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HomeMy WebLinkAbout0142 WHISTLEBERRY DRIVE �.. . . � ,- _ _ � __ a 0 . .� � �_ : . .��� _ . ACTIVE r pFIKE)q� Town of Barnstable *Permit# Eaplres 6 roadd f n Issue dale Regulatory Services Fee ' _ unxrtsrABLl3 M"S& Richard V.Scali,Interim Director A�FO►M`1� Building Division ^IMPRESSN� Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 27 2015 www.town.barnstable.ma,us Office: 508-862-4038 TOWN OF tJ[�OJZYAo-8��0 EXPRLSS ,RMMT APPLICATION - RESIDENTIAL ONLY o(V� 2 q�r Not Valid without Red X-Press I»rprint Map/parcel Number J (� /✓,J Property Address 1 residential Value of Work$ 1 , wo .o 0 Minimum fee of$35.00 for work under$6000,00 O«mer's Name&Address U-alei ee i;p— I"ui Contractor's Name Telephone Nutnber Home Improvement Contractor License#(if applic ( Email: Construction Supervisor's License#(if applicable) ❑Workman's Qompensation Insurance Che9K one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Pen-nit Req t(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections requited. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Pro erty Owner Letter of Permission. A copy of th proveme ntractots License&Construction Supervisors License is r e q SIGNATURE: Q:I MILESTORMSI r ' rmit forms%YPRISS.doc Revised 061313 1 • oFmE Tod, Town of Barnstable ti Regulatory Services aarwsrAe[s Thomas F.Geiler,Director �'ArFocA`0 Building Division Tom perry,Building Commissioner 200 Main Sheet,Hyannis,MA 02601 www.town.barnsfable ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder i � lee— bEnu*--,as Owner of the subject prop" hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit: (Address of f ob) **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 O er a f Applic t L( &� Wmce—tvu* am. Print Name Punt Name Date Q:FoxMs ONVNERPaWssrotJroots 612012 t Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License: CSSL-099138 JAWS CURLE)� 287 FULLER ROAD CentervMe MA 954, Expiration commissioner 01/28/2016 i i " V/ze cpw»vneaiacaer.��a���aa�rcc�ccaell`J i 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: 124310 Type: Office of Consumer Affairs and'Business Regulation Expiration TT Individual 10 Park Plaza-Suite 5170 Boston MA 02116 James Curley r'." i' ✓ James Curley 287 Fuller Rd. Centerville,MA 02632 Undersecretary of valid without signat re , Ria Comyrxottwealflt of Massachusefts Dvarfinertt of Industrial Accideras Office of Irtvestiga#ioru 600 Washutgfort Street Bosfvrr,MA 02111 if wmi.rrrasmgovIdia Workers' Compensation lnsuranceAffidavit:BuilderstCoatractuxsMectricianslPlumbers Apyfficant Information F Please Print TAgibly Name "0T onffndMdml): Address r�Q,�A 931 City/StabelZ- : "n ,11 V %Q�hons 9-- Are you an employer?Ch cktheappropriatebox: Type of project(requind): L❑ I a employer with 4. ❑I am a geleral ctmtractor and I 6 El New eonsfrmdon Ioyees(full andlorpart-time).* have hiredthe sub-contractors 2 I am a sole proprietor orpartner- lisfed on the attached sheet 7- ❑Remodeling scrip and have no employees These sub-contractors have S. ❑Demolition Working for me in any capacity. employees and have workers' 9. 0 Building addition (No wotioecs'comp.insurance comp.insurance.$ required] 5. We are a corporationand its 10.❑Electrical repairs or additions 3.❑ I am homeowner doing all work officers have exercised their 1LE]Plumbing repairs or additions myself[No workers'camp. rightofexempdomperMGL 12-0 Roofrepairs insurance required.]t c.152,§1(4),and we have no employees-[No workers' 13_❑Otiret comp.insurance required.] *Any RppUcwt east dhecks box#1 rmstdso fill out the sectioa below shoteing theuwodme compeusationpolicy infatmitian 1•Homeowners abo submit this affidavit indicating they ace doing nU wmk and thin bire outside contactors;MnA submit a new affidavft indicating sari. tContcactors that check this bare was attached an sUltional sheet shmring thenameof fe sear-omttrxbors and Stateubetherocnot thus entitiesbaw employees. Ifthe subtontractorshave uVjoyees,theyimst provide their workers'camp.policp lumber. I airs air etioployer thatisprovidvtg workers'coniperisativn irtrrtraitce for i?iy eitzplrryees. Beiaw is thepoficy and job site information. Insurance CompanyName: Policy#or Self-ins.