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TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION dq Address of Project: �� tt 8a rM le— STREET � VILLAGE Owner's Name: G Phone Number Email Address: Cell Phone Number Project cost$ �E goo` 00 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Q Siding E-1 Windows (no header change)# r-1 Insulation/Weatherization P oors (no header change)# Commercial Doors require an inspector's review E.:=1 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name !M 1✓� �O Home Improvement Contractors Registration(if applicable)# 16YO 3 (attach copy) Construction Supervisor's License# 'Q G ®y0 (attach copy) Email of Contractor Cl��l rX01 1,Q0 kJ Phone number 5-0,Y169 0100 ALL PROPERTIES THAT HA E STRUCTURES ODWR 75 YEARS OLD OR IF THE SUBJECT PROPERTYIS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. A � APPLICATION NUMBER............................................................ [ r q q *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No if es a as permit i required.e g y g pe t s r q ed. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand m responsibilities under the rules and regulations for Licensed Construction Y P � 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. p Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiordlndividual): 0me {'J') Q Address: P0, c� City/State/Zip: ��Q,1/V � `� Phone#: 50 31 69 Are ybu an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 410 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• # 9. ❑Building addition [No workers' comp.insurance comp.insurance. repairs required.] 5. ❑ 10. Electr We are a corporation and its ❑ ical or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑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#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 hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below ifjr±W information. � a � "� Insurance Company Name: 1AA UX Policy#or Self-ins.Lic.#: 9 Expiration Y �+ s -9 2 Job Site Address: / City/State/Zi,• �� /✓� 1� Attach a copy of the workers'compensation policy declaration page(showing the policyS Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impo. ;-;aiaities of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a S.vt,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• ce coverage verification. I do hereby certify un the t d enalties of perjury that the information provided a�7�' true and correct Signature: Date: P� Phone#: 309 `T 69 V(Q 2- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to is statute,an employee is defined as"...every rson in the service of another under any contract of hire, express or im lied,oral or written." An employer is efined as"an individual,partnership,asso iation,corporation or other legal entity,or any two or more of the foregoing gaged in a joint enterprise,and includin the legal representatives of a deceased employer,or the receiver or trustee f an individual,partnership,association r other legal entity,employing employees. However the owner of a dwelling ouse having not more than three apartents and who resides therein,or the occupant of the dwelling house of ano er who employs persons to do ma' enance,construction or repair work on such dwelling house or on the grounds or bui ing appurtenant thereto shall no because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) ]so states that"every stat or local licensing agency shall withhold the issuance or renewal of a license or per 't to operate a business r to construct buildings in the commonwealth for any applicant who has not produc d acceptable eviden a of compliance with the insurance coverage required." Additionally,MGL chapter 152, 5C(7)states"Ale' er the commonwealth nor any of its political subdivisions shall enter into any contract for the perfo an of publ' work until acceptable evidence of compliance with the insurance requirements of this chapter have been esented the contracting authority." Applicants Please fill out the workers' compensation affi avi ompletely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), ddress s)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(L C)or Limi d Liability Partnerships(LLP)with no employees other than the members or partners,are not required to c workers' co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be advis that this affidavi may be submitted to the Department of Industrial Accidents for confirmation of insurance verage. Also be su to sign and date the affidavit. The affidavit should be returned to the city or town that the a lication for the permit license is being requested,not the Department of Industrial Accidents. Should you have y questions regarding the w or if you are required to obtain a workers' compensation policy,please call the D artment at the number listed b ow. Self-insured companies should enter their self-insurance license number on the propriate line. City or Town Officials Please be sure that the affidavit is omplete and printed legibly. The Departmen has provided a space at the bottom of the affidavit for you to fill ou m the event the Office of Investigations has to co tact you regarding the applicant. Please be.sure to fill in the pee it/license number which will be used as a reference ber. In addition,an applicant that must submit multiple pe t/license applications in any given year,need only sub 't one affidavit indicating current policy information(if neces ary)and under"Job Site Address"the applicant should writ "all locations in (city or town)."A copy of the affi vit that has been officially stamped or marked by