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0049 TREE TOP CIRCLE
o a 0 , „ a i o o n , h, T,Y Mi u n n r n Q 9 r, f1 y CAPE COD INSULATION FIBER GIAIS SIAIAIISS SVBATIOAM SUSV111010 BAITS OUT"" MUTAIION ISIIIN01 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit i application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village y Fero Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( x) ( ) (30) O O Slopes Floors ( ) ( ) ( ) ( ) ( ) 2 Walls Sincerely Henry E Cassidy Jr, President Cape Cod Insulation, Inc. ,, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ParceC ation # LApp S S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Stre t Address Village Owner Vk Address Telephone . 761' ff0 ? 'I ,_, Permit Request l l(/(�l� .1 1 Z-31 k V Square feet: 1 st floor: existing. proposed 2nd floor: existing proposed Total new Zoning District �1 Flood Plain Groundwater Overlay Project Valuation 4061 Construction Type 4 Lot Size Grandfathered: ElYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,6 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sCRA Number of Baths: Full: existing new Half: existing new; -- C> 1 Q Number of Bedrooms: existing _new 2-1 c_ �, Total Room Count (not including baths): existing new First Floor Roo Count N Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other `, m Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: .Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes R'N0 If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number41 � �"(-�'� � Address / V / License #li'm, L y U Kam/ Home Improvement Contractor# Email Worker's Compensation # CJ LJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -Z i b i FOR OFFICIAL USE ONLY o APPLICATION# � Q - r DATEISSUED MAP_r/PARCEL NO. ADDRESS VILLAGE ' OWNER I DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING, DATE,CLOSED.OUT T 'h r ASSOCIATION PLAN NO. r try • • � � Massachusetts - Department•of Public Safety `✓ ..:Board of Buildin Regulations . g g ns and Standards Construction Superriso I' License: CS-100988., HINRY E CASSII)AI 8 SBED ROW , WEST YARMOLFIr i 0 "'w Expiration Commissioner 11/11/2015 t a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6:rjtra'ctor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr#- 259188 CAPE COD INSULATION, INC HENRY CASSIDY ----- 18 REARDON CIRCLE — - SO. YARMOUTH, MA 02664 ' Update Address and return card. Mark reason for change. :CA1 ti 20M•05n1 ❑ Address Ej Renewal ❑ Employment Lost Card �e tpanv�no�acuerc�C/c�C�/�/L✓rwdrec/uaeGti Q'� Office of Consumer Affairs& Business Regulation License or registration valid for individul use only i OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: egistratlon; 1.53567 Type; Office of Consumer Affairs and Business Regulation xplratlon: :.;.1,21:15/20:16 Private Corporation 10 Park Plaza -Suite 5170 ;., Bo ton,MA 02116 CAPE COD iENRY CASSIDY 18 REARDON CIRCLE":.''':';':'• 30, YARMOUTH,MA 02664 Undersecretary qNyvalid 4wi tit sign e The Commonwealth of Massachusetts Department of IndustrialAccidents W Office of Investigations 1 Congress Street, Suite 100 cy Boston, MA 0211 A-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Or zatton/Individual); Address; 60V City/State/Zip; L � Phone #; Are you an employer? Check he appropriate box: Type of project (required): 1.5'I am a employer with ' 4• ❑ 1 am a general contractor and I employees (full and/or part-time),* have hired the sub-contractors 6. New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet, 7, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp, insui•ance,t 9, ❑ Building addition required,] 5, ❑ We are a corporation and its 10•0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l 1,❑ Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL 12,❑ Roof repairs insurance required,] t c• 152, §](4), and we have no employees, [No workers' 131[ Other `'( comp, insurance required.] // J *Any applicant thai checks box Nl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit thisU Uri indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, If the subcontractors have employees,they must provide their workers'comp,policy number. I am an employer that Is providing workers'compensation insurance for my employees, Below is the policy and job site „ —Information, I f Insurance Company Name;-& Policy# or Self-ins, Lic, #; ko - 0 Expiration Date: Job Site Address; 17 f(l�/�i City/State/Zip; t Attach a copy of the workers' compensation policy declaration'page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator, Be advised that-a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurancelcoverage verification, I do hereby certD, n r pains and penaltles of perjury that the Information provided r bov Is true and correct, Si nahire; � 1(1:2 Date; Phone#: Offlclal use only, Do not write In this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority(circle one): 1, Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector 5, Plumbing Inspector 6, Other