-11c.4- 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 requiredunder Section 25A of MGL ow 152 can lead to the imposition ofcrmz*nal penalties of a fine up to$1,500.00 and/or one yearimprisonmeat,as well as civil penalties in the form of a STOP WORK ORDM and a fine of up to$250.00 a day against the violator. RpA4visr4tht a copy of this statement maybe forwarded to the Office of Investigations of the DIA for' ca c ge verifica'on. AT do hereby edify rtlrder Tts MPG 'ss euury Hiatt ie irrformcd&n pr ni&1 a Pars `an orrect Si tome Date: �� I Phone 4: (),ff ai nse only. Do not sprite ill this area,lobe completed by city ar town officfal City or Town: PerutitUcense# IssningAathoiity(circle one): 1.Board of Health 2.Building Department 3.CitylPown Clerk 4.Electr ical Inspector S.Plumbing Inspector 6.Gther Contact Person: Phone 9: 6 Commonwealth ®f Massachusetts Sheet Metal Permit M2j��Parcel Date: Vll Permit#.6 CO- Estimated Job Cost: $ l/ Permit Fee: $ SAY 4 Z014 Plans Submitted: YES NO ✓ Plans Reviewed: YES NO Business License# °� TOWS! OF 13A4�� 4j inse# 1-19 17 a 40 Business s�/IIAnformation: ec&(M—_(�ame: F Property Owner/Job Location Information: �`Cl�`Name: _ � t4� `F A-9-k-(I Street: �Yfj 14 Street: `-1,a 6Lal',y City/Town:S -r- -W-C-6t City/Town: Telephone` `!;-off Telephone: 3 e Photo I.D..required/Copy of Photo I.D. attached: YES ✓ NO Staff Initial J-1 1VI-1 stricted license J-1 (M 1 ' J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /.2-stories or less j Residential: 1-2 family Multi-family Condo/Townhouses Other. Commercial: Office Retail Industrial Educational t Fire Dept. Approval Institutional_ Other ' Square Footage: under 10,000 sq. ft. `/ over 10,000 sq. ft. Number of Stories: b Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System i Metal Chimney/Vents Air Balancing G Provide detailed description of work to be done: ,�A t �r-(00 41,C- sc� sd4* oc i INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes oa/No ❑ If.you have checked lg,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the iMassachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and I accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be i in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments i Final Xnsgection Date Comments l Type of License: I 3y �ster .I ritle ❑Master-Restricted i i '.itylrown ❑Joumeyperson Signature of Licensee permit ❑Joumeyperson-Restricted License Number: �Z =ee$ ❑ Check at wnaw.mass.govldal I i nspector Signature of Permit Approval i ' The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia ' Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Pl"ers Applicant Information Please Print LeLribiv Name(Business/orgenization/Individuan: Address: j City/State/Zip -A(A- a-5*6,*hone.#: Are u an employer?Check appropriate box: -Type of pioject(required):•' 1.( I am a employer with �4. Q I am a general contractor and I 6 ❑ employees(full and/or part-time).* have hired the sub n�tor New eliniiction . 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an aci employees and have workers' YP capacity. 9. ❑Building addition [No workers' comp.incrrrar,� comp.insurance.# required.] 5. Q We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their - l 1.Q 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 ` ,cam. B� employees.[No workers' 13.Q Other 7g' 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. $Contracton that check this box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the subcontractors bave 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. � Lai Insurance Company Name: �"�lA� .t Policy#or Self-ins.Lic.#: t%tJ � NT 17 Off!i Expimtion Date: Job Site Address: � �` � � c1 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 tare imposition of criminal penalties of a fine tip 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 statemerit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct. Signature: Date. r3 dOl Phone#: e3 3 �0 Official use only. Do not write in this area,to be completed by city or town offuia1 City or Town: Permit/Ucense# -Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other I Contact Person: Phone#: � i _ b� OMMONWE/XTH16F�MASS6'1�04,+U'S MS j • • f • • - £OMMONWEiaLTH OF MtSSC.HUSEITS SHEEN ITAL WORKERS �l • • • • • ' ISSUES THE FOLLOW I IG I:1 Ef NS:E 3' BUS I NESS f, SH ET, ELQlORK RS ISSUESETHE FOLLOWII<'GELICENSE 3 n:.. AS A MASTER UNRESTR I ETE� �� �. CtIRISTORHER MEiVSLAGE L� AtL�,G°AS :HEAT l NG AND COOLING 1 NC Z CHRlS30PRER L ME�fSLAGE £ ' J AN: S1=RASTI QN f1R at� t1w1L:HMA" " o2563 o2%2Q16 �9250.3 PO 5 Box; 5o :.... r . .: S,A�I t�H f MA o2563 0550 2 6� ' V �7f : Oar/28/lli 221718 ;� Town of Barnstable Regulatory Services o s � Thomas F.Gealer,Director 3 Building Division Tom]Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barustable.ma.us Office: 508-862-4038 Fax: 508=790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �16-A)c-4 ,as Owner of the subject property hereby authorize �"G�. 