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Home My WebLink About0240 TREE TOP CIRCLE to 9 0 a ACTIVE 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION'J Map Parcel Application _ - Health Division Date Issued Conservation Division Application'Fee Planning Dept. Permit Fee W7V) Date Definitive Plan Approved by Planning Board (�(� Historic - OKH _ Preservation/ Hyannis In �L Project Street Address a?,q14 2!ke0;<0/" efiA:P Village��o;f�dl f�,`�S OwnerAdf?o,& � o,�,!�d X Address �6�/ Telephone_c � Permit Request X/y- 0&9, vu�C1�id/Csl-- .Sf �®� �'�� /P�-f e' Square feet: 1 st floor: existing proposed 2nd floor: existing �U�L proposed PT Total new Zoning District Flood Plain Groundwatgr4 e jlay Lu 10 Project Valuation c376 4, o Construction Type (�J �d�WN OF gqRM Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ,"o On Old King's Highway: ❑Yes )d No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name / Telephone Number t57 g ,��s%Z l Address /if X99"O�AP Gib• License #�/ea Home Improvement Contractor# Email Worker's Compensation #4ze'g�® e Z�J j Q/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �U!h SIGNATURE Z A, DATE Z�// FOR OFFICIAL USE ONLY `APPLICATION # r DATE ISSUED r MAP/ PARCEL NO. ADDRESS VILLAGE r OWNER , DATE OF INSPECTION: FOUNDATION f FRAME INSULATION ' FIREPLACE J ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL S"FINAL BUILDING f I r , r , DATE CLOSED OUT , ASSOCIATION PLAN NO. r i. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY 8 SHED ROW WEST YARMOUTH� °2' /� 5 11'155 5 5 Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co:ntractor 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. sCA i t; 2OM-05r11 Address Renewal Employment Lost Card V/ee epom�r�aoaacuea•�G/olg/t/lculauc%ccaeCl'a C—\ -Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT'CONTRACTOR before the expiration date, If found return to: egistration: -4.53567 Type: Office of Consumer Affairs and Business Regulation xpiration: ;:1;2%:1:5(20:1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION....INC'' . HENRY CASSIDY 18 REARDON CIRCLE" . g� 'SO.YARMOUTH, MA 02664 Undersecretary qNvalid wi ut sign e I I .:.... ., The Commonwealth of Massachusetts - - -- Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatioriAndividual):41 1 Address: City/State/Zip: laid V)A, Phone #: A - 17,4 Are you an employer' Check th appropriate box: Type of re l. .I am a employer with 4. ❑ I am a general contractor and I yp project (required): ) employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ 1 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' insurance.# 9. ❑ Building addition (No workers comp.comp. insurance p' � 10,❑ Electrical repairs or additions required.) 5. 7 We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their l l,❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12,0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.� Other (� comp, insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affiMit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name; Policy # or Self-ins. Lic. #: Ci I N Expiration Date: -Job Si.te Address;�yv /��/° �//� N1A2�s� �`�ity/State/Zip: &P z,G 4-e 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 insura coverage verification, I do hereby certify d the pat an penalties of perjury that the information provided above Is true and correct. Signature: ` Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1, Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I� ACAPECOD-27 TQUIRK .4COR0° DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/27/2016 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 endorsement(s), PRODUCER CONTACT NAME: ROers&Gray Insurance Agency,Inc. PHONE FAX,134 4 A/o No): (877)816 South Dennis,MA 02660 ADDRESS:mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company INSURED INSURER 8:SafetyInsurance Company 39454 Cape Cod Insulation,Inc.: INSURER c:Endurance American Specialty Ins,Co. 18 Reardon Circle INSURER D:Atlantic Charter Insurance Group South Yarmouth,MA 02664 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'INSR TYPE OF INSURANCE LTR IN SD WVD POLICY NUMBER MMIDD/YYYY MMIDD� LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR CBP8263063 04/01/2016 04/01/2017 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jECT LOC PRODUCTS•COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY nCOM (Ea aBINEDISINGLE LIMIT $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPTY DAMAGE AUTOS Per acciERdent $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE R/O EXCI0006635000 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER 0 - AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER D ANY PROPRIETORIPARTNERIEXECUTIVE WCE00431901 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE $ 1,000,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bill Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS. Brewster,MA 02631 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD . HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: - i The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic & basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) `� Home Owner email: Date: Agent:(Signature) Date: Weatherizatio Antractors*C7,," Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Buildin Si Construction Resolution Energy ape Cod Insulation Tupper Construction f I Building Performance Contracting,LLC Nauset Insulation P.O.Box 1044 N. Eastham,MA 02651 1 Phone(774)316.4464 Fax(774)316.4462 Date v� l i RE:Insulation Permits Dear Mr Perry, This affidavit is to certify that all work completed for the insulation work at -LL lv I+UI�� has been inspected by a certified Building Performance Institute(BPI)Inspector.All work performed meets or exceeds Federal and State requirements. ;Respectfully, s mond aT f� r_z. L� i� ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y Map Parcel 6 Application # (o 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 ® Ire P P' In �r ►rC.l P Village 080,VS Owner o4 OU rf.t A`L Address�o�i`4)f Pie7�C T&GI�c�tS1zS Telephone ' ��1 --�� A 4-L Permit Request ja)D' o S l - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District c'Flood Plain Groundwater Overlay Project Valuatio , ZS Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ 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 (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑'existing 0 new s ze_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: `w T I � Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# �• Current Use Proposed Use vi APPLICANT INFORMATION (BUILDER OR HOMEOWNER) (� Name —� � — Telephone Number Address I oa* �P License#��f 1 `u 1M y a(4 b Home Improvement Contractor# 1r=_(�h�' �; Worker's Compensation # &LV0o 232 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE I �• FOR'OFFICIAL USE ONLY z APPLICATION# i DATE.ISSUED MAP/PARCEL NO. ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION i FRAME - INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT' r ASSOCIATION;PLAN NO:, ' ° .s,t.►a +� `�•.�:w;a h r The Commonwealth of Massachusetts Prmt'Form Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): &-L Address: ' �33 City/State/Zip e, Phone#: �Z7/997j Are y an employer? Chec the appropriate box: Type of project(required): 1. I am a employer with `o t 4. ❑ I am a general contractor and I • employees (frill 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 8. ❑ Demolition 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.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ of repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 Insurance Company Name: &&,ZJhC ��7 Policy#or Self-ins.Lic.M y0(!:_1V©093c�� Expiration Date: no yLZ Job Site Address: a T D / �ee-fP Ct K--//e City/State/Zip: &C6!!St Attach a copy of the workers'compensation policy declaration page(showing the policy number.and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceLftA under the ains and penalties?fee!142 that the in ormation provided above.is true and correct Signature: Phone#: Official use only. Do not write in this area, to be completed by city or town offzciaL 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#: t91/11/Lt71J f7L:Oi3 y/ti/!lt1415 t'Htat t71 OA7E(iwaWVWftVV) �o CERTIFICATE OF LIABILITY INSURANCE 1/11/2013 TI�1 ONLY AND CONFERS NO W"" UPON TN¢ CfRT>}rAU HOLDER TNOB THIS GERTWrATE 19 ISSUED AS A MATTER OF INFORMA ,� AFFORDED BY THE pOLICNE9 CERrdgCATE DOER NOT AFFHU"TNELY OR NEGATIVELY AMBID. EXTEND OR ALTER ZEr#AWX THE 1 S0"Q INSUIMWSb AUTMOOM www. Two CERTIFICATE OF INSURANCE DOES NOT GOj42T1T= A CONTRACT REpREBSUTATTVE OR PRODUCER,AND THE CERTIFICATE HOLDER. mwt U>SUgRO�ATION 19 WANED,slrb t m IMPORTANT: U the cwbTA is holder k en AD60IONAL IN911RED.1f�Pollry(Ns1 �not rights to 1M the terms wW eonditl m of IN PD&Vi co tom�may rsdttars en ar donemuz A sbitv"M On 0"oatl6ab oerdfic*a holder In aw.of ouch Mdmser— c 2ROVJCE 777-8415 ro�Y ntgpRWg AGMCy INC (979)774-2463 123 Sylvan St Danvers, bA 01923 Commotce Ztss. Co. a i pgPJREFL INSURED Building Parformmacw Cont:xacting, ji,C. 5�A ab� Ins. Co. tic Curter P.O. Box 633 netuaEaO: Truro,. M& 02666 e: RHtF. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIO=OF INSURANCE LIST®BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE. NOTWIT WANMO ANY REOUffd3 ENT.TERM OR COImIT10N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO THE Tt(S C MFIOATE MAY BE GSUED OR MAY PPERrAIK OLICIES.LTHE SHOWN MR BEER Y THE;EO u CIES CUt�MS..ED H EN is sLJBJECT TO ALL THE TE3�IR. EXCLUSIONS AND CONDIiIONsS OF SUCL� � TYPE OF U46UPAHM wro POUCY KIMBBL MWO LtR �nCCURR94M i 1,000 000 C431ERAl UABRRY o�f�n s 50 000 8 COMMMCk4L GENERA.LVAL"y WD pips 1,000 CLAIA6MADN= OCCUR 15 3D$9441 11/19/12 il/19/13 P�taoNALaAOve� $ 1.000 000 cE+ERAL AGGREGATE s 2,000,000 PROOCrg_ IOPAM s 1 000 000 am AGGREGATE UMTT APPUM FM i POUCY M WT LoC 1 000 000 AUTOMOSU LdABR.RY (Ea aedNn —L BODQ Y NiNRY(Per D� Q S ANYAUTO LQ3983 WOLY"wuRY(P.rawdaena i AvT &LOWs NED x AUTOS /2/12 2/12/1 HIED AUTOS AUTOS : � �uAa occxrR � ocou�NM $ 2 000,000 a wM COBIP3904112 5/1/12 5/1/13 AGGRMATE s 2,000,000 DCSTATU- =R s amRE NIMON i W WORIO=RS COMPENSKt10N Y AM ELFLOVIEW UAeam Viol 11/23/12 11/23/13 E.L EAC1 A=jwff : 500,000 AW PRC '9 r"' WCV00939900 Ei OtsEASE-�► t 500,000 Hd,,a�.