the city or to may be provided to the applicant as proof that a lid affidavit is on file for future permits or licenses. A new you ' must be filled out each year.Where a home o er or citizen is obtaining a license or permit not related to any business r commercial venture (i.e. a dog license or pe it to burn leaves etc.)said person is NOT required to complete this affi it. The Office of Investi tions would like to thank you in advance for your cooperation and should you have any questions, please do not hesitat to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of luvestigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www,mass,gav/dia 11 4M f-Pt CAPE COD Home Improvement CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (508) 469.0102 CAPECODINC@GMAIL.COM, www.RoOFCAPECOD.COM, www.FACEBOOK.COM/CAPECODHoME ------_ CAPE COD HOME IMPROVEMENT TM WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE (PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT TM WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. - - ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE.IN THE CASE OF ANY ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY,ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES, ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENTTM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI"TONY"SFVITSrL ACCEPTED BY / J SIGN ✓� DATE *BYa:�b_ I/ACCEPTED SIGNDATE 12•G�' G�( J CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAG Ac©Roy CERTIFICATE OF LIABILITY INSURANCE FDATE TE(MMIDDIYYYY) llkw ► - 06/1512018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME:CT Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY AHON o EMI (508)775-1620 ADDRESS: Isullivan@doins.com 9731YANNOUGH RD INSURERfS)AFFORDINGCOVERAGE NAIC1f _.._ _.-. -..----_.. _ HYANNIS MA 02601 INSURERA: AMGUARD INSURANCE CO 42390 INSURED __.._ ... ._.-.._.._.__. ,_._.___.... INSURER B: CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 281511 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR} " - - 'ADDL BUBR` POLICY EFF _ POLICY EXP LTR r TYPE OF INSURANCE POLICY NUMBER MMIDD1YVYY) (MMIDONYYYI LIMITS I COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE S r~i I 1 bAMAGE TO RENTE=b r CLAIMS-MADE t (OCCUR j _-PRgMiSES Ea.occurrence)-- _5 _ M_ED EXP(Any one person) -- S — S NIA PERSONAL&ADV INJURY S i GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S L_._.'PRO- POLICY, JECT (_ I LOC k PRODUCTS COMP/OP AGG S 'OTHER 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea acc!dent ANY AUTO i BODILY INJURY(per person) $ ALL OWNED SCHEDULED l AUTOS ( Y AUTOS NIA BODILY INJURY(Per accident) S ! ( NON-OWNED ( PROPERTY DAMAGE S t E HIRED AUTOS AUTOS i s LPeracadent I UMBRELLA LIAB' -_ OCCUR I EACH OCCURRENCE S I ly- EXCESS LIAB j l CLAIMS-MADE{ N/A AGGREGATE S ' I DED i�I RETENTIONS I $ I WORKERS COMPENSATION X PER OTH. !AND EMPLOYERS LIABILITY f' STATUTE ER _ 'ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E L EACH ACCIDENT S 1,000,000 A 'OFFICER/MEMBEREXCLUDED� NIA NIA NIA' R2WC940123 06/03/2018 06103/2019------- ---------__.-._-_______._ ,(Mandatory in NH) I E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under .... _- -------. __ I DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 1,000,000 I I NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay Claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at wvAv.mass.govllwdlworkers-compensationfinvestigationsi CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Anat011 SIVItSI(I ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUT-fORIZED REPRESENTATIVE West Yarmouth MA 02673 \_Danieell( + M.Cro�y, CPCU,Vice President-Residual Market-WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Reg ulations and Standards Constructio - S r Specialty CSSL-106040 c E" Tres : 05/14/2020 ANATOLI SIVITSKI JV, [ 27 MILL PON YR D WEST YARMO Z T3 U,T;o M A 02 Commissioner Cj 0/ Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation Registration: 168043 IMPROVEMENT, INC. Expiration: 12/0612018 ARMO'�:,;i H. MA 02673 Update Address and Return Card. -,usiness Rugulatiotl iz 14 PIR DV 411 3 CONTRACTOR Registration valid for individual use only Y 9 before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suit INN Boston,MA Not valid without signature Undersecretary TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map li ` Z S a Application Parce Health-Division n Date Issuod l Conservation Division Y Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board P�� Historic - OKH _ Preservation / Hyannis Project Street Address �� C Village R-)A-Q_NJ S 1 Af-IF L-6 Owner (,A-kLA Address y AAA ) srk�tL,, bVQ5f Telephone 50'9 3 ( - &3 3 9 Permit Request 17�oLAs(t �xi5m,36- iZs1 22-Z- s��►C�i sna24 Si�� 2a�F u-►" J &�)W LACE x s tt>r7D 20iji;:: V-I T -t- k), i N STJT i.-II_ Square feet: 1 st floor: existingZdy proposed �_2nd floor: existing l 17 Z proposed 113 2.Total new 10� Zoning District Flood Plain_ N 0 Groundwater Overlay Project Valuation�$_ 0 00 Construction Type__ Lot Size . 