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Home My WebLink About0007 ORR'S AVENUE �' CQ,e.� s �y� ��\ r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION C4 Map r- Parcel Application # w/ -S� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee f � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis r Mw4z�.- S ENT Project Street Address _-7 Village S Owner I'I n da L e-o ii a, Address o r ps {�V P. Telephone g_ A-) 11 Z-7 I � Permit Request & t c�a m r e im o J l .— n1 yj s o w e Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /.;D0oe, Type. � Construction T e 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 Xlo On Old King's Highway: ❑Yes XNo Basement Type: �kFull ,Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) D� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new C Half: existing new Number of Bedrooms: existing D'new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: AGas ❑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: ❑ existino Ll new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ,>"o/' 94 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 1Pox, Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION I ) (BUILDER OR HOMEOWNER) Name DCLui C� �c�,e�v ( l Telephone Number -76 Address cat Fre-�e lrJ c k License # CS ER- 0 L 0 Q 6- t - Fo-1 m Home Improvement Contractor# io) I� , Y Email ZW E C..I L L L@ �d+yy% C O M Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO O0tJr&-e SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 8 .. I -7JO- INSULATION QL'Y-� 3GZ17 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING S ! p j DATE CLOSED OUT ASSOCIATION PLAN NO. z The CoIIZmo2rweakh qfA&wadi=e& Department fr dmvbi&Acddentr 600 Washungion meet Boston,MA 02111 '. fv�l�x�m�,gFov�d'ia Wurrjmre CUMpensafi=L s r=ce ATu1wvft-BwlderslCtmtx7.ctmrsiEechit-iauslP �ers AppEcaiEd Warm,afing Please Print BIne -.1 )a t b city/staff (M o Phone Are you an employer?Checkthe appropriate box Type of project(regained r_ L❑ I ant a employer vd-ft 4 ❑I ant a general contractor and I employees(fsll aml/or gar�time). * 'h"e lib!d gm sub-cotes 6. Elau New os�ion • 2: I am a sale prgpdetos orpartner- Fisted Cafhe affaclied sheet I`- El R— deling and have no 1 These s'ob-caafradn s have �P�� . ❑Detnalifion: ivmidng forme in any capacity emprlayees andhave wad=- ENO T4�8'Comp-*rnvx�nr-e COSIIP. nertrattrr$ BIISI S[ SfI4II MFEM&I 5- ❑ We are a vxposafi=and is 1�1 0 Electrical repairs ar adQions 3-❑ I am.a homem mes doing aft wmk officers have exercised fhesr 1L�Fh=bingregai=or ad�am Myself[NO workers,�. Tight of eaepag m per MCI L?p Roofrgmim amn=e retEdmd,-j i c-M JIM andwehaveno employees-[No WMAM& 13-O'Other camp-ms=anc a required-] •�4ay�F6�t6astehectsbozrl®sttilsoSIla tSesectEoaheIaa slrat�g�rswooice�s'm®p0!09 ,.poy�i fiotL TME7L'.OGr71et5Sr}!0 sahmlt i�S it�d3iII 1 argdc !tg W�ita��hae oilde Ca�adaL��t sahmita IIeW�tiaait u7di cnrSf -�a�sf�sf d�ecT�dus bme a3�c aaa3di a2 s�xePt sboaingthe-" m of the sdb-c Xmd stEevhethez ornotg=e emities eagglopees.Ifthe al-CantadvShaveadorns,ffmyffistpnM&dLeir uv 'tomP•FaTic�a�treL I am are eirip�er tl>otirgrux2+iirrb tcrorkets'cou�resatimt irasrzracrca for��FIQS�ee� SeTatt=is t!'teprr8cy aid jaFa sips , ir�farr+r�n Is�xanceiComgaapNaiSe: PC'ficy'or f-ias-Iic-.� ate: Job Sife Address: C4/St2fe/zig: Af 2ch a mpy of the workers'cbmpensationpoliey deciara4ion page(shovkg the policy number and expiration.date). Failnre fo secure:coverage as requiredunder Sw6on 25A of MGL r-IS caa lead fu the imposi!•ion of miraiiial penalties of a fine up to$L5aD 0U and/or One-year imprisonment,as well as civil pena19 a fhe fo=of a STQP%DRK ORDE znd s:Eme of up to 1kQ a day against ffie viola m Be ad-,ised&d a cry-of this Ademat maybe farwarded to the Office of Izrvestigatians offhe DIA Ew;n=m covemgc ve.dfica#iotL Irfp&er�y u tits atld F 'fhatfiTis informa€i nPra i&d above h tress and correct -�-� OjakiaI am anTy. Do not curls in this area,to be co-zapLeted by edy artolm offidaL City or Triwa: PertgitiLkense;g Lwaing Aaffierhy(code one): 11 L Soard of Hz iii 1 BuT Tug 73gm meat 3.MyJTowa auk 4L Electrical Tnspectur S.Pimziarng Emspecfmr 6.Other Caabct Person: PhanL-9: 1 1 11 , I1 11 1 1 11 _ r[lt• •`rR I• r, ■• •- •lI■1rR r■n■n rt .t\•1/ [11 [\ [ .aa1■ • ' - •� r rw•t u i■ - r • .n■n� m■r _n rum .r • ■n '■■ V1,01.I21 no in 7. 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'&WC Guide to Wood Construction imHigh . 110emoh.M'�ad Zone � � Massachusetts u.hec8fist "�for � (70UCvIK5BO1.�X'1)� Check Compliance �� Wind Speed(3-sec.gust)................................ - ___.__--___-_-11V mph ,`"=E~p"""=Category-------`-'---'---_--_---_...................................................... --2 1'2 /PPLICABIJTY Number cfStories � Moan Roof �� --- Building_ Width,_ - '_..................-...................................... � B�d�Q/spe�Rado ---------------`---- S80, --- , »-� 31 Nominal Height m[T��Opan�Q^ -_--____.--__.(=�4)_'._.-_-_---_--____-----�O�^ ---� 1'3 FRAMING CONNECTIONS General compliance with framing connections....................(Table Z)....................................................... ....... � 2.1FOUNDATIO0 � � Foundation Walls meeting requirements o[78O CMR 5404.1 ^ Concrete.......................................................................................----------------- ConcreteMasonry....................................................................-_--__' ---- � 2.2 ANCHORAGE nOFOUNDABoN1,3 5/8 imbedded Sc?lt.Spacing general.......................................... �� n. �_ Bolt Embedment concrete--'------------' Bolt Embedment � ' --- � cmo�o��n -n�uon�_--'--_-__-'--(�Q5)'_'__'---__--__-.. in.;-�1T � � Plate Washer...............................................................(Fig5)...............................................2t3ra3'x 1/4' --- 3.1 FLOORS Floor framin-member spans checked -__-__''''--. Maximum Floor Opening Dimension...................................(Fig O)......................... . ft 512'mrU2pr ! --- Full Height Wall Studs,t Floor Openings less than 2'from Exterior Wall VFigQV.................................. _ ' ---- Maximum Floor Joist Setbacks � ---- ' Supporting Loadbearing Walls ur3haanmd ................Figr>...................................................`__� �d .' Maximum Cantilevered Floor Joists � - ' Floor �� Floor 7�� - ---' Fk�r-----~ ` --- � Roo Fos�n�g___--'---___---.--'..(Tab�2)-___dnails,d �—in edge ---- ' 4.1 WALLS Wall Height and Table �---.-__-----ft �V� --_' � wm�_____-_--_._-__ and Table Q........................... ft :5 20' Wall Stud Spacing ..................................... o and Table s)-_--_---__��.u24^o�' vwaa��unou� -_-___---_---_-__'(�us7&U)------_----'----____ft :5d 4-2 ExFERIOR WALLS3 Wood Studs ` � ' L°a"==""e walls..................--.................................(Table o1.......-....................uxL__- ft i� No,L^"d=°o � � Gaom ---' ` Full ' Height --Studs.........-................................. . Gypsum Ceiling Length Cff VYSP 11 --- � 'ux4 Continuous Lateral Brace @nmLo.c.-(Fig 11)....................................................... �_. ---' Double Top note --- � Splice Length ........................................................(Fig 13 and Table 6).....................................___� � | S�coConn�m��uf1Cdcommm n�e -'^--.�au�6V_-_-____._____, .........