>a+o:,a„ E-ofmm-Pour.YUMIr : $00 000 WG rw 1 OP OPERAnONS below DESCRFMON OF OPMA71QNS I L='nONS I VMCUM(AMPM ACWW 10%Addteonel fWw"SdWW%If nnre W=b MV CERTIFICATE HOWER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DFSCREW POLICIES BE CANCEIIED BEFORE Barnstable, Na TKE EXPIRATION DATE THEREOF. NOTICE WLL BE DELNE ED IN ACCORDANCE WITH THE POLICY PROMSIONS. AWMRIZED AT7 *iM.2010 ACORD CORPORATION. NL"reavved. ACORD25(2010/Ov7 The ACORD rwme mil logo are regot mA merles of ACORD f OWNER AUTHORIZATION FOR M Lwm� ZL (OWNERS NAME) Owner of the property located at: (PROPERTY ADDRESS) L�az� ! "W( i (PROPERTY ADDRESS) Hereby authorizeEll ( L (SUBCONTRACTOR) , An authorized subcontractor for RISE engineering,to act on my behalf to obtain a buiding permit and to perform work on my property. Owner I signature Date ucense or registration valid for individul use only Office of Consumer Affairs&Bos►um Regelation before the expiration date. if found return to: ME IMPROVEMENT CONTRACTOR pfrtCe of Consumer Affairs and Business Regulatio istration: ;f 4235 Tom: ` LLC 10 Park Playa-Suite 5170 Iration•:r16 Boston,MA 02116 BUILDING PERFORM WRAcTiNG,LLC. JOSH EDMOND 8 KINNIKINNICK RD `, �.•�-- TRURO,MA 02686 - UnderseeretarY of valid without signature �i:►ssuehu+ett.-Department of Public Safety Board of-Building`Regulations and Standard License: CS. 78815 JOSH ErJ6ND 50 SUNSE *DRIVE _ .BEVERLY, MA 01915 Expiration: 32I3- C-onuni+winner.. ;T pp SHE 7 ToWn of Barnstable Permit Expires 6 nromtlrsfrom issu date Regulatory Services Fee uRrtsrnat�, Thomas F. Geiler, Director htnss '�,, Building Division rEo Mop° Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508=790-6230 EXPR.ESS.PER>MIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (1-9 0a-3 Property Address :L!n ( f e C I tt= 1V1Ctil�s�C �\ S M 1 s residential Value-of Work NO Minimum fee of$2S.00 for work under$6000.'00 Owner's Name& Address S('�' �� Yl��pnvi Contractor's Name _Telephone Number Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor mP ESS PERMIT [� I am the Homeowner ��9 ❑ I have Worker's Compensation Insurance S E P 2 2 2008 Insurance Company NameI OWN_ ARIVSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box). ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) �] Re-side ' I EX Replacement Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign,Property Owner Letter of Perms A copy of the Rome Improvement Contractors License is required. g+� :6 ► ZZ ��+5 9��Gc SIGNATURE: Q:\V,PhLES\F0R_MS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of lndustrialticcidents Office of Investigations 600 Washington Street Boston, Mft 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians plumbers Applicant Information Please Print LeEibly Na f,- (Businessorgarizz onllnciividuan: sV6_)(_nV1_% Ad�Te55: ,Z�i C e- -Fn City/state/Zip: - .Aj_i MAI A phone-#: S�c� • �� • 1 Are you an employer? Cbeck the appropriate bwc: 'Type of project(required): 1.❑ I am a employer with 4- ❑ 1 am a general contractor and 1 6. ❑New construction employees(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 wot3ing for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' crmtp."irsul-ncc coup.insurance. required] S. ❑ We arc a corporation and its 10.❑Elcdrical repairs or additions 3.[� I am a homeowner doing all work officers Lave exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per lv1GL 12 ❑goof repairs incrrrancc required]t c. 152, §1(4), and we havc no employees. [No workers' n13.9] Other rn T— comp, ingurace required] 1� c_ tQ U �- O `Any zpplicant that chccla box#1 roust also fill out the acction below sbowing their wmnicas'coroprnaation policy information- t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contructars must subnut anew aE3davit indicating such iCantractDrs that ehxk this box must atEaArd an additional sheet showing the name of the sub-coup aeto, and statz wbetha or not thosd cntitia have cmploycrs. If the subcontractors lave muployccs,they must provide their wort-zn'camp.policy number. I am an einployer that is providing workers compensation insurance for my employees. $claw is the policy dnd job site info rmmation. Tngurance Company Name= Policy#or Sc1f-ins.Lie.