4- �1 S 5F ^'i3 � Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family (# units) Age of Existing Structure i(a Historic House: O(Yes ®No On Old King's Highway: A Yes ❑ No Basement Type: 4Full $Crawl ❑Walkout 01Other $I=A:Fj _ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 3 2® S Number of Baths: Full: existing_3 new _ Half: existing _new Number of Bedrooms: 6 existing 'new Total Room Count (not including baths): existing 1 L new 1 First Floor Room Count Heat Type and Fuel: ❑ Gas ' Oil ❑ Electric ❑ Other Central Air: ❑Yes XNo Fireplaces: Existing__L_New _ Existing wood/coal stove: ❑ Yes �(No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size __ Barn: ❑ existing ❑ new size_ Attached garage:14 existing ❑ new siz6VShed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal #_ Recorded ❑ q _ Commercial ❑Yes X No If yes, site plan review # _;> C) •,fir t: E Current Use �C�S ���� - S��� � iL`I _ Proposed Use lL6 1(?y-J T1 q'-Si NELk_�------ _ ..v APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � 1 mDbQ Telephone Number 60[� g 7� 2527 Address el _-1- y (Z.'t15 5"1 License # CS S13115 SC_[..TV rTTL_ M4 0 LOW Home Improvement Contractor# 15'_� I )0 Worker's Compensation # WC 3 G 3 15 r3'� 11145 i i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 00 Nj SIGNATURE DATE FOR OFFICIAL USE ONLY l - APPLICATION# F 'DATE,ISSUED . - MAP/PARCEL NO. i ADDRESS i VILLAGE t OWNER' { DATE OF INSPECTION: -,:-FOUNDATION!_A i -}„ 1 FRAME FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t - ,GAS,n-i ti. ROUGH , _ FINAL . ; FINAL BUILDING t. DATE CLOSED OUT ASSOCIATION PLAN NO. . .r- I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individnat): 9U 1 L, I A r Address:_ City/State/Zip: NO DER � M- p� Phone#: (o 1-1 �i S A re an employer? Check the appropriate box: a employer with Z 4. I am a general contractor and I �e of project(required): loyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner- listed on the attached sheet. 7, Remodeling and have no employees These sub-contractors have king for me in any capacity, employees and have workers' 8. Demolition workers' comp, insurance comp,insurance.$ 9• ❑Building addition ired.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions a homeowner doing all work officers have exercised their e1 11.❑Plumbing repairs or additions [No workers comp. right of exemption per MGL ance required] t c. 152, §1(4), and we have no 12.❑Roof repairs 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 Eiomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, xContractors that check this box must attached an additional sheet showing the name of the subcontractors 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 the policy andjob site information, Insurance Company Name: ��(��11�, tf 1�� ���� , � p� DA- r Policy#or Self-ins.Lic.#:_ r Expiration Date: 2� 011— Job Site Address: 101 0 Ar 1 N3 City/State/Zip: dA N5 A1A--0,1V?)p 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 fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form criminal penalties of a 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 u the pains and p f perjury that the information provided above is true and correct Si tare: Date: GL�'i ` Z ^ �,1 1 Phone F only, Do not write in this area, to be completed by city or town q�cial n: PermitUcense# hority(circle one): Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: L r �I ,,KE Town of Barnstable Regulatory Services • BARNSTABLS. • MASS Thomas F. Geiler,Director ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize (N 1 L LA AM to act on nay behalf, in all matters relative to work authorized by this building permit. N-70 AAA-1 Q ST. �j !`15T LE✓ (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner i afore of Applicant CA%LA Ag-pgj In1 tiw i Ja-n'1 /�(l t � Print Name Print Name 11 14 11 Date QYORM&OWNERPERMSSIONPOOLS Town of Barnstable ' Regulatory Services BAENSTABLE. * Thomas F.Geiler,Director y MASS. i639• ��� Building Division lEc 1NA�" Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ti HOMEOWNER LICENSE EXEMPTION :i Please Print DATE: JOB LOCATION: mber street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRE city/town state k r 1 ,zip clode The current exemption for"homeo rs"was extended to includ owner-occupied dwellings of six units or less and to allow homeowners to engage an indi 'dual for hire who does of possess a license,provided that the owner acts as supervisor. FINTTION OF H MEOWNER Person(s)who owns a parcel of land on which e/she resides r intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or d ched stru es accessory to such use and/or farm structures. A person who constructs more than one home in a o-year riod shall not be considered a homeowner. Such "homeowner"shall submitto the Building Official n a f rm acceptable to the Building Official,that he/she shall be responsible for all such work performed under the b '1 ' ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibili or compliance with the State Building Code and other applicable codes bylaws, PPrules and regulations. The undersigned"homeowner"certifies that he/s underst ds the Town of Barnstable Building Department minimum inspection procedures and requiremen' and that he e will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings co aining 35,000 cubic feet or larg will be required to comply with the State Building Code Section 127.0 Cons tion Control: HOMEOWNER'S EXEMPTION 4 The Code states that: "Any homeowner rforming work for which a building permit is equired shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of cons ction Supervisors);provided that if the homeo er engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.' Many homeowners who use this exempti n are unaware that they are assuming the responsib ities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often sults in serious problems,particularly when the homeowner hires unlicensed persons. In thr�case,our Board cannot proceed against the uniicense 7s, n as it would with a licensed' Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt OP ID: MIL