1't /r�� f'��D l(.,-,q��'act on my behalf, in all matters.relative to work authorized by this building pemait �C(-vGL-S" (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until ill final inspections are performed and accepted. ignature of.QAet Signature of Applicant Print Name Print Name Date Q:FORMS:0 W NERPERMM SI0NM0LS Adtek Software Co Bennett 105 S Main St -Toluca, III 61369 142 Whistleberry 815-452-2345-sales@adteksoft.com Martons Mills Sales Consultant: chris menslage Job#: 02-27-2014 Date: 02/27/2014 System l (Average Load Procedure) Design Conditions Location: East Falmouth Otis Angb, Massachusetts Elevation: 132 ft Daily Range: Medium Input Data: Outdoor Dry Bulb Indoor Dry Bulb Latitude: 41° N Design Grains: 39 Summer: 82 75 Heated Area 1906 Sq.Ft. Winter: 14 70 Cooled Area 1906 Sq.Ft. Heat/Loss Summary (July Heat Load Calculations) Gross Sensible Latent Area Loss Gain Gain Walls 2432 9536 1858 0 Windows 298 9512 12366 0 Doors 21 706 265 0 Ceilings 540 1845 1156 0 Skylights 0 0 0 0 Floors 470 658 0 0 Room Internal Loads 0 7195 1200 Blower Load 1707 0 Hot Water Piping Load 0 0 0 r ��•` Winter Humidification Load 0 0 0 Infiltration g060 509 1759 A roved ACCA Venti lation 0 0 0 MJ8 Calculations Duct Loss/Gain EHLF=0.096 ESGF=0.048 3006 1121 532 AED Excursion n/a 0 n/a Subtotal 34323 26177 . 3484 Total Heating 34323 Btuh 11 kw of electric heat Total Cooling 29661 Btuh 68 Linear ft. of Hydronic Baseboard "Calculations are based on the ACCA Manual J 8th Edition and are approved by ACCA.All computed calculations are estimates based on building use,weather data,and inputted values such as R-Values, window types, duct loss, etc. Equipment selection should meet both the latent and sensible gain as well as ,J -1b+ P i ,�� �' �. ��t 1 � � �o . �� �-1�� s����� � � u . � ���� a36 � a N �� ' / {uI/'/�/` I � r 1 l ' �`/ 6� V1 L Client#: 15794 2ALLGA ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/14/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ONE C FA - A/XDowling&O'Neil PAHNo Eat:508 775 , 5087781218 Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:Associated Employers Insurance INSURED INSURER B: All Gas Heating&Cooling,Inc. INSURER C A/O AG Realty Trust INSURER D PO Box 550 INSURER E Sandwich,MA 02563 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER ADDLISUBR MMIDDY EFF MMIDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JE C LOC $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC50050054172014A 5/07/2014 05/07/201 X WC Y LIMIATUT OTH- AND EMPLOYERS'LIABILITY IER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $5OO OOO If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstalbe SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S130447/M130446 LS1 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ap v��nn Parcel Application# Health Division Conservation Division Permit# Tax Collector Date Issued �a Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis �G Project Street Address J4PhS77E Geee, gelt1E Village 1�Yafa1-r •1S Yv1III's Owner A2(!u ( WC-A91 �E.:riJ£r7- Address Telephone e 6)13 9 i � Permit Request Remo ,(�,_L J�p 6;�XIof .CYiSi/Ne I`?✓�TL/��n...� 10C,T C A10 Aj -.17- jr r,..,i_ 4deg d! : 7// Wo.16 LJr,,J Ask XdtrAsf ��i�� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4�22 000 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 B o On Old King's Highway: ❑Yes Basement Type: mull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new —Y Number of Bedrooms: existing new � - Total Room Count(not including baths):existing new First Floor Rooun,Count - r— •� N :r Heat Type and Fuel: Gas ❑Oil El El Other c`y cr' co Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/co.,11 stove: ]Yes%? ❑No eetached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑e isting bnew 2size Attached garage:O'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 ifs �G�a�rG Telephone Number b rag • ')ao.3 Address License# C)6 56Z 1 j'►'►�S 9tt 4 Home Improvement Contractor# Sy 3y Worker's Compensation# 20o/PJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 'RW_A m r- SIGNATUR DATE J 9 26--->9- J' • FOR OFFICIAL USE ONLY • PERMIT NO.. DATE ISSUED MAP/PARCEL NO. ADDRESS, VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION R$/lr/fG /�f� FIREPLACE ELECTRICAL: ROUGH FINAL 0 _ PLUMBING: ROUGH FINAL GAS: 'ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN.NO. i a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . ' d 600 Washington Street Boston,MA 02111 • ww s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetriciaus/Plu;mbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . Address: 2:3- /ate li✓A°I City/State/Zip: IT43V£f Phone:#: _5_6k 4 '9'- ' 900-3 Are you an employer? Check the'appropriate box: Type of project(required):. 