EywraiL INSURERS AFFORDING COVERAGE NAIC# INSURER A:Associated Industries Insurance Company,Inc. 23140 INSURED INSURER B: Joseph A.Rennie INSURER C: 4 Wayside Lane INSURER D: Sandwich,MA 02563 INSURER E INSURER F: 9-f% Conr_eey CERTrcrCnTc arraaeoen. REVISION NUMBER:WV-.—w " v nau rac r.Avvw�u�n. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP R. TYPE OF INSURANCE POLICY NUMBER IM z raaawmnnvwi LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE U OCCUR DAMAGE TO RENTED MED EXP(Any one rson $ PERSONAL R ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ipErT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION'$ $ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NSTATUTE CC5005018295 nlr2rt2019,01/2L+/2p20 1[Sns¢RL► ANY PROPRiETORJEXCLUDE/r�CECUTUE N N/A EL.F.AC;FIAc;C;IUtNI OFFICER/MEMBER EXCLUDED? I ' (Mandatory in NH) u EL.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town OF Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ?9. �1-9/7 ACORD 25(201"3) v 19 8-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home tmprovemenontractor Registration Type: Corporation -- -STEPHEN DUFF CONSTRUCTION,LLC z Registration: 188860Expiration: 09/11/2019 1586 HYANNIS RD M BARNSTABLE,MA 02630 - f d . _ a w f- � wa L.lA� gV0 Update Address and Return Card. SCA 1 O 20M•05t17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 188860 09/11/2019 1000 Washington Street-Suite 710 STEPHEN DUFF CONSTRUCTION,LLC Boston,MA 02118 STEPHEN DUFF4 € t JY 2 1586 HYANNIS RD\, "" Not valid without signature BARNSTABLE,MA 02630 9 Undersecretary i • _ itlP. 712J??f2J?flt'?Qfl ! (`lflil<1C1'4' lfftt?1�a1 Office of Consumer Affaits& Business Regulation _ HOME IMPROVEMENT CONTRACTOR ¢ TYPE: Individual Regis r6tion Expiration .159942 'y 06/10/2020 JOSEPH RENNIE- ' I .. JOSEPH RENNI 4 WAYSIDE LN. Y r SANDWICH, MA 02563 ry _ " undersecretary - cKti i-7' V _:a s r. ... "` COn'll't'1onwealth Of MassaC'husett5 Division of Professional Licensure Board of Building Regulations and Standards Constr, j�l§b- r µ , ! Visor _ CS-086 728 r Le �i res 6/201 JOSEPH A RE NNIE - 4 WAYSIDE LANE SANDWICH MA02 2563' 117 CommissionCL r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street, Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2iibly ' Name(Business/O-rganization/Individual): � .t.Y�kll� (-,o r\ stw Address: City/State/Zip: M4 30 Phone#: S o V- b�6 P -110 r1' Are you an employer?Check the appropriate bog: TYPa of project(required): . . ., 1.❑ I am a employer with 4. ] I am a general contractor and I 6. 0 New construction a employees(full and/or part-time).* have hired me sub-contractorsb 2.❑ I am a sole proprietor or partner- listed me attached sheet. 7. [ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. employees and have workers' 9. ❑Building addition [No rrkers'comp.insurance comp:insurance. required.] 5. We are a corporation and its 10.[1 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL uE]Roof repairs insurance required.]t: c. 152,§1(4)9 and we have no. employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I 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 hue outside contactors must submit a new affidavit indicating such. $Contactors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. If the sub-contactors have employees,they must provide their worker;'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: Policy#or Self-ins.•Lic.#: !.t/C C -5 0 U CV 1 rl 5T.l Q-0 l C Expiration Date: Job Site Address: fo 1 U-y-tS i r- d,r : C City/State/Zip:'re M--yy"kU w-C- - 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 under p an ena4ks of perjury that the information provided above is true and correct Signature: Date: - Phone#• 3(O - oZ =l .C) Official use only. Do not write in this area;to be completed by city or town official City or Town: Permit/Limnse# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk.•4.EIectrical Inspector 5.Plumbing.Inspector 6.Other Contact Person: - Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the ; dwelling house of another who.employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required:' Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. ; Me Commonwealth of Massa&usetts Department of In&mftial Accidents Office of Investigataow 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia °,4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AO NFERS NO RIGHTS UPON THE CERTIFICATEu NDCHOLDER. THIS ( I 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 have ADDITIONAL INSURED revisions or If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policie endorsed. this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). s may require an endorsement. A statement on } PRODUCER CONTACT Lar Cowan Cowan Insurance Agency,Inc. PHONE 359 Main-Street .978-372.1451 FAx ;978.521 4669 EMAIL far covraninsurance.com Haverhill MA 01830 IN URER S AFFORDING COV91RAGE NAIC INSURED NEUREIR A• As Employers Insurance Company R Stephen Duff a 1586 Hyannis Road JbLSMRER C, - INs JN59RER E - I( Barnstable MA 02630 t !COVERAGES INSU ER F• ... 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 B INSR Y PAID CLAIMS . TYPE OF INSURANCE ADDL SUER P C MBER POLICY EFF POLICY EXP COMMERCIAL GENERAL LIABILITY LIMITS CLAIMS-MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMIR rnrrr+nr $ MED EXP An one erson $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ POLICY JECOT LOC GENERAL AGGREGATE $ kOTHER* PRODUCTS-,COMP/OPAGG t I AUTOMOBILE LIABILITY $ I ANY AUTO COMBINED SINGLE LIMIT $ OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED ( ) AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ UMBRELLA LIAR - $ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS ADE - } NT AGGREGATE $ I _ WORKERS COMPENSATION - $ E I AND EMPLOYERS'LIABILITY Y I N X PER OTH- } ! ANY PROPRIETOR/PARTNER/EXECUTIVE� PR A OFFICERIMEMBER EXCLUDED? L_" J N/A WCC5009775012018 0211012019 02/1Q12Q20 E.L.EACH ACCIDENT 1100,000 I (Mandatory in NH) i II yes,cigitie under E.L.DISEASE-EA EMPLOYEE $100 000 E I IOPERATIONSbelow i E.L.DISEASE-POLICY LIMIT $500 000 f 4 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161,Additional Remarks Schedule,may be attached if more space Is required) fax:508.790-6330 i I Carpentry contractor. CERTIFICATE HOLDER CANCELLATION Barnstable Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF,: NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA AUTHORIZED REPRESENTATIVE <LM> s 01988-2016 ACORD CORPORATION. All rights reserved. iACORD 26(2016103) The ACORP name and logo are registered marks of ACORD MAP INSTALLED BUILDING'PRODUCTS OF SAGAMORE PO BOX 1309. SAGAMORE BEACH, MA. 02562 INSULATION CERTIFICATION-PER IECC 303.1.1 JOB SITE: 6-7 CX4j i MA. BATT INSULATION:. Exterior walls: Type:_ Manufacturer: oi4j wg _ R-Value: 21 I rat +s roa I+s/Sta n°tiee i l: CtAx K UA-.