HomeMy WebLinkAboutBuilding Permits Backfile"LUW UP IFLUrlUU"L)
APPLICA Han
.r addition
BUILDING
PERMIT'
DATE September 7, 2001 PERMIT NO. 8-02-233
ADDRESS 24 Rainbow Road W.Y. 02673 061815
(NO.) (STREET) (CONTR'S LICENSE)
( ) STORY
NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
18 Channel Point Drive W.Y. 02673 oSTRICT R 25
' (NO.) (STREET)
y BETWEEN - - AND
m (CROSS STREET) (CROSS STREET)
m
m SUBDIVISION 14/11 LOTB109 BLOCKIDap 9' LOTSIZE•61
Q
O BUILDING IS TO BE ' FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
TO TYPE
5B USE GROUP R4 BASEMENT WALLS OR FOUNDATION (TYPE)
R
O
REMARKS: add two story addition to right aide of building with wrap around deck — 1 kitchen
1 diningroom, 1 livingroom, 1 study, 1 bath, 1 open deck, 1 opem porch, 1 laundryroom.
AREA OR
VOLUME.
ESTIMATED COST $ 919400.00 FEE PERMIT $ 657.00
(CUBIC/SQUARE FEET)
OWNER James Burke
ADDRESS
18 Channel Point Drive W.Y. 02673 BYILDING DEP
INSPECTION RECORD
-DATE
• NOTE PROGRESS - CORRECTIONS AND REMARKS
-
INSPECTOR
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.
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ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OF�TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 • Yarmouth, MA 02664-4492 A '
Tel: (508) 398-2231 x261 • Fax: (508) 398-2365
Office Use Only
rr��""������ ����� ��q�
Permit No. GJ°fate �r`�`t"
Permit Fee $ 65-7
-leposit Rec d., $°y Dat
Net Due $ G 3A , —
Planning Board Information
Plan Type
Endorsement Date
Recording Date '
Plan No.
Other
Assessors Department Information:
Ma Lot Map cot
O/d New
1.4 Property Dimensions:
ac 5'i .
Lot Area (sf) (o Frontage (ft) Lot Coverage -
This Section for Office Use Only
Building Permit Number:
Date Issued:
Signature: 9 d /
Certificate of Occupancy
�/
is is not required
Buildi Official Date
Section 1 = Site Information Use Group: R-4 Type: 5-
1.1 Property Address:
1.2 Zoning Information:
Zoning District Proposed Use
O2t� 73 •
1.3 Building Setbacks (ft) -
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
3d
' r
"1
1.4 Water Supply (M.G.L, c. 40. S 54)
Public Private
1.5 Flood one Information: Comments:
Zone: ALA-- BFE: /a,
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
S rdl uu � T L)2
�n� ��
Name (p ' t) U ailing UQF ss �/
a2=1 &4JT L 1*1�4 62497-3 p n ?
Sign u Tele ho
2.2 Autl,eedi%iG1 Af3A//3L
rint), l Ug /`A fling A ss �/ /` /
Signature !/ Telephone U/ 0 1 '/
Section 3 - Construction Services
3.1 LIc0r0.sed���truytfon,Eypervio�2� BY
�•�" C/�r�
Not Applicable ❑
�J� `/T^' 1• o(,7, C 4�
` W !/
License Number .
OK l em
Addr
log / <Q 2zfs
Expiration Qate
Si nature Telephone
3.2 Registered Home Improvement Contractor:
Compa �� l/
Not Applicable ❑
License Number
o 91
`J
Addr s� M /� " AV 4t6m � I'ly� 026 �3
Sig(,naattur ?/ Telephone
Expirat n Dat
�/1/ 03
9- 15-56�'
1 of 2
OVER
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure " '
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Section 5`=.Description of Proposed Work:(check all applicable)
New Construction I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work: 11dq
00
cRck 0 A/° Gh 4 79 —,4 —axwd :L. -Ve6-
Section 6 - Estimated Construction Costs;
Item Estimated Cost (Dollars) to be
completed by permit applicant
1. Building
2. Electrical ,
3. Plumbing / Gas / ^ p .
4. Mechanical (HVAC)
5. Fire Protection
6.Total=(1+2+3+4+5) Ll Z,00
7. Total Square Ft. (new houses & additions)
, I/Vizy
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
, as owner of the subject property
hereby authorize 2) 11'ie /� ��k�� to act on
my behalf, jp all matters relative to work authorized by this building permit application.
M
14'Zu Zi :.
Date
, as Owner/Authorized Agent
r
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury. en
Print name
i
Signature of Owner/Agent
9-15-99 2 of 2
Date
°FY�R TOWN OF YARMOUTH �//�0
03� �_ c
�e�;+�,�`' BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION SIGsN OFF
Applicant:
Building Permit No.:
2-9
No.: f '*90299ILe Filed:
Bldg. Site Location:) 6 ��u� �� �� Map No.: Lot No.:
The following information outlines the procedural steps required to obtain a permit to build, alter, or add
to a structure within the Town of Yarmouth. The Building Department will determine compliance to the
following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department
will be responsible for assisting the applicant through the following departments:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability. (applicant to obtain)
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
----------------------------------------
The following Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit:
REVIEWED BY:
LIKWATERDEPARTMENT: —DATE:3• 0-0 ( N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
tONSERVATION: DATE: N/A:
HEALTH DEPARTMENT DATE: U N/A:
5. WIRING INSPECTOR:
6. PLUMBING INSPECTOR:
7. FIRE DEPARTMENT: —
PLEASE NOTE
All stumps and/or brush must be disposed of at an approved site.
`'f l
DATE:
DATE:
N/A:
N/A:
DATE:
N/A:
8/99 Applicant Signature Date
o�.YgR'�r
C
PLEASE PRINT:
Job Location: _
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
Number
Owner of Property:
Construction Supervisor:
C ro or Lk w
Street
!�S 01A 2Af/
�znou71-f 114e Cn28 77
Village
0619 /S 5� 790 3�.
��% / %� I , J L //�j Phone No.
Address: "a K 1 yUV8ao Od, 0, ���?(��tT ' � 9 0.2672 .
Licensed Designee:
(If other than Supervisor) Name
2.15 Responsibility of each license holder:
License No.
License No.
2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair, removal or demolition involving the structural elements of building and structures only pursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
I have a current li ility insurance policy or its substantial equivalent which meets the -requirements of MGL Ch.152
Yes No ❑
If you have checked ems, please indicate the type coverage by checking the appropriate box.
A liability insurance policy [� Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Clof the Mass General L$Vvs, and that my signature on this permit application waives this requirement.
Check one: Signatture of Owner or Owner's Agent Owner ❑ Agent pl_/�
Signature: Building Official Approval:
i � I
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements. {y�A/ / � n J�� fflcl �Tl�
Type of Work: I'w'���'L t%r%04 r QC7`k'l& `" Est. Cost4k/1l(m
Addr f W k �,YL%/���L�l �c . �il , Y��ZAU7l� i�ICJ26%�
ess o or
Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
p/ A�dlo�, 441
Dat6 I Contractor Name Registration No.