#: Expiration Date: ,>-Aob Site Address: (-I PA D �►� Cti�c a,-, M��)�C City/Statdzip: Q 2 " Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to scenic coverage as required under Section 25A of MGL c. 152 can lcaii to the imposition of criminal penalties of a 5ne tip to 31,500.00 and/or one-year i>riprisonmcat; as well as civil penalties in the form of a STOP WORK ORDER and a fit of up to S250.00 a day against the violator. Be advised dial a copyof this statcmcrit may be forwarded to the Office of Invcstig&tians of t:hc DIA for incnramc,coycragc ycriFicatian. - I do hereby certify under the pains.and envlties ofperjury that the information provided above is true erred correct •.n�-= r ` =L� Date: Ph d onc 4- �U " "1 1D 9 1 k Q I Official use only. Do not write in this area, tb be completed by city or town offx—!aL City or Town: PerraitlLicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#: Town of Barnstable O�THE Tp�y yw o Regulatory Services = BARNSTABLE, • . Thomas F. Geiler, Director Building Division JF0 M�� Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION /� Q Please Print DATE: `°' `"� JOB LOCATION: /�� rG r ' C P I� C � ��y�•S ► �I t �� numbcr —street village "HOMEOWNER LG,CY\ot)rCe-,j J.Og •�1� Q• i �g � Sog 2 name C 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 HOIVIEO\vNER 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 permst. (Section 109.1.1) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons 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 re uirements. 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 stairs 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-Liccrising 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&c unaware that they arc assuming the responsibilities of a supervisor(sec Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.1S) 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 uiih 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 hc/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formhcrtification for use in your community. NY �oF�HE, Town of Barnstable Regulatory Services, r + wRAS X MI $ Thomas F. Geiler,Director lfo ,�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 wyew.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 , as Owner of the subject property " hereby authorize to act on my behalf, in all.matters relative to work authorized by this building permit application for: (Address of job) signature of Owner Date i Print Name If Property OwnerEtle g for permit pleas complete the Homeoamers License Exemption Formrse side. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost:$30.0o for 4-years). A business certificate ONLY REGISTERS YOUR N AME in you must do by M.G.L.-it does not give you permission to'operate.) Business Certificates are available at the Town Clerk's Office, 1' FL.[367h Main Street, Hyannis, MA.02601 [Town Hall) �n90, 552Mg � : ;:� Fill in plQnce! ' APPLICANT'S YOUR NAME: YOUR HOME ADDRESS;_Z TELEPHONE # Home Telephone Number_ ry y - NAME OF NEW BUSINESS' IS THIS A.HOME OCCUPATION?._. �—' �`- TYPE'O.F BUSINESS_ _- — YES. IVO .. Have you been given ap.proval'from'tlie build,in:g:divisiori?'Y)=5 NO ADDRESS OF BUSINESS -o %%ce jd. c;� . T" y �s 11/IAP%PARCEL NUMBER ( vZ (7 When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you-in obtaining the.information you may need'. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street). to make sure you have the appropriate permits and licenses-required to legally operate your business in this town. 1. BUILDING'COM ER'S OFF E This individu J,has b ein infor edtof permit requirements that pertain to,this e of business. MUST COMPLY WITH HOME OCCUPATION �Yp RULES AND REGULATIONS. FAILURE TO Aut oriz igra e** MPLY MAY RESULT IN FINES. COMMENTS: 2.. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** CDMMENTS: . 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.* COMMENTS: Town of Barnstable ��TME Tp� Regulatory Services � ` ` ''" BARNSTABLE Thomas F.Geiler,Director 2004 AUG -9 N� 9: 3 • Building Division 3 HAM raBM M^M �' Tom Perry,Building Commissioner 1639• iOrE M a 200 Main Street, Hyannis,MA 02601 �-- www.town.barnstable.ma.us Office: 508-862-4038 Fax• 508-790-6230 Approved: Pee: .2157 Permit#: HOME OCCUPATION REGISTRATION Date: Name: 5-co Ir% ,l Phone#: 50�' y a Address: 1. �40 Villager Name of Business: G' Type of Business: Z`��/;,9,v,�j,�� Map/Lot: 0.2 3 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for home occupation I am registering. Applicant: Date: 4V Homeoc.doc Rev.5/30/03 TO ALL NEW BUSINESS OWNERS DATE: Fill in please: YOUR NAME: APPLICANT'S `.. ' YOUR HOME ADDRESS: BUSINESS Tele hone Number Home O'� C TELEPHONE TYPE OF BUSINESS NAME,OF NEW BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ,4P�PARCEL NUMBER ADDRESS OF BUSINESS When starting a new business there are several things you me nfo�mati n in eyou may need.. Once you have obtained the required sr to be in compliance with the rules and r6gulations of the o ignat res, listed Barnstable. This form.is intended to assist you in obtaining th Town Clerk's Office (Ist floor-Town Hall). You MUST go to the following office to make sure you below,you may apply for a business certificate at the have all the required permits and licenses.. GO TO 200 Main St. - (ce er f Yarmouth R . & Main Street) and you will find the following offices: 1. BUILDING C MI S I. ER'S I This individual s e inf med of mit equirements that pertain to this type of business. A th ized gnature * I r,4 17 - COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit require nts that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements_that pertain to this type of business. Authorized Signature.