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0014 BRANDYWINE COURT
iy 8��d��� C� �V*per, Application number �6 S® Date Issued.... ...... ... ...................... BAA XMIN 8 M RE I 12019 Building Inspectors Initials..... p �FDMA'� Dn1c ff`` ...b.............. Map/Parcel .........Q. ..b.....�.2........................ ® �S, TOWN OF BARNSTABLE � EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /L/ 1-3c ,,Jy Lj V1)f- NUMBER STREET VILLAGE Owner's Name: 3r;&, -`�vn n Phone Number g s 5��fc-c�z O Email Address: ho*croSs an a cn.A:I.co Cell Phone Number Project cost$ Check one Residential ✓ . Commercial OWNER'S.AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 1eP 4c cf,4 c gA-tr,a,-4- Date: TYPE OF WORK ❑ Siding U Windows (no header change)#L_3_❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to tJOLS�P Ma�«.�e.•- — '^,c����r. U� CONTRACTOR'S INFORMATION Contractor's name � LJ r �rQ�'3oSfon Home Improvement Contractors Registration(if applicable)# LY2f2-P2 S (attach copy) Construction Supervisor's License# 0,7 ? 7 7 L- (attach copy) Email of Contractor Phone number 7 b%1 — ALL PROPERTIES THAT HAVE STRUCTURES OOER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. IAPPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL,/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOVVNEIt'S LICENSE EXEVIP'ITION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date LICANT9 S SIG'NATM Signature _ Date All permt a 'ons are subject to a building official's approval prior to issuance. n .- Wlndow.WbAd.-Oi oston IViillltcHasllratlon �Qj�/.'. •aNl�e$;.&Slho�irgoins, N�rohe- lix-Cum ltlltigb .Msotd'Qe1t,Stre91` ij.950 psto'jjTO. plh"e. 1880$5: Fedar@61P(h i W.otiiQtl;MA,•b1Bgt : dttiroxel,trlAd23¢� hi$v9$J7l1ry;MA0154g:; dD84S2' {7aj);MPla s (16 e2t)•62ay t l)s{eg6asie ^� "tvY�wlJ+triiiovNVotlitq)Qoblo'ri,,.tigrrj + .,:C11stQiftQr`:•�2iei�1 •L:ru1F11J �Phone(li}', = 3 (5(yr Y�:yi1}.?� ;giaie::Mtii�p. ti�31_e_ u1 1QI�r►tnsa�L�+n id,am :WINff.OWWO LO, QLAS¢:OPT}qNS zsA50 o0soliesrieehyafwenr ig4s° .,2,, orerzoiia��De,=:ounti'aF:e,` # _20o8Seifea;[2HhfI*atd �� y arl@82 HAilSketd' f284• ljTdP}e}'i. S?QQ 1300pS9fieskiAlltA1@rd 5309�_ WINDOW CP710N3 + 21It9$1(d6t �� _�plass'B're&.a ViatrenN(/i100160Qgj 515 y1CLURED' al)tai jf¢taY lvi�awi pMia;iiv ,�' 1 _ .r4eM6 gg'flVftllDEO+ �P.Iqure%5bsetlLll9'(¢9a:Ul)' $419: i,...:. 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Uyerlueyeon e} }.ranpc 1.na; I m@ p!4r a'_ n 0 obthd f npMacyatler e A eall1m nnsaeU d. ; Nullee;cicenEeUsllenriwcl.�d.14 I�1nttpbftmarkc4.ct.latdt.Nidgild'. blA11R4:M�1n01_,iQ•tipilnea�;d>1}r- 1 nUcItsalr bld mach 6'P O -on tin:NG f Itrtme hMtVJiadpiYyf' lat.-.. •. :•- Ofera �pn fliliirnmarry 6teelc4A"g4:'y6 .ri ttareto�r.Cq r _.piMnp.!!m�!41•enklpar�y-•Dole 'Or4na}:Oorfati Itunre'Ciidr,yOlenKtpdfy�.;'o'ate . . . worn�•r; lYl�o'COpy;d)attpl �'4!�ii'�roP�f.� VeYjFypy:q¢tlojer. :� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards onstruction Supervisor CS-072772 Expires: 04/07/2020 JEFF C STEIEI 24 SHERWOOD AVE , DANVERS MA 01923 Commissioner r'/%/%1 ((Y:N/%IIRI/I/lPIIII�f/'�'f((N.iCI</IIIJP'��: Office of Consumer Affairs&Molness Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC RggIWXatfon EX19m Son 1t 25 04/11/2020 _ WINDOW WORLD OFOOSTON,LLC. JEFF C.STEELE �fc.CGQ -- 15A CUMMINGS PARK WOBURN,MA 01801 UntieMWetary The Commonwealth ofWassachuseas Departiveni of ndustrial Accidents I Congress Street, Suite 100 Boston AM 02111-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERXvIITU iG MHORITY, _Applicant Information Please Print Legibly Value (Business/Or;aruzation/Iadividual):/_-//� S�oi► / fr.o L/1r �gA u/ii�aw c✓y�a(d Address: 15 f} Ct Y_n ry",in City/State/Zip: Wnbyrli M Phone#: 7,?1 - 19 ; Z-�(ZS :ire yoy an employer?Check the appropriate box: Type.of project(required): 1.(LtJ7l/I am a employer with_employees(full and/or part-time). 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3T�I am a homeowner doing all work myself(No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 3. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.: o.❑We are a corporation and its officers have exercised heir right of exemption per MGL a. 1 ther !N il��r✓ 152,31(4),and we have no employees.[go workers'comp.insurance required.] r 4ce,..,e— 'Any applicant that checks box#1 must also MI out he section below showing their workers'compensation policy information. Homeowners who submit this.affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ram an employer that is providing workers'compensation insurance for niy employees. Below is the policy andjob site information. Insurance Company Name: A S3a6 o-led El`olu�/P r 5 Policy#or Self-ins.Lic.