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1593 SOUTH COUNTY ROAD
P � '93 S�u oo� �' t r C f C i O o ` - - - - _ __ Zo�� d33 � 3 � � � �� y � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION M O Parcel ` Application # I-7 ap r ace Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis . Project Street Address Village��?�i� V,I/� Owner -Se©17- r_*146IV Address /5"9 3 5, Telephone SOU - ,3 4P ;L 5-3 Q r Permit Request 4& G S& s�.c a� F�vu✓� CK�� ��' ff�e�,d rvp van . 40T.G.. keeyeJ <Y- ?61-rb+ Al-17cf71 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Avg Zoning District Flood Plain 0 Groundwater Overlay AQ Project Valuation f��lJ Construction Type 14A)o Lot Size a �-7�' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ) Two Family ❑ Multi-Family (# units) Age of Existing Structure 17 ' Historic House: ❑Yes ;kNo On Old King's Highway: ❑Yes*No Basement Type: V 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 A'Oil ❑ Electric ❑ Other BUILDING DEPT. Central Air: ❑Yes X No Fireplaces: Existing_.New Existing wood/coal stove: ❑Yes No Detached garage:)f existing ❑ new size_Pool: El existing ❑ new sizeJUN B.3n2Q11xisting ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ newTOsi%%'OFett"OrdST^h• Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes >k No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION C/�`� 7Z) (BUILDER OR HOMEOWNER) Name Telephone Number Address License Home Improvement Contractor# ' Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r. SIGNATURE DATE (U `� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. A ADDRESS . VILLAGE 4 OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION .- k FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL '. GAS: ROUGH FINAL 'FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. r 37ie Corr monivedth of Massachuseffs Departirrmrt o,f'1ndustrid Accidents - - Q -Ce 0f 1M. stigatioirs 600 Washington Street _ =y Boston,ALA 02111 • }4'FV1M1rr1AT�gt79�ll�lll star•leers' Campensaflum Insurance Affidavit Builder-,JCuntractursMectdrianslPhimbers Aliplicmat rnfm-m,afian Please Frint Le Name(B zgauim ion/)&yidaA Ay Address .3 ,4- /'d ,P AVC- City/Sta.& Phcn� Are you an employer?Ckeck the appropriate box: Type of project' (required).: I am a general contractor and I.El I am a employer with ❑ 6 ees(full and(orpart-time).* bavelvredthe sub-contractors . ❑New constrmctior3 2.P am a_sole proprietor orpartner- listed on the.attached sheet. 7. ❑Remodeling slip and have no employees . These sub-contractors have 8..❑Demolition wort ing for no in any capacity- employees and have woticere 9. ❑B.nildiug addition INo tzoders' comp.insurance Come-tnsuMMI regnired 1 5- ❑ We are a corporafion and its 1@❑Electrical repairs a additions 3.❑ I am a homeomner doing all work officers have exercised their 1 L❑Plumbingrepairs or additions. m,sdf[No kers'camp- right of exempfion per MGL 12[-1 Roofrepairs inmr ance rezEuir•ed]T c.152,§1(4�and we have no employees:[No workers' 13.❑Other comp.iasruance required-1 'Any applicsat6ratchecksbox$1tintalsofMoutthesectioabelowshadingttieir woffierecompensatioupoTicyimformsooaL #Hameownecswho submit this sf6da«in&cY _gtheyRmdoing-allwar£andthenbireautsideconimdorsmustsobmitanewaffid2v-tindi -53rCh rCaattactors 1Rzt checYthis bmc mast attached as additional sheet shoticmg the nmsseof the sub-cootrzcAw sand stsfe whether.arnatthose eatitieshave employees.Tf the iub-cantactom hive empioyee_%they:mustpmuidetheir workea'tomp.palkynumber. I am art eurpL r flail is pratzdirr1Q workers'conr;reresrdiiart irtszirruica f or rrz}�entplv3�e�s BeIory is the policy and joh site information Insurance Company:'Mania: Policy AtL or Self-ins.I1c.4 ExpirationDate: Job Site Address ��'��'3 'Sr) (/��;/�1`� f� city/Stawz p:��1l l AC#at h a copy of the wark-ers'compensationpolicy-dedaration page(showing the gouty number and expiration date). Failnre to secure coverage as requiredunder Section 25A o€MGL r 152 can lead to the imposition of criminal penalties of a fine up to$L50D d0 ar for one-year imprisonment,as we11 as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a dap against the violator. Be advised drat a copy of this statement.maybe forwarded to the Office of Investigations of the DIA for Mi surance c ge ideation. '.I do herby ca r rr:arder tliepaii arrd n afgarjuty fhatf7is for>gttr{iouprarir d abo��a is true acid correct Sit�ature: Date: �� r Phone i OfiSciid use only. Do not tvvrite in tlds area,to be compTetird by city or town 4o ffi eat City or Town.: PerrmtMicense# Issuing Amthority(circle one): L Board of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: — --- -- - -- - - - 6 oar mation and lnstxuctiois Massach=--ft Gd)amal Laws chapter 152 req�all employers Yo provide wotcc�s'compensationa far their ofhfiees. p m this fie,an ar�IQyee is defined as."_.epeay Person m.ihe service of another uauder any eoxdract ofhire, express or fimplie d"oral or " An ezzTloyer is def red as"an mcfividnA paxinersb�p,association,corporation or other legal eufity,or any two or more ofthe foregoing=gagedinaJoint ,,aad including the legalrepresmffatives ofa deceased employer,or the receiver or trost=of as iadividnA partnership,association or oilier legal entity,e nploymg employ. However the owner of a dweIIinghouse having not more tim three aputn.ents and who resides f =ia,or the ocaTant ofthD - dwelling horse of another who employs pemous to do maintenance,conskuction or repair work on such dwelling house shall of such employment be deemed be an employer_ or on the grounds or bunking appratmant thereto MGL chapter 152,§25C(6)also stems that"everysfate or local licensing agencyshaIlwithhald fh issuance or renewal of a Hcrose.or permit to operate a business or to construct bmldings m the commonwealth far any applicant who has not produced acceptable evidence of eompfiance with the insurance coverage required_ Additionally,MGL chaptrr 152, §25dM states=Nieither the commonwealth nor gay of its political subdivisions shall ester into any contract for the performance ofpablic work-umt3l acceptable evidence of compliance with the ias�=-. requm-me nts of this chapter have been presented to flie contracting authority." I APplic=-& Please fill o� the worker'compensation affidavit completely,by checIdag the boxes mat apply to your situation and,if necessary,Yopply sob-contractDr(s)name(s), addresses)and phonenumber(s) alongwAhtlieir cerifficste(s)Of ingorance• LimitedLiabrlity Companies(LLC)or Limitedl iabffity-Pa:Lta hies(LIP)wr&no employees other fhau the members or pacfneas,are not required to carry wDikers'compensation msurnce If an LLC or ILP does have empIoyees,apolicyisrequned. Be advised that this affidayh maybe snhmitti--dfo the Depa.-trnentof Indnsfrial Accidents for confirmation of finTlance coverage. Also be sure to sign and date the affidavit The affidavit should beTetnmed to the city,or town that the application:for the permit or license is being requested,notthe Department of LndnSftWJ Ar-ddea,ts. Shouldyou have any questions regarding the law or ifyou are reqused to obtain a workers' compensation policy,please call the Dep mtm ent at the n=ber listed below..Self-inslured campanies sh0 eater their s elf-ins-armmce license number on the appropriate line. City or Town OfE! aJs Please be sore that the affidavit is complete and prar:d.Iegi 1y_ The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office oflnvestigations has to coufactyouregarding tine applicant- Please be sin a to f M in the pen�itlIfcense manbm which will be used as a reference nummber. In.addition,an applicant that must sabnit multiple p=/Iiccose.applications in amy given year,need only submit one affidavit indicafing cogent policy information(if necessary)and umder`Job Site Address"the applicant should wnte"all Iocaiions in (may or town)-' A copy of -flit that:has been officially stamped or mau3ced by the city or town may be provided to the applicant as proofthat a void affidavit is on file for fitz'pemits or.Iicenses Anew affidavitnust be f (--d out each year.Where a home owner or citizen is obtaining a license or permit not related is any business or commercial venom (i.e_ a dog license or permit to bum leaves etc.)said person is NOT regoaed to complete this affidavit The Office of Invesligahons would like to thank you in adsmce for your cooperation and should you have any questions,. please do not hesitate to give ns a call The Departunenfs address,telephone and fax mmaber: f ommm qe Sty of MassachuaaE s ' IIepai�rnent ref lndn�ial Accidents . Off lce of TILve&figatio--� �Q,4��bing�n Sfz�et Boston=MA,0�111 TeL 4 617-' -4900=t 406 oar 1477 MA SSAFE. Fax#617`27 7M Kevised424-D7 asd_gq c a �IHE,, Town of Barnstable Regulatory Services 1ARNSTAaLE. • MA.S& �, Richard V.Scali,Director �'°rfDt�la'�A,O Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder t le I, s� � � �- �l ,as Owner of the subject property hereby authorize �/LC' u/e to act on my behalf, in all matters relative to work authorized by this building permit application for. /S 56v-7X C'o Llh lk /Z:2! (Address of Job) **Pool fences and alarms are the responsibility of the'applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applican Scc, I` LX k l e y Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services p4tKE Richard V.Scali, Director' Building Division aAretvsTnsie, Paul Roma,Building Commissioner � �: `�$ 200 Main Street, Hyannis,MA 02601 AtED www.town.barnstable.ma.us j Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. ' DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to -be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. . The undersigned"homeowner"certifies.that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 100.