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0107 SEAGATE LANE
le- y Town of Barnstabledift - 7 . F� ry ." .., �..; r,. , ,, : <-, .; '� ., •, A roved Plans Must be Retained ort yob and thi�C��rd Must" a Kelfit �.Cacd�So„T<hat„� :�s.V�sibl Frio, the,$tr:�� .. „Post This ., m, z F �: r;� :: r tiA�EitBTABLL ,� p .;;r.,ry. �" . ,,.� � een,:Made. Until-Final ins ection..Has B�....,. ,. . Posted., r p ,. . .ems. ,.,. m ,r.. er ml� .: .. ;: z: f cc anc asfred such Bu�ldin ,shall Not be Occupie, unt> a .mi Inspect,onr;has ,:��, Permit NO'• B-17-783 Applicant Name: ARCEBUCHE, ROSALINDA&VINCENT C R Approvals Date Issued: 04/26/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 10/26/2017 Foundation: Location: 107 SEAGATE LANE, HYANNIS Map/Lot: 249-150 Zoning District: RB Sheathing: Owner on Record: ARCEBUCHE, ROSALINDA&VINCENT C R y r £ 5 Contractor Name,: Framing: 1 Contractor Dense 2 .Address: 107 SEAGATE LANE � mk y Est Pro ect Cost: $50,000.00 HYANNIS, MA 02601 1 Chimney: Description: adding 3 bathrooms,move kitchen into exist,g garage,turn existing Pe mit,e: $305.00 1v Insulation: kitchen into dining room.Add a wrap around heck toll master ���Fee�Paid $305.00 bedroom and living room. Moving another be on top of garge. Final: r Date ,. ` 4/26/2017 Project Review Re adding3 bathrooms,move kitchen mto.existmggarage;to nrnr r fr � J 4 . ' r�—` Plumbing/Gas /Gas existing kitchen into dining room Add a�wrap around'deck to,to � � � � , ,r g master bedroom and living room Movinganother bedrooms Rough Plumbing: top of Barge. ," _ ._ _, Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bythrs permit is commenced within s,xmonths after=issuance. p Rough Gas: construction documents,for which the permit has been granted. All work authorized by this permit shall conform to the approved application and the,approved co All construction,alterations and changes of use of any building and structures shall be in with the local zon ng by la�wsad codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road land shall be maintained open for public rasp ,on for the entire duration of the wo.Zk until the completion of the same. �, Electrical fih2 Certificate of Occupancy will not be issued until all applicable signatures by;the B ,Idng arid,F,re Off,c,als are provided on tFIs,permit. Service: . Minimum of Five Call Inspections Required for All Construction Work Is 1.Foundation or Footing Rough: 2.Sheathing Inspection 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 S.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; .. , .. "Persons contracting with unregistered:contractors.do-nct_have access to,the guaranty.fund"{as:set .orth in_MGL c:142A):,. merit re Fi Depart Building plans are to,be available on site Final: All Permit-Cards are the,property of the APPLICANT=ISSUED RECIPIENT $a &n,HA.02M -tp Wurke s° Cumpem—►I ceAffdxvi -Rwlde�bRft- ,�F�i* ns hers 1 p'fr�#I�ar nea aprlid - AddFms: /0"' 5t7A- 6A0 C,47,5= yJ �r5 02�)© 1 Ph `i (cl 46( ) Eire po-ir=enTIuperZ CReeT€•ffic appraprlafe:ba= L<❑I am a emplo�v� 4- ❑Z as m a�i ca�c=-mcf 1 6- NEW feet€r r.� erx�'Icsgee�(fs��foegar�fim��* Sr�e.lsffec€fhe su�� 6� ❑N'�causir�cfius� 2.Q Iam a sale l}zazparfaer- fished�flxe af#acfi�d ghe�� '�= �-�o _ &bip and have;Asa empl These sdb-c=ftacf=have g �F emanFdia� a f meiQa>�YMfg_ ° andhmvawajimrs' ' jP�"4 `�.sncsxxnra _ - GQfII1J_4+•+errr�rsrr$ 9• QBusfdmgffrT.rrTf;na ❑ �areaco>parafioaam# s 1 �(Eleirepaiara3s 3.PrIam.abates d6ir aIf as3 ai5hmhav>; ressed 1L�Phm?bmgs sail araacEaams of cr MGLzeg wg-Aayem END wad=& i Q'otiier I 4�]C SII �.rr 2CQ '� QSg miffEnIfFEal'Rr SUCSL , rCam�rsmst d�CYi3as B¢s mast zffid%A ffi sdrIj6nO34 shPlt sb gtisra of lbe sxr-c�.=ul ait-a -heda mmatQis sh=.M • e�lo�mes 7fS��,1u�.+,A,+s,.��� tbe��,,,�,�r��,t..g�a Qa�'tmn�•PaFe�m�br� Iam itte zfiigla,�sr tl�isprl��urkers}caar,��rrsm`i�rt i�.rnrar�ca fpr st�eacFfa��e.>;. $etatvisi�capir&cy�d fvli,sz� - Ta�E�GornpaFiyi`'�asae: JobTifmA.ddrel= d2lg: Mfa6a copy aforevvarkrs'ebsrlp==9=poEcydecFaiafimpago-(sh imgOlepafiey mm�fBerandexp -ation,dafe). Fad fa se�vser caeeLage as r�nisedumder 5ezfrog 2].fi cs€MCA c.]