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0030 PINE AVENUE
�. 30 Jai n e - ' ,qYe, i� i ' I s , J i .�' Town of Barnstable Building - ,. #' .: s' :* '�i v„x•fix a� ', -a ':b s�% x. .:' ;. Post This Card So That+t isU+s+ble From the Street Approved Plans Must be:Retamed on Job and this Card Must be Keptx%x, Posted UntilFinalpinspect+on Has Been Madej K >� > Permo � Where'a CerE+fcate of Occupancy is,R�equJired,�such Building shall Not be Occupi d,until awl Inspect�ohasbeen made Permit No. B-17-4379 Applicant Name: Michael Connors Approvals Date Issued: 01/02/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/02/2018 Foundation: Residential Map/Lot, 308-097 Zoning District: SF Sheathing: Location: 30 PINE AVENUE, HYANNIS Contractor Name: MICHAEL J CONNORS Framing: 1 Owner on Record: BARNSTABLE HOUSING AUTHORITY Contractor:License: CS-104018 2 Address: 30 PINE AVE Est Profect Cost: $30,141.00 Chimney: HYANNIS, MA 02601 Permit Fee: $374.28 Description: Renovate the existing kitchen. New flooring,cabinets;counters,sink Insulation: Feb Paid $374.28 and faucet. ` Date T, 1/2/2018 Final: � � Project Review Req: INTERIOR RENOVATION OF EXISTING KITCHEN-NO�KITCHEN " r HOOD WORK v vy -- Plumbing/Gas Rough Plumbing: " - Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after'issuance. Rough Gas: All work authorized by this permit shall conform to the approved applieat on and the approved construction documents;for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning`by laws'and codes. final Gas: 'Y: This permit shall be displayed in a location clearly visible from access street,ofrrbad and shall be maintained open for pul)lic inspection for the entire duration of the work until the completion of the same. Electrical s The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are`providd don this permit. Service: Minimum of Five Call Inspections Required for All Construction Work, 1.Foundation or Footing Roug 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ONE PROJECT NAME: � l ADDRESS: yt l- P w n l S PERMIT# 1- Q PERMIT DATE:-5/1-7 U M/P: 01-7 LARGE ROLLED PLANS ARE IN: BOX 3 (� SLOT` Data entered in MAPS program on: BY. q/wpfiles/forms/archive F •-, � f ;� �. r ��,: TownK401 of B`arnsta-ble: NX r s u 1 Pos This. tdrt. .T at�tt U s bl :.F t r ti� rov Plans�Mus be:Retained do ob-.antl�• i < � �y�• --:- ,'.. , <:' -� . t th s Card.fylust,be.Ke t. < 'Rr ak ,..�.. .»ef' ,+. <n`2+.. b.� h, Posted U ti Final: ectton_, B e .Ma • _,�• ..,.. <� ,_:, c a�-.,.....: �.;r-; *,, re a:�E:•f a eao0•ctl i �111� Not�be,Oceu ,edrunt�l a Final:tns ection'has;bee�n�made <'��,� ��- .. 1, .-.', : . ��at:.,%�,» �?>�., Pesrmit^Nr) `.-", B-17 32 5 - Applicant Name MICHAELJ MOORE Approvals Date i9sued. ' 09/25/2017 Current Use ;i Structure Per, it T' e, =6uildin .Siding/W Foundation: indows/Roof/Doors Expiration Date "03/25/2018 Location: 30 PINE'AVENUE, HYANNIS Map/Lot 308-097 Zoning District: SF Sheathing: Owner on Record: BARNSTABLE HOUSING AUTHORITY #� Contractor Name: MICHAEL J MOORE Framing: - 1 Address: 30 PINE-AVE. Contra or�icense` CS-077024 2 HYANNIS, MA 02601 fstProJect Cost: $4,000.00 Chimney: Description: reroof porch P P Permit Fee: $160.00 �k Insulation: Project Review Req: reroof porch Fee Paid $160.00 Y ' Final: D_ate. 9/25/2011 �A, E � Plumbing/Gas _... � Rough Plumbing: �� �� . ; Building Official Final Plumbing: r This permit shall be deemed abandoned and invalid unless the work authorized by�this permit is commenced within six months afterfissuance. 7i A s Rough Gas: All work.authorized by this_permitshall conform to the approved application and the approved construction documents for which this permit has been granted. .All construction,alterations and changes of use of any building and strictures shall be in compliance with the local zonin b laws and codes. P g y Final Gas: This permit shall be displayed in a location clearly visible from access stredfor�road and shall be maintained open for}public inspection for the entire duration of the work until the completion of the same: Al Electrical .. The Certificate of Occupancy: not be,issued until all applicable signatures by the Building and'Fire Officials are provide i ori'Yhis permit. z ,. Service: . Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rou h: 2.S eathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final-Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall-not proceed until the Inspector has approved the various stages of construction Final: ;."Persgns contractin <with u re istere "contractors.d no. v c s t : h ar ," 4 g , ,q - g d _ __. ._o._ .t.ha a ac es o t.e gu anty fund (asset forth,In MGL c.1 2A). c _ Fire Department.. i Building plans are to be available on site Final: AII;Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION stA P�1� Map Parcel iN � Application # Health Division i ` IN 119: Date Issued , L1 117 Conservation Division Application Fee Planning Dept. FIT 3,.- Permit Fee ��� . o 0 ' M, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 20 PIA-4 -,q vE Hy /v,,j JS MA rQa6Q 1 Village Owner ARnJSi,43tf. Wau'sixL& Au►HOr,rfYAddress 3D 7°I%,.;E Ay6 '"19tiAJ kS N+W$Ol Telephone SOSZ /Z► Permit Request ft®©F RZRL-AL6r46Af_'1_ P0R2GH 'Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 400 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ` (BUILDER OR HOMEOWNER) Name /`1 &Z 00 Telephone Number 13— 419— N10-4 Address License # Ls — 0 -4 ` �✓ O a o5 Home Improvement Contractor# 16 G5a J Email fHZry00A1_', >L Y.�3 Y��• C9fj Worker's Compensation # (OPWIEL&M � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YxJ fL)A)1L/ .A �q � S 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 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t! 4T t- q � i''� can �• °' `c'' A a, W r ' -+ ° obi • .� � �� �;�••a c� �'r `� � � � � � � � �a t`�.� �.` � �� _, Ol •! � � � SP lq GI � Ei A �f1 a tin yp 'n G by MQ Nt OIL IS aco '* h cl aro ❑ ❑ ° CZIto fa n ¢ w ppi Rs aryl Ft tr CD 00 El 0 CD O q "' S 4 ►� ormation and lnstructious Massachme#ts Ge,nPaal Laws chi 152 regoaes aB=PIoy=to PITM&wmi=e""Peen for fheir=Ployees Pmsaautto this sib,a ��3' - ee is defined as.¢;epeayp=sonm.•die service of anuffimu ader airy coatxact ofhire, .n express or impliecl,oral or wrWas." An ez�Ioyer is defined as-an indiviffiA pffifn�,assort on,cmpor- or oth=legal arft or any two or more of the foregoing e ina Joi nt ,aaA i=hLdnmg the legal seprme�ves of a deceased employer,or$le reim or trastee of an kdrviffiA paltnershrP,assoc�nn or otffierIegal entity,eMploymg emPloYees- However the ec owner of a dymning homy having not mc=than tbim aparbae sand ho ri des ihetem,or the<occupant ofi3�e- dwt✓J i house of andffier who employs persons tD do maim ce,r,,,,efrnrt;on or repair v on such dweIIing house ur�na�i$erefo sbaIlnotbecanse of surds employmedbe deemed to be an employe" or on ffie grotmds or building apg . M13L chapter 152,§25C(6)also states that¢evexysfata-or local HceTMsima agency shall withhold$e issuance ar renew-al of a Tir- se or permid to operate a or to cons;tmct buffdings in the contmor Wealth for any appTrcantWho has notpr•odnced acceptable evidence of cdmp&ancewn the iasur'dnre coverage requited." AdclitionaAY;M( -chapter•152,§25C(7)states-NDfther the=m=wca i,nor a"nY ofits pDHfical subdivisions shall enter into any contract for the paforram-W ofpublio work mtfl acrzptable evidence of DaMPHancevrifh&5 insurance• rej:L=FdncUtS of this chapter have been presenfted to the contraCtm mth]A�" Applicants , Please f0I oi¢ the wogs'compensation affidavit corrplete n by r he g boxes$ apply to pots sifnaiion and,if necessary,supply sab-contra�r(s)name(s), addresses)BndPhone—ber(s)aIongwtth.ii�cetf'c3b (s)of insurance. Lmmite d Liability CamPanles(ILC)or LmntedLiabi7ityParfneahigs(LIP)withno M3pIoy=other than th.e members or pm fnetrs,are not rbq=md to cagy wozkr&compensation insmance_ If an LLC or LLP does have employees,apolicy is rued. Be advised that this affidavitmaybe sobmiifed to the Deparfinerrt of Indastial dents for.confirmation of insurAmce coverage Also Be sure to sign and date the affidavit. The affidavit should Acci cc xnaed to ffie eify or town that the application for the penmit or license is being regneste�,not the D epartmenf of boTL-ndas r al Azddeats q"nTdyou have amr questions rega-dmg the law or if You are:recp0ired to obtam a workers' compensationpoIicLpleasecallth.eDepartmentatfhenumberlisfr.dbelow Self-imuedcompaazes shouldeaterlieir self--;,,m„ce license number on the appropaate line. C ty or Town Offs aLs . t Pleas a be sore timt the affidavit is complete and pried Ieg�Iy_ The Departmrnt has povided a space at$ie bottom of the:affidavit for yontD fM Ott is the event the Office oflnvesii���has to contact.youregarding the applicant. Please b e store to f ll in the pen Il ce; t mnaber which will be rsed as a refermco n=berr. In.addition.an appIiamt ffia t must sabmit I mrbiple pmmuVHcense appliesions is any given year,need-only m1anit one affidavit indicating cusent p olicy m crorn ation(if ne y)and tinder"Tob�A-doss"tie apPlicant sh0rld v;It--"all 1Daafi�'ns'U (ci[Y or town)--A copy of the dfdavit that has be n officially s�.ped or maficed by the city or dxv may be provided to ar applicant as proofthat a valid affidavit is on file for f&a 'penifs or lieenseS- A new affi business o xst be: erci out each year.�liere a:home owneg ar citizen is obfaiIIing a IiceIIse or permit not related in any bn�—�s or crnnmeacial v&EtCre (ie_a dog license or permit to b n leaves eta.)said person is NOT mpired to complete this affidavit TheOfficeofln�Testig�°7�worldlticetotbankyoumadvaacefaryotzrcoape�ianandsbnrldyonhaveanygresfiaas, please do nothes>tia to give us a call. The BepMimenfs address,telephone and fax number ]��f��TjeqjtjE of Mgssach , DepartmMt oflidmtialAODdenta O.face a kvestkatio= 4Qn SiBQAOU�M&Rill T(�-L 4 GIT- -4 =t 4.06 or 1477 MA&,RAC Fax a7 727 7M geviscd424-D7 w ,m-a. gIdi-a AWC Guide to Wood Construction in High Wind Areas:110 rnph Wind Zone . Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)` Q Check 1.1 SCOPE Compliance � - WindSpeed (3-sec.gust)................................................................. .................................................110 mph WindExposure Category.................................................................. ...............................................:.............B 1.2.APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch ..........................................................................(Fig 2)........................................... 5 12:12 MeanRoof Height ..............................................................(Fig 2)................................................._ft <_33' BuildingWidth,W...............................................................(Fig 3)................................................ _ft 5 80' BuildingLength,L ..............................................................(Fig 3)...........................:....................._ft <_80, Building Aspect Ratio(L NV) ...............................................