W
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date
Owner Name
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their
employ ees. As quoted from the -law 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
d" elline house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
%lGL chapter 152 section 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, neither the commomvealth 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 ha\ e
been presented to the contracting authority.
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplvin`_ company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affdavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
once of Iavestllatlaas
600 Washington Street -
Boston, Ma. 02111
fax #: (617) 727-7749
phone 1$: (617) 7274900 ext. 406, 409 or 375
0V'Y'�R
SS�
i C
` MATTI. Lff ��
PLEASE PRINT:
DATE:
JOB LOCATION:
"HOMEOWNER"
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
NAME STREET ADDRESS SECTION OF TOWN
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
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 attached or detached structure assessory 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 pem►it. (Section 108.3.5.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142.
Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
h:homeowndicexemp
Check one:
Owner ❑ Agent ❑
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH MASSACHUSETT702664-4451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL
GAS
PLUMBING
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at - fO Chtqv4�rG /` A-7- 7Z;?Z . (J, (IkAL(M7V 1;*9 0246
Work Address
is to be disposed of at the following location: \102MaeiTi1 1)C6W1P
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
&1z /-101/ S117101
Signature of Applicant Date
Permit No.
PLOT PLAN
Abuttor's
Name
Lot #
FOR LOT # IOct
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool) ED
Well
(lot.o..^.�....ft. rear) I
If this is a
corner lot,
write in name
of street.
v
b
SIDE YARD
� _ (5 FT_
1Q . 0
V%
N�
MARK NORTH POINT
.Q.
i
REAR YARD
i
HOUSE
S�IyD�E YARD
�W D FT�
Q
I
SET BACK
..�9• a ft.
i'
I
I
(lot... .L�V....�'....ft. frontage)
I GpwrL 6`o7 Oa -
(NAME OF STREET)
Information /J✓/� f Imo, /
Supplied by
AbuttorIs
Name
Lot # 1CV
If this is
corner lo-
write in
name of
A,
other
street.
v
TOWN OF YARMOUTH
ZONING ADMINISTRATOR
DECISION
FILED WITH TOWN CLERK: November 4. 1997
PETITION NO: #3422
HEARING DATE: September 19, 1997
PETITIONER: James Burke
PROPERTY: 18 Channel Point Drive, West Yarmouth
Map: 9 Parcel B109 Zoning District: R25
It appearing that notice of said hearing has been given by sending notice thereof to the petitioner
and all those owners of property deemed by the Zoning Administrator to be affected thereby, and
to the public by posting notice of the hearing and published in The Register, the hearing was
opened and held on the date stated above.
The petitioners, represented by the construction contractor, Mr. David Anderson, seeks to expand
an existing boat storage building at this residential lot. The building, and proposed addition, meet
all applicable dimensional requirements. However, the building is present by virture of a Special
Permit (#2974 & 3005), because it exceeds the permissible limit of §202.5 footnote 5, of parking
for not more than 2 vehicles.
The prior decision, as modified, preserved this bylaws intent and purpose by restricting the use of
the building to boat storage, with no automobiles allowed. The petitioners proposes to continue
that restriction with the expansion of the building. The proposed addition would be 18' x 20' and
would comply with the set -back requirements of the bylaw.
No one appeared in opposition to the petitioner. Mr. Campbell approved of the addition, on the
condition that it not be used for automobile storage, but be limited to storage of the personal
boat(s) and related personal property of the homeowner, and on the further condition that the
petitioner file with the Board a certified plot plan, showing the proposed addition, prior to
commencing construction.
-1-
No permit shall issue until 30 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c40A § 17 and must be filed within 30 days
after the filing of this notice/decision with the Town Clerk.
Leslie Campbell, Zoning Administrator
David S. Reid, Clerk
-2-
ALCULATION FOR PERMIT Co
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IDATION
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A('66 /
TOWN OF YARMOUTH BUILDING DEPARTMENT
PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
Address: J1�CHr3NNE� t�eefr� PD
Map/Lot: )gIjI 0;/BJo)
Date of Initial Review: g, Other: g/z y`� Approval Date:
Inspector F,
Notes:
/ 11`6�UKD,q-r-,0,y .�r! ",",cP 0-41/1 - CiG. /D - #4V,5 S/Lu eTvnys-ct
6940"R 17ss/6/K fLOvti- %�rtsisT.4�rT SN �eco2D�,�c� itJITN �L17G CdD�
SFiG, 31d7. Q
02 �li3J �iirvN OR Sof=�-v T lN�TK if/AdE ✓,91;oLe
a ��� Ii�izS /i%aX S�h'�i.�eG- /{=G �� f%�!i(zSs /7�7Ls,�m��r•�-r� r-arL�'P<er•e.
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rn�N Viz"���✓, SAS On- TFfr2-V t3,P -28ocT5 4149-0-y 07tfOO- y
s� !4-D U S �T /f9iv6�s $oTrt EX,DS
e) RFNLs rYIyzrGAt w Usrozs a'i' �Di /y1,4x- S",
i) A0P 10tND l71-ocicr eN i P oP 0PPL�7-0-s r3,f-rwECAr t?j4FT'4`S
Zoning Denial (if applicable):
Section 104.3.2, para. Change, Extension or Alteration (pre-existing,
nonconforming)
The proposed requires a Special Permit from the Zoning Board of Appeals.
Other
Building Code Denial (if applicable)
.Ysf�
Important:
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
return key.
_ Its
1[�
Note:
Before
completing this
form consult
your local
Conservation
Commission
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1. Applicant:
Name E-Mail Address
DEP File Number:
, 'c 173 - is51?
Provided by DEP
T§0d n
JUN _- 8
Mailing Address =--- z�.c_7z7__ , ; �urUN
L1nr+liY amn+ }} MA nl n6n
Cityfrown State Zip Code
508--775--4634
Phone Number Fax Number (if applicable)
2. Representative (if any):
regarding any
municipal bylaw
or ordinance. 3.