___ ---_ � N . | m / �Jf AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone f Massachusetts Checklist for Compliance(7so cMR 5301.2.11.1)1 Loadbearing Wall Connections Lateral(no.of endnafled 16d common nails)..............(Table 7).......................... ........................... Non-Loadbeadng Wall Connections Lateral(no.of endnaffed 16d common nails).._..........(Table 8).............._.................................. Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ................................................;..(Table 9)............................... _ft_in.511' Sill Plate Spans .......... ............................. _.__......(Table 9)._._:._....._ ._............._ft_in.511' _ Full Height Studs (no.of studs).. .......... .... ...:._._..(Table 9)........................................................ _ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans..............__................................_....._.....(Table9)................_.._............._ft—In.it — S1l Plate Spans.... able 9 Full Height Studs(no.of studs)............_......................(Table 9)..........:......................... _..._ _ Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W Nominal Height of Tallest Openin ......................................................._......I................ 5 618' SheathingType................_...._......................(note 4)...................................................... — — Edge Nall Spacing.................................._._..(Table 10 or note 4 if less)........................—in. _ Field Nall Spacing..........................................(fable 10)................................................. in. _ Shear Connection(no.-of 16d common nails)(Table 10)_......................................................— Percent Full-Height Sheathing.................._....(Table 10) o _- 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... Maximum Building Dimension,L — Nominal Height of Tallest Openine.......... ................................. .............._< ............. SheathingType.........................................�_(note 4)..........._...........:.........._..............._.. _ Edge Nall Spacing......................_.................(Table 11 or note 4 If less)........................—in. _ Feld Nail Spacing..........................................(Table 11)................................................. in. Shear Connection(no,of 16d common nails)(Table 11)........................................................ Percent Full-HeightSheathing.......................(Table 11)........._..... ................................. % Wall Cladding _ 5%Additional Sheathing for Wail with Opening>6'B'(Design Concepts).............. ... — Ratedfor Wind Speed?.............__...:................................................................................_..........I....... ... 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) _ Roof Overhang .................................................. (Figure 19)........... _ft<smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls — Proprietary Connectors Uplift................................................(Table 12)................................_..........U= pif _ Lateral......._...................................(fable 12).............................................L= plf _ .....(fable 12)............................. _ Shear......................................... ...............S= pff Ridge Strap Connections,If collar ties not used per page 21.....(Table 13)..............................T= pif Gable.Rake Outiooker.........................................(Figure 20)............ _ft<smaller of 2'or L/2 — Truss or Rafter Connections at Non-Loadbearing Walls — Proprietary Connectors Uplift_..............................................(Table 14)............._...........................U-_ lb. _ Lateral(no.of 16d common nails)_(Table 14)................................ - Ib. _ Roof SheathingType.YP .................................................:.(per 780 CMR Chapters 58 and 59).................. RoofSheathing Thickness...........................................................:....._......_..........._in.a 7/16'WSP Roof Sheathing Fastening.........................................(Table 2)........._.................._............... __.. .... — Notes: — — 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 53012-1.1 Item 1.9 the checklist Is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a. 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and-11. 3. The bottom sill plate in exterior walls shall be a minimum 2•in,nominal thickness.pressure treated#2grade. AFVC Grcide to Xbod Corrmf wct ort zrr 1{�h H ru-z Areas_110 mpIr Brad-71717e . assachusetts ChezkHst for Compffmce cnD C&TRs3nt 2 i_I�r . 4. a. From Tables ID and 11 and for fmn of viall sheathing and 13ur7dmg AspectRafio[determine Pmr FU& teight _ Sheaffhing and 149 Spacing requirw=ft ' b. Wood Structural Panels shall be n*ft mh thicimess of 711 6'and be ins led as fonom L . Panels shall be installed N%A slrengtih azis par-Ael fn sleds- ii. AII horh=AW joinfs shall our over and be rrAed to fi ning u'Z On single stilly mnstrh�cfian,ganeds shall be attached b batbm ptatrss and iap.inember of the double —_-- -__---- --.—$t Dn Wwo-s{nry=„L l5anrupperpanelsshaIIhe alfadhed taAhe bP in mber-of the. doubler top-- --- plale and fo band joist at baiiam of panel.Upper attadv ent of lower pafiel shall be made to band joU and lovveraffacfhment made.ta lowest plate at fast fli5x aming. v_ Harimrdal hall spacing at timbfe top plates, band joists,and girders shalt•be a double row of ad - staggerEd at 3 inches on cm6r per figures below:Vmlml and Horrmntal hfariing far Panel A4fiachment �. Glazhg prrfte t a)new house whorimntaladMon—re luirad ifprnjeifi i mile Drcloser•in share(generally.south of Rte.23 or milli mf Rfe.5) b)verCl addmon—not required cuiless there is e,�atsive:rernwdon fa the fi st-iioor c)replacamerikidows—needs energy mnservation cumpWc:h only(chap 93) Waad Precise Con=5vclan Manual(14Mh5)for i 10 MPH, �m B may be cbfabedfrom the Ameri�n Wood Cottncrl (AWb)vnebsfh� . . rra-asa ur�rs 'ATE-== [j it (. �• 7 K itkx ll•� I LI II L 1 _ • rss as cc - i Ir 1 ) _T[ ll av 1>1 [ [ s _ C i ' m ii id XL JL: IS it „ l [ tea.evr a 1 E ll ar • [ ' _ 3 � It �� 1 ti • i i j`ri 11 _ • Tl =l[ y1� AL4�L?A7Z1�N Z • f V�{ESPJEC�JCS•Atld3 e� ` - - � •...__ PI.F� - , See DHIQ:in Raxt Page - - - VmrUcal and Horizonte(hlerT .9 De�lf - - for Pang Aft�ht � �ernFal Grid 1-J'an'z�rrial Nat7mg , - fDF Pa< Masi inmerjt _ . Town of Barnstable Regulatory Services Richard V.Seali,Director 6 •`� 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 ►�l.c Gc� j./��l ,as Owner of the subject property hereby authorize _.�/Qn;l� Cl t�8'�� : I to act on my behalf in 0 matters relative to work authorized by this building permit application for. c rr (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. L d- 1 Signature of owner Signature of Applicant z,)a U Print Nams Print Name Date . QTORMS:OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services o�Irma. _. .Richard V.Scali, Director Building Division • � Paul Roma,Building Commissioner KABIL `.� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ` JOB LOCATION: number street village "HOMEOWNER": -_-_-.-.