#: .Wa c-"-5/DD- So / (i10 ri- Z D l 9 Expiration Date: L/—_�. Z O Job Site Address: /`1 /?��nd y t./Y/t r_4 City/State/Zip: M Attach a copy of the workers'compensation policy declaration page(showing the policy number d expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the Aolator.A co n this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific "on. I do hereby certi and he pa'is a enalties of perjury that the information provided above is true and correct Signature: Date: — g Phone#: 8 g Official use o not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i r aTECERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) 03/26/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: amy roberts AX M.P.Roberts Insurance Agency Inc. AICNN Ext: 978-683.8073 A/c No): 978-683.3147 1060 Osgood Street North Andover, MA 01845 ADDRESS: amy@mprobertsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA: WESTERN WORLD INS COMPANY INSURED INSURERS: MERCHANTS INS COMPANY L 8r P BOSTON OPERATING,INC INSURER c: ASSOCIATED EMPLOYERS DBA WINDOW WORLD OF BOSTON INSURER D: 15A CUMMINGS PARK WOBURN,MA01801 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCLIIL IIENERAL LABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTET- CLAIMSaIAADE Fx-1 OCCUR PREMISES a occunence $ 100,000 MED EXP(Any oneperson) $ 5,000 A NPPS525379 04/05/19 04/05/20 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OPAGG $ 1,000;000 OTHER: $ AUTOMOBILE LABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED x SCHEDULED MCA1002569 04/05/19 04/05/20 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NONLOWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LAB CLAIMS-MADE AN065362 04/05/19 04/05/20 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBER EXCLUDED? NI N/A WCC-500-5018609-2019A 04/05/19 04/05/20 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP ENTATNE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ate - Map v 7 Parcel V `' Application # c) Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee C • DlJ l Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village (A�u.I Owner 8lziAh) Address _'94A165' Telephone 271 _s41 -3 11 Permit Request IAlL& b7r U(tN- 0 F["-tCe A- awy,,Sr, RUdhh 19 4-TH- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay Project Valuation�10 ,00 Construction Type. .Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Q�, Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes CiLNo On'-Old Kin-g'p Highwa�. �0 s fJ�No Basement Type: Wull ❑ Crawl CkWalkout ❑ Other Basement Finished Area (sq.ft.) °��0 Basement Unfinished Area (sqr) Number of Baths: Full: existing_ new l Half: existing new Number of Bedrooms: existing —new trl . Total Room Count (not including baths): existing �v new �• First Floor Room Count Y Heat Type and Fuel: $-Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Q9-No Fireplaces: Existing I —New' Existing wood/coal stove: ❑Yes Flo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:Wexisting ❑ 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 _� �e l�� Telephone Number 77g( 3S3 v6}7X Address License#_ Y nu' O(ktR/ ri- AA C)A7 Home Improvement Contractor# Email 1, U3Q waiconceptA e h Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i flI _U01 __ SIGNATUR DATE f S , FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED �. MAP/PARCEL NO. 4 r ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: t FOUNDATION FRAME I© S INSULATION 1 31 t3 FIREPLACE r ` iy IL ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL F GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. k .. f _. •� Town of Barnstable t Regulatory Services Thomas F.Geder,Director BWIding Division Tom Perry,Building Commissioner 200 Main Stiff Hyannis,MA 02601 www:tnwn.barnsfable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must •Complete and Sign This Section If Using;A Builder Ida as Owner of the subject l property hereby anilLorize to act on rap behalf; in all matters relative to work authorized by this building permit (Addres of Jo ) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are petfornned and accepted. S of Owner Signs licant zip(- u rOD A- Print Name Print Name Date Q:F0RMs:0wriExPERM=0NP00J-s s2012 _ The Commonwealth of Massachusetts Deparbnent oflndurtd&Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass govh a Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Basinesslownization/Individual): rL/ "�� Address: )Lg 6) 6 City/State/Zip: PubA)q dM S Phone#: .56 J, �p Are you an employer?Check the appropriate box: Type of project(requited): 1.❑ I am a employer with 4. ❑I am a general contractor and I employees(full and/or part time).