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0500 OCEAN STREET (5)
SAD 6,-G"qA1 S r r l TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION BUILDING DEPT - Map Parcel 0 40 Application f Health Division APR 2 2017 Date Issued Conservation Division TOWNOPBAPNSTABLE Application Fee Planning Dept. Permit Fee f Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis. Project Street Address q,l Q ©C ,,k SEC ?J6 Zsµ/ t 6D Itl'o S Village `� tlt�t.�S OwnerJJ&Y k sybneA Gk4tx:*f� Address Z?j GY1 V4 Telephone _�ol'l Zl 2 1 Z5,G Permit Request tG1 w_.& �v`t . C. -r'aLeyt�`t@�:' "VTA L Square feet: 1 st floor: existing proposed O 2nd floor: existing100 proposed 0 Total new 0 Zoning District P.-lb Flood Plain Groundwater Overlay Project Valuation 21 ,, Construction Type Lot Size 0 Grandfatherec: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)*,CWMJ't 4,LS �eKyL�,o Age of Existing Structure 4-t Historic House: ❑Yes M-No On Old King's Highway: ❑Yes 0-No Basement Type: ❑ Full &Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) O Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing a new Number of Bedrooms: S '" existing 0 new Total Room Count (not including baths): existing Ja"_ new O First Floor Room Count 3 Heat Type and Fuel: &-G'as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Cg1N-5- Fireplaces: Existing New ® Existing wood/coal stove: ❑Yes 'i-Ne- Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial n❑Yes ® No If yes, site plan review# n- Current Use ��c Proposed Use 2�a->WC-Q> APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S�[N'Pts i l AeVA4 1P4�s Telephone Number Address 5O!t SXMAJIgS� Vttu.- R-�> License # cs - 0352-61 6,�,w)&WLU_6 RA O�'-"7Z Home Improvement Contractor# (:Us+ Email 5"G_D6WeS DtyP_,S &, 4M8"AVL_ QgWorker's Compensation # 1i, �A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO E 11655 SIGNATURE DATE 4 1 Ad 1:7 �V FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. . 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City orTaw 6.Mar Cact�ersazc Phana•g: .. 1 ■ m ` 1 i ��■■ i � � ■ S' � ■■ y ` i • , ' � v � . � ■ �1 ■ � � r it • S i 1' \ r � . ■ � • S i ti 1. � - = - ■ l � � '1. �1 _ >• 1 \ 1• � 1 .. � � • ' � • � - G � = � i e = 1 e 4 + ' 1' s \ ■ 1, S • . • _ � � • ■ � � ■ it � m .� � �• ■1 � i 1 ■ � it i i i \ j ■ O i _ r _ f ■ � ! '• 5 � a � e .. i • ■ v • �� � • � • 1 1 ■ • • ■ 1 • • ■ • ■ , � ■ m � ` 1 1' m \ Ir \ ■ _ - _ s • 1 ._ � i ` 1 ! - z f. � i ■1 � n � 1' C I � ■ wl 1 J p - ;� = t - . _ s ■� � � • i i ` = - — � - � 1 • AWC Guide to Wood Construcfian in High Wind Areas:110 mph,[Hird Zone Massachusetts CheckMt for Compfilaace(790 C)4R 5301.Z.1.1:)1 - � -C1 cbesk COMPHEMC 1.1 SCOPE WindSpeed(3-sec,gust).._._.. »....._. _.____..................._.......__.»..»._..»...._.._..__»... ».110 mph Wind Exposure Category 12 C ILITY APPLI AB Number of Stories . .» .._ _.._._.» .. __...»..._ _.»(Fig 2)..............___ stories 5 2 stories Roof P'rtof[ ». _ _.__...._ _.__...... _.»..._. »_. .(Fig 2).........._. ...._ ._.._....... 512:12 , Mean RoDf•Height _ ...........Fig 2)- _..___.:.._.__ : �.._». ft 5 33' Bulking Width,W.._ .__. �___._»..__ {Fg 3}, »_____W_.. ,�» _ft 5 80' Budding Length,L ......... _».._..................