*. L-_A Ili Type: Manufacturer: R-Value: I Basement Ceiling: Type: Manufacturer: R-Value: Flat Ceiling: Type: Manufacturer: R-Value: Sloped Ceilings: Type: G�c3's� ��-�-- Manufacturer: �cM�e ��L R-Value: 1 BLOWN INSULATION:(FIBERGLASS OR CELLULOSE) Exterior walls: Type: Manufacturer: R-Value: Settled Thickness: Settled R-Value: Installed density: Coverage Area: Number of Bags: Flat Ceilings: # Type: Manufacturer: .i i'a R-Value: Settled Thickness: Settled R-Value: r; Installed density: _ Coverage Area: Number of Bags:"". Sloped Ceilings: Type: Manufacturer: R-Value: Settled Thickness: Settled R-Value: Installed density: Coverage Area: Numb r of Bags: _, Installed By: . Date: �7 For MAP Installed Building Products of Sagamore _ CIOto _.. t Xlr �- ° " ez o � - .......0 •+ �i Y Co tu wV17" .. w w . p-- w Z3-. -+ -- Q _ tZA - - - -- -� - _t ___. .�_ - - , - P� I d d L Q �e 00 a� SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser G S,O= 220 Occidental Ave. S.,Seattle,WA 98104 888-453-8358 x6131 May 3, 2019 Andy Hall Falmouth Lumber 670 Main Street East Falmouth,MA 02536 Subject: Tech Call#: 101326 67 Lakeside Drive East Centerville, MA Attached is a Trus Joist® structural member calculation for the referenced project. The attached calculation was prepared using accepted design values for Trus Joist® products and software analysis in conformance with accepted engineering practices. With respect to design values for Trus Joist® products as well as conditions of use,and design and installation guidance, please refer to International Code Council Evaluation Reports ICC-ES ESR-1153 and ESR-1387; ICC reports can be obtained via the Internet at www.icc-es.org. The attached calculation is provided as a supplement to the work of the project designer. The product application,input design loads, dimensions and support information have been provided by Stephen Duff to Andy Hall—Falmouth Lumber. 1 have not reviewed the project plans or field conditions. The proper authority is to review the calculation inputs and confirm they are consistent with the intent of the overall building design. If the attached calculation is not consistent with the building design, it should be rejected or returned to us to be corrected. The calculation applies only to Trus Joist®products for the referenced project. Uniformly loaded joist members verifiable through product literature span charts may not have been included in this package. Neither the undersigned engineer nor Weyerhaeuser NR Company is acting as the engineer of record for the referenced project. Weyerhaeuser warrants that the sizing of its product as set forth in the calculation will be in accordance with Weyerhaeuser product design criteria and published design values. Please call if you S. O� JASON yG Digitally signed by JasonShumaker Cordially, eV OWEN � DN:r—US,st=Ohio,l=Pickerington,o=Weyerhaeuser, OSHUMAKER `/.// ou=ProdudSupportEngineer,cn=JasonShumaker, r� CIVIL C emiil=Jason.Shumaker@Weyerhaeusercom Jason O. Shu , kto.53219 Date.2019.05.03 09.4638-04'00' Product Suppo Signed for attached Forte® Member Calculation dated: 5/3/2019 7:31:32 AM MEMBER REPORT-` -Lei, Opening to Sunroom PASSED Y 2 piece(s) 13/4"x 11 1/4" 2.0E Microllam® LVL Overall Length:13'11" y r. a 13'4" 0 All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal. Design Results Actual @ Location Allowed Result LDF Load:Combination(Pattern) System:Wall Member Reaction(lbs) 4307 @ 2" 8881(3.50") Passed(48%) — 1.0 D+1.0 L(All Spans) Member Type:Header Shear(Ibs) 3546 @ 1'2 3/4" 7481 Passed(47%) 1.00 1.0 D+ 1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) 14276 @ 6 11 1/2" 16137 Passed(88%) 1.00 1.0 D+ 1.0 L(All Spans) Building Code:IBC 2015 Live Load Defl.(in) 0.401 @ 6'11 1/2" 0.453 Passed(L/407) — 1.0 D+1.0 L(All Spans) Design Methodology:ASD Total Load Deft.(in) 0.613 @ 6'11 1/2" 0.679 Passed(L/266) — 1.0 D+ 1.0 L(All Spans) Deflection criteria:LL(L/360)and TL(L/240). Top Edge Bracing(Lu):Top compression edge must be braced at 6 9"o/c unless detailed otherwise. • Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 13 11"o/c unless detailed otherwise. Bearing Length Loads to Supports(Ibs) Supports Total Available Required Dead Floor Total Accessories Live 1-Trimmer-SPF 3-W' 3.50" 1.70" 1489 2818 4307 None 2-Trimmer-SPF 3.50" 3.50" 1.7T 1489 2818 4307 None Tributary Dead Floor Live Loads Location(Side) Width (0.90) (1.00) Comments 0-Self Weight(PLF) 0 to 13'11" N/A 11.5 1-Uniform(PSF) 0 to 13'11" 13'6" 15.0 30.0 Roof Weyerhaeuser Notes SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. \\ Weyerhaeuser expressly disclaims any other warranties related to the software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards.For current code evaluation reports,Weyerhaeuser product literature and installation details refer to www.weyerhaeuser.com/woodproducts/document-library. The product application,input design loads,dimensions and support information have been provided by Stephen Duff Forte Software operator Job Notes 5/3/2019 7:31:32 AM Andy Hall Stephen Duff Forte v5.4,Design Engine:V7.1.1.3 Falmouth Lumber 67 Lakeside Drive East DUffAte (508)548-6868 Centerville,MA andyh@falmouthtumber.com Page 1 of 1 Town of Barnstable Building oA Post This Card So That it is Visible From the Street-Approved Plans Must be,Retained on Job and this Card Must be Kept > Posted Until Finale-Inspection Has Been Made. rnivermit _ a .' _ .�� ..._.m __._.... _ .__. ....� M �.n.._ .._ . Where a Certificate of Occupancy is Requited,such Building shall Not be Occupied until a Final Insp has been made ection Permit NO. B-19-1845 Applicant Name: STEPHEN DUFF Approvals Date Issued: 07/15/2019 Current Use: Structure3Z Permit Type: Building- Deck Expiration Date: 01/15/2020 Foundation. �( Location: 67 LAKESIDE DRIVE EAST;CENTERVILLE Map/Lot 252-096 Zoning District: RD-1 Sheathing: Owner on Record: FIELDGATE DAMON& NATALIE ELIZABETH Contractor-Name"^F:STEPHEN DUFF Framingfl s Address: 10 MORRIS ST Contractor License: 188860 2 LEXINGTON, MA 02420 - 4n r- Est. Project Cost: $ 14,000.00 Chimney:. Description: Deck w/steps to ground 12x30 Permit Fee: $ 110.00 Insulation: Fee Paid: 5110.00 Project Review Req: 'AS BUILT'SURVEY REQUIRED DEMONSTRATING Finale ' — COMPLIANCE WITH SETBACKS. _,�.�'' Date. , 7/15/2019 Chi 1 Plumbing/Gas Rough Plumbing: N z Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized, this permit is commenced witliin.six months a M � fter issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for y'public inspection for the entire duration of the Final Gas:. work until the completion of the same. i � r -� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the,Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is'installed` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: - 5 ® € Application Number............................................................. anfuvsrasi.E, ; �(� p . MASS �rtd;t✓b a,ti,,a �� Permit Fee.......................................Other Fee........................ 059. Total Fee Paid..:. .......... .. ................................. ...... TOWN OF BARNSTABLE Permit Approval by. ...............on.../.,1��t?........ BUILDING PER UT �O Map.......a ................. ..Parcel............................................. APPLICATION Section 1 — Owner's Information and Project Location r Project Address 01 C a-L,(,S oLp— r r tAS I- Village. Owners Name / 9,Ln o n t /'I,A f a.Li•Z I e %L/d-4 a-vt-- Owners Legal Address /D 41,6 rtj S� E City Z-t xln a-fah State In eL Zip 6 a q.2 a Owners Cell# E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet 11 Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use � ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm f+ Rebuild ® Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description CIP w s x Application Number...................................... ........... Section 5—Detail Cost of Proposed Construction fe-, Square Footage of Project 3 420 Age of Structure iJ L4. Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑:MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring v " ❑ Oil Tank Storage. ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑'Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway i Debris Disposal Facility: I am using a crane ❑ Yes:WNo Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed '3 Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No I T act—Aat—l- 11/1 gnn18 " Application Number........................................... Section 9- Construction Supervisor Name�1, o t h CL�.v.n i 9- Telephone Number :570 S' zJ a J Address L( W a.Aa 5 i oU (.n City San d,w i uk- State JM .0•1 Zip O a 5(0 3 License Number 2!(¢7,2 License Type r Expiration Date /_T t. ao/ Contractors Email - Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ed by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10-Home Improvement Contractor `! Name ���-,�f1,�iyL L)u Telephone Number 5djs- 1 2,)`Z - l -1 l *� Address t6X ojo. U State Zip O& , A is Registration Number /8 8!o d Expiration Date /c2,o I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation requir D CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date, Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date Print Name 13-� t,D yam " -)u rr- Telephone Number 50a- c3(O o2 -c2 9 o q E-mail permit to: R QU 4 CO CD O"h ace , Cb X\A Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ �' t For commercial work;please take your plans directly to the fire department for approval Section 13— Owner's Authorization i I, , as Owner of the subject property hereby authorize . to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name 1 j1 1 �{y 71 1 3 J 9 1 ' ., a •( +. Y.. to t , e 4 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invest1gations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: a City/State/Zip: /-,PZ Phone#: -�50.9 -3,(go 22.3 6 Are you an employer?Check the appropriate bog: Type of project(required): 1.ElI am a employer with- 4. 0 I am a general contractor and I 6. 0 New construction jemployees(full and/or part-time).* have hired the sub-contractors 2.,011 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. El Building addition [No workers'comp.insurance comp.insurance.# required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their 11. Plumb'mg ❑ mg repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance requireA]t c. 152,§1(4),and we have no employees.[No workers' ME]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 hue outside contractors must submit a new affidavit indicating such. . tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. _- I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#i Expiration Date: Job Site Address:_7 �0- '.�i e � City/State/Zip: c;Z 6 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 under tthe pains and penalties of perjury that the information provided above is true and correct Sit=.nature: li/-�� Date: -72,Z/j� f Phone#: Ojj"icial 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 iri the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the penniVlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person.is NOT required to complete this affidavit. The Office of Investigations would lie 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: Me Commcmwealth of Massachusetts Department of Industrial Aoddents Office of lavesttitgatlow 600 Washington Street _ Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 MASSAM Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston, Mqs chusetts 021,18 Home Improvement ��Gbntractor Registration Type: Corporation STEPHEN DUFF CONSTRUCTION,LLC , Registration: 188860 - 1586 HYANNIS RD - ' Expiration: 09/11/2019 BARNSTABLE,MA 02630 Update Address and Return Card. SCA 1 0 20M-05/17 ........................ r7- ..------....-....._..-. ...-....---------_;..._....,.... . .. ._.-.. ._ . .- .. , . ✓�ie C7I��7Irr,4/2 �0�✓/�l�Cli7Jt�C/LctJP.�1- . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Renistf W' \-- Expiration Office of Consumer Affairs and Business Regulation il. . --Q 09/11/2019 1000 Washington Street-Suite 710 STEPHEN DUFF l UGTIQN,LLC Boston,MA 02118 �z� STEPHEN DUFF��,�, 1586 HYANNIS RDA 5` j valid without signature BARNSTABLE,MA 102 30'' Undersecretary ro 9-1 FIF .501 f is s s �Nid A :✓x i 1 x�, 1 - x n ..�^,..a+, .: �.`i -cam,' -ri t y; � r`,c�s45 +.�.•�ax4',k"'R'�r"Aisa - 4 Y�yg;��: Hr� Office of Consumer Affair & Business Regulation HOME IMPROVEMENT CONTRACTOR Y� o TYPE: Individual R Re is ralioor Expiration ram" 159942 06/10/2020 JOSEPH RENNIE JOSEPH RENNIE, , 4 WAYSIDE LN. - SANDWICH, MA 02563ice- UndersecretaN �Q_,M COMMOnwealth Of MassachusettsVy Division of Professional Licensure Board of Building Regulations and Standards CS-086728 -spires: 12/16/2019 JOSEPH A RENNI E 4 WAYSIDE LAME SANDWICH MA 2 3 M - ;w p -., e ? e +e. r✓,. fi. y Lx 0. .cs �e s a -, '� f` � �sz.7 � It �.+*d'" � '� a�- Y �'•"e arAOt` ' t ifi yy J -•� t P- .9 _ -t� s .rY -21 K S A _ 1.. �` d� {Sh �y� ✓&� � �s.ems.-..¢t' - - _ �.:'� OU on 1 � F j s K`t °k 4 >-•_ r <• ;^^`...ry.�� a,ie ,�3•�-�+'�iy�{� t °"� '�� g, °:c e - � - 4 y4.. €� >, y i ip IA fig...r�y_��; ;4 _t,�4f -•�ti; ,�'•��t6.LQ1� . +f.`.c. r.>��.5 r ,�F`• -.Y^� �,'� ,z� � �. __ ,ary,.T.r•: i ��,'�'t•{* '� � rb, c�-.k."L:f `rr,.y ,.-. - �r�L-+n ::s k � S �- .�� 1, L - b � =; - �a+� c.• a H fs�.� pvy_t v �� �� � �.x'+�"�`� .v a,( ; F "�'" - i..�y'� '�� yff `.0 1 � r '�2 a ?a �Y s•� arc _`e S`' f t Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvemenontractor Registration Type: Corporation ` STEPHEN DUFF CONSTRUCTION,LLC X. Registration: 188860 _ - r Expiration: 09/11/2019 1586 HYANNIS RD BARNSTABLE, MA 02630 7 a w C Update Address and-Return Card. SCA 1 Ca 20M•05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use onIX TYPE:Corporation before the expiration date. If found returd to: Repistr�ation Expiration Office of Consumer Affairs and Business Regulation 188860 09/11/2019 1000 Washington Street-Suite 710 STEPHEN DUFF CONSTRUCTION,LLC Boston,MA 02118 1�1 � • STEPHEN DUFF� 1586 HYANNIS RD, -'.