Paul'E Sweetser Professional Land Surveyor
Finn
Vito C. Marotta
Contact Name E-Mail Address (if applicable)
900 Route 134 415
Mailing Address
S. Dennis MA na6a
Cayfrown State Zip Code
508--385-6530 508--385--7854
Phone Number I Fax Number (if applicable)
Property Owner (if different from applicant):
18 Channel Point Drive Yarmouth MA
Name
Mailing Address
City/Town State Zip Code
4. Total Fee:
(from Appendix B: Wetland Fee Transmittal Form)
5. Project Location:
to Channel Point Drive Yarmouth
Street Address City/Town
Map 14 Parcel 11 (Lot109)
4DO Assessors Map/Plat Number Parcel /Lot Number
6. Registry of Deeds:
Barnstable Ctf. 69927
County Book Page
(if Registered Land)
Rev. AMW Fam 3 H
Property Location: 18 CHANNEL POINT DR
Phion ID: 106
MAP ID: 14/ 11/ / /
Other ID: 9/ B109/ / /
Bldg #: 1 Card 1 of
Print Date.08/20
CUKRENTOFVATR
T PO
UTILITIES
STREIROAD
LOCATION
C JRREATASSESSMENT
URKE,JAMES
8 CHANNEL POINT RD
YARMOUTH; MA 02673
Description
Code
AnDralsed Value
Assessed Value
815 '
YARMOUTH,
SLAND
SIDNTL
SHINTL
1013
1013
1013
323,60
18290
22,00
323,60
182,90
22,00
q 696.
d
SUPPLEMENTAL DATA
Account # 0001500
Subdivision 130
Photo
Precinct
IS ID:
VISI
Total
528,50
528,50
RECORD OF OWNERSHIP
BR-VOLIPA E
SALEDATE
V1
SALE PRI E
V
PRE VI ASSES
ME H/ TOR
URKE,JAMES
C
Yr.
Code
Assessed Value
Yr.
Code I
Assessed Vale
Yr.
Code
Assessed
20011013
20011013
2001
1013
323,601
182,90
22,00
200
200
200
1013 1
1013
1013
241,50
140,1
22,70
toL
404
otal.
EXEMPTIONS
0THER
ASSES
NTS
This signature acknowledges a visit by a Data Collector or As
Year
nvelDescription
Amount
Code
Description
Number
Amount
Comm, In,
APPRAISED VALUESUMMARY
Appraised Bldg. Value (Card)
Appraised XF (B) Value (Bldg)
Appraised OB (L) Value (Bldg)
Appraised Land Value (Bldg)
Special Land Value
Total Appraised Card Value
Total Appraised Parcel Value
Valuation Method:
Cost/Market V
NOTES
5 RMS IG DCKS=PP
0130
NEW ADDN.26X16 2 IV
YR BLT 1995
et Total Appraised Parcel Value
BUILDING ERM/T RE RD —
V!S/T
CHNA
E HIS RY
Permit ID
Issue Date
a
De crt lion
Amount
In to
Date Comy.
Comments
Date
ID
Cd.
Purpose/Res
723
996577
99759
998790
ionl98
7118/94
1/27/93
12/7/88
AD
Addition
9,50
3,0
12,50
50,00
5/25/99
8/16/95
_
-KComa
100
100
100
100
1/1199 BOAT
1/1195 ADDITION
1/1/94 BOATSTOR
i/l/90 4DDMON
HOUSE 18 X 20
5/25/99
8/16/95
4/29/94
GM
JF
DB
00
00
00
essur+Listed
easur+Usted
easurf-IJA d
LAND LINE VAL I A TION
SECTION
B#
UseCade
Description
Zone
D
frontage
Depth
Units
Unrt Price
I Factor
S.L I
C Factor
Nbad.
AdY.
Notes- AdilSecial Pricin
Act, Unit Price
Land V
1
1013
SIR WATER
26,571.6C
St
L7
2.71
8
2.50
0080
1.0c
12.1
Total Land Un
26472.0
S
Total Land Vala
Property Location: 18 CHANNEL POINT DR MAPID.; 14/ 11/ / /
Vision ID. 106 Other ID: 9/ B109/ / / Bldg #: 1 Card 1 of 1 Print Date: 08/20/2001
ONSTRUCTIONDETAIL SKETCH
Element Co. I Ch. Description
tyle/ Type 3 olonlal Element Ca. Ch. Description
odel H Icsidential eat & AC 34 WDK
rade 6 :cellent rameType WDK
athsMumbing WDK DB 32 K 1
tones
z
Stories
12
26
Dccupancy
0..
iling/Wall
34
ooms/Prtns
2
xterior Wall 1
4
Wood Shingle
4 Common Wall
S
FUS
2
Vall Height
BAS IE 16
toof
3
able/Aip
2
toof Cover
3
ph/F GIs/Cmp
CONDO/MOBILE HOME DATA
13 B
nterior Wall 1
S
rywalUSheet
6 2PUS
lemen!
ode
escri Lion
actor
nterior Floor 1
9
ine/SoR Wood
FUS . 3
omplex
loorAdj
2
4
arpet
nit Location
7
eating Fuel
4
lectric
umber of Units
OP 27
eating Type
7
Iectr Basebrd
umber of Levels
16 2
CType
1
one
/o Ownership
edrooms •
33
Bedrooms
COSTIMARRET VALUATION
athrooms
J.5
1112 Bathrms
FGR
nadj. Base Rate
0.00
22
otal Rooms
ize Adj. Factor
93947
rade (Q) Index
.38
Bath Type
j. Base Rate
7.79
Kitchen Style ..
Idg. Value New
23,102
22
ear Built
979
kop
ff. Year Built
981
mil Physcl Dep
9
2
uncnl Obslnc
n Obslnc
pecl. Cond. Code
MIXED
USE
pecl Cond %
erall %Coed.
1
1013
FR WATER
100
prec. Bldg Value
80,700
OB-OUTBUILDING & YARD ITEMS L /XF-BUILDING EXTRA FEATURES B
Code
Describlion
UB
Units
Unit Price
Yr.
Do Rt
%Cnd
Ayr, Value
OOS
Open Oats Shwr
B
I
0.0c
1987
1
100
FPL3
2 STORY CHIM
B
I
2,800.00
1979
1
100
2,20
FGRS
/LOFT GOOD
L
994
24.00
1993
1
100
22,00
B UILDING SUB
-AREA
SUMMARYSECTION
Code
Desch Lion
LtvinLy Area
Gross Area
Eff Area
I Unit Cost
Unde rec Value
BAS
First Floor
1,211
1,21
1,218
77.7
94,74
FGR
arage
484
194
31.11
15,09
FOP
orch, Open, Finished
7
14
15.1
1,08
FUS
pper Story, Finished
02
1,32
1,325
77.7
103,07
WDK
ecl4 Wood
1
1,17
117
7.7
9,101
... ---
•' ---- '- -
, Re
e'171
1 aR
nrt. v r.
1211n
Proaen18 CHANNEL POMA14111/ / /
heck COMPLIANCE REPORT
i_§aehusetts Energy Code
MAScheck Software Version 2.0
CITY: Hyannis
STATE: Massachusetts
HDD: 5973
CONSTRUCTION TYPE: 1
HEATING SYSTEM TYPE:
DATE: 8-22-2001
DATE OF PLANS:
TITLE:
COMPLIANCE: PASSES
Required UA = 413
Your Home = 411
or 2 family, detached
Other (Non -Electric Resistance)
Permit ##
Checked by/Date
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value
-------------------------
UA
------------------------------ CEILINGS 852 38.0 0.0
WALLS: Wood Frame, 16" O.C. 1829
_ __
26
19.0 3.0
GLAZING: Windows or Doors 475
99
DOORS 0.320
152
126
FLOORS: Over Unconditioned Space 852 19.0 0.350
44
BSMT: 4.0' ht/3.0' bg/3.0' insul. 512 10.0
40
50
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent
with the building plans, specifications, and other
calculations submitted with the permit application. The
proposed building
has been designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate
has been determined
using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat
or cool the building
shall be no greater than 125% of the design load as specified in
sections 780CMR 1310 and J4.4.