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a.licensed Supervisor.. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ,t—� .. C�/ e�p�rivrrca�ataec�llf a��aoac�ivaelta �\ Off Ice of Consumer Affairs&Business Regulation — HOME IMPROVEMENT CONTRACTOR s type: Individual - "'�-''11eaistration Expiration j — } 822 02/01/2019 Gregory M.Caijley Gregory Caul&y.yv_..� a: 33A Baxter Ave,,.. W.Yarmouth, 673, ` Undersecretary Massachusetts Department of Public-Safety - Board of Building Regulations and Standards License:-CS-009013 Construction Supervisor GREGORY M CAULEY 33A BAXTER AV r_ r W YARMOUTH MA 026Z3,�,�) �...v� CA— Expiration: Commissioner 05/11/2018 _ l i Registration valid for Individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 h - f i i I j Not valid with t signature f. . JI � Construction Supervisor Restricted-to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIPS Licensing information visit: WWW.MASS.GOV/DPS FORM B-BUILDING MASSACHUSE'1TS HISTORICAL COMMISSION MASSACHUSET'TS ARCHIVES BUILDING Assessor's Number .USGS Quad Area(s) Form Number 220 MORRISSEY BOULEVARD 097016 COtuit 3 `R ,•�11 BOSTON,MASSACHUSETTS 02125 Town Barnstable Photograph Place(neighborhood or village) Marstons Mills 17 Address 1593 South County Road Historic Name Bremner Bungalow e ;r ` `.""":•, " Uses: Present Residence ` Original Residence Date of Construction 1922 tt Source Barnstable County Deeds 386-322,376-524 Style/Form Craftsman Bungalow Architect/Builder Unknown;probably local Exterior Material: Wall/Trim Cedar shingle Sketch Map Roof Composition shingle "' Foundation Poured Concrete Outbuildings/Secondary Structures Garage NW .per Major Alterations(with dates) Solar room added 1984; "As Savo, Garage 1986; °t Sunroom added on south side c. 1993. Front porch enclosed and front door closed 0 off,c.2000. »mn c mmion inn � ui 0 5 et A Condition Somewhat altered from original o Moved 4 No ❑Yes Date Recorded by James W.Gould Acreage 0.77 acres Organization Marstons Mills'Mstorical Society Setting Rural,at junction of ancient road to Center, Barnstable.Historical Commission ville(now Bumps River Road)and Date(tttonth/year) August,2008 South County Road,connecting Marstons Mills and Osterville. Follow Massachusetts Historical Commission Survey Manual instnretions for completing this fonn. BUILDING FORM 150 South County Road,Marstons Mills,Barnstable ARCHITECTURAL DESCRIPTION ❑see continuation sheet Describe architectural features. Evaluate the characteristics of this building in terms of other buildings within the community. This is a one-story side-gabled Craftsman style bungalow,measuring 44 x 24 feet,with front porch fully enclosed and a shed dormer above. A greenhouse has been added at the south end. The exterior is shingle clad,with cream trim. HISTORICAL NARRATIVE ❑see continuation sheet Discuss the history of the building. Explain its associations with local(or state)history. hiclude uses of the building,and the role(s)the owners/occupants played within the cornrmtnjty. This was the smallest of three buildings,two houses and a garage,built on 2 1/3 acres for Osterville landscaper Alexander N.Bremner(d. 1962),and his wife Elizabeth Glancy,in 1922. The land without buildings was bought. by Bremner in 1922 from the sisters Frances and Minerva Baxter(Deed 386-322). It lay west of the junction of South County Road and the west end of the ancient road from Marstons Mills to Centerville, now known as Bumps River Road. Bremner was also a coal dealer in 1926-7. At Christmas, 1928,he played Santa Claus at Marstons Mills Liberty Hall. In the summer of 1929,Bremner rented his house and moved to"a portable house" across the road. At the end of 1929,Bremner,sold this house,its neighbor to the north,and the garage in between to his neighbor, Edward K.Davis(Deed 470-1.52)and moved to Chatham. Davis's chauffeur,Thomas Bertram Fuller(1895- 1973) lived here from 1930 to 1972. In the late seventies, it was rented to carpenter John T.Blokker(b. 1936)and his wife,Pauline,a nurse(b. 1946), who purchased the house from the Davis estate in 1978 for$35,500(LC C73934). Blokker added the 107 x 24' solar room in 1984,at an estimated cost of$8,000. The 26' x 26' garage was built in 1986 for about$13,000. A A greenhouse/sunroom was built on the south side about 1993 and the front porch enclosed about 2000. BIBLIOGRAPHY and/or REFERENCES ❑see continuation sheet Barnstable County Registry of Deeds. Deeds 386-322,376-524,470-152,LC 73934,Plan 13104. Town of Barnstable Building permits 26720(1984),97-106(1986). Interview with former owner Holbrook Davis,July,2008,letter from former owner Joel Davis,July 28,2008. Barnstable Patriot,Apri18, 1926,October 20, 1927,December 27, 1928,July 11, 1929. Interviews with current owner John T.Blokker,May 22,2008,August 7,2008. Interview with Robert S.Bremner,son of previous owner,August 6,.2008. i ❑ Recommended for listing in the National Register of Historic Places. If checked,you must attach a completed National Register Criteria Statement form. Follow Massachusetts Historical Commission Survey Manual instructions for completing this fonn. '`". -� i �l /� a 1 ' = —- I Town of Barnstable BARNSTABLE ST Barnstable Historical Commission www.town.barnstable.ma.us/Historical Commission NOTICE OF INTENT TO DEMOLISH APPLICATION SUBMISSION REQUIREMENTS ❑ Application—3 Copies Complete all sections of the application form including"detail of demolition proposed"and "type of new construction proposed" narratives. Three copies of the application shall be submitted to and stamped by the Town Clerk at 367 Main Street, Hyannis. One copy of the application remains with the Clerk, two copies shall then be filed with the Barnstable Historical Commission, at 200 Main Street, Hyannis. ❑ Supporting Materials—3 Copies ❑ Photographs Include photos of: Each elevation where demolition is proposed Structure from all abutting streets ❑ Site Plan A plan showing: All structures on the lot All proposed demolition, additions or changes to those structures Existing structure footprint Proposed structure footprint ❑ Elevations Detailed elevations of all building facades outlining existing and'proposed. An existing floor plans must be included highlighting,the areas to be j demolished ❑ $100 Filing Fee $100 fee shall be submitted with the application. Check made payable to the Town of Barnstable. ❑ $34.50 Advertising Fee The applicant shall pay the cost of the required two advertisements in the local newspaper. Check made payable to the Barnstable Patriot. ❑ Postage Stamps LLO) First class postage stamps are required for abutter notification. Commission support staff in the Planning & Development Department will provide the number of stamps required. ADDITIONAL INFORMATION • To prevent delays in processing, please provide all requested information with the application • The applicant or a representative must be present at the public,hearing Please contact the Planning & Development Department at (508) 862-4787 or contact Erin Logan at erin.logan town.barnstable.ma.us with any questions Planning & Development Department • 200 Main Street • Hyannis, MA • 02601 Application checklist 2017.doc ,.� BARNS LE Town of Barnstable Planning & Development Department Barnstable Historical Commission www.town.barnstable.ma.us/histodcalcommission NOTICE OF INTENT TO DEMOLISH A SIGNIFICANT BUILDING Date of Application ❑Full Demotion ❑ Partial Demolition Building Address: Number Street Assessor's Map# Assessor's Parcel# Village ZIP Property Owner: Name Phone# Property Owner Mailing Address(if different than building address) Property Owner e-mail address: Contractor/Agent: Contractor/Agent Mailing Address: Contractor/Agent Contact Name and Phone#: Name Phone# Contractor/Agent Contact e-mail address: Detail of Demolition Proposed: Type of New Construction Proposed: Provide information below to assist the Commission in making the required determination regarding the status of the Building in accordance with Article 1, § 112 Year built: Additions Year Built: Is the Building listed on the National Register of Historic Places or is the building located in a National Register District? No ❑ Yes 0 Property Owner/Agent Signature BHC Application 2017.doc Town of Barnstable Building s .n A Posth�s(eacdSoThatzit is wsib�le Front th Street-.Approved Plans Must beRetained o_n Job and this CardMusi be Kept • Unt�l�Final Inspection Has�B,een Made. ._ re Permit ,aocaR Where a Ceatificate of Occupanry is Required 'suehB.uilding5hall Not beOccupied u.ntil#a Finahlnspection hasbeen made. Rermit No. B-17-1701 Applicant Name: GREGORYM.CAULEY Approvals Date Issued: 09/27/2017 Current Use: Structure l Permit Type: Building-Addition/Alteration-Residential Expiration Date: 03/27/2018 Foundation: Location: 1593 SOUTH COUNTY ROAD,MARSTONS MILLS Map/Lot: 097-016 Zoning District: -RF Sheathing: Owner on Record: BUCKLEY SCOTT&.KAREN F NlffactoraNamW REGORY M CAUIEY Framing: 1 Address: 1593 SOUTH COUNTY ROAD Contractor�license CS 0090i3 OSTERVILLE,MA 02655 Est ProfectCost:' $40,000A0 Chimney: Description: Remodel House,Change One Bedroom into faster Bath,Add New � Pe mitF e: $254.00 � "' � �.. Bedroom Add New Stairs to Cellar and Attic wypart,dal fi�ni ed attic Insulation: ,¢Fee�Paid` $254.00 space,Add Smoke Alarms,Rebuild Glass Wall `Rebuild Deck with < Final: new Roof Structure Replacing Old One. a �j Date. 9/27/2017 Project Review Req: _ r Ltstrv�.