(Fig 4). ............................................. s 3:1 Nominal Height of Tallest Opening ...................................(Fig 4). ............................................ 5 6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2). ...................................... ................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry................................................................................................................................... 2.2 ANCHORAGE TO FOUNDATION''3 5/8"Anchor Bolts imbedded or 518"Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing—general ................................. ........(Table 4)............................................... in. Bolt Spacing from endfjoint of plate ............................(Fig 5). ................................. in.5 6"—12" Bolt Embedment—concrete........................................(Fig 5)................................................. in.z 7" Bolt Embedment—masonry.........................................(Fig 5): ........................................ in.>_15" PlateWasher...............................................................(Fig 5)...............................................z 3"x 3"x Y4" 3.1 FLOORS Floor framing member spans-checked ...............................(per 780 CMR Chapter 55).............................:...... Maximum Floor Opening Dimension...................................(Fig 6).................................................. ft 512' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall.:..............(Fig 7).....,............................................... _ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)....................................................._ft <_d FloorBracing at Endwalls...................................................(Fig 9).................................................................... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)................................... Floor Sheathing Thickness ................................................(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fastening..................................................(Table 2)..._d nails at in edge/ in field 4.1 .WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)...........................—ft 510' Non-Loadbearing walls................................................(Fig 10 and Table 5)...........................—ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)..................._in.5 24"o.c. Wall Story Offsets .............................'...........................(Figs 7&8)........................................... ft 5 d 4.2 :EXTERIOR WALLS" Wood Studs Loadbearing walls........................................................(Table 5)..............................2x -_ft_in. Non-Loadbearing walls...... . ...................... .'...........(Table 5). ............................2x -_ft_in. Gable End Wall Bracing 1 FullHeight Endwall Studs............................................(Fig 10). ........................:....................................... WSP Attic Floor Length...............................................(Fig 11)........................................... ft 2:W/3 " Gypsum Ceiling Length((if WSP not use ..................( i9 11)............................................ ft z 0.9W and 2 x 4 Continuous Lateral Brace Q 6 ft.o.c.. (Fig 11). ........................... ............................... or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length .....................:..................................(Fig 13 and Table 6)................................... _ft Splice Connection(no.of 16d common nails)............ (Table 6).............................o ........................ _ ;a .4WC G(dde to Wood Construction in Sigh Wind Areas:I10 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails)...............................(Tables 7)...................................................... Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9).................................._ft_in.511' SillPlate 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.............................................................(Table 9).................................._ft_in.512' Sill Plate Spans...........................................................(Table 9).................................._ft_in.512" Full Height Studs(no.of studs)....................................(fable 9)........................................I............... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W . Nominal Height of Tallest OpeningZ .............................................................................._5 618" SheathingType.............................................(note 4)...................................................... Edge Nail Spacing........................................(Table 10 or note 4 if less)....................... in. FieldNail Spacing.........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)........................................................ Percent Full-Height Sheathing.......................(Table 10)..................................................... 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest Opening2. ..............................................................._5 6'8 SheathingType.............................................(note 4)................................................... Edge Nail Spacing............:.................:..........(Table 11 or note 4 if less)....................... in. Field Nail Spacing ........................................(Table 11). ............................................. in. Shear Connection(no.of 16d common nails)(Table 11)........................................................ Percent Full-Height Sheathing.......................(Table 11)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Wall Cladding. Ratedfor Wind Speed?............................................................................................................................. 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............. ft<_smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).............................................U= plf Lateral.............................................(Table 12).............................................L= plf Shear..............................................(Table 12)..............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= pif Gable Rake Outlooker.........................................(Figure 20).............._ft 5 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). .....................................L= lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) ...•......... Roof Sheathing Thickness........................................... ............................................ _in.z 7/16"WSP RoofSheathing Fastening...........................................(Table 2).......................................................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11, 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMRs301.Z.1.1)` 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -MEN THE EDGE FEM ON RRAlwIING USE 8d NAiL$ AT6t, 11 11 JI 11• 11 1 Y N it 11 11 1 1 It 1 11 11 1 I 1 11 1 G 1 II 11 .[ N _O JY r/ �- • II Q 11 ii - 1 EdII m fi It I Z II o it ii t I yy 4:1 It i • It ii it I I a U lU 1 II Q II II W 1 () id i i I 1 1. ii ii Ts i 1 �11 I1 �11 JI - 1 1 ii n e DOUBLE MX; ------ tJAILSPACIfIN3 r� . PATiEt_ 'I{ " See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7go Cmx 5301.2.1.1)I ► • ; ; as ► r tr Ed 6 z In I ► ` CJ� �I (i 8 ' FRAMING MEMBSr3 r � I EDGE INTERMEDIATE 3w S Sw i I ir MIN I I STAW. MNI. HAS.PATTERN PANEL PANW WGi DRUM E MAL OGE SPAMG DETAL Detail Vertioal and Horizontal Nailing for Panel Attachmant AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7so Cmx53o1.2.1.1)t FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a iio mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM1oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has. been used in North Carolina over the past io to 15 years which has performed well in severe hurricane weather in that state. Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. • Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner • • 200 Main Street, Hyannis,MA 02601 • MASS. • www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "H01V OWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityAown 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:IWPFILES\FORMSIbuilding permit forms)EXPRESS.doc 0&/16/17 A Town of Barnstable Building Department Services ` INUINSTAIRLA Brian Florence,CBO 6sq. ►`� 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 as Owner of the subject property r bi hereby authorize to act on my beh alf n 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 1, are not to be filled or utilized before fence is installed and all final ' inspections are performed and accepted. ;Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:09/16/17 a Commonwealth of Massachusetts rJI Division of Professional Licensure �. Board of Building Regulations and Standards Construct��inpe.'SiSrvisor CS-077024 �E��ires: 07/01/2019 MICHAEL J MOORS .;;r 56 NEWBURYSTREE7 /' r REVERE MA 021.51 J. 4-1 Commissioner v" - U/z.e WpomvnaoaacuealC/&qe'VD_ a,jack deff4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration =ti6952�1 06/30/2019 CHAEL MOORS.:--;, MICHAEL MOORS':,- of - 56 NEWBURY STREET REVERE,MA 02151 Undersecretary Construction Supervisor 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 ofthis license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl 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 I OWNER-CONTRACTOR AGREEMENT COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT This agreement made the 4r+u day of 576/07' 2017by and between Barnstable Housing Authority hereinafter called the"Owner",and P.Moore Painting and Contracting hereinafter called the"Contractor. WITNESSETH,THAT THE OWNER AND THE CONTRACTOR,FOR THE CONSIDERATION HERE/NUNDER NAMED,AGREE AS FOLLOWS: ARTICLE 1.SCOPE OF WORK: The Contractor shall perform all Work required by the Contract Documents for Porch and Entry Repairs#02078 at Captain Eldridge House in Hyannis, MA(667-03)prepared by Southeast Regional Capital Assistance Team acting as and referred to in the Contract Documents as the"Architect/Engineer". ARTICLE 2.TIME OF COMPLETION: The Contractor shall commence work under this Contract on the date specified in the written "Notice to Proceed"and shall bring the Work to Substantial Completion within 45 calendar days of said date. ARTICLE 3.CONTRACT SUM: The Owner shall pay the Contractor,in current funds,for the performance of the Work,subject to additions and deductions by Change Order,of the Contract Sum of: Seventeen Thousand Seven Hundred and Eighty-Four-------------------- Dollars $17,784.00 CONTRACT SUM IN WORDS CONTRACT SUM IN NUMBERS ARTICLE 4.ALTERNATES: The following Alternates have been