�'cali`f�d fn fF�impas�sc of cti>�tmai penalties of a . frsFe lip b$L SOO:-00 amdfar as w�U as dvR ra$sm farm of a SIM WORK CO?DEI?Lzmd a rmia of Dp to$?59m a(kF Be adYiscd f d m copy afthi%zhd=Enf=ybm fmwarded td five OXna e lmves Saf$aI33A:&- cagempterEm6n„ .f�a�er-abp�ra/� an�'�ah'i�r r�Fer�fu�r f&atfi�rs u��t�a€i�ugrm�d,�d rrb�org.i�true arr�d arrr�ct t} a� .Y� Inc uat eerie At fids=el,fa be.cazrp kd by city artalm draal G ood): L Iiaa-rd of$ fi I Rmffirmg D,�lament S.Eftylrawa O=k 4-F wftia � 5 Pkmb%ng T>a=lbar 6.mar Cfll>t ctPersam M. ma-9: �,■■1■ ■'wR 1• /1 ■' ■- •'9f■1wR w■11/n rr Y_■■•n t•1 i• ■ wnn ■ ■.n.- .■SEMI i. -1 r U ■l■ ►J: -n■L wu_ -.■rr. ... _ .n■n.. n1•� al w■nnr. .� r wR■n a i■- ■ •n y■I:i■1 ■r n•Y nn• y■ ur- n •9n11-r■ .n n•■ uuc •rnn►R lm■ .L`l•wrn u■ .0 ■r _r■m n ■i\: -_r- r■J:•i• rr ■nt wil■i� ■1.1 .It/ tr l - _ � .i• i■ ■■- a•1 - •n■■• ■• won• ••is • • - � i3rl/t wnn AWL, - ■ :n ■■■■ ■tl. ■_It1/rR nl■ -L\.■lJFn•]r ■1 •■1 w -1 a •w • ■ ■ •�- !mc\n . it Im• ■■■ r.•n: ■■ n n it_n n\ � .0 ann�uR a■■ '�■r .�■■ i\:, .In ■'•■• n1 u ■ ■.. 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Concrete-Masonry..............................................„._................_............................_........._._�.... 22 ANCHORAGE.TO FOUNDATiON''a , 5/8"Anchor Bolls imbedded or 5/8'Proprietary Mechanical Anchors as an affematfve in concrete only Bolt Spacing-general..........................................(Table 4)....._..„.._.................. :, in. Bolt Spacing from•endrjoint of plate ....... (Fig _._ ._... in.5 6'-12" Bolt Embedment-concsete.�..__..._.._._.._._..___.._...(Fig 5).:..:....__._... m.>_7' Bolt Embedment-masonry._._....... ._..._.�. __.(Fig 5).-.--__,._..--. .._.-.-.... in.;--1�5/'- Plata Washer. _._.._.„....._.....__::..:_._._......._._ (Fig5)_._.._......... ._....__._.._.._ >3'x 3'x/{' 3.1 FLOORS Floor framfng member spans checked . _._-__:_...„_.......:(per 780 CMR Chapter 55)..__........................_..r Maximum Floor Opening Dimension_._._._._.,_._._..._.........(Flg 6).--_._...:....-._,._.,•_,_•ft!;12'or L/2 or W/2 Full Height Wall Studs at Floor.Dpenings less than 2'fmm Exterior Wall Fig 6).................................. Maximum F9oorJoist Setbacks Supporting Loadbearing Walls or Shearwall....._....... (Fg 7)-__--__-.- ..: -................... ft s d Mabmum Cantilevered Floor Joists — Supporting Loadbearing Walls or Shearwall..............(Fig 8)....................... ft 5 d Floor Bracing at Endwalls.........................__ ...........-_.(Fig 9),__...._.. .__ ___. _....:............._ :_._., Floor Sheathing Type ....._.........................._................ per 780 CMR Chapter 55}.:_.._._..._.._.�_:...._ Floor Sheathing Thickness......._........_...------.,._r._..__...(per 780 CMR Chapter 55):-_--...._...._.__ in. Floor Sheathing Fastenin able 2)-__.d nails at in edge/—in field 4.1 WALLS Wall Height Loadbearingwalls.....__.._,._.._..__... .............:_..(Flg 10 and Tabfe•5)........_...._.._,._..._ft Non-Laadbearing walls_. ._. ._..................._ .(Fig 10 and Table 5). ._........_.._-...... _ft 5 20' Wall Stud Spadng ....._».._.... _»_.. .. '.(Fig 10 and Table 5). _._......_... in.s 24"o.o. Wall Story Offsets .:.__. ...... ............_„._. _.(Figs 7&8)............_....-.......... ft S d 42 EXTERIOR WALLS; Wood Studs Loadbea n*g walls_._._...._............_.._„....._.._.._ .(Tahle5).._.............._.......2c— —ft_in. able 5 __ 'Non-Laadbearingwafts...._._._.._.._......_„.........._.. (T ),-.... ._...„._...__..2x ft—in. Gable End Wall Bracing — Full Heigh Endwall Studs. __...__ _..__......_ _ (Fig 10)....... ..............__. . . WSPAttic Floor Length......._...r_..„--_..._.,___-......r..._.,(Fig 11)._..........._._._...._...._.._ ft>W/3 Gypsum Gelling Length(if WSP not used).....-__.,._.„(F{g 11)..__.._.. „....... .___..__ ft z 0,9W -.2 x4 Conffrruous Lateral Brace @ 6 fL o.a-.(Fig 11)........._:............. _.... — Double Top Plate Splice Length .................__.. .__._._.__. ... ,(Fig 13 and•Tabfe 6)_.