___,(Fig 3). ........_. _ _..» __. _ft 5 B0' ' Budding Aspect Ratio(IJW) ___. _. _. ._._ _..».(Fig 4).._...... ». _ _._.. . ._._ <_3.1 Nominal Height of Tallest OpeningZ_..._.».. .:,:_ .. �_:(Fig 4).—_:._..... _ 1.3 FRAMING CONNECTIONS. General compliance with fanning connections.____,.....(Table 2) 2.1 FOUNOATiO.N . . FoundaBon Walls mEet g requirements of 730 CMR 5404.1 Concretai_ _.._._.............................................. ...._.__..............__ .. ._......_......_.......----•• Concrete=Masonry............................_....._. ___.. ._......___._____..._.: ..._.._ ...» _. �... 2.2 ANCHORAGETO FOUNDATiONt'a 5/B',4nchdrBotfs imbedded or 5lr Propriefary Mechanical.Anchors as an aitematfve in concrete only . Bolt Spacing-general ..... ..»»» .(Table 4}:_._.»..»....._»..» _: _.. in. Bolt Spacing from•endfjolnt of plate » ...._..__»...,.»,(Fig 5) ».___..___._........ in.5 6'-12" Bolt Embedment-conaete.�.__._ _ .._...(Fig in.y 7" Bolt Embedment-masonry.._. _. _ _.(Fig 5). _ .__..._.._--- irl.z 15"- Plate Washer.-_. »... _. :....»..__._....... _(Fig ...... _..».._2 Y x 3"X'/." 3.1 FLOORS Floor flaming member spans checked ....._..__:................(per 780 CMR Chapter 55).._.____._...................... Maximum Floor Opening (Fig 6).__._:..:_..... ft s 12'or 1J2 or W12 Full Height Wall Studs at Floor Openings less than T from Exterior Wall(Fig 6)..................... :..........._ . Ma)dmum 1=1norJolst Setbacks Supporting Loadbearing Walls or Shearwall..............(Fig 7).__�_..._:r....»_.__.._..._._._^tt 5 d Mabmum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig B)......................__..._................. ft 5 d Floor Bracing at Endwalls........................_. ..........--.(Fg 9)..._...._.... _. _....:....»......_» _. _. Floor Sheathing Type »..._...».......».......»..._-._.......».._.(per 780 CMR Chapter Floor Sheathing Thickness (per 780 CMR Chapter 55)....................T in. Floor Sheathing Fastening___ __......._ ...:»_:.. _.• » ,,(Table 2)__d nails at_in edge/—in field ' 4.1 WALLS Wall Height _ Loadba=aring walls, __.. . .._..__...__.. .»._ (Fig 10 and Tabfe•5). ...__......._,_ ft s 1,0' Non-Lc adbearing walls»» ._.._..»_. .... ..._..... (Fig 10 and Table 5). _.._.... _ft 5 20' Wall Stud 5padng _»..... - __».. .. '.(Fg 10 and Table 5). _._.__........_in.s 24"o.c. Wall Story Cf"tsets . .»_. ...... ».. ............_._.' .(Fgs 7&B)_._......._....»_.. . ft 5 d 4.2 EXI- 7JOR WALLS3 Wood Studs: Loadbearing walls _».»...._.»_ ._............._-_»_. Jable 5).._....-...... Non-Laadbearing walls»._:_._ _.. ......:._.__,(Table 5).__»_»__.__..__Zx _ft_in. Gable Fnd Wall Bracing Full Height Endwall Studs (Fig 10).....__......_.._....»...........»_ _..:.._ ....... WSP Attic Floor (Fig 1 i)_..._..... _ „. _.... ft>W/3 Gypsum Calling length(d WSP not used).. (Fig 11).._ .._.».. ».__ __ _ft 0.9W _2 x4 Continuous Lateral Brace Q 6 it.ox,_.(Fig 1 ............ Double Top Plats Splice Length ...... - _._._._ .»... ,(Fig 13 and•Tabie 6) ......... _.._. _ft Splice Connection(no,of 16d common nails). (Table 6}. _„ _-........_._�.. A WC Cuzde fa Wood Cottsfrur-d0:n in H191t W rnd Areas:ll0 -Ph Wind Zone Massachusetts Checklist for Compliance po't_-mu 53oi_-M)1 Loadbearing Wall Connecoons Lateral(no_of andnalled 16d common nails).._-.._.._-.