accepted and their costs are included in the Contract Sum stated in Article 3 of this Agreement: Alternate No(s): N/A and total cost for accepted Alternates$0.00. ARTICLE S.THE CONTRACT DOCUMENTS: The following,together with this Agreement,form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents,Contract Forms,Conditions of the Contract,and Specifications as enumerated in the Table of Contents,the drawings as enumerated in the List of Contract Drawings, DHCD publication known as the Construction Handbook,and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. ARTICLE 6.REAP CERTIFICATION: Pursuant to M.G.L. c.62(c) §49(a),the individual signing this Contract on behalf of the Contractor, hereby certifies, under the penalties of perjury,that to the best of their knowledge and belief the Contractor has complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors,and withholding and remitting child support. DHCD 11/7/16;RCAT RCAT 06/21/17 OWNER-CONTRACTOR AGREEMENT 00.52.10 c.149$lOk-$50 1 of 2 ARTICLE 7, WORKER DOCUMENTATION CERTIFICATION: In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract;that pursuant to federal requirements,the Contractor shall verify the immigration status of all workers assigned to such contract without engaging in unlawful discrimination;and that the it shall not knowingly or recklessly alter,falsify,or accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach,subjecting the Contractor to sanctions,including but not limited to monetary penalties,withholding of payments,contract suspension or termination. ARTICLE 8. CONFLICT f F INTEREST: The Contractor covenants, that (1) presently,there is no financial interest and shall not acquire any such interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this Agreement or which would violate M.G.L c.268A,as amended; (2)in the performance of this Contract, no person having any such interest shall be employed by the Contractor or engaged as a subcontractor by the contractor,and (3) no partner or employee of the firm is related by blood or marriage to any Board Member or employee of the Awarding Authority IN WITNESS WHEREOF,THE PARTIES HERETO HAVE CAUSED THIS INSTRUMENT TO BE EXECUTED UNDER SEAL: 1 CONTRACTOR 7 AWARDING AUTHORITY Pauline Moore Barnstable Housing Authority Name of contractor Name of Housing Authority 23 Bean Street z. ' 146 Souto Street,Hyannis,MA 02601 street Address Weymouth;MA 02189 City State Zip Signature and Seal By: / �_i Executive Director Sig awre and Seal ti` Title Witness " Attest: 'If a Corpor6lh,attach a notarized copy of the Co to Vote 31f signed by someone other than a Housing Authority Board member,attach a authorizing signatory to sign contract copy of certified Board Vote authorizing the signatory to sign contract DHCD 11/1/16,RCAT RCAT06/21/17 OWNER-CONTRACYOR AGREEMENT 0OS2.10 c.149 S10k-S50 2o1`2 �— ROOF REPLACMENT KEYNOTE LEGEND LEGEND GENERAL NOTES: 2 TYPICAL REMOVE AND DISPOSE OF EXISTING WOOD SHINGLES,ROOFING 1. CONTRACTOR IS RESPONSIBLE FOR AND 1 AREA OF ROOFING i •,,,,,,,,,,, ,,,,,,,,,,■ � UNDERLAYMENT(S),FASTENERS,DRIP EDGE,FURRING,FLASHINGS, � SHALL VERIFY ALL EXISTING ■ � AND OTHER ACCESSORIES RELATED TO THE EXISTING ROOFING,AND REPLACEMENT DIMENSIONS AND CONDITIONS PRIOR TO REPLACE WITH NEW WOOD SHAKE ROOFING SYSTEM,TYPICAL ...... SUBMITTING SUBMITTALS,SHOP 5 B FACE OF ' LIMIT OF WORK AREA DRAWINGS AND/OR ORDERING TUCK BASE FLASHING UP TO UNDERSIDE OF EXISTING WINDOWSILL, �..... MATERIALS. EXISTING TYPICAL AT ALL EXISTING WINDOWS EXTERIOR WALL,TYPICAL REMOVE AND DISPOSE EXISTING /4'x 8-3/4" ACTUAL TRIM BOAR 0 REPAIR KEYNOTE 2, EXISTING BUILDING TRIM,DOORS, R SE OF E ST NG 3 (ACTUAL) D ❑ WINDOWS AND SIDING ADJACENT TO ENTIRE HEIGHT FROM GUTTER LINE TO EXISTING WOOD FRIEZE BOARD � 2 EXISTING PORCHES SHALL REMAIN,DO 1 ABOVE,AND REPLACE WITH NEW SOLID WOOD TRIM BOARD TO MATCH DIRECTION OF ROOF NOT PAI T TED. EXISTING DIMENSIONS. RUN TYPICAL BASE FLASHING BEHIND TRIM AND N ,U NLE SS 0 THER I E W S NO sIM I ; ' FORM DRIP EDGE OVER GUTTER. PREPARE,PRIME AND PAINT SLOPE(APPROX.4:12) REPLACEMENT TRIM BOARD. SEAL ALL JOINTS BETWEEN NEW AND EXISTING TRIM. —► +1 EXISTING ALUMINUM GUTTER AND DOWNSPOUT TO REMAIN,PROTECT N ALL EXISTING ADJACENT MATERIALS TO REMAIN DURING REMOVE EXISTING WOOD �• .I I 2 CONSTRUCTION. CORNER BOARD GUTDOWN TO TER AND ■ CAREFULLY REMOVE,STORE AND PROTECT EXISTING VINYL SIDING IN Ic ■ ❑5 WHOLE PIECES TO ACCOMMODATE ROOFING WORK. TRIM AND REPLACE WITH WOOD TRIM. _ y, ' • 3 REINSTALL UPON INSTALLATION OF NEW FLASHING AND ROOFING. SEE ROOFING KEYNOTE#3�� t;,• -,-..., � �8 FURNISH AND INSTALL ALUMINUM KICK-OUT FLASHING AT CORNER OF ■ TYPICAL ROOF INTO EXISTING GUTTER. 6 WOOD SHAKES,TYPICAL ' rl ; ark''1 arts :afac� `BUILDING FELT INTERLAY,TYPICAL 3 ' CONTINUOUS UNDERLAYMENT,TYPICAL .; ti .................. 4 SELF-ADHERED LEAK BARRIER w 1111, W: b ' MEMBRANE,TYPICAL �pfoy 1/2"PLYWOOD SHEATHING OVER EXISTING ROOF DECK,TYPICAL nl_4fi r 1�ROOF PLAN i REINSTALLED VINYL SIDING,TRIM TO ACHIEVE 1-1/2" z CLEAR BETWEEN J-CHANNEL AND ROOFING,TYPICAL LAP EXISTING BUILDING PAPER OVER STEP 'ry ®VIEW PORCH`B'ROOF I FLASHING,TYPICAL NO SCALE CONTINUOUS SELF-ADHERED MEMBRANE FLASHING EXISTING WOOD CONTINUOUS DRIP EDGE,TYPICAL ALONG TOP OF BASE FLASHING,TYPICAL , ROOF DECK TO H STEP FLASHING,TYPICAL I g REMAIN,TYPICAL w CONTINUOUS VINYL J-CHANNEL TO RECEIVE , EXISTING REINSTALLED VINYL SIDING,TYPICAL F EXISTING ALUMINUM GUTTER ROOF KEY , TYPICAL ROOFING -ASSEMBLY,SEE TO REMAIN,TYPICAL m PLAN x —" — , H DETAIL 3/A1-02 EXISTING PAINTED WOOD FASCIA BOARD,SOFFIT AND m m O TRIM TO REMAIN,TYPICAL "•'' 2 TYPICAL BASE FLASHING DETAIL s^MIN 3�TYPICAL WOOD SHAKE ROOFING DETAIL l-tm=r-o" +-in"•r•o' PINE AVE Regional Capital Assistance Team PORCH AND ENTRY REPAIRS D-w: AS"OTE7 Taunton Housing Authority ROOF PLAN,TYPICAL DETAILSISSUEDPERAOIENDUMN0.2 o■m: oe/o2/zon Al 'O� ��. SubmisaloN, 143 School Street Building l Tounton,MA0fl80 CAPTAIN ELDRIDGE HOUSE,667-3 AND PHOTO BIDDING Phone:508-823.6308 Fax:508-812-7050 BARNSTABLE HOUSING AUTHORITY FISH No.:020078 DOCUMENTS RCAT y� !y, 123 P.,S.I C onstTuctl®I1 IncVaim 77 North Main St•V lchs►o-,MA 015700 Phcmc:508-944 5124. Date.:.Junc 2.41 `01 4 Town of Hwumis Building Dept 200 Maih St Hyannis,?VGA 02601 p P.S.I Construction Inc g� ' wi f C) 77 1Vortli Main St Webster,MA 01570 NJ Owner. Piotr Piwowarczyk (508)944-5124 ' To Whom It May Concern, This lcu.cr is to make the Town of Hya►uvs- Building Dcpartnient aware that Wojcicch PiwovvArc:zyk is an employee of P.S.I Construction Inc. Suicerely, Plat. Plwow-uriyk, Owner 1'.S.X Ci(111SI.IlJ('6011 Iuc `I ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION To vil OF d n I Map t� Parcel Application # f { ` ?! Date•Issued Health Division ' •��?� �_ � _ ,,, r_ _ � Conservation Division Application F Planning Dept: • .� „r Permit Fee 4TI/�t3,E Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7 v1 P ve l,ca �S Village 4&nc` Owner 4 Address Telephones-08 1 _721 . 772 2 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay " Project Valuation 00 Construction Type Lot Size " Grandfathered: ❑Yes O,No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing 0 new size _ Barn: ❑ existing ❑ new size_ Attached garage: 0 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 C>�C,e dn Telephone Number g�� 6.2- 317 Address er g License# CS S d:?6 ) q 6 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �✓� //� DATE Of'ol-33 r � r z FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED t MAR-1 PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING; 14 DATE-CLOSED OUT ASSOCIATION PLAN NO. The Commamveafl h o,f Massachrusefts Deparbnent ofIndusftial Accidents Office orf Investrgations 600 Washington Street Boston,MA 02111 wnw,m ss:govldia Workers'.Compensation Insurance Affidavit: Builders( nt mc.torslE ectricians(Plumbers Applicant Information Please Print Ledbly Nattle �51 C,,,4 Inc Axidrt Cityfsta&zip: W as ev vi- Phone## 6 - Are you an employer?employees{foil audforpart-time). Cheer the appropriate box: . Type of project(required): 1.�am a employer urith 4. ❑ I am a genzeeral contractor and I �� )) p * have hired the sub-cantractors G_ �New constzn�ioo 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition. [No workers'comp_insurance comp_insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all.work officers have exercised their I L F�Plumbing repairs or additions myself o workers' right of exemption per MGL � [N - • 12. of repairs insurance required.]1 c_152, §1(4X and we have no employees.[No workers' 13. Other �t comp.insurance required.) *Any applicaat that checks box#1 amst also fill out the section below showing their workers'corapevsation.policy information- I Homeowners who submw this of idima ubdicating they.are domg all wmk aid theen hue outside coninctors»submit a new a5davu ln&cR=q.such. ZCout mctmrs that check this brut must attached an additional sheet showing the mope of the sub-contractors and state whether ur not those entities have employees. If the sub-contractors have employees,d6 ey must pmvide their workers'comp.policy number. I am an employer that is prm iding warikers'congmnsation insurancefor my empdo Tees. Below is the policy and,job site information. � J Insurance Company Name: UYtC�I Yv► Policy#or Self-ins-Uc.9: U B %30/h 3!y ExpirationDate: 10 _20/y Job Site Address: City/State/Zip: Attach a dopy 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.OQ anddor one-year imprisonment enta as well as civil penalties in the form of a STOP WORT,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 ofthe DIA for insurance coverage verification. I do hereby cart( under the 'ns and penalties afp4uty that the information ptmided abm a is true and correct Date: l 7 Phone#: of jf cial use only. Do unit write fn this area,to be completed by city or town official City or Town: PermitfLicense Issuing Authority(circle one): 1.Board of Health 2.ceding Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact.Person: Phone#: 6 Rightfax N2-1 6/6/2014 8:38:47 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T.111SX.MIFICATE 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 TIJE CgEITIFICATE HQ DEFL IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the erms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s_ PRODUCER CONTACT NAME: HERMAN W LAPOINTEJR INS PHONE FAX 1777 PLEASANT STREET (A/C,No,Ext): (A/C,No): E-MAIL FALL RIVER,MA 02723 ADDRESS: 72WDY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICANZURICH INSURANCE COMPANY P S I CONSTRUCTION INC INSURER 8: INSURER C: INSURER D: 77 NORTH MAIN ST INSURER E: WEBSTER,MA 01570 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS O CORIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE T15URED 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 TOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS S140VM MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (Miam'YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE Q OCCUR. REMISES(Ea occurrence) ED EX (Anyone person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY ®PROJECT®LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB Ll CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-993OM318-13 10/15/2013 10/15/2014 LIMITS ANY PROPERITOR'PARTNER/EXECUTIVE ®�A E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yea,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CER711FICATE HOLDER AFFECTING WORKER COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION BARNST'ABLE HOUSING AUTHORITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 14fi SOUTH 5T BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR El E --� :- HYANNIS,MA 02601 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION.All rights reserved. Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-076146 WOJCIECH J PIV W tARCZYI ':i ©� 4 Tanner Road Webster MA 01579 1 ��'% n O NN Expiration �-� 01I0212016 Commissioner V'ze rpoar�iiiaorecueull�a�Vvcat�tcc�uoeClrs ffice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 14k06 Type: I } xpiration: 1/26GHA6 Private Corporation. I — tgg WPI CONSTRUCTION INV'kN"- WOJCIECH PIWOWARCZY- .. 4 TANNER ROAD WEBSTER,MA 01570 Undersecretary f IOWNER-CONTRACTOR AGREEMENT Commonwealth of Massachusetts,Department of Housing and Community Development This agreement made the 26th day of February,2014 by and between the Barnstable Housing Authority hereinafter called the"Owner",and PSI Construction Inc.,hereinafter called the"Contractor." WITNESSETH,THAT THE OWNER AND THE CONTRACTOR,FOR THE CONSIDERATION HEREINUNIDER NAMED,AGREE AS FOLLOWS: Article 1.Scope of Work:The Contractor shall perform all Work required by the Contract Documents for the roof and skylight replacement at the 667-3 elderly housing development as prepared by J.M.Booth&Associates,Inc.,acting as and referred to in the Contract Documents as the"Architect". Article 2. Time of Completion: The Contractor shall commence work under this Contract on the date specified in the written 'Notice to Proceed"and shall bring the Work to Substantial Completion within 70 calendar days of said date. Damages for delays in the performance of the Work shall be in accordance with Article 9 of the General Conditions of the Contract. Article 3.Contract Sum: The Owner shall pay the Contractor,in current funds,for the performance of the Work,subject to additions and deductions by Change Order in the Contract Sum of SIXTY-EIGHT THOUSAND NINE-HUNDRED DOLLARS $6( 8,900)which includes Alternate No. 1&2. Article 4.The Contract Documents: The following,together with this Agreement,form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement,Bidding Documents,Contract Forms,Conditions of the Contract,and Specifications as enumerated in the Table of Contents,the drawings as enumerated in the List of Contract Drawings,DHCD publication known as the Construction Handbook,and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. Article 5. REAP Certification: Pursuant to GL'c.62(c) §49(a), the individual signing this Contract on behalf of the Contractor, hereby certifies under the penalties of perjury, at to the best of their knowledge and belief the Contractor has complied with all laws of the Commonwealth relating to taxes,reporting of employees and contractors,and withholding and remitting child support. Article 6. Worker Documentation Certification: In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract; that pursuant to federal requirements, the Contractor shall verify the immigration status of all workers assigned to such contract without engaging in unlawful discrimination; and that it shall not knowingly or recklessly alter, falsify, or accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, including but not limited to monetary penalties,withholding of payments,contract suspension or termination. Article 7.Conflict of Interest: The Contractor covenants,that(1)presently,there is no financial interest and shall not acquire any such interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this Agreement or which would violate M.G.L. c,268A, as amended; (2).in the performance of this Contract, no person having any such interest shall be employed by the Contractor;and(3)no partner or employee of the firm is related by blood or marriage to any Board Member or employee of the Awarding Authority. Article 8.Validation:This Contract will not be valid until signed by the Undersecretary of the Massachusetts Department of Housing &Community Development or its designee. In Witness Whereof,the Parties Hereto Have Caused This Instrument to be Executed Under SeaL CONTRACTOR AWARDING AUTHORITY PSI CONSTRUCTION,INC. 4--BARNSTABLE HOUSING AUTHORITY Name of Contractor �� a of Housing Authority 77 NORTH MAIN STREET,WEBSTEI2,MA 01570 V f ddress Signature and Seal By Signature and Seal Title " Witness Attest: Department of(Housing and Community Development Undersecretary or Designee S Iz2'Id• Date CERTIFICATE OF VOTE OF AUTHORIZATION 2014 hereby certify that a meeting of the Board of Directors of the: 00 "S�T Lk C-�, W Inc NAME OF y Old on the CORPORATION %D day of r 2014 duly called and held at�7 � b1 ; �� At which a quorum was present and acting, it was voted that 1'r C>-h tuv lNbr Name of Corporate Officer of the coy (26 1((L-h 6V1 , be and hereby is authorized to execute and deliver for and on behalf of the Corporation a Contract with Housing Authority, for work to be done at State-Aided Housing Project No. 66�-3 In the City/Town of LUan n! S And to act as principal to exe cute bonds in connection there wlth which Contract and Bonds were presented to and made part of the records of said meeting. further certify that fq VV5W CkYCN Is duly qualified and acting Name of Corporate Officer Pra5iCd of the Corporation and that said vote has not been Title Repealed, rescinded or amended A true copy of the record, ATTEST: (CORPORATE SEAL) NZ. On this/' r day of /1/0"' 2014, before me, the undersigned Notary Public, personally appeared "°/ -a r" ,LVA . C ZYZ<, duly designated by the board of directors and proved to me, through satisfactory evidence of identification, which was A5�� that s/he is the person whose name is signed on the foregoing documents, and acknowledged to me that s/he signed it voluntarily for its stated purpose and that it was her/his free act and deed. Notary Public TIMOTHY CHERNOSKY M Commission Expires: Fs""�` y p Notary Public Commonwealth of Massachusetts My Commission Expires December 11,2020 IIFT"Cinnla Trorla rnrnnrota Vnta FORM OF GENERAL C®NT CT®R°S EQUAL EMPLOYMENT,CERTIFICATION Commonwealth of Massachusetts Department of Housing and Community Development This form must be completed and submitted by the Contractor prior to the signing of the Owner-Contractor Agreement. This certifies that: Contractor Street Address !, M � City/Stat Zip Code 1. Intends to use the following listed construction trades in the work under this contract: 2. Will comply with the minority manpower ratio and specific affirmative action steps contained in Article 14 of the Conditions of this Contract; and . 3. Will obtain similar certifications from each of its subcontractors and submit to the Owner prior to the award of any subcontract under this contract the subcontractor's certification. i v!Q(J 04C7 SIGNATURE OF AUTHORI D REPRESENTATIVE OF CONTRACTOR NAME AND TITLE DATE i!6(('ID C:nnln Twda Gf F.Fl1('artifnota �^ Bond Number: 012021614 � PERFORMANCE BOND COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT KNOW ALL MEN BY THESE PRESENTS: That we,PSI CONSTRUCTION,INC.,as Principal,and THE OHIO CASUALTY INSURANCE COMPANY,as Surety are held and firmly bound unto the BARNSTABLE HOUSING AUTHORITY,as Obligee,in the sum of SIXTY-EIGHT THOUSAND NINE-HUNDRED DOLLARS($68,900) to be paid to the Obligee,for which payments,well and truly to be made, we bind ourselves,our respective heirs,executors,administrators,successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the said Principal has made a contract with the Obligee,bearing the date of February 26,2014 for the roof& skylight replacement at the 667-3 elderly housing development in Barnstable,Massachusetts. NOW,the condition of this obligation is such that if the Principal and all Subcontractors under said contract shall well and truly keep and perform all the undertakings, covenants, agreement,terms and conditions of said contract on its part to be kept and performed during the original term of said contract and any extensions thereof that may be granted by the Obligee,with or without notice to the Surety, and during the life and any guarantee required under the contract, and shall also well and truly keep and perform all the undertakings, covenants, agreements, terms and conditions of any and all duly authorized modifications, alterations changes or additions to said contract that may hereafter be made, notice to the Surety of such modifications, alterations; changes or additions being hereby,waived,then this obligation shall become null and void;otherwise,it shall remain in full force and virtue. .IN THE EVENT,that the contract is abandoned by the Principal,or in the event that the Obligee, under the provisions of Article 19 of the General Conditions of said co ntract terminates the employment Yment of the Principal or the authority of the Principal to continue the work, said Surety hereby further agrees that said Surety shall, if requested in writing by the Obligee, take such action as is necessary to complete said contract. IN WITNESS WHEREOF,the Principal and Surety have hereunto set their hands and seals this: 10th' Day of April ,2014 The Ohio Casualty Insurance PRINCIPAL PSI CONSTRUCTION,INC. SURETY Company By: By: e, Seal Attorney-in Fac Car rains Attest: Attest The rate for this bond is 3 %for the first $ 68,900. and %for the next $ 2239.00(includes a . The total premium for this bond is $ for the 2nd$172 warrranty fee year maintenance) DHCD Single Trade Performance Bond 2014 1 of 1 Bond No.012021614 PAYMENT BON® COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT KNOW ALL MEN BY THESE PRESENTS: That we,PSI CONSTRUCTION,INC.,as Principal,and THE OHIO CASUALTY INSURANCE COMPANY,as Surety are held and firmly bound unto the BARNSTABLE HOUSING AUTHORITY,as Obligee,in the sum of SIXTY-EIGHT THOUSAND NINE-HUNDRED DOLLARS($68,900) to be paid to the Obligee,for which payments,well and truly to be made, we bind ourselves,our respective heirs,executors,administrators,successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the said Principal has made a contract with the Obligee,bearing the date of February 26,2014 for the roof& skylight replacement at the 667-3 elderly housing development in Barnstable,Massachusetts. NOW the conditions of this obligation are such that if the Principal and all subcontractors under said contract shall pay for all labor performed or furnished and for all materials used or employed in said contract and in any and all duly authorized modifications, alterations, extensions of time, changes or additions to said contract that may hereafter be made, notice to the Surety of such modifications, alterations, extensions of time, changes or additions being hereby waived,the foregoing to include any other purposes or items set out in,and to be subject to,provisions of M.G.L.c.30 §39A,and M.G.L.c.149 §29,as amended,then this obligation shall become null and void;otherwise it shall remain in full force and virtue. IN WITNESS WHEREOF,the Principal and Surety have hereunto set their hands and seals this: 10th Day of April, 2014 The Ohio Casualty Insurance PRINCIPAL PSI CONSTRUCTION,INC. SURETY Com any c By 1 �;f� By; c� I La Seal Attorney-in Fact Carl L.Traina Attest: Attest \\ The rate for this bond is NA %for the first $ and %for the next $ The total premium for this bond is $ Included in the performance Bond T O ]ICY R Y INSURANCE GROUP - - ALBERT J.TONRY&CO.,INC. 300 CONGRESS ST.,STE 104,QUINCY MA 02169 617-773-9200 www.tonry.com_ DHCD Singe Trade Payment Bond 2014 1 of I THIS POWER OFATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED$ACKGROUND - This Power of Attorneyaimits the acts of those named herein and they have no authority to bind the Company except m the manner and to the extent herein stated _. , - Certificate No .eiz27o2 :_ '= American Fire and.Casualty Company Liberty Mutual Insurance Company The Ohio.Gasualty Insurance Company- WestAmerican Insurance Gompany "'a--��:":2-,-,.