Builder/Designer
pUG 2 3 2001
Date
MAScheck INSPECTION CHECKLIST
Ma, s' r
sachusetts Energy Code
MAScheck Software Version 2.0
DATE: 8-22-2001
Bldg.
Dept.
Use
i
CEILINGS:
1. R-38
Comments/Locati
WALLS:
I. Wood Frame, 16"
Comments/Locatio
O.C., R-19 + R-3
AUG 2 3 2001 D
WINDOWS AND GLASS DOORS:
1. U-value: 0.32
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes Comments/Location ( ] No
DOORS:
1. U-value: 0.35
Comments/Locati
FLOORS:
I. Over Unconditioned Space, R-19
Comments/Location
BASEMENT WALLS:
1. 4.0' ht/3.0' bg/3.0' insul., R-10
Comments/Location
AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. Recessed
lights must be type IC rated and installed with no penetrations
or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation.
VAPOR RETARDER:
Required on the
ceilings, walls,
warm -in -winter side of all non -vented framed
and floors.
MATERIALS IDENTIFICATION:
( ] ; Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications.
DUCT INSULATION:
] ; Ducts in unconditioned spaces must be insulated to R-5.
Ducts outside the building must be insulated to R-8 0
DUCT CONSTRUCTION:
] ; All ducts must be sealed with mastic and fibrous backing tape.
Pressure -sensitive tape may be used for fibrous ducts. The HVAC
system must provide a means for balancing air and water systems.
TEMPERATURE CONTROLS:
Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in sections 780CMR 1310 and J4.4.
MISC REQUIREMENTS:
Refer to 780 CMR, Appendix J for requirements relating to swimming
Pools, HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F, and circulating hot water systems.
----NOTES TO FIELD (Building Department Use Only) -------------------------
p DII AUG 3 O1zoo,
Eti�Ch.W N� h,Qsg1 = 4-W SQ lw ,
Solt
�SV�EETSE�Z �11\N DdTEn 3` 3�`(�—aS 2EVtSED)
OG NTElD '(0 5tJ,7
l8 cw-waeE , Tol+-- 'erg
vJ1 vs'?— wTN
FD— I
l S lzs� o l
JAMS E.
EGAN
rpUcXN.. I
m
I
L� Won Not-S
1-C 9 IF ui
(T Y P)
4-4 G 'Past
vJB� 15. OIL
v�toXiS.
4 YIFT
S . Z TS 4"4"4
�-Jr i71FF
4 �G R)St L 7 ` x
t_44 PjUI.'fS
CNANNEL 170INT D2
— W, \�P FL\400T�A
J-0 (sl $ f la - Co 403
40 ? S F
Aao F 2 5 ?SF
r L5 P5F
llim
V 2
Iry 5g� I�
�Ecurtk Tl
'3E Ring
�Typ)
$TsF�•
r EGANE.
RUCTL U
No. 2mv
- 235°1
/0/ l-71 of
SK - ! S cogml) ;
5k--I, Pl\uEE I
CANTILEVER BEAM CHANNEL POINT DR., W. YARM.
C1 Date: 10/18/01 BeamChek 2.2
Choice W 8x 10 A36 Wide Flange Steel Lateral Support at: Lc = 4.2 ft Max.
Conditions Actual Size is 4 x 7-7/8 in., Overhang,
Data
Attributes
Actual
Critical
Status
Ratio
Values
Adiustments
Mm tseanng Lengm
R rr U.v u1. nc- w.0 nl.
Beam Span
16.0 ft
Reaction 1
3032#
Beam Wt per ft
10.0 #
Reaction 2
4993 #
Beam Weight
195 #
Mabmum V
3528 #
Overhang Length 3.5 ft
Max Moment
11188 W
Max V (Reduced)
N/A
Total Beam Length 19.5 ft
TL Max Defl
L / 240
TL Actual Defl
L / 349
OH TL Actual Defl L / 254
Section in'
Shear(in')
TL Defl in
Urr i L Uen
7.81
1.34
0.55
-0.33
5.65
0.24
0.80
0.35
OK
OK
OK
OK
72%
18%
69%
94%
Fb (psi)
Fv (psi) E (psi x mil
Base Value Fy
36000
36000 29.0
Base Adjusted
23760
14400 29.0
YP Factor, Lc
0.66
0.40
At Point Loads: Provide these minimum bearing lengths in inches or provide web stiffeners.
F = 0.6
BeamChek has automatically addea the Deam sen-weigm into me caacuiawi m.
Loads Uniform TL 400 = A (Uniform Ld on Backspan Only
Point TL Distance Par Unif TL Start End
F = 800 (OH) 3.5
L = 180 (OH) 0 3.5
Pt loads: I Q ,
R1�3032 R2 = 4993
BACKSPAN =16 FT OH = 3.5 FT
Uniform and partial uniform loads are Ibs per lineal ft. Overhanging load distances are from R2.
Notes
PAGE 1
BOISE CASCADE - BC CALC'rm 2001 DESIGN REPORT - US Tuesday, August21, 2001 13:38
File
` Triple -1 3/4" X 9 1/4" V-L SP 2900 Name: Hanbburkebeam a CC
Job Name - Burke Residence Customer - David Hanbury 's ajjWrL &7PC
Address - Specifier - yn&"oL4rA�
Designer - Jay Malaspino W
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
Beam a
BO
10 lbs LL
511 IT
DL
General Data
Version:
US Imperial
Member Type:
- Floor Beam
Number of Spans
- 1
Left Cantilever
- No
Right Cantilever
- No
Slope
0/12
Tributary
08-00-00
Repetitive
n/a
Construction Type
n/a
Live Load
40 PSF
Dead Load
10 PSF
Part Load
0 PSF
Duration
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a
particular application. The output
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Total Horizontal Lenqth - 05-06-00
131
1464 Ibs LL
761 Ibs bL
Load Summary
ID
Description
Load Type
Ref.
start
End
Live
Dead Trib.
Dur.
S
Standard
Unf.Area Load
Left
00-00-00
05-06-00
40 PSF
10 PSF 08-00-00
100
1
p.l. from beam b
Conc.Pt. Load
Left
03-06-00
03-06-00
300 Ibs
637lbs n/a
100
2
p.u.I. from front section
Unf.Area Load
Left
03-06-00
05-06-00
40 PSF
10 PSF 06-00-00
100
Controls Summate
Control Type Value
Moment
3022 ft-Ibs
End Shear
1675 Ibs
Total Deflection
U2972 (0.022")
Live Deflection
U4740 (0.014")
Max. Defl.