Contact Person; Phone#: CAPECOD-27 KLIGETT �- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 13014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements , PRODUCER CONT ACT Rogers&Gray Insurance Agency, Inc. NAME: Barbara DeLawrence 434 Rte 134 PHONE FAX South Dennis,MA 02660 EMAIL A/C No): (877) 816-21 S6 ADDREss: bdelawrence ro ers ra .com INSURERS AFFORDING COVERAGE NAIC n Y INSURED INSURER A;Peerless Insurance COm an INSURER B;COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURERC:Evanston Insurance Com an _--- 18 Reardon Circle INSURERD:ATLAN I IC CHARTER INSURANCE GROUP—---- INSURER South Yarmouth, MA 02664 E; —"---- 00 ERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE INUMBEOR THE POLICY PERIOD NOTWITHSTANDING ANY IN ICATED. 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. MT PE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP IAL GENERAL LIABILITY MM/DD/YYYY MM/DD/YYYY LIMITS S•MADE a OCCUR CBP8263063 EACH OCCURRENCE $ 1,000O— 04/01/2014 04/01/2015 PREMISES Ea occurrence $ 100000 MED EXP(Any one person) $ATE LIMIT APPLIES PER: PERSONAL&AOV INJURY $ 1,000,000 PRO• GENERAL AGGREGATE $ 2,000,QQO JECT LOC PRODUCTS•COMP/OP AGG $ 2,0001000 ABILITY $ -- I COMBINED—SINGLE ANY AUTO 14MMBCKVMK Ea accident $ _ 1,000,000 ALL OWNED X SCHEDULED 04/01/2014 04/O1/2015 BODILY INJURY(Per person) $ AUTOS AUTOS X HIRE0 AUTOS X NON OWNED BODILY INJURY(Per accident) $ AUTOS PROPERTY DAMAGE ----- --- Per accident $ X UMBRELLALIAB• X OCCUR $ EXCESS LIAB CLAIMS-MADE y j XONJ453514 ' EACH OCCURRENCE $ 1,000,000 04/01/2014 04/U1/2015 AGGREGATE DEO X RETENTION 10,000 $ ORKERSCOMPENSATION Aggregate $ 1,000,000 ND EMPLOYERS'LIABILITY PER OTH• NY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 STATUTE ER FFICER/MEMBER EXCLUDED? ❑ N/A 06/30/2014 06/30/2015 E.L.EACH ACCIDENT Mandatory In NH) $ 1,000,000 f yeCRIPTION OF OPERATIONS below s,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,000 ES E.L.DISEASE-POLICY LIMIT $ 1,000,000 SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Irkers Compensation Includes Officers or Proprietors. dltional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certl(icatd'Holder. I :R IFICATE HOLDER CANCF.I.I nTlnnl i Town of Barnstable Regulatory Services asAss MAn Richard V.Scali,Director o�L Building Division Tom Ferry,Budding Commissioner 200 Maiu Sweet,11 arinis,ACk O2601 -ww•w•.tow n.barnst abl e.ma.us Office: 508-962-1033 Fax: 50S-r 90-6230 Property Owner Must Complete and Sign 'J'Ws Section If Usin�o A Builder 1 can as C?w-ner of:.he suhjec.- pm,,,.n:y 11c1'0hyautholi7e (,Gt�(t (.�A 1.t,\, l lU',`h VVN to act nn my behalf. in-fl anuers relative to work authorized by,this b,i&ny pernut apphu" on for: � o �fi� ,yr I y l elpp L^� r /c. ` {/.>f Gir j' i 1i (Address of Job) ' "Pool fences and alarms are the responsibility of the appli.c.tmt. Pools are no%to be tilled or utilized bel'orc:femce is iwtaued anti all fin all tIsp CColis ' C p rforrned and aCCepL[d- 1 v �r Sign e of °her SiPatl' e of Applicwil. P nt V ie47 Pnnt Narm Date Q:FCJRMS'OV•i:NERP .NUSSIONT H)LS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map "'b `ir-7 - Parcel TO�ff OF . Permit# Health Division Cl 2fi QARNSTABgte Issued 91Z� 0y � 20 Conservation Division J< �2_ ,O ''4 APR 2 7 AH I j: 5/pplication Fee Tax Collector Permit Fee :V 6V Treasurer DI `iSfO�b Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address qcj ZkY/C�E P Zr? &A C/e /'!Village IV5 Iyyc) c �(J Owner Ghtdl 2Z t,�/ Address Z?fBnGs7a"p elf Telephone Permit Request Square feet: 1 st floor: existing / proposed 2nd floor: existing proposed �� Total new-Z: Zoning District be- Flood Plain G. Groundwater Overlay Project Valuation ?5Cg6. Construction Type Lot Size 200mb sy Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure d Historic House: ❑Yes R No On Old King's Highway: ❑Yes erlTo- Basement Type: 6full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Z 'U Basement Unfinished Area(sq.ft) 3Z- Number of Baths: Full: existing 2-. 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: s ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 4No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name l�• -+n�S�E Telephone Number :271 27 Address License# ©S 1 1 30 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 394764t," SIGNATURE DATE • FOR OFFICIAL USE ONLY I PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS t VILLAGE r T¢ OWNER DATE OF INSPECTION: FOUNDATION ,aew ode ��i Oy ' FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 0 s�11CQ� x DATE CLOSED OUT •' ASSOCIATION PLAN NO. r - f . ....... The Commonl:veahh of Massachusetts Department of Industrial Accidents' - _ l _ '�16s d�d�' • 660'Washington Street _ Boston,Mass. . 