- name home phone# work phone# CURRENT MAILING:ADDRESS: ( cityhown 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. Sign=m of Homeowner Approval of Building Official APP „ 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 of 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. —,� •.- c_/ize�pai�anzayccuea��a�C?�oac/uaeLr' Office of Consumer Affairs&Business Regulation i HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual I before the expiration date. If found return to: =<_=<Regstration Exoiration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 12/09/2018 Boston,MA 02116 DAVID A.CARROLL DB/A Cape Cool Remodeling and Design n DAVID 12 Frederick B DouglasRd::' N.Falmouth,MA 02556 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-060265 "_ t Construction Supervisor 1 & 2 Family DAVID A CARROLL r, 12 FEDERICK B DOUGLAS`RD. N FALMOUTH MA 02556 �.�rtIz -- Expiration: loner 03/08/2019 ervisor Constcu&a t Sip Rest�icte F USe�s sack se- of the Maf this t►ceps treat edition°canon GOV IDPS 55ess ,c cause tot rev��J MAgs i5 - FadutgU`a 9G°ao ffmatiOn vis Sta- es to OP i C3-- Omni t1^� � `1T s - 2 O TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma p___C- 96 Parcel O A pp lication # Health Division Date Issued Conservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �ryl Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner ( G{ -�(�Y�Q1 �1 e Address YLW/�s Telephone 2-Da c27_� :7/ 9 rr Permit Request �FM F� �� i�,)�J��+one ��C� � � � [A C. � E,rnpy CC �C'c{u3A PA Sk�E Square feet: 1st floor: existing L?(%broposed 2nd floor: existing proposed Total new Or Zoning District 4 9 Flood Plain Groundwater Overlay Project Valuation 00 'O�Construction Type E �q Lot Size i ,� /4�, Grandfathered: ❑Yes J1I No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) > Age of Existing Structure < Historic House: ❑Yes �3 No On Old King's Highway: ❑Yes U No Basement Type: )7ull ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0' Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _ Half: existing new ey- _ Number of Bedrooms: existing0new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil Electric ❑ Other Central Air: ❑Yes �W Now Fireplaces: Existing New Existing wood/coal stove/:�❑Yes,�"No Detached garage: ❑ existing T new size_Pool: ❑existing new size _ Barn: ❑ existing�0 ne- r size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing new size _ Other d' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 6 Commercial ❑Yes C No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION v (BUILDER OR HOMEOWNER) Name Pwe_r L_0_rOGVle_, Telephone Number Address License# (f s "-O -7 n Jtl j 0 , . G'c ( :Z(4?, -)Z Home Improvement Contractor# Email�t - Y_ era CEiCLQ j r r , Cnyn Worker's Compensation # O!S—/OCR- (A6/9 Scia- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE =4 DATE % f • FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: x . FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING D ,5/1 / DATE CLOSED OUT t w, ASSOCIATION PLAN NO. THE RIGHT CHOICE -- -- - 1 k. Since 1971 i Office Use Only *Clecansi e. JOB:NUMBER ] Restoration - - 217 Thornton Drive,Hyannis,Mass.02601 508-771-3110 800-464-3318(MA.Only),774-470-2211 Fax ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant ' s policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside ' s claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Inc. within sixty (60) days after work has been completed. Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster. Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one- half (1-1/20) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover, as additional damages, attorneys ' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant . 7 Drys G?ve : G LOSS/DAMAGE ADDRESS ' ��'� �a �l►� -e all a r @ C..a,-ACa s f' o e1- MAILING ADDRESS (BILLING) CITY STATE ZIP INSUURANCE ADJUSTER' S NAME/CO. LOCAL INSURANCE AGENCY NAME PRIN NAME INS . CARRIER/POLICY UNDERWRITER DATE: CfA'IkANTFS G&ATbtt PHONE: SOg- c` 74` 919( EMAIL: r Yp 1 License orxegstra"tiofl valid for individual use only. tiefore;the expiration date =1.f found'return to: . Office:of Consumer Affairs and Business Regul'at'ion •10 Park Plaza-Suite 5170 B;os,"ton,MA:021I6 Not valid x i't• � kout sigpatu_r,.e ' Construction Supervisor Restricted to'. Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIPS Licensing information visit:WWW.MASS.GOV/DPS UOU£O/4 JauoissiwwoD :uoijejidx3 yw� 1Z19 0 VW 3llIAa31N3D a atl021 01?J030 8L 3H0021tl1 tl 21313d d josiniadnS uoipnj;suo: L60£10-S3 :asua3i� spiepue;S pue suoi3eln6a7d 6uipline;o pjeo8 /la►eS oil4nd;0 tuawpedaa su9sn43esseW ro 3HOabl 21313d'' p?e0 3u2w6lddr S' a e ld- 2101:JVVH N0 0?1dWf3W uoye�n8'a�ssay�sn�r�gsa�e��awnsuo�,o,aa� The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114--2017 www mass govAka AYiorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbem TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/lndividual):-n ' (a n s(cke -r� , Address:_ i:9 12 Tho rr14o n D 6 ue, City/State/Zip: Q rin i-5 Ma 0zf o ! Phone#: 1 — 31 0 Are you an employer?Check the appropriate box: Type Of project(required): 1.[9 am a employer with R—JT'employees(full and/or part-time)." 7. ❑New construction 2,❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] ❑ 3. 1 am a homeowner do' all work myself o workers'co 9• Demolition ❑ � Y (N mp,insurance required.]t 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees, 12.[]Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-oontraactors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.$ 13.&ther oof repairs 6.[1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ' � M l rIC;r- ccz Yi� 152,§1(4),and we have no employees.[No workers'comp.insurance required] aloe— 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below Lr the policy and job site information. Insurance Company Name: A , T_. M . /►'1 U iJ�L I Policy#or Self-ins.Lic.#:-WC C- /©0 -74ZO/9 D,Q- O I&A Expiration Date: V 1 v/. Job Site Address: � �r�f� `� City/State/Zip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. I do hereby cerli r the pains and penalties ofpedury that the information provided above is true and correct Si tune:. ate:11 Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A`CORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 03/30/2016 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 ;CONTACTLinda Sullivan DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 775.1620 FAX ADDRESS* lsullivan@doins.com 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC 8 HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER e: OCEANSIDE INC INSURERc: INSURER D: 217 THORNTON DRIVE INSURER E: HYANNIS MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 41040 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. L R D SBR T TYPE OF INSURANCE POLICYNUMBER P0M D O I EFF MM1DD E LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TUAMM CLAIMS•MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any oneperson) $ NIA PERSONAL$ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY j�T LOC PRODUCTS $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL AUTO OSWMED AUTOS SCHEDULED N/A BODILY INJURY(Per accident) $ NON-OWNED PROP TYDAMAGE $ HIRED AUTOS AUTOS Par. UMBRELLALIAa OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DIED I I RETENTIONS $ WORKERS COMPENSATION �/ STA E H• AND EMPLOYERS*LIABILITY YIN /� ANYPROPRIETORIPARTN£RIEXECUTNE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMeEREXCLUDED? NIA