0.022" (Limit: 0.5')
Soan/Depth
7.1
Elearina Supports
Name Type
BO WalVPIate
B1 Wall/Plate
% Allowable Duration
16.2% @ 100%
17.8% @ 100%
8.1 %
7.6%
4.4%
Loadcase Span Location
2 1 -internal
2 1 - Right
2 1
2 1
2 1
1
Dim. (L x W) Value % Allowed Case Material
3-1/2" x 5-1/4" 1587 Ibs 20.3% 2 Spruce -Pine -Fir
3-1/2" x 5-1/4" 2225lbs 28.5% 2 Spruce -Pine -Fir
NOTES:
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Design meets arbitrary (0.5") Maximum load deflection criteria.
Page 1 of 1 BCIO and Versa -Lam® are registered trademarks of Boise Cascade Corp.
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Tuesday, August21, 2001 13:34
File
. " Triple -1 3/4" X 9 1 /4" V-L SP 2900 Name: Hanbury burke beam b.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
Beam B
-3-1/2"
BO
300 Ibs LL
637 Ibs DL
General Data
Version: US Imperial
Member Type:
- Floor Beam
Number of Spans
- 1
Left Cantilever
- No
Right Cantilever
- No
Slope
0112
Tributary
01-03-00
Repetitive
n/a
Construction Type
n/a
Live Load
40 PSF
Dead Load
10 PSF
PartLoad
0 PSF
Duration
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a
particular application. The output
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Total Horizontal Length - 12-00-00
B1
300 Ibs
637 Ibs
Load Summary
ID Description Load Type Ref. Start End Live Dead Trib. Dur.
S Standard Unf.Area Load Left 00-00-00 12-00-00 40 PSF 10 PSF 01-03-00 100
1 wall load Unf.Lin. Load Left 00-00-00 12-00-00 0 PLF 80 PLF n/a 100
Controls Summary
Control Type Value
Moment
2811 ft-Ibs
End Shear
817 Ibs
Total Deflection
U1368 (0.105")
Live Deflection
U4274 (0.034")
Max. Defl.
0.105" (Limit: 0.5")
Soan/Depth
15.6
%, Allowable Duration
15.1% @ 100%
8.7% @ 100%
17.5%
8.4%
21.0%
Loadcase Span Location
2 1 - Internal
2 1 -Left
2 1
2 1
2 1
1
Bearing Supports
Name Type Dim. (L x W) Value % Allowed Case
BO Wall/Plate 3-1/2" x 5-1/4" 937 Ibs 12.0% 2
B1 Wall/Plate 3-1/2" x 5-1/4" 937 Ibs 12.0%, 2
NOTES:
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Design meets arbitrary (0.5") Maximum load deflection criteria.
Material
Spruce -Pine -Fir
Spruce -Pine -Fir
Page 1 of 1 BCI® and Versa -Lam® are registered trademarks of Boise Cascade Corp.
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Tuesday, August21, 2001 13:41
Triple -1 3/4" X 9 1/4" V-L SP 2900 Nlame: Hanbury burke beam c.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
Beam c
Standard Load - 40 PSF 110 PSF Trib tary 14-00-60
•�,'eEr2-�`...,, r,.n-.� W 6�'fi ,.P o';, `be m 07s ".drv;w.:e k . R��@ a, �`� ..:�e p3 ,,"" & �§%� .. a,4 e�c:2 £<. isx-- mb.
3-1/2'
BO B1
33 0 Ibs LL 3360 Ibs LL
92 Ibs DL Total Horizontal Length - 12-00-00 922 Ibs PL
General Data
Version:
Member Type:
Number of Spans
Left Cantilever
Right Cantilever
Slope
Tributary
Repetitive
Construction Type
Live Load
Dead Load
Part Load
Duration
US Imperial
Floor Beam
_1
No
No
0/12
14-00-00
n/a
n/a
40 PSF
10 PSF
0 PSF
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a
particular application. The output
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
I
Load Summary
ID Description Load Type Ref. Start End Live Dead Trib. Dur.
S Standard Unf.Area Load Left 00-00-00 12-00-00 40 PSF 10 PSF 14-00-00 100
Controls Summary
Control Type Value
Moment
12846 ft-Ibs
End Shear
3732 Ibs
Total Deflection
U299 (0.481")
Live Deflection
U381 (0.377")
Max. Defl.
0.481" (Limit: 0.5")
Span/Depth
15.6
Bearina Supports
Name Type
BO Wall/Plate
131 Wall/Plate
% Allowable Duration
69.0% @ 100%
39.7% @ 100%
80.1 %
94.3%
96.2%
Loadcase Span Location
2 1 - Internal
2 1 - Left
2 1
2 1
2 1
1
Dim. (L x W) Value % Allowed Case Material
3-1/2" x 5-1/4" 4282 Ibs 54.8% 2 Spruce -Pine -Fir
3-1/2" x 5-1/4" 4282 Ibs 54.8% 2 Spruce -Pine -Fir
NOTES:
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Design meets arbitrary (0.5") Maximum load deflection criteria.
Page 1 of 1 BCIV and Versa -Lam® are registered trademarks of Boise Cascade Corp.
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Tuesday, August21, 2001 13:42
• Triple -1 3/4" X 9 1/4" V-L SP 2900 Niame: Hanbury burke beam d.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
Beam to
D
Standard Load-40 PSF 110 PSF Tributary 11-06-00
3-1/2'
12 B7O LE 06-00-00 B1 06-00-00 B2
345 bstE 1207AbsTLL
289 Ibs DL Total HorizoMINah - 12-00-00 289 IbsPL
General Data
Version:
US Imperial
Member Type:
- Floor Beam
Number of Spans
- 2
Left Cantilever
- No
Right Cantilever
- No
Slope
0/12
Tributary
11-06-00
Repetitive
n/a
Construction Type
n/a
Live Load
40 PSF
Dead Load
10 PSF
Part Load
0 PSF
Duration
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a
particular application. The output
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Load Summary
ID Description Load Type Ref. Start End Live Dead Trib. Dur.
S Standard Unf.Area Load Left 00-00-00 12-00-00 40 PSF 10 PSF 11-06-00 100
Controls Summary
Control Type Value
% Allowable
Duration
Loadcase
Span Location
Moment 2649 ft-Ibs
14.2%
@ 100%
2
1 - Right
End Shear 1043 Ibs
11.1 %
@ 100%
4
1 -Left
Cont. Shear 1754 Ibs
18.7%
@ 100%
2
1 - Right
Total Deflection U4547 (0.016")
5.3%
4
1
Live Deflection U5301 (0.014")
6.8%
4
1
Total Neg. Deft.-0.004"
0.8%
5
1
Max. Deft. 0.016" (Limit: 0.5")
3.2%
4
1
Span/Depth 7.8
1
Bearing Supports
Name
Type
Dim. (L x W)
Value
% Allowed
Case
BO
Wall/Plate
3-1/2"x5-1/4"
1497lbs
19.2%
4
B1
Post
3-1/2" x 3-1/2"
4415lbs
42.4%
2
B2
Wall/Plate
3-1/2" x 5-1/4"
1497 Ibs
19.2%
5
NOTES:
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Design meets arbitrary (0.5") Maximum load deflection criteria.