1.❑ I am a employer with I am a general contractor and I employees(full and/or.part-time). * ave hired the sub-contractors 6 ❑New construction . 2.K I am a'sole proprietor or partner- sted on the'aitached sheet. 7. ,®.Remodeling \\ ship and have no employees hese sub-contractors have g, ❑Demolition working for me in any capacity. mployee's andhave workers' [No workers' comp,insurance omp, insurance. t 9. ❑Building addition required.] We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing.all work 11:❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ 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 anew affidavit indicating such. tContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have _ employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the'policy and job site information. Insurance Company Name: 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 to250.00 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 t pains-and penalties of perjury that the information provided above is true and.correct, Signature: Date: c4' / / Phone#: ? `� • �� 1130 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 I Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." • An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the mc�vnr tr��tee of an individual�parhiership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein;or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal.of a license or permit to"operate a business or to construct buildings in the commonwealth for any applicant who has not produced,acceptable evidence of compliance with the'insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract forjhe performance of public work until-acceptable evidence-of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or.license is being requested,not the Department of Industrial Accidents.- Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is compiete'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 questionaJ please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massach=tts Department of 11adtstrial Accidents Office of Investigations 600 Washingtm Street Boston,ILIA 02111 Tel. #617-727-4900.ext 4.06 or 1-977-MASSAFE • Fax 4 617-727-774.9 Revised 11-22-06 www.mass.gov/dia i 1 v TT lA v1 1J al ila L.C11✓1a7 p °* Regulatory Services • a►Rxss Thomas F.Geiler,Director �plEoiF9 Building Division • Tom.Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.towA,bzrnstable,ma.us ice: 508-862-4038 Fax: 508-190-6230 Permit no. Date AFFIDAVU HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION M(3L 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, AA. certa n exceptions, along with other requirements. Type of Work: 4-1,222 Estimated Cost 4z) Address of Work:. Z Owner's Namee�i'��� SDate of Application: 7 — d ' O I hereby certify that: Registration is not required for the following reason(s): OWork excluded by law OJob Under S 1,000 ."V OBuilding not owner-occupied ❑Owner pulling own permit (? Notice is hereby given that: oWhrERS pULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME ZIPROVEMENT 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: ate Otactor Signature Registration No. OR Date Owner's Signature • Q:wpfiles.fnrms:homeaffidxv Rev 060606 JUL-19-2007 08:31 From:MARK SYLVIA INS 5084209227 To:508 477 9011 P.1/1 .ACO,�,, CERTIFICATE OF LIA13ILITY INSURANCE D 1�14`"""i2008 PRODUCER ' ' Serial# THIS CERTIFICATE 19 ISSUED AS A TTER'OF INFORMATION MARK SYLVIA INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 771 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFF21MP JtZa POLICES BELD-W. OSTERVILLE,MA 0286e INSURERS AFFORDING COVERAGE NAIL# INSURBD' INSURER A: FARM FAMILY CASUALTY INSURANCE CO J.S.CLARK BUILDERS, INC. INSURER B, 759 FALMOUTH ROAD#5 INSURER C MASHPEE,MA 02649 INMURFR D: INSURER E: COVERAGES THE POLICIES OF INSURANCE UST@D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIND ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PIRTAIN.THE INSURANCE AFPORDE013Y THE POLICES DESCRIBCD HCREIN IS SUBdOCT TO ALL THO TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,A00ReGATp LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAB4, TYPE OP INSURANCE POLICY NUMBER P P T N LIMITS GENERAL LIABILITY EACH OCCURRENCE 6 _ 1,300,000 A X COMMSR'CIAL ODNGRAL LIABILITY 2001XO243 04/29/2007 04/29/2008 TA '° s 