� Plumbing/Gas Rough Plumbing: — Building Official Final Plumbing: ssuance. g w � d b ftou hGas: This permit shall.be deemed abandoned and invalid unless the work authonze this permit is commenced within six monthsafteri All work authorized by this permit shall conform to the approved application a approved construction documents for whieifth s permit has'been granted. `x Final Gas: stnu All construction,alterations and changes of use of any building and cturesfshalEM in compliance with the local zoning by�laws and codes: This permit shall be displayed in a location clearly visible from,access street orxoad,and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. _ .,__. . _. __ _._. :. x :. -- _ _ _ __ Electrical.% -' _- - k ¢� Service: The Certificate of Occupancy will not be issued until all applicable signatures by thexBwldmg and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All-Construction Work Rough: 1..Foundation or Footing x 3m g 2.Sheathing Inspection m 3.AllFireplaces must be inspected at the throat level before firest flue lining'is installed F' al: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) LowYoltage Rough: 6.Insulation Low Voltage Final: 7.,Final Inspection before Occupancy Health He I ._ _ a i Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A): Fire Department•= Building plans are to be available on site Final: ; All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O// Applicatio Health Division Date Issued . Conservation Division Application Fee V v Planning Dept. Permit Fee A20Y. JD Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address l S .3 50a i-A 66,., l Village 0!5 � �o /l E , Owner _Scu Address i %' 3 Telephone U a 3 der • - 1 0 Permit Request A u /S � 4 - A--d- ell zv A Ex/ s u n2 '�'ellds ®/W Squire feet: 1 st floor: existing. Cproposed r S8.2nd floor: existing _proposed Total newe BUILDING DEFT Zoning District Flood Plain Groundwater Overlay Project Valuation 000 Construction Type k/00P F/Z/h-m 4�5' JUN 012017 Lot Size o7 ; Grandfathered: ❑Yes ❑ No If yes, attachrs„r�p,ovira%do�c,upentaon. -Dwelling Type: Single Family )6 Two Family ❑ Multi-Family (# units) Age of Existing Structure\ Historic House:. ❑Yes ,WNo On Old King's Highway: ❑Yes *,No Basement Type: 'Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 1380 Number of Baths: Full: existing new Half: existing 0 new Number of Bedrooms: existing)dnew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas X Oil ❑ Electric ❑ Other Central Air: ❑Yes J No Fireplaces: Existing New Existing wood/coal stove: )fYes ❑ No Detached garage:X 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 0 Appeal # Recorded ❑ Commercial ❑Yes �C7 No . If yes, site plan review # Current Use D&7A)TZ4-4_ Proposed Use 4L---5/ 0t7(117*L APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address—ss-4 f7-U e License # 900 ' Home Improvement Contractor# L9 Email Worker's Compensation # �/— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 'F t I F. •+ FOR OFFICIAL USE ONLY ' APPLICATION # - DATE ISSUED - MAP/ PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: " FOUNDATION FRAME I' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH •FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I ' r • y he Commarrivealth ofMassadiusetts Deparhrrerrt Qfiyn&S—h ial Accideras �► - Q -Ce of 1MW igatiorrs . . 600 Washington Street -- , Boston,AA 02M tmi-s-,rturss govldia N[Tnr•kern' Campensaticm Insurance Affidavit BuildermIC"antracinrsMechiciansJPhrmbers Applicant Infarm,atian / Please Print Le 'bl Name�USIIIe�Ig3Ri�iflaDfL na} � L < Address-3- - Cityft ateJ B Phan lJ / Are you an employer?Checkthe appropriate box: ' Type of project(rufaire4: I.❑ I am a I am a general coat mctor and I 6. New consiaucfiion❑ employer(full and(or part-time * ❑Have hiredthe sub-contractors 2. am a sole etor ar rtnt'r- Tisted on the attached sheet. 7• ❑Remodeling These sob-contractors have slop and have no employees 8.,❑Demolition w Q for 7YIP is an employees andhave Wo&ers' o�+no y �`- � itisurant�l 9. ❑Building addition` . o odors camp.insurance coP- rewired] 5. ❑ We are a•corpmafiou and its lfl_❑Electrical repairs or adrifinns 3.❑ I am a homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or additions. Myself[No WWI'gip- right of esempfion per MGL 13_❑Roafrepairs inner- nce required-]Y c.152,§1(4k andwe have no employees:[go workers' 13.❑Other camp-iasnr m required.] #Any WHczateut rhecksbas M mn;t also Moutthe secdcabdowshvtdng diesvm&eie compenudanpoTuyinfarmsuaa- iffameoaraenwhosuborn[$isdfid=qiiaE=ngtL--Yaredoinganwaaicand.d—hireoutsidecontractors� submit anew affid2vkindi—inostul ICa=Rct=1ffi.t rhea this boor mast attached=addi6anal stet showing thenmeof lbe sdb-cam=ctDa&and stae whether or not those eaatieshaoe emplayem Ifthesub-caatractom have emptofee-%theymnurpmv'idetheir workea'romp.palkynumber. I arrt ara erxpIa r flsat i�r prm�din�markers'conrpertsatiarl ireszcratrca�'or rrr}�c�rrpio}�ees Beloav is Ae paalicy rod job rite irrformatiom Insurance Company 1£anre: Policy or pelf--ins.Iic. Ekpiratioa Date: Job Site Address I' L� f�/'f U�` CitylStawzip:62 4.e-C_: Attach a copy of the workers'coanpensationpolicydeclaration page(shaving the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A o€MGL c 1572 can lead to the imposition of criminal penalties of a finz up to$I,SQQOU endfor one-yearimprisoumeuf,as we11 as civil penalties in ihe fom of a STOP WORK ORDER-and s f me of up to$250-00 a clay against the violator. Be advised that a copy of this statement maay be forwarded to the Office of Imvestrgafions of the DIA€or instlaance covers vertion I do heraby ce&f-y rlud thapauis ar i so erj..Ury tliatfiie information proiuTed abo�s is&ue acid correct Sit?nattare: Date: / Phone OBidal usa wdy. Dn not&write in tli s area,tit be caWTetad by city artoml officiaL City or Town: PermibUceuse;g Issuing Authority(drde one): 1.Board of Health 2.Building Department 3.Citytrown Clerk 4.Electrical Inspector 5.Plumbing Inspector f.Other Contact Person: Phone#: ormation and Instructions Macc,��Cr-n=-A Laws chapter 152 m1ases all employees`Eo provide woiiceas'compensation far t3ieir=PIoyees. p to this fie,an employme is defined as."_.eveay person in,the service of another ceder any comrart Of hire, eSpresS OZ 1U3phe6,oral or writt ." An e7,T&yer is defiard as"an fndiyidnaL pmtaersbip,assOdalian,corporation or other legal ent'ty,or any two or more of the foregoing engaged in aJoint mterprisq,and including the legal aepresefatives of a deceased employer,or the receiver or trastec of an individual,partumsbiP,association or other legal entity, zplOYin9 employees_ However the owner of a dwelling house hav ngnotmore than three apartments aadwho resides themin,or the occ¢pant ofthe - dWellmg house of another who employs pemans to do mafntenan w,consfracfion or repair work on such dwelling house or on the gro-unds or budding app thereto shall notbecanse of such employment be deemed to be an employs." MGL chapt:nr 152,§25C(6)also sides that"every state or local licensing agmcyshallwithhold ffie issuance err renewal of a Tice-a a or permit to operate a bnsmess or to contract buildings in the comm oawealth for any applicantwho has notproduced acceptable evidence of c6mP112nce with the i„nsurance.coverage required-" AdditionaRy,MGI,chaptea 152,§25dM states-Neither the commonwealth nor lay of ifs political subdivisions shall enter into any contract for the paform.ancz ofpublic woricuahl acceptable evidence of complfancewith the msm-aac6.. reqLTHma3jents of this chapter have'Seto presenindtn the co*acting anfho4ty.7 Applfcaats ' Phase fill oht the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sob-contractor(s)name(s), addresses)and phone numbers) along with their cerbficat*)of instaance. Lmmite:d LiabR4 Companies(LLQ or Lfi itedLiabMty?mta tships(LLP)withno employees othea tb-an the members or partner are not squired to carry workers'compensation insOl-ance If an LLC or LLP does have =PIoyees, a policy isre#u Lc Be