02111 �.J Workers'..Coin ensation.Insurance Affidavit-General Businesses OR name 'G �`'x /1�0•_�LY/VJ,[/^ 1 state ziv QZd 73 vho*+e# ' MtV � work 'te location full address : : ' []Retail❑RestauranfBai/Bating Establishmeat am•asoleproprietor.andhaveno out; ' easiness�'pe: 0 Office[]Sales(mcludingReal'Esta'te,Antos etc.)' worlong in any capacity. ❑I am an em to with . etn to ees(full& art time): ❑Other % ///J//.1//%/%////%%%%/%//////%/%%%////O%%%//ter on this 'ob., . I am an�m�loyer providing-wkers compensation for my employ g , coin it. ,:c.: ; L ,�E'• ' ;l . l5• �. .•i'-.;:;: . ... ,•l l Ly�/�}. •��+t�'V�r L7t �•i�a •'••'•r7•':ilJ�� :t�•i£:. ..a.•~ �n.:.'::L..4,. .Ir: S:,n l.: i•�7'=Y'.:tf•'•;1::� _� _ ' dedress•' •`V� a' •' '` r 4 7 '� ,..•�.t..s , t. - Ij 1•• r 1 ',f'. .• •. jj ".FYI• ,�• •�•�'.J:•'�V t' � ,t •,7.,'• !• •. •.p .mow +1 r.l•� •�: •' ollC.'.�� •', '"alice.co'd —.::iG.yt;^vie'•' ,�"�'"';' '•':��.� .,;1,%a•':x�,.. 'I am a sole proprietor an -have hired the independent contractors listed below who have the following workers' .compensation polices: • '•. � _ v: : :Fi'r S.,"t�'•-;ii+•' '.r?:',i'1�4vt�}!,r*'t. .r.,rt•..J1_ ..ids: ,'ent.'•t;, "t^h:".i' .�: +,^it: 3,• .r,r.:•• t�,,•.. .< ,i a ` .. .. .a- COIIIµaD ilSn7 '�.. '?,' •: ' �, ,:.'' :t':' 'e.rt,:,Y:.: :'�i.,: ' 'i.l Y�: •.v ,•.z'i�-' ,fi,•" i l 5:fr \t�:a ,1. :.. ., r;:t4 y; =Pl':•• r7':'i., :t., �4:.'cii:ir •j•. ':�.1•: ;•.. � ?i t. , ;." •' ;s'.:�• ,t�.i.;.: addre'ss:. f,.`• _'.t, �6i"' .s•,,.�,r.r i ,,•� 7.r i:l .rr. .i' ., '•�- :7��•:i"'^�•{�:Qt'r.• •;�t;� Ll.,:i. r'. .��.�i. �t• '�'•�•rY - .,h�,•.:�.,,•!• Ct, t' ..t ''n•,.� •\ >„i niP;. .• '. ,r:.^yi;.�l l.::• ��rr' �;t ::q,-: •!r ?n'"� 1, fss:' •r a:. ' •' :.t t'j•• :••., •S'• 1 l'•. �:' .-'-r.:e:ai. ''f•:` ,.s• •.1�.': ,. .. ':,;� '' :;5,: y,. v.?,:' �.'. .'-•":n ,i:,':•y.' .r:::..o�iC '�, .f,:+'1:�'i•�:tf".3.` :, fi' �•:• +: insurance co. :�='*.�'=�'•`' / l/%////%////////%%• /_ :a; :r'r.l% ;'i•j•1•''' :tf .lij !t. i...i: r;r :t';'rtt `:yttilr't , Isa :•�.� :1,;. :t .,...:fr t' •�Y.:�.' :t•y, �1.:!'' u�•,. '•\ \.�!,�:. P,,:? ,3r}: .•.":iif• ,:s>,•- ,n f �', „•,,, t.. Y'^','_f„t% .1.1•:fir, „c,.� `r•7;•..: ,:... •'> ::. .. n-- ••• coin 91i. Ilg e:s rr t: •:! r . .i:, �• ' +".f::"::,' Cl • ' a..e4 i ! q,,.t�. i.. t.a rl•J:. �`'t,4• ri;, '�.•t ;p.'. •.!"•' •,.•.34. • fidlic.•: :,•. .i�;1't,,:ttiM1.! •:,, - ••tt' 'i: lIISltr$ilCP�S:b�'i i. .';•, •�r�:' . Failure to secure coverage as required tinder Section Z5A of MGL 152 can lead to the imposition of crlmfnal penalties of a fine up to$1,500.00 and/or one years'imprt+onment as well as cfvilpenalties lathe form of a 6TOP WORK ORDER and a fine of$100.00 a'day against me, I understand that X copy of this statement may be fol warded to the Office of Investigations of the DIAfor coverage verification. I do hereby ce fy u� r t ains a d enalties bfperjury fhat the information provided above is true and correct Date �� 3 Signature .• - � .. q ' • . - Print name (�Wd Phone# official we only do not write in this area to be completed by city or town official permit(license# ❑Building Department city or town: OLicensing Board ❑selectmen's Office (3 checkif immediate response is required ❑$ealth Department phone#; Other contact person: (revised Sept 2003) Iuform'ation and Instructions. Massachusetts General Laws-chapter�152 section 25.r.equu•es all employers to providd workers' compensatioa for their. employees.. As quoted-from the `law', an employee is.defined as every person in the service of another' under any contract of hire; express or implied; oral or written. Cr , An employer is defined as an individual,Partnership; association, corporation or other legal entity, or any two'or mare of the foregoing engaged-in a`joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. 'However.the owher of a dwelling houSe haymng.-not'inore than three apartments and-who resides therein, or thepccupant bf the,dwelling house of to s-persons to do:ma- tenance, construction or repair work on such dwelling houk`6r on the grounds or another who.emp-•y .P b g app�tenant thereto shall not because of such.employment.be deemed'tb be an employer. MGL chapter 152 section 25 also"states that'every. state'or local licensing-agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for.any"applicant who has not produced acceptable evidence'of compliance with the insurance coverage required. ;Additionally;neither'the' commonwealth nor'.any.of its political subdivisions shall enter into any contract for'ihe performance of public.work unti acceptable evidence of corripliance with't: a insurance requirements of this chapter have been presented to the contracting authority: Applicants please i4 in. the workers"compensation affidavit completely,by checking the box that applies to your situation.. Please supply company narne, address and phone mmnbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents-for confirmation of insurance coverage. Also be sure to sign and date the - affidavit The affidavit should be returned to the city or town that the application for the permit or license is being t of`Tndustrial Accidents. Should you have any questions regardi�rie the"law"or if you are requested, not the Departmen required to obtain a.worker. -compensationpglicy,please call the Department at the nimiber listed.below- City or Towns . Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in'the event the Office of Investigations has to contact you regarding the applicant Please be sure to film the permit/license number`Much will be used as a reference number. The.affidavit may.be.retLuned to. t b mail or FAX unless other'arrangements have been made. the Deparmmnn, y. ike to thank you in advance for you cooperation and should you have any questions, The Office of Investigations would l please do not-hesitate to give us a-caIL V / The Departrnent's address,telephone and fax number: , The Commonwealth Of Massachusetts- Department.of Industrial Accidents Bf lu of lawesfipdona 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 .. .11. ii-d/I, nn/T.Annn __L 'AAL r Town of Barnstable Ei Regulatory Services • - Thomas F.Geiler,Director s6 S& Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 pffice: 508-862-4038 P ermit no• Data AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW j SUPPLEMENT TO PERMIT APPLICATION j conVersiorIj MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization, or construction of an addition to any pre-existing owner-occupied -improvement,removal,demolition, ur dwelling_ bung containing at least one but not moreented oontractorawith certain ex pti ns,along with other nt to such residence or building be done by registered requirements, r Esti=ted Cost Type of 2-11a Address ofTo&'-4— IF Ovmer'sN�e� . Date of Application: I hereby certify that: Registration is not required for the following reason($): [3Work excluded by law []lob Under S 1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OR DEALING WITH UNREGISTERED OARS PULLING TB EIR OWN PERMIT ILM CONTRACTORS FOR�,PPLICABLE HOLM OR UARANTYWFUND UNDER MGL c 142A• ACCESS TO TEE AjaYT�'TXON PRO j SIGNED UNDERPENALTIES OF PERJURY - - I hereby apply for a permit as the agent of the ow4er: / ctor Name �'Z �0 •J' /V ire RegistrationNo. Contra Date Z,ud ° s ,✓ Owner's Name °FTME T°�ti Town of Barnstable Regulatory Services i 13ARNSTA31J Thomas F.Geller,Director XAM Building Division _ Tom Perry, Building Commissioner 200 Main Street; Hyannis,MA 02601 office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder Y T'RlSL'1�' MIc, A•I�YSZaf�....::-.... .;as.0w•net.nf the.subject prop erty- ._.._..._. .: hereby authorize in all mattets relative to-work authorize by this building•permit-application for: (Address of Job) r0 Signature o Date 1 Print Name I N LOT 51 ° LOT 52 l 055 All impervious material shall 125 rL shall be removed for a distonc < , 0' of 10' all around leaching Q system down to the strata of ILDT 57 natural sand. Replace with 20,000 S13, clean coarse sand or other 4•xQ'FLOWDIFFUSORS granular material having a I with 2,of stone oil ends percolation rote of less than I 16' _ _ and 4 of stone on sides 2 min. per. inch. before and S — after placement. Compact 4 to 4r -i, I (Reserve 2` fill as directed. f10 - rb—TEST HOLE 2.0= .l i0,� LZ Dist.Box - I �- I ,000 Ga,lcn o LOT 56 LOT 58 I - 6 eptic Tank Lo — e 4.25' — -- -- -- 3Z - - - - I FO U&FAT)N EIev=43.0 _ 4-7 ADJUSTED GROUNDWATER 45z vi 160:RVIF( 71+0 � }�OIX� )2 L46kTEP NI I \ F)1�D Pi h�r�N Z�N� G oN F,i o l I 9- ,MuNrNJ FRN�. No.25Q�D1/UDo5A fwv v I � r 7P46 G 15 NoT A *FafOL RWD i 9�• ExISTING , \ t�D ARC+ - -- I ,`- — - WELL_ 14. ►`lam - - _ _ _ - NTi2` 6 - TREE TOP CIRCLE ( PUBLIC 40 WIDE ) CE ttul. 9 I►4 la4 Aw �Is+�t �wr�v��tolJ� naat' we err w" �cr � ► M ,9 ,'CH 8/3/84 REVISE PROFILE, ADD FLOWDIFFUSSOR MJ8 3. .._ 84 REVISE PERC. TEST, REDESIGN SEPTIC SYS, MJ8 J� DATE DESCRIPTION CIrowoby jched ft W'S <t> REVISION4� --- 5' PLOT PLAN O FIF F O Wf W&MT =�1� \r .� FOR POLCARO CONST. CO. INC. `' ! SUBDIVISION PLAN LOT 57 TREETOP CIRCLE �d; JMARSTONS MILLS BARNSTABI F MASS.TONES M- 1LLS- "': .I�p►'tE: MARCH- g�iS. -E fiei t iEF'T.1965 P6.198 PG.48 oOrnc�m $ C ?44 , 41tL I N E R 1 . cn-C2-�7 12e•a sal* V M.%� a N- 84049 DWG. [`f" A�.��— BOARD.OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:GS, 081139 . Expues 09Pf6%2065 Tr.no: 81139 Restricted:--,OU = MICHAEL J NARDONEi 10 BARNBOARD C W YARMOUTH, MA 6673 Administrator ✓fze C�aminzaruveall/ o�./�aavac%uaella Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR Registration:. 4-358,87 Expi ateon 5116iO4 Types Individual MICHAEL J.NARDONE:. MICHAEL NARDONE:.'; - 10 bAANBOARO LN,: : W.YARMOUTH,MA 02673 Administrator d'n 6 o 2 v rl'naA F�t�SG yn W-Osr dn, 4'x/o"Ilborl N4 ax�o�,;���� rc'' o•c 3/ex6"`AC►S �y k ZxIo Latfgk 2 X 10 P.T. J015TS 4"X 6" P.T. DECKING AT 16"O.G. (2) 2 X 10 P.T. GIRDER 4 X 6 SUPPORT POST 4 X 4 P.T. GRO55 GRADE BRAGE5 r /��/�\rr��r���\�\\/\\/\\r\�r\\r\�r \\ \�r\�r . • r'\fir\\/\\/\\r\\r\\/\\/\\r\\r\\r\ 10"DIAM. CONCRETE FOOTING FORMED WITH 50NOTUBE-(TYP.) SECTION A-A TYPICAL DECK SUPPORT DETAIL SCALE: 112"= T-O" cs 1� GAP RAIL 2 X 2 BALLUSTERS AT 5"O.G. %4"X 6" P.T. DECKING n, DECK SURFACE 0 0 0 0 4 X 4 RAIL POST- 2 X 10 P.T. RIM JOIST BOLT TO JOIST TYPICAL DECK SAILING SCALE: 1/2"= 1'-O" t r, I (N Finish grade above and adjacent shall slope min.of 2%oway from system 4 dlam. cast iron or Sd*dule40PVC pipe (tight joints). 