Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0242 OLD TOWN ROAD
a ya. c�e� �� �� - 4 i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION lP•b f Map �1` Parcel I Application # �' C- 7W, i Health Division Date Issued 6/2-L Ll4 Conservation Division Application Fee Planning Dept. Permit Fee I Date Definitive Plan Approved by Planning Board � Historic - OKH _ Preservation/ Hyannis �vy►µ-pc_ S��" Project Street Address 7C_ (Y Village Owner /�1�Gf ' Address 7Etdw __k� TelephFe Perinig4i s a :C:K; e) Arcl 11r*0 LJ/t/ o 4~7�49 Square feet: 1 st floor: existing !;EZ8 proposed U_y 2nd floor: existing&Q proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation..3 e 0OV° "� Construction Type 6nni. /�G� 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 g No On Old King's Highway: ❑Yes_#'No Basement Type: ❑ Full ,Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 6 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new d Half: existing 0—new Number of Bedrooms: r existing 0 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove.`' ❑Yes ❑ No Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0l newj size._ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: T 1) TOW/V Op - Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ R�STL� Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � Aw _ Telephone Number �� ���`�✓ Address S-3 /�'���� �y License# Home Improvement Contractor# © � / z Email !�, `'' Worker's Compensation # ALL CONSTRUCTION D BRIS RESULTING FROM THIS PRO T WILL BE TAKEN TO GU�sl���O�� JE� SIGNATU DATE �- r 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. l�. _ Message Page 1 of 1 Anderson, Robin From: Anderson, Robin Sent: Wednesday, October 05, 2016 10:23 AM To: 'whalen108@comcast.net' Cc: Anderson, Robin; Lauzon, Jeffrey Subject: Permit/Application: TB-16-2788 at 242 OLD TOWN ROAD, HYANNIS for Building - Addition/Alteration - Residential Please be advised that your application concerning 246 Old Town Rd, Hyannis is missing a site plan/plot plan. We are unable to approve the application without this document. Please provide one ASAP in order to complete the review process. Thank you. �a6ln Robin C.Anderson Zoning Enforcement Officer 200 Main Street Hyannis,MA 026oi 5o8-862-4027 f 10/5/2016 Town of Barnstable $ Regulatory Services NAM Richard V.Scali,Director Building Division. Paul Roma,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 I // ! ,as Owner of the subject property l P Pay hereby authorize [ Z"T- to act on my behalf, in all matters relative to work authorized by this building permit application for. 01� OGC)/2/ (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature o1rowner ignature of Applicant Print Name Print Name Date I Q :FORW:OWNERPERMISSIONPOOIS Town of Barnstable Regulatory Services o�TME Richard V.Scali,Director Building Division t Paul Roma,Building Commissioner MAM 39. M�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": _ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, . bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person 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 this.issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc 06/20/16 F • -d The CoHIT1Ranwe.alth t9fManffdhtmd& DePa 'bwent af cb'idACCIdentr r 600 WaS1z�S red Boston,HA#2111 kv VM Mm=gom1dia Warps& CampensatimInsn-.nceAffidavit: Saffde7jQmftucft -s/Ekctti��ers InfbrmafiGn Please Print .4117 • c���� a• .���j �_ � �'�-Z-By-�s.3 �sre you an employer?�eckthe appropriate bow Ty}}e of grnjeet{regnire�: . I.❑ I oat a employes v� 4.�I eta a general coafz$ctar and I . ' eatpla (fu11 agdfor garb-dime j.* 1sa�e hQedBse sir-cotes � Reza was 2.❑ I am a wle proprietor orparEaw listed omthe atbmhed sheet 7- ❑Ran odermg i ship and have as 1 These sab-ca aftwlars have �P�`� S_ F1 Demolition waridag forme is aqY capaciXy wnplayew andhave worms' [No svaimrs ooazp.iasufaace comp.k++a,ce I • - 9. 0 Buffs mg sdditiau reTLire�] �. We are a cmposatifla and its 10-0 Elechicai repaim or add¢ious 3.❑ I am homeovmer doing all worst offs have exercised fek 1L0 Phmmbkgrepaiss or addii-iams myself[No 'Cep- dEbt of==Pfim per Me- 12 0 Rflofrepaim R=mteereT ired]i c.M¢1{4)�aadwelmeno employees.[NO VO&Ess' 13-0 o&er • �cbeds'�oszlmuste]soffioaftheseciioabeLaas�rasfmgtheawac&ecs'mmP��fi^^poTicgi a— # eoarn�rs�nc�sal�3 ihis>�daridicat�g 8�ey a��am�slE�ra¢Sc atlgxe ausid�coramst svhmitanawa�dt mdica ssic� r ZCar=C1bM*z1dhec1[tYx box m=attad�edsasddiKaIIa2sheetsLoa�gti�e�meoEthe sad state s®rnottbnseer�itiecbxm 043!ayem Iftiamffi{ cshaveeqo9ee&,they=,5rpium&&eir aorkas' .gaIicgtt�bet -Tam tan errcp �er flint is preirrg tvetrkers'casat'art ursrtrartcs jFvr emppb�} Setriw is 7Yts pgliep to jQ�ae irLfiarm¢finn . lasaa e,Company Mine: Paficy 41or Self jM Iio. i�iaa Date Job Site A &v= cifylSlatelz�p Attach a cuff of the work re compensationpoUcy declaration page-(shawkg the policy number and exppn atioa date). Failure to secm-e coverage as required nudes Sec€ioa 25A of MGL m 15 can lead to the imposition of minimal peaahies of a, fine up to$Igor}00 andlor one-geerimgrisoameak as vaell as civil pendfit-a the fom of a STOP WORK ORDER and a fine of up to$250M a day against dlte violator. Be advised that a copy of this rtade*ant may,be de d to the Of of Isvestigatioas of fhe DIA,€ar ffisumce coverage vedfica iaa_ Ida&ersby can* 6ke a fpzrjzuy ihatdie informa€i m prmaW abmw is tree and correct Bate ®� 61 PhC0e 0j Wd aw anly. Do not Wrefe jfi 093 MWO,tar be carnpfete d by city aFrtaii u gjoydat Ley or Ta wn: Per icelm# '=ling arFty(dr&-ow):. I.Hard of$eel I� Department 3.gotta caerl~ 4-mectrical� s- mr C.ac . co�ttac Pecsnn: Mow-9: a 6 1. 1 ■/: r Jif 1.?'.r. - ■� ..:.■ti! �•.0:.- I :3.t1■ .•�.F I• •1 • ■- •••7■1�r. r•ir•.t:!1 :t■•n in [• ■ �irtlr • r 'n •.nl u u t. r.Init .n �..+ � • m�. a ' . Yi II / r j ■i7[./�• -1. .■•t ■l.Y •Y.■ ■■ R•tt• k•RYn•1. r•1 1• .It•/• •1 •..�? •J: �3..•t • •1 _U• ••• • n•1 - • n »I •Iu tier i• tt : •1. �i•I.i' rl•�i .It• t/ 1•a.I.� n- -� - .i ��.IY■•i� • : .i I as ►11■■• ■•�' .t ■." • :n n a n•. •.. n.�w■u -��••.Y.n n■ n •\■► -_ u.u. gnu •• n: :;nn • •►... :••• •� u- ■■ \•■ - ■-•[■ ■• I►•1 - ■1:.[ t[I �' .n:t t/1 i.i■. :lt a •'■[• :+Y•- ■\�? �/.■ ■1 .■ •rrt[rK•tl • ■. 71 ■r U.UII■:!t.1/r •n . r.^,•n •1 •.0 •'.■. \n •I 1 ■••- IUt� 1•\I." • ••1. to- •J •■1■• • r■. /.t• .1•.■1 t�r..nl 1.ai - i• ■ I ■• •�r:.t r • .■ Win.• ••.I:!t7 ■ •i:i[t is ■■ ■ :.\ �i.r1. •• " / _ ,. • :i• - . •� t■ f ■. . •- : ■" - . I■.Ytl i..`l . tt r•. ■ 1 Y ■ 1• • .. [I •l r•t1•n■ 1 ■. • • • r • ✓ . t 1 . . t. . 1■ 1 r-■ -/ Y . - -' . .r" t .1. . - .r - ■• t••r. I / � •••r■�' .:tw - It\�+ ■■- r•1\t/■.•1■•'�It. .• .n• 1•. .. n r lip■ Y•7t •-1 �t■' ■.t• .t■ • ►•■ ■ M 1•/ tt ■��Y\•.■.1■." • a.r 1 •'•7■. 