Material
Spruce -Pine -Fir
Versa -Lam
Spruce -Pine -Fir
Page 1 of 1 BCI® and Versa -Lam® are registered trademarks of Boise Cascade Corp.
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Tuesday, August 21, 2001 13:46
Single -1 3/4" x 11 7/8" V-L SP 2900 Nlame: Hanbury burke beam e.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCC19852 Misc: - Eng. Wood (508) 862-6223
Beam e
d
0
d = 09-00-00
o = 00-09-00
5.7
P-1/2" 3-1/2'
31-00A11 bsLE 12-08-12 b2 L
�0
364 Ibs DL Total Horizontal Length - 13-09-07 599 Ibs L
General Data
Load Summary
Version: US Imperial
ID Description Load Type Ref.
Start
End
Live Dead Trib.
S Standard Simple Hip Left
00-00-00
13-09-07
25 PSF 15 PSF n/a
Member Type: - Simple Hip
Number of Spans - 2
Controls Summary
Left Cantilever - Yes
Control Type Value % Allowable
Duration
Loadcase Span Location
Right Cantilever - No
Moment 3305 ft-Ibs 28.9%
@ 115%
5
2 - Internal
End Shear 1018 Ibs 22.0%
@ 115%
2
2 - Right
RafterSlope 8/12
Cont. Shear 705 Ibs 15.3%
@ 115%
2
2 - Left
Total Deflection U712 (0.237") 25.3%
5
2
Repetitive n/a
Live Deflection U1332 (0.127") 18.0%
5
2
Construction Type n/a
Total Neg. Defl. -0.06" 8.0%
5
1
Span/Depth 12.9
2
Live Load 25 PSF
Dead Load 15 PSF
Part Load 0 PSF
Bearing Supports
Duration 115
Name Type Dim. (L x W)
Value
% Allowed
Case Material
B1 Post 3-1/2" x 1-3/4"
760lbs
14.6%
2 Versa -Lam
Disclosure
B2 Wall/Plate 3-1/2" x 1-3/4"
1300lbs
50.0%
5 Spruce -Pine -Fir
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
NOTES:
evidence of suitability for a
Design meets Code minimum (U180) Total load deflection criteria.
particular application. The output
Design meets Code minimum (U240) Live load deflection criteria.
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Dur.
115
Page 1 of 1 BCI® and Versa -Lam® are registered trademarks of Boise Cascade Corp.
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Thursday, August23, 200107:19
'-' Single -1 3/4" x 11 7/8" V-L SP 2900 Nlame: Hanbury burke beam F.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
Beam F
d
0
A 5.7
12
d = 12-00-00
o = 00-09-00
Lu-uc
01-00 � 16-11-10
77-Ibs-LL
602 Ibs DL Total Horizontal Length - 18-00-06
3-1/2'"
B2
1235-lbs-LL
1039 Ibs IDL
General Data
Load Summary
Version: US Imperial
ID Description Load Type Ref.
Start
End Live
Dead Trib. Dur.
S Standard Simple Hip Left
00-00-00
18-00-06 25 PSF 15 PSF n/a 115
Member Type: - Simple Hip
Number of Spans - 2
Controls Summary
Left Cantilever - Yes
Control Type Value % Allowable
Duration
Loadcase
Span Location
Right Cantilever - No
Moment 7645 ft-Ibs 66.8%
@ 115%
5
2 - Internal
End Shear 1897 Ibs 41.1 %
@ 115%
2
2 - Right
RafterSlope 8/12
Cont. Shear 1224 Ibs 26.5%
@ 115%
2
2 - Left
Total Deflection U231 (0.974") 77.8%
5
2
Repetitive n/a
Live Deflection U428 (0.525") 56.0%
5
2
Construction Type n/a
Total Neg. Defl.-0.183" 24.4%
5
1
Span/Depth 17.1
2
Live Load 25 PSF
Dead Load 15 PSF
Part Load 0 PSF
Bearing Supports
Duration 115
Name Type Dim. (L x W)
Value
% Allowed Case
Material
B1 Post 3-1/2" x 1-3/4"
1279 Ibs
24.6% 2
Versa -Lam
Disclosure
B2 Wall/Plate 3-1/2" x 1-3/4"
2275lbs
87.4% 5
Spruce -Pine -Fir
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
NOTES:
evidence of suitability for a
Design meets Code minimum (U180) Total load deflection criteria.
particular application. The output
Design meets Code minimum (11-1240) Live load deflection criteria.
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Page 1 of 1 BCI® and Versa -Lam® are registered trademarks of Boise Cascade Corp.
Beam G
BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Thursday, August23, 200107:27
Double -1 3/4" X 14" V-L SP 2900 Nlame: Hanbury burke beam G.BCC
Job Name - Burke Residence Customer - David Hanbury
Address - Specifier -
Designer - Jay Malaspino
City, State, Zip - Yarmouth, Ma. Company: - Shepley Wood Products
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc: - Eng. Wood (508) 862-6223
�a
12
BO 131 B2
P6 Ibs LL 5842 Ibs LL
3949 Ibs DL 1483 Ibs,
8 Ibs DL
16-06-00 11-06-00 560 Ibs k
General Data
Version:
US Imperial
Member Type:
- Roof Beam
Number of Spans
- 2
Left Cantilever
- No
Right Cantilever
- No
Slope
0112
Tributary
11-06-00
Repetitive
n/a
Construction Type
n/a
Live Load
Dead Load
Part Load
Duration
25 PSF
15 PSF
0 PSF
115
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a
particular application. The output
above is based upon building
code -accepted design properties
and analysis methods. Installation
of Boise Cascade engineered wood
products must be in accordance
with the current Installation Guide
and the applicable building codes.
To obtain an Installation Guide or if
you have any questions, please call
(800)232-0788 before beginning
product installation.
Total Horizontal Length - 28-00-00
Load Summary
ID Description Load Type Ref. Start End Live Dead Trib. Dur.