20'min. distance ( building to edge of leaching system) N 10'min.dist. LOT 51 o LOT 52 Qom. V O� All impervious material, Shall - - ' 125 / rL shall be removed for a distance 0' of 10'all around leaching Q' system down to the strata of v LOT 57 natural sand. Replace with 20,000 S,F First floor £fev.= 52.5 MANHOLE COVER A clean coarse sand or other - - granular material having a 3 4'x�'FLOWDIFFU SORS FINISHED GRADE with 2,of stone on ends percolation rate of less than 16' 12 Max. cover 2 min. per. inch. before and I • ---�--i and 4 of stone on sides g.� Offer placement. Compact ,r tOQ�__-i4 I Re serve 2 S=. 005 2' fill as directed. 4 I ' 5= .02 Removable cov s i .'� I _-- Removable 0 y 0-TEST HOLE \ 5.. . . k; �.or carer 2 s=.o. 3- 4' x 8' 2.0- L i i0, -� Li rid lave level I IF , a, I_ L _Dist.Box o __ — a�� oao 0 4y o 0 0 0 es���e LOT 58 000 Gal. Septic Tank LOT 5 6 ` -.-- -- — BOXro r2 � • . a a e o 4 — m ad SEPTIC TANK c� l �— E ► �t — — � L - -� -- � - - - - —0DI_ _ _ _Bottom L1ev= 4�25- - 'N- - - - - Sl. 51 IOOO-GAL. _ u �� � �� 4.25 b > - > _ PROPOSED' W v }„ HOUSE/ ? �a EIev=43.0 / \ Ik, �C ?� 9r• - C I� ADJUSTED GROUNDWATER M1 ," = PROFILE 74 �, I Not to scale CRITERI-A tr t' « 93. EXISTING , NUM> #2flFA EbR00M5 3 (0g0ji lent tp'330 gals/day). — — — WELL i GENERAL NOTES Ti25 6 G B�IGE�J�SFOrA-CUNIT NONE yL ACMING`A EA ITY REQUIRED 330 GALS/DAY. I)NO CHANGE TO THIS SYSTEM SHALL BE MADE UNLESS { 51pE APtt Ay PROPOSED 60 SQ. FT, 2 j SUBJECT IN�SPECTIOfV DUR NG SCONSTRUCT ON'BYC; . TREE TOP CIRCLE ( PUBLIC 40� WIDE ) r. i�. .' , t r i, a 1 SOTTC�M ARE lk PROP.. SED„256 SG!•. FT. Y SOARD OF HEALTH AND HOLMES and McGRATH,INC. 3)HEAVY.CONSTRUCTION`EQUIPMENT SHALL NOT'TRAVEL f? IQI? b L Y G CAPACITY'4(08 GALL ONS DAY. I, OVEA,OFVOSAL.SYSTEM DURING OR AFTER CONSTRUCTION. 'St 'l.Y, TOWN 4)DISPOSAL. SYSTEM TO BE CONSTRUCTED IN ACCORDANCE P r WITH;TITLE 5 OF ThIE.STATE ENVIRONMENTAL CODE_ . - '� T "Ur•HTtfltQANG. tT» � • • _, 5)A COPY..OF THESE PLANS MUST BE KEPT ON T ':Sl T EI BN'MARKHYD SPN..AT LOT 51-52 EL.=50.00ASSIGNED DURING THE TIME OF CONSTRUCTION. IN`- 6)A COPY OF THESEPLANS MUST BE"FURNISHED TO THE LOG CONTRACTOR CONSTRUCTING TH.Ir DISPOSAL'SY,rTEM. I® PROPOSED SPOT ELEVATION ): FOR!~ BACKFIL THE CO ITR,gCTO SH,ti O.T1 FY ,.. WOE ME5 anal Mc t ".1NC.'`AND=NE BOARD HEALTH y'r'`• rM^` .MB"1, N' 2 AGEf,IT101, PECT.THE SYSTEM AS CONSTRUCTED. 8/3/84 REVISE PROFILE, ADD FLOWDIFFUSSOR MJ B r'rAa,` r+��M1So►'Is Elt Dept s6u E eK 8) FLOOD,PL`Ai:N HAZARD•.'ZONE C 5 8 84 REVISE PERC. TEST REDESIGN SEPTIC SYS. : MJ B 9)ZONIN:G OF.3Ti1CT' F_) _ ----� DaT E D E S C`R I PT I O N Drawn b'Y Checked`by LOAM t,; i0)THE t�k(JR M,AR OW !S DERIV9 :FROM RECORDED PLANS H4US SUBSOIL OFt QEEDS:•Tt�iE.NORTIt,ARROW.SNALL NOT,BE J 'N REV I.S I ONS,. c • ,..°• FORORIEN1"AT10N`'F(3R'SOL'A1? HEATING PURPr�SirS. -4S 5'S Y 4 5 5 :Y P..L O T PLAN OF PROPOSED SEWAGE DISPOSAL SYSTEM :SOIL TEST T1TLE REFERENCE : FOR POLCA•RO CONS' CO. INC. FINE 5 �; 'i "t;• DATE OF SOIL TES MAY ' 7• 1984. "_PLEASANT PLACE SUBDIVISION PLAN LOT 57. TREETOP CIRCLE f F�,��.�;i, ii TO TEST TAKEN BY' ROBERT• 'BUR;GMANN••- MARSTONS MILLS ARNSTABLE MASs. MEDIUM RESULTS WITNESSED BY JOHN JACO81 S�F LAND IN M'ARSTONS MILLS I 4o, �AI MARCH �. IS,B SAND BAR MASS FOR NORMA !.r t PERCOLATION 'RATE_?,,,_MIN./ INCH. t»C TOM", tC � `�y;., ,,•' ;��` 9.0 4 2_ n clvtl'erttjtneer.� Ydl,d surveyors, _ ROUND- GROUND WATERS 8ELOW �ROUNn DI BON AL I"= 100' SEPT.1965 PB.198 PG.48 200matn street" WATER " , ASSESSOR MAP" 2 150- 6.3-5 o Checked tied ?V IN ,ER falm iith' ma 02540 i IVII S N Z 548_3554 s, + y �% 148 N2 8404 DWG. N o Assessor's wap and lot number ...../. ....... ..... THE Sewage Permit number � �TiC � } INSTALLED IN WITH TITLE a t BASH9T11DLE, House number #... t639- ... ...:......................... y rasa ENVIRONMENTAL T . TOWN OF -PARKISTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....4.6..1. A.............................................. .......................................... TYPE OF CONSTRUCTION ........iN.O.Q. J......P .)q.1v ......1 ...�.id�� . ... ..............................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........7....�......./ !.�. ... .�..... ✓/.. ..t.. .Cr ...................L'�..T..# .. .......d•••!. .l 0/ (�IA14_ r ProposedUse .....�: ...../.. -.Y..... D.. I.. ....................................................................�...... �- Zoning District ..........A. .Fire District ........... Ll Name of Owner .l.T../��-.:...'11. ��/•1 ....Address ......�a(.. .0.0w .............................................. Name of Builder ...(:.. .. /1. �....�ltdF........Address ...... .� Q.l1F .../....1..��-L.. ......... ,� /l , Nameof Architect ........... j.. .......................................Address .................................................................................... Number of Rooms ............ ...............................................Foundation ......Pa 4.1./�. U................! . _/.. Exterior .... ...... .............Roofing ....... .. .SI...T/.AC.411AL7............................................. Floors .i..j0............................................................Interior .......... f.\ /..�.. L— ...... ll........./� ,p �f ..................................... Heating ......9L 1-�.�./. I..0....................................Plumbing ..............�.......AA7—�.................................... Fireplace .............../. C..............................................Approximate Cost .............'7. / .................. ........ ........ Definitive Plan Approved by Planning Board ------------_-------------------19-------- , Area ..... ....0 ....... .......Diagram of Lot and Building with Dimensions Fee `��. ...... ............. .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby, agree to conform to all the Rules and Regulations of the Town-of Barnstable regarding the above construction. Name ..... .... .. . . . . ..................... Con truction Supervisor's License ..��. 5/.4�..... WJ:NGS, KARL Story 26975 1�, No ................. Permit for .................................... Single Family Dwelling ........................................................................... Location ..4.9...Tree...Top. Cixc.l.e..Lot...47......... . ........ ........ . .. ...... .... Marstons..Mills ................................ ............................................. J Owner ......Karl.............!�M�PNs............................... Type of Construction Frame............................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... 19 84 Date of Inspection 7..7................19 Date Completed TOWN OF BARNSTABLE Permit No. ---------- - Building Inspector Cash ------- —- OCCUPANCY PERMIT Bond -------__ -__ a_ Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... ..........c/.I.............................................................................................. Building Inspector FROM f— TOWN OF BARNSTABL.E Mr. FYancis Iahteine 'M•. _ .. ' BUILDING DEPARTMENT Town Clerk 367 MAIN STREET HYANNIS, MA . 02601 w ..w.__. __ ._ ... . _ ., Phone` 775-1120 ♦r SUBJECT: FOLD HERE Y DATE ^ December 4 1984 MESSAGE Wbrk has 'been canplefe d under-Permit #26975 (Karl Jennings) . ay » ..R.N MrwIL nMOs•fM� F., «i9"I Sq.K�'._ Q ,Y,. ._tww♦.fw tv Please release•Bc s» �--�- • OL SIGNED DATE a, - REPLY Q . ' SIGNED , N E17•RMI - - 'RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED INU.S.A. r - SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessor's'map,and lot number 11_�21 (� / .. T E Tp�♦ow Sewage Permit numbbeerr ...................................................... ... sn House number �l �7`, �i . ..... :.......:..... 90b L0� a O 9• ` TOWN OF BARNSTABLE BUILDING INSPECTOR _ l . /z sTo�� APPLICATION FOR PERMIT TO ... . ..!✓.d........ .............................................................................................. TYPE OF CONSTRUCTION ........!!! .Q.Q.. ...... /.,.J L. ............. 1k. ..L:r . . .... .. . .. ............................,9 y TO THE INSPECTOR-OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: " Location ......... ..9..... !.�. ... D.l4.....�� .!10.. .�- ................................. ..#.S............ •a 4 � 5 s,��l/.�rL �/IIL-.. . ,. 0 .. ..>�............................................. ..LLS Proposed Use .......... ...... �..... ... .. .... .... �......!/. ...... .................................... Zoning District ........... ... .................................................Fire District ............C Name of Owner .r.X.�T.. .....�1./4�.� ,1�1.� v ?....Address ......�Qv./.:\. .. ............................................... Name of Builder ... ....COPY-F........Address ....../.A�./.T.AIE LOW /11/"�-L. ......... Nameof Architect .........../S( .......................................Address .................................................................................... Number of Rooms ..............j..............................................Foundation ......... .U..../ ........a?,V . ,....../...���-C.. Exterior ....ChUe.� r.... .............Roofing .......1h tANA .'.............................................. Floors1.1 .................................................... ...............Interior , w ..................................... Heating �-. 4% �...1.^...::..................:.......:....Plumbing ..............1.........`r �. y /..... ......... .................................. Fireplace ...............11Q..�,_.._..............................................Approximate. Cost .............. .. .......I.................. ................. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ...... �. . . ......... Diagram of Lot and Building with Dimensions Fee . `... ..... .. � SUBJECT TO APPROVAL OF BOARD OF HEALTH �A0 a 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. qq j Name ... ...