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0345 WHISTLEBERRY DRIVE
Of tf, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Zcv, # ` cog Health Division Date Issued ' 1 Conservation Division Application Fee Planning Dept. Permit Fee X&,a) r Date Definitive Plan Approved by Planning Board D L Historic - OKH _ Preservation/ Hyannis ,Q Project Street Address Village l'j'I&s AD IJ,� f�N S 9 Owner Fr <.C h1d)v f6�l/�};�( Address Sr�W e_ Telephone 7.7 q _ S b Permit Request c4�ru 6NS/4 /4 40k) 0 ,0�^ ties Inoue &)1b co ne �Craow_ A�Ader Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 'Zoning District Flood Plain Groundwater Overlay. Project Valuation Uo� Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting dgcumsntation. © � d o Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) CD Age of Existing Structure Historic House: ❑Yes ❑ No On Old KingYPighway:s b Yes ❑ No _ co Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Othery Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 1 �o Number of Baths: Full: existing new Half: existing R newt-.i d w Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) D Name Telephone Number f1'11�c�o�� 7"7q4� 6 �►� � Q Cr,ddress /5 O 7,1k o -A �ourAle License # 07tg7`/ )4,96174 f A%0 D2S-z-7 o Home Improvement Contractor# 13 6 3 kY- Email 47A c NP 7�At. Gom Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ovrtie Lur, // SIGNATURE ( DATE I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED' MAP/PARCEL NO. I ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING D�i CLOSED OUT AS`S'E ;FATION PLAN NO: r1- The Ca'nwompeidA ofHassachtwegs K q'Ards&i dAccden&- 600 Wm*ington beef Boston,MA 02L wmP Yna=gOv1dzfa Workers' Cumpe-n=fwnInsm-anceAfficdavit Bmgders/Cantractors/Electdcians/Piumbers AppUcant hfarmaticm Please Print Name(Snsess/d�miioa/In3viduaq: 14 C�4A-2� Address Gty/stamp: rJ (IMOA- 0?- 0�f- 7 7 53 C 5 v' " 0 Are you ait employer?Checkfim appropriate bow Type of project(regvim -: L❑ I am a employer wift 4. ❑ I mn a gamesal contraetur and I 6_ ❑New lion employees(€nll andl(3rpmt--ime)-* havemre4t 2. I am a sole propfietor orparfner- listed on the attached sheet; 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑D)ernotitiocL wotddng for me in any cagacitjr employees and have woAmrs' 9_ ❑Building addition [No wadals'Comp-i M=-a=C comp-insraran el mod] 5. ❑ We are a corporation and its 10Z]Electrical repairs or additions 3.❑ I am a homwwner doing all wori: officars have exercised thew 11-.❑'Plumbing repairs or additions n ofe�emgtioagerMGL f o 12_.❑Roofrepaits insurance required.]F c-152, §l(4)>and we hati a no employees-[No worms' 13-0 Other comp-insurance require3:f ;"anysQPHuIItfx[chedcsboz#1=w-rtalsaffioatthesectionbnlowsbneria5tbeirwa�ceaTrompens aapoTieyi ia� Hameownes echo submit tbis sdFLdivff n mz:h_ TCa�aoa thst check this baxmast sitadbed an adri;t9nn91 sheet showingthemane of&a smb-boa m3smtP whether ornotlhaM t have ang ogees. Ifthe mVcanbactms bare employees,they must provide their warless'camp.paa c mnabm lam arz employer thnt is prmidieg itorlrem'cortgwLv than insurance for my employees. Below is fhepagcy raid job situ in,fora a om Insurance ComparryName: PoTacp 9 or-'Self-ins-Uc- PxpirntionDate: i Job Site Address City tawzip: Attach a ropy of the workers'compensation policy declaration page(show.mg the polio tramber w d cq ation date). Failure to secure-coverage as tequireduuder Sectioa25A o€MGL r- 152 can lead to the imposition ofcsiminal penalties of a fine up to SL 500.00 and/or one-yearimprisonmerd,as well.as civil penalties in the fb m of a STOP WORK ORDER-and a fine of up.to$250.00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of luvesfigatitms of the DIA for insurance coverage ve�catitm Ida hgreby ca r s oat ofper wry fhatfhe injormafianprovided above is h7m and rrect Sitma Date: �o Phone# Q,ffzctirl use only. Do Trot writs in flits area,to be campieterI by city err town of,/icraL City or Town: Perr arivucense# Issuing Anthnriiy(circle one): L Board of$e:eltft I Building I}epartment 3.CitFfrowma Clerk 4.Electrical bnspector S.Pfumhiag Inspector 6.Cthrr Confaet Pe:rsan: Phone 9: 6 Information and Instructions Massachusetts Geaera.I Laws chapter 152 requires all employers to provide workers'compensation for their empl6yees. Pursvantto this statute,an employee is defined as 1`_every person in the service of another under any contract ofhire, 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,paitnership,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 budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(t7 also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho has not produced acceptable evidence of compliance with the insurance,coyerage required.' . Additionally,MGL chapter 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 of compliance with the inc,rrance 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-contractors)name(s),addresses)and phone nu mber(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 pariners,'are not required to carry workers' compensation ins nance_ If an LLC or LLP does have employees,a policy is requu•ed. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofimmiance toverage.. 