---......... _.._. ft _ Splice Connection(no.of 16d common nails). ..._. •(Table AWC Guide fa Woad Comfruc6gn in H gift Wrr-nd Areas.110 W19 Wind Zatte Massachusetts Checklist for Compliance(78o'cm s3oi.2.1.1)1 Loadbearing Wall Connectons Lateral(no.of endnafied 16d common nails).__._.. {Table 7)_ _.___._.__».._._...__...-.».•-_ — Non-Loadbearing Wall Connections Lateral(no.ofendnaffed 15d common rrals). __.._(Table — Load Bearing Wall Openings(record largest opening but check aN openings for compliance to Table 9) Header Spans _-..—.--- -......-._.._.._.__.._.(Table 9)._.__.,.. ._........... _ft_in.s Sill Plate Spans — 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) Header Spans.:_.._.. .�._......._. __ _, _ .(Table it_fn.512' — Sli Plate Spans. _ __ .(Table 9)_......_.._._. .......--•.• _ft_in.s 12' — Full Height Studs(6o.of studs). �.. �~_-- _.(fable 9)_._...._ .........._.._._._.._.-- •_ — Exfedor Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Openinga r..__..._ »............... _... 5 6'Er — Sheathing Type........._.___.._._._...-.... --...(note 4).... ...._ . ---..... _...._..... — Edge Nag Spacing-- _ _ .(fable 10 or note 4 if less) �... in. �. -. Feld Nall .._..:...._..__..(Table 10)...... Shear Connection(no.Hof 16d common nails)(Table — Percent FulkHeight Sheathing..-- .(Table 10)___:..-..-...__.._ - 5%Additional Sheathing for Wall with Opening>6'8'(Design — Maximum Building Dimension,L Nominal Height of Tallest OpeningZ.__......_............................_............................. — Sheathing Type.___ ._...... ..__..__.— (note 4)—__... ...._. . .... .._..... __.... — Edge Nail Spacing.............___..».___.___.......(Table 11 or note 41f less)..... in. — Field Nal (rablell). ._...... _.._..__..-- ___..._... in. _ Shear Conne4on(no.of 16d common nails)(fable 11)..__._ _.-. ------ .........- ' Percent Full-Height Sheathing._._....._». ....(Table 11)..._-_._..;......_...............__..___-°/a — 5%Additional Sheathing for Wall with Opening>611'(Design Concepts).._...... _... Wall Cladding Ratedfor Wind Speed?....._.__.___._..._..__._ .... _. ......_._ _..._.. _ __._. __... 5.1 ROOFS Roof framing member spans checked?.-.__._..... _ _.(For Rafters use AWC Span Tool,sea BBRS Webslfe) — Roaf Overhang ..............................»............. (Figura 19)......... ft.-9 smaller of 2'or 1_ 3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connecters Uplift..__..»._..._.........._........__.._.(fable 12)...................._._-..._._._.._U Of Lateral..___.. .......... _.___......_..(Table 12)._._.__. _._.. _...._.. ...L= plf — Shear...._ _.(Table 12)_ ... ___....._. __..5____plf _ Ridge Strap Connections,If cellar ties not used per page 21..._.(Table 13)T....__..__...._...._.T= plf _ Gable•Rake Outiooker................................... (Figure 20).........._ _ft9smallerof 2'orL/2 _ Truss or Rafter Connections at Non-Laadbearing Walls Proprietary Connectors . Uplift_._.. ...:__.__.._.^ .__. .._(Table..14).......�...__. ........................U=_ib. — Lateral(no.of 16d common nails)_. Table 14)..... ...........__....:__---+ L.' _Ib. — Roof Sheathing Type._._`.... ....» .__............._.....(per 760 CMR Chapters 58 and 59}:.................' — Roof Sheathing Thickness_................._.. ...__..... f _......r.._._.. ..,..__.__... _in.a 7i16'WSP Roof Sheathing Fastening _....._ ............___.___. ((ab(e 2)..._..._,...... ... �.._....._»,.�. Notes: 1. This checklist must be met in ifs entirety,excluding the specific exception noted in 2,to comply.with the requirements of T80 CMR 53012-1.1 Item 1.if the checklist Is met in its enfir*then the folowing 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 1T e. Comei Stud Hold Downs per Figure 1 aa.. 