- / U BARNSTABLE,MA 02630 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation-Insurance Affidavit: Balders/Contractors/Electricians/Plumbers Ayplicant Information Please Print Legibly Name(Business/OrganizEdon/Individual): Skt.p V`z� S-C-C(-Hoyx (.•L. L Address: A c)$Cp 4tAA &-vx&A S 6-dL " City/State/Zip: y 6 Phone#: `j 0'� �(o c r1 . Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. I am a general contractor and I h. NLNew construction employees(full and/or part-time).* have hired the sub-contractors 2.;E I am a sole proprietor or partner- listed on the attached sheet. 7: ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.instuanceJ 9. ❑Building addition ram] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12. Roof repairs incrn-ance required.]t c. 152,§1(4),and we have no � employees. o workers' 13.❑Other DCG. C X. comp.insurance required.] , *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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: C 0 W O.:y\ - 1 h SU f 0,-YX C.Q.- CNA-W -CAA 1 n C . Policy#or Self-ins.Lic.#: ,/� C. f G O 4 '7 17 S 012 b Expiration Date: Oct/to/I o;LC) _ Job Site Address: can L s i CJLt- rL r City/StatelZip: ��v�'t"�cM/� 4� N`� 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi n and penalties of perjury that the information provided above is true and correct Si Date: I ON Phone#• 3 tp a-011 Official use only. Do not write in this area,to be completed by city or town oficia[ City or Town: Permit/License# ' Issuing Authority(circle one)r 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical 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 iri the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into arty contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lime. 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would bike to drank 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 Mwsa&usetts Depm meat of Industrial Aeaidents. Owe of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 w €w:mass.govfdia , �w pa .K >m >m } Ari IS: ram. . o 24 $ ro iv i eOn I'fif li I�8t e E it 'v a Ya�H�� $�3y�•E4 �ggi�pm�i! E88 YCReS6�9 Miami! w � . U o F � Q • � .0 O •ncr_ EUILDE¢i0'TRIFY AND COGR i-Ic-��vLiH THE HOIE- F O U N D A T 1 O N / FIR 5 T FLOOR F R.A M I N E PLAN Gvm=R FRIG¢TG Ga'E . T.ACE VOTc OF 4,�Y UNIT$THAT MISHT REWIRE TEIPER6$I_AS GR GTHE2 SF-CIALTY FEANaES. > .AL 1,Mr To F iGIGNS E+f3GVAwEDJE i0 THE ALT TYAT r:1515 AN EASTIN$5iRKtU2E iHAi IS TO.. HDDIF!ED AND ADDED - NIFIGANi DIFEErTcI,LEE Io.,T A I • = loz o.vim aRlr��ISTRucTION. A�• CERTIFICATE OF LIABILITY INSURANCE Fe.20i19M""'°°""""' 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 have ADDITIONAL INSURED provisions or 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 endorseme s). PRODUCER CONTACT Larry Cowan Cowan Insurance Agency,Inc. PHONE .978-372-1451 F"" .978-521-4669 359 Main Street ADDRE . larry@cowaninsurance.com INSURER S AFFORDING COVERAGE NAI Haverhill MA 01830 INsuR R : Associated Employers Insurance Company INSURED INSURER B Stephen Duff INSURER C: 1586 Hyannis Road INSURER D: SURER E: Barnstable MA 02630 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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. ILTR NSR TYPE OF INSURANCE DL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADEOCCUR DAMAGE TO RENTED MED DIP(Any oneperson) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY❑ COT- LOC PRODUCTS-COMPIOP AGG O $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident)dent $ AUTOS ONLY AUTOS ( HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE WORKERS COMPENSATION )( I PfARTUT' OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE /N E.L.EACH ACCIDENT 100 000 A OFFICERIMEMBERECCLUDED? rN N/A WCC5009775012018 02/10/2019 02/10/2020 (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $100,000 If yes,describe under EL.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Biuilding Dept. Carpentry contractor. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE <SC> Fax 508 790-6230 MTPW tw'L� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit# Expires 6 months front issue date Regulatory Services Fee . Thomas F.Geiler,Director Building Division p Tom Perry,CBO, Building Commissioner 20 200 Main Street,Hyannis,MA.02601� �> www.town.barnstable.ma.us C)p Office: 5 - an Fax: 508-790-6230 SS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number4�7 Property Address- � � �����/cam. ll�� Zfio'. tol e- Residential Value of Work l , L%6 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 11210 .77— ee cgq -�--/- Contractor's Name C10 40 C�C.t 1/1-(9/i/ Telephone Number'-5-Di j�1 2 Q V��/�7 Home Improvement Contractor License#(if applicable) 7 7 7 Construction Supervisor's License#(if applicable) 0 C Y Zy! ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor kvam the Homeowner have Worker's Compensation Insurance Insurance Company Name S `f fit:U 1 l� y�( x el . C 7/r 0 ��� B�s' /G� /off Workman's Comp.Policy# / x 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 roof) Re-side a,#j/ �e���� N�✓�1_//,�tUt;1GRfe /zoI" o& Gt f ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department reguladons,.i.e.Historic,Conservation,etc. ***Note: Prop, Qwner must_ ign Property Owner Letter of Permission. c me Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 [TOWN1 _ a File Edit T0013 Help t� Action Year/Type/Bill No. Customer Account Information-- - --� History 2006 �R-E--R- 1 5198 173083 j ary �Y Detail CHALLEN,ROGER W&KAREN K Property Information El CASH 4MECKa 29 OAK HILL RD FAYVILLE,MA 01745 Orig Bill Parcel ID 2522`0�9 EffectiveDate Alt Parc _ Prop Loc 67 LA E Lien/Sale [ Special Conditions/Notes [; Quick Scan Specific Bill Int Dt Billed. Abt/Adj Pmt/Crd Interest Unpaid bal 08102J05 j 1 ,282.50 �.00 L1.282�60 00 .00 i U I yiiU Acct 11/02/05 1,282.50� 00 1,282.50 00 00` Customer 05l02l06 �1,838:37 �.00� 1,838.37� D L r--- 05IO2I06 1,83835 00 1,818.60 2.08121.83 Parcel - - -- Fees/Pen: 00 ffi 5,00 .00 00 5 00 ( Name Totals: M� 6,241.72 5.00 6,221.97 2.08 26.83 =� jN Billing Dates t6. �.Notes/Alerts Due 02/13/2007 referencesPer Diem JAN.1 Owner: CHALLEN,ROGER W&K --� -= Int Paid Display transaction history for the current bill. !. r I /re-t?a,�rnnax�ve�ll/, c��il�lavJac/ru�elta J Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR Registration: 105737 Expiration: 7/20/2008 Type: -individual JOHN C.BOWDEN John Bowden a 28 Lady Slipper Lane Marstons Mills,MA 02648 Deputy Administrator -- _ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:-CS--- 014224 --_ Birthdate: 04/08/1954 Expires: 04/08/2008 Tr.no: 22434 Restricted: 00 JOHN C BOWDEN BOX 26128TONS MILLS, MA 26 LN MARSTONS MILLS, MA 02648 Commissioner s The Com»ion'vealth of1ylassachusetts - • Department 0f1n6str1at dccidents -Office aflrivestigatz'ons • 600 Washington . Street Boston,AM 02111' VW-?nassgov/dia Workers' Compensation lusur,mce A.ff darit; Puflderg/Contractors/EleCtlicialL Alicant Info s/pl ers' mation . Le 1 Name(Business/orgamzatimVindividuat):, .J0 hff C / 0 t�l D-e Please Print Address: ! 