(!..., iC.. ................ Con ruction°Supervisor's License .. ..... JENNINGS, KARL A=150-63 26975 11'- story No ................. Permit for..................................... Single Family Dwelling..................... ............................................... Location ......49 Tree To ..qiKple W.t..4 ................ .7 ...................Marston ............................ ................ Owner ...Karl...Jennings................................... Type of Construction ...FKWne............................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ....Sep.t.e,!�.r..17..........19 84 ...... . .. ..... .. Date of Inspection ....................................19 Date Completed ............................. . .. ... .. . .19 Ll Assessor's office(1st Floor): Assessor's map d lot num er ._ ..- 8 L ° ° � �da�.r�,' THE O ` HNSTALLED IN OOMPLIA ' �• Conservation ` ` , e Board of Health(3rd floor): r rf fir, I MH TITLE 5 ` w Sewage.Permit number �J -7 .--HVIR®HMENAL CO® s a 0 1 P ( ) TOWN 6�E�'alJlL�'fIOV �a o d' EngineeringDe artment 3rd floor)- House number �Y1� Definitive Plan Approved by Planning Board g w APPLICATIONS PROCESSED 8:30-9:30 A.M.•and 1:00-i00 P.M.only i TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO A PP D Y 11 TYPE OF CONSTRUCTION _ 1.13 O m C CD r1 Q T I lU e 1 c n /b 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: � ,C l • Location Y �f�' �� Cr o d`t I 1 Proposed Use C S i e,'� I -R ( S f� ✓I c� r T b i-" Zoning District Fire District �. Name of Owner TAG P r' : CYN>1X\ A 4 S Address S G Name of Builder m 4 'V qI t r c Address "m cr :,N 1�1'1 i I C VIA r9, Name of Architect J e e r a C o r o L 04,4 Address r I l o'LI 19. Number of Rooms S A,,_S �`� Foundation P o:s r e 4 Exterior W S ^ �� r° Roofing c r n ! j r 1 Floors. Interior S ��- 'A V`c1<• 1 Heatingr' c� r c, oG , Plumbing � c 1 Fireplace Approximate Cost (a ��� A c9,. .1 : C Area _ Diagram of Lot and Building with Dimensions Fee �0' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r ng a ab construction. Nam Co struction Supervisor's License C>A14, a JENNINGS, KARL 1 No 3 5 416 Permit For ADD DORMER Single� Family Dwelling Location 49 Tree Top Circle Marstons Mills Owner Karl Jennings Type of Construction Frame Plot Lot Permit Granted October 2 , 19 9 2 Date of Inspection ' 19 Date Completed 19 r y� .s.. zz ki °' f +J` `n 4 kv, s-! J.t �,7 I COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ' ' OF 1010 COMMONWEALTH AVE. lug 1 MASSACHUSETTS BOSTON,MA 02215 LICENSE CAUTION EXPIRATION DATE 44 CONSTR. SUPERVISOR Q 94 �d�12,' FOR PROTECTION AGAINST } Re%fA o'N% EFFECTIVE DATE LIC-NO. THEFT, PUT RIGHT THUMB C�1 609/30/1992 046236 1 G PRINT IN APPROPRIATE BOX ON LICENSE. 1 & 2 FAMILY HOME 9JOSEPH C VAUGHN t o : BLASTING OPERATORS m43 TROTTERS LN rM f LUJ MMARSTONS MILLS MA 0264 MU NCL EP PF pTO(BLASTING OPR ONLY) FEE: ' ( ." 100.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ; �., JUL1992 _. ; STAMPED-OR-SIGNATURE OF THE COMMISSIONER ` yti •.;:: •fr `'_ :: HEIGHT: ,,I I!�•.;1 2'=� II�I: « SI FULL O Q�NA i • 41n��a��^,�.;�, TMIS DOCUMENT MUST 8E SIGNATURE Of VE f IL i 2.. 7; � LICENSEE '�.!1y.• $•. i•CARRIEDONTMEPERSONOF -. �• � -T THE HOLDER WHEN OTHERS•RIGHT,�U GAGEDINTHISOCCUPATION SSIONER ION. COMMI T Ai ds , s i;h -S rc . HOME IMPROVEMENT CONTRACTORS TORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place — Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 100513 Expiration 06/19/94 Type — DBA HOME IMPROVEMENT CONTRACTOR Registration 188513 Vaughn Homebui 1 ders Type - DBA Joseph G. Vaughn Expiration e6/19/94 43 Trotters 'Lane Marston Mills MA 02648 � Vaughn Hosehuildersp i Joseph C. Vaughn j ' 43 Trotters Lane ADMlNISTAAMR Marston Mills MA 02648 �i'[gineering Dept.(3rd floor) Map 1TI) Parcel L126 Permit# J House# d Date Issu —9 , Zon rd of Health(3rd floor)-(8:15 -9:30/1:00-4:3 - servation Office(4tli floor)(8:30- 9:30/1:00-2:00) STEAM MUST BE S VANCE P Admin. Bldg.) I�]STALL Board 19 OOB AND ENVIRO TIONS IL6 TOWN OF BARNSTABLE Building Permit Application Project Street Address 4 7—ok e c a A C r Village - mg r Sion r Owner�� P C A d ' 4 A f Address Telephone a © tt y Permit Request --rf, s S o 4 r �c r 7 n �X i S ��n re First Floor square feet Second Floor square feet Construction Type L-0 ao Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size d& ©off Grandfathered ❑Yes ❑No Dwelling Type: Single Family J Two Family ❑ Multi-Family(#units) Age of Existing Structure oilVaS Historic House ❑Yes 9,No On Old King's Highway ❑Yes ,4 No Basement Type: 4Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Z Number of Baths: Full: Existing o9L New Half: Existing New No.of Bedrooms: Existing 0New Total Room Count(not including baths): Existing New First Floor Room Count 3 Heat Type and Fuel: ❑Gas ❑Oil 'Electric ❑Other Central Air ❑Yes �No Fireplaces: Existing 10 New © Existing wood/coal stove ❑Yes ,W No Garage: ❑Detached(size) V-J D eA Other Detached