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#trade. fiF rC Gr�ide fQ Ff`a GarrsrS-uctiort ttr I SFr j�uz�,r{-azrs 119��� f3�cAd ugz - Ylagmchusets Chadiist for Cora-p-Hmce ma cr��sunt-2Lis)I a From Tables IDandIfandToczdkcafw2dWeaffnngandB: TmgAlpadWm,dek- mFerrerFuff-Height . SI°rm:ffdhg and NA Spacing mquhmwfm h. lucid Sfrvdrn-A PME-TS droll ba n**=fMcImess of711['•r,and be bss-- led as fallow L . Panels shall be hmtaBed r sf1�cl7g�7 a�patalid fa CSTFf 3C b M hmrfmrrfal jninfs shall omit aver and brr r-oBad fn flaming RL Dn single sbiiy rsrrrsirucfianr panes shall Lsa atiadied In bafinm pbks and Inp:mer b of fhe double n, Mr)Eon> fnry 4m►sari.tr - -alLbe�died is$rE<#op rrretnberr3f$�euppr� double:in PF�P�Rr`� R-- - phL-and to band joist at baf nm of panmLUppei-affadmrotrif iDwer paw shag be rnade In fraud joM and IDwerafiadm7erft rnacb iD Tawas t pf3im ai:f rmt fiborfmrbq. v: Hor¢nrdal nark sparing of drnHe iDP pfas band 1o'rsls,and grrdas sha11 be a double row of ' sfaggc-fed�E3 ladies an cet�-pe�Frgw-rs be3'o�.Ue��and Hrn-imrFbl hlas g fcXPane!�r�rmc�rt, 5-' Glaring pwber- t a)tred house orb nbladdTian- Fprnjerfis I m9e Drdas�'fn share(genw4Y.soMi of • - � b)�l adt�an-nat r�ulrzd unless fh>���t�ve rer>a�an fn f3�e first•fforar c)r,!pTa=mer6vMcIDvm-rinds energy mnswr bn mmpM3n=only(crap 93) - rL WDDrf Frans a Carrsflvdion Mmrf sal CNFC I for 110 MPH,F cposLu-a B may be obtained frnm'the Arrimi�n WDDd C-Duumj (ABC) !• . _ WA--- LE u - - - - u • tl [I � - [- t Qo 1 � [I I1 • t -: � i it IL c r r Lr i I {F Lo it c 1S1 r 1 _ -a. L tI- _ [ [ I rr — r [ r 1 1 i {c IL� •r y s 1 E • W ii LI qq L - • . 1[ it Fl L 1 r LI sla' u rr g L r i F _ L L [ L L L L ri 1 n r r , 4 —r'IdF3_ 4� - !r fit— DefaU17CrrRa� s?�xr�S?ACztS3S - - • .- SEA T�Hfs��n���.� - _ V-Mrscsl and Hozimrrtal fdanrg 4fa aI �f rrl I h[ailisx� - far Panel Afiad� Town of Barnstable Regulatory Services Richard V.Sca14 Director. Bwildi g Division. Paul Roma,Building Commissioner , 200 Main Street,Hyannis,MA 02601 www.town.barnsiable.ma.us Office, 508-862-4038 Fax: 598-790-6230 Property Owner Must Complete and Sign This Section = If Using A Builder as Owner of the subject ptoperty hereby-auth.otize to act on my behal� in all taatters telat ive to work authorized by this building permit application for: j4(/-ffl7ij5 V14)�--- a145 e l (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools ate not to be.filled or utilized before fence is installed And all final inspect't are performed and accepted. Signatrste of Ownez Signature of Applicant V I nC�1nT1'�-(�•9�UT Print N=ae Print Name Date I QYORNS:OWNMERMISSIONPOOT S 1 V Y1 u Vx "ILL1 A.JLP viv Regulatory Services �ttta Richard V.ScaH, Director Building Division t PauI Roma,Building Commissioner 1�q 200 Main Sheet, Hyannis,MA 02601 16 ►M� www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 HOMEOWN RLICE1riSEE1 EMMON / Plmse Print DATE• Jos I.ocATlox: /Lj ntmmber• shut village �iOMFOWNER name home phone# work phone# CURRENT IdAILINCIADDRESS' /O 7 5c'J4 C i3T� !.� � • �/�It�rtv�`f �at� OZ 6ca dty/ypV;M state up coda The cuaent exemption for"homeowners"was extended to include owner-occuuied dwellings of six units or less and to allow homeowners to engage an individual for hire who dyes not possess a license,provided that the owner acts as supervisor. ,' . DEFT MoN OF HOMEOWNER Persons)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 Off he Building Official,that he/she shall be cial on a form acceptable to t responsible for all such work pmbffied under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsib�7ity 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 minimmn inspection procedures and requirements and that he/she will comply with said procedures and ' requir me • Signatnro nfHomeowner Approval of Building Official Note: Tbree-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 17-7:0 Construction Contol. HOMEOWNER'S EXEMTZON 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 nse this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. on the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/cerfification for use in your community.. �v�s~r iNilL i�jC `UCf 0 er •�f be iG w� w eP 6�, fl fry fz/ S ✓r'r�'e / �o""`i'. y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION D Map 2 4 01 Parcel � � Application # s Health Division Date Issued !2.72 Conservation Division ' `7 9: 9 '+ Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �` �„.'- Historic -'OKH Preservation/ Hyannis Project Street Address 5t+t AM C.KW Village Owner V I V"CEW'V_ Pt2 ►S UW� Address (CUB Telephone n0 - �2� - `E2�1 / l t l'^ y,7 i Permit Request tfipVS�1F- 2=__3l6vATcg-h 6 7 IWA/~,/ ; ^,IC !