NIA NIA VWC10060198022016A 01/01/2016 01/01/2017 E.L.EACHDISEASEAC IDENTEMPLOYE S 1,000,000 (Mandatory In NH) EA Kra describe under DESt;RIPTIONOF OPERATIONS below E.L.DISEASE•POLICY LIMrr S 1,000,000 NIA DESCRIPTION OF OPERATIONS 1 LOCATIONS/VE81CLES(ACORD 101,AddlUonal Remarks Schedule,maybe attached Irmore space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 D6 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwdtworkers-compensaUon/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.' AUTHORIZED REPRESENTATIVE C n C�� Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD z� p O co I 12/14/2016 Print Page Print this page • Owner Information -Map/Block/Lot: 290/062/-Use Code: 1010 Owner Map/Block/Lot GIS MAPS 290/062/ LEONARD,LINDA J Property Address Owner Name as of 1/1/15 7 ORRS AVE 7 ORR'S AVENUE HYANNIS, MA. 02601 Co-Owner Name Village: Hyannis Town Sewer At Address: No GIS Zoning Value: RB • Assessed Values 2016 -Map/Block/Lot: 290/062/ Use Code: 1010 2016 Appraised Value 2016 Assessed Value Past Comparisons Building Value: $ 60,400 $ 60,400 Year Total Assessed Value Extra Features: $ 12,900 $ 12,900 2015 - $ 144,200 2014 - $ 144,200 Outbuildings: $ 0 $ 0 2013 - $ 144,200 2012 - $ 143,900 Land Value: $ 70,700 $ 70,700 2011 - $ 149,700 2010 - $ 186,500 2009 - $ 217,000 $ 144,000 2008 - $ 234,900 2016 Totals $ 144,000 2007 - $ 234,700 Residential Exemption Received= $90,000 • Tax Information 2016-Map/Block/Lot: 290*/062/-Use Code: 1010 Taxes Hyannis FD Tax (Residential) $ 348.48 Community Preservation Act $ 15.08 Tax Town Tax (Residential) $ Fiscal Year 2016 TAX RATES HERE 502.74 866.30 http://www.townofbarnstable.us/Assessing/printl6.asp?ap=Msearchparcel=290062 1/3 12/14/2016 Print Page • Sales History-Map/Block/Lot: 290/062/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: LEONARD, LINDA J 1999-12-29 12751/171 $93750 MURRAY, EDWARD R 1990-12-15 7393/186 $50000 BURROWS, DOROTHY E 1990-12-15 7393/184 $1 BURROWS, DOROTHY E 1990-12-15 7393/178 $1 BURROWS, OSCAR S & DOROTHY 1956-08-14 950/353 $0 • Photos 290/062/-Use Code: 1010 ti • Sketches-Map/Block/Lot: 290/062/-Use Code: 1010 32 4- iaks 2 OAS 1 1 .14 As Built Cards:Click card#to view: card #1 • Constructions Details -Map/Block/Lot: 290/062/- Use Code: 1010 Building Details Land Building value $ 60,400 Bedrooms 3 Bedrooms USE CODE 1010 Replacement Cost $90,170 Bathrooms 1 Full-0 Half Lot Size (Acres) 0.35 Model Residential Total Rooms 5 Rooms Appraised Value $ 70,700 http://www.tawnofbarnstable.us/Assessingtprintl6.asp?ap=O&searchparcel=290062 26 Cller0:$86926 20CEANSIDEIN ACORM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) Q4104/2016 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(8),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 OrCT Dowling 8 O'Neil insurance Ag N, 508 775-1620 (AIC No, 5087781218 973 Iyannough Rd,PO Box 1990 E-MAM Hyannis, MA 02601 ADDRESS: 5O8 775-1620 INsuRER(s)AFFORDING COVERAGE NAIc r INSURER A:Arballa Insurance Company INSURED INSURER B: Oceanside,Inc. 217 Thornton Drive INSURERC: Hyannis,MA 02601 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MP�<�IC F MP Y EXP LIMiTB A GENERAL LIABILITY 8500061423 0110112016 0110112017 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY % UJ D $1 OO OOO CLAIM84 AADE �OCCUR MED EXP(Any are arson $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY 1,1 M�d�DISI G T S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OAMAGE HIREDAUTOS AUTOS PPer�eoEckleM $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DIED I I RETENTION $ WORKERS COMPENSATION WC STAT - OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE EL.EACH ACCIDENT $ Y I N OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) EL.DISEASE-EAEMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained In the certificate of Insurance shall be deemed to have altered,waived,or extended the .coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/06) 1 of 1 The ACORD name and logo are registered marks of ACORD #S167993/M167992 LS1 12/14/2016 Print Page Style Ranch Heat Fuel Electric Assessed Value $ 70,700 Grade Below Average Heat Type Hot Air Year Built 1954 AC Type None Effective depreciation 33 Interior Floors Carpet Stories I Story Interior Walls Plastered Living Area sq/ft 936 Exterior Walls Wood Shingle Gross Area sq/ft 1,320 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Crop • Outbuildings & Extra Features- Map/Block/Lot: 290/062/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 story 1 $ 3,000 $ 3,000 BMT Basement- 384 $ 9,900 $ 9,900 Unfinished • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) SPE Pool Enclosure BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ ' Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio Microsoft VBScript runtime error 800a0la8 Object required:" r /Assessing/print16.asp, line 151 http://www.townofbarnstable.us/Assessi ngtprintl6.asp?ap=O&searchparcel=290062 3/3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel . O Application # /.� `' 3 6q� Health Division BUILDING DEP r, Date Issued f Z l9 G Conservation Division DE 3�Q16 Application Fee Planning Dept. Permit Fee r� Date Definitive Plan Approved by Planning Board TOWN OF 1,3ApN's_1111 Historic - OKH _ Preservation/ Hyannis EN lNi3:-i._ S Project Street Address _� ��✓S ,/� _ Village w,44 Owner Li L c„ L-e ev►c�t Address 2 5 ✓� �C� Telephone 5ZI- 7 2 b -- n'1 Z u Permit Request ^" �5 L 2 �c / VKO� �u Lim �S )I-A\►tit, 4� �e V S � LL T11Q4" ;,e to rO ULJ LAZL ll JAU�. 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 El"_ 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 L � Telephone Number 3 S Address 5^� Aa e-LyL VWA f 91L_ License# _Z�57ZIV ou�5 Home Improvement Contractor# 06 � Email -(LA-bld LZ) &4--,-Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Alf L SIGNATURE DATE 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 k FINAL BUILDING v6* DATE CLOSED OUT ASSOCIATION PLAN NO. CERTIFICATE OF LIABILITY INSURANCE108/29/16 DATE(MMIDDIYYYY) 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). CUNT CT PRODUCER NAME: Pahl MacElhiney Duncan MacKellar Ins. Agcy.Inc. PHONE 781-335-1170 FAX 781-331-6507 , No,Ext: (AIC,No): 835 Broad Street E-MAIL ADDRESS: E. Weymouth, MA. 02189 INSURER(S)AFFORDING COVERAGE NAIC i INSURER A:Scottsdale Insurance Company INSURED INSURERB:Granite State Insurance Co. American Mobile Homes, Inc. INSURERC:Arbella Protection Ins. Co. 51 Moore Road INSURERD: East Weymouth,MA. 02189 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR POLICY LIMITS TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) _ GENERAL LIABILITY EACH OCCURRENCE $ .1,000,000 A X COMMERCIAL GENERAL:LIABILITY BCS0033697 02/04/16 02/04/17 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE OCCUR - MED EXP(Any one person) $ EXCL PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JET LOC COMBINED SINGLE LIMT_ $ AUTOMOBILE LIABILITY - 1020014697 02/26/16 02/26/17 (Ea accident) $ 1,000,000 C ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY.INJURY(Per accident) $ AUTOS X AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ hEXCESS LIAR CLAIMS-MADE . AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X TORY LIMI S ER AND.EMPLOYERS'LIABILITY YIN' B ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ N/A WC ,003-60-3470 08/12/16 08/12/17 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 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) Rental of Mobile Homes CERTIFICATE HOLDER CANCELLATION Town of Dunstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 511 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dunstable, MA. 01827 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD • a Massachusetts Department of Public Safety t0i Board of Building Regulations and Standards License: CS-057291 Construction Supervisor FRANCIS V WARD; II 61 MOORE RD WEYMOUTH MA=02 7' - Expiration: Commissioner 09117/2017 ��e �Ganvr�za�aeuecc�C� rajoac�cr�eCt� Office of consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:';.."106386 TYPe- Expiration--. 