�--a�,----.��_-.-r�-,�-''..--�_1'-__:.----,--,f1--�a4:,�-a,�----,--,--.-�r-!�:�,--.�1,r_'.a---r:..r:'.---.-_a--r,-a-�.,,-�.--,,�_.1'._,"',.�;_:.--,r�_�,-_"Ij'�---,".".,..--�:�.'"-.�',..,,-,,-.,-.--,:.,,���,-,.-r.,'-.-,"'I.',,,-r,,I,,.�.--'-.-,,�.�.�I,.-��,--�,-:.,...`.L.-'�-,_,,,,.::�l..-:---�.,-:�-..:-.q.——_,-�.�-,----'_-,'-_-�-,--_.o--:---,_----_r-�-�'��-_-�-.L---.--.-----.r;�r-_--.I,-,_--,_.--.,,._i-a-.".-_-..I"---a--�-�..-.-:I,"'-,,:,Ia----,-a::a,---_-��.r--;.,.�-�-Iv.-�M-�'-L'-:,---r:-�,:�r�,_-�-�a,��ra,,�-_-�-_.-:---_-.--,-------,----__-'--_-�------r��.'--_,-_a---�,-.------�rr--��_-i--.�_-�-,,..,'--,.r�.---'-.,,--.�--I----,-a-f'p--�.-__--�-,,�-_-:.-.,�_-�-,-�-,--,--,._,,,,'r-,-.L'-,,�,L,",,,�-�.�,'.,.,'X-.',,��;5�,,",-fi,,.,�Z<\r�"L'/,-,,L�,,r,':.,,,..,,�-.�',a-�r-q--r�.,-,-",,,,-�,-,-'--�-_,,:-_--,-,V_�,--i/.-a;�,,��---.----I,r.�'__-'----_-._.:-a-:_--�gar---_a---a�-r�-,---_a1�:--.'?,.ra--`,_-,-��,--�._#-.r.,.-';.,�,'a�1'�-�_-,aL—ar,��',�a--���---.--,�.�..-a,-.-.�-,---_-.-�����---,�.K--...,.N--a'a-a,.--,�'_a_---._"�1,r�---..;',.-..',-� ,POWER OF ATTORNEY — �,--,"---'_-r":1-7.7,��.-r,-��-.:',rr,-,.1--:.�"z-.-�"-._,.�a�1-"-.,.,,'�:-�.:,._,�,:..,�,��'',,,a a--',-���,..-.,.,,�-,'r.",:'1,-,,L.-.'�_._,,_�.IJ.,,IL,:�.q-_,..:,,""'�,,.r-�-��Lrrr:.-�':.-�,,-,�,,,":,�-''.-�-',','-,L,�,��*—.i.:,_L,...--,r-'a._Z�-,'-'-,.-'--:aa-,.-.--.�__--,,"�----,---_�,--------a--:K,j-:---_:,_.--.,�:r':-..r:.,-----:7 __--__-1--._---_'_--a-,-�-_-__�------�-_-��-,r---�--:-----__-------_�-,_---_--_-__-,�-_;-.--a--_':---z_�':---:�-_-_��-,_a�_:_-:--a.--z,---__"A-�-�_"'r_I:,--,,, KNOWN ALL PERSONS BY THESE PRESENTS That American Fire"&Casualty Companyand The Ohio Casualty Insurance Company are corporations duly orgamzed under the laws of . the State of New Hampshire that Liberty Mutuafihsurance:Company is.a corporation duly:orgamzetl under the laws of the State of Massachusetts and WestAmencan Insuiance.Gompany. . -. rs a corporatrori duly organized under_the laws of.the State of Indranajhererri collectively called the°Compames);pursuantto and byauthonty herein set fortti;;does hereby name;constitute and appoint Carl L Trarna -Edward J Mulcahy-Jacgs.elynne R`-Maloney Lours A Tonry J'r = J - all of the cdy of Qu@ncv state of MA - each individually if there be snore than one named its true-and lawful attorneym-fact to make execute;seal acknowledge antl deliver focand on itsbehalf as surety and as ds act-and deed,ariy and all indertakings'bonds:re..I -arices and other surety obligations;:irrpursuance of these pr. ,tsand shall : be as=biding upon the Compames as;rf they have been duly signed by the president antl attested by the secretary of the Compames in their own_proper persons .-, _ _. _, IN WITNESS WHEREOF:-thi s s Power of Attorney_has beensubscnbed by an authorized officer or official of the Companies;and the corporate seals of the Compames have been affixed; thereto this 1"9th day:of June "2013 - Amencan Fite and Casualty Company -a The Ohio.Qasualty Insurance.Company _ ui k r - b rt M t I C N. , a, €r F 4 Li e y u ua Insurance ompeny = a� T 1' WestAmencanlnsuranceCompany _ STATE OF WASHINGTON ss _ro - - ce: w.►- COUNTY OF KING - - Gregory Davenport,Assistant Secretary ra m On this 19th dayof June 2013 before me personally appeared Gregory W Davenport;who:acknowledged himself to'be the Assistant Secretary of American "-_ _,._ - y pay P Y s such being;authonied so to do , v`� Fire and Casually Company Liberty M-Ut-yal Insurance Company The-Ohio Casualt Com -nap West American Insurance Com an and that he a _. =� execute the foregoing instrument for-the purposes therein contained by signing on behalf of.the corporations by Himself as a duly authorized officer d-liJ. d> IN WITNESS WHEREOF I;have hereunto subscribed my name and affixed my notarial seal at Seattle;Washington on theday and year first above written` `p=o �.:_� Q.o =� ' ✓ M' y -- ; - By -O O_:i. D`Riley Not Public =L.Z3: `..O _ ' ,Q), _ _ K — 3 r> - o at n. �,w, This Fower ofAttome is made and executed pursuant to and by authority of the.follow€rig Bylaws and Authonzafions ofAmerican Frre and Casualty >_ ea Y Company;The Ohio Casualty.lnsurance ;N. Company liberty Mutual Insurance Company and WestAmencan Insurance Company which resolugons are now m full force and effect reading as follows -=a 4-:;, eo rm ARTICLE IV OFFICERS-Section12 Power ofAttorne' offs-'-r other official of the Corporation authorized for that purpose in writing by he Chaiiman or the President and subtect;.-p. L ;- _ - - - .. _ .-._ _ - .. _ _.a. a� to uch limitation as the Chairman or.the President may_;prescnbe shall appoint such attorneys to fast as maybe nec.. - to actin befialf of.the Co .oration to make-execute seal -a:4- ,O acknowledge and deliver as surety any and all undertakings;bonds recogn¢ances and..other surety_o.til.igations; Such attorheys iri-fact;subject to limitations set forth m their respective 'S E powers of attorney shall have full power to bind the Corporation bytheir signature and execution of any such,instruments.and to attach thereto the seal:of the Corporation :When so --a. -a' executed such instrumentsshall be as bindin as if si ned:b .the President and attested4o b ttie Secrets An ower or-authori ranted to ari re resentative or attortie=iri-fact under. R �O"tv _. - 9.._. 9, Y_ Y ry.::_YP 9_ Y P Y j -- " =L the provisions of-this article;may -e-revoked at any time bythe Board;j e ChaiiMain the President or by the officer or offcers grantingsuch power or authority at, m.-e ARTICLE XIII "Execution:of Contracts SECTION 5 Surety Bonds and Undertakings Any.officerof.the Company authorized#or that,purpose--irrwntmg oythe chairman or the president-- :C0: >::=L and-subject to such limitations as the.chairman oethe president may,prescnbe=shall appoint such attorneys in=fact as may be-necessary to acEin behalf offhe;Compariy to make:execute:-,f O,M seal.acknowledge and deliver as surety any grad all uni e' '-mgs;,bonds recognizances.and othersuretypbllgations ".Such attorneys m fact subject to-the limitations set forth m their . 00 Z respective powers of attorney shall have full power to bind the Company any -and execution of any such instruments andao attach_thereto theseal of the:Com an .When—so.. O:o _ - executed such instruments-shall be as:bmdmg as d signetl by the president and;attested by the secretary 1 O F- Certifcate of Designation The President of.the Company acting"pursuant to the Bylaws of the:Company`authonzes Gregory WDavenport-Assistant Secretary to appoint such - attortieys m fact;as may be necessary to acl on`behalfof,_ Company to make;execute;seal acknowledge antl deliver as surety any and all_undertakings bonds recognizances and other-surety obligations -- _ - = Authgnzation- -.By unanimous consent of the CompWY,s:BoaN of Directors the Company consents filial facsimile or mecfianicallyreproduced-signature ofiany assistant secretary of the Company wherever a earn u ona certfied co of anypower of:attorney issued by the Company lnconnection-with siirety bonds;shall be valid,and:bindmg upon the Company with c- PP 9 P ,PY the same force and effects§though manually affxed v f > n,._ .. I David M Carey the undersigned Assistant Secretary of-AmencanFire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual lnsurance'Company,and West - _ = American Insurance Company do hereby certifythat the original power,of attomeyof whichthe foregoing-is a full,true and coFrect copy.ofthe Power ofAttomey executed:by said Companies is m full force and effect and has not been revoked A A IN TESTIMONY WHEREOF I have hereunto set my hand and affixed the seals of said Compames thls day of 1-'1. 20 L� w, r `c,L K k 3 f B w t l OG t tI t> 7 1 i l � I. Y ., David M Carey Assistant Secretary ti j \ -� LMS--t2873 092012 ,; �_- .,.: � � •' _ '66 Of 300 • r ®• CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY► ThIL&GERTIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: HERMAN W LAPOINTE JR INS PHONE FAX 1777 PLEASANT STREET (A/C,No,Ext): (A/C,No): PO BOX 4098 E-MAIL FALL RIVER,MA.02723 ADDRESS: 72WDY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY P S I CONSTRUCTION INC INSURER B: INSURER C: INSURER D: .77 NORTH MAIN ST INSURER E: WEBSTER,MA 01570 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MWDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. DAMAGE RENTED $ ❑ PREMISESS((Ea occurrence) VIED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS. BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS - BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE.' AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-9930M318-13 10/15/2013 10115/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NSA E.L.EACH ACCIDENT $ 500;000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS TIES REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER. CANCELLATION BARNSTABLE HOUSING AUTHORITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 146 SOUTH ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA E HYANNIS,MA 02601 ' � r ACORD 25(2010/05) The ACORD-name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. Ail rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 05/20/2014 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 phone: (508)987-0333 Fax: 508-967-0063 NAME"cT Oxford Insurance Agency Inc. OXFORD INSURANCE AGENCY INC H NE Ext: 508 987 0333 FAX (508)987-5517 P 0 BOX 370 E-MAIL AIC No OXFORD MA 01540 ADDRESS: PRODUCER 21418 - CUSTOMER ID: INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURERA :Atlantic Casualty Ins.Co. PSI CONSTRUCTION INC. 77 N.MAIN STREET INSURER WEBSTER MA 01570 INSURER INSURERD: - INSURER E.: INSURER F - COVERAGES CERTIFICATE NUMBER: 82670 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, INSR TYPE OF INSURANCE ADD'L SUBR - POLICY EFF POLICY EXP - LTR INSR WVD POLICY NUMBER MMIDD MM/DD LIMITS A GENERAL LIABILITY L081001135 08/31/13 08/31/14 EACH OCCURRENCE $ 1,000,000 X1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Meoccurence $. 