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-in uraince 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 e the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact your boarding the applicant -Please be sure to f M in the pennit/license number which will be used as a reference number. Ia addition,an applicant that must submit multiple penmiUhcense 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 fur futrrre 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 tie.a dog license or permit to burn 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: 'Ile Commoi:m Tth Of M ssachumtt s Depaztmeat r?f l dual AocOmts Gfuli e ofkv(a Stigatiaxui ��'�ashzn�tan Str�e� Baffin=IAA G2111 Fax# 617-`27- 4� Revised 4=24-07 . . W�PCrg2a��Ol7�ElIa Vl q__&Conir.acizn� i PO Box 769 East Falmouth,MA 02536 Phone:508-360-8604 or508-548-8808 Fax:508-548-8808 wwwAiandcontracting.com Eric,Holly Robillard Contact: Dan Maclone 345 Whistleberry Drive Construction Supervisor License#079974 Marstons Mills, MA 02648 Home Improvement Contractor#136388 Estimate: Kitchen Remodel, Misc. remodeling Work to be performed: Kitchen- * Removal of existing cabinets,Removal of wall to dining room (None bearing work, if bearing wall we will need to figure the difference at time of construction.)Removal of wall to right of frig. • Framing Frame new 6'x4' gliding window unit • Installation of new Andersen 400 series Gliding unit(G64) white interior and white exterior with white hardware and screen • Patch in siding and installation of new trim exterior and interior to match existing • Insulate as needed on all exterior areas • Installation of sheet rock and patch work as needed, walls and ceiling • Installation of new kitchen per plan • Installation of all hardware for cabinets • Installation of new baseboard through out Kitchen, dining area to blend with existing Electrical work • Add, move recessed cans as desired • Added two pendent fixtures (Owner to provide fixtures)? • Move switches as needed,relocate • Remove and add plugs,switches etc. as needed Electrical allowance: $3,100.00 Plumbing work • Capping of all water lines at demo j • Installation of all waterlines and hook up of drains, move for new plan • Hook up of dishwasher, water line for frig. Any misc. Plumbing allowance: $700.00 Gas, Heat work • Remove and replace baseboard heat in dining area to accommodate new plan • Move gas line for new stove location • Allowance: $1,700.00 Painting • Kitchen walls, Ceiling and trim as needed Allowance $800.00 Flooring • Refinishing of all pine flooring- kitchen,hall, 1 bedroom, living room • Staining(dark black—walnut) 3 coats poly. Note: if flooring needs to be.patched under cabinets it will be billable on a cost plus 15%basis Tile back splash • Installation of appox. 28 sq ft of tile (Owner to provide tile) Total estimated cost: $21,850.00 Living room estimate- Adding of 4 recessed cans for lighting Installation of new ceiling fan(Owner to provide) Patching of drywall as needed Painting of walls and ceiling Total estimated cost: $2,430.00 All allowances are calculated on a cost plus 15% basis Any changes/stipulations made to the above will be incorporated into a revised contract,as necessary. . Upon signing the contract,a retainer equal to 25%of the total estimated price will be due in order to assure project placement. Please Note: When remodeling, unforeseen problems may arise, which could result in additional costs not included in the initial estimate. If situations such as these should occur, any and all changes will be subject to customer approval. L-IZY Customer Date VHI 77— � Ko ��'I�Ccr` �-eS. Mir,64-viuS X�� III N;d�osa l i 111 IL Cn +rA,, �cv r ��N e IM�c.(o 17— s„ 232 43 12 18" -- 63o,r . . 21" . 30" 21" ; 24" t s r err .... _...._.. i ! t ._..._.... 4311" 33.. I 30 ..9 _ _ .. _ 36 "r I IN: '�f i 0® � BTG B9 x r r { , ! 171SHW24, lfi jk F ' i B36RTNGrE GAS 30' D9 1 L t� s � _ SB 3 - - -4 00 B30 3DB30 1330 t I —_ .�-------38 ..... or I -- —105" --- --- - LOSC ADDED :a 2178 r _�__.._.._..30"_.........-..l..- .....30"..._.._..�._..._.._30"-- ►�.:-'-- �., ,j - -—►J 1 t 8', _,_._ F336 ller Added t -,m I FtC=91-3/8" v I Set cabinets at 89-3/4"+/-. 1-5/8" Crown to Ceiling j All dimensions and size designations � � This is an original design and must Designed: 11/27/2013 I given•are subject to verification on 1"A �' not be printed,copied or released Printed: 1/9/2014 job site and adjustment to fit job unless applicable fee has been paid II I I conditions. M�E 7 or job order placed. Y i Design Mark Dupont(C)2012 11 _...._ ! --_ -- - - -- - --- --_- Robillard Kitchen_Island Version - -- -_-- - -- FL_PLAN Drawing#: I No Scale.�1 e Massachusetts.-Department of Public Safety i Board of Building Regulations and Standards Construction Supen-isor yF License: CS-079974 DANIEL C MACLE)NE PO BOX 769 EAST FALMOUPH M�;e Expiration Commissioner 07/07/2015 - a Office.of Consumer Affairs & Business Regulation=Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting HIC Registration Complaints Registration# 136388 Home Improvement Contractor Registrant DANIEL CRAIG MACLONE Registration Home Page Name DANIEL MACLONE Address 206 E. FALMOUTH HIGHWAY City, State Zip E.FALMOUTH, MA 02536 Expiration Date 07/22/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.usPnic/licdetails.aspx?txtSearchLN=36757 10/21/2013 Town of Barnstable Building Department Services Brian Florence,CBO � ��'olio IAENWA M v , Building commissioner ��)7 200 Main Street,Hyannis,MA 02601 APR 12 2018 www.town.barnstable.ma.us rOVVNQ'CBAF1lU T Office: 508-862-4038 Fax' =508'&O-6230 NOTICE TO THE BUI LDING DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT Construction Supervisor License # C)o�3 ZS ,.hereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit #Z-\-1- u Zo g , issued to (property address) ' A% _on_��r�11.. —, 201-77. I also certify that on A,Qe.- Q- , 201" , I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. CENSE HOLDER DATE q/forms/newcontr reference R-5 780 CMR rev:08/23/17 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q-_ %Nap (OZ Parcel Application # Health Division LQ/ Date Issued Conservation Division Application Fe Planning Dept.. � ���Uj�p^ 8?