11■It r1�•Y r - - ' •il• - • I:.tlt ..• - • 1■. t.- ■• •■ :•• i•att �•.-tlr. • t■ J:n./ \.•- •:•�. • :w aal1�Y It t.- r•■n V■t■ .nn■•■1 ' is - all •■1 ■■ ..•■.�:! •ntl■�!.r[■■/ ■■.. 1 .•utr �■" . .■� .•Ir_ �t� .a►�' ■.l .Ir• • ■• •••1 Y■■.1■•• -u■ ■ n n a■ u■ ate• r•• •u•:m a. •I [...•�• .• 1' ':. n�w n■■ •li■ ■• gnu •• ••• •u� u.n n NJ .15 r - ■• �•m ►• a rn ^■■.a rnnn:+■`�:t nl n n :n -Jur • • •• �.•■1 :■ .• -. U. ■■ ■••. I u. ." •tl•[Itt�■ t. U" �crr. r..:att • r al ■ • ar •un• i•. tom. ■• t1 ��•.• •tt 1. • •" -•■.rr as .• ■- I • 1•• ■ tt.t t■ .n■t.•:■Ut U t1- .7rrnt • • mw�.r■.q■ •• / • �: r.I n ��r.1 to i1.1 n- tmm.� t.r■ ■ r•. n u .n - .1• - If....■�+ ■n it- .n. •u• • . / '• [ for. ' � - •' •1 - ■•.l U ■t•.•1 rUnl• �I' :U■ r•11/!i• -J. • n .In■. •/ n .t a 71 .n .. u: - :ia a oi■r • t•w•�..•.1. .: .• ..n.•:r •. _.. ■u._ ■. .u■ .:■ ■.m 1 ut G■■. 1 n• ✓.nr• to :?a •. is ••U. ■•1 1�r ti_. .0■ n■•:1 •r 11" ■U :+•7. i - .n r rnl .• ■ •'•P- •r_■. • n _ n••• 1 m • 71►• • 1 �■ r■t� ■•.• - ••'t:! a NI. /fit •r Y.t.n' ►if.� •7 r.;rt.1 .• • r wU■1 as • 1■[ - �■ • ■�. ■7. �/•U �a t• .•Iltt• il" U[ ■■a ._ . ■■ • . ' a :1■•1 •'•■ / .•- [• t1.t• •.1 t. ■ •ll•� •1 •••t r•.•� ..Y•n .I/. .•■ ■ ••. t-•- -1.' •■w\•1. ■■- i••:t ■U vlt •I■ .t.■ Y.• ■Litt. so AGE C■ �a_� 1 21, SW .• ,: o�� ' /lz.� ��,/✓/rrD�r .��-sGo�e�iS / � �/I/�Sr/�/n�iiC��yJ� .311/'�,� 0 9 8 ell �o p - ix, o,- fJW �olv r���1- oZt3L God, �� �,5.� /j/i9l/a�rr,�L Ci.�wCGr /yJ`l/ 7�✓��/�J 1G '.4 /�/V/S Gl/ t o GU C �DD �1�� AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION ZV�2-_O4p 7Z-J.J rt`l SEWAGE #__ `�f 9 VILLAGE_ C ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. µ cy-0E4 SEPTIC TANK CAPACITY Oop LEACHING FACILITY:(type) Wc-L6A%a S—3 (size) NO.OF BEDROOMS_ _PRIVATE WE O�PUBL�ICWATER BUILDER O DATE PERMIT ISSUED: q i DATE COMPLIANCE ISSUED:_ VARIANCE GRANTED: Yes .. No y � ( 1b a http://issgl2/intranet/propdata/prebuilt.aspx?mappar=268187&seq=l 9/23/2016 v,'►,, '_'`""' ' e IT vac v _ 1 . - �ros�a0 /�_.of_._ BUILDING DEPT. / - � OCT 0 5 2016 TOWN OF BARNSTABLE �S r V I' --EL a c--RM j zx8 rr zX$ - • T or [� sego rpgE r - . , w P1 � . me s6Vo���` S 4 b i Lo �p ell T-0 nF '11tso A7 k, ITCe��'1� ' P1. 4M t�N�C�1��r�C..._-• �� .Z a. o C EA/7-EX V P G i f� RM LM t a BUILDING DEPT. OCT 0 5 2016 TOWN OF BARNSTABLE .4 D V/ T I O_/Y ��c-� e �s ----------------- e- LEI i C ( sd� R L a V7" A ! �, ► �� s� I 6• close pgam` ZX � F - pow . .rTl Yrw S I Por- to Ejv4 PR L � , �. � ��� use � .t��a•<� � � rJV rl DRfr- ek Tp a F Cleso T-1v a.- - 0 0 ri. 4AI r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map dj Parcel 0 ;Application #r_;)61CX0 63a Health Division Date issued c Z- Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 0 _ToUJ n Village (� i Owner- "R(-a C-Q, 1' Ealc ono ' p Address _A�0x Telephone_. 1;D — �' 7-S, Permit Request Air 6 rah ++ia oL4 yo t,-5 22a.nn Xa R&(2 e,lJ vS eSL 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: )4Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes liNo Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑ No C) Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn tl'O existing73❑ n6w.- size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:` Lt.P _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ I --3 Commercial ❑Yes ,(No If yes, site plan review# _ _ co G y Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W 1�1 i jn rCj /COLDC Svt Telephone Number Address C Nye, License # st-+h Ycv(nowi�/ cj 4 Home Improvement Contractor# 14 S Worker's Compensation # C ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ymmoi� A SIGNATURE_ DATE 'e • FOR OFFICIAL USE ONLY / APPLICATION# c • DATE ISSUED, ,,MAP./PARCEL NO. -.ta ti ADDRESS, VILLAGE OWNER DATE OF INSPECTION: ;FOUNDATION !"I FRAME _—INSULATION)" FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS:i" t- z%. ROUGH 4l FINAL r ' .,�s=FILNAL,BU;IL•DING t;,`f=�-�?` -� t• -!_DATE CLOSED OUT G ASSOCIATION PLAN NO. ` The Commonwealth of Massachusetts `r Department of Industrial Accidents Office of Investigations , 600 Washington Street Boston,M.A 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(Business/Organization/Individual): 1 C'. e- . A&C i4AS K6st D+ C vy-1 Address:. -C� ' .. G• u,� l t �^ca�.l City/State/Zipt &• YM:,oMos i 6L"Koi #: - 3 - Are you an employer?Check the appropriate box: 4. Ej I ant a general contractor and l Type of.projeet'(required): 1. I am a employer with T 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ l am a sole proprietor or partner- listed on tare attached sheet. 7. Q Remodeling These sub-contractors have. ship and have no employees 11, ❑.Demolition working forme in any capacity. employees and have workers' 9 0 Building addition [No workers'comp..insurance comp.insurance.- required.) 5: We arc a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 LC]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.n Roof repairs insurance required:]t. a. 152,51(4) and we have no f� employees. [No workers' 110 Other:KMA d�Tldli. comp.ursuraircc required.] 'Any applicant that checks box#1 must also fill out tie section below showing.theirworkers'compensation,policy information. t Homeowners who submit this affidavit indicating they an doing all work and then hire outside contractors must submita new affidavit indicating such_ tContracton 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-contrecton.have employees,they must provide their workers'comp.policy number. I am.an employer that is providing workers'compensation insurance for my employees. Below' the.poftc and job site information. Insurance Company Name: I P,C, n b � `—o m Policy#or Self-ins.I:ic:#: T(,�(, 3 a.. g �' / "1'"d� Expiration Date 1 0 �I I � a.0 1 o'�, Job Site:Address:: O i d T 6yi n City/State/Zip: ` Attach,a copy of the workers'compensation policy declaration.page(showing the policy npmber 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 d wnaldesyjVerary that the information provided above is true and correct i — Si ature: .. Date: v`- Phone 'S 9 FS- AR Official use ontw Do not itirite in:this area,to be completed bji city or town official City.or Town:. . Permit/License_# . Issuing Authority(circle one): -L Board of Health 2.Building Department. 