0 2 City/State/Zip: 4AJ7-014 (k,('1(1 / ,¢ Phone,#: 'r66 Yz,�_Y'�!4 e on an erd yer? Check the appropriate box, I"aan a emplgyer with y" I 4, ❑ I am a general contractor and ;Type of project(requu ed): 1pyees{full and/orpart time).*. have hiredthe stab-contractors S ❑Newoonsttlaction . a sold.proprietor or partner- . listed on the'attached sheet: �. []Ramodelin slaip,andhEmp no employees These sub-contractors have g 'iiorlang for and in any capacity,, erngloyeba and have workers' 8. ❑Demolition. [No wo*vs, comp,inset' a comp, insurance, '- 9. ❑Building addition requited] 5: ❑ We ,corporation and its 10,❑'•Electrical r .,3:{�I am a homecwwner-doing-a'11-work - officers-have exercised their eP�s of additions myself.[No workers'comb, right 6fexemptionper MGL 11:❑Phmzb?ngzepairs or additions insurance.required,]t c. 152, §1(4), and we haven'. 12•❑Roofrep*s•. , employees, [No workers' 13.1j?0ther J,(!/l gomp,insurance required.] 4'4l!J t7 Q/� . c*Any applicant that checks box#1 must also fill oyt the section below showing their workers,aampensation poHax infomiaflo0 t Iiomeowners,who submit this affidavit indicating they are doing ail woik and then hire outside contractors must submit a new tiffidayitindicatin rCantraators that abeck this box must attached as additional sheet showing the name of the pub-contcaotors and state whether arnotthose enp(oyees, If ibe sub-contracts have ' to ees th must pravidb th , g va �P Y e3' eR workers comp.palidy number, entities havo I am an emp foyer.that is providing workers'compensation insurance for my employees. Below is rh.e polic Jobcte y and' information, n n s I=ance ConTma y Name: -4 U•e—/e�2 f Polity#or Self-ins,Lit,A. 5�! C'-7 / r-d�p Expiration Date: -P 02• 2-0 7 Job Site Address: 7 L I !L2, f�`o2�. Q4 Ile City/State/Zip; Attach a copy of the workers' cginpensation policy declaration page'(showing the policy number and e FailureJo•secure coverage as requiredlmder Section 25A,of'M-GL C. 152 can lead the imposition of crirnin�?ratioa date), fine tip tb$1,500.00 and/or one-year imprisonment;as well as civil penalties in the fowl of a STOP Fi 4RK,Q�naltles of a of'up to$250.00 a day against the violator, Be advised that a•c of this statement may b e forwarded to ER and a fine Investi ations of the )U far insure ce covera a verification, �PY Y tbe•Office of 1-do hereby c ji and r the pains•and penalties v ' (perjury that the information provided above is true and correct. Si tore: "' C _ Date: d Phone O&M use only. Da not write in this area,fa be completed by c{ty or town official City or Town: ' •PeTn?it/License# . ' Issuing Autkflrity(circle one);' 1.Board of Health 2,Building Department 3., Citp/Town Clerk ,Electrical 5, Pltamhin 6,Other g inspector Contact Person: Phone#: 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 hie, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or mole of the foregoing engaged in a joint enterprise,and hn lnding the Iegalrepresentatives of a•deceased employg, or the receiver or tmsteb•of an in.divi.dual,partnership,association or other legal entity,employing employees, Howeverthe 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 maiEtenance,construction or repair work m such dwelling house or on-Le.grounds or building appurtenant thereto shallnotbecause of such employment be'deernedto be an employer" I GL 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 bnsmess or to construct buildings in the commonwealth for any applicant who has not produced•acceptable evidence of compliance with the insurance coverage required,". Additionany,MGL ohaptoL152,§25C(7)states"Nether the commonwealth nor any of its political subdivisions shall enter into any contract for,thb perforce of Publiawork until aoveptablp mil of coinp:6ace lie in aT�e' re uirerrents of this chapter have been presenteSto the contracting authority, Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitaati°nand,it their certificates of ece ' - 'actors names address es and hone numbers along with ( ) n ssary,supply sub contr O O, O p O g than the 'thno'e to ees other ' C antes' LC or Limited Liability?artnershi s LLP with mp y insurance, Limited•Liability, omp , (L ) ty p ( ) members�or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Bp advised that this affidavit may be submitted to the'Dep'arbnent of Industrial. ' Accidents for confirmation of insurance coverage. Alsb be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Aocidents. Should you have any questions regarding the law-or if you are required to obtain a workers i comp en.satiou'policy,please oall the Department at the n=ber listed.below. Self-insured companies should enter their . self-insurance license number onthe appropriate'line City or Town Officials Please be sure that the affidavit is'complete'and printed legibly. The Department has provided a spacq at the bottom of the•affidavit for yov.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 refereiice number: In addition,an applicant that must submit multiple permMicense applications in any given year,need only submit ono affidavit indicating current policy information:(if necessary)and under"lob Site Address"Yha applicant should write"all-locations in��(city°r town):'A copy of the affidavit that.has been officially stamped or maricedby the city or townmaybe provided to the applicant as proof-that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not relatedfo any business or commercial venture (i.e. a dog license or permit to bum loaves•eto.)said persbzris-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 givens a call The Department's address,telephone and fax number:; cql=(�Iuwil th Of Mwadwws � x l.� I A �ditnts' . . B ==MA 02111 Revised 11-22-06. P #617 7-7749 f Town'of Barnstable Regulatory Services 9 eai e,$ Thomas F. Geller,Director e 639.. 0 wilding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ffice: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, G P y e 1l-e t , as Owner of the subject property ? l p p� hereby autlhome J o bov C' 6 o wpe to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signa e f ner Date TocteV W C-14411eK Print Name. Q:F0RMS:0V NERPERMISSION oFtMME t� Town of Barnstable *Permit# S4!U_ Expires 6 months from issue date ,,,R, L& : Regulatory Services Fee � Q Y v MAM •� Thomas F.Geller,Director 1639. Building Division Elbert C Ulshoeffer,Jr. Building Commissioner �+ 367 Main Street, Hyannis,MA 02601w X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 J U N 2 9 2001 EXPRESS PERMIT APPLICATION TOWN OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number Property Address 6 7-' I-At-,"�7`1,01-5 Residential OR ❑ Commercial Value of Work �d(7 Owner's Name&Address Contractor's Name � //�'� �,O,k_ Telephone Number���eI� � Home Improvement Contractor License#(if applicable) ��0 �,o'7- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name 31y,5z xZ, Workman's Comp.Policy# 61c Z/ 2 e5W F, Permit Request(check box) Vie-roof(stripping old shingles) ❑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 expmtrg HOME IMPROVEMENT CONTRACTOR Registration: � 100491 Expiration: 06/18/2002 Type: Individual DAVID R. COIF David Cox EO/LAVENOER LN ADMINISTRATOR Y. YARMOUTH NA 02673 e ✓ate L�om�mza.uuea`!