ACORN" DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/14/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. CONTACT PRODUCER 781-455-0700 -NAME: Roblin Insurance Agencyy,Inc. 781�49-8976 PHONE FAX 144 Gould Street,Suite 100 !c No Ell: AJCNo: Needham,MA 024942321 E-MAIL ADDRESS: Bradley E Roblin PRODUCER HARDE-1 CUSTOMER ID#. INSURER(S)AFFORDING COVERAGE NAIC• INSURED Harden Design and Build,Inc INSURERA:Selective Insurance Co of Amer 12572 Mr.William Harden INSURERB:National Union Fire Ins of PA 19445 144 Gould Street STE 160 INSURER C: Needham, MA 02494 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMM/DIDmYY MMRIDN XP LTR YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY S 1889175 06101l11 06I01112 DAMAQ E TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS-MADE Fx�OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV IN URY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO A 9092298 06/01/11 06/01112 (Ea accident)BODILY IN,URY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIREDAUTOS (Pereocident) X NON-OWNEDAUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY IN TIC LIMITS ER B ANY PROPRIETORIPARTNEREAECUTIVE Y❑ NIA C007124291 01/27/11 01/27112 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 A Property Section S 1889175 06/01/11 06/01/12 BPP 5,20 J DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of Insurance. CERTIFICATE HOLDER CANCELLATION HARDENR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Harden Residence ACCORDANCE WITH THE POLICY PROVISIONS. 2970 Main Street Barnstable,MA02360 AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Office of�o sumert af"'i s l3iness gu� License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: HOME IMPRO Registration: .,153910 Type: Office of Consumer Affairs and Business Regulation Expiration: 1/24%2013 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 H' EN DES IGN,&BUILD INC _ is V i WILLIAM HARDEN 58 CURTIS STREET SCITUATE, MA 02066,, Undersecretary JANot valid without signature Massachusetts - Depai-tment of Public Safety Board of Building Regulations and Standards Construction.Supervisor License License: CS 83787 WILLIAM HARDEN - 58 CURTIS ST SCITUATE, MA 02066 -- - �y� Expiration: 6/19/2012 ('ununissiuner Trt#: 28529 REScheck Software Version 4.4.2 Compliance Certificate Project Title: Harden Residence Addition Energy Code: 2009 IECC Location: Barnstable,Massachusetts Construction Type: . Single Family Project Type: Addition/Alteration Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 2970 Main Street Carla Harden William Harden Barnstable,MA 02630 2970 Main Street Harden Design and Build Inc. Barnstable,MA 02630 144 Gould Street 5083626339 Needham,MA 02494 617 875 2527 will@hardendesignandbuild.com Compliance:0.7%Better Than Code Maximum UA:152 Your UA:151 The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. AssemblyGross Cavity Cont. Glazing UA or or D•• Perimeter U-Factor Ceiling 1:Cathedral Ceiling 385 38.0 0.8 9 Skylight 1:Wood Frame:Double Pane with Low-E 55 0.510 28 Wall 1:Wood Frame,16"o.c. 380 15.0 0.8 21 Window 1:Metal Frame:Double Pane with Low-E 52 0.300 16 Door 1:Glass 39 0.470 18 Floor 1:Slab-On-Grade:Heated 80 6.0 59 Insulation depth:3.0' Compliance Statement. The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has be in desi ed to e t the 2009 IECC requirements in REScheck Version 4.4.2 and to comply with the mandatory requiremen listed in the R the In ection Checklist. t,wt ��► t,� Co� 2 , L L Name-Title SigrI464 Date Project Notes: Replace an existing 12'-9"x 22'-2"single story shed addition with a new 14'-9"x 26'-4"single story shed addition. Project Title: Harden Residence Addition Report date: 11/08/11 Data filename:C:\Users\Will's Laptop\Documents\REScheck\2970 RES Check.rck Page 1 of 4 l k 2009 IECC Energy Efficiency Certificate Ceiling/Roof 38.83 Wall 15.83 Floor/Foundation 6.00 Ductwork(unconditioned spaces): Window 0.30 Skylight 0.51 Door 0.47 NA gplo Heating System: Cooling System: Water Heater: Name: Date: Comments: I R AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for ComP liance(780 CMR 5301.2.1..t)' Q Check Compliance 1.1 SCOPE / WindSpeed(3-sec.gust).................................................................. .................................................110 mph ✓ WindExposure Category.................................................................. .............................................................B 1.2 APPLICABILITY Number of Stories ..............................................................(Fig 2)............................ i stories 5 2 stories RoofPitch ..........................................................................(Fig 2) ................................. 56 5 12:12 Mean Roof Height ..............................................................(Fig 2)................................................. 0.1 ft <-33' ✓� Building Width,W...............................................................(Fig 3)................................................ 11 ft <_80' ✓ Building Length, L ..............................................................(Fig 3)................................................&ft `-80' Building Aspect Ratio(L/W) ...............................................(Fig 4).................................................Z!1 <_3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)................................................ 6'$ <_6'8" 1.3 FRAMING CONNECTIONS / General compliance with framing connections....................(Table 2)................................................................ V 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. _ ConcreteMasonry.................