®JJ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis ��F Project Street Address &L1 S WW\ Village I�AQS�G.)JS �LLS Owner Z�\3 ll t- \(c Address SA4lue Telephone Permit Request F���`� �ASSu� � �J��( �0.�,{1� r L\V��CS gtQ�p tV Square feet: 1 st floor: existingUS5roposed 2nd floor: existingi�ft proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 35� —Construction Type Lot.Size \ • G C Grandfathered: ❑Yes ❑ No , If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure \ 3 Historic House: ❑Yes 0"No On Old King's Highway: ❑Yes al< Basement Type: 56ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) o1Z3 Basement Unfinished Area (sq.ft) 3�q Number of Baths: Full: existing Z new i Half: existing new Number of Bedrooms: 'S existingQ new Total Room Count (not including baths): existing (—new 7_ First Floor Room Count Heat Type and Fuel: I/Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes l/No Fireplaces: Existing \ New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C�\(Ac 1c� �� Telephone Number _ G)Cx Zci�Z Address ,OAA9 6I LA) License # C�A�3ZS 4 CLA Ax Home Improvement Contractor# kTS 1.1L\"8_ \ Email DRAMUAMR201 i2AACAs_\ .1 T Worker's Compensation #(�,�,Cx-3-Xk�o n.z Q-vi ALL CONSTRUCTION DEBRI ESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Sr Q; S &7 i FOR OFFICIAL USE ONLY ,APPLICATION # DATE ISSUED MAP/ PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION —2®' Fie FRAME Cn e. a�IISi-_ INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT _ ASSOCIATION PLAN NO. r - 27m Comwomveaitit of-Musadrusedts. Deparkrtest cr,f 1ud=rid Acdde,-ds 09we gfhrPeW;ga&i= 600 WasIdzWaa b�hr t Boston,AA 02111 iwvm ma-mgo ldia Wnr mrs' Coffipensafitm Insm-ance Af Rdavit Buildeis(CantractursMecbacians/Plm:Lhers App$can#Infmrmaf an PleasePrintE�e�r V Name ESSIQ)J hi_C Address: H Wou =!QMs—mac. Cifyl at�l igQMG3 Plhont;,.• SCE —11-1 7CIN Z Are ypu an emplayer?Checkthe appropriateb= ' L pd I am a la with ❑I am a general con�cr anc1I TY Qf Pam]ect(required): Ales o ee frill andfor art-ime * Rageluredthe sub-contmd m 6. ❑ 2.❑lam a sole prupzietoff orpartner listed onthe attached sheet. 7. Leo deag slip and have no employees These$0b' ftado=ha7a $.,❑Demolition. worldng forme in any capacity. employees andhave wodmrs- 9. ❑Building addition [NO TUP&M S' comp.ii annice comp.imurallml reT2ired] 5. ❑ We are a cotporatian and its 10❑Eleodcal repairs,or at3ditians 3.❑ I am a bomemm:ex doing all work officers have exercised(heir 1L❑Plumbingrepaim m additie5as. myself of otr per M-GL , [No regnired i r-11552,§1( dwe have no L❑Roafregairs employees.[No worms' 13_❑Other conrp.insezrance required] •Anygpp dMtCh2CUh0:ff1 a]saffio thesectioaheIow do �e¢u�a�s�'c�pens�aupaTstyi�r�'no¢L tSameaaraers who sab®dtthisdffidavi:i gthv_pRmdaingRHWaal=A&mbimo-umderontict,.zamstsnbmitanemsfdavd sacTi TCaonad. ffixt dea thi box mast stfarhed=2ddifimal sheet shoe ngthenmneof the sob-cansclassa3.d stdewheibec atnatfase eaikiEsha-e eap!'ayees.Ifthesnhtantncfn sh=ce eiplayEs,they mnstpm d&thw warkea'�mmp.polky numbem I am art employw Scat is pr4n dui;markets'compertsdioa irtsrtrance for my*anWgloyees Hdow is Stepoff6y=d job site Fttformadom Itts, ecompanyName: 1�rA`?'Z�7 l)3. ►�Q�1.���CT�S Policy 44'or self-ins-EC-4(aSC-QTa 4"K B(YZA 7-0-a- VI 5TRaEibnDafe: CN-A -pC-, - Job siteadtS 1. ���►t\ Sd2S.A� \,Q�.V�- eifylstp: "�1 Aftac:h a copy of the wort-ere c ensationpolicrdectaration page(showing the parity,number and expiration date). Fatinre to seem coverage as r>rq under Section 25A of MGL a 1572 can lead to the imposition.of criminal penalties of a fine up to$U00.0o andlar one- impfisoumelif as weg as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$251 W a dap ab " violator. Be advised that a copy'of this put.maybe fatwarded tia tlm Office of Imvesfigations ofihe DIA >tranc�cavemge ti ter I do hereby carlffj�amd�r s prtuts and pstta)hs v' pgjir y Siatf ur iTtfonna&npmi&d a bona h';hare and tarred Signature: Date- Phone ik 11 Zq�Z Orwitd use wily: Do mat write tit Sits area to be crnnpl<eted by city artanni offidn'L City or Town: Permit ;tense� Issaing A.uflOrity(circle one): L Board of Health 1 Building Departtnent 3.Cityl£own(.3erk 4.Electrical Inspector S.Phtffibmg hispecter 6.Other Conact Person: Phone#: - 6 ormation and Instrucfions GAeaal Laws dmptcx M r q=us all=9107=to PMVI&WOEIM&m=[peasaf for f E r e pkyees. Pmsaantto thisstatofc,as c,_j7Iay=is defined am'_eveaypeson.ia.flie service of another .der aay contrast ofhn, express or implied,'oral or w ftbmf An Moyer is de<fined as-an indixvid±I,parfn�.�D�aA�P�on or oihM legal e�iY,or any two or m� m a o>nt and inclndmg flie legal seprese= ves of a deceased elaploYer, of the foregoaig engaged� J �@� or ffif rmeiM or haste__of an individual,partamship,association or ofherlegal entity,�y��ploY� $oweQer tha owner of a dwellii:,g house having not more than three aparEments andwho residEs or the occupant of the- dweIIing house of anon who employs pis to do maijjf�,C^„efraC on or repair work on such dwelling house aPp therein shallnotbmause of sash employmeutbe denedto be an=3PIU f or on the grounds or buIdmg MM cduaptn r 152.