* have hired the sub-contractors 6 ❑New construction 2.Wain a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working fur me in any capacity. employees and have workers' insurance.t 9. ❑Building addition coinP• [No workers'comp.insurance ] 5. We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repass or additions myself [No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[:] Offer comp.insurance required.] *Any applicant that checks box#1 umst 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. tContractws that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have e¢rployees,they most provide their worker;comp,policy number. I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �y (�1`Gan4, k'i C.Ae �Jt`� City/StatelZip:_ GOT�IT Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi n the pains and penalties ofperjury that the information provided above is true and correct. Date: Cone#• -7W ial use o . Do not write in this area,to be completed by city or town ojklal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - -[* B sachusetts-Department of Public Safety L _ d of Building Regulations and Standards Construction Supervisor F ` License: CS-075746 1 I♦ �. REY L WRAG - - EEIY ST. uth Port NfA 02ExpirationCommissioner 09/20/2015 License or registration valid for individul use onlyAINOffice ofsu �'u�,ro�u«a/�/ � r/«��J . before the expiration date. If found return to: Consumer Affairs&Business Regulation Office of Consumer Affairs and Business Regulation — OME IMPROVEMENT CONTRACTOR g egistration: 149773 10 Park Plaza-Suite 5)<7D Type: Boston,MA 02116 xpiration: 2/7/2016 Individual JEFF Y WRAGG JEFFREY WRAGG 54 EILEEN STREET YARMOUTHPORT,MA 02675 g � � va' withou signature Undersecretary r , 3a.a i6'—W 14'—O• r--� M RUN Y — li � i I3'A 3/4' I W-1 3/4 . m � � 1 a Ff I U Psi a Co lag I I I w'-0• la-o• DLIPTROSIDENCE FM LM DESIGN 1 � � 14 BRANDY WINE COURT GOTUIT, MA 8 WEST BAY ROAD 091 MtVILLA MA 0 „ EXISTING CONDITIONS PHOE 5�� � D r i �O ( B l � � o Z b El I $ I '° 0 I m -7,0 0 r 1-41= , Y D ��11 ti $ a $ N Ira I d� I � I b 1.3 ,a .l I� I£ I I I � I W-W W-v i I I D DUNN RESIDENCE Ely l 14 BRANDY WINE COURT FAME LM DESIGN � l COTUIT, MA _sH > � 8%VMT BAY ROAD OSTERVMLM MA O RENOVATION PLANS PHOM 508-420-17M I P 9a-o• 1a-o• u�-a ��_ - - Amon I5' 3/�• tv-1.B/$ CD I I - A I a Q�1 66 IL------ 1 I rT; I sr-u• I I 1 I DUNN RESIDENCE FINE DESIGN 14 BRANDY WINE COURT GOTU17, MA S WEST SAY ROAD OS I MALLA MA 02M PHOM„ EXISTING CONDITIONS �'2M i i i I6'-0• 14'-0• o z� C, oj -------------- EllN E g i z ID C! � O N P N 1 ® I � N Hm 4'-O• 1 I I 1 14'-& id-O• z4'-W o NN RESIDE GE FINE LINE DESIGN 14 BRANDY WINE COURT m GOTUIT, MA 8 WEST SAY WAD OSTERVMIA MA 02MB N RENOVATION PLANS PHONE r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 01 S Health Division Date Issued S 2.1%0- �(S Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project)Street Address II 2Ar wu.✓1 CO Village , A T Owner ei Address CWz-4— Telephone TY5—— S 1-1Ua'-eD Permit Request t-1 P//��� xs �Cs,o;S; K.kAc.) . 6,9¢ /z&x , � cJ� 6R2 €. r2 u ag_p X►� � ;.19 T cy 00 Q(lng KXw�IL)`! r'.f //�J a AC L&Z A_) ,y 1 N� Tf N�rw 5 Li fCl o ts. -4 fry Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Ile Flood Plain Groundwater Overlay Project Valuation l 5_Y3 Construction Type ; ' 1 s Lot Size Grandfathered: ❑Yes ❑ No If yes, attach upporting documentation. Dwelling Type::,Single Family ❑ Two Family ❑ Multi-Family (# units) -, Age of Existing Structure Historic House: ❑Yes ❑ No On Old King Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1,�,;� [ �-�.� �� Name p _ vLSS Telephone Number /� 2 / Address 9 ( 5 26e� License # (Z J —0 J kvz,� 044, GAS-'Cow Home Improvement Contractor# 166c36 Email Worker's Compensation # �oC 5 3/ " �1�/ 7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1^ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. F. ADDRESS VILLAGE OWNER z DATE OF INSPECTION: FOUNDATION I' FRAME 6 SIZ?AS INSULATION a —5-h-4 1S' t FIREPLACE ELECTRICAL: ROUGH FINAL z PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO.. r The Commonwealth of Massachuseds.. Print Form . Departtnent of Industrial Accidents: ' Office of Investigations 600 Washington Street Boston, ALL 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �� C City/State/Zip: 5)}-C 19wt(1(L� Dtf lN� hone #: 5� e 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 k have hired the sub-contractors 6. ❑New construction employees(full and/or part-time).' 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y p n' 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] . 