advised that this aftidayhmaybesubmittrdtutheDepatmmtofIndustrial Accidents for conf=ation of furor-ice coverage: Also be sure to sign and date she of davit The affidavit should beretnmed to ffie city or town that the application for the peanit or license is being requestE�,not the Departm.eat of LnAustrial A_cmdem-ts. Shouldyou have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,Please call tine Department at the number listed below. Self-im�ed companies should emir their ens self-insurance license number on the appropriatE line City or Town OfFscials t . Please be sore that the affidavit is complete andpriate .legibly. The Department has provided a space of the bottom. of the affidavit for you to fill out im the event the office oflnvesti gations has to comtact you regal ding the applicant. Please b e sure to fEll in the penmitllicrose maMber which.wffi be used as a reference n=ber. In addition,an applicant that must submit multiple pe�WHcense applications in any given year,need only submit one affidavit indicating „t p olicy information(if necessary)and under"Job She Ad&ess"the applicant should write"all locations is (citY or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proofthat a valid affidavit is on file:for future'peunits or liceuses_ A new affidavit must be fi]Ied out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial Tenure (ie_ a dog license or permit to bum leaves etc.)said person is NOT requires to con3Iet,this affidavit The Office of Investigations would like t o thank you in advance for your cooperation and shfluld you have nay questions, please do not hesftatE to give us a caIl_ The,Department's address,telephone and fax member .1 e C�a.nmo th of I chhusatb; . ..Degaxtment cif Iiid�ial A�i�.en� - f��e �4�asIaingtau Sty Boston.,MA 02111 TeL 0 6I7-727-4940 Qxt4€6 or I- 77 MASSAFE Fax#6I7=727 7M xevised¢24-07 mamas,- tgf i AWC Guide to Wood Construcdan in High Wired Areas:110 mph.Wind Zone Massachusetts Cheeriest for Complia.i ce(790 CM 5301.2.1,I.)' Q Cherk Cornplieace 1.1 SCOPE Wind Speed(3-sec.gust)..................................»...................._....._.........»....................... .110 mph Wind Exposure Category»._.._.»......._..__... ........»». ..._..... ...... .»._.................... 1.2 APPLICABILITY Number of Stories _ ........... (Flg'2)._..........__........... stories 5 2 stories Roof Pitch »._._».... »_»_. _ Mean Roof Height _.....................»_...__.............._._._..(Fig 2)_._.._....»_.__....:_._._._...._...._ft 5 33' _ Building Width,W._.._........_....__....._.»:».... __.._--.(Fig 3)............................ _ft 5 W _ Building Length,L ..................._............................(Fig 3)._.._....._»._....___....».._..»... _ft 5 S(Y — Building Aspect Ratio(LAY). _..........._..._.._... _.._»....._.(Fig 4). ..................._.»_..._._.»._... <-3:1 Nominal Height of Tallest Opening2................_.......___...(Fig 4).__..._......__.:........_.... _.._._» 5 6'8' 1.3 FRAMING CONNECTIONS General compliance with framing connections..».._:..»_.....(Table 2)..............................................._.._....... 2-1 FOUNDATION Foundation Walls meeting requirements of-780 CMR 5404.1 Concrete............................................... .........._......................._........................._............. _ ConcreteMasonry...................................... ...__.._»».._...._.. .... ..._ . ».. »_. 22 ANCHORAGE TO FOUNDATION' 5/8'Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only . Bolt Spacing-general.........................................(Table 4)._....._.._..............._......... . in- Bolt Spacing from endfjoint of plate ....... (Fig 5)....... _._._..._..........». In.!;6'-12" _ Bolt Embedment-concrete.._.._»...».»...»_..»..»._.:.(Fig 5)..._.._.._._....» __.._..._._...._in.;-*7' Bolt Embedment-masonry.».................................(Fig 5)._.._.__..._..............._. _.. in.z 15' — Plate Washer._...........»..»....:............_..................--(Fig 5).._.._.........._......................_.2 3'x 3'x'/s' 3.1 FLOORS Fioor.framing member spans checked ..................._...._.(per 780 CMR Chapter 55)...__........................_.. _ Maximum Floor Opening Dimension:....__.._................:.(Fig 6)....................._.._..�fts 12'or L/2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall...............(Fig 7)......._................................._...__._ft 5 d _ Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)........................._......................_ft 5 d _ Floor Bracing at Endwalis.......... .__-•---...... ..............._._.(Fig 9).».....................-................................ _ ._ Floor Sheathing Type ................................_..................._..(per 780 CMR Chapter 55)....... _ Floor Sheathing Thickness..._..._,. _..__»......_....».._.....(per 780 CMR Chapter 55).._..............._.. in. Floor Sheathing Fastening.__ ........._........_...».._..._...._:.(Table 2)__d nails at—in edge/ infield 4.1 WALLS Wall Height Loadbearingwatls...._..._ ».._....._.._..._..............»_..(Fig 1d and Table 5).........--:............ _ Non-Loadbearing walls....._.._................. .._..»..._..(Fig 10 and Table_5)._._.._........_....... ft 5 20' Wall Stud Spacing .......»»............................................(Fig 10 and Table 5)..... �........_in.:5 24'o.c. Wall Story Offsets ...................._.»........................_.(Figs 7&8)..........................:..........__ft 5 d 42 EXTERIOR WALLS' Wood Studs Loadbearing wails._.........»_..._._...._ .:........._.._ ._» _(Table 5)....................._.......2x - ft in. Hon-Loadbearing walls....._................. .....................(Table 5)......._................_2x --ft—in. _ _ Gable End Wad Bracing i Full Height Endwall Studs.........._. _..._......-..»».._.(Fig 10)........................................._.._............. WSP Attic Floor Length_.»........»..._... ..._.»_....... .._ (Fig 11)_.._.........__».»...»._ ...... ft>W/3 Gypsum Ceiling Length pf WSP not used)...___:.._,.(Fig 11)...................._.... _ft z 0.9W 2 x 4 Continuous Lateral Brace @ 6 ft o.c...(Fig 11)........................_.... Double Top Plate Splice Length ...........I.,......._.____..._._...._........._..(Fig 13 and Table 6) ..._...»....._.»_.....____ft Splice Connection(no.of 16d common nags) (Table ............. AWC Guide to Wood Canstruc n in Sigh end Areas:110 mph Wind Zone i Massachusetts Checklist for Coimpliance(7so CMR 5301.M.1)t Loadbearing Wall Connections Lateral(no.of endnaged 16d common nails able Non-Loadbearing Wall Connections J•.__..._.{T 7). __.__._.. .. ..... _....._........ Lateral(no.of endnaffed 16d common nails) _..__... (Table 8)._._........__.......... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans _.._.._..__ ._...._.._ _.._ (Table 9):_-,-_................... _it_in.S I V Sill Plate Spans _.._ ._.._:___. _. Pan _.(Table 9)____....._»_....._....., ft_rn.511' Fug Height Studs (no.of studs)__.�...____ _..__._.(Table ._......__. Non-Load Bearing Wail Openings(record largest opening but check all openings for compliance to Table 9) Header Spans_....._..__.»»......_......._.. ...._.....(Table 9)__...___._._ .....___ft in.s lZ Sill Plate Spans........_...�__..._. .........___..__._(Table 9)_..».._..__.. .__...... ft_in.s 12• ,___ Full Height Studs(no.of studs)._ ....__ .._ . _..(Table 9)... . ...._......_......._,._.... .... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 M-mirrrum Building Dimension,W Nominal Height of Tallest Opening ....... Sheathing Type.........__._�_...._..._...__......(note 4)............................................ ._ Edge Nail Sparing._... ._...._, _...._.._�_..(Table 10 or note 4 if in. Field Nail Sparing.._.... _... .....»......_..__..(Table 10)_..,_.........___. .._,_......._......._ in. Shear Connection(no.-of 16d common nails)(Table ,_........_ Percent Full-Height Sheathing._.....--....(role 10)____:....._.._-.._»........._.._. 5%Additional Sheathing for Wall with Opening>6'V(Design Concepts)-____ Maximum Building Dimension,L Nominal Height of Tallest Opening...._,_,__:,......... < Sheathing Type............................._.._ _(note 4)......................... _..__.....:...._.. Edge Nag Sparing_,..-.,--__-__-_____•_.-_._.,_(fable 11 or note 4 if less)......_......:....._. in. Feld Nail Spacing...__.__:.....__.....»....._..(Table 11)............................ in. Shear Connection(no,of 16d common nails)(Table 11).__.._ _....__ .___.... ..._....._...... Percent•Full-Height Sheathing...._......._,.......(Table ll)--.__..____......_ _.._......._.... ._% 5%Additional Sheathing for Wag with Opening>6'8'(Design Concepts)_......,,_,_...... Wag Cladding Ratedfor Wind Speed? ..._.._..__........_........._---.. _____..... .._.:_... .. _.._.. _.._.. --••---._... 5.1 ROOFS Roof framing member spans checked?._...,._.._.._.(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang .....__..........:...............................