60,000 CLAIMS MADE OCCUR MroFxP An enn ennn S 5000 PERSONAL A AOV INJURY 6 GENERAL AGGREGATE 6 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO S 2,000, OOO POLICY12 P LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 6 ANY AUTO (Eo sooldont) ALL OWNED AUTOS pOdLY INJURY 6 SCNL'DULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per eeelden0 = P ( e�iOPER reco Endo�?AMAOE 6 GAR"e LIABILITY AUTO ONLY-FA ACCIDENT f ANY AUTO OTHFR THAN CA ACC I AUTO ONLY Apo I AACEBsdUMDRELLA L(ADILITY EACH OCCURRFNCFl S OCCUR 1:1 CLAIMS MHOS AOOACGATE 6 f DEDUCTIBLE i RETENTION 6 6 WORKER'S COMPBNBATION AND 2001 WO337 12)02R008 1210212007 " ' X WL A RMPLOYBRB'LIAGlwry ANY PROPRIBTORIPARTNGR(OCCCUTIVS El EACH ACCIDENT s 500000 •OPRICZWMBMBI:RBXCLUDEDi f LDIlIMBE-I'A BMPLOVkT f 5000DD Itpyest describe under SPECIAL PROVISIONS below GL DIRRARR•POUCY LIMIT 6 500,000 'OGBORIPTION OROPERATIONBILOCATIONWVUMIC4E81@XCLUBIONB ADDED GY CNDORDEMONTMPUGIAL PROVISIONS CARPENTRY ELECTRICAL WO•g WITHIN BUILDING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DBBCRIBIED POLICIES pp CANCULoD BEFORE THE NxPIRATION FAX TO CERTIFICATE HOLDER DATE THEREOF,THU ISSUING INSVRP.R WILL aNDCAVOR TO MAIL 30 DAYa WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 714E LCPT.BUT PAILURQ TO OD 00 SHALL 508 477.9011 EM K IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THL 1NSURSR,IT0 AGENTS OR REPRESENTATIVES. AUTHORIZED RI!PRCBCNTATIVB ACORP 26.11001108) qk,66M CORPORATION 1908 I I li i ' "�E'�' ✓/ze �a»rmzo�isueaLD�i o�./�acaac`u�6ek6 BOARD OF BUILDING EGULATIONS . License: CONSTRUCTION SUPERVISOR Number:;CS, 06562.9 , I ;..;. ,. 1. Birthdate_°_1;0/14/1966 is Expires:'1;U/14/2Q08,e Tr.no: 3369.0 -., Restrictedsir00. ` JOHNS CLARK 25 EAST WAYG- MASHPEE, MA 02649 Commissioner �ie-Vanv»zaozcuea� a��/�c��oe`u� Board of Building Regulations and Standards Lieen. HOME IMPROVEMENT CONTRACTOR before ' Boarc Registra4n:1.145474 Onelug A Ezpiration:`a112009 Tr# 126664 Bosto =Type:"Private Corporation JS CLARK BUILDERS;INC: JOHN CLARK 25 EAST WAY MASHPEE,MA 02649 Administrator J l r I \ i Larry& Wendy Bennett 142 Whistleberry Drive Marsttons Mills MA:02648 Town of Barnstable Building Department Barnstable A4, 02675 July 9, 2007 Dear Sir or Madam: This letter is to authorize John Clark of JS Clark Builders/DreamMaker Bath& Kitchen to apply for a building permit for work to be performed at 142 Whistleberry Drive, Marstons Mills; I am the owner of the property and have retained Mr. Clark's company to perform the aforementioned renovations. If further clarification of this matter is required,please do not hesitate to contact me at 508-428-9138 Yours Truly, I r , f 1. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division �P 27 �� Date Issued 16 D Conservation Division Tr �g 2 Fe ? � ^ Tax Collector .. Treasurer � 3t� ED IN CCL9ICE Planning Dept. VVI TH'PITLb 5 Date Definitive Plan Approved by Planning Board Y'C4" 2ECULASi.IC�y Historic-OKH Preservation/Hyannis , Project Street Address 1,ya I o h 1--S+)C 6efa1 Ire✓e. Village Mar-I �n_`. M i 11 S Owner r ce_ Address 50,_ eC.` Telephone 6'0%" off$ '9 I m 11;50X�=�5_7V Z i Permit Request n laves d ram%u ®vim ��. k aK /rtod� Square feet: 1st floor: existing , 3�o`a proposed 2nd floor: existing proposed Total new (o Valuation orra0 . ro Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size I Acre- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling,Type: Single Family A Two Family ❑ Multi-Family #units Age of Existing Structure Historic House: ❑Yes ItNo On Old King's Highway: Cl Yes 9No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) '&— Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new -E!7- Half: existing lj new - 3- Number of Bedrooms: existing_ new Total Room Count(not including baths): existing _ new First Floor Room Count Heat Type and Fuel: ❑Gas 14,Oil ❑ Electric ❑Other Central Air: ❑Yes 4 No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes XNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:A existing ❑new sizeaqga Shed:❑existing ❑new size Oth - D Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ AUG 2 3 2001 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use TBY BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t SIGNATUR J, DATE FOR OFFICIAL USE ONLY PERMIT'NO. DATE ISSUED MAP/PARCEL.NO. • 1 ADDRESS VILLAGE I OWNER 1 DATE OF INSPECTION: y FOUNDATION FRAMECUf INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. y �P`oFIHEr�o �� The Town of Barnstable BARNSTABLE. » 9 MASS 0 "`Department of Health Safety and Environmental Services s639.....