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HomeMy WebLinkAbout0377 WHEELER ROAD f a �Im Town of Barnstable BU11Cl; r BARNnABM Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept t"'M Posted Until Final Inspection Has Been Made. it bs�' �� Perm ' at° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made:. Permit No. B-19-1081 Applicant Name: Jamie Brids Approvals Date Issued: 04/09/2019 Current Use: Structure Permit Type: Building-Solar Panel- Residential Expiration Date: 10/09/2019 Foundation: Location: 377 WHEELER ROAD, MARSTONS MILLS i_ Map/Lot: 081_002_ y Zoning District: RF Sheathing: i Owner on Record: BIERWIRTH,WENDY& BETTE ANN Contractor Name: MY GENERATION ENERGY INC. Framing: 1 Address: 377 WHEELER ROAD Contractor License: 163006 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $ 24,220.00 Chimney: Description: Installation of 45 360w roof mounted solar panels. 45#ea,i3#/sf, �i Permit Fee: $ 173.52 17sf ea,total of 765 sf. 16.20 kW system Insulation: i Fee Paid:' $ 173.52 Project Review Req: � Date: 4/9/2019 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit I�is commenced within six months afte� MR!?e.Official Final Plumbing: All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. / Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire-Officials-areprovided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing f Service: F 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 010 ,,. Final: To v \ Oats Time WH1� YOU WERE OUT M of Phone J v 5 y- / 0-S— Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YDUR CALL Message 22 2 Operator AMPAD EFFICIENCY( 23-023 CARBONLESS To n Date:/ "-,52-.1 Time WHILE YOU WERE OUT M of ICJ10,11-1p J-11 x2L Phone �/ O Q /QS- Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Mess ge r M Operator AMPAD 23-021-200 SETS �j EFFICIENCYe 23-421-400SETS eCARBNLESS Town ®f Barnstable Building _.. _ T uilding s t Post'This�Card So That it is Visible From the Street-Approved Plans Must be Retained on`1ob and this rd Mus a Kept " •,, 'Posted Until Final.Inspection His Been Made. ^� �� Where a Certificate of Occupancy is Required cc,such Building shall Not be-Oupied until a FinalRlnspection has been made m Permit No. B-18-3336 Applicant Name: Carl Rebello Ap provals Date Issued: 10/10/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 04/10/2019 Foundation: Location: 377 WHEELER ROAD, MARSTONS MILLS Map/Lot: 081-002 Zoning District: RF Sheathing: Owner on Record: BIERWIRTH,WENDY&BETTE ANN Contractor Name: Carl J Rebello Framing: 1 Address: 377 WHEELER ROAD Contractor License: CS-084358 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $7,467.00 Chimney: Description: Insulation &Air Sealing Permit Fee: $88.08 Insulation: Project Review Req: Fee Paid: $88.08 Date: 10/10/2018 Final: I Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. • Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on thispermit• Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: j 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT boy 2G ,f (Tice, 1 c�� I- I I W f � I o�'THE r Town of Barnstable *Permit# Building Department �Ces s Expires6mofe from issue date • aMAS&I,E, • Brian Florence,CBO EX.�Ar i639, ►�e� Building Commissioner ` aj� I sn t�•� 200 Main Street,Hyannis,MA 026p`Jjdi� www.town.barnstab t�s 3 2C Office: 508-862-4038 �����- Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL OWILY Not Valid without Red X-Press Imprint Map/parcel Number rResidential Address 3� i.� e.`�k✓ `�� S Value of Work$ l00 O Minimum fee of$35.00 for work under$6000.00 r Owner's Name&Address e/v` Contractor's Name Cc4e Cos :kov-,� IV }U�.KA .4z� Telephone Number Home Improvement Contractor License#(if applicable) 16 a O L( Email: CO, C C0 k" ✓�C. 4 v%— . i. Cayt•� 7Cons `ction Supervisor's License#(if applicable) i O 64o4 O Workman's Compensation Insurance Check one: ❑ I am a sole proprietor am the Homeowner❑ have Worker's Compensation Insurance Insurance Company Name j Workman's Comp.Policy# $3�3Zf0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Rwie-roof t(check box) (hurricane nailed)(stripping old shingles) All construction debris will be taken to Pkv co Owe vim.S ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner ust sign Property Owner Letter of Permission. A copy of t me Improvement Contractors License&Construction Supervisors License is require SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doe 08/16/17 .77m Comm.omveal&ofMa_wadiusetts DVaakrfertt afrxdrusftialAcddads Off-weaf.£m? gatiMS $00 WashfiW=,5`tk'eet Bastin,AM 02U1 ivrvnuma3mgor/ilia WnrI;: & Caffipens3fim Insucmnce Af fidavit:Bmlder-lCnntracturs/Elecfrl inns Iomhers AppHrantTnfGrma6an PleaseprintF.e Iy Nag„ _ ao � cod Adam M,P OUTgIhonc �b Lf 69 (�' �- J. Are u an emplUer?Checkthe appropriate bom • T of project r L ' I am a em 1 veitfi s 4 ❑I am a general contractor and I Type P ] (required): employees(Call aa&or part-time)-* have hired the sub-contractors 6_ ❑New=struction 2.D I am a sale propdooff orgartaw- listed onthe*attached sheet. 