{Table 7) �_._._ -- - _-•.•- ••.. — Non-Leadbsaring Wall Connections Lateral(no.of endnaffed 16d common nals).-(Table — Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ._ �__ _ ....._._ (Table 11' — Sill Plata Spans __ _ -. .(Table 9). !_ .._. _..__... _ft_ln.s 11' Full Height Studs (no.of studs)_-. __ _.. ,.__._ (fable 9). _ .._.___ ..._� ._._. compliance to Table 9 . Non-Load Seating Wall Openings(record largest opening but check all openings for p ) ft_in.512 Header Spans-;- Sill 5 ns_:_ Sill Plate p ..Spans. .. ._ .... ...-__.--(Table 9)_...... ___._._ .. _ft_in.!;12" Full Height Studs(6o,of studs).; -..(rable Edetior Wall Sheathing to Resist Uplift and Shear Simultaneously+ Minimum Building Dimension,W Nominal Height of Tallest OpeningZ s 6'B' Sheathing Type.----------(note 4)..�_..__._... ._.... _ Edge Nall Sparing_ .. '-.----•.-_-••-.-.(Table 10 or note 4 if -. Field Nail SFadng__. __ .._ .._..:...._ _ ...(Table 10} Shear Connection(no.-of 16d common nails)[Cable — PercentFuM•ieightSheathing - 5%Additional Sheathing for Wall with Opening>6V(Design Maximum BuldingDimepsion,L Nominal Height ofTallest Openin _...__ ..........................._._........._....._.._.. <6'a' — Sheathing Type.-__... ._._ _-..__._(note 4)__.___.______..._._.._ — Edge Nall Spacing (Table 11 or note 4 If less). —in. _ Feld Nail Spading_._._ _...._.._.._. _ (rable 11). ». _. .____.... ___._ in. _ Shear Cohne�on(rm.of 1 Sd common nails)(t-able 11). __ --•- -- — Percent Fuli-Helght Sheathing.__.... (Table 11). __._ _ .. .._.--••.-- �. _ _% _ 5%Addrfional Sheathing for Wall with Opening>Va"(Design Concepts)-- Wall Cladding Rated for Wind Speed?......-._.. _....._.._. ____ _..__....._.._. ..._. - - • - - __... _ 5.1 ROOFS Roof framing member spans checked?._._,. _ _(Far Ratlets use AWC Span Tool,see MRS Website) _ Roof Overhang ,---.1.............._...........(Fgu fts smaller of2'or Truss or Rafter Connections atLoadbearind Walls Proprietary Connectors Uplift.___ ...___.____ (Table U=_pif Lateral _. .. .__...._..(Table 12)._.__. _-.._._._.. _...L- Of — Shear.. . _..__. . _.(fable 1 Z)____. __ _.... _._S__pif — Ridge Strap Connections,If collar ties not used per page 21:.-:.(rable 13)._.w.....__.._-..._.T plf Gable.Rake Outfookar._-._.._----------------------------(Figure 20)...:._..---__fts smaller of Z orL12 — Truss or Rafter Connections at Nori-Laadbearing Walls Proprietary Connectors Uplift-.._._... Li= lb. — Lateral(no.of 16d common nails)-(Table 14)................................ � — Roof Sheathing Type______.._________._.._--...(per 780 CMR Chapters 53 and 59).'................. Roof Sheathing Thickness in.z 7/1 W WSP — Roof Sheathing Fastening Notes: 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to corn ly.whfi the requirements of 780 CMR 53o12.1.1 Item 1.If the checklist Is met in its entirety then the following metal straps and hold downs'are not required per die WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. .20 Gaga Straps per Figure 11 C. Uplift Straps per Figure 14 d. • All Straps per Figure 17 e. Comaw•Stud Hold Downs per Figure 1 aa.. 2_ Excep0on:Opening heights of up to a f.shall be permitted when 5%is added to the percent full-ftefghtsheathirig requirements shown in Tables 10 and'11. 