Structures: ❑Pool(size) ❑Attached(size) N c ❑Barn(size) done ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# - Current Use ��9`^J Proposed Use Builder Information Name &DA Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTIN ROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE BUILDING PERMI IED FOR THE FOLLOWING REASON(S) o, r. FOR OFFICIAL USE ONLY W +1 Y PERMIT NO. DATE ISSUED r- MAP/,PARCEL NOy i a i ADDRESS r. VILLAGE OWNER DATE OF'INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ". ELECTRICAL: ' ROUGH FINAL PLUMBINO: ,.R0004 FINAL GAS: OUTi FINAL FINAL BUILD%Cr� ar 9 . DATE CLOSED�W R ASSOCIATION*AWN,% s IME . . : The Town'of Barnstable: 9e� Aft Department of Health Safety and Environmental'Services OrEDI Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office,use only Permit no. , Date f j AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. r Type of Work: Sv IdP I r Pmt�'�'m— C0 "O Est.Cost 6 Address of Work: ! ef !'e-e i0a �r �''l A °f�d%l' 011 S Owner's Name Q a t' A Date of Permit Application: 9 2 / 2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent.of the owner: Date Contractor Name Registration No. OR Date The C(lnlll101t 1l'call/i of afassuc•huscttr Department of Industrial Accidents ONCOal1ffV9S/gatlonS tSUO ►f'asltin�touStreet Bmwin. Jfasx 02111 Workers' Compensation Insurance Affidavit '".. NTlebi iiy�•___•�_..,"-..,�,.�_....----_- aplilEnt PlcnsePRi LLintormation• _ _ (tea t TlrA A i'Aotlocition- InIp VIA, s �m n-I )h nhnnc 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one workin- in any capacity [j ensation for my employees working on this job. I am an emplover providing workers* comp cnnrnnov name: ;tdd rccc• gin nhnnc i!- incur-ince cn neiicv o 1 am a sole proprietor. general contractor• or homeowner(circle otte) and have hired the contractors listed below who F the following workers' compensation polices: comn•rnv n•rrnc• nddreee- gin•• phone>�• nnliev a incrir�ncc rn _ _ _ cmmnnm• nhrnc• addrecc- gin• nhnne N! incurnnee co ^Olrcc• -- Attachadditianal Sheet ifneccisa :...--"�. ^_"•':•�ys. �L�. .�..a� ......r. r_._,::`.+..N� �."M �1�"`�� a:•—•....�.... . Failure to secure coverage as required under Section 35A of A1GL I52 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiL une ran• imprisonment ar%vcll as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a dad•against me. 1 understand that copy of this statement may be f 'arded to the Ofrrce of Investigations of the DIA for covcra�e verification. 1 do herefi•gear! er t p otr ualtics ojperjun•algae the lnjortrtorlotr prorided above is rru and cvtrectq Si_anature Date 7^/ Print nam .:4 r -S - %n Phone# '•official use univ du not write in this•area to be completed by city or town official town: permitAicense city or re # r111uildine Department ` C3ucensinr.!Board C t check if immediate response is required OScicetmen s Other ►.. 1- nttcalth Ucnanmenr TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION /DATE P.lease print.^ JOB. LOCATION �j'° l'c�.�o� Cr n , v/4 r Number Street address Section of town "HOMEOWNER" Name Home phone Work phone - - PRESENT MAILING ADDRESS � 1� Lt) Its 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia on a form acgeptAble to the Building Official, that he/she shall be, responsibl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes ..responsibility for compliance with the Sta- Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Depa t4ment imum i ection procedures and requirements and that he/she will co ly_ i pr edures and requirements. HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OF CIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Hom '� Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction* Supervisors, Section 2. 15) .. This lack of awarenes often results iW serious problems, , particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner' actin as supervisor is ultimately responsible. .J. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner 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. 2 ,/ 2 PROPOSED CONSTRUCTION 49 TREETOP CIRCLE MARSTONS MILLS, MA Project - insulate existing concrete walls with 1 1/2" foil backed rigid insulation and partition basement into two rooms. - Foundation walls - Construct on top of existing poured concrete walls, with 2x4 studs on the flat with'2' centers, raised 1 1/2" off the floor. Inserting 1 1/2' rigid foam insulation in between studs finished with 1/2" wallboard. All will be non-load bearing. Partition wall - Construct with 2x4 studs on 2' centers, raised 1 1/2" off the floor. Finished with 1/2" wallboard on two sides. Insulation will be 3 1/2" fiberglass batt insulation. Will be non-load bearing. Electrical - Receptacles will be placed around the perimeter of the room. Attachment to the concrete walls with lx3 secured on the flat covered with plating material to avoid puncture. Two circuits will be run using 12/2 gauge wire with ground. 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