� o�./���aaoac`euae�l4 BOARD OF BUILDING REGULATIONS License:,CONSTRUCTION SUPERVISOR Number-CSj 063537 Birthdate: 10/15/1953 a Expires: 10/15/2001 Tr.no: 7365 Restricted To: 00 DAVID R COX PO BOX 401 S YARMOUTH, MA 02664 Administrator Assessor's map and lot'number ....... ........ ......... ... r� Sewage Permit number lj yo�T"Er,�° TOWN OF BARNSTABLE i i DAMS &BLE, i 16 " IN BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... -'"'..,.G`..: .......................` ...........`........................................................ TYPEOF CONSTRUCTION ....................... ...................................................................... .................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the/following information: Location .................. F...d r;l ................................................... Proposed Use '•s'",�. �'-c'f_ �i-s'�?"r?+:; ................................... ................................................................................................................. f ZoningDistrict ..........X-D..............................................................Fire District ...... .....7..................::......................................... 4.0 Name of Owner �i✓.r�..•.. -' :.........'�r........................Address f 7 44... 44A4Ae +� . Name of Builder .... •r •'-���� f°^W.A_..........................Address ....:��7 „ � s.nef e y ... .. Nameof Architect ..................................................................Address ...................................................................,..`.................. Number of Rooms ................Foundation ....... �, *- Exterior .....�..f. 'J` .' .dr ....................................Roofing C ' s. '- '............................... tf Floors ...: ..............................................................Interior ........ O� s Heating .::..............................................................Plumbing ..... *......................................................... Fireplace -1:t 4 t. -' .........................................Approximate Cost ...A?a4�1 ................. ................. ................................................ Definitive Plan Approved by Planning Board ________________________________19________ . Area f :a'........::...�..�.p..... Diagram of Lot and Building with Dimensions / PV Fee ..................�.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......�,r,..;...�........ ................ ;� Ruete, Edward may„ No ...17506... Permit for ....enc,lose sundeck ............... ............................................................................... Location ...............67...L.a.�CgS00..D1 iv9............ .............................. etitervi l.l.e......................... Owner ................Edwaxd.Alle tlr....................... Type of Construction ..........fxam,e..................... ................................................................................ Plot ............................ Lot ................................ Permit Granted Dec. ... ember 27. ......19 74 ...... ... .... . .. Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED 19 .........................:..................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot numbero? a 7X ...... SPT1G GYSTM AM BE INSTALLED IN COMPLIAH �f Sewage Permit number ... . . . . ........ , ear e WITH -ICY CLE 11 STATE SITt ,n � NMI, . �tNEro� T®W1v Of BAR. ALE o BJHBSTAXE, i "6 BUILDING INSPECTOR e ti APPLICATION FOR PERMIT TO .................................... .... .......... .......... .......... .................... :............... TYPEOF CONSTRUCTION. ........................ ................................................................................. .... .........19.7f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location H+ �. `� �P .................................... ...� ...................... ....0.7...... ...... ..... 01.4# ...... ProposedUse !P ...r� ................................................................................................................. ' Zoning District .......................�...............................................Fire District ..... Al Name of Owner ....!, .......................Address .... lT..... ... ...� �f�s Name of Builder ....Al4if.... . ..7 ....-t..........................Address ...., . ....� `''".. .. .. �1 ............... Nameof Architect ..................................................................Address ..................................................................... Numberof Rooms ..................................................................Foundation ......� . 'N �... ............... Exierior ..... .....................................Roofing ..... .............................. Floors ..............................................................Interior .... ................................................ Heating ...........................................:.................Plumbing .....1440016<W........................................................ Fireplace ..... #49'7%4...0.......................................................Approximate Cost ...:es.5-on.0................................................ Definitive Plan Approved by Planning Board ---------------------------- ----19--------. Area ............� 6r(/ Diagram of Lot and Building with Dimensions Fee ................../...... ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... J ....... Ruete, Edward No 17506 Permit for .....enclose sundeck Location .......67..Lakeside. . . ..Drive. . . ..... a .... .. ........ . .... .. . . .... : Centerville ............................................................................... Owner Edward HIS Ruete frame Type of Construction .......................................... ........................ ................................................. ' » Plot ............................ Lot ................................ is December 27 74 Permit Granted .......................................19 i <-70 Date of Inspection st .... . ..7� 1 Date Completed ;l. t ... ..........:t: 9 S PERMIT REFUSED - ..................... ....................................... 