3.City/Town Clerk 4.1lectrical:Inspector 5.Plumbing Inspector 0:Other Contact Person:. Phone#; DATE(MWDD/YYYY) A009" CERTIFICATE OF LIABILITY INSURANCE 10/20/2011 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 NONT T Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FAX (781)963-aa20 C No: 15 Pacella Park Drive E-MAIL ss errazza@risk-strategies.com AD DRESS: P Suite 240 INSURERS AFFORDING-COVERAGE NAIC# ,Randolph MA 02368 INSURERA:SeleCtive Insurance INSURED INSURERB:Safety Insurance Company 3618 Michael McCluskey, DBA: Cape Save INSURER C:Technolo Insurance Company 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER CL11102041451 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. rLSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF PMIDDY� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ED X COMMERCIAL GENERAL LIABILITY A TEaa occurrence) rrence $ r 100 000 P REMISES A CLAIMS-MADE ®OCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMR APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO X POLICY LOC $ AUTOMOBILE LIABILITY Ea aoade0 SINGLElIM1T 11000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Peraccident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS E AUTOS Pera 'dent X Underinsured motorist BI split $.100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Executive excluded X I WC STATU- 0' AND EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN rom coverage E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? ® N/A 0/21/2011 0/21/2012 (Mandatory in NH) C3297972. E.L.DISEASE-EA EMPLOYE $ 500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance-Corporation are listed as additional insureds as respects General. Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street Hyannis., MA 02601-3698 AUTHORIZED REPRESENTATIVE Michael Christian/SMS �' ACORD 25(2010105)+ ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 oninnsi n7 Tha annon name anti Innn era ranleforad manta of OCI'11211 f L 7t z 460 !Vest Ma'ln St,-,:cr ASSISTANCE T r50 ' 771-i-it00..F ;505)790-=475 � AR1 0 ATIOlam TT�` cm all fiiit. ti ,fiG . ,cr}r.'.T t'Cr1Lt.(itn HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN TMS TQRM IP YOU ARE THE APPLICANT HOME OWNER hereby consent to and agree that weatherization work maybe done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency") on the property located at. The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors,insulation of attics, sidewa7ls &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency"its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed.. I have read the provisions of this agreement as listed and freely give my consent. Home Owner. (Signature 9 Date: l��z3z' - Agent: (signature) Date: HAC approved Weatherization Company: Co J 'Caliber.Building&Remodeling Cape Cod Insulation ape Sav' Creswell Construction Frontier Energy Solutions Lohr&Sow Peter Smith Resolution Energy Rock Solid Construction .All Cape Insulation o Office of Consumer Affairs,and usiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 i Home Improvement Contractor Registration Registration: 164432 Type: DBA CAPE SAVE Expiration: 1002013 Tr# 217656 MICHAEL MCCLUSKEY _.. 7C HUNTING AVE. _'._.. . ..... .... ... . ... . . .:. . ._. _ S. YARMOUTH, MA 02664 .. _....... Update Address and rest✓.. ...._._ ...... _ _..._ ._.._....__.._.. .... _ .. p urn card.Mark reason for change. DPS-0A1 0 SOM-04/04-41o12le [_'] Address (:� Renewal ["j Employment F Lost Card I ✓1� {oo9�r�r�uMuaeal/ft n,y�✓`�aT��cuaead , Office of Consumer Affairs&l iness Regulation License or registration valid for individul use only V-VF�sl HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Registration: 164432 Type: Office of Consumer Affairs and Business Regulation Expiration: 1OJ612013 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116VE MICHAEL MCCLUSKEY 8201 S.HOURD CT CHAPEL HILL,NC 27516 Undersecretary of valid without signature *} `lasacbusettx- Department Iif Public Safer} 4 Board of Building;Regulations and Standards Construction Supervisor Speciait;License License: CS SL 102776 k M Restricted to: IC f WlkLIAM MC CLUSKY 'T 37 NAUSET ROAD k �_ Y F WEST YARMOUTH, MA 02673 ' Expiration: 6l2812013 ("nntmi��i.mcr Tr#: 102776 1 OV25/202 0 09:23 91%212955 PAGE 01/01 cAPE SAVE Weatherization 508-398-0398 August 22, 2010 7o Whom it May Concern; William J. McCiuskey is an employee of Cape Save. He is authorized to negotiate contracts and building-permits for your.company. Michael McCloskey. Cape Satre—owner 919-593-5939 cell X Huntington.Avenue, South Yarmouth, MA 026" W'CONSTRUCTION ISTOM CARPENTRY :PAIRS-RESTORATIONS ^ )NTR.UC.Y 12562 . �a,�--6% G jJ SURED 15 Jerry Phillipp hlomes euin wm Fade' , ov aEE ESTIMATES 45 CAP'N JAC RD. )9-362-4566 CENTERVIUF MA 02632 C 1. M rri-J " 20 2.� v � N L � 2 (j pO 0© � � 2 0LO T NEW CC+NSTRUCTION t cu Fpbm CARPENTRY Wit° ` gAIRS-RESTORATIONS t:= Y;O MR.UC.N 12562 INSURED . , Jerry Phillip -- --cv�NDb , -- JG - -C(! - _� r ' .._-cr, -__----- - - p ---- - ---- v. Q r ` .�. �f�u � E u t.�GGf� lN..J .Hm eupt wlrh Pride- � � T �.�,s5- Tr c � •t-� ? �� 24 ,310 FREE ESTIMATES 45 CAPN JAC RD. t" 508-362-4566 CENTERVIUF, MA 02632 - w �y�. �d�-'^'� � y•!" .moo �• � .. � ! � ..._. - � •� ..... ..__Z - CD rt. Z W Ln 1 J L W CL 01. ram, ___ � .' � � • y I V -- i u --_T-� - — —-- --J—-- —----- < - N O 1 t hl ------------- Qd ` r: r:. r f 1# 1 1 T '• I II iLco L3 p,,:T_-S OF' F _ !J le � - >.x I G � ==L_------ � � ..0 Syr ' - • -- - H 'f � JI - y : tiDh` 1•�xyt�T k L I S r L JA` I I ems! ... • tY a YY'.,9y .. 6 /S - Co k 12 `. Ot 19,- i i . `oF,HE r The Town of Barnstable BA MAR% LE. MAS • Department of Health Safety and Environmental Services S. 039• �0 �fDMPya• Building Division _ 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection �( O Lj Location �y2 d�d� l � Permit Number _3 -3 / `L� Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: PIL o TYpv P �� �L Please call: 508-790-6227 f -inspection. Inspected by Date �iMET The Town of Barnstable RARAq-q E, MASS � Department of Health Safety and Environmental Services 1639. �0 pTFo � Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen + Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location Permit Number 3-r 3112-- Owner Builder One notice to remain on jobsite,.orie notice on file in Building Department. The following items need correcting: r i � a Please call: 508-790-6227 for'-e-inspection. Inspected by Date � r Date v Hour To W ALE YOU WERE OUT M Of Phone Area Code Phone Number Telephoned Returned Call Left Package Please Call I I Was In Please See Me Will Call Againj I Will Return I I Important Messa e AJO CA, Signed AVERY FORM NO.50.736 PRINTED IN USA _ f T - i - I - I i I - s i , 1, - . - I , ! a Jw l � ��� 8 l��ai� Gri�i�% . o ��i � � __ � a a <�amc'w-i�DO o�q x r:. � � 'p �v .-•- t� � � � "� rn 1'+7 S cn c v v me M= 'a CO r.o I co i o a O'i a �i-:z s ai o- 4, t ti .o T t t--4-1 O _ I I I I The Town of Barnstable sum �e8 Department of Health Safety and Environmental Services 1"9. Building Division 367 Main Strew,Hyannis MA 02601 Office: 508-790-6227 Ralph Ctossen Fax: 309-790-030 Building Commission: For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONITRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, moderni=don. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least.one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. f Type of Work: f� t . Est.Cost — O gov, � Address of Work: c�� d�rlry Owner's Name Date of Permit Application: �� g I hereby certify that: Registration is not required for the following reason(s):. Work excluded by law Job under SI.000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. f ze Date Contractor Name Registration No. OR Date Owners Name The Commonwealth of Massachusetts ! ,^ _ Department of Industrial Accidents ...... OIfCE 0f1/li/ES11g8U0/1S 600 Washington Street Boston,Mass. 02111 Workers Compensation Insurance Affidavit �����:1�1�����/ @fir/ name: locatioufe,2 0, -S. city I//o rU G��S 40, yhone# ❑ I am a homeowner performing ail work myself. J I am a sole proprietor and have no one working in any capacity %/ //////%/%/%%%/ /////%%// l//% /%%//%% ///%%%/%%////%%%/%%%�%%%%%�%%%%%%/%/%//%/%//O%/ ❑ I am an employer providing workers' compensation for my employees working on this job. com anv name: address: city. phone#: insurance ca. Rolicv# //// 00/000/OD//%/O/00////O//i// ❑ I am a sole proprietor, general contractor. or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .......... company name: address• c1hr phone# insurance cm olicv# cam anv name: address: city phone#: oliev# insurance co. W17ZI11111111 Fafiure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one years'imprisonment as we vil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement ma a fo ed to a of Investigations of the DIA for coverage verification. I do hereby certify der e d pen ies o ry that the information provided above is truo and correct i Date �:-z Signa �} Print name ��� 12� Phone# / � ��CT official use only do not write in this area to be completed by city or town official city or town: permit/license# OBuilding Department ❑Licensing Board ❑Selectmen's Office ❑check ifimmediate response is required ❑Health Department contact person: phone#; ❑Other (mvued 9/95 P1A) 4 ti Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any con=c 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 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 o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha- not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. , The Department's address,telephone and fax number: , The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigaflons . . 600 Washington Street Boston, Ma. 02111. fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 The Conrmonit'calth of:1 trrssachusctt.1 yell `:--=�•:= Department njlndustrial.4ccillents f °i 1• ONCOOtl IMOSV9211,otrs •.\j=;= . _.; :+' 600 !f ushittrtun Street `—' Workers' Compensation Insurance Atfidavit appiic�intinformatinn'• -__. Plc�se/P�RiNTlebitily�•�—�'���—�---•�r w� - Incitinn -C/C /e City. C- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _ _••_.-- __•�-�.,..,s......�.�r-••-••�-,...�-yam-- +-�--••---•-�.,...--•---`*�---- [I 1 am an emplover providing workers' compensation for my empiovees working on this job. comn•fnv n•fine- atitlrc�t• city• nhone 0- incnrnnce co policy# [� 1 am a sole proprietor. general contractor, or homeowner(circle otre) and have hired the contractors listed below who h:N the following workers compensation polices: compan't• n•tmc• • •tdrlrcac• phone a• incur^nrc rn. nniiri- d cpmn.inv n•tmc- addresc� rite nhnnr Ft� incur•tnce en Attach additional sheet if neeessatV.-;— •_•:!_"- ::r..�.'�-:Y��=--�-- :�: ' --�^'---�� -''="`�":��= ;.....����"• Failure to secure coverage as required under Section-5A of 11GL 152 cZn tc::u :u the imposition of criminal penalties of a tine up to 51.500.00 andiur uric,cars' imprisonment as,.ell as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be fursvarded In file ott'ice of lnvesticanons of:hc D1 fur coverage verification. I do herchr cerrift•tinder the pains and penallics of crj r/ear rile::r%or.^rz:ion provided above is true wed correct. Si=Satire Date Z Print name (9'tie,,4 LD r PA((L Phone>* ok 6'2 t{5—G _ w ' ofrtciat use univ do not,write in this area to be completed by city or to„n official city or town: permit/license d r111uilding.Department C3t•icensing Board check if immediate response is required ❑Selectmen's Ortice ►_ C3ticalth Department ` phone=: r•tUther Ccontact person: information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compcnsatiair emploYees. As quoted from the an enrplt ree is defined as every person in the service of :uu)thcr undo contract of hire, express or implied. oral or%vrinen. All etyzplorer is defined as an individual. partnership, association. corporation or other legal entity, or any two or m: the foregoing engaged in a.joint enterprise, and including the legal representatives of a deceased employer. or the rccciver or trustee of an individual . partnership. association or other legal entity, employing employees. Howevc: cm•ncr of a dwelling house having not more than three apartments and who resides therein. or the occupant of the divclling house of another who employs persons to do maintenance, construction or repair wort: on such dwelling or out the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio. MGL chapter 152 section 25 also states that even state or local licensing agency sliall withhold the issuance or o t construct buildings in the common�•ealth for any rcrtc��:tl of:t license or permit to operate a business r o ors r applicant who has not produced acceptable evidence of compliance with the in coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting, authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and su1:,^,i�•in-_ company names. address and phone numbers as all affidavits may be submitted to flue Der,artnicrt c• Industrizi Accidents for• confirmation of insurance coy era`e. Also be sure to sign and date the affidavit. Tile aifidavit should be returned to the cite 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 requir: to obtain a workers' compensation polic}•. please call the Department at the number listed below. City or towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regardin=the applicant. P1. be sure to fill in the permit/license number,which will be used as a reference number. The affidavits may be returnee tiie Department by mail or FAX unless other arrangements have been made. The Office of investi=ations would like to thank you in advance for you cooperation and should you have any questic please do.not hesitate to _give us a call. ax number.Department's address. tee hone and f The Commonwealth Of Massachusetts Department of Industrial Accidents .. Office of investigations ' 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 ,..7.? 1�nn ..