3/2_3/2018 Private Corporation AMERICAN MOBILEAOMES I-C:': FRANCIS WARD 51 MOORE RD ;S:c,;_„_ =t•...... -_. E.WEYMOUTH,MA 02189 Undersecretary Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. . . . DPS Licensing information visit: WWW.MASS.GOV/DPS License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature d f .77re Comtarorrivealth of- assachusetts Deprartinetlt of lrndustxial Accidents - - O, c.�e of lm—wstigatioras �r Gil D Waslringlon Street y Boston,MA02111 4 c�tc�t�r Ynassgovfdia Workers' Campensatian Insurance Affidavit-Builders/Contractors/EIectr cianslPlumbers Applicant InfGnnatran ' Please Print Legibly Name S sslY�iganizationflndivirinal}: �(1 w Y4L.1 log l�ttii�c�_s � 7!;;,L Address: �� Y dllllJl�2 I� City/sta&zip.: Phone l -v Are you an employer?Chec the approp ' to box: Type of project(required): I J2-'jam a employer urth /2�_ 4 ❑I am a general contractor and I employees(full ar<dforport-time). * leave hired.the sub-contractors 6 ❑New consisucfiroa 2.❑ I am a sole groprietar arpaifiner- listed on the attached sheet. 7. ❑Remodeling ship and have no emplayees These sub-contractors have g.,❑Demolition wvaddng far me in any capac_i4y employees and have woAcers' jNo ry-orlrrtx' comp.insurance � comp.insurartt�.l 9. ❑Building addition required.] 5. ❑ We we a corporation and its lU'-❑Electrical repair or additions 3.❑ I am.a homeommer doing all work officers have-exercised their 11-❑Plumbing repairs or additions myself o workers' fight of exemption per 1'i!IGL comp c.152, §1(41 and 13.❑Raofrepairs insr�-+nce retluifed]T 13.❑Other employees.[No workers' comp.insurance required-) •clay w1icz=thatchecUbox 91 must also filloutthe sectioabelowshmring their wo&ez'compensating policyin5nnation.. #Homeowners;who submit this R daxft ia&cating they are doing RU Waak and,then hire outside contractors— submit a new affidavit indicatiq;5UdL rCantractorsthat cbecictWs boa must attached ss.sddiriaasl dmt showing thenarne of the sob-cogs sad state whether or notthose eatitieshaee employees.Ifthesubtantractces have emptayees,they mautpnnridetheir workers'romp.policy number. I urtt era erlepla;}�ar ticatis prat-adirt�ivarkers'catrrpertsrrfiorl irtsrcrartca fur rrry*cnrplay�ees $eIoty is fhepaliay�d job sits information. Insurance Company Name: Policy fi ar pelf-ins.I ic_ U) L 3 6 n 3 Y 20 l w:piration Bate: p 1 Z Job Site ALddmn:__ :2 6,rr 5 City/Statel,' iv t L s Attach a copy of the workers'compensation.policy declaration page(showing the policy number and expiration date). Failure to se=e coverage as required.under Section 25A of MGL a.152 can lead to the imposition of criminal penalties of a fine up to$1,50100 andfor one-year irzVrisonwwf as well as civil penalties.in I ie farm of a STOP WORK ORDERand a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations.of the DIA for insurance-coverage verification. F do hereby certFfJ�raacdtsr the s a dpsrtabYes ofpe jury that the irtfot uativar pra ided abme is tar$mid carrect Sismature_ Date: Phone i�7 70— 3,3J— Official use only. Do itat wits in this area,to be campleted by city artonm official. City or-omm:. PermitUcense# Issuing Authority(cirde one): 1.Board of$ealth I Buffding Department 3.CR3 own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other C'oatact Person: Phone#: Information and Lustructions Massachusetts Ge=al Laws chapter 152 regaires all employers to provide workers'compensation for tbeff employees. pur.g�this staite,an wT&yre is defined as.-..every person in the service of another under any contract of hire, exppmss or implied,oral or wrirm" An vpproyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or otherlegal 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 - dWPT?mg house of another who employs persons to do maintenance,construction or repay work on such dwelling house or on the grounds or budding appur[cnaz t thereto shaIl not because of snch employment be deemed to be an employer." �4 MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance wn the insurance.cove,.age required." Additionally,MGL chapter 152, §25Co states"Neither the comm®.wealth nor any of its political subdivisions shall enter inf any contract for the performance ofpublic work until acceptable evidence of compliaace with the insm-ar,ce.. ments of this tea have been presented to the contracting authority." requse cep , Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their certificates) of in ure. ce. Limitrd Liability Companies(LLC) or Limited Liability Partnerships(LLP)withno employees other than the members or partners,are not required to cant'workers' compensation ins raance. If an LLC or LLP does have empIoyees,apolicy isrequued_ Be advised that this affdayitmaybe submitted to theDepar-iment of Industrial Accidents for confnmation of fim:man ce coverage. .Also be sure to sign and date the affidavit The affidavit should be retzmmed to the city or town that the application for the permit or license is being requested,not the Department of Irui 7s-trial Accidents. Shouldyon have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below Self-inan-ed companies should enter their self-fisura ce license number on the appropriate line. City or Town Officials t Please be sure that the affidavit is completh and printed legibly. The Department has provided a space at the bottom of the affidavit for you to f M out in.the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permu t cense number which will be used as a reference number. Ia addition,an applicant that must submit multiple pezmitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Adtiress"the applicant should write"all locations in (cry or town)-"A copy of the-affidavit that has been officially stamped or marked by tie city or tows may b e provided to the applicant as proof that a valid affidavit is on file for ht im permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permituot related to any business or commercial venture (Le.. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit like to thank you in advance for your cooperation and should you have any questions, The Office of Investigations would please do not hesitate to give us a caIL The Department's address,telephone and fax number: 1 e CGmMMWezjtla of MassachuseM ' Depar#ment of 1ndustial A P-r CU:ts Q ice.of lv e-g- tio= . FQ4 Wastdnzan Strut` ` (,-L#617 727-49QO Qxt 406 or 1-977-MASSAFE Fax#617-727 774 1Zevised 4-24-07 wW_mas5_gDv/di& Town of Barnstable Regulatory Services ' KAM Richard V. Scab,Director Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I. LI'L da' 1_10CM04A ,as Owner of the subject property hereby authorize ✓�Cr y Y�Lpl�d � S e to act on my behalf, in all matters relative to work authorized by this building permit application for. (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 Owner tore of Applicant Print Name Print Name VI \-� Vb Date I Q:F0RMS:0WNERPERMISSI04WLS Town of Barnstable Regulatory Services pFtNE Richard V.Scali,Director Building Division t Paul Roma,Building Commissioner KAM 639. �� 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 forms\EXPRESS.doc 06/20/16 f AMERICANMOBILEHOMES INC.. 5 i Moore Road Weymouth,'MA 92189 www:ameri canmob deh o mes.com. {781)531-0333 1-806 232-9991 780 CMR I I O.R3 Mobile Homes/Manufactured Homes 11OA3 1.3 Scope. 