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION''3 5/8' Anchor Bolts imbedded or 5/8" Proprietary Mechanical Anchors as an alternative in concrete onl)�q, ✓ Bolt Spacing-general ..........................................(Table 4)..................................... ....... _ -I_in. _ Bolt Spacing from end/joint of plate ............................(Fig 5)..................................... in.<-6"-12" Bolt Embedment-concrete.........................................(Fig 5)........................................... .6 in. >7" Bolt Embedment-masonry.........................................(Fig 5)............................................ in.>_ 15„ Plate Washer...............................................................(Fig 5)...............................................>:3"x 3"x W 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension...................................(Fig 6)............................_ft 5 12'or U2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)........................................ _ Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7)....................................................—ft 5 d �!k Maximum Cantilevered Floor Joists Supporting Loadbearing'vValls or Shearwall................(Fig 8)...................................................._ft <_d � FloorBracing at Endwalls...................................................(Fig 9).................................................................... � Floor Sheathing Type ........................................................(per 780 CMR Chapter 55).................................... �L19 Floor Sheathing Thickness .................................................(per 780 CMR Chapter 55)....................... in. N �! Floor Sheathing Fastening..................................................(Table 2).._d nails at in edge/_in field Nit 4.1 WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)........................... ft <-10' Non-Loadbearing walls................................................(Fig 10 and Table 5).......................... l�ft <-20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)............1.Z, _.in.<_24"o.c. Wall Story Offsets ........................................................(Figs 7&8)................................. ._ft <_d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls....................................... ..... .... .....(Table 5)..............................2x - ft 6 in. Non-Loadbearing walls................................................(Table 5)..............................2x_- ft:i�in. Gable End Wall Bracing' Full Height Endwall Studs............................................(Fig 10)....................................IJ.U.... C�.!�.(.�.. �A- WSP Attic Floor Length................................................(Fig 11)............................................. ft>_W/3 Gypsum Ceiling Length(if WSP not used)...................(Fig 11)..........................................26R ft>_0.9WQ 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11).............................. .............................. Double Top Plate Splice Length ........................................................(Fig 13 and Table 6).....................................I ft _ Splice Connection(no. of 16d common nails)..............(Table 6)..........................................................LQ i f AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails)..............(Table 7)........................................................ Non-Loadbearing Wall Connections .� Lateral(no.of endnailed 16d common nails)...............(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance,o Table 9) Header Spans ........................................................(Table 9).................................. ft G in. <_11' f Sill Plate Spans ........................................................(Table 9).................................. ft_'ZT in. <_11' Full Height Studs (no.of studs)...................................(Table 9)........................................................_Zi_ �^ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) ✓ Header Spans.............................................................(Table 9).................................. (' ft D in.<_12' Sill Plate Spans...........................................................(Table 9).......................................L ft O in.<_12" "/ Full Height Studs(no. of studs)....................................(Table 9)........................................................�J Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 .......... ....................................................................L'9<6'8" V" Sheathing Type..............................................(note 4)......................................................? _�Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ Field Nail Spacing..........................................(Table 10)................................................. Shear Connection(no. of 16d common nails)(Table 10)..................................................... .. V Percent Full-Height Sheathing.......................(Table 10).................................................. �/o 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... _V Maximum Building Dimension, L Nominal Height of Tallest Openingz.......................................................................(P'�<_6,8., f Sheathing Type..............................................