`t y FYiis nn� 6/n e' 4 /✓vim cx,�WP�f �-(l<<" /1-` 7" n;l v, Yva OrsT's)o� Square feet: 1st floor: existing 2_proposed�- �2nd floor: existing_proposed 3�- Total new t�1Z- Zoning District Flood Plain Groundwater Overlay Project Valuatioo v°® Construction Type Lot Size ,1-3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family - - Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes -EMo On Old King's Highway: ❑Yes ET'No Basement Type: .0'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing D new Number of Bedrooms: existinWnew Total Room Count (not including baths): existing new First Floor Room Count J Heat Type and Fuel: was ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes _9-No Fireplaces: Existing New Existing wood/coal stove: ❑Yes-.@-No Detached garage:41 ix sting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:.0 existing ❑ new size —Shed;,aexisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes -E�No If yes, site plan review# Current Use �a�� Proposed Use fAY1110 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name OiffYlt A` Z-13VA Telephone Number t �' el Address 1b3 StW,ME- Y)VIf License# ( Home Improvement Contractor# Email �'�tK y►YlCfW- %Q� Y CK?'O� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -Zz r� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. - ADDRESS VILLAGE i a ` OWNER I` DATE OF INSPECTION: FOUNDATION FRAME INSULATION 1 lq 17 c FIREPLACE ELECTRICAL: ROUGH FINAL -PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,o, + DATE CLOSED OUT I ASSOCIATION PLAN NO. 9 F O R Y E° 70B SUMMARY REPORT f 0 � S � �ts� 1-- tj , fat 7obAte 61:Second Floor Member Name Results Current Solution Comments. Second Floor:Flush Beam A Passed 2 Piece(s)1 3/4"x 11 7/8"2.0E Microllam@ LVL Second Floor:Flush Beam B Passed 3 Piece(s)1 3/4"x 11 7/8"2.0E Microllam@ LVL Second Floor:Flush Beam C Passed 2 Piece(s)1 3/4"x 7 1/4"2.0E Microllam@ LVL Second Floor:Joist above Garage Passed 1 Piece(s)2 x 8 Spruce-Pirfe-Fir No.1/No.2 @ 16"OC `-7 r) 133 CP 10 Forte Software Operator Job Notes 4/3/2017 9:52:47 AM Brandon Sect Vince Forte v5.1,Design Engine:V6.5.1.1 Mid Cape Home Centers Hyannis,MA Job.4fe (508)760-4479 bsecl@midcape.net Page 1 of 5 ® MEMBER REPORT • Second Floor, Second Floor:Flush Beam A PASSED O R 2 piece(s) 1 3/4" x it 7/8" 2.0E Microllam® LVL Overall Length:11 7 0 a 0 1100 0 All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontaL;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF Load:Combination(Pattern) System:Floor Member Reaction(Ibs) 2816 @ 0 2 0 5709(2.25") Passed(49%) -- 1.0 D+1.0 L(All Spans) Member Type:Flush Beam Shear(Ibs) 2233 @ 13 6 7897 Passed(28%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) 7833 @ 5 9 8 17848 Passed(44%) 1.00 1.0 D+1.0 L(All Spans) Building Code:IBC 2015 Live Load Defl.(in) 0.1420598 0.375 Passed(L/948) 1.0 D+1.0 L(All Spans) Design Methodology:ASD Total Load Defl.(in) 0.204 @ 5 9 8 1 0.563 Passed(1-/661) 1.0 D+1.0 L(All Spans) Deflection criteria:LL(L/360)and TL(L/240). Bracing(Lu):All compression edges(top and bottom)must be braced at 11 4 8 o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Bearing Loads to Supports(Ibs) Supports Total Available Required Dead Floor Total Accessories Live 1-Column-SPF 3.50" 2.25" 1.50" 868 1998 2866 1 1/4"Rim Board 2-Column-SPF 3.50" 2.25" 1.50" 868 1998 2866 1 1/4"Rim Board •Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Tributary Dead Floor Live Loads Location(Side) Width (0.90) (1.00) Comments 0-Self Weight(PLF) 0 14 to 115 12 N/A 12.1 1-Uniform(PSF) 0 0 0 to 11 7 0 1160 12.0 30.0 Bedroom Loading Ta 12d 30L Weyerhaeuser Notes aZ�SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards. For current code evaluation reports refer to http://www.woodbywy.com/services/s_CodeReports.aspx. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator .Job Notes 4/3/2017 9:52:47 AM Brandon Sed Vince Forte v5.1,Design Engine:V6.5.1.1 Nlid Cape Home Centers Hyannis.NIA. Job.4te (508)760-4479 bsecl@midcape.net .Page 2 of 5 I " MEMBER REPORT • Second Floor, Second Floor:Flush Beam B ' PASSED O R 3 piece(s) 1 3/4" x it 7/8" 2.0E Microllam® LVL Overall Length: 15 7 0 0 0 1500 0 0 All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal.;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF Load:Combination(Pattern) A System:Floor Member Reaction(Ibs) 4737 @ 0 2 0 8564(2.25") Passed(55%) 1.0 D+1.0 L(All Spans) Member Type:Flush Beam Shear(Ibs) 4012 @ 13 6 11845 Passed(34%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) 17913 @ 7 9 8 26772 Passed(67%) 1.00 1.0 D+1.0 L(All Spans) Building Code:IBC 2015 Live Load Defl.(in) 0.407 @ 7 9 8 0.508 Passed(L/450) 1.0 D+1.0 L(All Spans) Design Methodology:ASO Total Load Defl.(in) 0,545 @ 7 9 8 0.762 Passed(L/336) 1.0 D+1.0 L(All Spans) Deflection criteria:LL(L/360)and TL(L/240). Bracing(Lu):All compression edges(top and bottom)must be braced at 15 4 8 o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Bearing Loads to Supports(Ibs) Supports Total Available Required Dead Floor Total Accessories Live 1-Column-SPF 3.50" 2.25" 1.50" 1215 3584 4799 1 1/4"Rim Board 2-Column-SPF 3.50" 2.25" 1.50" 1215 3584 4799 1 1/4"Rim Board •Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Tributary Dead Floor Live Loads Location(Side) Width (0.90) (1.00) Comments 0-Self Weight(PLF) 0 14 to 15 5 12 N/A 18.2 1-Uniform(PSF) 0 0 0 too15 7 0 1160 12.0 40.0 Living Area 12d/40L Weyerhaeuser Notes SUSTAINABLE FORESTRY INInATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards. For current code evaluation reports refer to http://www.woodbywy.com/services/s_CodeReports.aspx. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator Job Notes 4/3/2017 9:52:47 AM Brandon Secl Vince Forte v5.1,Design Engine:V6.5.1.1 Mid Cape Home Centers Hyannis,MA JobAte (508)760-4479 bsecf@midcape.ne[ Page 3 of 5 G3 CC® MEMBER REPORT • Second Floor, Second Floor:Flush Beam C ' PASSED-2 piece(s) 1 3/4" x 7 1/4" 2.0E Microllam® LVL Overall Length:19 10 8 0 0 1100 800 All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal.;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF Load:Combination(Pattemy, System:Floor Member Reaction(Ibs) 4088 @ 115 4 8881(3.50") Passed(46%) -- 1.0 D+1.0 L(All Spans) Member Type:Flush Beam Shear(Ibs) 1977 @ 10 8 4 4821 Passed(41%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) -4196 @ 115 4 7115 Passed(59%) 1.00 1.0 D+1.0 L(All Spans) Building Code:IBC 2015 Live Load Defl.(in) 0.189 @ 5 5 5 0.376 Passed(L/715) 1.0 D+1.0 L(Alt Spans) Design Methodology:ASD Total Load Defl.(in) 0.341 @ 5 4 0 0.564 Passed(L/397) 1.0 D+1.0 L(Alt Spans) • Deflection criteria:LL(L/360)and TL(L/240). Bracing(Lu):All compression edges(top and bottom)must be braced at 19 8 0 o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. Bearing Loads to Supports(Ibs) Supports Total I Available Required Dead Floor Total Accessories Live 1-Column-SPF 3.50" 2.25" 1.50" 762 823/-36 1585/-36 1 1/4"Rim Board 2-Column-SPF 3.50" 3.50" 1.61" 2034 2054 4088 None 3-Column-SPF 3.50" 2.25" 1.50" 450 638/-166 1088/-166 1 1/4"Rim Board •Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Tributary Dead Floor Live Loads Location(Side) Width (0.90) (1.00) Comments 0-Self Weight(PLF) 0 14 to 19 9 4 N/A 7.4 1-Uniform(PSF) 0 0 0 to 19 10 8 5 60 12.0 30.0 Bedroom Loading 0 12d 30L 2-Uniform(PLF) 0 0 0 to 19 108 N/A 90.0 Gable Wall Loading 0 90d PLF //�� Weyerhaeuser Dotes - _ (IS)SUSTAINABLE FORESTRY INITIATIVE �l t' Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards. For current code evaluation reports refer to http://www.woodbywy.com/services/s_CodeReports.aspx. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator Job Notes 4/3/2017 9:52:47 AM Brandon Sect Vince Forte v5.1,Design Engine:V6.5.1.1 Mid Cape Home Centers Hyannis,MA Job.4te (508)760-4479 bsecl@midcape.net Page 4 of 5 ��0 R T E® MEMBER REPORT ' Second Floor, Second Floor:Joist above Garage PASSED ' 1 piece(s) 2 x 8 Spruce-Pine-Fir No. 1 / No. 2 @ 16" OC Overall Length: 12 0 0 0 0 1200 0 0 All locations are measured from the outside face of left support(or left cantilever end).AII dimensions are horizontal.;Drawing is Conceptual Design Results Actual @ Location Allowed Result LDF Load:Combination(Pattern)• System:Floor Member Reaction(Ibs) 330 @ 0 2 8 1434(2.25") Passed(23%) 1.0 D+1.0 L(All Spans) Member Type:Joist Shear(Ibs) 286 @ 0 10 12 979 Passed(29%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-Ibs) 939 @ 6 0 0 1322 Passed(71%) 1.00 1.0 D+1.0 L(All Spans) Building Code:IBC 2015 Live Load Defl.