§25C(6)also sues that revery state or local Hcendngagency shall Withhold IhD i=ance or renewal of a Iiceo se or permit to op crate a basnaes.s or to contract btuld oV in the co onvvealih for any applicantwho has notpradneed acceptable evidence of compliance with the�arance.covexage regniired_" Additionally.M(H-r�tvr 152,§25g7)sfafrss-Neither the _ nor nay ofifs poIifical subchvisions shall enter into any coafrad for the pace ofpnblio vmk untrl a coeptable eyi&um of coraPliancewith the msoz '. req===f s of this dUpt M have been p=M t I to the c nfra�.aaf o�Iy.7 A-PPIicants ' Please fiIJ ovt the worms'compensalion affidavit corapletP L by g fhe boxes that apply to your dfnatiou and,if necessary,supply sat 'r(s)names), addres's(es)and PhMe"'ber(s)along wrththorr certEcate(s)off than the insui�ce. Limit Liability Companies(LLC)or Li U3i e LiabilityPa-tw h s(1 LP)vn-dLno e�ployces members or pm tam are not rimed to cauy wurke&co3Pensafron insurance If an LLC or LLP does have employees,apolicy isregahed. Be advisedth�atthis affidaykmaybe sohmitti d to the Depa-finent of Ind The affidavi da-Vi l A=cle�for conIS oration of insurance coverage. Also lie sure to sign and date ae affidavit t should bez� e th immd to e city or town that the application for the:permit or Iicense is being r ,not the D�pariment of kdrr ctr-ia1.A_c;dd=ts- SbouIdyou havo any questions reg>aTmg the IEW or ifyou are requn-ed to obtain a wozic=' compensation policy,please call the Departure ±at fiie numbez Hsind below: Self-insured companies should ester their s elf-insurance license number on flie line. City or Town Officials Please be sane that thb affidavit is c;ompleZe and printed Iegiibly. The Department has provided a space at fhc bottom ofthr,affidavit for youin fM out iathe event the Office ofTmves-d93fi=has to coibaYonregM7dm9 ti`e applicant. Pleas a be sure to fill in the:Pm�>i'/liceuse nu nber which will be used as a ref=nice nzubcr. In addition,an appU•camt that mast submit multiple,pennifllic=se applrcalions in any given yea,need•only submit°Ile affidavk indiraiing cati eat p olicv inforznatian(jf necessary)and under`lob .4 chase tie applicant Should wrh$"aII locations is (dY O1 town).-A copy of the-affidavitihathas beea offidaIIY stamped or mmimd bythe city or to maybe provided to,ihe ' applicant as proof that a valid affidavit is on file for futzzre permits or licenses Anew affidavit must be filled oth earl year.V7 =o a home owner or citizen is obt iin g a license or permit not rrlat in any business or c°mmercial v a dug license or permit fn bum leaves e#c.)said person is NOT req�ed to complete this affidavit The Office of Invesliga ions would like to thank you in advance for your coupmation and should Yon have any gm ems' Please do noth d atn to give us a call. The Depart =rt's address,telephone and fax rmmbes: -Th.e Conm=vealtlE Of I u Degaztmmt cif AoDidenta 6DO-Wadfiatm Street R YIA Oil 11 Ta 4 61�-M-49W cmt4.06car1477- MAT3.AM Fax#617`27 7M Kevised424-07 p Wma I AWC Guide to Wood Construction in Sigh Wind Areas:110 inph Wind Zone Massachusetts Checklist for Compliance(780 CAIIR 5301.2.1.1)1 Q Check 1.1 SCOPE Compliance WindSpeed(3-sec.gust)................................................................. ................................. ...........110 mph WindExposure Category.................................................................. .............................................................B 1..2..APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch .. .......................................................................(Fig 2) ........................................ 512:12 MeanRoof Height ..............................................................(Fig 2).............................................. _ft 5 33' BuildingWidth,W...............................................................(Fig 3)................................................ —ft 5 80, BuildingLength,L ................................:.............................(Fig 3). ......................................1...... —ft 5 80' Building Aspect Ratio(LNV) ...............................................(Fig 4). ............................................. 5 3:1 Nominal Height of Tallest Opening (Fig 4).............................. 1.3 FRAMING CONNECTIONS General compliance with framing connections..............:.....(Table 2)................................:............................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION'.3 5/8°Anchor Bolts imbedded or 5/8°Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing—general................................. ........(Table 4)............................................... in. Bolt Spacing from endfjoint of plate ............................(Fig 5)..................................... in.5 6°—12° Bolt Embedment—concrete........................................(Fig 5)................................................. in.z 7° Bolt Embedment—masonry.........................................(Fig 5)............................................ in.>:15° PlateWasher...............................................................(Fig 5). .............................................z 3°x 3°x'/.° 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55).................................... Maximum Floor Opening Dimension....................................(Fig 6)........:......................................... ft s 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7)....................................................—ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)..................................................... ft 5 d Floor Bracing at Endwalls...................................................(Fig 9)...................................................... ......... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55).................................... Floor Sheathing Thickness ................................................(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fastening..................................................(Table 2)...—d nails at in edge/_in field 4.1 .WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5). ....................... _ft s 10, Non-Loadbearing walls.................. ............ .................(Fig 10 and Table 5)......................... ft 5 20' . Wall Stud Spacing (Fig 10 and Table 5 in.5 24°o.c. Wall Story Offsets ........................................................