5. ❑ We:are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers,have exercised their I L❑Plumbing repairs or additions myself. [No workers'.comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J— Sr SVLVZc►nc`c alc) , Policy#or Self-ins. Lie.#.:I,e)C, — 3)S— 362296el—a2 Expiration Date: 7_3/, Job Site Address: f '7 � ;�ft� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date): Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties.of.a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under d p and enalties perju tl:at the informatiofi provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: DATE(MMIODIYYYII A COOR a® CERTIFICATE OF LIABILITY INSURANCE 9/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTAM PRODUCER DOWLING&O'NEIL INSURANCE AGENCY INC NAME: 973 IYANNOUGH RD PHO N A No): PO BOX 1990 MIL HYANNIS, MA 02601 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURERS: CAPE& ISLANDS KITCHEN&BATH REMODELI.NG.INC INsuREIR c: 99 STATE ROAD ROUTE 3A SAGAMORE BEACH MA 02562 INSURERD: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: 21723685 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 WFTH 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR SUER -POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MIDO MID COMMERCIAL GENERAL UABILnY EACH OCCURRENCE $ DAMAGE To CLAIMS-MADE MOCCUR PREMISES Ea occurrence $ MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO-JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SPIGLE LIMB $ Ee accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROP AG NON-OV,NED Peracci nt $ HIREDAUTOS AUTOS Is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADEJ AGGREGATE $ DED REnTTTION r I _ $ A WORKERS COMPENSATION WCS-31S-369904-024 7/32014 7/3/2015 J srEAruTE ETH AND EMPLOYERS'LIABILITY 500000 ANY PROPRIETORIPARTNER/EXECUT1VE YIN N E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? a N/A El.DISEASE-EA EMPLOYEE $ 500000 (Mandatory In NH) Ity85,describe under EL.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlona)Remarks Schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA This certificate cancels and supersedes all previously Issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 21723685 CLIENT CODE: 1788572 Anne Chandler 9/25/2C19 9:15:16 AM (EDT) Page 1 of 1 �e�omvi�ca�acuen•�a�C�a�ac✓zu�eC!a�/ F�`4. . ffice of Consumer Affairs&Business Regulatiiju License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,? Office of Consumer Affairs and Business Regulation WE egistration_ 1:6:Q266;_ ? tE 10 Park Plaza-Suite 5170 texpirati.n:=7 / 0.16 �.1 sup�z; inent'l and on,MA 02116 Cape&Islands Kitchdn&0hsAem_odeling Inc M� 7 _ rev; .._ t #;;_� WILLIAM SCHMITZ -'. 99 State St. Sagamore Beach, MA 02562 Undersecretary Not valid without signature Massachusetts -Department of Public Saf6ty Board of Building Regulations and Standards Construction Su.pe-<-yisor License: CS-076571 WILLIAM L SCH)dT 66 CARAVEL:DR HATCHVILLES 92, Expiration Commissioner 09/09/2015 Apr 08 15 04:16p Cape&Island Kitchens 5087751162 p.6 J • Blue board and plaster walls and ceiling. • Provide Durock on walls in shower. • Provide Hardi Backer underlayment throughout bathroom floor. • Provide all interior trim in bathroom. - • Install all owner supplied fixtures such as towel bars, toilet paper holder and towel warmer if selected. • Hang mirrors or medicine cabinets. No allowance in this proposal. • Install all matching granite pieces in shower to match vanity top. • Supply and install custom shower doors_Allowance: $2,500.00 • Open wall at wet bar for plumbing access. • Make all necessary wall repairs. • Replace baseboard molding as required. • Clean work areas each day. Not included in this proposal: • No cabinets or tops. No appliances. • No painting. i Total job: $51,593.00 Payment schedule: • Retainer received: $500.00 / • Payment required upon signing contract: $10,000.00 V • Payment required upon completion of kitchen and bathroom gut. $15,000.00 • Payment required upon completion of rough inspections. Plumbing, electrical and building:$10,000.00 • Payment required upon completion of all plastering and hardwood floor delivery:$11,000.00 • Final payment due upon completion of work: $5,593.00 We propose to furnish material and labor in accordance with the above specifications for the sum of TOTAL OF$51,593.00 In the event that it is necessary to pursue any legal a i n to collect any outstanding balance the customer shall be responsible for the total balance plus all I osts. ACCEPTANCE OF PROP S SrGNATURE _Y DATE Cf (: l Michael Heinrichs Project Manager 3-28-15 C#774-208-2362 i r Apr 08 15 04:15p Cape& Island Kitchens 5087751162 p.4 -4.4 e CAPE&ISLAND KITCHEN AND BATH REMODELING INC. 99 State