100,000 CLAIMS-MADE 11� I OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMPIOPAGG $ _ 2,000,000 POLICY PRO- LOC IFrT AUTOMOBILE LtABBJTY - - - COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS - BODILY INJURY(Per person) $ SCHEDULED AUTOS. BODILY INJURY(Per accident) $ PROPERTY DAMAGE ' HIREDAUTOS (Per accident) $ NON-OWNED AUTOS - - - $ $ +me ELLA LIAe OCCUR EACH OCCURRENCE $:. s LwsCLAIMSMADE AGGREGATEUCTIBLE $ NTION $ $ WORKERS. COMPENSATION - WC STATU- OTH AND EMPLOYERS' LIABILITY YIN TORY LIMITSER $ ANY PROPRIETORIPARTNERIEXECUTIVE- E.L.EACH ACCIDENT - OFFICERIMEMBER EXCLUDED2I� NIA - (Mandatory to NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below - - E.L.DISEASE-POLICY LIMIT $ 17 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE .HOLDER - CANCELLATION Barnstable Housing Authority SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 146 South Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 012601 AUTHORIZED REPRESENTATIVE Attention: /�� `Brian M. Rav nelle ACORD 25(2009109) ©1988-2009 ACORD CORPORATI0H.. All rights reserved. The ACORD name and logo are registe,ed marks ok ACORD PSIC0-1 OP ID: SC CERTIFICATE OF LIABILITY INSURANCE DATEIAeM/DDNYYY) 05/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT Charniak Insurance Agency PHONE Stephen Chamiak FAx 274 Main Street A/c No But:508 943 0938 ac roc: 508 943 6423 Webster,MA 09570- ADDRESS:scharnia chamiakinsurance.com INSURERS AFFORDIwG COVERAGE NAIC 0 INSURERA:Safe Insurance Company 39454 INSURED PSI Construction,Inc. INSURERS: Piotr Piwowarczyk iNSURERC: 77 North Main Street Webster, MA 01570 INSURER D: INSURERE: 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. TYPE OF INSURANCE POLICY EFF POLICY EXP LdTR -POLICY NUMBER MMID MMIDDIYYYY LIMIT'S GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY D PREMISES Ea occurrence S CLAIMS-MADEE OCCUR MED EXP(Any one person) $ PERSONAL S ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG- $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . Ea accident A ANY AUTO. 620SS87 03104/2014 03/04/2015 BODILY INJURY(Per person) $ 260,00 AAUTOOSMED ._ �_ AAUTOESULED BODILY INJURY(Per accident) $ 500,00 X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDE $ 100,0O $ UMBRELLA LIAB OCCUR EACH OCCURRENCE .$ EXCESS LIAR HCLAIMS4AADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION - WC STATU- I 1OTK- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS I ER ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NM) EL.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Ausch ACORD 101,Addidanal Rsmarft Schedule,it more space Is required) 2006 GHC Van 1GTGG29U561107494 CERTIFICATE HOLDER CANCELLATION BARNHOU SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable Housing AuthorityACCORDANCE WITH THE POLICY PROVISIONS. Lonna Sinton - 146 South Street AUTMORW. D REPRESENTATIVE L'dyauunas,MA 02609 ©1998-2010 ACORD CORPORATION. All right-,reserved. ACORD 25(2010/055) T hG ACORD name and logo are registered marks of ACORD 3 O ?lute- 74Venuse _ ARCHITECT'S Field Report 02 BHA CAPTAIN ELDRIDGE HOUSE,DHCD#020049 1214 BARNSTABLE BUILDING PERMIT#201207861 Observation Date: April 22,2013 Issue Date: April 23,2013 Contractor: Eagle Eyes Construction Writer: Rob Smith Weather: Cool,windy and dry. Construction deficiencies omitted from this report do not indicate acceptance of construction, assemblies or finishes observed, or relieve the Contractor of responsibility to install all work in accordance with the Design Documents. LOCATION Work in Progress: Painting of exterior wood siding,flooring and trim is in progress. Observations: Roof patching was complete,and included additional rake area on the east side of the front gable,and a portion of the rear gable to the north. The Contractor appears to have successfully woven into the existing shingles. The Contractor has replaced two windows;the first was a change order,the second was done at the Contractors discretion in place of the sash and jamb replacement kit that was specified. A new wood gable end wood louver was installed. Non-Compliant Items: None. Photographs: J.M.Booth&Associates Inc. Tel no.508-999-6220 47 N. Second St.41h Floor Fax no.508-990-1265 New Bedford,MA 02740 www.jmba-architects.com O Captain Eldridge House Page 2 of 3 i ����,��� • ^�I AJW TI . r. � I M F M t r e Painted front historic gable end with porch. New window installation. Rk r � k c y ME Front gable of addition showing roof patch with drip West side,painting in progress.Partial roof patch at edge and replaced wood gable end vent. upper gable end,above right dormer. s:\DATA\12\1214 BHA Eldridge House DHCD\field reports\1214 Field Report 02.docx Captain Eldridge House Page 3 of 3 1 i '�, a 't Gz����"' �x.».'•x F Yrw �,,, ��d° ^a rrt aJ4 {�(<�e t"e I 4 r.f Yr� � �_��yuy�Imy„r..,.r.. � �"e�drs E 6e�?r r •..r.«n.+Srivr+rrF t-r.� �_ 7T. Yr. ♦1 .f •t p d4 i 4i. '� ^}€� �w t 7� r tee fi �'�� '"rt w;° f r ua���r�+ ,�**P'�M'•*.�ti. 4 t t. VT +tir �r r r `� 4 � -a � �. # «rf .• v�r t dot.•� �&.."d b'Mi�„xsz ..# r _ y � �4 WI S�•S� �.^ f r , t•„ i_ F . .� r, f �'`" � _ �:iv ri 4 ��'�tF k� d �,,�� }�� Jr ny� ,« in..,' in p.• i i � ter.. � v' iL e��3 ''fit�`�k k � A 9 ��. First coat of paint on front porch floor. Painted front porch ceiling,matching original color. Attachments: s:\DATA\12\1214 BHA Eldridge House DHCD\field reports\1214 Field Report 02.docx TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .Map pp Parcel Application Health Division Date Issued 1� �— Conservation Division Application Fee' 0 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address -30 pig? Village I .S, Owner B199n/S A9 61,e , (�S/ M/Address Telephone SOY 7 2172 2 2 Fa' �5j Ok 7 7F 73 1 Z Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District45MAV /41, iZrood Plain Groundwater Overlay Project Valuation Construction Type ZE Lot Size Grandfathered: ❑Yes ❑ No If yes, atta 3upportipq domg1rnentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) °:,' -- Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin 's Highway: 0 'es ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (s .ft) r"zsl '"; Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including bathe): 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 ��7 C= t L Z 4a Telephone Number 617- Address -3L 6 /V VMA4 License#e S 6 V( g 2 9 Home Improvement Contractor# / 70 'W7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO OS rl l tj � � �� 6 k (set� ®� inw&) SIGNATURE DATE f FOR OFFICIAL USE ONLY a :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. .. vJlcw vJ t�arw6""• u 600 Washington Street Boston,MA 02111 :' fvww.mass gov/din , Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Pll<unbers A. Iicant Information Please.Print Le bl •. Napo(Business/Orgmdzafion/Individual) t ale C��� c' Address: C f r�`yerSa` A,P / City/State/Zip: O EF � � Phone.#: A-re you an.employer? Chmkfhe_appropriate bog .Type of project(required); 1.[ I am a e to er with` 4. F1.I am a general contractor and I -' 6. 0 New construction employees (Mull and/oi part time) * have hired the sub contractors 211 I am a dole proprietor or partner- listed-on the-attache,d sheet 7. ❑Remodeluig ship and have no employees These sub-contractors have S. 0.Demolition wo for rue in an, i employees and have work=' Lking . Y capacity.P t5' 9. 0 Building addition . • . [No workers' comp.Insurance comp.nFurance.t . Electdcalrepairs or additions _. 3. T am a homeowner doing all work officers have exercised their 11..❑Plumbing repairs or additions Myself. o workers' co right-of exemption per MGL ys [N up. ' 121- Roofrepairs insurance required.]t c._152, §1(4),.and we have no ,�- employees.[No workers' 13.1V Other�MW9t''W comp,rusurance required_] P •, *Any applicant that checks box#F1 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-conh actors and state whether ornot those entities have employees. If the sub-contractnrs have employers,they must provide their workers'coin.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. k/ �,`21'7 L L�1 +�t/oC' (.. / Insurance Company Name: (P Policy#or Self-ins.Lic.# S "f "L.l® Expiration Date: Job Site Address: ® l`d�e �' 54LI, W City/State/Zip: 1�y�/✓/!!!`, , Qt��o" Attach a copy of the workers'compensation policy,declaration page'(showiug the policy number and expiration date). Failum.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 forwarded to the Office of. Investigations of the DIA for insurance coverage verification. I do hereby certify nude the pains and penalties of perjury that the information provided above is truce and correct Signature:'-- Date: . Z hy/E 012 Phone#: 6`7 Official use only. Do not write in this area, to be completed by,city.or town official City or Town: Permit/License# IssuingAuthoritp(circle one): J.Board of Health 2,Building Department`3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6..Other. Contact Person: Phone# 4 . i Massacbnsetts General Laws chapter 152 regdrres..all employers to provide workers'coMpensatran.for their employees P Y any contract of hire, 3'P Pursnanf to.this statute an-em to ee as defined as .:.ev erson m.the service of another under express.or implied, or, or Written An employer is defined as"an individual,partnership,.association,corporation or other legal enfity,or any two;or more of the foregoing engaged m a-joint enterprise,and including the legal representatives of a deceased employer,:or the-- _ _. . _. . - . ... . receiver or trastee•of an individual,partnership, association or o egal erzmy,employing employees. However ttie 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 or building appurtenantt4creto shall not because of such employment be deemed to be an employer... ' MGL chapter 152,.§25C(6)also states that"every state or local licensing agency shall.withhold the issuance or renewal oft license or permit to'operate a business or to construct buildings in the commonwealth for any app4cantwho has notprodnced-acceptable evidence of compliance with fhee-insurance coverage required-" Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contra.ct for the performance of-public.work until-acceptable tvidence of complia-ce with the in.�rni;e requirements of this chapter have been presented'to the contracting airthority." Applicants Please fill out the workers compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)-,a- (s),address(es) and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers.'compensation insurance. If an.LLC or LLP-does have employees,a policy is required: Be advised that this affidavit may be submitted to the Department of.Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or town.that the application for the permit or license is being requested,not the Department of Industrial Accidents.. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in event the Office of Investigations has to contact you regarding'th.e applicant • Please be sure to fill in the permit/hcense number which will be used as a reference number.. La addition,an applicant that must submit multiple permit/license applications in any.given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit: The-Office of Investigations would hike to drank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,.telephone-and fax number: M"CwDmouwc�altiZ of Ma vht DQ-Put zlat cif taduslual Avid=mts 0MCC Of y�t1�ttQTtS. 6shinfiettt�tti 9.617-727-4-M ext 406 of 1-M—MASSAFE Revised 11-22-06 F� 617-72 - 4� `. wwwmaMgov/cis From Tonry Northwest Tue 18 Dec 2012 01:30:37 .PM EST Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE 12/1B/2 o12 DATE(IJIIJUDD012 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. 1f 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 endorsernent(s). PRODUCER - "- CONTACT Colleen MatheWS - NAME: Tonry Northwest Insurance Agency, Inc. . PHONE . (781)"861-1800 FAX No (781)861-1804 238 Bedford Street ADDRESS:cmathews @ tonrynw..cam INSURER(S)AFFORDING COVERAGE NAIC it Lexington MA 02420 INSURERA:Citation Insurance Company 40274 INSURED INSURER B:NorGUARD Insurance Company, 31470 Eagle Eyes Contractor, .Inc. INSURER C 366 Riverside Ave. #2 INSURER 0: INSURER E: - Medford MA 02155 - r1 INSURER F: COVERAGES.- CERTIFICATE NUMBER:CL12121805541 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE. S COMMERCIAL GENERAL LIABILITY - _ D A TO RENTED - PREMISES Ea occurrence - S CLAIMS-MADE �OCCUR MED EXP(Anyone person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS-COMP/OP AGG S POLICY PRO- LOC - - - S AUTOMOBILE LIABILITY. - - - COMBINED SINGLE LIMIT. - Ea acciden S 1 000 000 ANY AUTO - - - BODILY INJURY(Per pers_on) S A ALL OWNED. SCHEDULED LJ2031 2 5 2012 12 5 2013 AUTOS X AUTOS / / BODILY INJURY(Per accident S X - X NON-OWNED - Per O a cidentDAMAGE HIRED AU . .S TOS AUTOS Medical payments - S 5,000 UMBRELLA LIAB:.` OCCUR EACH OCCURRENCE S EXCESS LIAB - CLAIMS-MADE. - AGGREGATE S - DED RETENTION$ B WORKERS COMPENSATION - WC STATU- OTH- AND EMPLOYERS' YIN LIABILITY - X TORY IMITS ER . ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT S• - 100,000 OFFICER/I.IEMBER EXCLUDED? N/A (Mandatory in NH) - ?C217119 9/21/2012 9/21/2013 EL DISEASE-EA EMPLOYEE S 100,000 _ If yes,describe under DESCRIPTION OF OPERATIONS below - EL DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1D11,Additional Remarks Schedule,if more space is required) Project: " Trim and Paint Repair Location: 30 Pine Avenue.Hyannis, 'MA CERTIFICATE HOLDER CANCELLATION (508)7 90-6230.: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE'THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE L Tonry Jr./CMATTH ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 onirdn rit The Ar f1Dn nnrna end 1-bra rn Lr of AfY1Dr) Erg Town of Barnstable 0 Regulatory.Services NAM � Thomas Geiler,Director :Building Division Tom Perry,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 , �0Qwws f !e I, J'ao .,�dy u'i/��KEC. 17cr = SjFr q , as Owner of the subject'property hereby authorize J a-g9 f? E�J tS OM r ri dTTyI G• to act on my behalf, in all matters-relative to work authorized by this building permit' 3D RnP (Address of Job) Pool fence - s and alarms, are.the responsiblltty of the applicant: Pools are not to be filled or utilized before fence is installed and all final inspections.are performed and accepted. Signature of Ow er Sign e of Applicant �- Print Name print Natne .: Date NSTA9LE.HOUSING AVrHORffY Q:FORMS:OWNERP 012 s r Town of�a� stable Re ulato Services P g �'3' * sAxivszAsr� �Thomas F.Geiler,Director. y MARS 4, i63;9 �10 Building Division Tom Perry;.Duilding Commissioner 200,Main Street, 'Hyannis;MA 02601 www.town.barnstable.ma.us Office: 568-862-4.03 8 . . 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 re-Sponsible 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 ' 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 personas 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 ofthe permit application; that the homeowner certify that he/she understands the responsibilities of a Supervisor..On thelast page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. Q:forms:homeexempt Ems( Massachusetts -Department of Public Safety � F Q I-Awagp.344� nlr� ineQe eCC Board of Bwlding Regulations and Staridard5 ME�i P ,4l! _ :. OyEME{9T OMI T Construait)n.Super%isor, "�"� p �a h mel ojslfr#@th A.V2469 fi License CS-09447ypi� ti `�t#1 7 T{�S • Qd# a ( 01afiNr�tf9,[j MENEZIO LQV�LADA /� : r . . RN19CTQR�,=INC �E 4Aj ,� 366 RIWRS Medford MAC 02155 �o- �.q ZA a IRIVftpm �ett�` expiration Commissioner '03/09/2014 + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION tp Mapes" J Parcel Application : 6too Health Division Date Issued C O c> Conservation Division '-Application Feed Planning Dept. :.Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 30 t14( Village )qV1-dH I S Owner QNS`7"A171F US066 A UT"t,l'r Address 14& Telephone Permit Request �Zi=© Fife 1 el IG. a oidC'_ 5`(/�- 11,0 i IC r-C nlAC-C ct a ►2u� Iy'��-Q��c (&,,r7k ,42.G./ 01; k:t`,�A oyE-Z. i2e 1x4e� Two Gz-yreiz.iw Reik #f S jxc4 Fie fIeO_,� 2•er2 tO(-e 'ruu0 6 _ S . RerAAc e 8 VC19&P,a e Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 00 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) o -© z Number of Baths: Full: existing new Half: existing r`W o -n Number of Bedrooms: existing _new s m Total Room Count (not including baths): existing new First Floor Room CounE Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Co >. W Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stovES Fes ❑ 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 it�446463 10C Telephone Number I Address /c',3 .-"t,,jew T")e License # G 6 S�3 C�e' �I�i/�, e✓a�` �' Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 00 b4L 12 SIGNATURE` DATE ��� Z/—C !' FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED MAP/PARCEL NO. t F ADDRESS VILLAGE OWNER 4 DATE OF INSPECTION: > F0 NDATIOW p FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL.' 4 ` i PLUMBING: ROUGH FINAL r -GAS: ROUGH * ca- p FINAL '? 'TINAL BUILDING1, ` DATE CLOSED OUT 4 ASSOCIATION PLAN NO. C - The Commonwealth of Massachusetts Department oflndustrial AccideWs Office of Investigations + 600 Washington Street Boston, I M 02111 °� w• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricia)as/PIumbers Applicant Information Please Print Le�iblY e 5 ' Name (Business/Or ganization/Individual): L,, /K%�iGS �cee�Ld1�y Ri2mcde kv 5 Address: 1.83 Arevl✓Yrqt) on City/State/Zip:c-ew j'e�s//e ,ej4 o0q& Phone.#: 5'ok l Y16 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am-a general contractor and I 6. ❑ New construction ployees(full and/or part-.time).* have hired the stab-contractors . . . 2_�am a soleproprietor part--time) 2- listed on the attached sheet 7.. Remodeling ship and have no employees These sub-contractors have g. 'D Demolition workin for me in an capacity. employees and have workers' g y p ty. $ 9.� ❑Building addition [No workers' comp.-insurance comp. insurance. required.] S. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work > officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required-] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers''comp.policy number.' I am an employer that is providing workers'compensation insurance for my employees., Below Is the policy and job site information Insurance Company Name: Policy#or Self-ins. 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 ins ce Coverage,verification. I do hereby certify under ns and e es of perjury that the information provided above is true and correct. Si ature: . _. Date: Phone #' C bs 77/A'11 O fficial only. Do not write in this area, to be completed by city or town official n: Pern-it/License# hority(circle one): Health -2. Building Department 3. City/Town Clerk, 4.Electrical Inspector 5.Plumbing Inspector . .cnn: Phone#: Information and Instruction - Massachusetts General Laws chapter 1S2 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in.the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity; or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of.another who employs persons to do maintenance, construction or repair work on such dwelling house of on the grounds or�building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers' compensation affidavit'completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),-addicss(es)and.phone number(s) along with then certificate(s)of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should.you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'aud 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 permitllicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" fhe.applicant should write"all locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the vit is on file for future permits or licenses. 'A new affidavit must be filled out each applicant as proof that a valid affida year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to born leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to giye us a call. The Department's address, telephone and fax-number: The Commonwealth of Ma,ssarhus(-,ts. }depart nont of Industrial Accidents Office of IaVestigatious, 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ofT r ti ` o wn'of Barnstab4e, M Regulatory Services S Thomas K Geiler,Director m Building Division Tom Ferry,Building Commissioner 200 Main Street, Hyannis, MA 02601 wtivw.town.b arnstab l e.ma,us Office: 508=862-4038 riFax: 508=790-62: { Property Owner Must - Complete and Sign This Section if Using A.Builder I, � J& Y� , as Owner of the subtect,property hereby authorize / ,4(�IeS t"�1�1^S1Og to act onrnybehalf, in all matters relative to work authorized by this building permit appication for., ir.144 (Address A rob) Signature of er Date BARNSTABLE HOUSINGS AWN 140 SOUTH Prurt Name r. If Property Q-wne.r is applying for permit please complete the Homeowners License Lxemption'porm on the reverse side. Town of Barnstable + o` . T Regulatory Se'rVices atixxsrtiat Thomas F. Geiler,Director ' Building Divisi0n PrED �a Tom Perry, Building Commissioner 200 Maid.Street; Hyannis, 1 A 026.01 Rwv.t o wn.b arnsta b l e.ma.us Office: 508 862 4038 Fax: 509-790-6230 E Ol11EOWNER LICENSE EXEWTION Plcase Print DATE:. JOB LOCATION: nu mber street village __--'HOMEOWNER": name home phone# work.pbonc# CURRENT MATLTNG ADDRESS: city/towo state rip code The current excmpption 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 SuperY150r. DEFINITION OFEOMEOWN'ER, Persons)who owns a parcel of land on which be/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detacbed structures accessory to such use and/o fame structures.fa structures. A personm who constructs more than one home in a two-year period shall not be considered a hoeowner. Such "horrieowner"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_�e/sbe understands the Town of Barnstable Building Department rrnnirnurn inspection procedures and requirements and that.he/sbe will comply with said procedures and rern rt cements, r Signature of Homeowner t .