(Figs 7&8) .................... ft 5 d 4.2 .EXTERIOR WALLS' Wood Studs Loadbearing walls.........................................................(Table 5). ............................2x -_ft_in. Non-Loadbearing walls.................................. . ...........(Table 5).............................2x ft in. Gable End Wall Bracing' — — Full Height Endwall Studs............................................(Fig 10). ................................................................. WSP Attic Floor Length ..............................................(Fig 11)........................................... ft ZW/3 Gypsum Ceiling Length(f WSP not used)..................(Fig 11)............................................_ft z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11).............................. ............ or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ........................................................(Fig 13 and Table 6)......................... Splice Connection(no.of 16d common nails).....:.......(fable 6).......................................................... AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance (780 cNm 5301.2.1.1)` Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Tables 7).................................................... Non-Loadbearing Wall Connections Lateral(no. of 16d common nails)...............................(Table 8)........................................................ , Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(fable 9).................................._ft_in.s 11 SillPlate Spans ........................................................(Table 9).................................._ft_in.s 11' Full Height Studs (no.of studs)...................................(Table 9)........................................................ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans............................................................(Table 9)............................... _ft_in.512' Sill Plate Spans...........................................................(Table 9).................................._ft_in.s 12" FullHeight Studs(no.of studs)....................................(fable 9)........................................................ Exterior Wall Sheathing to Resist.Uplift and Shear Simultaneously, Minimum Building Dimension,W Nominal Height of Tallest Opening2 ..............................................................................._s 6'8' SheathingType.............................................(note 4).................................................... Edge Nail Spacing........................................(Table 10 or note 4 if less) .................... in. FieldNail Spacing.........................................(Table 10)................................................. in. Shear Connection(no.of 16d common nails)(Table 10)...................................................... _ Percent Full-Height Sheathing.......................(Table 10)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest OpeningZ . ........ ........................................................ _s 6'8° SheathingType.............................................(note 4).................................................... Edge Nail Spacing. ........................................(Table 11 or note 4 if less) .................... in. FieldNail Spacing ........................................(Table 11). ............................................. in. Shear Connection(no.of 16d common nails)(Table 11). .................................................... _ Percent Full-Height Sheathing.......................(Table 11)....................................................._% 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?............................................................................................................................. 5.1 ROOFS Roof framing member spans checked?.......................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............._ft s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).......................................:....U= plf Lateral.............................................(Table 12).............................................L= pif Shear..............................................(fable 12)..............................................S= plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker.........................................(Figure 20).............._ft s smaller of 2'or v2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14). ...... ...............................U= lb. Lateral(no.of 16d common nails)...(Table 14).......................................L= lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59) ........ . Roof Sheathing Thickness........................................... ............................................ _in.a 7/1W WSP Roof Sheathing Fastening...........................................(Table 2)..........................................I.........I...... _ Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11, 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in Sigh WindArea.0. 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)t r 4 a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment '-VA4M THIS EDGE REM ON RIAMM EME Sd NAU _.. AT6b 11 11 • 11 ii 11 1 11 1 91 11 ' I it 11 1 II If 11 11 1 • 11 11 11 1 11 11 I � • 1 It 1 i 11 11 N 1 11 11 G M 1/,F 1 . 11 F li I L 1 11 0 Z a 11 o it ii � 1 .' u II W t Z 11 1 I po 1 n- V Y ttt 1 P-31 1 II 1 - •-h.