* COMMENTS: E in the to. n (which you do Busin ess certificates (cost$30'00 for 4 years]. A business certificate ONLYIREGISTERS completion of the rocessesnfrom the various departments tinvobved M.G.L. -it does not give you permission.to operate-you must get that through camp **SIGNIFIES APPROVAL FORA BUSINESS CERT/F/CATE Oft Y. { o� z TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel o a3 Permit# (M 3(o . D Health Division o ! s "l��U� �To RT�BLEDate Issued - y ��i� Conservation Division ILI ll &00Z, i 2003 JUL �� P�j f: �p Application Fee > �.� Tax Collector 1�161e/ 1- Llz �,9 Permit Fee - Treasurer �l _____._. SEPTIC SYSTEM MUST BE C1'JIS10�? INSTALLED IN COMPLIANCE Planning Dept. Date Definitive Plan Approved by Planning Board KITH TITLE 5 ENVIRONMENTAL CODE'ANG jHistoric-OKH Preservation/Hyannis TOVVII REGULATIONS Project Street Address a-A(D T V_e 5_=- T c Village Owner SCb OV C"tQ X Address D A D T�-tz OCR C Telephone Q) — l A a c�n ` 9zo/g Permit Request Z)�CA(=, Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain G Overlay Project Valuation$15 00o bD Construction TypeWk\ V\a o Lot Size y Grandfathered: ❑Yes *o If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: Cl Yes ❑No Basement Type: Wull ❑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 40il ❑Electric ❑Other Central Air: ❑Yes CT'_o Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes 40 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size 'Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: 'Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name��CQ_ -- 55 \ XQn `�CA`MOU Ct-IJ'k Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. "DATE ISSUED MAP/PARCEL NO. -ADDRESS , VILLAGE "bWNER DATE OF INSPECTION: FOUNDATION 3s ® J !®3 , _ FRAME . INSULATION--, , FIREPLACE ELECTRICAL: ROUGH FINAL E t = PLUMBING: ROUGH + FINAL GAS: . ROUGH, ,' : FINAL FINAL BUILDING ` L x DATE CLOSED OUT ASSOCIATION PLAN NO. . The Corrimonweatth of Massachusetts , -- Department of Industrial Accidents -- - _ - Office olln�es�igada�s . - 600 Washington Street Boston,Mass. 02111 Workers' Co ensation Insurance Affidavi� m e: S io�txoit: a-A o c �. ��- Q _ o►.� S-\,�-C>\(\S D ci . _I am a homeowner performing all work myself I am a, I ro rietor and have no one workin in ca achy rkers' com ensation for my employees working on this jab. • ...•:•.�•• :ye•n;n}Y)r?R>:a:i•:}`.8:: .vii:f;;:g!l:n:!<7.;;'y:'?y.3:C.,•.`,{ryi:`}5:::< i:?:'�%�^ %%°�i; one 1 g ;n}:.,.{:•..})h2::'!r^}R::::�;>:::<�.�:i::4.:>a?>;:::..r..}:: ..:w.��:..: .::i,-:.{.. ..4:.;.}.,.):r::rn..,..$:.:..:. !;..i';:,:t4:4,.2::>.. .:�:�<2i ..........�.n..:nn.:n•..,.:.}:..Y;>}:.:}:.:....t.. }., ...... :F.....,:.:...r;?:.i}{{).:;nv..,.:n.?.Y.3:....... ....: .r.:-r..,. ..,..}, {} ::<!f:...., ... ....x...r....n ... ..... .r: n....:..•...J.... ..:..v...n... ..v.?i:......r...........w,.....n,. 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Yi<:E<•.fk•:..;?•..,..:::,i:a::•n:::..{::.r......r.,y<�;:r:al•y.;..:: r.Su.E?4Y3;L:::::..:..:........ � ..3.:::•.?•:�:......:.:..n•.......... I .{!:?.:.:a}xh.�•:..,.>.:;t•.;;:.;!:...;,.t•:. -. ..i..:.f}..:},2.:.,•:•:.i•::.�:i}.:....:.. !..t<.,:..:2::::r.....:................r::,L...:::::. '' '�n:TST2rf%`<GQ:::yi�2•.;:�•r,;;:V•;.?23;;}:,••.;v:`c:•n.,::?::2i?2;St.}•.y:?.<;.c:i!;t?{%:3:::;;«d%:v••}}n{::•.n•:r........ �� • Failure to secure coverage is requited ender Section 25A of MGL 15Z cariL ad to the imposition oI c:irninal penalties of a fine ue. to dem6.00 and/or one years' secure coverag as well u duff penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ma I�dersGond that a' be forwarded to the Office of Investigations of the DIA for coven copy of this statemeatmayge veritication. �' •_ I do hereby-certifyunderthepains enalties-of-perjury tha�the-information_pravidedabvveass cr1au correct --.. Date signature \ :- "i�1� I D Paint name `�lU.C LU�Ol� .:Phone# official use only do not write in this area to b e completed by city or town official pendliceme# • C3BuJ1d1ngDepartment city or town, ❑Licensing Board _ ❑Selectmen's Office contact person: ! f-A-19195 PTA) = 9 Information and Instructions Massachusetts General Laws chapter" section 25 requires all employers to provide workers' compensation for their `law , an employee is:defined as every person in the service of another under any contract employees. As Quoted from the of hire,'express or implied, oral or written. artners , association, corporation or other legal entity, or any two or more of An employer is defined as an individual, 9 hip _ the foregoing engaged in a joint enterprise,-and including the legal representatives of a deceased employer, or the receiver or ociation or other legal entity, employing employees. However the owner.of a . trustee of an individual,partnership, ass .. dwelling house having not more than three apartments and who resides therein; or the occupant of the dwelling house of ction or repair work on such dwelling house or onthe grounds or another who employs persons to do maintenance, constru building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance br 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 rm cal subdivisions shall enter into any contract for the perfoance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. . .. .;. W. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and: supplying company names, address and phone numbers 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. 14 Tlie•affidavit should*be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or�ifyQu aie required•to obtain.a workers' cAmpensatioix policy,please call the Depai•tirierit atthe number listed below:. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. PI e A emutllicense ii ber iach will e used as a refeieace nuiiE 'I'Fie affidavits maybe'r au> be sure.to fill inb a Have been iriade the Department ya or FAX iwless other arrangements _ � ations would like to thank you in advance for you cooperation and should you have any�uestions, . The Office of Investig. ,. . , j please do not hesitate to give us a call. The Department's address,telephone and faxnumber. The'Commonwealth Of Massachusetts Department of Industrial Accidents amce of lavesilgallons 600 Washington Street , Boston,Ma. 02111 • fax#: (617) 727-7749 406, 409 or 375 : phone #: (617) 727-4900 ext. FINE T° Town of Barnstable N °* Regulatory Services WINsznsIX, " Thomas F.Geiler,Director rsAM 90 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 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. ""' Type of Work: � �� O lv Estimated Cost Address of Work: aL"�C7 �e� —vc>,Q Owner's Name: V L Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ,®owner pulling own permit 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 Owner's Name Q:forms:homeaffidav i The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: rr�� JOB LOCATION: number treet Q 1 Q Qvillage /�Q "HOMEOWNER!*: �G\��f1 d� X 1 r ls— 1 l�� s—ZCO C) name home phone# work phone# CURRENT MAILING ADDRESS: � T - oo C\\g— M axs_ �6cs - . MA 0Q0A9 city/town sfatd zip code The current exemption for"homeowners"was extended to include owner-oc.Wied 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 i The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the Provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. O:FORMS:EXEMPTN LC lllJ e22�� u c t ct ti LA� . I-ts6-1 c� V-1 I z. L05, I G a i4'C Go �t� I3 V Y lJ 1�1 v 99-01695 SURVEY, INC. P.O. Box 220 Charlestown, MA 02129 (617)242-1313 MAIN (617)242-1616 FAX APPLICANT: LAMOREUX LOCATION: 240 TREETOP CIRCLE DEED/CERT.- 11518-238 CITY, STATE: MARSTON MILLS, MA PLAN REF: 198-43 ------------ -------- looso LOT 9 o a 10 ` 21,200+I-SF S �( }C io g (11 7 STORY LDS .. TREE TOP CIRCLE 1994(c)Boston Survey Software PREPARED: 01-28-1999 SCALE: 1 inch = 40 feet CERTIFIED TO: BANKBOSTON-, N.A. Assessor's office(1st Floor): 'Assessor's map and I tnum r !\ '� '"ba 3 f K` o�THE v(5onseNation // Board of Health(3rdfloor): ��S'�{�PA MUST Sewage Permit number ��® { 1iaaEST�nt i��'I�E �- rua Engineering Department(3rd floor): INSTALLED,� 5 House number v2`�� 2� e I f��,E E"'. �e mill�. All Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BX-RNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TOCousqleaz--r (-x 3n 'Prop t-[la,A TYPE OF CONSTRUCTION �lw1l�t-t✓ V w"%%A uoery �elkf�— f 00y ',>o 0-5 2y- 19 9Z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for �a permit according to the following information: �1 Location Z�° �L ToP l��w= �D�S'C�.�� \ I�tas,� �Ib OVAb Proposed Use i Zoning District Fire District yi' Name of Owner Address �11%6 Name of Builder Address N Name of Architect btpp,60-- Address Number of Rooms 2 Foundation /► 11 A Exterior 6wyl"4 +�- Roofing yWA*L-'t ' Floors 'g � t 09 ��i� . i �'I'^3�D Interior Heating( sl0 "Q-M &"" 'fo Vta?Wle �T M-plumbing Fireplace Xl'S'I-,�t 1° X O v E1D Approximate Cost �2 boo Area Diagram of Lot and Building with Dimensions Fee 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. NameI e� • Construction Supervisor's License ,-9 itj A.)e►r' GLESS, EDWIN & CLAIRE No 35088 Permit For Build Addition Single Family Dwelling , Location 240 Treetop Circle Marstons Mills Owner Edwin & Claire Gless - Type of Construction Frame Plot Lot Permit Granted May 27 , 19. 