3. The bottom sill plate in exterior walls shall be a minimum 2,in,nominal thickness.pressura treated#Z-grade. X T C GeLL-fa Hro od CvnT i'rrcdDrr fir 1�,)r KE d Zr=�11 rit f3fraz� fl Fz� x . . YLqsgachusatts Chid for CompHan.ce ua crTR53Di2�Ti)` - a. Fj=n Tables i[ and�d and ior�on ofrt�allsf� g and du�g,4�perPMa.chine Pen tFuf�Heigi . Shmi$rkig and hl7 wing - �- •Wood 6lrur.Lnal panels shall be mi fm3=Ndm—of7fi 5`and be d as fan i, . Panels shalt be bnsdaIIed Wt simt7gffr azrs parallel fn I Al h=im�joints.stall orstir aegis and be;n aned b franimg M. Dn single siDiy mrmturfmii,pis shall be armed ID bDdDm pis and fnp•imar b oFihm dmbL- iv r�1,hm,sfnry rich r irfid YI�rmrar�rr�n���e ci��IT fug fD$l fnp uie�tlb�'of$ieupper dovbIE#la}�= - phia and b band joist at bofbm of panel Uppetmffadw „f of Iowa pail shalt be made In band joist and lo�verat�e marfein lowest pb at tirsf $oorfrarning. ' v. Idnrmc�i rrall spa=g at dmk&-IDp pla!,lmmd,jo'rsi and gods shall be a double tow of!�d - sbr�gr d 9 3 WiE s on rmh!r per f gt�below--Verimd-and 13rnimrfbi NaM g fnr Panel Af z h erit. Gbaing pmfecB=a)tied house ff prajecfk t mile orrioserrb shore[g=aralfy,with of Rfe 2S orrsorih of Fib 6} b)ire Sml addmon—naf retpYed mil ffieam is rm7i;vgorl in i ie fast ilmr cj reptaramer twBdows—neds energy oorp=vk5m wmpZ ihm oriTy(chap 33) ' rL Wood Fiam a CpmtU dion Va%ial MFC 4 fhr i in MPH(Fxpasm-a S may be ohMmed finm1he Arnerirzhi Vi►ood Cc>unral _ • u I I _ _ - • sr Lk tL u t [ ii it. q i it ' - F Li tl Q [ ► - a c �L i rr rr c r . r La R L c Ir Ct c --t( 1i ' C7if •� �, [ AtsF�i�tJ'iTKtT - t L 9-1Pd rc iL •r } - l E • LI[ [i l l LF , l L a ii PHEZ: c l r � . -I[ rt 1 -_• F� i Fr't��. •� f�1r.L�t7bR R�'�i�� • _ ` See-DafrZ qn 9�1 Rage • -lr�t�caI snd Hor�rrlat l�Ta-rg , Va-R�>3nd I-f�r3�I hfar7mg• -. • fir l?Wv-4 Afhlcfm� 1bE P�TeI liffF[rJ�rnwif _ Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis,MA 02601 DATE �.RE: Unit_a� Yachtsman Condominium Trust, 500 Ocean Street,Hyannis To the Town of Barnstable Building Commissioner, The Board of Trustees for the Yachtsman Condominium Trust voted and approved the attached proposal to be performed as is delineated in the request we received from the Unit Owners. Contractor, mwiVIA S has been contracted by the Unit Owner to perform the work a, defined in the proposal. { This letter serves as notice of the Board's vote to approve the proposal,which has been noted in the Minutes of the Board Meeting. Signed Under the Pains and Penalties of Perjury this CU.day of_ _; 20f 1 ecre to;r�dof rustees man Condominium Trust 500 Ocean Street(c/o Manager's Office) Hyannis,MA 02601 Enc./File i �t • of .Town of Bimstable Re golalyory Services MAM Richard P.Scab,Director Building Division Paul Roma,Bugdhg Commissioner 200 Main Street Hyamus MA 02601 ' www.tombarnstable.ma us Office; 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section . If Using A Builder I,.s�0�1� COLS I t p&M ,as Owner of t-he mbject pxoperiy hereby mtharize Ste'iatj9;tA,_tj6MJ1.1I3 to ac-t on say behA in in nzattcts relative to work auth-orized by this building peimit application for: (Address of job)' **Pool fences and alarms are the