S Standard Unf.Area Load Left 00-00-00 28-00-00 25 PSF 15 PSF 11-06-00 115
1 P.L. FROM BEAM F Conc.Pt. Load Left 13-00-00 13-00-00 677 Ibs 602 Ibs n/a 115
Controls Summary
Control Type Value
%Allowable
Duration
Loadcase
Span Location
Moment 14576 ft-Ibs
46.7%
@ 115%
2
1 - Right
End Shear 2862 Ibs
26.3%
@ 115%
4
1 - Left
Cont. Shear 5247 Ibs
48.2%
@ 115%
2
1 - Right
Uplift -27 Ibs
4
2 - Right
Total Deflection U574 (0.345")
31.3%
4
1
Live Deflection U905 (0.219")
26.5%
4
1
Total Neg. Defl.-0.072"
9.6%
4
2
Max.Defl. 0.345"(Limit:1")
34.5%
4
1
Span/Depth 14.1
1
Bearing Supports
Name
Type
Dim. (L x W)
Value
% Allowed
Case
Material
BO
Wall/Plate
3-1/2" x 3-1/2"
3415lbs
65.6%
4
Spruce -Pine -Fir
B1
Post
3-1/2" x 3-1/2"
9792lbs
94.0%
2
Versa -Lam
B2
Wall/Plate
3-1/2" x 3-1/2"
2044lbs
39.3%
5
Spruce -Pine -Fir
CAUTIONS:
Uplift of -27 Ibs
found at span 2 - Right.
NOTES:
Design meets Code minimum (U180) Total load deflection criteria.
Design meets Code minimum (U240) Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
Slope = 0, consider drainage.
Page 1 of 1 BCIO and Versa -Lam® are registered trademarks of Boise Cascade Corp.
e-&f� lit-lus o is '0--
a
�\ 1 \
49.2� / F
cb EXISTING 19.3'
DWELLING
EXISTING 4.2� 2nd
FOUDND CONCRETE per' STORY
r I � FOUNDATION DECK �
\\� LOT 10-9 N?\� DECK %K
60,E ti.
_ _ > a of
g
\� DRIVEWAY // 52.644.8
EXISTIN
8.0 0 GARAGE
ol
�Os �GJ ASSESSORS MAP 14
PARCEL 11
G�
PREPARED FOR: THE STRUCTURE IS LOCATED IN ZONE "A-12"
Mr. JAMES BURKE AS SHOWN ON FIRM COMMUNITY PANEL
18 CHANNEL POINT DRIVE 250015 0005 D, EFFECTIVE DATE: 7/2/1992
W. YARMOUTH, MA 02673
I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP, INC
MY PROFESSIONAL KNOWLEDGE, of 657 MAIN STREET WEST YARMOUTH MA.
INFORMATION AND BELJEF THAT THE
LOT CORNERS, DIMENSIONS AND
SETBACKS To THE STRUCTURE ASA CERTIFIED SCALE: 1 =40
DETERMINED BY INSTRUMENT SURVEY CIRW
FODa
AND sHoyyN ON THIS PLAN ARE wum -In#Pg CHANNEL DATE: 9/28/01
LOT PLAN
CORRECEC T.
A POINT DRIVE BSC# 48349.00 � CRAI A. FIELD, PLS DATE W. YARMOUTH
FOR THE BSC GROUP, INC. MASSACHUSETTS SHEET 1 OF 1
FILED WITH TOWN CLERK:
PETITION NO:
PETITIONER:
HEARING DATE:
L ..
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
AUG 1�93
3005
49
193 U 10 A9:45
IOWN
James Burke, West Yarmouth, MA
7/8/93 & 7/22/93
PROPERTY LOCATED AT: 18 Channel Point Drive, West
Yarmouth, MA and shown on Assessor's Map 9 as Parcel B109.
PETITIONER REQUESTS: A modification/clarification
of decision #2974 to allow a peastone driveway (already existing per
Conservation Comnission) leading to approved boat storage building
(appeal #2974).
MEMBERS OF THE BOARD PRESENT AND VOTING: Leslie Campbell, Chairman,
Fritz Lindquist, David Reid, Joyce Sears, Jerry Sullivan.
It appearing that notice of said hearing has been given by sending
notice thereof to the petitioner and all those owners of property
deemed by the Board to be affected thereby and that public notice
of such hearing having been given by publication in the Yarmouth Sun
the hearing was opened and held on the date first above written.
Mr. Burke appeared before the Board and presented his own petition.
This is essentially a request to clarify or modify Decision #2974,
filed on March 8, 1993, by eliminating the condition imposed at that
time which prohibited the installation of a driveway leading to the
new storage building. The petitioner presented to the Board a plot
plan of the site (dated June 23, 1993) which shows that a peastone
driveway already exists in front of the storage building. He
represents that this driveway pre -dated the construction of the
building, but that his contractor, who represented him at the hearing
on petition #2974, failed to make that fact clear to the Board. The
Board has also received a letter, dated July 22, 1993 from the
Conservation Administrator, indicating that the stone driveway is
considered to be more desirable from a Conservation perspective, as
it will help to control dust and erosion.
The Board m�-tubers discussed the fact that the driveway condition had
been inposed in order to help assure that the building is used for
storage, and not as an automobile garage. The petitioner acknowledges
this purpose and restriction, but indicated that the stone driveway
is nevertheless needed and desired in order to store his boat, etc.
in the building.
After deliberations and considerations, a Motion was made by Mr.
Lindquist, seconded by Mrs. Sears, to modify decision '2974, by
ctri ki ntt frnm tha nrrtnv of the relief the condition that "no driveway
i
to maintain the existing driveway, as shown on the current plot plan
which is incorporated herein by reference. In all other respects,
said decision shall remain in force and effect. The Board members
voted unanimously in favor of this Motion. The petition is therefore
granted.
- 17 jam✓
David S. Reid; Clerk
Board of Appeals
c
o .'
1� 1
rr
tSi
FILED WITH TOWN CLERK:
PETITION NO:
PETITIONER:
HEARING DATE:
PROPERTY LOCATED AT:
and shown on Assessor's Map
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
M: P
2974
David Anderson for James,6fke
y.S MAR -8 A 903
February 25, 1993
18 Channel Point Lane,)i CWtIAI"A ;li F•E is
9 as Parcel B109.
PETITIONER.REQUESTS: A variance from section 202.5 Q3 to .
allow the construction of a 24' x 26' boat storage building as per
design and specification.
MEMBERS OF THE BOARD PRESENT AND VOTING: Leslie Campbell, Chairman,
Fritz Lindquist, David Reid, Joyce Sears, Jeanne Bullock
It appearing that notice of said hearing has been given by sending
notice thereof to the petitioner and all those owners of property
deemed by the Board to be affected thereby and that public notice
of such hearing having been given by publication in the Yarmouth
Sun, the hearing was opened and held on the date first above written.
The petitioner/owner was represented at the hearing by Mr. David
Anderson, the general contractor for the owner. The property in
question is presently improved with a single family home, including
an attached two (2) car garage. The owners propose to construct
a free standing storage building, located as shown on their Sketch
Plan, revised through 2/2/93, drawn by Stanley R. Sweetser, Inc.,
Engineers (Robin W. Wilcox). This out -building is proposed to
be used for storage of the owner's boat and for miscellaneous personal
yard items . No automobiles will be stored therein. The building
conforms to all applicable by law requirements, except for the
limitation imposed in section 202.5, footnote 5 which requires this
Board's authorization since the structure as designed is capable
of storing another motor vehicle. The petitioner represents that
no motor vehicle (other than a boat) will be stored in the building,
and no driveway leading to the building will be provided in the yard.