(note 4)......................................................'l tb w5P Ede Nail Spacing Table 11 or note 4 if less ........................ in. Field Nail Spacing Table 11 ................................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................ •{- PercentFull-HeightSheathing.......................(Table 11)....................................................3Q% 77 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... _ Wall Cladding Ratedfor Wind Speed?.............................................................. ................................................................ 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ................................................... (Figure 19)..............J:71 ft<_smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U=Z�l plf Lateral.............................................(Table 12).............................................L=I&O plf Shear...............................................(Table 12)............................................S=-2j plf V Ridge Strap Connections, if collar ties not used per page 21.....(Table 13)..............................T=_plf Gable Rake Outlooker.........................................(Figure 20)..............L-1 ft<_smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U=31Z lb. Lateral(no. of 16d common nails)...(Table 14).......................................L=_LlLIb. Roof Sheathing'Type...................................................(per 780 CMR Chapters 58 an 59).................. Roof Sheathing Thickness........................................... .............................................Y&in.>_7/16"WSP/ Roof Sheathing Fastening ...........................................(Table 2)............,.............................&��...... d Notes: 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness.pressure treated#2-grade. FEB-28-2012 04:18P FROM:INSUL-PROP INC. 17818571977 TO:15087906230 P.2/2 CERTIFICATE OF INSULATION AND AIR SEALING WORK Address of Residence: Name and Address of Contractor: �7a 1V VZF% ' ,N INSUL-PRO INC. e�J . 267 North Ouincy St, Abington,MA 02351 Areas Insulated WALLS ATTIC/FLOOR CEILING/SLOPES MATERIAL/ Added MATERIAL/ Added MATERIAL/ ADDED LOC SO FT Bag Count R-value LOC SO FT Bag Count R•Value LOC SO FT Bag Count R-VALUE 01 390 Fes ' r-U �9D /Q' Cellulose, loose fill: R-3.7 per inch Cellulose,Dense Pack: R-3.5 per inch Fiber Glass Batt: R-3.0 p/inch Poly-isocyan u rate, Rigid Board: R-7.0 per inch Air Sealing #Attic Access Blower Door Completed Treated Results Attic Pull Down Stairs Pre Test Basement Hatches Post Test Living Space None Q Full Size Doors No Blower Door l certify that the residence identified above was insulated as specified, he=OaCrIWIV ucted in accordance with Building Performance Institute (BPI), standards, and ti . v I FEB-28-2012 02:15P FROM:INSUL-PRO, INC. 17818571977 TO:15087906230 P.2/3 / v�LECTIOW 500 Spray Foam Irtw1adon ��. Technical Data Sheet DEMILEC (USA)I-.C. Semi-Rigid, Spray-Applied Polyurethane Foam SEALECTION® 500 is a two-component, open-celled, spray-applied, semi-rigid polyurethane foam system. This product is a fully water-blown foam system with a very low in-place density.SEALECTION°500 meets the off gassing requirements of CGSB 51.23-92 for new residential construction.SEALECTION®S00 has been approved by the EcoLogo'm (formerly Environmental Choice) Program of Canada and is listed as a Certified Green Product.SEALECTION®500 complies with the intent of the International Code,Council's residential and commercial building codes for spray polyurethane foam plastic insulation. Physical Properties Method Description ':. Value ASTM D 1622 Density(core) 0.45-0.s Ib/ft' ASTM C 518 Thermal Resistance 2 days @ 76°F,per inch 3.81 ft'.heF/BTU (R-value) Thermal Resistance 90 days @ 761,per inch 3.81 ft'.hQF/BTU r ASTM E Z83 Air Leakage(Air Impermeable IAW 2006 IRC Requirements) 3.5"@ 75 Pa(25 mph wind) 0.001.L/s-m 5.5"@ 75 Pa(25 mph wind) 0.001 L/s•m' i 10"@ 75 Pa(25 mph wind) D.002 L/s-m' E Sustained Wind Load for 60 minutes @ 1000 Pa(90 mph wind) No Damage Gust Wind Load Test @ 3000 Pa(160 mph wind). No Damage ASTM E 2178 Air Permeance if Building Materials 3.5"@ 25Pa 0.001 L/s-m' . i 13.5"@ 50 Pa 0.001 L/s-m' 3.5"@ 75 Pa 0.002 L/s•m' 3.5"@ 100 Pa 0.003 L/s-m' ! 3.5"@ 150 Pa 0.004 L/s•m' 3,5"@ 300 Pa I 0.008 L/sem' t ASTM E 96 Water Vapor Transmission(Goss III Vapor Retarder of normal installed thicknesses) 3.5" 6.6 Perms 5.5" 4.2 Perms 7" j 3.3 Perms i 10" 2.3 Perms ASTM D 1621 Compressive Strength i, 0.7 psi I ASTM D 1623 Tensile Strength S.6 Ibs/in' ASTM E 413 Sound Transmission Class(STC) 49-Si• 1 ASTM C 423 Noise Reduction Coefficient(NRC) 75 i CGSB 51.23-92 Off Gassing Tests(VOC Emissions) { Pass(No toxic vapors) ASTM D 2863 Oxygen Index 22% ASTM D 1929 Ignition Properties(Spontaneous-ignition temperature) 1040°F(S60"C) ASTM E 84 Surface Burning Characteristics,6"thick Class l ' - Flame spread Index 21 Smoke Developed 216 t ASTM E 119 Wall Assembly Test(non-loadbearing) Pass_ 1 hour" *based on specific wall design. DEMILEC(USA)LLC" - 2921,Gallena Unie Arlington,i k 7601.1 SEALECTION'500 Technical Data Sheet (81,71640 4cJ00 phone '!877 DIEM([ i?ib 451<j toP free lR171 6 14 21CA)fix Rev. 10flo5i09 page I 1 www UemcecUSA cum Info(Mr-mik WSA.,nm I I I I FEB-28-2012 02:16P FROM:INSUL-PRO, INC. ' 17818571977 TO:15087906230 P.3/3 1 PropertiesLiquid Components Property Isocyanate A 500 Resin B 500 Color Brown Transparent Clear Viscosity @ 77°F 180-220 cps 150-300 cps Specific Gravity 1.22-1.25 1.09-1.11 Shelf life' 6 months 6 months Mixing ratio(volume) 100 100 •See MSDS for more information. Processing Parameters Imperial units Metric units Type of machine GracoO Reactor E-30 with Fusion gun and 02 Mixing Chamber Components A&B temperature 130°F 54.5°C Hose temperature 130°F 54:5°C Ambient temperature 70°F 21°C Thickness per pass Full thickness of application I Substrate Plaster board Reactivity Profile Cream time(s) Gel time(s) Tack free time(s) End of rise(s) 1-2 3-4 6-7 6-7 Recommended Processing Conditions Value I Primary heater 130°F Hose temperature 130°F i Mixing pressure 1000 psi Substrate&Ambient temperature >23°F I Curing temperature >23°F General Information: It is recommended that the foam is covered with an approved thermal barrier in accordance to the local and national building codes when used in buildings and a protective coating when used outside. This product should not be used when the continuous service temperature of the substrate is outside the range of-602F(-512C)to 1762F(80K). i QP _ LECTION• IBOO 4 C / \•4`tia�n A-+ .III L ' SprayfaamNauladnn Disclaimer.The information herein is to assist customers in determining whether our products are suitable for their applications.We request that customers Inspect and test our products before use and satisfy themselves as to contents and suitability.Nothing herein shall constitute a warranty,express or implied, including any warranty of merchantability or fitness,not is protection from any law or patent infringement. All patent rights are reserved. The foam product is combustible and must be covered by an approved thermal barrier.Protect from direct flame and sparks contact. The exclusive remedy for all proven claims is replacement of our materials. DEMILEC(USA)LLC° 29256 01 nd Unve Arlington.-1 X 76011 SEALFcfibN"`00 Technical Data Slieet 181:7)6-10 490CI phone 1 877 UEMILEC(336 4 321)toil 4rop• t 1?I 633 21CO"ay Rev lciji)9J09 wi4:4 LM?ITII?PI:uSA r,<oin Infe 'iDerr:ilo_USA<�,-iin r NO2°31'12"Y4 N00°3616"YV N01°46'12"W'E 45.51' 62.52' 92.50' 338.12 51DE LOT LINE AREA = 5.52 AGRE5 UPLAND 2.46 AGRE5 WETLAND 341,875 +-5QUARE FEET TOTAL ZONING = RF-1 RE51DENTIAL D15TRICT DEED BOOK 10661 PAGE 26 A55E55OR5 MAP 279 DATE PARCEL 18 v4s1oN DATE 4-21-11 4-22-11 w + 5-23-11 z - J w w Z z A "- 91 + 2' EXTEN510N EXI5TING KITCHEN STRUCTURE TO 111 = BE RAZED ABD REBUILT. F— 4'-2" EXTEN51ON -� 241' ° #2910 MAIN Z t� w o Z � GARAGE - � ua Q Q J 51DE LOT LINE `r 212.45' V +, ... ....... 13.34' W 125.'10 51TE PLAN � o Dwg. No. rA 4 1 1 - PE 0 -H'EA5T A h b . 3 - 6'-4" W02 W04 W041 IIIIIII IIIIIIIIIIIIIf Wr0=2 IIIIIII 11I1I1111 � - R�QQEV 15O~J' IO N - DATE 4-21-11 4-22-11 2-3" 5-23-11 RANGE/HOOC - - - D LE51NK Irl - - - 2'-4" B4 33" FULL GAB. 4-28"X 72" 5KYLIGHT5N I I w � Lu `' SMozk vier DI INOROOM COFFEE MAKER 5TON FLOOR TILE OVER GONGR E 5LAB ITH RADI \ 4'-2" 11I1 EAT NEW ADDITION EX15T. DH WINDOW TO BE REMOVED INE OF EXISTING KITCHEN 1 AND STORED AT OWNER5 DIRECTION. EXTERIOR WALL5 TO BE REMOVED. - INFILL OPENING WITH 2X4 5TUD5 AND N 1 FIN15H MATERIAL5 TO MATCH EXISTING EXISTING DH WINDOW AT B REMOVED. INFILL TO MATCH ALL JUN 5URFAGE5. 5URFAGE5. 1 N EN 17TCHEN FLOOR PLAN Dwg. No. J W VI51ON TE 1-112-11 3-11 O ~ i �7_ -ILILIL w E I TI _ [i i ffl��l -1 t v L 4- i NEY�- CON °FOIE-f�DAT.ION hNALL o o � to 4-2 LINE OF EXI5TING KITCHEN TO BE EXI5TING T NEW ADDItION REMOVED _ NEW ADDITION EXI5TING TO RE 0 REMAIN 'T �. �T - - - - - - -T- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --� Dwg. No. 3 NE5T ELEVATIONSCALE: 1/411 EXI5TING MAIN STRUCTURE TO REMAIN. EXI5TING GABLE END WALL BEYOND TO REMAIN-NO WORK REV15ION DATE 4-21-11 4-22-11 NEW SHED ROOF WITI 5-23-11 5KYLIGHT5 AT NEW KITCHEN EXI5TING TO REMAIN ` EXI5TING SHED ROOF BEYOND TO REMAIN-N, WORK .5 EXI5TING TO — Z REMAIN CEDAR CLAPBOARD O Q W Q J E ISTIN T RENAIN — N N _� _ - N to I � sz— EXI5TING TO EXI5TING TO BE EXI5TING 2-0 TO EXI5TING TO REMAIN REMOVED BE REMOVED I REMAIN O NEW KITCHEN I ADDITION +2' I = CV I .- - - - - - - - - - - - - - - - - - - - - - - �- I I Dwg. No. t - - - - - -B - - - - - - - - - - - - - - -` P� -,-A- . 4. 4 OU Y T I O N 56ALE: 1/4" =V-01, NINDON 50HEOULE NUMBER QTY FLOOR SIZE WIDTH HEIGHT R/O DESCRIPTION W01 1 1 36311AW 42 " 41 " 43X46 1/2 AWNING W02 2 1 211311 AW 35 " 4-1 " 36X45 1/2 AWNING W04 2 1 19311AW 21 " 47 " 22X48 1/2 AWNING DOOR SCHEDULE NUMBER JOTY I FLOOR I SIZE lYqlDTH jHEI6HT R/O IDE50RIPTION. REV15ION D02 1 1 1 1606b EX 172 lbo" 73X81 1/2 EXT. 5LIDER-6LA55 DATE 4-21-11 4-22-11, 5-23-11 GAB1NET SGHEDULE EX15TINCGBUILDING CABINET SCHEDULE NUMBER QTY DIMEN51ON5 HEIGHT DESCRIPTION C01 1 12X12X30" 30.. WALL GAB G02 1 12X24X36 36." BASE GAB CO3 2 15X12X30" 30 .. WALL GAB C04 1 15X24X36" W. END BASE GAB CEDAR CLAPBOARD G05 4 18X12X36" 361, BASE GAB 5/4"X 7" CORNER BD5. C06 2 18X12X36" W. PEN BASE GAB C01 1 18X18X36" W. BASE GAB GOS 1 24X12X15" 15.. WALL GAB Z C09 1 24X12X30" 3011 WALL GAB G10 1 36X12X30" 30 .. WALL GAB Z {— G11 3 24X12X36" W. BASE GAB G12 1 24X18X36" W. PEN RAD BASE GAB C13 2 24X24X36" W. BASE GAB Q Lu 614 2 30X24X36" 361, BASE GAB Q J C15 1 33X24X84" 54" UTIL GAB G16 2 36X24X36" W. BASE GAB GONGRET FOUNDATION C1l 1 18X18 1/16X36" 36 " BASE GAB C18 1 45X21 5/SX36 " 36" BASE GAB C19 1 25 13/16X1 X32" 32 " BASE GAB I 7-0„ C20 1 36X27 5/16X84" 54 " UTIL GAB j C21 T-1 15X24X36" 361, BASE GAB G22 1 142X24X36" W. BA5E GAB N L NORTH ELEVATION 5 � � o 5 GAL E : 1/4 = 1 -0" = cs c� Dwg. No. EXI5TING TO EXI5TING TO REMAIN BE - ASPHALT 5HINGLE5 ON 51b"COX ROOF DECKING (4)5KYLIGHT5 2b"X'12" 2X12 @ lb"O.G. • 12" LINE OF EXI5TING KITCHEN/ _ .5 BUILDING TO BE REMOVED IGYNENE OR EQUAL EXI5TING KNEE WALL AND FOAM INSULATION