Road,Route 3A Sagamore Beach, IAA 02562 Phone: 2 Fax 1442 - Contract Date: 3-28-15 To: Dana & Brian Dunn 14 Brandywine Court Cotuit, Ma. Dana -#845-558-4016 Brian#845-558-4020 Cape& island Kitchen &Bath Remodeling Inc. will provide the following renovations as per plans provided. Included are as follows with respective allowances. Plumbing: Kitchen, Bath&Wet Bar. • Disconnect all existing plumbing in kitchen. • Cap pipe for clean installation of cabinets, • Provide all new connections with shut off valves. • Provide new water line for new frig location. • Disconnect all existing plumbing in bathroom. • Remove existing tub completely. • Relocate wet wall plumbing in shower, • Toilet allowance: $400.00 • Vanity faucet allowance:$300.00 • Shower valve, trim and hand held spray allowance: $750.00 • Sinks: Included in other contract with counter tops. Kitchen faucet allowance: $400.00 • Bar faucet allowance: $250.00 • Provide all rough and finish plumbing connections for wet bar. Provide new shut off valves drains and water supplies. • Connect wet bat to vent pipe. ' Electrical: Kitchen, Bath &Wet Bar. • Provide all necessary receptacles in kitchen as required by code. Optional plug strips under cabinets. • Provide all electrical connections for owner supplied appliances. • Install all owner supplied track lighting in kitchen. • Provide proper appliance circuits. Apr 08 15 04:15p Cape& Island Kitchens 5087751162 p.5 • Provide arc fault breakers. • Install all appliances. • Supply and install [3]4' recessed lights in soffet in bathroom. @ $180.00 per light installed w/dimmers. • Supply and install [1] Panasonic Fan/Light combo as close to shower as possible. Vented to outside. • Provide proper GFI receptacles in bathroom as per code. • Provide receptacle in drawer as per request. • Install owner supplied sconce lighting. • Provide all necessary receptacles above counter top at wet bar. • No service panel upgrades at this time. Kitchen Floor: • Pre finished hardwood_ • Somerset. • Wood: Oak • Size: 2 '/4" • Color: to be selected. • Material allowance: $5.30 per sq. ft. Kitchen backsplash: • Tile allowance: $8.00 per.sq. ft. allowance. • Grout Once Sealer provided. Tile to be selected from Best Tile if possible. Bathroom tile: • Shower wall tile allowance: $8.00 per sq. ft. • Shower floor tile allowance: $20.00 • Bathroom floor tile: $8.00 • Grout Once Sealer provided. • Deco.tile: Not included in allowance numbers. To be priced if selected. • Install recessed niche in shower area. • Supply and install Nu Heat floor warmer in bath. Allowance With thermostat: $700.00 General: • Provide all necessary permits and fees. • Provide 20 yard trash container for al I waste. • Remove cabinets and tops in kitchen. • Remove all existing appliances. • Remove existing floor in kitchen. • Remove all necessary wall board in kitchen. • Frame in pass thru. • Supply and install new kitchen window. Shorter window above counter top. • Keep existing.shutters..Trim exterior as required. • Remove existing French Doors. Trim opening or plaster. To be decided. • Plaster all necessary wall repairs in kitchen. • Install oak flooring. • Cover floors upon completion for protection. _ • Coordinate installation of kitchen cabinets. • Re trim pass way door to kitchen as well as interior of new window. • Provide base board moldings to match where necessary. • Coordinate delivery and installation of owner supplied appliances. • Complete gut of bathroom. • Frame shower as per plans. • Frame in floor in place of existing sunken tub. • Insulate exterior wall and interior wall where possible for sound. Jr in-vY or Sw,r•wt. .Rob It O erpn� ��G,�/ ♦ _ F f:1 N q ia�k.dT�or• caB.�� / � . nz dV4Adier n . ��G✓Lt, �w7o ; y ... 3 Th rrr 0••0'0 $974 IS, I 35' 508.888.4762 SAGAMORE SHOWROOM ' 50&a33.1442FAX DESIGNED FOR: RANGE MICRO D.W. 99 STATE RD..RTE.3A SAGAMORE BEACH,MA 02562 508.775.3664 HYANNIS SHOWROOM DESIGNED BY: COOK TOP HOOD REFRIDG 50e.77s.r16zFAX DATE: APPROVED BY OVEN COMPCTR SINK CAPE. ISLAND I63 IYANNOUGH RD.,RIE 28,HYANNIS,MA 0260I K I T C H E N S WWW.CApOUTCHENS.COM 135" V. W3615-24 OFLS384-24 . 2430-15 2430-15 OFLS384-24 OFLS38 -24 O M O 1C212484L BC212484 0 0 CYE23TSDSS 0 0 DB24 DB24 0 0 RFR84L WD All dimensions-size designations Paul Savage This is an original design and-mu.st Designed: 3/17/2015 given are subject to verification on Cape Island Kitchens not be released or copied unless Printed: 3/17/2015 job site and adjustment to fit job cl.508-776-6717 applicable fee has been paid or job conditions. of. 508-775-3664 order placed. psavage726(a msn.com Design with beams^4 El 5 Drawing#: 1 No Scale. 