7- ❑Remodeling ship and have as employees These sib-contractors have g_,❑Demolafiba woridng for in any sagacity: employees andhave wogs' 9. ❑Building addition INo VUP&MW comp.iasuraztce comp-ksxtra rt e l required-] 5- D We area corporation and its 1@❑Ekoxical repairs or addiians 3_❑ I am bomeovmer doing all;work officers have exercised their 1 L❑Pir moingrepairs or additi ms. iw gel€ o wokk ars' F eight of emotion per UGL 7 , �+ required_)Y c.152,§IM andwe Piave no 1�❑Roafrepairs employees_(Noworl=e 13_D Other comp_msn omw required-I ;Any aWffcstfat chedsbox R mast aLsn fiIla the sec@oabeLaR dad�ecw�kess'camp nupnycyi�aamsa� Smneaaaenwho submit this affdarili tb-,yamdoia zUwaakend&mbimoutsideconftsd=nmst.mbmitamwxMdadtmdic i, sack TCaaTractyaffn2rhwA'hisb=must=u2wdmsddifimal shed showzagtheaaaeofIbesdb-�m=dstxtewhedmarnot$mseeafiflesbrm employees.If the sab-caatcadaeshave mnpicyees,sheyams'pmvide•thez- waimn'crmp.policy numbez I our all ffdToly is Aft pvl~rcy artd job site iRfORRIifiDPL Cl�� • InsuranceComparryName: 'Policy 9 or Self-iris.-Uc_ S "l F piratiaaDate: 0 6(a Job Site Address City/Statelzip: Attach a COPY of the workers'compensationpolicy echrafum page(shoving the porky number and expiration date). Fa*are to secure coverage as requiredunder Section 25A of MGL c-152 can lead to the imspositioa of crinniaal penalties of a flue up to$UOD OU andlar one yearimpiisonment,as w6U as civil penalties in the form of a STOP WORK ORDERand a fine of up to$250-00 a dap against the violator. Be addsed drat a copy of this statement maybe forwarded to the Office of Iff vestiptions,of the DIA far i-srrrance coverage Ixcific nn Frla ker-�by ce p under a 1s a.jFCUft 'tft& a iRformaiivu proiir&d a5m o is true and correct Sit�atnr� Date: C) , 2 3. L Phone t3,� W um mitt' Do eat write in d ds area,fa be cmnpfeted by city artnn�ti aiciat �F or Town: Permifff icease 4 Issuing Au�r4(cede one): L Board of Health I lBarilding Department I City/Town Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other C'onact Person: Phone#: -- 6 ormation and lnsttuctions ' 161ssac m etts ere=aal Laws rhzptr M rec=es all employes m provide -f=their=TJOyees: ee is defined err¢— yP�as°nm Hie service of mother ceder any coact ofhii r Pm�-fn this MT&Y sib,an empress or implied'oral or VZWM ' �. Air.employer is defined as-sa iwaidnA partnersbT,asso®iion,carporafion or other legal erdity,or MY two or more of the foregoing eggaged is aJOiat @,amdiaG •die legal apses of a deceased empIoYes,or$ie receiVM or trustee of au mc£vidnral,parWM3hjp.asociafzan or o$ierlegal mtdy,=ploy�Mg CPIDY=s- Hovm-ver Ihe owner ofadwellmghonsehavingnotmmei3zaati�ree arhnentsand�hore�idesfbem,ortheoccapantoftl�e- dwa ing horse of anUfl=who erupIoys pens=to do ,cancFrttrfi;rsn or repair work om such dweIliilg house or on the grotmds or building agpur� fhexeto sl aIlnotbecanse of such employmentbe d=medto be an=.ployrd A M(rL d3apter 152,§25C(6)also states that-every state or local1"i=Lomg.agency shall wrthhola$ie issuance err renewal of a license or permitto operate a business or in construct bu tidings inn the common:Wealth for any applicantwho has notprodnced acceptable evidence of cdULPH=ce W!ffx the msurance.coverage regnaed- AdcfltionaIIY,MOM chaPtm L52,§25dM states-Neither the nor gay ofits poIitical snbdivisions shall enter info any contract for the pMf MnBnce ofpubhO wM k Uohl acceptable evidence of ccanphancewh the msaranca., oftbis ffiVt rbavn be=prese=frdto the mrftactinnv.axx&olrty_" APPlicaats , if Pleas fM out the woiias'compmsatton affidavit completely,by chums the boxers that apply to your sitnafion and, e necessary,snPPIy ems)�e(s). ��es)and phMe nomber(s)along with ffi=oeathi�s)of insrirance Limit Liabil$y Companies(LLC)or Liuut Liabtity Pmt=ships(LLP)•wrthno=3pIoyees other than the members or partneav,are not rimed fo cry wo&M-e ccmzpensation insuranm If an LLC or LLP does have eanpIoyees,a.policy is required. Be advisedthatthis aTa&-Vkmaybe sabmft�;dla the Department of In&mtdal AccirT for confnmation of fimr. mce coverages Also be sure to sign and date the afIIdarif The affidavit should beret=e d to the city or town that the applicaiim for the pit or license is berg requested,no t the D epartment of Lndasftu I_Aram;dam, Sbo�dyon a�5•gnesCions regard'mg the IaW or ifyon are required to obtain a worlo�rs' � � m popolicy,please:call the Departme�atthemmmberlis� below: Self-i �d a�� odd weir s elf-insuraace license number am the agpropaaiE]me City or Town Offidals Please be sate that tie afffidavif is complete and prinfed legffily. The Depactnenthas provided a space st the bottom of the affidavit for you.to fM Out is the event the Office oflnvesdg ors has to co�actyouiegazdmg the applicant Please be store to MI.in the permit/Ii.cm=m=ber whichv3M be used as arefermce nximbm ln.addition,as apphr�t that mn st submit multiple peTM*+IceM a BPPht9 ions in amp given yam',need.only mhmrt one affidavit mdicating cu„-�.t p olicy inforrhation(if Y)and wader"lob Site-Addr �the applicant should write-aU locations m (may or town)-"A copy of the•affidavitthat has been officially stamped Or matted by the city m town may be provided to the applicant as proofthat a valid affidavit is on fle for fofnrE•pemits cr Hceuses- Anew affidavitmust be fMe:d out each year.'Whem a home owner or citizen is obtaining a license or permit not related to aty bps or cmmerGial Cio. a dog license or permit to b=leaves eta.)said pmgson.is NOT reqaircd to c=pjeta this affidavit The Office OfjnVcS6gafiOns would Lire to thank you in advance for your cooperadion and.should you have any gnes'thons, please do nothesiiate to give us a call The DepartaaexLf's address,telephone and fax nlmmber: C�" tb�of .C)h ant of�Awi&mta fkf ce a jnvedkkti0= MA 02111 Tt,-L 617- -49W Cxt 4-06 err 1-977-IAAS'�AFE Fax#617 727 7M Revised¢24-07 - �gf� Town of Barnstable Building Department Services i A�AINCP�Af�, f . MAM Brian Florence,CBO 39. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder 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) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OW 41MFERMISSIONP00LS Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner '1 200 Main Street, Hyannis,MA 02601 MAM www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 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 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 J CAPE COD Hnmeln® CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (508) 469-0102 CAPECODINC@GMAIL.COM, www.ROOFCAPECOD.COM, www.FACEBOOK.COM/CAPECODHOME ---------------------------------------------------------------------------------------------- PROPOSAL 1 1 .21 .2017 TO WENDY BIERWIRTH LOCATION: ,377 WHEELER RD, MARSTONS MILLS WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION(APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE ROW OF CERTAINTEED WINTER GUARD PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF CERTAINTEED WINTER GUARD PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 18 INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF CERTAINTEED ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAINTEED LANDMARK PRO SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED. HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE J� i ,�� Al CAPE COD Homeln® CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME ------------------------------------------------------------------------------------------ CERTAINTEED LANDMARK PRO SHINGLES 50 YEARS NON-PRORATED TRANSFERABLE WARRANTY LABOR AND MATERIALS: $23,950.00 DUMPSTER: $ 1 ,250.00 TOTAL: $25,200.00 *WE WILL MATCH OR OUTBID ANY LEGITIMATE COMPETITOR CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES. IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION PAYMENT TERMS: 50%AT DEPOSIT; 50%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS,MOVING ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA,WILL BE SUBJECT TO EXTRA CHARGE.IN THE EVENT OF ROT REPAIRS,ROOF REPAIRS OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION,WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. CAPE COD HOME IMPROVEMENT TM WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT TM WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE CAPE COD Home improvement CAPE GOD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001 , (508) 469-0102 CAPECODINCOGMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE.IN THE CASE OF ANY ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT"A IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT Rm IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY,ETC. FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION- RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY - FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENT TH THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI "TONY"SIVITSKI 1 �E ACCEPTED BY SIGN Wendy BierwirtAh TE 11/21/2017 ACCEPTED BY �Qu^0 u V • �► K G DATE CAPE COD HOME IMPROVEMENT'm GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE PEEL FREE TO CALL CAPE COD HOME IMPROVEMENT Tm VVffH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE I AC'�® DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CONTACT NAME: Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 775-1620 ac N,: E-MAIL ADDRESS: Isuilivan@doins.com 9731YANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPE COD HOME IMPROVEMENT INC INSURER C: INSURER D: 27 MILL POND ROAD INSURERE: WEST YARMOUTH MA 02673 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 162263 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP IPIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMM E TO RENTED MISES Ea occurrence) $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY El JECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ E acrid nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS r accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILFTY YIN N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDE1 NIA N/A NIA R2WC835340 06/03/2017 06/03/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AI18t0l1 SIVItSkI ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 -D-0 C � Daniel M.Cro_Wey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Pubfic Safety Board f Buildi ng Regulations and Standards Constructio u rvjsor Speclialtv �Y $ License: CSS L-106040 .ti ANATOLI SIVITSI,E ���- � 222 BUCK ISDLAN R,']-D West Yarmouth MA 02673, ,)) Expi ration .00&.000�00 05/14/2018 Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place ' Suite 1301 Boston, Massac usetts 02108 Home Improvemerii,)-?R,ractor Registration Type: Corporation CAPE COD HOME IMPROVEMENT,INC. a Registration: '168043 m io Expiration: 12/06/2018 27 MILL POND RD WEST YARMOUTH,MA 02673 d w e� Update Address and Return Card. SCA 1 4 20M-0-05/1779 V/t6 f(1697M7tMt[/IIII.��O�.�i��Gfd(LI✓J//4C��f Office of Consumer Affairs&Business Regulation HOME IMPIROVEMENTCONTRACTOR Registration valid for Individual use only TYPE: Porwration ' before the expiration date. If found return to: Realstrattorr Expiration Office of Consumer Affairs and Business Regulation 1680-43 12/06/2018 10 Park Plaza-Sui 0 CAPE COD HOME IMP:O Boston,MA VEMEN�T INC. JJ - s ANATOLI SIVITSKI 27 MILL POND RD. a �� WEST YARMOUTH,MA'0263" Undersecretary Not valid wit out signature i i tl ` 1 i x; TOWN OF BA:RNSTABLE BUILDING PERMIT APPLICATION p Maps ~ Parcel Permit# `O Health Division p dam , i Date Issued l Conservation Division o 0 3 �� �L'�N •6/���` plication Fee $5 Tax Collector 4TA-3/2- 50(4 Vey Permit Fee-/U 9 /. Treasurer SEPTIC OTZ.