� I1/- 1 t 1. r DdUR E EDGE ------ ' MARSPACW4 t PANEt _ vy See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment i AWC Guide to Wood Construction in Sigh end Areas:110 mph end Zone Massachusetts Checklist for Compliance(7sa Cmx 5301.2.1.1)` t, FRAMING MEMBERS !'I If f i iY _ I I STAGGERED 3'MNI MAIL PATTERN PANEL PANEL EDGE DOUBLE MAIL EDGE SPAMG DML Detail Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance (7so Cmx 5301.2.1.1)1 FAQ ': WFCM Checklist Question: I understand if a new home is built in a town in a 110 mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM1oo mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this "modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips installed in the ceiling abutting the gable wall then 2 x 4s installed on top of the ceiling joists are not required. There are other changes as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has. been used in North Carolina over the past io to 15 years which has performed well in severe hurricane weather in that state. *Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. r Town of Barnstable Building Department Services Brian Florence,CBO 1 Building Commissioner aw�srr►ru. 200 Main Street, Hyannis,MA 02601 www.town.barustable.ma.us 163 Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": mane 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:\WPFIi.ES\FORMS\building permit forms\EXPRESS.doc 08/16/17 Town of Barnstable Building Department Services ` ` Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 i 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 I, E9b.0 Q-0 ����-�-H� ,as Owner of the subject property hereby auth rize`CQ to act on my behA 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 ' talled and all final inspections are performed and accepted. Signature of Owner S' tore of Applicant ��cz 12or�� �l ��►� I�I1 —'���Y Print Name Print Name 11 Z � F Z Date Q:FORM&OWNERPERMISSIONPOOLS Rev:OW160 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrgj t t�ri fSO rvisor CS-093325 lExpires: 08/06/2019 n � MICHAEL B BAKER 4 MOON COMPASS LANE,c SANDWICH MA,02563 r-: VAT"' Commissioner ; Office o Consumer Affairs nd Busine_ ss Regulationr ° 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement, Contractor Registration w t� r7 , Registration: 184481 TRADEMARK PROFESSIONAL /T Type: Supplement Card MICHAEL BAKE S LL,C -- 1 Expiration: 1/21/2018 R 4 MOON COMPASS LN. 'SANDWICH, -- MA 02563 ~` w SCA 1 0 20M-05/11 _ 55 Update Address and return card.Mark reason for change. e er� Address 0 Renewal 1-1 Employment Lost Card a"iuirviunen _ �\Office of Consumer Affairs&Business Regulation A r = F--'OME IMPROVEMENT CONTRACTOR License or registration valid for individual use only Registration; 184481.. before the expiration date. If found return to: Office of Consumer Affairs and Bus' Ex 1raUon Type' mess Regulation p 1/21/2018> l0 Park Plaza-Suite 5170 Supplement Card TRADEMARK PROFESSIONALS LLC Boston,MA 02116 MICHAEL BAKER iY 4 MOON COMPASS LN:;- ;- SANDWICH,MA 02563 g �{J C S-------- Undersecretary Not valid without signature - 1ry t. • Town of Barnstable Regulatory Services Richard V.Scali,Interim Director ' A Building Division R EGMC.I-� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# �'� FEE: $ � SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less _< 34� W Z�P�F�2 OK( K rv► 2 Q/J Location of shed(address) Village o C ,�? Property owner's name Telephone number = rn 12-, �ti zl 0 6Z 0 zo Size of Shed Map/Parcel /z/Z /y Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 V NATC 'UoI A: Ll . . .......IT ki co 4 .9 M; AL NA • 0 ro, L. e- ... ....... ti .-A ................... MR -9 DR EN IN R .SURVEMOR i�By �•`"" TOWN OF BARNSTABLB `�� •. Permit No. Building Inspector 7A11]7►n, : Cash ,639. �GYAY•� OCCUPANCY PERMIT Bond Issued to Acids es Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19......._... ......................................................................................................... Building Inspector FROM TOWN OF BARNSTABLE . Francis Lahteine BUILDING DEPARTMENT «�..�.. STREET HYANNIS, MA 02WI a•»¢stro�'••w os e»+s•q oraF��T^6A•i.i+..rllaw+•!`er-7l iG yr . Phone: 776-1120 SUBJECT: FOLD HERE ° DATE May 30, 1984 �«..,�. �e..a**YsSA'GE Work has been oatleted under,Building Permit t25027 (Stephen Pickul) '�^,art,, release ip ��Q� y s� Pwfs- tiA f '1Y 7eMwC♦R' �9 4 •t-� w At ♦rain ay• Please release ± r►r tx«Hy.' r+.�+*x wT«ti W+Y �•7!3 YNa r SIG E• IF _ DATE REPLY N87-RMI - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY ' PRINTED IN U.S.A. a SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessor's map and lot number ...[ ..........G!.!?� ...U... .. ...17• f r -� �' 3 - is %-- • ::.o�% �.�� _� ��- �3• THE t��♦• Sewage Permit number ..................................................s...... � J.0 Z BABMASIL E, i Housenumber ............. ............. ........................ ................... qpO rb 9. �OypY a` TOWN OF BARNSTABLE BUILDINS----INSPECTOR APPLICATION FOR PERMIT TO 2.J 1 „T J TYPE OF CONSTRUCTION ......�(./c?<?G.`✓.,. ...... .u.:�................... ...... ............................... 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to thee following information: Location �G� `� .... / .`.5 �..� ... '. . ..........I,.,It!` 11, l r ' J(�t ,`,�a!:� ........!....!..................... y s ProposedUse .............................................................................................................................................................................. ZoningDistrict ..........�......................... .....�.............................Fire District ........................................................../../�� Name of Owner >:..... .... ........ .11..........�..4.... . ................� i. Vl t^'�.......C... ............. lt!'1� Address .....