After hearing and considerations, a Motion was made by Mr. Reid,
seconded by Mrs. Sears to grant this petition, as shown on the plan
(of 2/2/93) on the conditions that no automobiles shall be permitted
to be stored or parked in the building and no driveway shall be
created assessing the building.
The Board Members voted unanimously in favor of this Motion. The
petition is therefore granted.
No permit shall issue until the passing of
of t Zcision th the Town Clerk.
UFid S. Reid, Clerk
Board of Appeals
20 days from the filing
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY)
TOWN OF YARMOUTH BY.
Fee: $��Q
PERMIT NO. C -pa _ 7O d— :. .
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention
work described below.
Location (Street & Number (� I
Owner or Tenant O Telepht
Owner's Address
electrical
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building �t' 9 Utility Authorization No.
Existing Service //
f Amps /�d G Volts OverheadQ Undgrd No. of Meters
New Service _ Amps / Volts Overhead Undgrd ❑ No. of Meters
Number of Feeders and Ampacity ,}
Location and Nature of Proposed electrical Work: It 141Aa Toil Loo o G, (e
Com letion of the follovving table maybe waived by the Inspector oWires
h
No. of Total
No. of Recessed Fixtures r1
No. of Ceil.-Sus . Paddle Fans
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
Above ln-
❑
No. of Emergency Lighting
No. of Lighting Fixtures
Swimming Pool rnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches 4;L 0
No. of Gas Burners
o. oT Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
Heat Pump
Number
Tons
KW
No. of Self -Contained
No. of Waste Disposers
Totals:
— -
— -
— —
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local ❑ Connection ❑ Other
Dryers
No. of Dr y
Heating Appliances KW
g pP
Security Systems:
No. of Devices or E ui valent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring
No. of )gevices or Equivalent
dromassa a Bathtubs
No. H y g
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
.vrracn aaamonat aerau g aestrea, or as requtrea ny me inspector of vvtres.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BONDC] OTHER (Specify:)
(Expiration Date) ..
Estimated Value of J,ri �I Work: 00. 0 (When required by municipal policy.)
Work to Start: f U / Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the ains and penalties of perjury, that the information on this application is'true and complete.
FIRM NAME: " LIC. NO.
Licensee: F�di(441-d SignatureLIC. NO. i CL
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:
Address Alt. Tel. No.: / 4 " e0v
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norma y required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 04100]
` of . y
APPLICATION FOR PERMIT TO DO PLUMBING
TOWN OF'YARMOUTH
,-(OFFICE USE ONLY)
WTT�CXEEASE
By ...
Fee:'$
PERMIT N0.
-Date
i 19
Building
Cin
((
n Owner's J ct fLe S o u r
P 01 /vim
AT: Location _ t
4 /NA 19 L.
Name
New ❑
Type of Occupancy
Renovation �'� Replacement ❑
Plans Submitted
Yes L- No ❑
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1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One -
Installing Company Name I'l / r I ❑ Corp.
Address t_Ae<SSPaz ❑ Partnership
y cr r C u) A&A (0 2'rjr—M/Company
Business Telephone Name of Licensed Plumber
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: YesGY<O ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box. .
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check on Owner ❑ Agent. ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted Signature of Licensed
(or entered) in above" application are true and accurate to the best of Plumber
my knowledge and that all plumbing work and installations performed
under Permit issued.for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and License Vumber
Chapter 142 of the General Laws: Type: Master Journeyman 0
of rqq APPLICATION FOR PERMIT TO DO GASFITTING
TOWN OF YARMOUTH • (OFFICE use ONLY) .
By z�
MA ACMEESE - •. - -
a Fee: $ S aJ /+
�j PERMIT NO.
Date
Building Owner's
AT: Location j `� r`n 21r i-d f 1, 1T Name ��i_ r�Q !S 3y r 2_
Type of Occupancy
New ❑ Renovation Replacement ❑
Plans Submitted Yes yr No ❑
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(PRINT OR TYPE) q Check One:
Installing Company Name v'"I �l��S ( i ❑ Corp.
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Address Li(:z ( A) a P SS ❑ Partnership
�a �n—t ELF-rrm/Company
Business Telephone �� U
Name of Licensed Plumber or Gasfitter ��� , �`ti1 6 r r L Vl�
INSURANCE COVERAGE: Check One
I have a current liability insurance policy or its substantial equivalent. Yes M-- No ❑
If you have checked yes, please inditype of coverage by checking the appropriate box.
cate
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
U
1! :
hereby certify that all of the details and information I have submitted
Signature of Licensed
(or entered) in above application are true and accurate to the best of
Plumber or Ga5fftter
my knowledge and that all plumbing work and installations performed
% R`
under Permit issued for this application will be in compliance with all
—T
pertinent provisions of the Massachusetts State Plumbing Code and
License Number
Chapter 142 of the General Laws.
TYPE LICENSE
0 Plumber ❑ Gasfitter aMaster Ud66rneyman
4.'
The Commonwealth ofMassaehusetts
Department of Industrial Accidents
Offics ollovest/pst/ess
600 Washington Street
Boston, Mass. 01111
Workers' Compensation Insurance Affidavit
sits W t /�!'v � "r`� 4A4 D�F�73 phone # uw 79b
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
(1• I am an employer pro%iding workers' compensation for my employees working on this job.
address: rc �✓�� ' ClX
city: %J t L%9Wi�' 7711C A14W 6267Y „hnnp M. s'b -9 20-9
insurance co. (�2' v 14V ' policy #
I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city: phone #:
insurance co. policy #
comfy name:
cam: phone #
insurance co. policy #
a
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Bat op to $1t500.00 and/or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Bat of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification.
I do hereby
Print name
the pains
. A
MY/
6erjury that the information provided above is true and correct
T Date _ /�����q
Y2yz Phone►
oll 621 use only do not write in this area to be completed by city or town official
city or town: YARMOUM
0 check if immediate response is required
contact person:
permit/lieense # nBuilding Department
pLicensing Board
261 Oselectmen's Office
OHealth Department
phone #; _ (508) 398-2231 eat. mother
(revrsed 7:95 PIA)
Information and Instructions '
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
etttplo.ees. As quoted from the "law", an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An emplr�yer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoin_ 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
ox%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
d" elline house of another -who employs persons to do maintenance , construction or repair work on such dwelling house
or oil tile urounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo.er.
%lG1_ chapter I section also states that every state or local licensing agency shall withhold the issuance or
reneNval 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.
Additionalh, neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the
performance of public %%ork until acceptable evidence of compliance with the insurance requirements of this chapter hay e
been presented to the contracting authorit..
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
suppl% ing company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation polic.. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
ance et invesuladles
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 7274900 ext. 4069 409 or 375
PARCEL:
PLAN REF. L.C.14426
8
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ry