7. W3012 uu W1830L W2430 JVM7195SFSS d � O I BC212484L o 0 0 CS36SW§S R BSP P2S'92OSEFSS DS24 FF All dimensions-size designations Paul Savage This is an original design and must Designed: 3/17/201.'5 given are subject to verification on Cape.-Island Kitchens not be released or copied unless Printed:3/1.7/2015 job site and adjustment to fit job cl.508-776-6717 applicable fee has been paid or job conditions. of 508-775-3664 order placed. psavage726@msn.com Design with beams^4 � - 135'° , 50 2 ie 31 8 ee 8 I� 00 L ANCVAL36 USF330 W2430 W2430 VV2730 US 330 M o 0 0 o D o ' V o o DB27 SD4060DSS CN I YSB30 TBI 8KSB CB36SWSSR 41 All dimensions_size designations Paul Savage This is an original design and must Designed: 3/17/2015 given are subject to verification on Cape-Island Kitchens not be released or copied unless Printed:3/17/2015 job site and adjustment to fit job cl.508-776-6717 applicable fee has been paid or job conditions.. of. 508-775-3664 order placed. psavage726@msn.com Design with beams^4 El 3 Drawing #: 1 Nn 'Qf-nl> W2430-15 W2430-15 W3615-24 N C212484 4 212484 ';� I a caed o OFLS384- FLS384-2 Chan opening 30 :I 9 p 9 to " _ LS384-24 plus casing Overall 35" N U) I R84L WD o M N (0 'm 24" 24" 24" 19" `~ .:s. 'ws U) LL e s?: d o 0 co J m CNTYSB3 TB18Kr SF SK SD4060DS DB27 2 OL W2730 =InL24 W2430 USF330 29B; USF330� 531" 31 a1 I 50a" 135" All dimensions -size designations Paul Savage This is an original design.and must Designed: 3/17/2015 given are subject to verification on Cape.Island Kitchens not be released or copied unless Printed: 3/17/2015 job site and adjustment to fit job cl.508-776-6717 applicable fee has been paid or job conditions. of. 508-775-3664 order placed. psavage726@nsn.com Design with.beamsA4 All T)rn TT^ c J TOWN OF BARNSTABLE Permit No. -_______-_- BUZZ Building Inspector Cash -___--- OCCUPANCY PERMIT Bond ----__-___ ___�__ f Issued to ,CharlAs 13od/ell Address J ,' Loth?l, ' !1,�4 Brandy w'N%�-> Court, Cotuit Wiring Inspector ), f 'fv; Inspection date Plumbing'Inspector i ,W t " Inspection date Gas Inspector -- Inspection date XEngineering Department � � Inspection date Board of Health�J- —J t r�jl Y— 2 � �l Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED/BYITHE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND'IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. -� oe Buildin ,,Ins ector _ r Assessor's map and lot number .... �i/." ............. J, P�Of TN E Sewage Permit number .0. ...... Z-Y..g................................ SAPSYSTEM TIC SYS�'EM MUST BE House number ........:.....I+............................................... y STAU 7 6N C0PA. LIANOE 0 16 a sAUST&BLe00 r�zr• 39' _prc;_ :7 MAY�►'. TOWN OF BARN, -aL �ANDBEe,� BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ................... .........�1 1.1. .. .�'1. ......%Aj.........l. G?......... TYPE OF CONSTRUCTION .........k. .".�................... .......41 ........................................ ......... ....................... . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .r{!.J'..........b.ki..........'................................................................ Proposed Use ............ ....................➢`f.!C9.................................................................................................................................. R.� Fire District .............w Zoning District ..................................................... .................... ...................................... 11**a�ttee rr '' a���� .............Address rr__PP� Name of Owner ... Qlt.W...T�. ���!���.�. �..!P�7.. ....S�s.........1�..:�:.�T. Name of Builder .................... .............Address ......... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms . .......�y.......:...................................Foundation 8. �� �.1 ./ ........... ............. .................. Exterior ..'R-TJJ...... LYRk......� -J -OW ..........Roofing . .... 444.... �!�S........................ Floors ......................................................................................Interior .................................................................................... �P£. 7 a -S 3 HeatingPlumbing.............. ...................................... .................... ...................................:........................ Fireplace ......................1. .::... ................................................Approximate Cost ........ � ' Definitive Plan Approved by Planning Board -----------____---------------19______ . Area .......................................... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ... ......................... .. .................. . ~ � a ................. Permit for. .................................... � . ' -------------.