-A MUN DE Planning Dept. INSTALLED IN COMPLIANCE ..T •.c" Date Definitive Plan Approved by Planning Board '- WITH TITLE 5ENNIRONIAENTAL CODE AN[ Historic-OKH Preservation/Hyannis .�+ TONI REGULATIONS Project Street Address 31 1 Wl e.e_I e_�- ILOQa) u Village r Owner � LSw_--ffii 1mc_ �` Address 1 1 A\s Telephone J�O - _ Permit Request Add TI vQ:�10� NONCY c AN p orb/ N OA)eWle)b ,�L &4\—V � Square feet: 1st floo . xisting _ proposed 2nd floor: existing proposed q Sr� Total new Zoning District Flood Plain Groundwater Overlay —Project Valuation 300,6001 Construction Type WC.0 6 _POML Lot Size . �l Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure qW Historic House: ❑Yes kNo On Old King's Highway: ❑Yes kNo Basement Type: dFull .:_,❑Crawl Walkout Cl Other Basement Finished Area(sq.ft.) (_ Basement Unfinished Area(sq.ft) a Number of Baths: Full: existing new Half: existing new�_ O Number of Bedrooms: existing �� new Total Room Count(not including baths): existing _new `1 First Floor Room ount rn o r- m Heat Type and Fuel: ,. Gas ❑Oil ❑ Electric ❑Other Central Air: 'Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Cl Yes WNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:)i�existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes kNo If yes,site plan review# Current Use Proposed Use r BUILDER INFORMATION G Name P (Se_::!h e— Telephone Number Address (L License# S \ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 SIGNATURE DATE ��- c r FOR OFFICIAL USE ONLY r ' PEFAIT NO. DAT4 ISSUED MAP/PARCEL-NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATJO,� �1\, 1 ' D Z. --71�7_ FRAME -?f}QLJC , ' INSULATIONS' ,Also tics /-Amow � � FIREPLACE 15 C %/,-77 /� l. r� :�. Q 4 f ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH r9 FINAL FINAL BUILDING 191K y ' na DATE�CLOSED OUT t ASSOCIATION PLAN NO. , h 37 � V� �G391,2 rfr��c`�� � �, M I� °FZi ZHE T°y, Town of Barnstable Regulatory;Services - BARMSrABLE. Thomas F.Geiler,Director y MAss. g 039..,a`0 Building Division ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 \ Permit no. Date"X3 Y AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the"reconstruction,alterations,renovation,repair,modernisation,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. 1 Type of Work: PV11 1 k- _CA � �2���� ()n Estimated Cost Address of Work: 1 1 ik 5h e ,l er EmA MQ rS- n S MI ( l S Owner's Name: —T�)l mme— 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 Wwner 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 Commonwealth of Massachusetts Department of Industrial Accidents OfNce of/nsesoffat/nas _ 600 Washington Street Boston,Mass. 02111 Workers' Coin ensationInsurance Affidavit���������� 1�1�/.�Y� �///////j////////��/j///jjjjjj�j�/�j/j��jjjjjjj�j��jj�j��j/ name �PC� � �i1P�11 ram� location hone# 5 ci I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one working in %%%ca achy rovidin workers' compensation for mY employees working on this job. :::: .....:: :: ::::::::: : :: :::::::: : :: I am an e to p g : aom an.<.nam tyre"ss.. ><:::; .. 'one�»t:: 4.lstuan am a sole proprietor,general contractor, homeowner circle one and have hired the contractors listed below who have ers' co ensation olices: the followm wo mP ................P :.::: .....:...........::.:::::::.::::::.:..::::.:::::.::::::::::.::<.;::.;::.;::.;;'.;;:.>:.:.: X. c n a �em ..m nv�u a >;> .: NE f:>< ......::..:.:. ....... ..... .. ... ..... ........ . .. .... :.:: :.:. ..:. .YS•�'-.•{ ^.ii'.ti!:�.:��'J::�i'.v�:.'}:•�''?:`.:.,.��v.i.,::j�jv v: ::.iv::v:::::::::.....::±iii:'+ii'v: :i4i•:::.y::::•iii'ii::•::CC:iii:F::•:v;bi: :::.....::.:... : .:.:.....:::..... .............`ett .....:»:.;:.;.::::...... ::::::::.:::;;;.:;;;:........ '`fit FailIIre to secure coverage as regidred raider Section ZSA o[MGL 152 can lead to the Lnposition of crhnlnal penalties of a fine up to$1,500.00 and/or one years,imprisonment as wen a,dvn penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be the Office of Investigations of the DIA for coverage verification I do hereby certify p ' and penalties of perjury that the information provided above is true and correct Date ? Z 1�G 1 _ Signature T—T— - Print name Phone#�5Nk-qQ S -AT' n- — ofndal use only do not write in this area to be completed by city or town official city or town: permittlicense# OBuilding Department ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response 1s required (J$emalth Department contact person: _ phone#; .. ❑Other Oeviwd 9/95 PJr) y 1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation 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. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a'deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling`house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 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 the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill 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 inciran_ce 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 of town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required.to obtain'a* workers' compensatiaii policy,please call the Department at the number,listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pe•nmit cease number which will be used as a reference number. The affidavits may be retinmed to the Department by mail or FAX unless other arrangements have been made. The office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. 