(Figure 19)............._f1 s smaller of Z or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Upifft.__.___.._. ._.:....._......_....»_..(fable 12).................._.....__...__.__._U= pif Lateral...._._........_..........__...........(Table 12)............_.__-_..._._..__...__.._.L= pif Shear..._... ...._..._.._.._.._._._.._..(Table 72).__.. ptf Ridge Strap Connections,If collar ties not used per page 21...-(Table 13)........ pif _ Gable Rake Ouflooker..................................... (Figure 20). ......... _ft s smaller of 2'or L 2 Truss or Ratter Connections at Non=Loadbearing Walls Proprietary Connectors - Up6ft........_.....__. ...._.._.__._.._(i able 14)....... ...__.._..._................_U= ib. Lateral(no.of 16d common nails)...(Table 14)...............................+...:.1= lb. Roof Sheathing Type._._�.... .__......._............._.....(per 780 CMR Chapters 58 and 59)......... Roof Sheathing.Thickhess_._....... ........_.._-__-.......__......._ ._..:...._....._.__ ...._in.a Mi;.WSP Roof Sheathing Fastening»........._ ......._..__ .......(Table 2)__.... ......_... Notes: ....._...._....._._ _ 1. This checklist must be met in its entirety,excluding the speciic exception noted in 2,to comply with the requirements of 780 CMR 53012-1.1 Item 1.N the cheddist Is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 a Uplift Straps per Figure 14 d.• All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 ft shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate In exterior walls shall be a minimum 2•in.nominal thickness,pressure treated#2-grade. AWC Guide to Wood Construction in Sigh Wind Areas: I10 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR53011.1.1)I 4. a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of T/I V and be installed as follows. C Panels shall be installed-with strength axis parallel to studs. I All horizontal joints shall occur over and be nailed to framing. M. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of Bd staggered at 3 inches on center per the Figure, Uerficaf and Horrontal NarTing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph end Zone Massachusetts Checklist for Compliance C7so CMR53o1.2.].1)' • 1 MM THIS®GE RBrs ON FFAMIWEWSdwAX$• AT6b= Y • .0 Ir I I = ' OY I F.F„ / SO a li 13 Ii or 6 . Ed . 4� z If l% / 3 ' I O N I W / Ij ILL rI _ • - i off / i� I I d Iw r,/• 1 Q ii iI f i m ' W ~ it � CDOUMEOXX '------ �� WJLSPAM\G • PA1V9_ 1 IJ . See D&WI on Text Page Vertical and Horizontal Nailing for Panel Attachment r f �1NE Ih Town of Barnstable Regulatory Services BAMffMLF' Richard V.Scali,Director �E039. `0� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder I, 56,1 77— ✓4-/G 4:Z ,as Owner of the subject property hereby authorize 6 t-E-Ca . Cc,uLo-� to act on my behalf, . in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applican - 5CU71— 3u�l�i� �- Print Name Print Name ' U Dad Q:FORMS:OVJNERPERMISSIONPOOLS Town of Barnstable Regulatory Services , p�FtKKE ibr._ Richard V.Scali, Director Building Division S suuvsTABM Paul Roma,Building Commissioner �m� 200 Main Street, Hyannis,MA 02601 �ATED � www.town.barnstable.ma.us 0ffice:• 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 MAII,ING 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 uermit. (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 to amend and adopt such a form/certification for use in your community. I Massachusetts bepartment of Public.Safety Board of Building Regulations and Standards License: CS-009013 � Construction Supervisor e GREGORY M CAULEY 33A BAXTER AV r W YARMOUTH.MA 02613:�*; cot; nn .. • Re tskil io (�--M l_Jl_� Expiration: i�/nrAS cte01r1 Sop Commissioner 06/11/2018 encio"SS thed s 6 006 dn /SOr pace cvb 9 feet 67/7 (99 j Se 9r t cubic UP k'hi �ters)och f°vtain y Fai/ Stat vre to Of'S Ci enspos �o 9 Cogre a cvrr 9igf BSc 4 I °� a se k at'on y�sn rr{7n 1, tihe lies �Igss co �0 eS PS - .. �e rpomnzoouuea�a�C�ac�ucaeli~a i Office of Consumer Affairs&Business Regutatio� HOME IMPROVEMENT CONTRACTOR ;.f ype: Individual { istration Expiration f 02/01/2019 Gregory M.Ub Gregory Caul , - . j 33A Baxter Ave,' ,, W.Yarmouth, ......, - Undersecretary i I Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 62116 Not valid with t signature �I f Cape Save Inc. TOn OF SARINSTAPLr. 7-D Huntington Avenue South Yarmouth, MA 02664 2013 NAR 22 r;P : 57 Tel: 508-398-0398 Fax: 508-398-0399 QIVI G� 06/24/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 1593 South County Road,Marstons Mills has been inspected by a certified Building Performance Institute (BPI)Inspector. Floor: R-19 fiberglass All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 Application Health Division Date Issued 0 Z Conservation Division = Application Fee Planning Dept. Permit Fee J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 50 Village n r S Owner U o6 b1 o k k e r Address S aL M 8 Telephone 5 0 8 " LI Permit Request a 1Z- q � p0.SS _ +0 :A-Joe 00C �aS,e Mend' Cp `;;n�— R :� SeAl 4E a �a�srmc ex�an� i n a to aM. Square feet: 1 st floor: existing_ proposed 2nd floor: existing proposed _.__Total new Zoning District Flood Plain Groundwater Overlay _ Project Valuation �_�_Construction Type_ Lot Size Gra.ndfathered: ❑Yes LI No If yes, attach supporting documentation. Dwelling Type: Single Family a� Two Family ❑ Multi-Family (# units) Age of Existing Structure 7 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.)_ Basement Unfinished Area (sq.ft) _ Number of Baths: Full: existing new _ Half: existing _ new Number of Bedrooms: _ existing _new Total Room Count (not including baths): existing _ _new _First Floor Room Count Heat Type and Fuel: ❑ Gas 2(Oil ❑ Electric ❑ Other Central Air: ❑Yes ,X No . Fireplaces: Existing New _ Existing wooc�Y�o��'�al stove]Yeses+❑ No Detached garage: ❑ existing ❑ new size._Pool: ❑existing ❑ new size _ Barn: ❑ce isting L7 mew zsize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size + Other: Zoning Board of Appeals Authorization ❑ Appeal #^ Recorded ❑ c`n Commercial .❑Yes ;K No If yes, site plan review # 0 Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��n( Mc, om_ Telephone Number 50% - 3 9 8 0 3 93 Address �"' D N u�n-�ing� _ License # Z C Sou.+1 l arm J W4 T M�1 0 a•b 6 Home Improvement Contractor# _ Worker's Compensation # TWC 3a 97 9 M ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL" BETAKEN TO SIGNATURE DATE S - �y � �• FOR OFFICIAL USE ONLY . APPLICATION# '•DATE ISSUED :�:•-"_ _.. :r ..MAP/PARCEL NO. ' F ADDRESS -- VILLAGE OWNER._ . •ry : ,' ,� M1 . _ + . DATE OF INSPECTION: ' FOUNDATION' FRAME ` INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL ' ? PLUMBING: ROUGH FINAL t sE GAS: _ ROUGH ,: ." FINAL, .' :.-FINAL BUILDING t DATE CLOSED OUT = ASSOCIATION PLAN NO. ,I „ e ^ The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations 600 Washington Street Boston, MA 02111 wtvw masSgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information ' Please Print Legibly Name(Businessiorganization/Individual):�A,.,.;_0 14 A Et. Address: C. , Au n1 at tsiGau t3 &E City/State/Zip: `�flt2MouTl,� AAA 61(0a Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[K I am a employer with_ I of 4. ❑ 1 am a general contractor and 1 6. ❑New construction eloyees(full and/or part-time). have hired the sub-contractors mp 2.❑ 1 ant a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have g, Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑ Building addition (No workers'comp. insurance comp.insurance required.] 5: ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 ant a homeowner doing all work officers have exercised their I t.❑Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. employees. [ 12.❑ Roof repairs 1 insurance required.]; c. ploy . (, we workers'have no 13.® Othersfld 1 d.T M comp. insurance required.] *Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they Pie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employers,they must provide their workers'comp.policy number. I are an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P G�n e o a V -Ins t."Ace- o M O O - Policy#or Self-ins.Lie.#: T Expiration W C 3 9 I T Date: I a f' a` ` (� t Job Site Address: S 9.3 So,,A ]`�O0t3 City/State/Zip: n ►'s 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$25.0.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains d enalties erjury that the information provided above is true and correct. Si ature: r Date: Phone#: 5 9,&' Official use only. Do not tdrite in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: . ACOR ® DATE(MMIDDIYYYY) :� CERTIFICATE OF LIABILITY INSURANCE 10/20/2011 THI$ CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER`AFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FAQ o:(781)963-4420 15 Pacella Park Drive E-pAIL .ssperrazza@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save INSURER C.Technology Insurance Company 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11102041451 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A DDL R POLICY NUMBER MM/DD1YYYY MMIDDII� LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AGE TO RENT0__ X COMMERCIAL GENERAL LIABILITY PREMISES SES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY JECTPRO LOC $ AUTOMOBILE LIABIUTY Ea acciCOMBIdeDISINGLE LIMIT $ 11000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS N AUT SEER Peer PERTY accidentDAMAGE $ X Underinsured motorist Blsplit $100000 300000 X UMBRELLA LIAB' N OCCUR CPPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 RED RETENTION$ $ C WORKERS COMPENSATION Executive excluded X WCSTATYL'MU- OR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN from coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? y NIA 7972. 