------------.. '~ ~ - ' ^ Location ................................................................. � ' --------.-----------------.. ` ` Owner ---------------------- ' Type of Construction .......................................... . ---------'r--' ' ----- - � � -------.� � Plot ............................. Lot ----------' ' /Permit Granted )� ' .lV ` ----------���-' ' . Dote of Inspection ..................................... ' Dp*a Completed _--------���`--lg _ ^- _ ~ - ' - ^ - ~ .. _ . ` . ~� - . � ` ` / . - A .or's map and lot number �TNE //a1 •/r............... I�• t &ewage Permit. number ............................. Z BA"ST�LE, i ,House number .........�...1„ ....................................................� %� 9 cram'"' op i639.d\0� �'O MPY ' TOWN OF BARNSTABLE BUILDING - I`NS,PECTOR APPLICATION FOR PERMIT TO © .s��� C- ., .1Y�... .1 ...`."' \1eS.� . ..... .0 ..' TYPE OF CONSTRUCTION dT... 1 .......w0C:�.C.. .:.......................... ..!..................19. 0� TO THE INSPECTOR OF BUILDINGS: ? The undersigned hereby applies for a permit according to th following information: Location .. ? ...........1.1......... ... ..C.��.C.C..5...'.......... �� � c e ProposedUse ... ....... .......................................................................................................................................... i ZoningDistrict ........................................................................Fire District .............................................................................. \\ \ \1 c Name of .................Address Name of Builder'`VJ��iGLer��D�.`... eat` .1.p..:..Address�4? ..a�.P. .�1�11?. ..1..1Ja.C. ..l�l.C1.l��....!`..1�!�^ �.Name of Architect ..... .1...�.. E?.-`�...... ...... ..:Q!►.'!:�............Address ...............................................:...........:........................ Number of Rooms .....7.........................................................Foundation �...�!4l� `�... U�..� �� � Exterior R`.�E.7�,QCl 0Jq .b.�'..r. S................Roofing .. ��v\. e Q{� Cl 2S�............... .... ... .. ...........: �a o Floors C / /�£T....................Interior ........> J... L .,......!....................................... Heating ........ Plumbing ................ .. i .�........................:.... t...................`........ ........... ......:�............... 5 oo Fireplace ................... ..............................................................Approximate Cost .................................�.............................. .. Definitive Plan Approved by Planning Board -----------_-__--__-_ / -3..� - 19 ---. Area .................................... Diagram of Lot and Building with Dimensions Fee L[ SUBJECT TO APPROVAL OF BOARD OF HEALTH �6 . vl 113 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tow of Barnstable regarding the above construction. Name. . ........ . /1....................... ?� -- - ' 4.l44_. permkfor _Oue_.1/2_St�ry ` . Si a�i bwellio ` ---�����...������.��----.���9`----.. Location ..Lmt-�7l_..l4.. ig�...{�oart ] ----.. ---------------. . / ' �> C���leo I�o���lI Owner -,.' . - ' � `��---~-------------.'- ~ ,\ Type of Construction ..�����--------- --------------------------. ` Plot ............................ Lot ................................ ^ June 17' 82 Permit Granted ---.,---_-----]V _ ~ ' � Dote of Inspection ------------lg . Date comp| � -~ ^~ ^ ~ ` ' . > ^ ^ ` ~ � ` � ' � \ `~ �� ^ ' ~� �U/ /�7„n[�........ ......... THE r Assessor's_ map.and lot:number /f' �o c� Sewage Permit number ``Q o SARISTAXLE, i klouse number ....:....y.,., �...................................................5 9000,1639' • .. � .. 'EO MPY p' .TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 1...:Or11c l)C •, ;1.Y�G �,�Je.• i•C ..;...1•C•P•• t TYPE OF CONSTRUCTION d5 •,\"� CJ�.V.! ....... > �r�r,A, C: 1M("............. .............: TO THE INSPECTOR OF 'BUILDINGS: The undersigned hereby applies for a permit according to the following\information: Location �O 1.........ICE( .Y\ '......... ProposedUse 'i��C,1r�P_Y� C. .................................................................................................................................... ZoningDistrict ..nn................................:....................................Fire District .............................................................................. Name of Owner`.,.,.. ?�.C``e cAw �1.................Address C�Q I,V�P n�� � Name of Builder'1.V,1! !1. - .aE'QW1,\. ....Addressl[>. ...'1.