•. tflA 1t14 nr 175 . . : The Town of Barnstable • eeaNerr+st� • t of Health Safe and Environmental Services 'Department artmen �ess� e P �' Building Division • 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building CommiSsiO; For office use only Permit no. d Date (� AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: A 6 19— eIV y r. a. Est.Cost 2 9— ev �. Address of Work: Z qZ 6 L1-D 7`C cA/ Al A • Owner's Name )9 2a C �,4 C I-901J4 C—10 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the ow r: J 2J Date Contractor Na Registration No. OR f Date Owner's Name ��arlr,m011 44. o/ NEW CONSTRUCTION 1:j±?. ;c(d OEPARTNENT Of PUBLIC SAFETY CUSTOM CARPENTRY Itl*I'A111.-11(:STO11ATION ` f ' ' � ; ± .• n, RASTER P1IEFITIER IILfN�[ CON III.IAGA 12bf7 1 / ;.. Jerry Phillipp Ar•rlrirind To: I "I l.•n r••-Ir,.11l 11711r f',1•l.•" ' 6ERA1.0 R PIIIIIIPP 1111:1:1.,;11MAI1:; 46 CAI''N JAI;1111. .��„�,•.wn•,.r f 45 CAPN JAC RD 362.4666 CENTERVILLE,MA 02632 I CENTERVIIIf, MR 02632 4• _...._.. ... :.......... . •....:. I (;A;:) 1G OIL. I IL:;IULNIIAL• COMMERCIAL (500) 362-4566 CENTERVILLE, MA 02632 i G[RRY R PHILLIPP - •I, _ 45 CAP'N JAC R0 ILA COMMONWEALTH OF MASSACHUSETT-S Sa' \ `. ''o •: o.«uron,—..evr!/��:.1(a..,.o�.�r.�a IN REAL ESTATE r NONE'.IHPROVEHENT,.CONTRACT.OR' p� Regi`strat10'n i11J41 LICENSED IFritIIL�T1fTI�t�1SCSlUCSPE a Type s`;iINDIVIDUAL"I': EzptfatloAr,1,�;12/11/90 GERALD Rr PHILLIPP CAP7IN 'JAC RD I GERALD.R PHILLI PP. . " r: 45 CAPTAIN'JAC'S,RD' CENTERVILLE MA 02632-0000 '&,�►TERVILLE'NA;02632• ••. C'ce>ti.d 7;'' 1.' 06of47 I ADMINISIIIATOR ''' I 0, ,.. IL U (L to u �/ C til J •Y OC ul rs Iq N —T c o , a, O q � ~ 0 � `� r` E IL �Nviz x � � 1 }. vbikz °P -,L 1�v. J w r° NEW N - CU�,OM CARPENTRY ,�� <jAIRS-RESTORATIONS , L`ONTR.UC.k 12562 INSURED Jerry Phillipp --------c��NDsa . //���U lE - (/l� LF-i �C. l/ IA' E7 T�_l`rGGf� l/V� Hanes Bum with Pride' ,U/�'��Y�__ n" i. l FREE ESTIMATES 45 CAPN JAC RD. -: 506-362-4566 CENTERVILLE, MA 02632 m 1�. ]k. Z LA N O , I V i - { L-� W _ 7-1 1I r > L x z� i I J t 1 I � i � ---- i i. - <t• d 1` l . a t 5 i - _ ;„ j ti • l _ I � I I , _-_.._....... ._.. , 01)4 C) f 711I f , ,4 L V f:1 G V T L�J _ _- •xL t Ar- r 4-- !; �- ti" „`_�, _ `' c 4 l 5 D 5 -- _--- - --- ------- J I - t � --7 %Xy-Tl3�- LiE 1. lux ILQ11 Also - ..�, C V.L._ ;+ �F ✓/ ,� / �� •� L- t!C.� �✓� �/' - `. ? < . `f ti l�iI ( Tzf!'i j g cry i �L,-1-L`' -. t � 1 li APF=?�•Ep B 1 . j{QQQ{ 1 ;k - - _ _ �E , A-- �,� � I I' t I � ' Alp C,ED B SCeIE' ��u' r Cape Inc. 7-D Huntington Avenue rQ� �'� ' Ri South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 � R 3/17/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 242 Old town Road,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-19 cellulose Walls: R-13 dense pack cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey -- - -_ � �►�I I� � Ili.+;�.�sl� 0,0110�1 1 �, yea.. � / •` � •� `` ,� �`� ���� ,���� � + Irk �+ ��� �� 1 � �^�►��' `� �� ��� t c ; � 1►, � �►� } � , ��i� �`1 ' ,' ���` �` • � � � `'s•� � tea►'` of FOR V DATE TIME P: M ,PHONED '. OF RETURNED PHONE ',YOUR GALL_ AREA NUMBER EXTENSION Usal MESSAGE �aSIGNED f N�7 �wryy , 1.�L/_..� _ r. � � � 3�r� .��. .� ,�a { S .� . t t � � , _,, . { ; ` , . s,.../''..-.'ti•.. ,,_,,,,y,,.,,,,1�.. rJ.. , ;sr .. - - �fa-sdi./+n 'w4 . -v - ., ., rf• ...S..r..`w:vl..,."4i....:y.s yam. .`�tHE T "�� The Town of Barnstable BARNSTABLE. Department of Health Safety and Environmental Services MASS. 039. �e Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice �r Type of Inspection _ Location �a IJ7 Ijw j Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Please call: 508-790-6227 . o re-inspection. Inspected by d ti Date /Z ¢' M MCMRAppa Wki Table J3.216(condoned) } prescriptive Paekaga for ana and Two-Family ResidentialBnlldiop Hated with F050 Fueb sr MA3dMUM .MINIMUM "aiazing alazing Ceiling Wall Floor Duement Slab Hating/Cooling An,'(OA) U-valuer R-value' R-valuo' R-veluc, Wall perimeter EqulPmeni Ellici Package R value' R value' 5701 to 6500 Healing Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52• 30 19 19 10 6 Normal 3 12% 0.50 3E 13 19 10 6 u AFUE T 15% 0.36 3E 13 25 N/A N/A Normal ' U 15% 0.46 3E 19 19 10 6 Nonni V.' 55Y. 0.44 3E 13 25 N/A N/A E5 AFUE W 15% , 0.52 30 19 19 10 6 E3 AFUE X 19% 0.32 3E 13 25 N/A N/A Norval Y 19% • "0.42 3E 19 25 N/A VA Normal Z 19% 0.42 3E 13 19 10 6 90 AFIJE AA 19% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: t • 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: S . 4. %GLAZING AREA(0 DIVIDED BY/12): _ 5. SELECT PACKAGE(Q--AA-scc chart abovc): OU•PiG vet N I 2&0 s f, 2 . �� �-T cv c� e c2 -J C NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. 13UILDING INSPECTOR APPROVAL: YES NO: q-fbrms-(980303a „ 3 4. r� Ni�I I �. 5 1 Y " Y-;.f `...� ' 7'a}t• IYI 1 ark t i ri .314n � '1�1;4e r �f� {�� 1 #� i'.�y�r7•c�gkhti'`� �I� t S 5 ti {,-: P. 7r i.Y fll :. A},IP;t� �y�l"M,.�•4'C -•:ll �;5 to, u 4 � a�G .M�G^�'•l ,•�jy'����1: f�N„*a 1 IH a f ar f IT i1d.1 - ... }p.,U4 r. • ~ . III . Ie -0-MY U)kIIllel'11t1W ullet;ti 1 " - 1. wunl{Ilugtalllnuvidld L_ _.I .1 , 1rs(Ilility (lnd ecollornicnl al tnp nI unit Casino 10 fa- CIIIIalO IIISIi111i111011, •~I�t )eralioll to satisfy virtually 2 I 2. Powerfnl thermo- UPTIONAI FLUSH >1 need- I Ip•11111 �lhf? f? uiiiil;;illl► tilliiiiiiuii I�iil, qt) )t) )ti•►rtilllct 11 IL It II' II110 111 (I11 o IIII( II I i n n uluuni I I „V�III�IIII vol 11,110 la W411!111i:4aI lilt s 1 I, 1111 III IIII llllilll IIIIIIII ' II q11 1 .aJJS111`l 1l} I y ti ROM 1118WAMOMI .4 III ..IIIIfH.L���YII�.� '�,'1�(�..�(�I� I ��V,�yt11" ,fit . I{I►11.1� � �11IIII� III II II III H III..:., } t.-:� S11y}:. S;':� ►I II�I1(I 1I11(�f�� (01111l1�11�'�OW + 11�11 I(II Iillllll IIII II ill' Ili it it IIII ill) IIII I►114 IIII Ilil.:,..,'�IIII Ill 1� IIIIlWI) iliulillllii ti >fi` :. _ !. i I III I II II II I Hill 11111 1 II I I III.I II III I IlllliuU II1i111 bulllllUlluul. �I onal heat into us Molly as 4. Auxiliary limit inter- iree rooms. A vent enclosure ru is burn C cle if air is IN NLET p y IN INLET (lcikoge is ovoilahle In crnn- rorlriclod, „.. I -al llle 4°oval B/W vent )Ipe t;. f:onho1011liolm.slarnl- I, 1 kill l'I(.11v-11lta[Ili t uppli l" IIIIJII:IIW-IIIIII'lllll'IIt,IIVllll ons. An optional Cabinet more econolnlc Intermit KNwK�N, r tent, electronic ignition SIDE O —I—_ im kit is available to trim out device. s�,E'wIFW IDAGK V�W !cess applications. The unit is ttractivel finished with a � G. Multi-port stainless Side/rear outlet installation Y t steel burners provide ex- and-beiqe cabinet, high- ® �mip. e nt flam rhar�ctroi�- r ,)IIIL^L1 11) LL kvIHIOU611111 LLL I L:111 III,;r VV1111111111:11U11111UII1111U "' '"" F' anel. The COZY counterflow is extinction. our best cold weather friend! 