responsibility of the applicant Pools are not to be BR6d or utilized before fence is iastaIled qnd all final . inspections are perfo=ed and accepted. , . iaya rri�awce- • • . V Ssgnatore of Owner Signatate ofipPliran} Jay. Guido"nefrs Print N=e Print Name ` Date ' �FORMS:OW2�RPERMISSIONPOaIS i 4 Y k I Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR° Type: Individual Registration Expiration 168054 12/08/2018 Stephen Mathias Stephen Mathias 304 Strawberry Hill Road Centerville, MA 02632 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-035267 - Construction Supervisor q STEPHEN F MATHIAS 304 STRAWBERRY HILL-ROAD CENTERVILLE MA 02632•F- CA-- Expiration: Commissioner 08/26/2017 1 n' M C20V BUILDING o o �`� APR 12 2017 OF f3ARNSTABLE tT- � d V I f - c� u1 - f ® G O �V le LE�� N be ry I Stu TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /1 Parcel V Application # t Health Division Date Issued ^�G Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hya' nis Project Street Address ec,v c2 Village Owner ���,�. c. �o G sa Address 3 v-1 C�- Telephone' Permit Request 5m sX4 e- l CaA J- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �-- Telephone Number ��? b ��`i c) Address Atve�, -V\ 0 License # , QX 0'7_()�2 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTR CTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IGNATURE DATE b �i FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER e DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. =may Town of Barnstable Regulatory Services pMASS. Rich wd V.Sm ,nrecmr Building Division Tom Perry,Building Conmissioner 200 Main Strut Hyannis,MA 02601 www:town_barnstable m&us Office: 508-862-4038 Fag: 508-790-6230 Proper..y Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize - �G �.: to act on mybebA in all matters mktive to work authorized bythis budding pem it appI nation for. , (Address of o ,`Pool fences and alarms are the responsibE7of the applicant.Pools are not to be filled or uidLed before fence is installed and all final inspections.are peifoaned and accepted. S f Signatme of Applicant Print Name Print Name Date . Q:Foxn�s:a�Ean�ssmr�oors • Town of Barnstable Regdatory Services sip r ov Richard �V.S Director ofy� . . b+ $�dTIIg�TYISIUri . Tom Perry,Bu7dmg Commissioner 200 Min Street Hyannis,MA t]260I �m W YV YVAown.barnstable:ma_us Office: 508-862-4038 Fax: 508-790-5230 HOAMOMMR r UMNSE 71")N . `� .Plezco Print DAIS: JOB LOCATIOI�L- \ . nnmbrr shin �agc moot - bomephonc# wo3cp&onc# CURRENT MAM3XG ADDRES S: may/ sty rip codc The current exemption for`homeowners" ext�ndad include owner-0ccnpied dwellings of s�units or Less�d to allow homeovrners to engage an individual for who does tpossess a license,provided that the owner acts as stperyisor__ D ON OR EIMMOwBTM P mon(s)who ogres a parcel of land on which. els resides or intends to reside,on which there is,or is intended to be,a one or two- fami7y dwelling,attached or detached strnctores ssory to such use and/or farm shructraes. A person who constructs tgore than one home in a two-year period shall not be `� . homeowner. Stich`homeowner"shalt sabmitto the Bml�Official on a form acceptable to the Builcimg Official,thathedAb a onsible for aII such wozic ezformed tmderthe ezmsit (Section 109.L1) The umdersi ed"homeowner-Man: responsiloy fo comp er='ceittfiesliance wrtiitbe State BmZdmg Code and other applicable codes, bylaws,roles andregulafi�+s- - The unaemsig ned`homeown thathelshe un mgtands�$le Town of$ams•6ble Building Departments inspwdon pmcedrn es and reguaements that helsha Will comply with sal proaedm:es and reqniemen±s. Siguahua ofHomeow= Appmval ofBmldingOfficial Note: Three family dwa ings conforming 35,000 cubic feet or larger wMbe regrmed to coruply with tha State Building Coda Section 127.0 C mnstru.cdon Control HOMMOWXMIS EXE3IrMN The Code states that: 'Any homeowner performing work for which a buMl ag permit is required shall be exempt from the provisions of this section(Section 109-U-Licensing of construction Supervisors);provided that if the homeowner engages a person:(;)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are uaaware.that they are assuaning the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Lic nSing Construction Supervisors,Section 2.15) This Lark of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this rase,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible: To enslm a that the homeowner is fully aware of hWher responsibrTit es,many communities regaire,as part of the permit application,that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last Page of this issue is a form currently Tiled by,several towns. You may rare t amend and adopt such a form/certificzflon.for use in your community. " Q;AWPFME9TOtizWrCIb��ri�p==ith=)EXF SS.doo Rtvised 06131.3 �� Pt Farm The Commonwealth of Massachusetts nn Department of Industrial Accidents - , Office of Investigations I Congress Street,Suite 100 - s Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): L D Kilkenny Electric Inc Address: 7 Henderson Way City/State/Zip: Medfield MA 02052 Phone#: 508-359-2980 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4 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 tY• 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Norflok& Dedham Policy#or Self-ins.Lic.#:WEND 3831 Expiration Date:03-05-2017 Job Site Address:500 Ocean Street Unit 36/38 E City/State/Zip:Hyannis MA 02610 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 cerfl2 under the eains and eenaltiesofperjury that the information provided above is true and correct. Si afore: . _ ....... Date 02/22/2016 Phone#: 508-359-2980 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#: f V 1 Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis,MA. 02601 DATE , RE: Unit �O Yachtsman Condominium Trust, 500 Ocean Street,Hyannis To the Town of Barnstable Building Commissioner, The Board-of Trustees for the Yachtsman Condominium Trust voted and approved the attached proposal to be performed as is delineated in the request we received from the Unit Owners. Contractor, L--VV, e _ ;c has been contracted by the Unit Owner to perform the work as defined A the proposal. This letter serves as notice of the Board's vote to approve the proposal,which has been noted in the Minutes of the Board Meeting. 2 igned Under the Pains and Penalties of Perjury this ay of ;20 / Secre Board f Trustees Y man Condo .' 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'-�-?