`0 �PrF0 Mai.> Building Division 367 Main Street, Hyannis,MA 02601 Office: 508=862-4038 Fax: 508-7{90-6230 PLAN REVIEW Owner: ( ) -f"of )a ^l;"1"' Map/Parcel: 010 Project Address: L�� �e 6Vr!S Builder: ��2Y �I _P The follow ng items were noted on reviewing: h4 aA AQ_ ('YeAAor 'YY)P")k -swig -AR Ck- 'IS i A-G, VAo All Reviewed by: r Date: q:building:forms:review I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 "ems Building Permit Amendment $25.00 FEE VALUE WORKSHEET c - LIVING SPACE t square feet x$96/sq.foot= 6 % x .0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$'64/sq.foot= x.0031= �" --- plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100,00 >1500 sf-Same as new building permit: sgtiare feet x$96/sq.foot= x .0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit ee L' PJ ro'cost LOT 5 - 170 gl N 711� 101rE cn LOT 6 T N CD C� O O- I _ _2 N J -. O O D 0 39 io_o__==-_� c 1V• ---:b ro4. A)c,,ve � I 22 2 E I 1 A I E E I , N i "r I 175.12 o 70.63 40 "E - N LOT 7 RES. ZONE.- '"RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "0" Bank Use Only TOWN: _______________ REGISTRY OWNER: LAWRENCE J_&_WENDY_J_.__BENNETT------ DEED REF: __745.5,13B-------------------BUYER: _BEFJNAiV-CE --------------------------------=-------------------- DATE: _ 11�1992________________________ PLAN REF: --------------------- SCALE:1"= 50"___FT. I HEREBY CERTIFY TO fAN1LUCKSQQPFR_A7Jf BA V 1T' _SUCCESSORS_A_N_D10R AS_S_IGNSA_TIMA_THAT THE BUILDING .°"'�f'`� YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN AND THAT ITS POSITION DOES ---- CONFORM ;/., `_�'. CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE t 143 ROUTE 149 TOWN OF ___BARNSTABLE_________ AND THAT MARSTONS MILLS, MA. 02648 IT DOES—NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD TEL: 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED_B,/-J-9105—_ FAX 420-5553 Co unit —Panel 250001 0015 C �� _____ THIS PLAN NOT MADE FROM AN INSTRUMENT 10115 DPG PAUL A. MERITH , PLS SURVEY, NOT TO BE USED FOR FENCES, ETC. of t�t : The Town of Barnstable 9' 'STABULg Regulatory Services Thomas F. Geiler, Director, Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 5087790-6230 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: A 1 Estimated Cost_4��=__ Address of Work: Owner's Name: /. / Ie2/?n 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 Narrdr q l6mis:Affidaw re v-070601 r The Commonwealth of Massachusetts = Department of Industrial Accidents ,A _ , :- OIIIc�of/o�est/gatioos 600 Washington Street 4 v Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name. n� �P�IIO)P location- Li a W V 1( 1'_Tl.2 r-t-je. city Mal_-,+t>ns / ' /l Iu shone# Sdg-y a25 -21 3 ❑ I am a homeowner performing all work myself. ' ® I am a sole rietor and have no one worldn in any ca acity ////%////%%/%%/%%%%/%%%%/%%/%/%//%%%%%///%%%///%///%D%%%%%/%%%%%%%��%��%%%%%%///%%%%�O%/%�%%/�/�%/�%%///�%/////%�%%%i I am an employer providing workers' compensation for my employees working on this job. : ::::::::::: ::: :: :::::: ::::::::::::::: :: : . ❑ :::..........::::::.::::::: copsnv n cite xx ' > ` <`> << CI Q hon ` >:?? % <?:Y:>?::i si:»`:3 s:ii::::i::;:>:':::•: ::? :': Y::;::::::i::::is i:::::":;:::;:::»>':>:::::;':>:::::::i::::is�:::::: »:•:;: ;;:•:::::•:::5:.:;:....:......... xx [] I ...ansUranam a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followingworkers' compensation polices: conoanv n ass.::.:..,..:......:.:....... :.:. ..... : .:.:...... ..... ............... . '< h n :••3 ................::::..............................:......... X. . .................................�:::::.: ....:......... ........... ,:.:.;;;:.;:.:::: X. :...:.::::::....:.::.,..,::..:..::...::.... oliev� lox "dares�a tl b ::....:.....:.::................:........:.....:...:.........::::................. el ....:::......................................... Q]QFAQ6e:C0;:.:<.;:.;: : :::.::::,................................. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury[hart the-information provided above is true and coned Signature _ Date zely A V Print name Qum rfa .�r " C1 ��h. ✓.Tl` Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; _ ❑Other. UcwsW 9/95 PJA) 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 mot 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 insurance as all affidavits 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. 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 permit/license number which will be used as a reference number. The affidavits may be retmmed fo 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 of Invesugations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or.375 °F.HME ° The Town of Barnstable • a�►artsrwer.e. 9e ht,►ss g Regulatory Services 059. 4� Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building-Commissioner 367 Main Street,Hyannis MA 02601 Office: 568-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:— JOB LOCATION: l�l� L(J�Y. f�lYA7+'�7 ©�`� number street village ,� L�/e�� .�r�.urf .r'oF-�/max-91.�b' "HOMEOWNER":4jAj Ctiee work phone# name home phone# CURRENT MAILING ADDRESS: ^r city/town state rip 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(p)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. SignatureH owner 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." responsibilities of a supervisor(see Many homeowners who use this exemption are unaware that they are assuming the res P P 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 pan 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:EXEM PTN Tab1aJSZtb( d) )'raeripebe Paelra;a for ans aad Two-Fa OdY Neidaedal BdWIoP Hta:ad with FosaJ Falb MAXIMUM MuVQ4H!!♦R U1a" Cal+e6 Wail Floor &='a mot Slab �Coolra6 Area'(•/.) U.val� R value R-vd Rrvand Wall P=kzffe 5101 to 65H Hemdog DeReea UAW Q 12!4P0,460j38 13 19" !0 6 N0�12% 30 19 19 106 Normal S 12%. 38 13 19 10' 6 OAFUE T 15% 38 13 25 WA NIA Normal U 15% 0.46 38 19 .19 t0 6 Normal V 1S'/. 0.44 38 13 25 NIA WA BSAFUE W 15% 0M 30 19 19 10 6 >is AFUE X 18%. 0M 38 13 25. NIA WA Normal Y 18% 0.42 J8 _19 - . 25 WA __WA Normal Z 18•/. 0.42 38 13 19 t0 6 90 AFUE -AA 18•/. 0.50 30 19 19 10 6 AEUE 1. ADDRES S OF PROPERTY: DARE FOOTAGE OF ALL EXTERIOR WALLS: I C 2 SQUARE 1 3. SQUARE FOOTAGE OF ALL GLAZING: 3e(;: 4. %GLA22NG AREA 03 DIVIDED BY#2): l l9 S. SELECT PACKAGE(Q—AA see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: ' q-forms-f980303a i Duct Leakage Test Form Customer Information: Test Conditions: Name: Lawrence Bennett Dater Address: 05/15/2014 142 Whistleberry Time: Drive City: Marstons Mills Indoor Temperature(F): 12:40p State/Zip: Ma 02648 70 Phone: Outdoor Temperature(F): 67 508-428-9138 Floor Area(&): 1139 Email: wbennett220comcast.net System Airflow(cfm): 812 Cooling Size(tons): 2.5 Building Address:(if different from above) Heating Size(btu): N/A Street: Primary Location of Supply Ductwork City/State: hacPmPnt Primary Location of Return Ductwork: — had zerneat— Comments• Total Leakage Test Depress Press XX Outside Leakaae Test Depress Press Test Pressure: 25 (Pa) Test Pressure: (Pa) Baseline Duct Pressure(optional): (Pa) Duct Flow Ring Fan Press Flow Duct Flow Ring Fan Press Flow Press. a Installed TO cfm Press. a Installed TO Wm) 25 124 70 Fan Model/SN: Results: Fan ModeUSN: Outside Leakage(cfln): Outside Leakage as% Results: System Airflow: Outside Leakage as% Total Leakage(cfm): 70 Floor Area: Total Leakage as% System Airflow: 6% All Gas Heating & Cooling Inc. Total Leakage as% 15 Jan Sebastian Dr Unit B2 Floor Area: 6% Sandwich MA 02563 508.833.5088 Y F : : : r i - C 1 GXiS ,� : — e oof j ,L k . - on I MAR 1 Nevi, Z-?tX�l... i - - :'�• ;r .i _ . \A1 ..Ceder P Allf d . . .. .:- r = - uq�s:� 2,2no.� 1 Ll To hoV»� : .. _ ... _ BACK( f 046*1 '/�! 1n/I�f l 3 L F BiF R.R►! :D'R/.V,K : . IflASToN.nrittS..M —.LOT`6: i 4 Assess office 1'st Floor): `n ( ) Assessor's, ap and lot number - U tP 3 S / ®pTjCSYSTEM T M M ' ��R-1®e+���1�1lld �Ytl f THE>0 Conservation', J--� 01 3` INSTALLEDIN OOMPL. Ow Board of Healt,-Rrd floor): _ I waTH TITLE 5 Sewage Permit number ENVIRONMENTAL O®D 11114111111, iTAnc I Engineering Deportment(3rd floor): T®WN REGULAT10 �e 639. v���d' House number' oZ Definitive Plan Approved by Planning Board 19 • APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO a TYPE OF CONSTRUCTION Lt'/.r n.✓ �i-a•mot c. 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location WhrSf1e- harry Qr. /dar6+ona A4, / t Proposed Use 5-1✓1 G lE g`-a-rn r N Zoning District r, Fire District Name of Owner/,&wrest c e /3en ne Address -2d lv�i���1i✓1 G / os f 4ane Cew�Pryr l/e Name of Builder ae-r-eJcl I kef" J (2. Address_ 9 O AJX is-1 J., "(/ 414r 6,2 6 7/ Name of Architect Address Number of Rooms 8 Foundation A w r e—cl eon c re->`e Exterior CealQ„ Roofing Z-s �• Floors A�aroiwood ✓i✓ IV Car Interior /,t lt/a/�hocrc� ~ Heating 'E'l-I fill Z f7/G- Plumbing a old /L4 4 S Fireplace I r y Approximate Cost r o O 000, a o' a 61P Area Plv s,7 e Diagram of Lot and Building with Dimensions Fee o �r c14(f 0j , yna � s � o267i /7or 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 �2 Construction Supervisor's License 007 k7 BENNETT; LAWRENCE No 