21he Federal manufactured Home Construction and Safety Standards promulgated by the Department of Housing and urban Development govern.the design manufacture of manufactured homes for installation in this state. 11013.1.4 Administration and Enforcement The state and local enforcement agencies shall deem aceeptable.......manufactured homes certified as;in conformance with the federal standards by the application of the applicable required HUD label: 1`10:R3.1..7 Time of Manufacture Manufactured home is deemed to be manufactured at such time as the label as herein described is duly issued label is attached to it in accordance with the approved r compliance;assurance program,, 110.R3.1.8 Retroactive Changes No changes in,the codes, standards; specifications and requirements of 780 CMR 110 R,shall apply retroactively., 7.80 CW.5313 Life Safety S stems y I 5313.2.8 Manufactured H® es The nnstallation:of household fire-warning systems for buildings designed and constructed as manufactured"homes shall be in accordance with approved methods of such homes as defined 24 CFR and are not,governed by 780 CIvIR 51.00 through.99.00. �iPF - r� � /r/„i r'i-��L�� f �✓ ✓ �r,�a H,sv �� i'/�� ri/ r �rF'yr ✓"�i'�.. / Qj N, Gj h ' E '�`-r �•�'t' t Amy r, /�,'/d"�` /� :2 � / h �,/< �/�� ,rr,- ,_ lam/ % / /i� / �✓rye�} �y z l� _> ��/k '�"�3',. .'sue � �z�a v .,�>✓�s,��&��zr/ ,.r//, r v � � �, ✓"-a' r �" /r �'� %�`L�'% i �w /i'.:: A, a />5�- �'/ l�..P � ✓ ,/,, 'air/.-x�c9"S' r� 5� EMS i� X I , WMg jRF%w amp 17 r / � " ,9�" .ty.'• ,/< --�, i / �r,� /�z ',. .,<``�"- �� 'zr«d�'..,'a''''' 3C Yam.- / s r �� - �/ /"��j r,/� � ,-�r s. �`�'1��,, /F' £'"�ass � ''✓ „rr` Oft � � '✓% � r9,,, -rri,. g''�„ Y •.,Wd^ I '.,ln .x Y,�,. ,n!' f JJ r/..?".? �.:.. �� «,� zi��l Ur ,✓"�"' �� /% i� / .Jam,. '�- W., s4s. % �,- �' ',.r j <``.✓ -vF"c as ,, �, � rii _v 3 q 7'.SP 10 7' BP-10 7'aP 1C1 7' gP-:tfJ 7' BP-10 21-0' BP-10 33,-5" L 1N t7 S " J 3Cl2 34j82.; 96" 72 D.` xW 6t7 1 j2 PLF 50 1/2 60:-1 j? Pll= 4a'-: 2"W' 272 PLC: 412 433. Pl F LAG BC,�T i LAG BOLT T 43 3 2-13" pp R JST) {4 FLR 3ST) AG BOL.; ! LAG 80L .�UCH3L43'vt:�3, RAFTS S & SAW 08L STUOS RAFTS S & STRAPS { FL�R JST) II 6 9 10 11 2 1 t 3 14H15 1.G 17 16 9 20 21 2t 23 24 25 26 27. ,IiNi i I " A f}t CLOSE REOROOOtA !�1 HALL 18 26 A C ()INiNC ROOM `c 3(3 LIVING R06M _1 _4" 2._7«. N ACE, BATH #1 _� CATHEDRAL 18'-6" � c _ a. 7 n 6 b0 i j2 n KITCHEN ¢ 60-1.j2: l�`/f LJ EGft00M Az - DISGONNEGT 1'2 X 1 48 P-BOX /� /''� 7�:077 BOX 24 DRYER VENT 26 `t 1 t - >1jH ?U8 r SW THOU WALLo" CLO. .:3 .. CLOSET * 34j82 t 3 4 5 6 8 9 10 1 12 13 14 15 1 17 18 19 20 21 22`, :23 24 5 26. 27 IS 1 9'-5" 5' . . . 6._1 t1.'.-11" .- 6'_ G b0' L S 05,. A TERS s& STRAPS ,I.. 4a*— SPREAD JOIST #10 PLUMBING 4-1 EXTERIOR OSB i 7' j" , r 34 j82 0-1/ 60=1 j2 RUN= VFRTICAL 36-11 j2 V. '< 2'-0' BP-i0 7' HP-10. f3P-10 7 9P-10 7' 8P-10 7' 9P-10 7 SHAMROCK HOMES we : oPsala� cuxu WIND� ZO NE ONE #2 12 X 44 ELC10R P_AN k4ei k AV-01 Manufacturer Address COMFORT HEATING Tr as an co iitruuzutremnd ahome o i#asy baemen tazhems%*fw-"Od to"twwm wthe rgement-of e fodo ,—l"ctued Shamrock Homes (Soo m2li at bottwtt)H"Ie4 1201 W.Markley Ave Pt APiT'NO 1 t amer cnd motel(sea rwt at M1.The abwe heatdf6 eat�cmo""Pa* mant>dr an Plymouth:,IN46563 DATE OFMFG ll(&06 1�amassFto ar +rei+€tastine utdawt«nw uresof•sodageesF. Tommmnearrrwiea npoTgytp ocononry,aMt to censetva:snO w,t is ratamihiwldad tti fits herne be IrAgod_wnwo the mtdow wstor desip tempwahre(41 m)4 not Now than 20 dagees Fatwer hd, HUD Label No;(s) The above information ices fan e�itatetl ass'+^I"9 o marsntart aired votactty of 15 teiph 2d staratwd etmospteds pratttaa. .. .. NTA 1414420 Manufacturer's renal Number and M[Tl Unit Designation SHRK746i1jN 12X44 Hutnild slid Fringe Climate Map Design Approva{ 11}}}}}}-�..--,,, Tlt s tw itr ro•?r:'d.i��'U a+x;:,x,s rU^t a i,;>•c ae1 •ay i:h}W r,;y t:�. NTA,INC, I tv hi..{t.C.lsnat.A a Y{ki 3�4 Pi RtrrY,•.t�.ta+ h�.stxn"<1 rvY.'t i' :'4^:-�nmCc-?;�'sp This manutaduted Some is designed to comply with the federal mh$atfedured home oonstructton and safety standards to force at tare Ot manufaoturc The factory installed equipment includes f: A .•-- r Model Designation ^ Equipment Manufacturer 9 Heafing BERKO MBB SERIES" ' v S r eM Air moling J v C o Via: GDOkin•y GE. dB527 Refri erator GE OTS18DBP ' RHEEM WARRIOR 71.-30B Ware(Heatef Washer Clothes Dryer Dishwasher ...... .......: :..... _. .......... ,,, Garbage Disposal ,.... COMFORT COOLING Fireplace SMOKE DETECTOR BERKO 4120E Air tonditonarnotprovidedatfattary . •The ae diistrt'6ution room of thio tame is adAlt,far the trWpatiwr pf twdratar wr rmt9:.The wp*as . "rVdi tron ii sdom instailail 0 this tome is s¢ed fore Manufactured WN Control*comk'WWQ Raw of tat 10 3l2Ua'KT UArs rated caps*wtdsh arm wrtified inaecordatue wo the appropido oft,co sd�Ottetg e!i+d jefiperofm i rst a standards;%hon dta:oir svctiiletma of sxi ere cmrdtiuners Or raw at 4 3'ouh water cohutv+. atat prosatro or tpaefar for the toerrhg a r delivered to the nrwdattuod forme supply w am s0ern Ihfartnew rmcessary to catcctkate coo6.4 roads at narrow letatione ane onertatons a.proveded in fhosposiell Comfort C00'eV HOME CONSTRUCTED FOR: wamiilimpr wNSff wtufachfredhome. TNs name hat not been dodgrmd for the highor wind pressure and mxhwing:provVawa rmquired for os saasiat azoas:arid. srwuid not.be located wttia,'1-w of ans soeW6 o Wnd Zones It end III,Most fhe hwu end Its wrtwfing oral fotn i3tido system line been'doarglwd fordo incroase0 rorpwantart speci5cd Fw rarposure d n AHSL!ASCf 7-88,-Tans twine.HAS 4ewi 'c,gspped wltn".storm shutors o Who prof ,00vemh8s for wmdows and t iterot dew npwwv' For hmtias demwwd to be ositai rs lW4vi Zones t€and it,whwh haws ri boer,prtwidad with ststttttti.oi¢gtztrslora cagorrtg dm�xes;d is strong`tr 1'o hSdprtrata the regtatad capadry of equpmwt to`teol a home-emcio*and eoorvnw*,a tod}ng load(k l recammend0d tsd tar hamv be.raade rowdy to.be eqh pad w#tt tthesa daHsot n axadauo wa'dh ttte rdethai rttswhmerdad n gain)Mort Is required.7tho cooky bad is depend'"an the wientatim ro bwn end the drud se of tte thane. mxwfacturw5prnited"ahsh C116M. Control w owu&esrs operate row offroiety earl pew&few gresied comfwf wtren tf tw capacity closely a morneles Ine s teel tooting l000-Each tmme•s ter condlohat Ltd be wed n accordance wth ft R BASIC WIND ZONE MAP Amon=Sob*of Healing,Refrigui rtim and As Gsrafd'w mg EnOmws fASHW Heniiood of Ftmdmnortats 1491 omr,mxo rise wation and Orientation are known. � ......... INFORMATION PROVIDED BY THE MANUFACTURER NECESSARY TO CALCULATE SENSIBLE HEAT GAIN C Wa95.(taatlrout windows and dews) 11 0578. s l "7'� ,.� C'` -•-•' � Cetings and robfsot€gMcobr..... pal its rand roofs of d�k cobr U. 6344 (-- Floors, .. 