(in) 0.243 @ 6 0 0 0.386 Passed(L/572) 1.0 D+1.0 L(All Spans) Design Methodology:ASO Total Load Defl.(in) 0.340 @ 6 0 0 1 0.579 Passed(L/409) 1.0 D+1.0 L(All Spans) TJ-Pro'"Rating N/A N/A Deflection criteria:LL(L/360)and TL(L/240). Bracing(Lu):All compression edges(top and bottom)must be braced at 8 113 o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing is required to achieve member stability. A 15%increase in the moment capacity has been added to account for repetitive member usage. Applicable calculations are based on NDS. No composite action between deck and joist was considered in analysis. Bearing Loads to Supports(Ibs) Supports Total Available Required Dead Floor Total Accessories Live 1-Stud wall-SPF 3.50" 2.25" 1.50" 96 240 336 1 1/4"Rim Board 2-Stud wall-SPF 3.50" 2.25" 1.50" 96 240 336 1 1/4"Rim Board •Rim Board is assumed to carry all loads applied directly above it,bypassing the member being designed. f Dead Floor Live Loads Location(Side) Spacing (0.90) (1.00) Comments 1-Uniform(PSF) 0 0 0 to 1200 16" 12.0 30.0 Bedroom Loading Weyerhaeuser Notes SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards. For current code evaluation reports refer to http://www.woodbywy.cam/services/s_CodeReports.aspx. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator ,lob Notes 4/3/2017 9:52:47 AM Brandon Secl Vince Forte v5.1,Design Engine:V6.5.1.1 Mid Cape Home Centers Hvannis:iMA, JobAte (508)760-4479 bsecl@midcape.net Page 5 of 5 CAPE COD INSULATION i 0: I-OEASS SEAMLESS SPRAT FOAM 9YSPENOEO I� r'- •.. ..i RAT 1-800-R6956-�6611 S Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation Inc. performed p p ormed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village A-sa I,;)de,,., Arce hucke �o� L .e. �►n, u Iu-el ens 6�-U Z Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors O Walls Sincerely He E Ca sidy r, President Ca e Cod sulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel A lication # 0 .1 v 7 Health Division Date Issued Conservation Division Application Fee Planning Dept._ � °' ` ; _? Permit Fee Date Definitive Plan Approved by Planning Board _ Historic OKH _ Preservation/Hyannis Project StreetAddress 0 / Village 164wto, Owner ,az? JJ 4? Address Telephone_j _A0 4L ,� 71 Permit Request f -3� /,f112 f� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 3000" Two Family ❑ Multi-Family(# units) �� I Age of Existing Structure Historic House: ❑Yes G�'I�loI On Old King's Highway: ❑Yes la o 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 eA 10 Z Telephone Number c52 3' 7 /Z fCyl- Address 00 c � az.)Idl V W License # /c3 3 �-01 Home Improvement Contractor# T Worker's Compensation # M ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G� I SIGNATURE _DATE����� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 1}� 3[�, i MAP/PARCEL NO. :7 J • ADDRESS_ VILLAGE i { OWNER _ w. v DATE OF INSPECTION: (_FOUNDATION FRAME INSULATION:' = FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL r -,FINALBUILDJNG''=• k+ • ;> DATE CLOSED OUT _. ASSOCIATION PLAN NO. t 10 Park Plaza - SO e577 A Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation 3' Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC ( , HENRY CASSIDY I, 455 YARMOUTH RD. ' - } C F ......... F HYANNIS, MA 02601 ,Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CAI 0 50M-04/04-G101216 Office o`�`�''mer Affairs Bus ne Regul Lion License or registration valid for i❑dividu!use en!y HOMR�' ' H�1A> ° before the expiration date. If found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 D INSULATIO:NINC 90- HENRY CASSIDY '— x 455 YARMOUTH RD•: g � P - HYANNIS,MA 0260.i1 Undersecretary t alid ith t si ture V_ MAss;tchusetts-Department of Public Safer% Board of Buildin- Regulations and Standards . Construction Supervisor License License: CS 100988 HENRY CASSIDY 8 SHED ROW' , • . WE&7.YrARMOUTH,--MA 02673 J' c— �''� Expiration: 11/11/2013 ('unm,isiFFuer Tr#: 7620 I Date: 4/19/20?12 Time: 10:13 AM Tot Cape Cod Insulation, Inc @ 1508-778-5735 Rogers Gray Ins. Page, 002 I + Client#:4597 CCINSUL ACORD. CERTIFICATE OF LIABILITY INSURANCE D4E(MMID 2YYYI 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:Ifthe certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WANED,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 NAMEA Margaret Young Rogers 8 Gray Ins.