'The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office 01 Investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406,409 or 375 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 ! Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE V .0 o. 1' _// x.0031= 9� �square feet x$96/sq.foot= — plus fromi below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _ square feet x$64/sq.foot= 3,;)-0 0 x.0031= 7S3r c plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1000 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS A Open Porch x$30.00= -30 .(number) Deck x$30.00= (number) Fireplace/Chimney (number) Inground Swimming Pool .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost i :L Permit Number MECcheck Compliance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename:C:\Documents and Settings\BILL DANIELS\My Documents\TELEGRAPH HILL\THIMME.cck TITLE:.ADDITIONS&RENOVATIONS FOR CITY: Barnstable STATE:Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:08/12/02 DATE OF PLANS:08/12/02 PROJECT INFORMATION:. FRED&SUE THIMhE 377 WHEELER RD. MARSTONS MILLS,MA. COMPLIANCE:Passes Maximum UA=271 Your Home=254 6.3%Better Than Code Gross Glazing. Area or Cavity Cont. or Door Perimeter. R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1333 30.0 0.0 46 Skylight 1:Vinyl Frame,Double Pane with Low-E 21 0.330 7 Wall 1:Wood Frame;16"o.c. 1372 19.0 0.0 70 Window 1:Vinyl Frame,Double Pane with Low-E 119 0.330 39 Door 1: Solid 39 0.400 16 Door 2:Glass 40 0.330 13 Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 1333 19.0 0.0 63 Furnace 1:Forced Hot Air,78 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date i - MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 08/12/02 TITLE:ADDITIONS&RENOVATIONS FOR Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] 1. Wall 1:Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: Windows: [ ] 1. Window 1:Vinyl Frame,Double Pane with Low-E,U-factor: 0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? [ ]Yes[ ]No Comments: Skylights:. [ ] ( 1. Skylight 1:Vinyl Frame,Double Pane with Low-E,U-factor:0.330 For skylights without labeled U-factors,describe features: #Panes Frame Type Thermal Break? [ ]Yes[ ]No Comments: Doors: [ ] . 1. . Door 1.: Solid,U-factor:0.400 Comments: [ J 2. Door 2:Glass,U-factor:0.330 #Panes Frame Type Thermal Break? [ ]Yes[ ]No Comments: Floors: [ ] 1. Floor 1:All-Wood Joist/Truss,Over Unconditioned Space,R-19.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1:Forced Hot Air,78 AFUE or higher Make and Model Number Air Leakage: [ ] Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ J When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled. r Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ J Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. . . Heating and Cooling Equipment Sizing: . [ ] Rated output capacity of the heating/cooling system is not greater than 125%.of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be i.nsulated•to the levels in Table 2. Table]: Minimum Insulation Thickness for Circulating Hot Water Pipes. - Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to I„ Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building.Department Use Only) i { i /ITS-+emu°, / .- / / _ ' yq•' /. PRL / / I J I // / — / DRIVE . �/ PITS / I J / l / ' / / Eis• 817V EX/8 1 DIRT Or-NI—�' I / y ao GARAGE �`�� / \ - �� /60.'bo' . 1 1 1 ► 1 1 1 0 <„ \ ;,�j t eEXaN ywf/c N 88.46.Op; 1 1 1 \ $I* � .o \ Al. SE CW Co/Ddl '� oll \ 1 \ \ < an \� \ ` \ \\\ \\\\`\ \\\ ♦\.\ ♦\\ ♦ \ pp• EXISTING WELL / \ \ \ \ / \\ L 0 l E 2 102. 2701 S.F. \\ UPLAND 1 I \ / 1 \% l� hl { r 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 n Please Print DATE: JOB LOCATIO number street I I QC�Q village "HOMEOWNER': ReA JUe, 1 { 11(n6�1e— 56 C�G `-1 — 108,5 name home phone work phone# l-7 CURRENT MAILING ADDRESS: �( I 1 nnLcd Lane- ma a oy 9 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Depart3nentpitfiE;u—m-�Ippection procedures and requirements and that he/she will comply with said pro ed ire ,and- uir ents. Sign re of 140m7eowner 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 12-7.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN �� Mono■ Mono■ � — i i �� I� Mono■ Mono■ :� '' '' � I'. �Illllll�lllll�l�lllllllllll� _— _� :, �:1►1� -: li_ =n_ �IIIIIIII—I�i'=�'Iai���IIIIIIILI!Llfll�l.— � -, COW,U3 .•.---_- III-� �� iI - I i I I Eli' Mono■ Mono■ rn ��1 �n �• �_ .' ; - ■■ Mono' no■ Mono �.� i �� I,�I,I �"a— �...� -.r 1 � � ■■:. Mono �� MoMono Mono■i■■� Mono■ r �r_�'. i �rrr�wnr.i I _ate -■■w Mono �.a_� no i ■■� Mono'. ` III_.I�wl is ii I, .... 1 �' -_ I I� - ... — III ! 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'{r•y� <-i�•.,. _ •• _ .� •���=T=ea atw+ty• .:�• _ _ rem L ' , _ __ _ (:i - ._l-,i'<c�+ - f Via..• _ _ie_ _�- w.� -•..�.f>i �` � ,{t Lo Al yl Im 1p zm ''• �- _1'e - •i.?':.:'.- .-`�Y`:•—tJ-'IT r"" 1. e _ ':r: �" •:2j., jr•;;�-•—! -.:t:.i••.]-•.. .{ ..,. ,-,.r o.. .. _ ,�c' - . •- -.r yam'"•, _1_ �-_ — Da POUIJC� foN EL (l1G�L. PLAN �--r- - ---- ----- --- - ;' = ----- �. 