'U' ow Air dtuis to flex.... .......:......... ... . . ... ....... .U` :05fi4 Air ducts In ce ing. U. Air dues installed otttsda the dome U . N!A ZONE If The following are the duct areas in this home ! Airducts.in fbor............. 95; sq'It ZONEI ' ,o Air ductsincm€ng ...:. .....: sq.fl, k ducts outside the horse .......... N/A sq.fl. ZONE 11€ ZONE€II ZONE ill ZONE;II.- I OE MIDDLEP5F UIO VALUE ZONE MAP WA _ U /I ,_._._(: � NORTH: Mh Mt ijHa �19 . M€DDLE MIDDLE l :to � I so �(w, f t I 4y tidy: { NE tPA �...,.CT H�. MIODLE NV UT77— tt I tea li ON/ 1; t Co wVA` MD SOUTH4 tkE4 l � ZONES AC v � r�.� �:• 0.098 m a.oTa J ED-71 P2006 Oe*•O•Art Inc. 03/06 Fit F,C O MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6168.FAX(8001851-8424 12/912016 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 HYANNIS BUILDING DEPT 200 MAIN ST HYANNIS MA 02601 �22 Re: Insured: LINDA J.LEONARD _ Property p rty Address: 7 ORRS AVE,HYANNIS,MA 02601 Policy Number: 0957147 Type Loss: Fire(including Fire caused by Lightning Date of Loss: 12/07/2016 Claim Number: 410698 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the'writer:and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 f oFIKETown of Barnstable *Permit# Regulatory Services Expires 6 months from issue date t - g o� Fee ` 5 t snxtvsTnst.s, � --' Thomas F.Geiler,Director RESS PER Building Division a( C. Tom Perry,CBO, Building Commissioner 2 !'�o 1' 200 Main Street,Hyannis,MA 02601 TO�tV CF f3A�NST www.town.barnstable.ma.us Office: 508-862-4038 a.$i'E Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 9lJ d f� Property Address 7 ® �1 Lj Residential Value of Work 0 0c;©O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_ Z l✓l d Cc L ec4 a 7 C V Contractor's Name Telephone Number -7 7� �3� 6 457 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Ch�,raalrone: M I am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 1 ftvy Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side #of doors. Replacement Windows/doors/slider . -Value D . _�J a� (maximum .44)#of windows *Where'required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A co of the Home Improvement Contractors License& Construction Supervisors License is re aired. SIGNATURE �. Q:\WPFILES\FORMS\building permit forTns\EXPRESS.doc Revised 070110 The Commonwealth of Massach usetts Department of Industrial Accidents Office of Investigations UV . . 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_—T/7 l if&-e-i TV fAp �O(L) .0�1, Address: & �-==� City/State/Zip: &,1�7-CC (f l L(r /"4. Phone k •77Y Are you an employer?Check the appropriate box: Type of project(required): 1...❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.$ 9 ❑Building addition required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 r t nder the pair nd penalties of perjury that the information provided above is true and correct Signature Date: �® Phone#: -77 36 - D 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#: ''44OF'THE TOII, Town of Barnstable Regulatory Services + BARNSTABLE, + y MASS. Thomas F.Geiler,Director i639• 1� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 •'"w 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 L /7dd - lt-d�'►CQI�` , as Owner of the e subject pro J P P nY hereby authorize &23C Sa to act on my behalf, in all matters relative to work authorized by this building permit application for. rI �rr5ahoe- (Address of Job) X�� Signalure of ir Date L e � Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORM&OVJNERPERMISSION I °FSHEr . Town of Barnstable " Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director ss v Mn . $ i639• Building Division �rEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Kww.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 foram 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 e applicable codes bylaws,rules and re ations. The undersigned"homeowner"certifies that he/she understands the Town of Barn table 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 of this issue is a form currently usedby several towns. You may care t amend and adopt such a form/certification for use in your community. Q:foirns:homeexempt i HIC Registration Lookup Page 1 of 2 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home>Consumer> Home Improvement Contracting> Home Improvement Contractor Registration Lookup The list is current as of Monday,August 22, 2011. You can search/filter the registration list by any of the criteria below. RELATED LINKS Search by Registration Number �- __ Home Improvement Contractor Registration Home Page `Search Registration Number I Search by Registrant Name INTEGRITY A �I Search by City T -_� _ Zip Code`Search Registrants Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. Search Results REGISTRANT NAME RESPONSIBLE REGISTRATION. ADDRESS EXPIRATION STATUS INDIVIDUAL NUMBER DATE ALEX O'HANLEYS O'HANLEY, I 127 COLONIAL RD. INTEGRITY ROOFING (ALEXANDER i 135546 BRISTOL, RI 02809 4/17/2012 I Current 1 CHRISTENSON 1 3 CARRIAGE HILL DR. INTEGRITY BUILDERS DEAN 136127 ROCKLAND,MA 02370 1 6/11/2012 Current INTEGRITY BUILDERS, 26 DUNLEAVEY BROOK RD. I KOSIBA TODD 160964 1 9/15/2010 Expired LLC. UXBRIDGE,MA 01569 INTEGRITY BUILDING 498 GREAT RD EtMIELE, DOUGLAS 112854 4/29/2013 Current DESIGN, INC ACTON,MA 01720 1 INTEGRITY REMODELING BUILDING Et ,SHOWN WOODBURN,---- 156311- - --i 11 DORCHESTEMINGTON,MA 01887 -'-,6/20/2011 Expired INTEGRITY CONTRACTING— 6 MONOMOY ST. ' NEELAND DANIEL 160891 9/10/2010 Expired i SERVICES INC WORCESTER,MA 01606 --..__...-.. --- --- - -... ...... ... - INTEGRITY DESIGNBUILD 150 NASHUA RD.SUITE 102 LTD. BALICH,JOSEPH 134576 -- LONDONDERRY,NH 03053 12/10/2003 Expired INTEGRITY DEVELOP Fi =J 110 PULPIT HILL RD CONST INC JESS� OPc PETER - 118041 AMHERST,MA 01002 1/20/2013 Current -}-�---- j 9 ELM CIRCLE 'INTEGRITY HOME REPAIRS ASSAD,JOSEPH 149147 11/29/2007 Expired WILBRAHAM,MA 01095 1 INTEGRITY HOME PECKHAM JR., P.O. BOX 1269 1 148541 10/4/2007 Expired �SOLUTIONS RICHARD_ i CENTERVILLE,MA 02632 1 (/INTEGRITY HOME PECKHAM JR., P.O.BOX 1269 - 166334 5/13/2012 Current (;SOLUTIONS -------� =,RICHARD_ HYANNIS,MA 02601 INTEGRITY INSTALLATION JANOSI,ZOLTAN 157676 7 DARTMOUTH ST. 10/29/2011 I Current WATERTOWN,MA 02472 INTEGRITY MASONARY 263 CHARLTON RD ' CONSTRUCTION (DAY, RONALD 1156009 1 SPENCER,MA 01562 5/29/2011 Expired INTEGRITY OVERHEAD 1119 KENNEDY ROAD DOORS dba INTEGRITY MANN,JAMES 149427 TEWKSBURY,MA 04187 1/10/2012 Current OVERHEAD DOORS 1 i GRIMM JR, 14 CEDAR ST INTEGRITY PAINT CO f 110532 10/20/1998 Expired RICHARD 1 I HOPKINTON,MA 01748 .---.........------........---- ..........-.. -E ----- -+--- -------i------- --------� -------- INTEGRITY PAINT i 1971 MAIN ST. I GRIMM RICHARD 146391 4/21/2011 Expired !COMPANY I 1 WEST BARNSTABLE,MA 02668 i 7 STONY BROOK RD 1 INTEGRITY REMODELING LOMANNO,DAVID 130339 2/22/2008 Expired KINGSTON,MA 02364 -------- -------------- - -------' - - --------------•-----� r 161 ROLLER COASTER RD INTEGRITY ROOFING HURST, KYLE 149160 HANSON,MA 02341 12/1/2007 Expired 151INTEGRITY W.BOYLSTON,MA 01583 ___....-_1--------.