� -Name of Builder ........... `` .Address /�� � f r . Name of Architect ......... Address n i., ............... .(.... ....................................... _, .........................................j/G.!.......... Number of Rooms ... .C......1`............................................Foundation .. .:..........:.;................!................:....................... ExieriorI��.r.� .�".!. ./lJr kl%1! �.�fr?.Roofing .... n_j{�i�..........:.......... Floors ............. .:. .tt' n�-! .............................................Interior ...5ti"4".... Heating .^ c . ..... ...........................................Plumbing .....�\ ...1�......... .......................... ' 1 Fireplofce'"............ ....................................................................Approximate Cost ....?..`- :. ( [.,.. ... ...........-..........:.... ..,. . Definitive Plan Approved by Planning Board -----------_------_-----------19_______ . Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �eln) I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS Y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �'�.. �. ................0:....................... Construction Supervisor's License ...1.,�.......... PICKUL, STEPHE A=62-20 25027 1�2- Story No ................. Permit for .................................... Single Family Dwelling ................................................. Location ..Lot....34, 345...W.h.is.t.l.e.be.r.ry', Dr. Marstons Mills .........................0..................................................... Owner ..."Stephen...P.....i c.k u 1.......................... .. ....... Type of Construction ........Frame.................................. ................................................................................ Plot ............................ Lot ................................ Permit Granted .....MaY .2.,,....................1,9 83 ... .. . Date of Inspection ....................................19 Date Completed ....................n............... �34 � ls, map and lot number ... . .a,o ......... eo, -V ., aA, CC STALLED I p/apyy Sewage Permit number .........................................:.......:...... t 3)I �� 96 .. ICE WIT House number ............ .. ..... ..................................... ONM , ; PAD 4 r" TOWN IRE w x � TOWN OF, ,ZARN,STABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 15 .rJ..:�'.,.,1.. �....R..��.. ?.1�� ......j/. .... TYPE OF CONSTRUCTION ......�(,%rJ. .. ............. :: ...................... . ...........19........ . a }TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the foligwing information: �^ Location .y `J. ..!�`�'�tiS .Q.... 11 1!'. .�.�1`�..r.. .1..:..! .lr bn cS d �.�._5.............. • ProposedUse ..................................................................................................... ............... .....:.. r Zoning District ... 4... Fire District ...........���....a ..... !.-5................ ..........n 00 Name of Owner '. 1_RC. ............. ddress �"/L�iuCu �. f• i Name of Builder .......... 4. �.....7.. dress ................................. . —_— Name of Architect ............ �_............ .......... . ..Address ......................................... G. ll..✓..?.1 ............... Number of Rooms ............................................Foundation .. fI Exterior CJ115k .. .�` ./Gr.SI. .�'YJ...`. .Roofing .... .. i ....C'.�..................�....... . �,.� .................... Floors ............. `'�. .. .. ... ...............................................Interior ... -� .�1. .................................. �/, V Pleating ...0.,�X,'�t�....................................................Plumbing ' �1✓C� (' ��-�' ... 4. J .. ......................... 137�s.� Fireplace ............. ....................................................................Approximate Cost ...�... .....lC/..1/.. .�..... .......... .... ..,. . Definitive Plan Approved by Planning. Board -------------------_.----------19_______ . Area ... ... ....... .........,.a� Gt Diagram of Lot and Building with Dimensions Fee �.. / SUBJECT TO APPROVAL OF BOARD OF HEALTH --ZaA)10 ! �- L `1 'Y q 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. NameJ., 0........................ Construction Supervisor's License ..J. .. ....... PICKUL, STEPHEN 25027.. Permit for ............. ............... -,Single ...................................... $inqle Familv Dwellincr Location 3A/...345...W.hi.stl.ebe.r.ry Drive Marstons Mills ............................................................................... Stephen Owner ... .......................................... Type of Construction ...:FrPA(A.......................... ................................................................................ Plot" ............................ Lot ................................ Permit Granted .......May........2..,..................1.9 83 Date of Inspection. . ...............................19 Date Completed ..........1 .19 4V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis J� Project Street Address Vf 1I _ZM - e�L. v'e1- Village /-s�� Owner hLy/IY it ar) Address rAf, Telephone 1�, ,'`��' �� 5 Permit Request �VCa*r,,Q !h to A t P a PFiC how "'A 12 ®iiZ Square feet: 1 st floor: existing proposed 2nd floor:-existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z 1-J (Z Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# -:nits) ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:,❑1' ❑ No Basement Type: -Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sod Q Number of Baths: Full: existing new Half: existing new 59 Number of Bedrooms: existing —new Total Room Count (not including bathe): existing new First Floor RoomlCount Heat Type and Fuel: DGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes [VNo If yes, site plan review # Cu nnrrent Use 4;Idcnce— Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Ira yc,n BN Telephone Number 5-or Address c).