0/21/2011 0/21/2012 (Mandatory in NH) C329 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE Michael Christian/SMS ACORD 26(2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025ortimsin1 Tho Arnpin n2mo anri Inn^oro ronieforurl m2r4c of Ar:non ., O ice of Consumer Affair and Business Regulation 10 Park.Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 164432 Type: Supplement Card CAPE SAVE - - Expiration: 10/6/2013 WILLIAM MCCLUSKEY = 8201 S. HOURD CT CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. )PS•CA7 6, 50M-ov04-G101216 h Address Renewal t� Employment J Lost Card OTe �a��v»zanuJealU o ✓l4wiackoelta — - sL\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ;HOME IMPROVEMENT CONTRACTOR before the expiration date.'If found return to: Registration: j64432 Office of Consumer Affairs and Business Regulation Type: 10 Park Plaza-Suite 5170 Expirationj0/t/2l)13 Supplement Card Boston,MA 02116 CAPE SAVE -== WILLIAM McCLUSKEY=>~- 7C HUNTING AVE".,- S.YARMOUTH,MA 02664.--- Undersecretary Not valid without nature -------------------------------------------- '`• iasNuchusctt.- Dcp:u'trncnt of Puhlic 4:afet., Board of Building Regulations and Standard. Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD ' WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 (nnuuisimcr 7r.: 10Z776 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 05/24/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 1593 South County Road,Marstons Mills has been inspected by a certified Building Performance Institute(BPI)Inspector. Floor: R-19 fiberglass All work performed meets or exceeds Federal and State Requirements. Sincerely, ® ^� Q ZOE William McCluskey cry o r' rn 4o0 West main Street HOUSING Hyannis, IAA 02601-3698 := A S S T STANCE ENERGY & HOME REPAIR = T (508) 790-7106 F (508) 790- CORPORATION 2925 -HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: �AfiE THE APPLICANT HOMEOWNER. I �Q f l r- ��/f���' hereby consent to and agree that weatherization work may be done by the Weatherization'Program of Housing Assistance Corporation (hereinafter referred as "Agency" )on the property located at: C Ko S Theweatherization work donewill bebased on programmatic priorities and availability of funding and it may indudeall or someof thefollowing measures: Weather-stripping& caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of theweatherization work to bedoneat my home I agreeto thefollowing 1. I give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no more than five(5) years after theweatherization work is completed. I have read the provisions of this agreement as listpd and freely give my consent. Home Owner: (Suture) Date 5 / .1-71f/ Agent: (signature) Date: HAC approved Weatherization Company : All Cage Energy, Caliber Building&Remodeling, Cape Cod Insulation, Cape Save, Creswell Construction, Frontier Energy Solutions, Lohr&Sons, Peter Smith, Resolution Energy, Rock Solid Construction CAPEO AVE wea tna-erizatioon 508-398-0398 August 221, 2010 To Whom It May Concern: William.I. McCluskey is an employee of Cape Save. He is authorized to negotiate contracts and building.permits for our.company. Michael McCluskey Cape Save—owner 3i9-593-s939 cell 7C Huntington-Avenuej South Yarmouth,MA 02664 i ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel '��� Application #how OF 0 Health Division ' Date Issued Conservation Division Application Fee Planning Dept. Permit Fee a�. Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis �`�'e' C_ S13 - Pro ct,Str-eettAAd ss Village - - Owner-,a / Address Tel p ne. Permit Reque t ,p Squa feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new- Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting=c�ocu�nentation. c_.. w Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) _Ck . N Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kingo ighwaT- ❑9s O-No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other M u, Basement Finished Area (sq.ft.) Basement Unfinished Area(sq. 0 N Number of Baths: Full: existing new Half: existing new Number of Bedrooms: A, existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Ga lOil ❑ Other Central Air: ❑Yes &0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:94 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 J;No If yes, site plan review'# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �N.am ��-� � 1 �7//� C_T_eIephone Number cQY- %����, Add e`s/_�5.� ��� License# �G' �!✓ d G Home Improvement Contractor# A/1X• �l� s /�2 " Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL TAKEN TO SIGNATUR DATE.Il'� s 1 FOR OFFICIAL USE ONLY ! o,APPLICATION# i J, DATE ISSUED 1 MAP/PARCEL N0. 1 , 1 � , ADDRESS VILLAGE i r OWNER ' , rr DATE OF INSPECTION: I' FOUNDATION z FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL j PLUMBING: ROUGH r FINAL GAS: ROUGH :: FINAL } FINAL BUILDING - e DATE,CLOSED OUT ASSOCIATION PLAN NO. ` = The Commonwealth of Massachusetts Department of Industriat Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le 1 3me`( -win-,s/Organization/IndividuaI ' fB� Address:, �� 1A em4�e#: J�/-R Y /2 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 6. New constrmtion employccs(full and/or part-time).* have hired the Sub-contractors 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 employees and have workers' working for roe in any capacity. 9. ❑Building aA ition [ND workers' t.Qmp.ins mrranCC comp.insuranCe.t rh or d.] 5. We are a corporation and its 10.❑Electrical repairs or additions ;ZT I am hoer m owner doing all work officers bave exercised their 11.Q Plumbing repairs or additions `�- `;'�-- right of exemption per MGL �--—m�y_sclf,[No workers comp: 12.0Roof repairs `-�incrmranCe'reglllled:jKt c. 152, §1(4), and we have no -13.0 Other etloyees. [No workers' comp.insurance required.j "Any applicant that cbcc3=box#1 mart also fill out the section below sbowing their workers'eonrpeusabon porky information. t Hameownen who submit this affidavit indicating they an:doing aM work and then birr outside contractors mast submit a new affidavit indicating mch. ICootrectors that ebcek this box must attacbcd an additional sheet;bowing the name of the sub-eanhaztmrs and state wbcther or not those entities have mmploycm If the sub-eonhmcbwr havo en ploycea,they muatpravidb their workers'comp.policy nranba. I curt an employer that is providing workers'compensation insurance for my employees. Below Is the policy and jab site information. Insurance Company Name: Policy#or Sclf--ins.Lie.#: Expiration Date: Job Site Address: City/Statc/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. 157-can lead to the imposition of criminal penalties of a fine 4 to$1rS00.00 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 st dcmerit may be forwarded to the Office of Investigations of the bIA for u* mnanc ,coverage verification. I do herM r the pa' s• d p n of perjury that the information provided above is true and correct Si afro t^—`--DatetC� � �� — P n 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): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: 'compensation for their a to ecs. Massachusetts General Laws chapter 152 requires aII employers to provide workers eompens mp. Y ,. 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,paiinership, association or other legal entity, employing employecs. 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 Iocal 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 ohapter 152, §25C(7)starts`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 mb-contractar(s)name(s), addresses) and phone numbers) along with their certificate(s)of insurance. Limited Liability Companies*(LLC) or Limited Liability Partnerships(LIP)with no.employees other than the =mbers or partners, arc not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial 4ceidcats for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should )e returned to the city or town that the application for the pest or license is being rcqucstcA not the Department of ndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' :ompensation policy,please call the Department at the nurgber listed below. Self-insured companies should enter their :elf-insuranc-n license number on the appropriate line. :ity or Towii Officials 'lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant 'lease be sure to Ell in the permit'license number which will be used as a reference number. In addition, an applicant eat must submit multiple permit/license applications in any given year,need only submit oup affidavit indicating c=rnt •olicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or )wn)."A copy of the aSdavit that has been officially stamped or marked by the city or town may be provided to the pplicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each ear.