* Auk rii '1'3Auz i cal. Approval of Building Offiicial ,c[t .€x,s, Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the Stitc Building Code Section 127.0 Construction Control. HOAfEOW'NER'S EXEMPTION . .Thc Code stales that "Any bomeownaperforming work for which a building parmtis required shall be exempt from the provisions of this&cc6 on.(Scction I D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a poson(s)for hire to do such work, that such Homcowna shall act as supervisar." Many homeowners who use this excrrrpdon arc unaware that they arc assurning the responsibDitics of a supervisor(see Appendix Q, Rulcs&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 ease,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisar. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her respannbilitics,many communities enquire,as part of the permit application, . that the hDmcDwna certify that hdsbe understands the respawbilitics of a Supervisor. On the last page of this issue is a,form currently used by several towns. You may care t amrnd and adopt such a forrnkcrtification for List in your community. Y ,a —'` - M;1,Ssachusetts - Department of public :tretY Board of Building Re-ulations and Standards Construction Supervisor License License: cs 6653 Restricted.to: 00 CHARLES G PALTSIOS 183 LONGVIEW DR; CENTERVILLE,MA 02632 Expiration:•9/22/201'1 . Commissioner J Tr#: 2790 e . > I i a - w. r .. " K Y d� a ��.,y..r, .' 'S,w .,,.._.. ,,a �,... ..-. ..�t •'�a'i, .->.».. .:...._ -.•� ., . ..., .,.;4 ., ., we w. . � �".•-,..reF s ...+ "'f`i.�: .:A�. .":'k.#.%!+6:.v. ...,t,... .,, -..... x .,..'�F.. �'M'•. .: e z•,.... 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'c, -:s. x ..f,±....,Y I, tic OWN y } y A. - � 'I•a Yi:. ad'"J i its: •MA .1 '^ .:Ada, U ;P;4?r t t w.1i` i M� `Le ays '�;: a ,�.'x' '-s� � ,# r�' '` -..i� k��`:.•X >st;.� d� �!� �,��:..� �x xe-- •4 J ns p:.°.,� 1, y. ,, •f.fk, 0. i T•al"! r 1 7.^ ,,3 ;+`�•,- .AJ' „�,_: ,r MP r xW M ". •.,-. ,,:,::,, .-. .� :. r with; , i :j - G 'I wZ „ Assessor's map and lot number ......... .............. r ?n�Sewage Permit number /1� ��:'..(/, y/'...:.::r-, Y.....,��rf'c��f � • M Z 11MUSTADLE, i Hou.. number 370 South Street, H;,ranni 9°o VAGt63 ........... .... 0 i D MAI a` TOWN OF BARNSTABLE r ` % BUILDING INSPECTOR Renovate and construct addition to existing home APPLICATION FOR PERMIT TO ..for..use by...20. ..elderly. ..Ders.on s........................................................:.. ..... . .. .... ........... ...... TYPEOF CONSTRUCTION ......... ..................................................................................................................... February 16 ...........19�9... TO THE INSPECTOR OF BUILDINGS: M The undersigned hereby applies for a permit according to the following information: Location ........i�-,E. Come-..Sou..th 9treet,..�aat�.,,P'���.................................................:........:... PropbsedUse ................... ........................ ................................................. .......................... Zoning District ...............................................Fire District ' ......................... I1;usnni;s................... .... ' Name of Owner .................................................�CAddress f,�) )5dX y.5-. l7� j / . ...... ......... ..............................F .................... . .................... Name of Builder ............. ... To Be..Hid. . ...................................Address.. .... .. . .. .................................................................................... Name of Architect Donham Rc Sweeney...................Address .....Tn.F mp, t;r g+ ?�n�tran Number of Rooms 3Q ....................Foundation Poured Concrete ........ ...................................................... Clapboard and. Shinpl .............Roofing Aimmhalt Stria Shinfles Exierior .....................................................::....j............ ..............................................................:............... ' Drywall Partitions To Code FloorsWood...To st...F"lnnr Svg1;P3!....'................Interior .................................................................................... Per Code Heating ...........Ff t....Rv rtA� .........................:Plumbing .................................................................................. Fireplace ......1.:Fadstiri ......................................................Approximate Cost ...........350,000........................... .... Definitive Plan Approved by Planning Board ---------------__ ...-...T•D� --- - - -�9 - ---. Area ...... � / ... .................... Diagram of Lot and Building with Dimensions Fee ` � �............. ............................ SUBJECT TO APPROVAL OF BOARD OF, HEALTH _ r 1 10 0 I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the above construction. Barns�abl Housing Authority Name . r: .....:...... , ;.��-::Q:........................... Leonard S. Jones; Executive Director Barnstable Houa 7 ' ``---vr~- `^-30=-9' d ; No ..�`/ reol7e—1 bome � v= -.--------. -----..�^�^���.--. ^ Location^ ..... ...... .......... ...... ....................---- a � Hyannis � . .`------~--------.-.-...------.. � . . Owner __Barootable........................Aotboritv ` � ~ ` Type of Construction / > . . � rm/ ` . . _ Permit Granted ;�(;!D 9Date of Inspection ` / "~'= ~=^pe'~~ / . ' ^ ' | RMIT REFUSED - � . ' ! / -- -. .......... ! ---� � ' � ^---' -'^-r--~'-'--' . / > \-.--.- --.. --.. "---^��'-^^'--' .f-+-''y^'� ....... .............. ' ^ \ ^ ' rovecl ----------------. 19 ` ..' � _-------..----.--.....--......-.-- | V ' ^ ^ ----.=-----.-----...---~.-.....- . '� •I..I - - _ _ >'_ _ - ':�.yl 'aid 21552 TOWN OF BARNSTABLE _ N• Permit o. r 1 saaisrlm f '' Boding. ZIi8p8atOT Cash 019. , : PER MIT Bond,OCCUPANCYW. � ` No buildindnor strn shall seawtt� ug:o' ll be structure eea orused-for a-newiferentehangedor. enlaged 'u - hou s Building Permit the' first having,•been obtained-from the Building Inspector.'No ;building shall be occupied until a certificate of occupancy ;has been issued ,by the Building Inspector." Issued to BH 1St4'Ale Housing Authority Address Hyamis " South Pig a Streets He is y • Wiring.Inspector 'Yj� !_ s` Inspection date ' Plumbing inspector l �s �r l � Inspection date Cues:lnspe°tor msvection date Etigineering Department o - N/ 1 Inspection date SiPERMIT ;B.;WILL-NOT BE: VALID;, AND THE- UILDI NG SHALL NOT BE OCCUPIED UNTIL dNED :'BY THE $UII.DING} INSPECTOR' UPON .SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ` J 19 r �1 j O. r Building Inspect P TOWN OF BARNSTABLP. Permit No. Building Inspector cash -- 039 i �P YPI Y'`� OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ..................................................-1 19 _ .................................... ... ................... Building Inspector '�Akewbr's map and lot number .......308-97........................ SEPTIC SYSTEM MUST -� INSTALLED IN COMPLI FTNET0�0 Sewage Permit number :/`1°��4"'111lef� . e.� ... . yc°��sc412e e WITH �4RTICLE II STA J. A1�*ITAPY CODE AND PHSTLDLE, House number ........37 South Streets Hyannis nrn r� .n,.� rase .. 0 9 OD 1639. `0 D MAY a. TOWN OF BARNSTABLF BUILDING INSPECTOR Renovate and construct addition to existing home APPLICATION FOR PERMIT TO ,for.,use b�„20„elderly,persons TYPE OF CONSTRUCTION .......... RAME................................................................................................................ ..........FebruarY.J a...........19.7.2... .TO THE.INSPECTOR...OF BUILDINGS;„ The undersigned hereby applies for a permit according to the following information: Location ........N.E.�...Corner...South..$ 'eet..an? ..k .................................................:............ ProposedUse ................... ........................................................................................................... Zoning District .................n...�. ..............................................Fire District .............his.................................................. Name of Owner l......SY§ .....A...!.�......�.......`......................Address fi0 �dx q3�- . �ylc} /�.Y!........................ ........ ............... Tamed ly�.D��� , �Gx s� Mir Name of Builder ............................................... .................Address ........................ ,......... ... .................�........ Name of Architect Dunham..& Sweeney...................Address .....�.Q3..BIMd.Street....33as.tm......................... .............. ..... Number of Rooms ..........3Q...................................................Foundation ........Poured..Ceg2?rrY'� e.................................... Exterior .............Clapboard and $hing�,s........................Roofing ..............Asphalt StriP..Shingles...................,.' ;; Floors Wood Joi t..k' ,QAaC ..Sya.tem....................Interior Dr�wa11 Partitions To Code .... ... .................. ....................................... Heating ...........#'.'I ....By..GAS................ .............Plumbing ....:........Per Code .................................................''Fireplace ..:....... fistg.....................................................Approximate Cost ...........3 .000 Definitive Plan Approved by Planning Board.-------------------_-----------19--------. Area Y-P aP ... ............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH loi<� I hereby agree to conform to all the Rules and Regulations of the Town of'Barnstable regarding the above construction. Aeon ble Housi uthority Name .. 5. Jones, Executive Director Barnstable Housing Authority 71 21652 110 ................. Permit for ...........�. to & I ................. remodel group home ............................................................................... Location .........Sou.th...&..P.i.ne..S.t.ree.t.s............ ........�yc .�nnis ................ ................................................. Owner Barnstable Housing -Authority ............................................................... Type of CQ'nstruction ....................frame ...................... U-1 ................. ............................................................. 11-4 Lot ................................ 'Plot ......... ................ Permit Grd�tecl ......Spptember' .1, '�i`19 '-79 n _7....... vo 4 .......19 Date of Inioection ............................ Date Completed .......................... ........19 C, PERMIT REFUSEDF ........................................ .... 19 A, ............. ...... ..................................................... ........ ............... .................................................... ........................ 0 ...................................................... .......................... 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