9 2 Date of Inspection f T 19 1 r Date Completed ,J� 3 19 J TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE ER ----------------- -,� EMPTION Please print. r --------------- D TE 2 ' Z JOB: LOCATION Z �� l a 1y P 5 Pit t tS } Number btreet Address i Section Of Town "HOMEOWNER" Name �Z-0 3ogb Home Phone Work Phone PRESENT MAILING ADDRESS 2qb T tLLs City/Town AZ I-L4 State Zip Code The current exemption for "homeowners" was extended to include owner- occuoied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that thelowner acts as su ervisor. DEFINITION OF HOMEOWNER: Per on(s) who owns a parcel of land on which he/she resides or inte reside, on which there is, or is intended to be, a one to six family d8 to dwelling, attached or detached structures accessory to such use and" structures. A constructs more than one home in a two-ye/or farm period shall not be considered a homeowner. Such "homeowner" sha ar to the Building Official on a form acceptable to the Building Official that he she shall be res onsible for all such work formed 11 submit buildinu tiermit. (Section 109. 1. 1) ed under they The undersigned "homeowner" assumes responsibility for compliance with State Building Code and other applicable b the icable codes, by-laws, rules and The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements i HOMEOWNER'S SIGNATURE I -APPROVAL OF BUILDING OFFICIAL Note:' Three family dwellings 35,000 cubic feet, f°or la i required to comply with State Building Code Section 127.0 Co larger, will. be Cont netruction Hzscs R HOME OWNER'S EXEMPTION The ..code states 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 thattif Home Owner engages a persons) for hire to do such work, that such Home Owner shall. act as supervisor'. " Many Home Owners who use this exemption are unaware that they are assuming the: responsibilities of a supervisor (see Appendix Q Rules for Licensing Construction Supervisors, Section 2..15) . Thisalackeoflations awareness often results . in serious problems, particularly when the Home i owner hires unlicensed persons. In this case our Board cannot proceed u against the unlicensed personas it would with Home Owner ..licensed supervisor; The ; 'acting as supervisor is ultimately responsible.' r To 'ensure that the-Home !Owner. is fully aware. of. his/her responsibilities, many' 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. Youa�may care to amend and adopt such a form/cer community. tification for use in-.your' ,a 1 Sr t c _ a i k q 1 i, i I t :t i 1 12 1/2" COX PLYWOOD ROOF SHEATHING 5 _O G- 235�YIN. ASPHALT 151j1 FELT PAPER 5 SHINGLES W/DOUBLE DIST STARTED COURSE, ENTIRE Of FRONT ELEVATION RD R-19 UNFACED INSULATION TO BE RESHINGLED f 2" x 6" CEILING JOIST 16' 0.C.7'x 8" FACIA BOARDI" x r FURRING 57PIPS 16" O.C. 16'-0" 1/2" PLYWOOD SOFFIT1/2' DRYWALL TAPED AND PAINTED TYP DOOR AND WINDOW HEADER ! FRIEZE BOARD DETAIL WITH 1/2' PLYWOOD /NFILL PROPOSED 1 T6' WHITE CEDAR—CLEAR _ ADDITION 5" EXPOSURE TYP. 3 SIDES ^� R- KR1FT FACED - •7YVEK HOUSE WRAP INSULUL ATION 1 2 1"x8" RIDGE ^ y BOARD Kr COX PLYWOOD SHEATHING W R q p NEW TO OLD CORNERS TO 1 2' DRYWALL TAPED AND PAINTED 2 PL HAVE A MINIMUM OF 2' OVERLAP / ' g tld PR£M/UM CEDAR CLAPBOARD 2" x 4" SOLE PLATE o N N a M ELEVA710 POSURE FRONT 1/4' PLYWOOD 0VERLAYUENT h 2"X 6" PRESSURE 1/2' PLYWOOD SUBFLOOR Z'6..12'-0" TRE47ED SILL PLATE 2' x 8" HEADER ( 16' O.C. TYP. CEILING JOIST- W/ AIR 84RRl£R - 2 2"x B" FLOOR JOIST 16" 2"x6"x12' 16" 0.C. ROOF x 10"ANCHOR R_11OR JOIST 2'x 10' HEADER W/ FINISH GRADE m s 80L75 HON ; I). 1/2" PLYWOOD INF/LL 8" POURED WALLS 1"x8" RIDGE BOARD �1 2'x6"x6'-0" BLACKJACK WATER �� 16" O.C. CEILING JOIST. REPELANT p 1" MUD SLAB (T)-E \27X6" 16" O.C. ROOF ' r 11io�S' -'�'� JOIST 1 1/2" x 3 1/2' 10' x 16' F0077NG KEY ROOF FRAMING PLAN UNDISTURBED COMPACTED EARTH SCALE 1/4" = P-0" TYPICAL SECTION SCALE.' 3/4" = 1'-O" Do-*a4 by SCALE PREPARED FOR DETAIL & ROOF hock °y` ED & CLA/RE GLESS �. s s d t la n t i c DESIGN ENGINEERS, INC. p"tl'b°Y AS NOTED 240 TREETOP CIRCLE GLESS RESIDENCE oeNUYBER P.O.Box 1051,Sandwich, MA 02563 (617)888— 9282 °Y' LICENSE NO. Date 1q Ml[ IR�at1 MARSTONS M/LL5, MA 02648 05120192 1000 J NOTE. 1/2"X70"ANCHOR BOL75 EMBEDDED 16'-0" 7" M/N., 8'-0' O.C. MIN, 0'-6" FROM ALL CORNERS AND DOOR OPEN/NGS. •_: BEAM CUP 1/2" x 10"ANCHOR BOLT CRAWL SPACE 7O HAVE 1" NOTE.- NEW WALLS AND FOOTINGS MUD SLABS (7YP) TO BE TIED TO EX/STING WALLS t , WITH TWO (2) 94 RESAR EMBEDDED _ 10" SONA TUBE AND GROUTED 4" MIN. INTO 2 - 14 REBAR EISNG WALLS AND PROPOSED INXTOT PROPOSED POUR. MIN EXISTING ING ADDITION r. r R FOUNDATION/ A A 8"x20"x20" p ,I fl VAPOR BARRIER F0077NG (TYP) 1 1 9 FRAMING _ =_ _ -_- .} 8" x 20" x 20" COMPACTED EARTH 3-2"x8" BEAM h POURED F0077NG _6' DEEP EX/STING = 70"SOMA TUBE V SUPPORTED ON BEAM POCKET T>P c[ T _ ,_ :_ UND/S7URBED -�j 10' REZ12'-O' R ( ) t7 STEEL COLUMNS _ ` Fp' 77E0 INTOq 8'-0" O.C. _�_ - ``FOO77NC _...� ? 's e2 c _ COMPACTED EARTH 2x8" FLOOR JOIST 1'- 4• 16" O.� SECTION B-B 16" O.C. (407f/ood) 0'-B" SCALE.- 3/4" = 1'-0" 3"x2O'x2O' EXISTING F0077NG ASSUMED 1-00771VG (TYP)17-71 F u ; POURED CONCRETE 2x8"x6'-0" F0077NOS (2800 psi TYP) F6-- C. (401 load) t 1/2 x 10"ANCHOR BOLTS = \y 5" WIDE x 6" DEEP NOTE.