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture _e. a dog license or permit to bum leaves etc.) said persou is NOT required to complete this affidavit he Office of Investigations would lilm to thank you in advance for your cooperation and should you have any questions, [ease do not hesitate to give us a call ie Department's address, telcphone•and fax number. The C6mmonvaealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tt:I. # 617-727-4900 ext 4.06 or 1-S77-MASSAFE Fax# 617-727-7749 sd 11-22-06 www.mass.gov/dia Town of Barnstable THE Regulatory Services Thomas F.Geiler,Director I3ARTI5rABLE. MASS 6.1639- 16 � . BuildingDivision PIfD t'u`� Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnst2ble.ma.us face: S08-862-4038 Fax: 508-790-6230 HOMCEOWNER LICENSE EXEMMON Please Print umber / street village "HO1vIEOWNER": name (� home phone# work phone# / ,C AIIING 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. DEFINMON OFHOMEOWIN'ER Persons) who owns a parcel of land on'which he/she resides or intends to reside,on which there is,or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a iwo-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum iIISpe tion proced es r irements and that he/she will comply with'said procedures and requireme i-c of Homeowner A,provafiof Building7OfTiicial-______, 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 -f this section(Section I D9.1.1-licensing of eonst action Supervisors);provided that if the homeowner engages a person(s)for hire to do such cork,that such Homeowner shall act as sup-Visor. Many homeowners who use this exemption air:unaware that they are assuming the responsibilities of a supevisor(see Appendix Q, v)cs&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly ,hen the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlit nscd person as it would With a licensed upervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is firl}y aware of his/hc responsibilities,many communities require,as part of the permit application, .at 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 weal towns. You may care t amend and adopt such a fomi/eertification for use in your community. �OF'`Etgs• Town of Barnstable "s Regulatory Services y$$ Thomas F. Geiler,Director. o;urb�� - Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b a rnsta ble_ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign ThisSection If Using A Builder as Owner of the'subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property O r is applying for permit lease complete a Homeowners License Exemption F on th'e---rever es side dh I E Assessor's offioe (1st floor): Assessor's map and lot number ..........1............................................................. Board of Health' (3rd floor): Sewage Pe&- it&number ........................................................ 33ABI9TABLE, MAS& Engineering DepArtment (3rd floor): t639. .............. House numbwer ................ ......... ................... 0 NOX APPLICATIONS PROCESSED 8:30-9:30-A.M. and 1:00-2:00 P,M. -only TOWN OF BARNSTABLE BUILDING INSPECTOR . .............. APPLICATION FOR PERMIT TO ............................................. TYPE OF CONSTRUCTION ...........�C..(,q ...................................................................................................... .............19 CW, TO THE INSPECTOR OF BUILDINGS: ;t;:o The undersigned hereby applies for a permit according to the following informa.tion: Location ..... ..... ........ ..... z......... ...................... ........... ProposedUse ........./. .......�* * ............................................... ............................................................... Zoning District ..... ..................................................Fire District ...��e -ze ................................. - ......................Address J�,tv4r__. .....:, ner l�/G..�/. Name of Ow ...... ...................... Name of Build(_5r777>4C) /��. ...... ...... to4.. .......... .. ........................f...Address/ Nameof Architect ........................................................ ... .....Address .................................................................................... Number of Rooms ..................... ....................................Foundation ....................................... Exterior .��45PCP.rz.... S.........................Roofing X411-1!7.......................................... Floors ... ............................................Interior .................................................................................... Heating ........................................................................Plumbing 4._�................................................................... Fireplace �.. ............................................................................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 ofithe Town of Barnstable regarding the above construction. Name .. ...... ..... . ................................................... ✓Constructian, Supervisor% License .................................... BLOKKER, JOHN A=97-016 No .... Permit.for ....dui I d...Garage..... Single Family..Dwelling .............. Location ........1.6.0.0...Sp.qt.h...C.o.unty..RQ4d.......... .....................Osterville.................................... Owner ........John Blokker' .......................................................... Type of Construction ....FraiRP............................ ............................................................................... Plot ............................ Lot ................................ Permit Granted ..... October 27,...................................19 86 Date of Inspection .................................... 9 Date Completed ......................................19 1107 9� � • Assessor's map and lot number .......... .•:•••• �/. uG� O*THETO Sewage Permit number C!� • �I G BAHB9TODLE House number •..... o 011/?1••••••'•• so ..................... roes 1639.0 OR \e� TOWN OF BARNSTABLE I BUILDING INSPECTOR �APPLICATION FOR PERMIT TO ......................r e%,/............................................�f.�....j...............................:. TYPE OF CONSTRUCTION .................Fr i ��........ /%:............................................................. .............. , ............................19A TO THE INSPECTOR OF BUILDINGS: The undersigned/hereby applies for/a permit according two the following inffooJrmetion: Location . �� C?. ..... LG ``/...... .GL</!/C `......`/ C/....1,. .. /.. .(..!1..:.�....................... // J / ProposedUse ...... / 'i .... "F..(1. 1'................................................................................................................ ,Ci� Zoning District ...../....�...1..................................:...................Fire District ./../... . ...>-..:�.�..e�..�.1.� ....................... � �D, /'OZ oo �S'i� l/- • Name of Owner ... ... .....................��..........,,�'7!....!T...!1.�Address ........ ..........��...'..................................................... Name of Builder {....Address ........en—p ..1Z—...�.................................................... Nameof Architect ..................................................................Address .................................................................................... 1 Number of. Rooms ............Foundation /s .4 Exterior .................... .4-5................................................Roofing ....../.. Floors / /ZG( il�/G'.��.+ './...............................Interior ........ � li<... �/! l/ ...r!��GUG/•••••• Heating .......a......:...... ...............................Plumbing ..........................5.........:........... Fireplace Ala. ............�.: :'.:...........Approximate. Cost ...... a.,......................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ` �1...... ................. Diagram of Lot and Building with Dimensions ''Fee ......... SUBJECT TO APPROVAL OF°,BOARD OF HEALTH 0 f/, 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 . ......... // . Construction Supervisor's L�er�s. .. ......... . . ..... ............. . BLOKKER, .JOHN A=97-16 No ..... Permit for ..ADDITION................. Singe,Family Dwe�.7� .g....................... ItM-3 Location 16"..S.Q.uth..Couaty..Road.............. ................ ......................................... Owner .....JQha....510kkeX................................ Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted :.�7uqy.9.�....................19 84 Date of Inspection ....................................19 Date Completed ................. ............ .......19 0. 