R-50 ROOF TO REMAIN 2'-b" EXI5TING SECOND FLOOR REVISION 5Y5TEM TO REMAIN DATE 4-21-11 „ 4-22-11 5-23-11 TOP PLAT TOP PLATE No TOP OF V4 N00loN VAPOR BARRIOR,2X4 FURRING @ 16"O.G. WITH-1X 6 r/ T&G BEAD BOARD-PAINTED NEW KITCHEN /r EXI5TIN6 WALL TO REMAIN � N O III H t- 2Xb 5TUD WALL @1 b"O.G. NEW STONE TILE FLOOR OVER 1" MORTAR BED CO 1/2"COX PLY. 5HEATHING CEDAR CLAPBOARD NEW b" CONCRETE 5LA6 WITH RADIANT HEAT Z R•t5 kt4sul- mw eje�Qj b" COMPACTED CRUSHED GRAAVEL FILL FIN, SLAB EXI5TING FLOOR 5Y5TEM Qlu 2-2X6 P.T. 51LL,BOLT D ON SEALERlo 2" RIDGID INSUL. -11 = e: :E =1°I I=1 11=1 11=1 I =1 I =I I 1=1 11=1 I 1=1 I =1°I =1 I =I I 1=1 I =1 I EXI5TING FOUNDATION WALL b" POURED GONG. FOUND. — — — _ _ _ _ _ _ — — m WALL I—III I1 I—I I—I 1 I—III—I I I-1 11-1 I I—I I I—I I I—I 11-1 1 11 11=1 11 COMPACTED GLEAN FILL —III=1 I lEd 1=111=1 11=111=1 I FE1 11=1 11=11 I—I I 1 -4- #4 REBR TOP AND BOTT 11 I IEEI I M 11-1 11 1 I 1 1 I —111—I I I-111—I 11-1 —I I I—I I I III=1 I I=1 I I=1 11=1 I I 1=1 I I 1=1 1=1 11=1 11=1 11=1 I I—III—I 11=1 11=11.1=1 11=1 11=1 11=1 II— I__ - �- = I 1=1 I I—III—III—IIII 11=1 11=1 11=1 11=1 11=1 11=1 I I I i 1=1 i 1=1 i 1=1 i 1=1 i I . 1= 11=1 11=1 11=1 11=1 11=1 11=1 11 1 I 1=1 1=1 I I-1 11=1 11=1 11 EXI5TING TO _ EXI5TING TO REMAIN -� BE RE-BUILT _ � o ca 2N (A-kBUILDINO !BGTlON Dwg. No. 6 5GALE 1/411 26-4" A b REV 15IO N DATE 4-21-11 Q � 4-22-11 r 16" W X 12" DP. CONT. GONG. FOOTING WITH I 2X4 KEY ON COMPACTED GRAVEL FILL I I UNEXCAVATED-F CONCRETE SLAB WITH RADIANT HEAT OVER POLY VAPOR BARRIOR ON 6" COMPACTED GRAVEL FILL OVER EXISTING CRAWL GLEAN COMPACTED FILL 4 I O SPACE I I < LU EXISTING GRANITE BLOCK WALL TO REMAI I - I EXISTING CRAWL SPACE � 'ca b � � . � o c� 2N FOUNDATION PLAN Dwg. No. 50ALE :, 1 /4" = 1 '-011 1 rA b 3 6'-4" 18'-b" 3'-7" G TI51ON DATE DATE 5 _ 4-21-11 4-22-11 5-23-11 O p 21_ — cV � I r HP — I � 2'-4" I r- O O 3 I ® 4 5KYL r5 I I B I ' _ I I — W I I A - AJ 2 1 FTER 6 Qfi'G. - I 1 @ I 4' „ I h Iry N U) O b ROOF FRAMINC PLAN Dwg. No. SCALE: 1/4" = V-0" FOUNDATION NOTE-5: 1. FOUNDATIONS SHALL BEAR ON UND15TURBED NATURAL MATERIAL HAVING AN ALLOWABLE BEARING PRE5URE OF 4,000 P.5.1. 2. EXTERIOR WALL FOOTIN65 TO BE PLACED ON NATURAL 501L AT'A MINIMUM DEPTH OF 4'-0" BELOW THE LOWE5T ADJACENT GROUND SURFACE EXPOSED TO FREEZING. 3. BACKFILLING AGAINST FOUNDATION WALL SHALL BE DONE ONLY AFTER WALL5 ARE BRACED TO PREVENT MOVEMENT. 4. BACKFILLING IN51DE THE FOUNDATION WALL5 WITH APPROVED STRUCTURAL FILL PLACED IN 12" LAYERS AND COMPACTED TO q5% DEN5ITY AT OPTIMUM M015TURE CONTENT A5 DEFINED BY A5TM 01,557 METHOD D. 5. CONCRETE WORK SHALL CONFORM TO THE LATEST EDITIONS OF BUILDING CODE REQUIRMENT5 FOR STRUCTURAL CONCRETE (AC 315) SPECIFICATIONS FOR STRUCTURAL CONCRETE FOR BUILDINGS (ACI 301) AND STANDARD SPECIFICATION REV1510N FOR COLD WEATHER CONCRETE.(ACI 306.1) DATE 4-21-11 6. CONCRETE SHALL BE NORMAL WEIGHT APPROVED READY MIXED HAVING AN ULTIMATE COMPRESSIVE STRENGTH OF 3, 4-22-11 OOOP.5.1. AT 25 DAYS EXCEPT CONCRETE FOR EXTERIOR SLABS AND WALKWAY5 SHALL HAVE COMPERE551VE STRENGTH OF 4, 5-23-11 000 P.5.1. AT 2b DAYS. 7. ALL EXTERIOR CONCRETE FOUNDATION WALL SURFACES TO WATERPROOFED WITH RIGID INSULATION MAT AND MASTIC COATING INSTALLED PER MANF. INSTRUCTIONS. 5. RETAINING WALL5 AND FOOTINGS TO BE CALCULATED BY A STRUCTURAL ENGINEER. FRAMING NOTES: � ���(� 2b Me1 r lf0 �1e �xPoS�Q�� G�i� ft� 1. ALL FRAMING LUMBER SHALL BE HEM-FIR GRADE NO. 2 OR 5PRUCE-PINE-FIR GRADE NO. 2 OR APPROVED EQUAL. (UNLESS OTHERN15E SPECIFIED)AND SHALL MEEET THE REQUIRMENTS OF AMERICAN FOREST AND PAPER ASSOCIATION. THE MINIMUM ALLOWABLE BENDING 5TRE55 (Fb) SHALL BE 875 P.5.1. THE MINIMUM ALLOWABLE COMPRESSION 5TRE55 Z (Fb) SHALL BE 400 P.5.1. THE MINIMUNM ALLOWABLE MODULUS OF ELASTICITY (E) SHALL BE 1,400,000 P.5.1. OTHER FRAMING MATERIAL FOR INTERIOR NON-LOAD BEARING 5TUD5 MAY BE SUBSTITUTED. 0 ~ 2. ALL PRE5URE TREATED DIMEN51ONAL FRAMING LUMBER SHALL BE SOUTHERN YELLOW PINE GRADE NO.2. THE MINIMUM ALLOWABLE BENDING 5TRE55 SHALL BE 1,050 P.5.1 .THE MINIMUM ALLOWABLE COMPRESSION 5TRE55 SHALL BE 565 Q H P.5.I.THE MIN. ALLOWABLE MODULUS OF ELASTICITY SHALL BE 1,600,000 P.5.1. Q 3. ALL LVL'5 TO BE GEORGIA PACIFIC OR EQUAL. THE MIN. ALLOWABLE BENDING 5RE55 SHALL BE 2,g00 P.5.1. THE MIN. ALLOWABLE COMPRESSION 5TRE55 PERPENDICULAR TO THE GRAIN SHALL BE 750 P.5.1. THE MIN ALLOWABLE MODULU5 OF ELASTICITY SHALL BE 2,000,000 P.5.1. 4. ALL FLOOR SHEATHING TO BE TONGUE AND GROOVE STRUCTURAL GRADE FIR PLYWOOD. ALL EXTERIOR WALL5 TO RECEIVE 3/4" STRUCTURAL EXTERIOR GRADE FIR PLYWOOD . ALL ROOF SHEATHING TO BE 5/8" STRUCTURAL GRADE FIR PLYWOOD. ALL HORIZONTAL JOINTS TO BE BLOCKED WITH 2X6 ON EDGE. 5. ALL INTERIOR STUD WALL5 TO BE 2X4 MINIMUM @ 16" O.G. UNLESS OTHERN15E NOTED ON THE PLAN. 6. PROVIDE ADEQUATE WALL RESISTANCE TO RACKING BY INSTALLING DIAGONAL CORNER WIND BRACING ANCHORED TO p� N L SILL PLATES. •to 7. PROVIDE SOLID BLOCKING BETWEEN FLOOR JOIST AND DOUBLE ALL J015T UNDER WALL PARTITIONS. b. USE FULLY NAILED 51MP5ON O R TECO METAL CONNECTORS SUCH AS JOIST HANGERS. CORNER BRACING AND TIE (Z/ •� DOWN5. q. ALL PLYWOOD FLOOR SHEATHING TO BE GLUED TO SUPPORTING WOOD MEMBERS U51NG AMERICAN PLYWOOD .� ASSOCIATION GLUED FLOOR SYSTEM -PL400 CONSTRUCTION ADHESIVE OR EQUAL. (a 10. ALL WALL STUDS TO ALIGN WITH FLOOR JOISTS AND ROOF RAFTERS. = N "11. ALL BUILT UP LVL BEAMS TO SHALL BE GLUED AND THRU-BOLTED WITH 2-1/2" DIA. BOLTS (ONE TOP AND ONE BOTTOM) @ 2'-0" O.G. Dwg. No. 12. ALL NAILS, FASTENERS, AND CONNECTORS EXP05ED TO THE WEATHER FOR ANY PERIOD OF TIME INCLUDING CONSTRUCTION SHALL BE HOT DIPPED GALVANIZED.