- ALL SPEC/F/CA77ONS TO COMPLY I BEAM POCKET WITH THE MASS. STATF BLDG. f7NISH jG2& 1005 CODE 8' POURED WALLS FOUNDA TION/FRAM/NG PLAN BLACKJACK REPELLANT ORR co EOUI✓ALENT SCALE: 1/4" = P-0" 2' v VAPOR BARR/ER (TYP) 1 1/2 x J 1/2 -`" 10" x 1 G FOOTING KEY a�=.• t='i-.��i=-�-.Jr" Tr�-�� UNDISTURBED COMPACTED I 64RTH - s -CT A-A SCALE.• 3/4' = 1'-0' D"'i4°y' SCALE PREPARED FOR FOUNDATION PLAN A `r `r �°°y ED & CLAIRE GLESS "°' a s o A 1 IQ n 1 i C DESIGN ENGINEERS, INC. �"d`*d by AS NOTED 240 TREETOP CIRCLE GLESS RESIDENCE P.O.Box 1051.SonEwkh• MA 02563 (617)888—9282 °7'' LICENSE NO. Dote on 0A1[ arm MARSTONS MILLS, MA 02648 05120192 1000 NEW ASPHALT SHINGLES NEW ASPHALT sw(GtEs IF-----------—-—- ---—----——---- 00 t REPLACE WOOD SHINGLES WffR-- CMAR CLAPBOARD EXIS77NG GRADE ... ............................................................................................ .. ............................................................ .................................................................... FRONT ELEVATION SCALE.- 114" = 1�0' RIGHT ELEVATION SCALE.- 114" = V—Cr' L-T-- NEW ASPHALT SHINGLic NEW ASPHALT SHINGLES IF-11 i, 16' Wrtc CEDAR—CLEAR 5' . ........ EXPOSURE TYPICAL .3 SIDES EXISTING GRADE ... ............................. ................................................................. .................... . ............... . .................. ... ................................... ......... . .... LEFT T EL EVA TION REAR EL -V SCALE.- 114' = V-0' A TION SCAL& 114" Fj -F 71 0*@Wad by SCALE PREPARED FOR ELEVATION PLAN Doc— by: D & CLAIRE GLESS 5 4Q ,A t 1(3*n t iC DESIGN ENGINEERS, INC. Che&ed by AS NOTED 240 7R,,L70p CIRCLE GLESS RESIDENCE P.O.Box 1051,Sandwich, MA 02563 (617)888 9282 Appro-d by LICENSE NO. 0.t. "a I DATE IRMSW ff/iy,"/()N-5 MILLS, MA 02648 05120192 7000 16'-0" 6'-1 1/4' 14'-5 1/4- v I' LlI/lNG ROOM BEDROOM # . PROPOSED FLOOR PLAN SCALE- 1/4- _ ,•_0- h' i REFRIGERATOR KITCHEN h BEDROOM BEDROOM • o o srouE 00 N ` o <o CLOSET SAUNA J2'-O" -_ W - �S — 4'-4" -0 3 " Y-10 1/2" 5'-1 1/4" 16'-4 1/2- L I SING ROOM BEDROOM EXIS77NC FIREPLACE TO BE REMOVED db �I �I Qb DN i N W / — EXIS77NC 100 AMP SERVICE f LOCATED IN BASEMENT EXISTING FLOOR PLAN BEDROOM KITCHE� NOTE.- EXIS77NG ELECTRIC HEAT TO BE SCaLE.• 1/4- = 1'-0- 1 REPLACED WITH PROPANE GAS HOT AIR , FORCED i OO / 2-011 I.bDes* :r' SCALE PREPARED FOR FLOOR PLAN — 2 5 • � tl t la n t i c DESIGN ENGINEERS, INC. Chocked r by� AS NOTED ED & CLAIRE GLESS P.O.Box 1051.Sond,iCh.MA 02563 (617)888- 9282 -d Dy: 240 TREETOP CIRCLE GLESS RESIDENCE o NUUBER MA LICENSE No. Data RSTONS M2LS, MA 02648 05/20/92 1000 27/yZ NOTES: ' 1. LOT 9 ZONED C FLOODING FROM FIRM MAP COMMUNITY PANEL NUMBER - 2500010015C, MAP REVISED AUGUST 19, 1985. 2. LOT 9 ZONED RF ZONING MAP OF • BARNSTABLE MASSACHUSETTS REVISED JAN. 23, 1985. OP 3. LOT 9 BOUNDED AND DESCRIBED AS # 147 62 C/(�CC C NORTHERLY LOF TREETOP CIRCLE. AS SHOWN ON PLAN HEREINAFTER MENTIONED, ONE HUNDRED FORTY-ONE AND 62/ 100 (141.62) FEET • ro ti� S69 3� EASTERLYSAIDPLAN.By LOT 10. AS SHOWN 14E HUNDRED FORTY- FIVE 70 F FIVE AND 00/100 (145.00) FEET. PROPOSED ti \ SOUTHERLY BY LOT 8, AND A PORTION ' Tg0 OF LOT 7. AS SHOWN ON SAID PLAN, AS4 ADDITION c BY TWO MEASUREMENTS TOTALING ONE HUNDRED SIXTY—FOUR AND 64/ ' p ° > Jz0" 100 (164.64) FEET; • VJ O WESTERLY BY LAND FORMERLY OF EMILY F. LAWRENCE. AS SHOWN ON Zry ,\O o e2J, SAID PLAN, ONE HUNDRED THIRTY I.? EWXISTING OD DECK AND 05/100 (130.05) FEET. EXISTING n 4. LOT 9 IS SHOWN ON A PLAN OF LAND ENTITLED "PLEASANT PLACE SUBDIVISION" • , HOUSE PLAN OF LAND IN MARSTONS MILLS- - FND BOUND SINGLE STORY STICK BARNSTABLE• MASS. DULY FILED INFRAME vATH FULL ), `r~ / BASEMENT BULKHEAD �J INPLANABLE UNTY BOOK O198. PAGEISTRY 433. Of DEEDS x EXTERIOR ACCESS \ Nst7•� ^ O�S !� IooBo'0� LOT 9 0 /O L O T 8 ! o0 h O v NOTE: 1.(20.0•)REPRESENTS PROPOSED SETBACKS "\ N69 '• 6,7 LOT 7 _. a APPROVED ❑NOTE C ti WNDFBABN ABLF Building Inupeclidn Depamneal A, Dim b 6y• SCALE— Dim PREPARED FOR PLOT/ADD/T/ON PLAN aO1A 6y° SCAL I = 20 & CLAIRE GLESS LV A r I4 n C DESIGN ENGINEERS, INC. Che6od 6y o 5 io 10 ED �. / 5 P.O.Box 1051•Sand,kh,MA 02563 (617)888_ 9282 6y• 240 rREETOP CIRCLE. GLESS RESIDENCE 1 —� ;:.::qE N . pxn IQ1apI MARSMIVS MILLS MA 02648 05120192 1000 r . TOWN OF`BARNSTABLE Permit No. ..3.5.Q.88..... BUILDING DEPARTMENT I TOWN OFFICE BUILDING$ Cash I 019• ��►�'' HYANNIS,MASS.02601 Bond A D. D I T I O N r, CERTIFICATE OF USE AND OCCUPANCY Issued to Edwin & Claire Gless Address 240 Treetop Circle Marstons.--Mills, Mass.i USE GROUP FIRE GRADING OCCUPANCY LOAD 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. ~ February 17, . 19 94 Buil i g Inspector pf*M >O TOWN OF BARNSTABLE Permit No. ..3.-r?JUB.. BUILDING DEPARTMENT I 'Aa"T I TOWN OFFICE BUILDING Cash .Na � HYANNIS.MASS.02601 Bond/ .....N AA..... A D D I T I O N CERTIFICATE OF USE AND OCCUPANCY Issued to Edwin & Claire Gless Address 240 Treetop Circle Marstons Mills, Mass. i USE GROUP FIRE GRADING OCCUPANCY LOAD 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. February 17, 94 , 19................. Buildi g_lnspector