350u4' Permit For Two Story Single Family Dwelling iocation Lot #6 , 142 Whistleberry Drive Marstons Mills Owner Lawrence Bennett Type of Construction Frame Plot Lot Permit Granted May �2 6,/g 19 92 Date of Inspection 7< "3` ` � 19 Date Completed-,—/7—2g 19 -� r TOWN OF BARNSTABLE Permit No 35084 . . BUILDING DEPARTMENT $1,000.00 (bldr.) tq""T I TOWN OFFICE BUILDING Cash .... �e 39 HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to LAWRENCE BENNETT Address lot #6 142 Whistleberry Drive, Marstons Mills 1 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. October 9 19 92 Building Inspector A _ tlh4h $ 11h uM�n.na=;•�;. ryry„ -t TOWN OF BARNSTABLE - 35�84 f Permit No t •4+�h• ,+ .M• ! BUILDING DEPARTMENT 1 s.a,n .:,:TOWN OFFICE BUILDING +••• •� HYANNM MASS. 2Bond .: • I .. if�_n rY 3�C t i CERTIFICATE OF USE AND OCCUP.ANCY P , I LAWRENCE ENNETT Issued to g ti Address lot #6 `142 Whistleberry Drive, Marstone Mi hls "t" ':"£�3 j• .4 F iks{�,1 t '• J \tiy�,3r USE'GROUP 1 FIRE GRADING OCCUPANCY LOAD ,tip THIS PERMIT.WILL,NOT } $ � A► .[DR I,D� �OCCV!'IED;UNTII;�' r Y,SIGNED BY THE'BUILDING MSPFl �R UPON•S'A`TISi+A� r M ' tr REQUIREMENTS-AND-IN ACCQFDANC1;W1TH S�CTIQ(V 1 Q " IVC>~ WI'�i n y 4 a •U wa jrr BUILDING COD(r, ;, 5 N S `$'TlX i t i 1� ,gp �i� �' s ro .S-� �'s,• �i � i f � October 92 Z4 s ♦ i J !0 �s r tr 5r r Build�ng.lrlspecr y TOWN OF BARNSTABLE BUILDING COMMISSIONERS OFFICE DATE_a ACCT. PAYABLE TO: VENDOR# Gary Baker AMT. /_ 90 Bell's Neck Road PO# West Harwich, MA 02671 APPROVED BY ` rTOWN�rO¢ BARNSTABL'E, MASSACHUSETTS �,IIILDING P MI' a�063-065 .t t DATE May '. 26, 19 .-�-92 4pERMaIT N�. NQ _ 1+� APPLICANT Gerald A�ik@rat Jr. ' ADDRESS Beii� LYE "�uM.� ••• arW t (NO.), y (STREET) .7 (.CO-�-S LICENSE.( g PERMIT TO Build Dwelling 2 Single Famil Dwellin NUMBER OF t` " { I STORY 9 DWELLING UNITS v I (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION)- Lot #6/ 142 Whistleberry Drive, Marstoflgy 8 . ZONING IN0.) (STREET) DISTRICT � BETWEEN AND - (CROSS STREET)., (CROSS STREET) 717, SUBDIVISION LOT BLO, K 'LOT T- BUILDING IS TO BE FT. WIDE BY FT. LONG"BY FT. IN HEIGHT AND SHALL.CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION Sewa g-a #92-154 (TYPE) ' REMARKS: � 1 Gt�ry' Halter ,l ($1,000. 00) 90 Bel l's Neck Rd. W. Harwich AREA OR w��µy, ^ VOLUME 1924 sq. ft:• $a FEE'1G0,b0t?•00 . 'PERMIT $'130.75 E _: +• (C.UBIC/SO UARE FEET( STIMATED COST OWNER Lawrellcc, Bennett ADDRESS 111E.` , U BUILDING DEPT. - BY 1 i THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY I PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISOEC,TION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINS FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIO OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I: FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL, ECH AELECTNICALRICAL,INSTALLATIONND 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, I OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS � q ELECTRICAL INSPECTION APPROVALS el 2 �� s 3% HEATING INSPECTION APPROVALS ENGIy4RING DE A TMENT ) 10� 2 CARD HEALTH OTHER 1 SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION y TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DT INSPECTIONS INDICATED ON THIS CARD CAN DATE THE CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITT NOTIFICATION. I 0 g\ LOB" .o c. 10 s C 0 L o• s s� 15 L�0 � a o \ b 0 �pT -7 JOB # 91-341 CERTIFIED PLOT PLAN PREPARED FOR., LOCATION: LOT 6 WHISTLEBERRY LN MARSTONS MILLS SCALE: 1 "=60 ' DATE: 05/21/92 REFERENCE: PB 349 PG 55 LAWRENCE & WENDY BENNETT I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. /�N of ARNE yc H. down cape engineering, inc . OJA N CIVIL ENGINEERS TE LAND SURVEYORS ROUTE 6A YARMOUTH MA DATE PEG. AND SURVEYOR i w` i r• 38 -GARY BAKER •+".del.•'` ,y,.+ ., ,,,�f .. ,�w� LL'S NECK RD-,,,PH. 508-432-5153`'`"y,../ .�• 4+ •.HARRWICH -mA"4026�17�'".ti",1. �`�:�,.;,` Q' �� e1 v 7 122 0�/ 3 �PnSr TO THFF� r� '�/` l0 ..K� V! ..� .KvYiy'�/!/f y j'w"`•'� o-�: '�' ..,�+ •rKl`.. �'+ . z� � ORLD BAI NK 10'' 4-cape Coq;MaaBach, ' �+. ,.MEMO• til'� � �, a.i✓' � .../�'!� 0 '70Q ? �:, 2 00 ... .+. .'�....r;,..'�..�` ."`..ram..'w��..•.�. 1_ +e. � _ ...+ . x.".. ,..�Y''.r..:+."'.►�*FY.��*!�'`�i�.�'*r`' �h�' / 1 R ]lI1N OOW SGHED UI_C ANOE.R,fjEN PFJL/hA•'SF110U-+ 00514I..,gTlol.i 04ANTI TY R —f oPe-NIN4• %VITN SG Rldu6 -p LACt1G GR+I.a4 1A310 9 i'-p'/a r 4'-1'✓Y i 20 3 Z 3 2'-1'/g oc D'-5'74• ✓ ' cH 13S .1 B'_B 114 v 9•-S.03_ 49 444t T-o 1 8'•0._.x 4'-4 y/4^ --- sT EL CGL.I.A R. 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