19 .............................................................................. f ............................................................................... i t r ................................................... .............. Approved ................................................ 19 ............................................................................... . ............................................................................... Assessor's map and lot number ���` 3` 70 . Bpi?H E L Sewage Permit number — SEPTIC SYSTEM MUST BE ..�,s'�Q� .. !.� cf% /qrd- + INSTALLED IN COMPLIANC 339HB9TeI1LE, i MA86 House number ... .....���P....................... ............................... WITH ARTICLE II STATE 'oo i639 �y SANITARY CODE AND TOWN awar�'e TOWN OF BARN'9 'AA`P�S�LE —�" SUBJECT TO APPROVAL OF BUILDING I$SPECTOR 6ARNSTCO MISSNOERVATi' � APPLICATION FOR PERMIT TO .............................. `Jttn .... . ................................................... .... �� TYPEOF CONSTRUCTION ..................... Q"::s-:..................................................:............................................ ...... . 1+ .....j.L.4.............192% TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location A- ... ......... k.3 Proposed Use lr�.a.n. ...f ..5 .�. z ,--�... .�i �, �.. Sn2.cx .5. .. x. ...................................:.................. r Zoning District .... .D..:..�.....................................................Fire District ..4,.At X �z...�.Q.�....... Name of Owner �� �G� :...5....... ......................Address ...............................................................IZ ^ l , Name of Builder .1w ....... 4�n.;....................Address .... ..�� i.:a....e...5. .......' � �� + 4!x5• .....r..................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........ ..' ..............................................Foundation ...... .................................................................... Exterior Roofing ....X. ......................................................... C Floors � Interior ...ta3(JA...� . a S Heating (�c_�.•..........................................Plumbin�. g ............. Fireplace h ..................................:.................................Approximate Cost ...�.�. �3�t...:............................................. �....... Definitive Plan Approved by Planning Board -----------_______-----------19:______. Area /q•<. .. ....................... Diagram of Lot and Building with Dimensions .�U Fee ... ......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . .... .. ..... .................. Ruete, Edward S. V No for .13-emodel................... ............................................................................... Location a7,..Lak,--sidP-.Dri.v.e..- Centerville ............................................................................... Edward S. Ruete Owner. .................................................................. Type,of Construction ....Woo.d..Frame................ .......................................................... ................... Plot ............................ Lot ................................ Permit Granted ..........Ma.r.c.h....1.4.............1979 Date of Inspection ........ ...... 19 Date Completed Y" ............19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... S1 ............................................ .................................... Approved ........................ ..................... 19 ................................................................................ ............... ............................................................ Assessor's `map and lot riumber 5�' . � .....je. /i"1I` 3' 7 / ' �OF THE T� Sewage Permit number ! ��... .r� ..:.. ^! +dt—�� rd w``Q ♦°w a.. Z BABHSTADLE, i House number !.... ........................................ so Mba y Oe� 39• �0 �F0MO�' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...t���?rv,n a� �.....� C (,v � .� ...°'�`'^: LT@,-rt ���m �. CGn ra c E tr4 ..... .. ....... ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, tip...... .J TYPEOF CONSTRUCTION ...................... ............................................................................................................. .............. 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .4'�....:� �th.... ........ ....... ...L... .4.a C •..4?i!.. .+?:......!,.'Y�.... . .��. . .............................................................. Proposed Use .P4.f.?.:.f8. a. .. (;s n r,r�..^ ... t,i,,. r_ :{. r.{n,)•C,.aG.�., ..................................................... Zoning District � .:...1..... .Fire District ..........� Name of Owner �t�.a UGnA r� VC.t,a„p l �. Address .���... C��_�;. �cQA,'c:..i� ��.......`, t •. ..1:.?. ?....s� �................... ................. � � , S �' � ..........................: : AName of Builder Nameof Architect .........................6........................................Address .................................................................................... Number of Rooms ....... ..............................................Foundation ...... ''........... Exterior (a,K .c_. ............................................................Roofing .................................................................................... Floors .... e., C Interior ................................6..................... . ..:,......................... Heating '........ ......... ......::�.:�.........................................Plumbing ...... ........................................................................ Fireplace ..................................Approximate Cost ...1.> ,q!tx:.................................................. ....... .��.................................. Definitive Plan Approved by Planning Board --------------------------------19--------. Area �`.o xI6................. ........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH J , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name.... ... ...........I ...................................... Ru6te, Edward S. 252-96 Location .67..Ladkeajda''Dx.j.ve--------'' Centerville . --------------------------' Edward S. Boata ' � Owner -------'�---'----------.. � Type of Construction —..�ood...F-rum----'' --------------------------' Plot ............................ Lot ----------' ` � ' Permit Granted ....March'3.4r-----l979 Date of Inspection ------------lV Date Completed ...................................... � ' PERMIT REFUSED , ` _____,__,---_---------. lA ............. ........................ r ^ . ...................................... --------------~---~--'—~--''' --------~.-----...--.-~.~.--.— . � � Approved ................................................ lg --------~-----~'---^-------' ' -----------''-----------^--^' N �,� SHALLOW KEY: NOTE:INLET PIPE WITH 8'INVERT E%ISTING CONTOUR:---- SEPTIC SYSTEM DESIGN. SEPTIC SYSTEM SECTION IS NOT THE CENTER INLET. hv04-/ POND PROP0.9ED CONTOUR:............. hS EXISTINGSPOTELEVATION: 25.5 FLOW ESTIMATE: FIRSTFLOOR COVERS WITHIN 6' JF NFO�, PROPOSED SPOT ELEVATION: 5® Sj-BEDROOMS AT 110 GAL IDAY= 660 GALIDAV .9 OF FINISHED GRADE KEV1E`N 4"A, TEST HOLE:+ TOP OF INSPECTION PORT Sn AVE UTILITY POLE:-O- SEPTIC TANK: FOUNDATION FINISHED GRADE FENCE LINE: _ ELEV.-'.00.0 $IOE HYDRANT:-6- 660 GAL J DAY 12 DAYS=1320 GAL I.8'cer h Y 101 LOPI RETAINING WALL® USE 10 GALLON SEPTIC TANK 100.78101.2 .; 1,8'oer0 COVER -LOCUS 1R'cerll (I MIN) LAKE LEACHING AREA: 1 . _ . ELEV. WEOUAOUET 420' 10027 9.96 79 99.11 USE SO INFILTRATOR QUICK PLUS STANDARD CHANGERS ELEV. ELEV. D-BOX ELEV. 7 ELEV. LOCATION NAP - /6 OF STONE UNDER OR ELEV. LOT 138(0.52 ACRES) vo� AS SHOWN(42'w15'X8'EFFECTIVE DEPTH)(STONELESS) 1500 GAL MECHANICALLY COMPACTED) 34'08' ASSESSORS MAP:252 PARCEL:P6 • SEPTIC TANK USE 48 INFILTRATOR QUICK 4 5• SIDE AREA: NA (0.74)=NA GALrDAV LAND COURT CASE 202 C //6'OF STONE UNDER OR _ STANDARD CAPACITY CHAMBERS LEACH AREA DETAIL BOTTOM AREA 50 UNITS x4.7=940 SF (0.74)= GALIDAY MECHANICALLY COMPACTED) AS SHOWN(34.x 18'.8'DEEP) CAPACITY.696 GALIOAV TEE INLET:G LIP. GAS BAFFLE (STONELESS) TESZES:,13'OOWN 1 AT OUTLET TEE PERCHED - OUTLET'6'UP,14-DOWN GROUNDWATER N arch TEST HOLE LOGS FILL TH1 ELEV. FILL 101.0 TH2 ELEV. kitchen ' O�Wn OOm ENGINEER! THOMAS MCLELLAN.P.E. (, >X hya. WITNESS:DONALD DESMARIUS,R.S. - - AKESJOE amn DATE:1b23t8A112918 PERCHED PERCHED 9 GROUNDWATER GROUNDWATER 100 RIB/ boa baln M- 9J.0 84' s4.0 - E EAST room �In Imnm 'PERGOLATIONRATE:�2NINAN A HOR120N AHORIZON slake /P 1"onl 151 lloor rm PEAT - A,p PEAT Je 10D? 10004gj 100.5 1t1' 89.0 156' .7 100�E 100.9 I .08 204' MEDIUM SAND 1'/ Or I POND ELEVATION=93 H4.0 bas¢menI 17o.x m' storage �il GamNOTES: EDGELAWNBENCHMARKAT $�4� G �. a fVrcem I.VERTICALDATUM:ASSUMED RIGHT CORNER 100 Ih-2y' m - OF CONIC.PORCH 'r ELEVATION=I03.82 O' 2.MUNICAPAL WATER IS AVAILABLE. birch - bdsemem oetl oo Gusicr ' ' ' 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. . ..r,.„ room �.a , 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. 98 a e ' S.PIPE PITCH=1/8'PER FOOT(UNLESS NOTED OTMEflWISEI- r W W) 17 W LA 6.FIRST?OF PIPE OUT OF 0.B0%TO BE SET LEVEL �! EXISTING FLOOR PLAN 8- 7 THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACGOMODATE'THE USE OF A GARBAGE DISPOSAL.J' ?N t. 8.ALL CONSTRUCTION DETAILS ARE BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL - CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 2 PAVED ' G ' DRIVE 102 S.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. �A 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'WITHOUT VARIANCE. 11.FIELD SURVEY PROVIDED BYTERRY A.WARNER,P.L.S.,HARWICH.MA. O ✓oAT✓g OgA'G A�� 12,THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND !b<T/OO,y_ 'JO 100 IS SURJECT TO CHANGE UNTIL SUCH TIME.THIS PLAN HAS BEEN PREPARED FOR THE SOLE PURPOSE OF CONSTRUCTION OF A NEW SEPTIC SYSTEM AND DOES NOT NECESSARILY REPRESENT A FULL DETAILED PROPERTY SURVEY. 13.EXISTING CESS POOLS(4)ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. `\ l4,D-BOXTO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 15.ALL UNSUITABLE SOIL,(PEAT,APPROX.13'DEEP)VJITHIN 5'OF PROPOSED LEACH AREA IS TO BE \ $ REMOVED AND REPLACED WITH CLEAN MEDIUM SAND. ` 16.SEWER LINE TO BE ENCASED WITHIN A 6'PVC PIPE WHEN WITHIN 10'OF WATER SERVICE. C SITE PLAN N LOCATION: s4 67 LAKESIDE DR.EAST CENTERVILLE,MA PREPARED FOR: 7Op DAMON&NAT.4LIE FIELDGATE A7 ED OF J-i•F GE,-pON DATE:12-12-18 SC.4LE:1"=3O FJF`ggpG - ,i BASS RTVER ENGINEERING 93 �q TIIUMAS 1.McLELLAN.P.E. P.O. ST'BOX 116?. EA DENNIS,NIA(1264I - 508-364-•XIJS M18 6B i BUILDING DEPT JUL 1 2019 1 + -rOW14 Ur- I/ABLE P P P t} 1' 1 t q i } II l z o Q. 0 n OD F Vl TINS 2X RID6E - EXISTING 2,A RUSE O �, TO REMAlm i0 REMAINvi \ �. 0 -' E::ILTIH6 4.AFTERS ��\\ -� TO 11TINS RAFTERS S�+ Er19TI R AT TO AMAIN. TO REN.11N. • �' RAflER9 AT 16"OL' INS1LiTE EXI5TIN6 - '__ __ ROOFFR EXT? ROOT W"ASLOM.-i OO / p. V M.4555UL01.�5 LOGE _ f� __ ____ '95 ULOIN6 COOE / \\\\ EXT T N6 wr-R / / TIES To REMAN xISTIN'b-PW R 4T 4REA NITN f-LAT :'10 - - R5 / TI"TO RN1714 I LELINS.Y TO AT FALL 1 N' T -4N fLAi REFIAIN TO REMAIN .. ; TO REMAIN RN ... __j _____ __ _ _____ ENTR"A'A"TO ., .- .� .. .. ... �ay . EMWE:"STINb �—REMOVE ALL LEILIN3 JOSTS y E41TER TIE5 Al IN THIS AREA.AS INOILATEG EXI STINS 2Y:GEILINS EiISTING SEARING HALL INSTALLER RAFTER JDISi5 m 16'OL. - - i0 Se R:NIOVED ... TESUJCER NEN RI06E .. BEAM II EID.LN—� ' I113,NS 57RAPFlN6 .. RE51111-0 E>,15TIN6 2X4 / A,1gY LO,T1N�5 2X6 ' HALL IA OEt5TiN6 - i .. EX5TN6'2XIO5 a 16"OO. - ft4F'ER� W v .. ... n Q a 0 E X I S T I N G S E G.T I O N PROPOSED S E C T I O N - VAULTED G L G: F R O F O.S E D SECTION - ENTRY/F L A T G E I L I N G SCALE- 1/4." = 1-0" .. SCALE. I/4' 1 G. 5 L A L E: 1/:' .. .. 6TfSllGTLPAL w✓ S G qq _ 4 — s 3Sis � age HN . ... . - - -- ------- ---------- -- --------- ----- ----- --- ---------- ----- --- ------ -- ------ --------- ------------- -- ----- ------- --------------------------- --------------------- _______ --------------------- --- - - WA 3- Y2XIO COLLAR T5 4T NFN A--LT ROOF RAKERS NFN s--LY 2a'6 RAFTER. NEN=RY:..lb R4F TER ALL . .. t -.n .. .. IN THIS AREA ki IN01LATEC __41\ ___ ___________ __ \ -------- ---- ------ ----- --- ----- .. __.__ ___ _ _ ______ ____ __ ___ .________ _ __ \\ ... IL .. \ .. m. ... - .. �� !EA 9.FLY 2XIO COLLAR TIES AT NEN 4-9.Y ROOF RAFTERS NEN 4RY'Xb RAFTER NEN 4-FLY 2.1,21 WTER. .. J __ __ _______ _ _.-__. __ _ ___ _. _______.. _____\�___._--. ______ O \\ LX16T 2X . .. KY 6 ROOF RAFTERS 4 l WA -EXISTING 2-9¢CROP RAFTERS-_ ........... _ n - ._______________ ____________ ____P-_.--_-_--______ __ S _ ________ __ ______ _____ �' _______ __..__ _ _______ — 1 Z Q . _1EN 3-FLY 2XIO COLLAR TIES T 4-N'-FLY ROOF RAFTERS j - - . .. ..� : .. .. _ __ _______ ___ _____._ -_._________ 1&YI .R.Y2XbR4TTCR ._ _________ __ D, N . F .n J v ------ ------------ ----- - -- ------ -- - ---- - ----- --- � � ----- ------ - WA 5- Y Z40 COLLAR TIES A NEW c_FLT ROOF RAFTER, HIM 4-L.Y 2X5 RAFTER .. ________ i N614-FLY<,Nb 24fi u Q --- -------------L--------------------------- - ' ---- — _- `-- :.'________._________ -- --- ---- . _ _ ___ __ _______ ______________ ----_______-------------- _________-____ --------- 7 —�..� — . ... .. - 'FLAT LEILA.6IN THIS ENTRY ` yII __-______ _ _ ___________ _________________________ __ _ .. 1 - _ . .. ... - .MAY AREA TO REMAIN �- -_ ___ _____ __ ___ _____ __ a - J _ __ _____ a ___ _ _-_ ___ ___ _ de a -NAR.16,2019 ___.. ________ _________ ______.____.__, _._______ _-_-___-_______ .. .. .. .. . S:d le .45 NGT7?O . .. draw GF.ERATOf21 EXISTING ROOF FRAMING PLAN PROPOSED G E I L I.N G F R A M I N G. P'L A N P R O POSE D ROOF FRAM I N G PLAN SCALE. 1/4. - 11-G. .. S O.4 L E /4' e '-O' S C A L E• I/-. 1 O. .. o A-1