7. Vent spilt safety device is standard on all models j ";!FA07 and automatically shuts off ' 6 in the event of flue block- ,h.. . age or improper vent in- �. SIDE II[All 5 stallation. Side/rear discharge kits w/diffusers SPECIFICATIONS Approx. Model Type Type BTU/HR. Vent Size Gas FINISHED Blower Shipping Number Control Gas Input (Oval) Inlet DIMENSIONS Speed CFM Weight CF353A 24 Volt Nat. 35,000 4" 112" 14-5/16"Wx10-%'Dx73-5/16 H 1 240 95 lbs. CF354A 24 Volt L.P. 35,000. 4" 112" 14-5/16"Wx10-%"Dx73-5/16"H 1 240 95 lbs. CF503A 24 Volt Nat. 50,000 4" 1/2" 14-5/16"W00-%"Dx81-5/16"H 2 340 107 lbs. CF504A 24 Volt L.P. 50,000 4" 1/2" 14-5/16"Wx10-%"Dx81-5/16" H 2 340 107 lbs. CF653A�24 Volt __Na(_' 65,000C- 4" 1/2" 14 5/16"Wx10-%"�D8 /16"E I 2 �44 116�Ibs* s. iCF654A 24 Volt L.P. 65 000�"" '4" 1/2" 14-5/16"Wx10 %" /16"H 2 116 Models With Intermittent Ignition CF357A 24 Volt Nat. 35,000 4" 112" 14-5/16"Wx10-W Dx73-5/16"H 1 240 96 lbs. CF358A 24 Volt L.P. 35,000 4" 1/2" 14-5/16"Wx10-%"Dx73 5/16"H 1 240 96 lbs. CF557A 24 Volt Nat. 55 000 4" 1/2" 14-5/16"Wx10-W Dx87-5/16"H 2 440 116 Ibs1 CF,558A 24 Volt L.P. 55,000 4" 1/27 14-5/16"Wx10-%"Dx87-5/16" H 2 440 116 lbs. Louisville Tin&Stove Co. INWRPORATED /..U�"_� P.O.BOX 2767 • LOUISVILLE.KENTUCKY 40201-2767 6m avrq.1 f/\JC//yid PHONE 5021589-5380 • FAX 502/599-5382 orm No.CWF IOM 8793 � - ID 71 A We 303 117 z ,lea.i,/I as o g Q` IA . . T,� Woe a � �� 'I � •� 11} `t' :i G f a I x :moo'toss%v tc'91� � - L. .�.o toy��✓ �o �J) � A�' `� ��' o � - � . is * •�•��.. �' � �` MAY 5- 19.74 � � , Nir N TOWN.OF BARNSTABLE BUILDING PERMIT APPLICATION Map b Parcel r� � °dfc, - Permit# 5-,3 1 2 Health Division - DatElssued to i' d�,? Conservation Division :�..�cr I!t� .� E`tr =;s °" ' " FeeVIV - Treasurer 0 Planning Dept. - Date Definitive Plan Approved by Planning Board PreservatiordHyannis42 ' r ' Project Street Address Village Owner l CL" dw C 0 .41 Address !Yz o! Q�uu Telephone Permit Request UlaC�" L41le �i�' %iOf�l' Square feet: lst a r:.e*t pray •d 2nd oor: existing proposed ' Thew Estimated Project Cost •4e Zoning District Flood Plain Groundwater Overlay Construction Type 0 Lot Size 16 3 Grandfathered:`0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 211 . gaily- etrrits) Age of Existing Structure � Historic House: ❑Yes No . On Old King's Highway: ❑Yes to ❑Walkout ❑Other B Basement Unfinished Area(sq.ft) Nqrbm-afSa-fffs---".-,FuII:existing' new Half:existing new ,N u ooms: a '- 'ng new ' T no in aths): existing • new First Floor Room Count H Oil ❑Electric ❑Other ,C Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garageXex+swg Anew new size P ew size Barn:❑existing ❑new size AttaeledVatage-&emsting-G-nmw ze Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review'# Current Use Proposed Use BUILDER INFORMATION • Name /✓� l,(��� Telephone Number Address /1149 License# Z7 9 Z zzew .5 Lez ". Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS R LTING FRO THIS PROJECT WILL BE TAKEN TO �,/�//v/S py �,�/,11u,�.�, �D SIGNATURE DATE /�— " r t, FOR OFFICIAL USE ONLY s, PERMIT NO. -_ � + � �; �' • , '. .. � r ', .. - •' r ti ` . .DATE ISSUED MAP/PARCEL NO. ADDRESS, Y ? , - 'VILLAGE' -OWNER h� « DATE OF INSPECTION: FOUNDATION 1 FRAME^ INSULATION _ FIREPLACE - }- .. ( -• , l _ r . ' it fi ' ` - _ , . fL� 4 ' ` � .r ft 4 + �_ - i , ELECTRICAL: ROUGH FINAL pp PLUMBING: ROUGH ° FINAL, GAS: ROUGH ' FINAL' FINAL BUILDINGfj - DATE CLOSED OUT - ASSOCIATIONTLAN NO. ? { Engineering Dept. (3rd floor) Map o� Parcel `t e-7 Permit# House# Date Issued00 Board of Health(3rd floor)(8:15 -9:30/1:00 '�� Fee. r •Conservation Office(4th floor)(8:30- 9:30/1:00-�2:00) - 36 Planning Dept. (1st floor/School Admin.Bldg.) {{}� Definitive P A roved by Planning Board '_ 19 INSTALLST BE S 'MCE Wl TOWN OF BARNSTABLF4VIRONIE ®DE AND Building'PermitApplication TOWN RED PLATOONS Prol t Address 2CIZ OLD Td Ui1 rll _,O, (_b&JLJ,7-J ,Village 0 t e2T Owner .62Cl C/= 1924-C z9aA14 L 0 Address Telephone ta- G Permit Request 4 19,0se1V S 6.© i % iw :.0 L d S' vc 57.41.-�_2 First Floor 26 , C 2 a ye9 0 square feA t - -5-6 6 square feet Construction Typew o 0 Q Estimated Project Cost $ Zoning District Flood *Lot Size s i k Grandfathered ❑Yes ❑. ��.�G �j� 9�� � � s� Q p�0 �t�` Dwelling Type: Single Family f� Two Family ❑ Multi-Fain +� Age of Existing Structure y04 Historic House ❑Yes C No`--., dA "� No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other lVoAl Basement Finished Area(sq.ft.) Basement Unfinished Area(stl.ft) G '� Number of Baths: Full: Existing�_ New Half: Existing•;-'•: eW .� No.of Bedrooms: Existing New Total Room Count(not including baths): Existing 3 New I First Floor Room Count I? Heat Type and Fuel: g Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes gNo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) None ❑Shed(size) _ ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ .Commercial ❑Yes No If yes, site plan review# Current Use ::�// Gy LE e;:w 41 Proposed Use 5,1,0-7 Builder Information Name cfL /LL P Telephone Number - - c. Address GA ro'i!4'�/� G 12�0 License# ngzt Z_ 9� "OrO14 Home Improvement C tractor# 1p� ,/�I�SsLsv{ Worker's Com sation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G SIGNATURE - r9&_ J�rf_ DATE —� BUILDING PER IT DENIED FOR THE FOLLO G REASON(S) t • FOR OFFICIAL USE ONLY • �, • r PERMIT NO - DATE ISSUED MAP/PARCEL NO. - _ADDRESS VILLAGE OWNER s• - - .- , _ - � - - � 1�. DATE OF,INSPECTION: FOUNDATION FRAME ' ,f z� �d�• ' 9� ,c��� ' '� �� . ` .; - .. INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL �� ` PLUMBING: ROUGH ! FINAL . c("'; Of GAS: ROUGH FINAL FINAL BUILDING r - c I$ NA DATE CLOSED OUT _ t, ,� , , 4 ASSOCIATION PLAN t m { . The Town of Barnstable armiver�►sss, 9 M �m� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: LT 6/:05 Estimated Cost /Y� / Address of Work: (a/J!/ A11-5 Owner's Name: 4 Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of th o er. Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav 7W OAR Appends J Table JS Zlb(continued) prescriptive Packages for One and Two-Fan*RaideatW Boildinp Hated with Fosil Foell MA)(IMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Hating/Cooling Am'(%) U-value= R-value] R valuue, R vakueJ Wall petlmota Egmpmcat Efficiency' Package I- IR value` R-value? 5701 to 6500 Hating Degree DaW Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal 9 12% 0.50 38 13 19 10 6 95 AFUE T 15% 036 38 13 25 WA WA Normal U 1.5% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 WA WA 85 AFUE LAA 15% 0.52 30 19 19 10 6 85 AFUE 19% 032 38 13 2S WA N/A Normal 19% 0.42 38 19 25 WA WA Normal 12% 0.42 38 13 19 l0 6 90 AFUE 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: L 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: () CJ/� 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a I 780 CMR Appendix J Footnotes to Table J5.