�. .,�,1,?P,S ?GI Name of Architect ..........Address .................................................................................... y ` Number of Rooms .....:/...........................................................Foundation Q.'%oC' \`\..... ��,c� ��C�� b o a....d.... R��� c e���� .ti ekes. Exterior S" �..�.............Roofing (. )O G / { }/L'/��� .Interior a �i_f �. Floors ............................ ..................................................... ............................................. Heatin ..............Plumbing ............. Fireplace ...................�..........................................................Approximate Cost .....i......... .�................................................ Definitive Plan Approved by Planning Board -----------______-----------19_______. Area Diagram of Lot and Building with Dimensions Fee ............................................. 'SUBJECT TO APPROVAL OF BOARD OF HEALTH / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......................... ............................ f '" BO.DWELL, CHARLES " p� A=56-4'2 n144 One 1/2 Story No ................. Permit for .................................... .......,S.ingle ............... Dwelling Location .Lot....U1...... 4 Brandywine Ct.` Cotuit .............................................................. Owner ...Charles Bodwell Type of Construction ......Frame ................................................................................ Plot ............................ Lot ................................ r Permit Granted ..........June...........1..7...,...............19 82i Date of Inspection ....................................19 a Date Completed ......................................19 i I Town of Barnstable *Permit# O•� Expires 6 months from issue date Regulatory Services Fie BARNSTABLK ® ' L.' T ` MAM v� 1639. 10�' Richard V.Scali, Director ArFD MA'S A Building Division Al' 2 3 2014 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY a s / Not Valid without Red X-Press Imprint Map/parcel Number 5 Property Address &ia c Q4 (p �o � Z Residential Value of Work$ ��(J'Il'D, `� Minimum/fee of$35.00 for work under$6000.00 Owner's Name&Address ) Contractor's Name K2b"� (' 463:69- 0 X_ Telephone Number Home Improvement Contractor License#(if applicable) Email: 4P L N 0, Construction Supervisor's License#(if applicable) C -7 b"_Z ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: �— ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is rmpired/11 SIGNATUR Q:\WPFILES\FORMS\building perms RESS.doc Revised 061313 G� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apulicant Information Please Print Legibly Name (Business/Organization/Individual): _00�4?,C {(1�9�(� �Z Address: 6or (or City/State/Zip: Q Phone#: 7 o 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2��I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13-2 Other comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby;erli �erlh�ep, �dpenallies ojperjury that the information provided above is tr e a d correct Signatur Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:. Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete 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. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Bosion,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia I 't • s�rrsresie, • Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize (��L°l^1 ��J' to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of J ) I ignatur of Owner ate LLlS We"5 � Print N e 4 If Property Owner is applying for permit,please complete the'Homeowners License Exemption Form on the reverse side. QAWHILESTORMS\building permit formAsmokecarbondetectors.doc. Revised 050412 Town of Barnstable Regulatory Services o4t Richard V.Scali, Director Building Division M . ' Tom Perry,Building Commissioner MAM 163 200 Main Street, Hyannis,MA 02601 6 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_pgrmit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. • � Y 4e L-7 To JOG � V 22z e o k >` SAP (camL',.4� AJL i r� Ca 010, \k ; O - 10 Ass = ;v VJ a 713,54 i Ar>f I �• C'. S. (3 ,i++af CERTIFIED PLOT PLAN LOB 7/ CUTc-l1:1 13 % �>,^ NEW CONSTRUCTION ONLY : _ Cv�-` l S y ! TOP OF FOUNDATION IS 21 FE 2W4�o IN ! ABOVE LOW POINT OF ADJACENT ho s S �.yo� .9AJool�� S �.�1 Ljlj �Il.�1��� ! ROAD. SCALE: DATE : G,% `31 -9 i i LDREDGE ENGINEERING CO.IN F�OAw �L I CERTIFY THAT THE /,.),,A,LiA & ✓ CLIENT SHOWN ON THIS PLAN IS LOCATED EOISTEREO REGISTERED JOB NO. = ON THE GROUND AS INDICATED AND CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY' ` � OF BARNSTA LE , ASS. T12 MAIN STREET CH.BY� J R 'E ' HYANt�I$, MASS. f / 0•82 �` �—�C—�.�' SHEET_OF DATE ,RtG. LAND SURVEYOR