-So.Dennis PHONE 508-760-4602 A"C. 28A/C No Ext: 508 434 Route 134 ADDRESS: youngma@rogersgray.com P.0.BOX 1601 PRODUCER CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:Peerless Insurance 18333 Cape Cod Insulation Inc INSURER B:Ohio Casualty Insurance Company 455 Yarmouth Road Hyannis,MA 02601 INSURER c:Atlantic Charter Insurance INSURER D:Commerce Insurance Company 34754 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:" REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N R TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP POLICY NUMBER MM/DDIYYYYI (MMIDDIYYYYI LIMITS A GENERAL LIABILITY CBP8263063 04/01/2011 04/01/2012 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY DAMA E T RENTED PREMISES Ea occurrence $100,000 ' CLAIMS-MADE I X1 OCCUR MED EXP(Any one person) $5,000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.-COMP/OP AGG $2,000,000 POLICY PRO- LOG $ D AUTOMOBILE LIABILITY 11MMBCKVMK 04/01/2011 04101/2012 COMBINEDSING LE LIMIT ANY AUTO (Ea accident) . $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accdent) $ X MIRED AUTOS PROPERTY DAMAGE ° (Per accident) $ X-NON-OWNED AUTOS _ $ B UMBRELLAS X OCCUR 0001254514645 04/01/2011 04/01/201 EACH OCCURRENCE $1 OOO OOO EXCESS LIAB CLAIMS-MADE - AGGREGATE $1 000,000 DEDUCTIBLE X RETENTION 10000 $ `+ WORKERS COMPENSATION WCA00525902 06/30/2011 06/30/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUT OFFICER/MEMBER EXCLl1DED? IVE NIA E.L.EACH ACCIDENT $500,000 (Mandatory in NHj If yes,describe under E.L.DISEASE-EA EMPLOYEE 1500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S80552/M68179 MEE The Commonwealth of Massachusetts x Department of Industrial Accidents w Office of Investigations 600 Washington Street F „a Boston, MA 02111 www.mass.gov/dia Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Ca P e C n C& , Address: ,� City/State/Zip: Xa 12 0 (S_ 41A © 6 C % Phone#: O0" '27 5 ' L,Z Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4 ❑ I am a general contractor and I have 6. ❑ New construction employees(full and/or part-time).* hired the sub-contractors listed on 7• ❑ Remodeling the attached sheet.$ 2. 1 am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition and have no employees working for employees and have workers'comp. 9. ❑ Building addition me in any capacity. [No workers' insurance.$ 10. ❑ Electrical repairs or additions comp insurance required.] 5.❑, We are a corporation and its officers have exercised their right of 11. ❑ Plumbing repairs of additions 3. ❑ I am a homeowner doing all work exemption per MGL c. 152§(4),and 12. Roof repairs myself. [No workers' comp, we have no employees.[No workers' 13. Other a"erg ZGIO insurance required.] t comp.insurance required.] ,`Any applicant that checks box#1 must also fill out the'section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attach 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: Af1a1,4aC_k r-�e r 0 (-M 4C e tfc F Policy#or Self-ins.Lic.#: W— ©- 1 � / Expiration Date: F Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratio datd e). 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 ma a forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do he c under the ins and penalties of pei jury that the information provided above is true and correct. Signature, Date: Phone#: -" C Official use only.Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other' ev Contact Person: Phone#: r� t ' OWNER AUTHORIZATION FORM I r CPS Cr ur (Owner's Name) owner of the property located at (Pr4erty Address) (Property Address) hereby authorize T'f , (Subcontra or) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. O ner's..Zigna reA---4 Date. D APR. 19 2012