'JG�t-1G i COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY_ r OF �; 1010 COMMONWEALTH"E. MASSACHUSETTS B�OSTON,MA 022$-5 �UP LICENSE EXPIRATION DATE _ ' CONSTR.. SUPERVISOR � CAUTION _ �{ t o 1 i fJ 5/31 / 1 995 FOR PROTECTION AGAINST 'A EFFECTIVE DATE LIC-NO. RESTRICTIONS f, THEFT, PUT RIGHT THUMB NONE ' 05/31 /1993 047993, , PRINT IN APPROPRIATE STEP�HEN J DEVLIN rr BOX ON LICENSE: 210 0 L Q MILL R a `jr' BLASTING OPERATORS SS q 029®36-621116 MARSTONS MILLS P9A 0261 :� � MUS IVCL EP O. t Ll"'" PHOTO(BLASTING OPR ONLY) Fj%0®0� � i D NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ' HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER �'i 1 I 7 DOB: V 02/04/1957 l JEE THIS DOCUMENT MUST BESIGN ! h1E I FULL A GNATU CARRIEDON THE PERSON OF4. SIGNATURE OF LICD00THE HOLDER WHEN ENOTHERS-RIGHT THUMB PRINT GAGEDIN THISOCCUPAT'ION:- + COMMIS • 1 w (`\ 07.TDo�n�xooue�ea�� .�uau+t✓t�s9eld3 �\ HOME IMPROVEMENT CONTRACTOR Registration 108752- n1 Type - PRIVATE CORPORATION -- Expiration 08/24/96 Central Construction Inc. When J. Devlin ADMINISTRATOR 21 D 011d M 1.11 Rd. Marstons Mills MA 02643 i , TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXE-MPTION Please print. JOB LOCATION 3 Q e N - N er Street address Section of; town':::: .; °. "HOMEOWNER" �/�/ /(/ sop— Name Home phone Work phone--• PRESENT MAILING ADDRESS ?3 3 Qs�, A 14 ,4 RAG c( Cat ��(iS' ,���' y 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 to six 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" ce f s t he/she understands the Town of Barnstable Building Depar i u in ection procedures and requirements and that he/she wil om w' i p cedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDIN O FICIAL 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 01,7NER' 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 Ownez 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 and -*-Regulations for .licensing Construction' Supervisors,- Section- 2. 15) This,-.lack of iwarenes often results in 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',bwner'actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her. re.sponsibilities,. man communities require, as part of the permit application, 'that the 16 ie -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. � ILNT Or ,-!�D USTRLAL ACC IDFh'TS ?:C)_. AFFI DAVIT (licensee/permincc) with a idcncc at 'A v� (G ry/S cau/Zi p) do hereby certify, under the pains and penalties of perjury, that: [ J l am an emplovcr providing the following workers' compensation coverage for my employees working on this job. Insurance Comp2n), Policy Number am 2 sole proprietor and havc no one working for me. O 1 am 2 olc proprietor Ecnc:�; cent zaor or homeowner (circle onc) end havc hired t}he contractors listed bclo,.t• who h2vc the follou•in.g wor'• rs' eompcns2uorfinsurznec policies: N2mc of Contr-zaor i:^.su-2ncc Company/Polio, Numbcr N2mc of Contrzt <o! Insw,ncc Company/Policy Numbcr N2mc of Contrzaor lnsurancc Company/Policy Numbcr 2m 2 homcow•r.c: tvrfor:nino A t_hc work mysclr NO TEE=: Isle=sc be ho�co�crs w^o employ p-rsoas to co raasnienamCc.construction or repair work on crwcllin;of nc: r:crc tLz _:cc Laiu i the borocowccr also resiics or cc Lc grounds appuncaaat tbcrcto arc not Ccacral;• con:idcrc�a "c \,:m'or.•cr:' Cornpca::tioa/•.c. ((;L C. 352,sccC. 1(5)), application by a boracowacr for a liccasc or Fcrr it r..:v c.•i2cc« L~c Ier J, ef a erlovcr ua�er the'Worl_ers'Cornpecs:tron ACL 1 ur.dcrsranc t�:r : co c!t sr-cement will be forwa:dcc to the Depa:trsent of Industrial Aeddenu'OGsee of Insurance for eoverafc a;� fi!crc ;e cce:< cc•lc:.�2c rccei:cd u.-.ce: Seeuor. 25t.of MiGL 152 e:n Jead to the imposition of_fUn iaJ pcnJeies eer:::h e�: :',c efC..C,C. d'or ir-�ri 0. ^..:'.l c. l'^ tG G.^.e �'C a7Z C�_ t CLaI"JCs L7 L�1C fore of a Stop Work Orcv ane' fir:-c Cl Signcd thi<- — 6y of S � U—ns"— Licensee Licensor/Pcrmitior n , /c,"� -SAFE'. F E NGVD PLAN. `\ ` VACANT ANqlr EXISTING \`\ lv�LL , O SEPTIC �\ j Ivf �t 1\ 1 \1 s \\ (PER ER) \ 00 I 11 91 fame MR CSMSK FAD ���. ��� ��� u rote IMC u� I?AD � fflm,-*STr T6'00 PROPO I t s I I I I I 4- I- I I I I I l _♦/ ,' / -i �� � Ise'• I I I 1 I / ♦ � _ I j Tdr N�-RIb sl` I I '.1 I 1 1 I I I ,f _ ♦ I I1 I j u II II 11 I1 11 I/ /��♦�. ♦, ►Ror of pR1RE / yst�""i'c:vie�ems•'___DIRT"oz 6cR • iit J r/l t 1•_1��'c..J . it 1 it I � � � 1 j 11 j � I l � I ��� I j ,� l ��I� ' / _ y�'•. '�'' ,♦��`\ d ! r , I I I I I I I „ l 1 , l l I l I 1 �� \'� • ♦, I 1 I I I , , 1 / / ! / / ! / 1 '�GARAGE-- 1 d awo /6 40 I �ro�RyrR•�vrp l I I I , , I I , l , l / I y m A. os� N dB'46'OPlY 1 1 1 1 I 1 1 1 I I I 1Too/ SE9 to 9a(COce/oN m \ C . �A.v.Ijw.Avo V.l I I I 1 11 ll 11 1 Il ; \ 1 \\ $N=o c \ • '. /♦ ♦♦ �. ` te►fltt i�Rt ♦ \ 1 •1 i 1 1 1 I I •' 1 \ 1 \ \ \ \ \ \ \ \ \ \ V iL 1 1 � 1 � 1 \ \ $ \\ `\ \ \ \\ �� `\ �\ �\ `\ `\'� •�' EXISTING WELL \111".0 L 0 T E 102.2701\SF.\ \\ �\ \\UPLAND \ \\ \\ r\ 01 Asses*r's of(*(1st F or): Assessor's map and I hum Conservation ��� � � ���� Board of Health floor)' 9 �0� ®���4411/ 1 / Sewage Permit u ber ® �� j� ®�!j'���j° { �act \.l T Engineering Department(3rd floor): �� ` ° i6�� Z House number 3? �—� c . �� �w� ,7, C �o Ysv►� v Definitive Plan Approved by Planning Boarob �..,,,�.. 