-- 1 CONS POHL JONATHAN 147653 17/27/2013 1 Current CONSTRUCTION http://db.state.ma.us/homeimprovementilicenseelist.asp 8/22/2011 r Massachusetts - Department of Public SufetN Board of Buildin�I Rc��ulations and Standards Construction Supervisor License License: CS 94193 . RICHARD J PECKHAM JR 204 SCUDDER AVEsry � . HYANNIS, MA 02601 a Expiration: 7/29/2013 ('onunissiuncr Tr#: 3298 = �/ I 01/12/1995 11:43 91508790623E PAGE 01 � � l T DWn of Barnstable 'Permit# ? �� Fapbw d MawthsJFwn Issue ddte l SAMWASM Regulatory Services Fee e?, d d s Th smas F.Geller,Director 7 M Building Division Ton I Ferry, Building Commissioner ��(( 200 Main Street, Hyannis,MA 02601 "-PRESS P —, Office: 508-862-4038 S E P 1 2004 Fax: 508-790-6230 E MSUS PERMI'll APPLI�A�'IQN - RESIDENTIAL PAW, Mr Valid withousItedX-Preaa rnsprMi V �F BARNS I ai+Li Map/parcel?`1•.tmber �� O Property Address o cc& S sidential Vahie of Work minimuLteo 5.0 r work under$6000.00 . 9 Owner's Name&Address Cs-ftactor'#Name' V_l n - JA) Telepbone Number_. H-=Improvement Contractor License#(if applic able) p g - Construction Supervisor's License#(if applicable)--- -7 q2 J --- MkMan, Compensation insurance "Or Chock oue: 1 am a sole proprietor I am the Homeowner 0 1 have Worker's Compensation Iwma ace Insurance Company Name Er� WCAI=M's COMP.Policy V L I f e Co of Insurance Co liance a -� 11Y mp rtide,ste'mast be on�e. Permit Request(check box) [] Re-roof(stripping old shingles) All c mshuction debris will be taken to ❑Re-roof(not stripping. Going over__existing layers orroot) �] Re-si e' - epiacemant Windows. U-Value t 3, *Where TaPdred: Issuance of this paidt dace not a:crust convrmnce v th other town depaitmeut regulations,i.e.Hismrie.Conservation.etc. ***Note: Property Owner must sh p Property Owner better of Permission. Home Improvement Cal tractors License is required. S*Uttae Q:Forms:expmtrg D..2-J.th M• Board of Building RegulaVons and Standards One'Ashburton Place- Room 1301 . Boston. Massa,ch'isetts 02I.08 Home Improvemeni d6ntractor Registrati w�•rvz.:.e 1 2'] on �CGrr 1040a8 NEW «t `-=--- � —i gm Tvm Prrr�corporation ENGLAND SASH, INC V w '" O'� 7i13rzccs Kevin Wells ` =- y___ ;•�; 1331 GraftonStreet Worcester, MA 01604 �'k'' -= = r =7 ,�"F` `a.? car='t.,:�.C`_= :L'i. .. ------------------- Update Address aad retarm. card.31ark reason for chan6.ED . u SOM-04/pq G101216 Address. �j Renewal v E�pis_sritent .� Lost Card �fre ��nranuJeall� ��faaftac�uc�. • • - .. • Board otBuilding Regulations and Standards __- HOAAE IMPROVEMENT CONTRACTOR License or registration valid fqr imd' dal ast only. x before the expiration date. If found return to; Reyi§trafilon;.104098 Board'of Building Regulations and Stasdrds 1.1312006. Oae Ashburton Place Rm 1301 YAM Gte•Corporation Boston,Ma.02108 ENGLAND'SASFi;fNC= =1 Wei1St't*=;'_ _3 'rafton Street ;.' •_.y - . . . stet,MA01604,• •-• �'�� <�� ' Administrator Notvalid withoatsianature ,.� ra; i 2 Main Offrce: Branch Offic 1331 Grafton Street //n • Worcester, MA 01604 508-792-9181 800-300-7274 THIS CONTRACT made the day of in the year between New England Sash,1nC.and j (HOME OWNERS) (HOME PHONE) (BUSINESS PHONE) of 5L s Gi 7 / <5 vZ 6 Gam. j (STREET) (TOWN) (STATE) (ZIP) i As used in this contract,the words we,us or our refer to New England Sash, Inc.and the words you and your refer to the customer. We agree to furnish all labor and material necessary to install the following described windows at: f9—'''1.1 Double H.P. / 2 Total Units: Glass Glass Grids: Y indow Color: ¢� Material: / ,/�rC,, Double Hun Units: `^ "-_ We do not do any painting or staining. 2 Installation: Y J , We are not responsible for conditions or circumstances Picture Units: beyond our control including condensation resulting from Total Contract: 2 or due to pre-existing conditions.Our limited warranty is Hopper Units: herein incorporated by reference. Sales Tax: Sliding Units: "— 2-1 - Awning Units: (� - ys, Casement Units:. s '"- 1-lit$• -lira s-liter_4 � TOtai Bay/Bow Units: DH/CS s.= 3-liter Price: Garden Windows: I e: I e. DepOSlt Exterior Finish: Reef- Sem T Ion: nee Brackets: 7-N With Order: Entry Doors: :Meet- -fiber Style: Add Deposit Storm Doors: -AItrrfr' W-€m S e: Due Date: Sliding Glass Doors: # �/ - color: Balance Due Ll i Cappin : Y"/ # 4141, ,Ll i On Delivery: Additional Notes: < g 1_ e-LU L- 6 5 14 '!5C A4 VC : . w z_ ,c.-",:55. 12 CS 77—,�� 1`S ,LiJ�J �c� 0fl2c DEPOSIT WITH ORDER ❑ CASH ZCHECK# BALAWC DUE L1 CASH LA NCE You agree to pay cash according to the terms shown above or,if your credit is approved,to sign a note provided by us for payment of the amount due.You also agree to sign a completion certificate upon completion of the work.If you fail to make payments when they are due,then we may immediately stop work.We may choose to not start work again until you are current with the payments and we feel secure in obtaining the remaining payments.If.there is any stoppage of work due to the preceding,such delay shall automatically extend the date of substantial completion. "'"- _..... Payments due and unpaid under this agreement shall bear interest from the date payment is due at the annual rate of 18%or at the maximum legal rate,whichever is less.In the event that we incur costs or expenses it collecting such payments due and unpaid,you shall pay such costs and.expenses including reasonable attorney's fees.In addition,you understand that by failing to pay according to the above a s,the eller may have a claim against you which may,be'enforced against yo property in accordance with the applicable liens laws. The installation will begin on or about " ,�r . nd will be substantially completed on or about AA t is understood by you that the following contingencies could materially change the estimated completion date stated above: customer's inability to obtain or qualify for fina King; inclement weather; strikes or other labor disruption; non-availability of materials;acts of God. We represent that we carry Workers'Compensation and Public Liability insurance in the amount of$100,000-1,000,00 ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOUL BE DIRECTED TO: DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION,ONE ASHBURTON PLACE,ROOM 1301,BOSTON,MA 02018{617)727-8598. CONTRACTOR OR SUB .ONTRACT R S OBLIGED TO OBTAIN THE FOLLOWING PERMITS: GY L /` .IF WE DO NOT OBTAIN THESE PERMITS,AND YOU OBTAIN THEM,OR IF WE ARE NOT REGISTERED WITH THE BOARD OF BUILDING REGU.LAT ONS,YOU WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS GENERAL LAWS,CHAPTER 142A. i ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN ADVANCE OF THE COMMENCEMENT OF WORK SHALL NOT EXCEED THE GREATER OF ONE-THIRC OF THE TOTAL CONTRACT PRICE_OR THE ACTUAL COST OF ANY MATERIAL OR EQUIPMENT WHICH.HAS TO BE SPECIAL ORDERED OR CUSTOM MADE,WHICH MUST BE ORDERED IN ADVANCE OF THE COMMENCEMENT OF THE WORK,IN ORDER TO ASSURE THE PROJECT WILL PROCEED ON SCHEDULE.NO FINAL PAYMENT MAY BE DEMANDED UNTIL THE AGREEMENT IS COMPLETED TO THE SATISFACTION OF BOTH OF US. YOU M CANCEL THIS AGREEMENT IF A EN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER ? WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BN ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE I SIGNING OF THIS AGREEMENT. BY SIGNING BELOW, YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY AND THAT YOU AGREE TO ALL OF THE TERMS OF THI: CONTRACT. YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS CONTRACT AND TWO COMPLETE[ COPIES OF THE NOTICE OF CANCELLATION AND THA U E BEEN ORALLY INFORMED OF YOUR RIGHT TO CANCEL., D N T SIG THIS C TRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS W p ies h re signe eir names is d of r,4 in the year of -( Signe Signed ` R• ING REPRESENTATIVE OWNER Signed Accepted:New England Sash,Inc. t By Signed