-- W,a e- License # T4-3578 y s1wofe4, IkA 01,117 Home Improvement Contractor# 1-1 0 0.17,7� Worker's Compensation # Wr,? '-31 S` s 62$57-D zJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 5h ownv r -Ovy' Aw Al,gM N' New &J tort SIGNATURE DATE f /3 / is FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. .,ADDRESS VILLAGE OWNER DATE OF INSPECTION: ...4FOUNDATION . z FRAME INSULATION } FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING +' DATE CLOSED OUT ASSOCIATION PLAN NO; J.*is. The Commonwealth of Massachusetts ��:�:��'.=,�s��1�;t!;i�'�"_•� Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individttal): Rebello Construction Inc. Address:24 Janes Birch Lane City/State/Zip:Swansea, MA 02777 Phone#:508-328-4723 Are you an employer?Check the appropriate box: Type of project(required): 1.Z I am a employer with 5 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). , 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8• ❑Demolition working for me in any capacity. employees and have workers' comp.insurance.t 9• El Building addition [No workers'comp.insurance P• required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs,or additions 3. officers have exercised their I am a homeowner doing all work 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.[D Otherweatherization-Residd comp.insurance required.] *Any applicant that checks box 41 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, tContractors 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,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:Main Street America Assurance Company Policy#or Self-ins.Lie.#:MPT4696E Expiration Date:5/2/13 Job Site Address: SAS \ City/State/Zip: ..l V7�S Attach a copy of the workers'compensation policy de ation page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A o£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 tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under ke gains and enaltles oUf:Lu2 that the Information provided above is true and correct. Signature: — - D to Phone#:508-328-4723 Official use only. Do not ivrite in flits area,to be completed by city or town official. City or Town: Permit/Licerise# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:MA ,ac-oRv° CERTIFICATE OF LIABILITY INSURANCE DATE(MIYY,fY) `-� 10119Dl12 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER 608-676.0308 C NTA T Partners Ins.Mizher Division NAME: Maria Arruda 560 Wilbur Ave. 608.676-3006 PHONE Q.No.rxtl:608-491-3176 n/cNe:508-491-3108 Swansea,MA 02777 AOD IE s:marruda g p @partnersins r Ilc.com PROD c .REBEL-2 INSURERS AFFORDING COVERAGE NAIC INSURED Rebello Construction Inc. INSURERA:Safety Insurance Co. 33618 Carl J.Rebello INSURER B:Liberty Mutual Ins.Co. 24 James Birth Lane Swansea,MA 02777 INSURER C:NGM Insurance company 14788 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �71y TYPE OF INSURANCE POUCY NUMBER BR POLICY MMIDD E P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C COMMERCIAL GENERAL LIABILITY MPT469SE 05102/12 05/02/13 PREMISES(Ea occurrence) $ 600,000 CLAJMS-MADE X❑OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 POLICY PRO- �CTRO LOC $ AUTOMOBILE LIABILITY (COMBBIINEa dEDI,SINGLE LIMIT S 1,000,000 Ili A ANY AUTO 6206368 05126112 05126/13 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULEDALrros PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNEDAUTOS $ $ X UMBRELLA LIAB X OCCUR EACHOCCURRENCE $ 1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,00 C CUT4696E 06/18/12 06/02113 XdDEDUCTIBLE $ RETENTION $ 10000 S WORKERS COMPENSATION 111'C STATU• AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNERlEXECIJTIVEY/N C2-31S-362857-021 07/27/12 07/27113 E,L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,00 under 0 SCRIPTIO OF OPERATIONS below/ I E.L.DISEASE-POLICY LIMIT I S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD tet,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSUREDS RECORDS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2009 ACORD CORPORATION. All rights reserved, ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD : Ma tachusett%-•.b0Uartrn'`t•of'Nblic Safety'• ?: Board Of Building Regu at#ons an4 Standards:.j Consituctiori-Sdpervisor License . 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O 0 oW I -r- 0 6 F A�EE l 15, AP,- Ste, � fio�l T ��iJ sP.gr� G.c•� DE�s�-tIL �E�IEL�ovDAAF�..1T �+ 1 CERTIFIED PLOT PLAN /ill A A4 L-5 1� IN SCALE: �''= y� ' DATE, LDREDGE OF ENGINEERI� 0-ON GI.IENT ���,L_ ���y�hb,,s• �. I CERTIFY THAT THE EOIgTERED REGISTEREDa° 0 SHOWN ON THIS PLAN IS LOCATED CIVIL LAND JOS No., . ,� y ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR4 DR,SY$•, A �o CONFORMS TO THE ZONING LAWS �a�" o, e. OF 8ARNSTA E 3S. �' 712 M A 1 N '3.T R E ET CH.9Y4 .,.,-�-•-- �� Rv�y�;' 1SV MASS, BHEET.,%„,OF'' ;t�• . . , DATE R_�'0. LAND SURVEYOR y( Robillard Residence 345 Whistleberry Drive TradeMark Professionals Marstons Mills Michael baker 4 Moon Compass Lane Sandwich, MA 02563 { Waste Pipe to Septic 508-717-2982 2040DH 2040DH 5068 2040DH 2040DH I ACE i WH co co N BATH 10'-5" x 7'-11" FAMILY Go r N ( - - 8481 - - 22'-4" x 12'-9" 2668 35'-6 1 I4" N ":41//2668 5068 STORAGE N 13'-8" x 22'-9" CE Chimney � a 3'-5 3/4" 2668 1 i � 2 OFFICE CIIE 12'-7" x 11'-9" UP CE 22'-6" Q IF 2x4 wall system w/ PT plates R-21 fiberglass wall insulation w/ vapor barri( 1/2" drywall on walls & ceiling r. Robillard Residence 345 Whistleberry Drive TradeMark Professionals Marstons Mills Michael baker 4 Moon Compass Lane Sandwich, MA 02563 r 508-717-2982 I 204ODH 2O4ODH 5068 a WH r-uP