7.7 Ac. o Q s? , S GEORGE LANIDF-S No. 22723 i • { , - ��'�:cl 04-�J-/b vJ r.�a.�• f � vt .• . � �s-r� � � ` Cv sups ` ,.y .310 4� --� tU �A �9 �'/G D U Q� •� 4,51 �i• 1 I • . N o3 -oF{ -�� U1 dc �• S -SD U T IA C D[J Jul 7 `r (?Y X CCO rol� 7�o rccQl�r.S a 7� 1peer 7'cl�..; Ao f ,. �J YPahel %"�2 500/ -60%,s-,4 i3arn�-f�cl�le ,lqn� C'o \TJ�1N sacs- 9s 9 ap ' 413 ..%. 'UShA YARNIUU7"H h')A . i t, a - .,�- - ... - Assessor's offioe (1st floor): f Assessor's map and lot number .........!...�.............�............. SEP'flC gYSTEM MU T"E'°`` Board of Health (3rd floor): p�N COMP Sewage Permit number ...D.............. ....... ........................ 9NSTAIJ- IM /� E E 5 . wff 4 LBLL i Engineering ,Department (3rd floor): METAL CO AS& y `� � RON 639. .....#..........House number ........................... G ...... . Ar 0� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR M .... .., . ..: APPLICATION FOR PERMIT TO . /..1--�.�. .......................................................... TYPE OF CONSTRUCTION ....... 'CJ�/..............................................................................:.. ................. . ...........191a� TO THE INSPECTOR. OF BUILDINGS: The undersigned hereby applies for a permit according to' the following inform ion: � ,�J. // Location .....�lf.l�a...r.���f .. �.1.....C.0 C�fY.G...�".....�1;4- ............................./.`.. .l ... ProposedUse ........ ... ........................................................................................................................................... , ,(/ ..................Fire District Zoning District .....'. ... ........................................ � .... . ...1: ................................. Name of Owned?/..-../ /`./ /.'Fs...........Address ,�G?ll�Y..G .` .. rr .... / � � s Name of Build r / ,( � �:i.?'�J . /y..:J�. .l�l•...r.................Address�...C..K�.........<<.G ... ....... ...................... Nameof Architect ..................................................................Address ......................................../............................................ Number of Rooms ...................... ./........................................Foundation ...�a����-.,�............ .......................... Exterior - ...Roofing .................................I...... ........ Floors ...evY. ecq��. .. .............................................Interior . ...................:....................................................... Heating /........................................................................Plumbing `/!....................................................................... 1 p I Fireplace ........................................................................Approximate Cost ....fc1�.AP ................................... ... Definitive Plan Approved by Planning Board --------_---------------_-------19________ . Area c q .. ..t. . ......�. Diagram of Lot and Building with Dimensions Fee ... ... ...r.............................. 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 regar ing t e bove construction. Name .. ...../. ....... .. ... ................ .............. nstruction Supervisor's License .................................... -�. BLOKKER, JOHN i No ...30057... Permit for ....j3ui,ld„Qarage...... Single...Family..DWP,.1I ?g.............. •ls� . Location .... L6601out.h..Q.QwMy..:.toad........... a .......... Owner .....John M okker Type of Construction ........F.x?Zle...........:........... Plot ............................ Lot ................................ Permit Granted .........O.ctober. . . . ...2.7. ,........19 86 . .... . . .... Date of Inspection ....................................1.9 Date Completed ........... �4: — .........19- Cr N. 0. - t ' �/ r JU - Assessor's map and lot number K � � fTNE t d /e. /C 7 /� - FY- X-� - Jc-w�� /p.&o6&1 c- lL� ..° 0 Sewage Permit number h<rs 'EvoNr �`-L�. g .........(/................... / c!(� G �/ Z AUST&B i House number zz- f/ ? B LE, !� .............c�...... .......�,�G..�....... ..... r rasa 039. TOWN OF BARNSTABLE -_ BUILDING L NSPECTOR APPLICATION FOR PERMIT TO .... ........ r��r`/. «C.................................... TYPE OF CONSTRUCTION ............... Si it.......� o�...%.................................................................. .............. .......19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inform tion: Location ...16-*•c,-�,. ..... �!'LG. '.�••.... .!>LC/4� 6....�J. ` �1..:.,...................... ProposedUse ......c.� / e6 .... (1 ...............................................;.......................................................:........ Zoning District ................/ .! .................................................Fire District � dam. ✓..4..11.G.G. . ...................... ... . Name of Owner ... /��c -/" 1r`�.... . .P.. . Address c .r� l/_y... ..................................... Nameof Builder .......... .. .....................................Address ........... ....................................................... Nameof Architect ..................................................................Address .................................................................................... r Number of Rooms .................../..........................................Foundation C�?'/.`.'..S........................................................ �S ... ! /r...� Exterior .................... .../�.�..r�...S..............................................Roofing ...... ........ . .....�.................................... Floors / f/Z�iC!`..1 ...............................Interior .....C�.�..... �'<(../ ...1�!�..U���r/.. Heating /. :. ...... ............................Plumbing ..............e� .�....................................................... Fireplace ...............Al��...a.....................................................Approximate. Cost ...... Definitive Plan Approved by Planning Board -----__------------_-----------19_______. Area .................. Diagram of Lot and Building with Dimensions Fee .PU SUBJECT TO APPROVAL OF BOARD OF HEALTH PERMITS 1/k �� �OCCUPANCYERMI S REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above construction. Name ..!1.�j. .... .. ................ .. C struction Supervisor's Li BLOKKER, JOHN 26720 ADDITION No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location .>90.',,,_5.0_uth Cdikj*1 j�QAD.......... ................. Owner ....JQhn..Uokker..................................... Type of Construction ......Frame........................ ................................................................................ Plot ............................ Lot ........ .......................... 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DATE FIRE DEPARTMENT U— DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTIN DU/LDING D 'PT. _ JUN 01 201 TOWN 0F,8ARNS ABLE sl Iz qi IL LL El _. ....... 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LANIDES D A n No. 22723 �. /6 o d P. ni o 3 =off '- � „� .f��,�. 4�� f� ® 61 o Ile, SD u 7'iq C D a,ki 7 + (�9 AcCorc%i7 �o rcc t Qr�ls o Jri''..1J�• /: reef ''. �Comrr7un�r�J Qagef i3ar'ns-{n�1� LRriel Coi)r. 06�/�/ I REVISIONS: LOCUS INFOWATION NO. DATE DESC 28 J� CURRENT OWNER: SCOTT BUCKLEY ( OVERLAY DISTRICT: GP KAREN F. BUCKLEY Q TITLE REFERENCE: CTF 208988 NITROGEN SENSITIVE — G ZONE: ZONE II N PLAN REFERENCE: LCP . 13104 FEMA FLOOD ASSESSORS MAP: 097 ZONE DISTRICT: X , DATED 7-16-14 PARCEL: 016 PANEL #250010544 J BUMPS RIVER RD, MINIMUM LOT SIZE: 87,120f S.F. ZONING DISTRICT: RF EXISTING LOT SIZE: 33,700f S.F. LOCUS SETBACKS: FRONT 30' RIEAR 15'DE 15' EXIS11NG BUILDING COVERAGE: 3,151 f S.F. (9.3%) PROPOSED BUILDING COVERAGE: 3,310f S.F. (9.8%) LOCUS MAP I CERTIFY TO THE BEST OF MY NOT TO SCALE PROFESSIONAL KNOWLEDGE, INFORMATION AND BELIEF. THAT THE LOT CORNERS, DIMENSIONS_ AND SETBACKS TO THE STRUCTURE AS DETERMINED BY INSTRUMENT SURVEY AND AS SHOWN ON THIS PLAN ARE CORRECT. HOFA{d� CRAIG A. lC'A c�i FIELD cn �PjO No.38039 LLAND CO& I PROFESSIONAL LAND SURVEYOR DATE ' �O EDGE`p=`AVEME sl,�ill ROgo NT s 45 400• pp' so� � CERTIFIED <k �� PLOT PLAN NO3o8, WITH LOT 2 �� w 33,700t S.F. $ PROPOSED 4 90 ' ADDITONS AT 159,3 SOUTH 0 COUNTY ROAD N IN #1593 I OSTERVI LLE EXISTING a. �o LO DWELLING "`V� MAS SAC H U S�S BULKHEAD TO BE o (BARNSTABLE COUNTY) REMOVED AND / PANTRY EXTENDED ` 439' �ry OVER FOUNDATION EXISTING ` 39.9 . GARAGE SEPTEMBER 19, 2016 PROPOSED PROPOSED BEDROOM OVER NEW FOUNDATION DECK EXISTING "-� DECK TO BE 504. REMOVED / ` 47 4116h / F PREPARED FOR: O SCOTT BUCKLEY 1593 SOUTH COUNTY ROAD 'OSTERVILLE, MA 02655 508-367-2530 " APPROXIMATE SEPTIC �a scott.wb®Iive.com SYSTEM A LOT IBSC` �h GROUP 2 So3.33, 349 Route 28, Unit b o�ryF West Yarmouth, Massachusetts pop 8 02673 s 508 778 8919 © 2016 The BSC Group, Inca --� SCALE: 1" = 20' 0 2.5 5 10 MUM r 0 10 20 40' r ® PROJ. MGR.: CRAIG FIELD 1 FIELD: D. SCHOENEMAN m CALL./DESIGN: K. HEALY DRAWN: K. HEALY CHECK: CRAIG FIELD - FILE: 50009-EXC.DWG DWG. NO: 6398-01 JOB. NO: 5-0009.00 SHEET 1 OF 1