4e.o ;;,i�,,( ,19 t APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:60-2:00 P.M.only � , TOWN OF' BARNSTABL - :� : BUILDING DIVISION - APPLICATION FOR PERMIT TO �— TYPE OF CONSTRUCTION _ (A160 0 19 y—_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location `� W t-�•-C e L--IA- R-fp - Vh IILV"ra k1.S yh 1-1 C Proposed Use Y,% Zoning District Fire District Name of Owner tit hn Vats-C- ,JrI G(a) Address Al '/ // Name of Builder Address C Name of Architect b a f(r) Address ��{1 Yh FYl'� Si `-/W4J4-tO U71d �Ori7— Number of Rooms Foundation r� NO t2-`M ( d I Exterior IL-716 (400 t`. F�lb�v 1-/(�f?Mt C-'I)qtA- S601oofing Floors -�G- pit LuO�s� Interior V 2 IS'Lutt 6 06-10 Heating Grk-S tfjo Q t V 6-1ofs Plumbing r-01 Fireplace 0�j Approximate Cost l r O v 61) Area Diagram of Lot and Building with Dimensions Fee R6� k4J-W,5 e, o2 �j ° O ON- ;z 6S3 G � r 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 Home Imrpovement Contractor Registration# Construction Supervisor's License# `- '- Nod"3'7-2 Permit For dwelling y� d Location 377 Wheeler Road Marstons Mills Owner Kimberley Brown ; Type of Construction Plot Lot Permit Granted November 7 _ 19 94 Date of Inspection- 19 q Co�z� Date Completed L 19 o-y� t, Ilk t. { 5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_��� _ . Parcel -�D� � Application# ,200��(,e Health Division Conservation Division Permit# Tax Collector Date Issued.— //o)a/O Treasurer Application Fee Planning Dept. '_ Permit Fee: o Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 311 W qca_oz_ b ta- Village 'M NIR-5_7O14� t-kywS M A . Owner �SV E 1�VVmt' . Address 3� W 1AC Telephone Permit Request Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new �.Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Typeti cn! Cn Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation'. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) r Age of Existing Structure Historic House: ElYes O No On Old ing's Hig wh ay:ray: Yes dNo Basement Type: tAFull ❑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:Cl 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 pcJ� co��R�c�.�ra Telephone Number Address C)ED ST_ Po. 5-1a License# S ST ti•A. N2_�AoS� Home Improvement Contractor# r:MC2,;t_ Ste' vAu� Worker's Compensation# � �� Tt?-A�.�^_S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE z1a '. FOR OFFICIAL USE ONLY a � PERMIT NO. DATE ISSUED MAP/PARCEL NO. ` -ADDRESS VILLAGE OWNER. DATE OF INSPECTION: ` '¢ FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL f • ',' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � Regulatory Services . raruvsres .$ Thomas F.Geiler,Director UAL• 9�pTEc .�� Building]Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towA,barnstable.ma.us face: 508-862-4038 Fax: 508-790-6230 ' Permit no. I 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 Rzth other requirements. Type of Work: Estimated Cost ?t)_Ana�o Address of Work: Owner's Name: Date of Application I hereby certify that: Registration is not required for the following reason(s); QWork excluded by law FJob Under$1,000 Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OVNERS 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 appl r a Permit as the agent of the owner: Date V Contractor Signatures'--` egistrationNo. OR Date } Owner's Signature Q.wpfnes.forms:homeaffidxv Rev 060606 The Commonwealth of Massachusetts Department of Industrial Accidents tl Office of Investigations 600 Washington Street Boston,M4 02111 ww.w.mass.gov/dia Workers-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print Legibly. Name(Business/Organization/Individual): . 50, •Address: \Lk O L E�9--�� City/State/Zip:W % �Y� �F3�`— Phone.#: Are you an employer? Check the appropriate box: .Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New 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 8. ❑Demolition workin for me in an capacity. employees and have workers' g Y P tY t. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work . officers have exercised their— . 11.[1 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance.required.]t C. 152,§1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.pohcy 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.#: Expiration Date: Job Site Address: _ City/State/Zip: Attach a copy of the workers' compensation policy declaration page•(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains-and penalties ofperjury that the infor�-oration provided above is true and correct. Si afore: e /� r—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 IHIUI IIIULIUII YlHU 1115tl t,ilAIU113 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of bile, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an.employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not pro.duced�acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ehapter..152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence Gf-complianc'a with the insurance. requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members*or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. Jhe Commonwealth of M.aachusetts E4eparttnent of Industrial Accidents Office of fnvestigatious 600 Washington Steeet Boston,.MA 02111 TO. #617-727-4500 ext 406 or 1- -MASSA.FE Fax 4 617-727-7749 Revised 11-22-06 W.mass.gov/dia HEELER TOWN OF BARNSTABLE ZONING ,- -_��--------- I ROAD t ?`r? BY-LAW DATED SEPT. 14. 100.9 'k ZONE RF SETBACK$ FRONT - 30' SIDE - d5' REAR - 15' 00'SL-B PROPERTY LINES SHOWN HEREON 6S'BL-7 WERE COMPILED FROM AVAIL49LE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. THE DWELLING DEPICTED'ON THIS 4 PLAN WAS LOCATED ON THE GROUND' BY SURVEY ON,JAN. 6. 