_-`� i. '--{ f �-•-t-�--�--'+-r-+-_-+_+-_�--r-_ '+.104_--•*-i--+__.r-r. +--i--+,-•f--y----t- ---t- -+- + -+ -+--t -+_.� -t -•- -+ +-.+-+-y.- - * - -+ + - -t-- -- +--t ' S t 4 r • - _�_, .......... --- , 1 , f 7. T f -1 � r r � E � -T�� - _.+--�—" 1-4 -4-4t , t • i � � i r t 1 r I tt _ , r r r f r 1 7 �- �� -f i -r-- -_-4-_ _ t- H Y I � J I • f } r � , , _ _ ._ ! ... 1 - + -� Y " � � -+ —� +— t— -•+ __ _ t_ r —f � 1 - — r —+ _t i -t + -s --^t , —� , i � I did . r ,aco CERTIFICATE OF LIABILITY IANCE °� `"�/°°"�"'"' ' ... _ _N.W. . : I I . : 2 .2 6 :16 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 CERFI'FICATE'HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must:be endorsed. If SUBROGATIO'N'IS WAIVED,subject to the terms and conditions of the policy,:certain;policies may require an endorsement. A:statement on this certificate does not confer rights to.the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME-.:. Richard Kowalsky. Richard A. KOWalsky. Insurance PHONE 7:8'1 ..::23'1-2:0'2:O FAx No:'(7B1) 231-,2021 544 Lincoln Avenue ADDDRES&d RK@Kowalisk Insurance.com 'P.O. BOX 999 INSURE S AFFORDING COVERAGE NAIC tl Saugus, MA 01906 INSURERA:Norfolk and Dedham Mutual INSURED. INsURERB.Dorchester Mutual L D Kilkenny Electric Inc, LLC - INSURER C: _. 7.Henderson 'Way INSURER O: Medfield, MA 020'52. _ INSURER F: .COVERAGES CERTIFICATE NUMBER: .. REVISION NUMBER: _ _ _... THIS IS TO CERTIFY:THAT:THE POLICIES OF INSURANCE LISTE:D::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 ,I 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 P.OLICY:EFF POLICY EXP LTR TYPE OF INSURANCE D POUCYNUMBER M/DDIY MM/DDIYYYY .. LIMITS A GENERAL LIABILITY R0.309538 .: 3/5/15 3/5/T6 EACHOCCURRENCE $ . 1 000: 000 X COMMERCIAL GENERAL LIABILITY .. DAMAGE TO RENTEDPREMISES ne :! $ 50 000 CLAIMS-MA&E OCCUR MED EXP(Arryone person) $ ... PERSONAL(&ADVINJURY $ -1 000 000 GENERAL AGGREGATE $ . 2 000400 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $. 2 OOO. 0.00:. _ _POLICY PRO-ECT: -.LOC :. .:':. : .$ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT - a accident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED: AUTOS AUTOS: BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE :HIRED AUTOS. -_AUTOS Peraccident UMBRELLA LIAB. OOCUR. .: EACH OCCURRENCE EXCESS LIAB _: r CLAIMS-MACE - _: AGGREGATE: $ !:: DED::' RETENTION$.:...:: B WORKERS COMPENSATION hTEND3831 3/5/1'5 3/'5/16 WCSTATU- XTnR OTH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTNE E.L.EACH ACCIDENT. :: $ 5 0 O 0.0 0 OFFICER/MEMBER EXCLUDED N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 5.0 0:,006 If yes,describe under .. .. DESCRIPTIONOFOPERATIONS.below:: E.L.DISEASE.,POLICY.LIMIT $ ..5.0�0i, OO�O*: DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aft achlACORD 101,Addldonal Re fire its Schedule,Ifl mom space Is re quiretl) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE, EXPIRATION DATE. THEREOF, NOTICE WILL BE 'DELIVERED= IN. - J. Jay Guidone' ACCORDANCE WITH THE POLICY PROVISIONS, . 500 Ocean St' Hyanni MA `02601'. AUTHORIZED REPRESENTATIVE Ramona Kowalsky, ©'!1988-2010 ACORD.CORPORATION. All rights reserved. ACORD 25'2010/05( ) The ACORD:name and logo are registered marks of ACORD - Phone: Fax:: E-Mail!