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 fl of glazing area. Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table JI.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include' exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages). Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J 1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with . different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- s than ore requirement(0.35 for doors).equal to the U-value value of all windows or doors is les q 43 - --- -- -- The Commonwealth of Massachusetts ` �i - `~— .=_=•Z Department of Industrial Accidents = gifice oi/nyesligatians 600 Washington Street +r Boston Mass. 02111 Workers' Compensation Insurance Affidavit ' name: location: Z �/ lNN city nhone# ❑ I am omeo4 r performing all work myself. I am a sole proprietor and have no one�vorkin in anv ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name: address: city phone#: insurance cn. 0HcV# ❑ I am a sole proprietor, eneral contract o , or homeowner(circle one)and have hired the contractors listed below who have the folloning workers' compensation polices: comanv name: �/ P/'/�✓I/U /UVN�/,J�/d�/ ..:.::....:...... address: city: phone# ®/O1O//��h/G'�:��d�/ �ls' 1l`� !�S eel.. a insurance en. - - ...: ppi1N#(/(/�i� Z��'�ls� V� iiaaii�iiili�il�i7///G, r - r. camnanv name- 'f 1Or address: 44 IF citri- ��:<M phone#- v , insnrnnce co. �. olicv# Failure to secure coverage as required updevsecrip 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as pe d the form of a STOP WORK ORDER and a Me of S1o0.00 a day against me. I understand that a copy of this statement may be f e e OMce of Investigations of the DIA for coverage verincation. I do herebv eerrify u r th d ien perjury th information provided above is true and /corrrrectt Si7ta �4Date e / y - Print name Z� __co h� Phone# �[� Cam-6l� Ccheck do not write in this area to be completed by city or town oMcial permit/license ft ❑Building Department ❑Licensing Board ediate response is required ❑Selectmen's Office ❑Health Department phone k; ❑Other (rrnsea 9,95 F1A) f Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any conrr::, 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 receive:c. 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. PIease be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retivaed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 0111ce of investigations 600 Washington Street Boston;Ma. 02111 fax#: (617) 7274749 phone#: (617) 727-4900 eat 406, 409 or 375 i 3-E NOTE 4 J TYPI C.AL,3KVLlgNT."F iZJM PL LTG PLATE .PLATC 2,X4, gNEET 2 -RAFTCIZS 3 -1¢QAR-WALL PL"6TW —HE-AI2 = 2r6 N I+10 CODAR N 'M ��4YPSUM N �� u U [� 10 0 Q woW %L7 C.YPSUVA _y4"PI N6 F q Ira •.PI AS"•y S Ix41NT•R IM4INTR r �� F! TRIM TRIM �F �• U b � T/cRlo2 \�-4 (4 1 1 m z 3 a d I D A 11! a 61 0 WW 0 4 N \ Ix4Qp s i a n x - ' 3 �° m �I Ir N I 0 0 4- W La n N R.. bL I I "� 4 JAMB Ira a 0 I; it 0 ._ gl4x2'/4 - V - in 0 0 3 STOB W tl I N OII, I- RID4R "A "� Z1iRE5N OLQ W 7 VI I Q I d II F I n .l9 U JOISTS —RAFTEIRs. WALL iD FRews LOCK4 -LAM Kw EH WALL PLATE InG�2/2 0 I N 5Yoo / P 14 I I� �\ N clrtneR ewo �+ 1 SNIM SILL NN �w IL W I� I A 4 1.4 ix4 TIES RACTQRs- PLAN VIEM1 6 • RUILb'G. I-Y ^ • v PAP6RRAFTERS CUT AWAY TO Ex- RAFTEsLS 3NOWN� p Pc 56. JOISTS �N FULL v vs..gA.bs- DO"OR. - DOUBLE 2r4 PICTURE Humq WINDOW _ _WINDOW- ` SCALE�1'••1•-0•� I / f N RGAR I 6,334� SA.DL PL ATG - - p•- SEE•-{ •� I SjCYL1GNT I • b „r,'�N OTC l2.nN � �'�• �� ZAQQT2. IFz•z.ls 3� I SEC DETAIL PI.Gs uR6 OeI.S.NQGTSAIM SJ I1 PIGTUgG C 24,42 DOOR- Lo•+4G' DDOR I . b SA 4 " I(- �STAIIra G 'sI 32•78 24 LTS ,� 32 H76 - I I oN MccT g y � I I 50_ 34 I Is; dd I 'I I I I SIc6 OF •1I , I n I li I I _STUv F�-4•e� 1 II ham--5"8-'=•13.2- OF WALL i wr to-g�j I i' I 21•-4^-- �_L I ��T---Za-or�1 ��- - - ♦-- -- lr+'111. r+-4--1� I--'`r---- -, -ri I-�.- _-- - - - _- -l� Z 4P RON E•D Ted REAR ^aC ALE: �g•sI O� UNo@R ROAR - GIROG.R POSTQ 4�Ro6R Po sT• _..____._..--•----•.._--------~._r—.-'._-----------------n•-tiT--�� r'�tl--- -- -----r�L-u-I-----._� —ELITOWNSEND&SON,INC. -'-- - -- - = - --=- -- ------I�_� L_L,� .. P.O.BOX351 UNORIP�RCAR --JS GALE: 1/B 1=o CLINTON,CT 06413 GIRDeti Pos7s DESIGN . SHEET A FOR STiZUCTURAL. SIZES, PERT.IN6NT 5TR C-rgR L- NO^�^E • SEETLS I79 f DCAI � DIMENSIONS, AND NOTE MQ F'ERCt4CMS. D SCALE: �� ����� SHEET 6 OF 07 ro 1 I G } j Ei ~L,LA I __�-�-1-�-'-- ,jL IJ'-�� i�,�ll_ -_�j�.._1-•-�� L f f� I _lil' _�I;�.-_�i, �I�.�, jTr --' E i SEE TABLET SHEET 5, 2' 'L{ � � /j // FOQ LETTEGZED DIM£N 5101.15 Ifl SKYLI GNT i f QA (sBE NOTQ'IZ) —E N II 1 ° \N I PLATE Q -Z.2 6 @ PLATE i (Z-2a4) _ \(2.2r4) ? ROO SI-ICATH- ti+ °� � +s F ING rZ' QIOGE @ 4° -3.2/y (Sa¢ A1o7st8) . CEYA 1 L- i J 244 STu17s I-•1•-0" 566 TA6L6. roR (pvEQ JOISTS) SA SH Z.C.Toes AT if, 2.4 T16S AT ALL. $ 9- 2R8Jo15Ts�_---_1J A A.LL.RAFTE.RS � � I mCI •9 RAFTERS (LAP �J - 10=0•LoN4 (L►P JOISYSA5") 2+4 STUDS (SEE NOTE Ej .N N,r' JOISTS 11%- SEE (ssF-&DOTES-5412) II (OVER JOISTg) II N a ins NOT65) G II II BRIDa'4 Yy P.W. t%s2 SHIM(ovQRJolspS) i yly SE6 OETP.IL G- . •' F , I - ON SHEET�j GAR fb• 37/g(.'S241') a ti / d2F oeR 3 ISIRUl=;Z<2.2-12w1T�I ,y(seeNores4 79 11� %y'•P.w. SPACER) fy^ �F'1 .r G STAID k � (sec Norc Io) �J0157(Sac AW DooR rn0.A4-24 LI W4T , (SGE NOTEIf) � WII.1ObW �Z- .. A a4•. 14-II�4 N 17 17" �I t„SASH 40 $•-10• SEE NOTES (o •T f 4'•O" - 4o1A. POST T %Z DIA. ANCHOR, BoL.TS SeE NOTES N I,T MID SPAN �N I ON LIOMI►JAL LY Go CTTzS. b b 7 -: of GIIROGR 16 16" 16- Ifo (SEE NOTE IQ (c 4) to 1 " 16 In. II i 2x4 STuos,l��o•G- 2+• 1 SILLIll'i A•PQON (I OUR, 44 WITH SLAB) GRADE. j ."7= --= -- + ;1• TOP 0p POUNDATION EAfZTH(TAMT) 07 , • 14.l'. 3•.'L- EXTEIVO SIDE I•"-'$" •I:' ��3TON�L BALLAST 19 •8-1-"1� .I•'. d-IIn F D'T'N WALL . ••I•< 2o_O" I• ♦ <, coR FROST 4 I' I - g-.8" .4 �, 4, a.. HARRIER °J-1/y CIENTURGD UNDffiR 4"POST FROST LINE .I Z4"x 24't� - .•'.I• `N� •,I I• ,. .� . °. SIDE N ., F-Ie,l ------ • I- CUPOLA{ - ELE VAT I O . .. � SCALE°I4"`I•. �� I Z4 x.24"(SEE FRONT - RIDGE ELevATION) �,KURRING - STR I PS W 2>6 IjAPTERS- 1A 20-0�� i �/ � K I FRONT PL ATC:2-2+4 (R6AR' RAFTER TIES MAY aE i Z x N PLATE NOT SHOWN) LAPPED ro EITHER SIDE OF' JOISTS A"V RXW N j IV ( ' FRS (5EE NOYE g)T- N OUGH Oto(-a1J1NC� FOR Ito 16 A 3 16 •�C pISAPo•EAIZINff STAIRS I Z g G RA.F-TE�S a �YP..W \\\ (StsE NOTE 10) SOLE 2 (sw4) 6RIDGIN4 "p W. 2*6 TIES 2x8 Jo15T Ar SIPEjCLSE- 2 WIaEsL.E ON 16" GEN- i• 1 TETa\5, uNaEF� DAFT- , -•'- EIS. , N SOLID I� BLOCK'Ca OVER GIRDERS I JOIST D6lR� I JOIST >�. ,� [SErWEEN ENDS OF 1 I +" q\Y •1T 2AFTERAND TIE (AT 10 Q 2•Zxl2 S,IIZCaR Ag• In 'f SIDE ONLY-SEE SHE ET�j� (W 1TH Y-P.W. 3PACEIZ) �' RAFTERS •� W IT 3 x 24" - 48 FRONT ELEVATION "P.W.51lBATHING, �• REAR • Q ?x` (s 1N4I-V PANELS) 2.2x4 REAR gT TZU C- SCALE:%4",<I' wl vTws As SHOWN, STUDS TUBE $ILL cur To LUNES INDI- �I •e•' CATEDj SEC NoTC6 16 0.C• �•Fd�-I'N. AND s►+sET'7_ I I DETAIL"A•" II I j1.. T I I 10 " L z-z•at II -- D BAILCoRc'GKJLTtNN"AECT�IZ ALL 10-0 0.0 " I TFrOURCO 41 OIA.STQBLPOST UN- x4s NOTE 7) DC¢ ¢ G W'DwR(SEE (S6E NOTE4) JOTE5 WILL BE SCALE:ISI' OI- FTION P G SIL FOUND CAN SHEET Z 4 1+4 4anDE ; ELI TOWNSEND&SON,INC. FOOY.4 '�'• I ..