199S AND. c? EXISTS AS SHOWN AS OPINE DATE v OF LOCATION. q� zq THIS PLAN IS FOR PLOT PLAN 3i pURPO8E5 ONLY AND NOT FOR g' RECORDING. DEED DESCRJPTIONS' v g OR ESTABLISHING PROPERTY LINES. mN Z i 'W Q • pj Shy � I•et ` r - i LOT E-2 4 102270 t S.F. UPLAND bh�° � h 3� ' PLOT PLAN I CERTIFY THAT TO THE BEST OF,MY PROFESSIONAL IN XNOWLEDGE. INFORMATION AND.OEVrEF`THE DWELLINO•• SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS BARNSTABLE. MASS. OF THE ZONING BY-LAW FOR THE R-F DISTRICT. SCALE: 1--40' JAN. 9. 1995 Of M4rp�4ti C. ,' EAVIZ SURVATING 4 ENGINE1tRING..W. FRANK L/M/T OF NE NO 10 seaboard Lane wHrriNGNO.290 9 — ��„ TOO Of BANK` Qyannfs; &. dZ$OI )SIT, �. (d08J 770-448t Q b� /T� �/9/9� 0 20 40 80 ... . ... Town'of Barnstable P Regulatory Services Thomas F. Geller,Director . Building Division ab39 � TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 509-79076230 Office: 508-862-403 8 Property Owner Must Complete and'Sign This Section If.Using A Builder as Owner of the subject property O to act on my behalf, hereby authorize j in all m attets relative to work authorized by'this building permit application for: i (Address of job) .Signature of Owner Date Print Name Q:FORMS:oVr9 iPERM1SSIGN y License CONST..= Gl1lA�t NUmtrer GS RWDT►ON SpE( V 064359 Sa R �t966 -ys ( , 08 , =sz SF� HEN•B Rh ed'f�0r j Tr.no. 2479-7: j .E r—g WA X 572h1401 rE 1 ; COminisso'ner 34 t,. Board of B6ildin g Regulati ` HpME IMR aris.aad.Staodards ROIFEME t' Regjstrat►on Nr CONTRACrpR Licen :Expireho 153262 1e istr 6eford' �r g 1rion ya/id ` n 11/1 :• .-- e�plratioii d for i:jdis�dul i 312068.. B ELD r�'Pe Pwate Try 8 oar4.1 Buildin atc. If found •.. �e only 25330 g.R t etur' STEPGE&SQNS ONSTRy�. C6rpbraGon B stoh5urton place Rini°ns and Stanil ds N ELDREI) _<_� _r UG;TION!INC: ,Nia.02108 301 I w BCEDq ST. GE:r.; r R ARNST j ABLE MA 02668 .........ministrato A. r natur e `�- . o 0 BEDROOM I ` B --___ BEDROOM I� z SING RM. L Zi —-— KITCHEN z., I I I 0 z z BREAKFAST , - ^ w m o LINE OF LONER • PLATFOidt PROPOSED NEW DEIX UNDER—IN DECK la4 F,AHOGANT DECXING •--------------------O_- 6 TUB TO BE re I , C1 ID'ABOVE DECK W W EX. ENCLOSED PORCH FNGi0i0 SLIDER DROP TUB ID' � NEW ANDERSEN FRON FLUN Dec; Qi x O DROP DECK O E-a.N] FOR FULL ACCaSS z a TO MOT TUD W W W NEVI ANDERSEN ° • O 1`a GLIDING WINDOWS F••A d .✓FIXED GLASS OK T E - A W In.� PANEL BELOW d. O GRADE ,y FIELD VERIFT Q W Ci SIZES Lz w z _ SLEW DECK PLAN-OPTIONAL NOT TUB LOCATION ScnLE.va•-r-o' -— DATE a/oe/oa R St NS t DRAWN BY DRAWING NO. Al " 1 TOWN OF BARNSTABLE --l- CERTIFICATE OF, OCCUPANCY PARCEL ID 041 002 G.EOAASE ID 4239 ADDRESr..4 �117 WHEELER ROAD PHONE "MarBtonz ,Mills ZIP,' - .1 LOT,' E--2 BLOCK 4 LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 11423 , DESCRIPTION SINGLE+ FAMILY ;.DWE:f,LING PERMIT TYPE BC00 TITLE CERTIFICATE OF OCDepaYitment of Health, Safety CONTRACTORS,: and Environmental Services ARCHITECTS: TOTAL FEES:, IN { FOND 4 + $-00 � Qi► CONSTRUCTION COSTS $-00 753 MISC. NOT CODED ELSEWHERE HpgN�i'pBI.E. 1 MASS. OWNER BROWN, LEOPOLDINE & ply ADDRESS BROWN KIMBERLEY T ^ ' 1733 OST/W BARN RD r ?t - WEST -BARNSTABLE MA ', f BUILNG DIVISION DATE ISSUED 11/03/1995 EXPIRATION DATE BY DIVISION APPROVALS FOR CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING: DATE: 'i COMMENTS: PLUMBING: = ��� DATE: - L COMMENTS: ` w. ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: y` TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARk COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. .J �3ULDING PERMIT r "TOWN 6F BARNSTABLE, MASSACHUSETTS ':'t �.;�:. ;p�,,�� `` art' DATE C ` PERMIT NO. ^�I,� 3 APPLICANT ,JL'.,' %(�::n ;)c�'Ii� ADDRESS tll. •r)�.•.: :..I"1 Rd IN0.) (STREET) (CONTR'S LICENSEI -L17 ';:c. iT; '1@i �:'P.i1!.7 _S'7'.l�:I_ NUMBER OF PERMIT TO 1' (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) t .!A DIG IN S CT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR s I.75,fY 0(:.�), PERMIT -- VOLUME ESTIMATED COST FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PpPERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- ool ROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ` MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2.-PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI To BEFORE FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUIL INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS At,/ I 3 I HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 i i BOARD OF HEALTH � w it' OTHER SITE PLAN REV( W APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT 15 ISSUED AS NOTED ABOVE. NOTIFICATION. ,try 4 . L£l 'Dd LZl 'H8'7d AHEEL ER n ROAD TOWN OF BARNSTABLE ZONING BY-LAW DATED'.SEPT. 14. 198.9 ZONE RF SETBACKS FRONT - 30' SIDE 15' REAR - 15' 00'Sl-�l 6S'9 8 PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. THE DWELLING DEPICTED ON THIS 3 PLAN WAS LOCATED ON THE GROUND o BY SURVEY ON JAN. 6. 1995 AND o EXISTS AS SHOWN AS OF THE DATE b OF LOCATION. b 'b b ` 3 2 THIS PLAN lS FOR PLOT PLAN o , PURPOSES ONLY AND NOT FOR o RECORDING. DEED DESCRIPTIONS 0 OR ESTABLISHING PROPERTY LINES. co M b N .w z w — z LOT E-2 U � u 102270 t S.F. - UPLAND ,00 .Vt ti b ti b PLOT PLAN I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL. IN KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS BARNSTABLE. MASS. OF THE ZONING BY-LAW FOR THE R-F DISTRICT. SCALE: 1'-40', JAN. 9. 1995 OF Mgff C. yG- EAGLE SURVEYING 4 ENGINEERING,INC. FRANK4 WHITING L/MI—r OF WETLAND 10 Seoboarrd Lane No.29869 � -� TOP OF BANK Ilyannis. Ara. 08801 (508) 778-44ZZ CIST i�F�©� 0 20 40 80 PROJECT NO. 93-396 . r