�• •.��- APRON R'O'T'el WALL �. . ' 4 .�I;t-*I •. (ATRgONrOF I:• 6 '-� Bps UNDER, P.O.BOX351 F.DTM 2 , • .• APFlCON ONLY) 12' 1•Ifl ROAR 41Qb6R s 1Da I O'-O" CLINTON,CT 06413 DESIGN wALL �ii' wA�L 6 I'. ,i 8+,xZ STRUCTURAL No.4" : 4F4 ';. vooT•q. -•1 24"x24' � D ETA I L I79N I ':: : I�—I�- a1DewALLF'T' Iro' - ' APQoN FCTN wAIL 4( ) SCALE I:I SHEET 4 of 'T Nx) .01 jO - zims NOTE 4 L ATC .P.L ATE .PL ATG. Z•x4 3NEET 2 ! TYPICAL SKYLI4NT Fi;CJlM I M, y -RA FTEP[S 3 -RGA4 WALL PLATE _H EAQ ? ! d P.W.SNTN4 /Q /Z P.W d O _ 3 J .N Ir10 GHDAR N '� P=4YP3uM N ��. H U •� W 0 a i _ < 2-4 %t•CwYPSuM _�q PI N6 F a ow Irb • Ir41NT'R Ir41nITR 1 .--PLASN'C�" TRIM TRIM I w V �r 5/4><2'/4 E%' \N� Z41 R4ocR-T 4 W O .T CR100.' T (2-2.12� b `\ III -TRIM � I ° ° I to 1le J 194 y = < I 6 k„. 1 3 2Y6 d I •mod Ir N J 0 0 4_ J W I wore. 4 �( 4 JAMB h I r4 N J I 0 ° ; Y a A s i °.1/4r21/4 _ �f 1 .. - ! sRICG4 0 N •d I - a .1 OAK ]STOP. W w II N I h rtloGt •41 T1iRE5 HOLQ ? 3 O I ° I m V JOISTS FweN —RAFTEIRS. 1�ar2'/2. PLATE U d ewcKa i•LATG n n KN Etf WALL_ N SYOOL P 11/• I I -�\M / 4 G1RORq!!ND I N _ /Y I - 51AIM d SILL \N \~ LTILS FL/.PTGRS NA/P VIE I*4 ^' 1.4 - �••�.�� e •na a ..PAP6IZ - I/i`6 `RAFTERPC 56 JOISTS O EX' -+i-- R'°.FT 's 3 dW IQ E LN_\ SLAPJ' sFD�N.. I S. D O'O�L. DOUBLE Zx4 PICTURE MUIJQ WINDOW ;WINDOW. SCALE:1"�1=0 SN•T 6� TADL PLAT.G ' SjCYLIGMT � fp ;Y�N OTC l2.ON \"� /' .N 3MQQT 2.. r. '�„Z"�a�.r• g�` Fr LySi'i l7ETA1L 2 2 12�.. "�� �� .:,yy;�,y.•m tff yO W.SMCa LrS�.',j. I1�--4-.-8dd•I SA:NH. IY r/1/ II IVIS.CsT1h su-NR—g 5•BTIr_-_=•••11--.__fi G1i SI"SN EE7..g 1F--f3I�4�- I i I[S•II i iI�i� O-1-SI-GAT SUT` 44%S 48'•4Ro o4 S Z4 L-m 'i�Ti LSGf S. ECDSTAI` 62 FO 50T, 34 L 1i III 1 r-S/ID O G _STUI7TEE- 9 -.7 T,1_ _ 11 1 ` L4 4'�-- -21-4- ----- -- - 24 rlT- - -rj _r- � T lj APRGN.E'D T:d ♦�_� .L uNecF� RaAR aCA,L Inc %,s I•O" usJ OER ROAR Q1K-Q1y Fro ST>D G�R06 R.PoiTc i ------ -----R —r+ +tr=.- =_ = 1 __===J— —ELI-TOWNSEND&SON.INC. L-,--- -- - ' -u_ ------__i_JI L_L�� ue.+CtlilseAR_ •'- - ` -JSGAL.E� I/B'C1=o' P.O.BOX351 i C.IIZeaer�,vosTs. _ CLINTON,CT06413 DESIGN : SEE SHEET 6 FOR STRUCTURAL SIZES, PERTINENT 5TRUGTuRAL NO. NOTi • DGTAILS, DI►,.tE14310NS, P.ND NOTE t7GFCRENGfiS. DETAILS 1•79 I - SCALE: " II� SHEET 6 OF 7 • �,L � �2 sGca�,—r— ...... _. .. .. ....__-..... ...._...___..__.._.-.._...............__._._._-_...____-.... _.. ...... __.__._.. ZO T. 15(_1 rrr, rrr rIFF FrFI I F_J Lr � • F F.r-FF :r_1 FL F __I i PPHrr F_j 1""� ! II C.H.^ASH 28+4G,� I .-_.-.,_ U• .1�•_.__.. r �fIF rrfr; rJ-1 rrr M li I,r1 FJI I II -- z i a ---------- - I I------- — --- 2 X 6, _... ....__I �21D4E Ib { sEE TABLE, SHEET rj= • R — Al �1� /j FO¢ LETTERED DIMirN510N5 00 SKYLI GNT N @ PLATE z'Z �' \(2.2r4) I 1zOOF St-ICATH- + (2/2x4) n ? /o�� �+ �I +6 (Saw NOTES) 6 40 ( I Iu Z C{IG4E �O/ {(� wIN�Told�i UCIS pEYA11_ _F 10 'L �666J..oL6� Y "' JOISTS) coq SA SM / 4 SIZE Zx4TI65 AT ALL Zxfo PIES AT 39»12" / / 2x8JOISTSI L1J I AT .q RAFTERS (LAP ALL-.RAFTERS 10=0 LONG Np JOISTS 11 56G (LAPJOISYs..L5') (/ 2.4 STUb5 (SEE NOT%5 ��(�_ :� N0T65) Cr• s1a (.4 V 1 EJO1r. N N Y. _ ✓✓ T,L oN SNBE5(58E DOTES Is 41z-) of E F SEE N oyE 3 Gt>. 37/g(•3241 ) Na—ILa AR - L-2 r4 / d�F o1C 2-z-c- '2•zrG .. GlR vccZ(2•zr:12 WITH 11 ji'P•w. SPACER) / /f •J m� Irj•O%�y,(6EG NOT6S•149) 153-1 D15AP'G 1• 2.8•rG-6 (ss¢Nora 1o) . �JO15T LENGTH-I6-O• I r i jmN . SCE NOT£r7)Jpp, DOOR !o0•r Oro--24 LIGIFIT I/Z"�`• .. i 0 1, a I WINDOW 3 •0+ SASH -1 SEE NOTES (o 'r ro-u% t 31" 31" A.o' __ 4 OIA. POST %Z D1A• ANCHOR f5"-rS 'I-,y"I; AT MID SPAN �a I ON %,IOMIIUALLY 6o CTIZS. 5LE NOTES I I F✓or 41RocR = b e`/ 4' SEE 4) I ( 1� 1�'NoT6 to4Y 16 2x suos ICo�O-G- I i I �• s) Z+•6 SILL AP12oN (POUR WITH SLAB) GtZIt 15, ADE • _•_ EXTEND SIDE' •To p•Ofr'FOUND ATION EAIZTh1(TA 1-11-) M. . = I' �' 3•Z- ,1♦'•. d.Iln FOT•AI WALL 4RADE :'• 4�STO NE BALLA S •8__I'I; •I.' I• Fow FROST . 4 .I• . 1, a•' HARRIER a""6- }•CIENTHRGD UNDER 4"POST •4 N•'4• FROST LINE .I ° � _ SIDE dl� '••' '• =NL ------ •;1 '• � : ELEVATION P I.-CUOLA--•-I SCALE "tI� 24'r.24"(SEE f-wONT RIDGE ELeVATION) ii�� FURRIN4 74 $TRIPS _ � 2r6 R,o.IFTEliS •I J 20-0 Y II ( .. ILA FTCR TIES MAY bE F I'ZONT PI.ATEt 2-2r4 (IZ6AR' I LAPPED TO E1TNER SIDE Z % N I PLATg NOT SNOW N) F O JOISTS AND RAFT- ERS (5EE wo-rE: g) IA x a' N Caoucrt OPENING FOR - 16 16 16 ZK 6 RAwTEGGS A. I 16- '� \ DISAPPEARING STAIR'S (l MW \ (S6E NOTE: 10) SOLE - '. 2r6 TIES 2y8 Jo(ST AT smIcicLSE'- t (2r4) gR ID61N4 jZ P.W. WHERE ON 16" CEN- _�n ! TERS, uNGBR �AFT- � ML JOIST DISLR� SOLID I%®LocK'4 OVER GIRDERS , i - Zy8 %t•P,W. esETWESN ENDS OF A F JOIST s SID MAYEiC ND TIE (AT x I i 4J m~ IT = I Z•Z'='z +IRosR; - RAFTERS E ONLY-5EE SNEETy� O (WITH %iPW. SPACER) �I 4" 48 FROIJT'ELEVATI ON 3 a 24 `A`P.W.SFIEATHIIJG REAR 1 • Q / (41N4LE'P4NEL9)1 REAR -r W-V G- SCALE% /4"i I ?'=G W,PTHS ASSMOWN, Z-ZxA' STUDS TUBE SILL GUT To LINES INDI- II 16 O•G• GA.TED,j sEC'No w'Za I I- 2y4 BLOGKlN4 . (STUD AtgR"G.T 4T ALL 10-0 IO+Or ni FOUR GoiCNEcLs) DETAIL"A" 4 OIA.5TKSLPOST UN- 2-zri4 It �-2x 4 S 11" DER 1iGAR ralmDEW, I I 10" II' . (,SEE NOTEFl 7) I• (SEE NOTE 4) 1" IUOTES WILL 13E SCALE-1 61' Q I" TOp OF, FOUNDATION -roip. OE 2x6 SILL FOUND ON 5H6ET Z 4' I--4 •N ; s L�.a A ELI TOWNSEND&SON,INC. P.O.BOX351 FOOT.4 ♦ I-I- -• (AT Pg 8N ONT 01F 1A' '' %V gr UDER ..-. 41•-� 11�4*12 APRON oNL•/) 12 1•!.I RCAR 41Ro�R CLINTON,CP06413 1 O'-O" S l.v.s •.:- a •I: ... ..� • 1;• G" 8"12". DESIGN WALL •12 -"I.� RHAR WALL re--y . .; -44".Z4" STRUCTURAL, No. 1. 4". FOOT'07• D ETA I L 5 179 4" ... IT N =MI •'.•_' I�---I+--a1DE WALL F=T'Ci (I`��) °.• SCALE �4 a;I:I7 SHEET 4'or� � � APrioN FC'TN WALL Z 7 � C a� 1 1 � i ' r �I i 1 1 r --- ------- DEPARTMENT'OF PUBLIC SAFETY r CONSTRUCTION",SUPERVISOR LICENSE Nu6W Expires: DAVIP,f'.MAIEN" q: 275 QUASON'PATN BREWSTER, NA 12631 OMIM �ROVEMENT;CONTRACTOR ` istr tion�t1S205 —1—VMS 1-1111 T BSA r x iraton Qi/06/00 DE CONTRACTINfi,¢3 a , r"��QUASO S PATH �. � ~ � a�� '�•••� -.CST ��:� :,_ �.�,-� ` ti � .•. # Ir ,. 6 2 `. i)e p k.Ac Nk IN Ak Ak Q Y \ Z O � � � � t ?^ "�s'���°F;gco/Ens i � ` q �4 4 � •{� V L, abO J .0 �i ol cp Ile ` Q � a