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HomeMy WebLinkAbout0155 WOODSIDE ROAD .� _�_ l _ ,,.. (` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `a Parcel Z Application # C�d 76 S® Health Division' Date Issued ZZ t S Conservation Division Application Fee L� Planning Dept. Permit Fee L�� Date Definitive. Plan Approved by Planning Board , Historic - OKH _ Preservation / Hyannis jee, ect Street Addressge �i4it.���u4Addrressn er �1��4/ ii ✓� /,�5 Go'6�q� 2 ' ✓phonemit Request ll'/./i/t! r2e L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ��n�'7 ��� Construction Type A-144ri'vk-li Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:.❑Yes-4❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑'e�Cisting O new Y ze_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' 6.3TI u — Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# d ? a Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A/ ;2Vlir/ A*171Aw Telephone Number ddress ��� �a�f�� License # Home Improvement Contractor# mail 21f «tit Worker's Compensation # A L CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S ATURE /I--" DATE FOR OFFICIAL USEa'ONLY APPLICATION# . DATE ISSUED MAP/PARCEL NO. r ADDRESS ` VILLAGE �* OWNER a t DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL >; PLUMBING: ROUGH FINAL �✓ GAS: ROUGH FINAL a V � FINAL BUILDINGit� 4 DATE CLOSED OUT ASSOCIATION'PLAN NO. . Ile Couiuiarrivealth e�,f Massrrc�rusetts ��r�trrretit a,f�rr�ustizal�ccideFrtr a,f'rMlestigations r 600 Washington Street :._: . Boston,41A 02M t�.'rvit-mass govfdia TaFI�e anzpensaHan Insurance Affidavit:B�de� Mebr Cuntradursc cians(P�hers fi a=ation Please Paint fell I! INs�E=SS�r3I1iL�dn/)nr�met7nalfsg o2 PCC hcnt S�. Are you an employer?Checkthe appropriate box: ' Type of project(required_ I.❑ I am a employer uritls 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time)-* have hired the sub-ccmiractors Z.❑ I•am a sole proprietor orpart ar- listed On:the attached sheet. 7. ❑Remodeling These sub-cendractors have shFp and haze no employees. 8_.Q Devnolition woding- for rue is any capacity. employees andhace wodcere INo tvarkers' comp.insurance comp_in¢nrauml 9. ❑Building addition eqaked-1 5. ❑ we are a corporation and its 1 ❑Electoral repairs or additions 3. lama bomeovuner doing aft work offerers have,exercised their 11-❑Plumbingrepai s or additions myself[No woikers•czmF- 17 l of exempfion per M-GL 117 ❑Roofrepairs in once required]1 c.152,§1(4k and we have no employees.[No workers' 13_❑other comp_mmrance required_] 'Any apprEcsat,that cbecksboxrl upoHeyinfan on_ #Sa�eaa�aeis who snb�t this ai�datdi imc5tating t3wy ase thing s1E�ca¢3t aad tnea hiie outside coatacmrs amst submit a near affidast➢"ate each ICaat<sctaaffist cher3ctliis bami mast aiterhe3=addiliaosl sheet shoceing tbe'asme of(be sub-can=;uomand stare whetheir or not these eatidesbay emp3vyRa:;.Ifthesnb-cast nctomhive employees,they=nTpmtiide.&dr ncorkm'comp.paliy at®be- I am an $e£oov is ether poll ry and job aitr irz,jormaliom Insurance Company Name: 'Policy 4 or Self-ins.Lic_k FspirationDate: Job Site Address: CitylStatdZip: Attach a copy of the workers'cosapensation policy-dedarafzion page(showing the policy number and erpiraiion Jate). Failure to secure coverage as required.under Section 25A of MGL r-157 can lead to the imposition of ctimival penalties of a fine up to$1,500:00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a.fine of up to M-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of IavesErpations of the DIA for insurance coverage verification_ Lda rereby carhfy rimW ttrepaurs and perratties afg ' thatdre irzfor mafiau prm fed abotg is/bus nerd correct e_ Date_ one 007mat use ova£}'. Do nat iviite in thb area,to be rainpleteJ by city artown o,ffrciet City or Towzu Perud&Ucense## "Issuing Anffiorhy(CcIe one): L Board of$•ealth -.RuMing Department 3.CitylTown Clerk 4.E1ectdcal Inspector S.Phrmbing Fnsgector 6.Other Contact Person: Phone#: ' Information and Instructions Massaclmseifs Ge-eral Laws ffiapt=152 rejmrm all employ=t3 provide workers'compensation far their=Play=. p=M,m3t-tD this ,an=Tkyee is defined as.¢,every person in fae service of another under any contract ofhire, express or Mxplied,oral or wr�em An_eznp&yEr is defined as"an mdavidaA pxctac ah�,asso�4.on,corporation or other legal entity,or any two or mare of the foregoing engaged is aJoiat mferprise,.and inclndmg the legal Fepn esenfa&es of a deceased employer,or the receiver or t ustee of an individual,per,association or other Iegal entity,employing employees_ However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of tjae - dwelling house of another who employs pexsous to do mahtmmce,constraction or repair Work on such dwelling house or oa the grounds or building app thf--Mt:)shall not becanse of such employment be deemed to be an employ n" MGL chapter 152;§25C(6)also states tiaat"everystalm or local Keens$ g agency shall wffihh.old$ire issuance ar renewal of a Ticease or permit to operate a business or to construct biding-in the commonwealth for any applicant who has not produced acceptable evidence of r-6' Tianmwith th-e incvrance-coveragereguired_" 4 AddiiionaIIy,MGL chapter 152,§25C()sfafrs"Neither the commonwr-alihnor wry ofiispoIitical subdivisions shall enter m.io any contract fortheperformance ofpublio woricuatil acceptable evidence of compliance with the ins*T ^ce. regvlLe .=ts of this chaptcr have been presented to the contracting .aufhoaty " ' AgpIican-Ca ' Please fa-II out the workers'compensation affidavit completely,by checl®g$e boxes!hat apply to your situation and,if necessary,supply mA-contractor(s)name(s), addresses)andphonenumber(s) alongwiththeircertificat*),of ' finis=„ez. Li ca t LiabMty Companies(LLC)or Limited Liabi y�Parineasbips(LLp)with employees other than the members or partners,are not requmrcd to carry workers' compensation insurance. If an LLC or LLP does have Io ees a olic is,�,�,,,,�,7 Be advised that this aftida-fit submit to the DeParfinent of Indnslrisl 5 YP Y ""1`y"""' ; Accidents for confirmation of finM=ce coverage. Also he sure to sig�x and date the of davit The affidavit should a, be-rutnmed to!he city or town that the application for the permit or license is being requested,not the Department of � „ a Aeoideofs_ Should you have any questions rega-dmg the Jaw or if you ate required to obtain a workers' compensation policy,please call the Department at the number listed beIow. self-insured companies should enter their self-hjgn=ce license number on the appropriate line. City or Town Of Please be sore that the affidavit is camplete and prmfedlegibly. The Departmeothas provided a space at tine bottom of the affidavit for you to fill ouf in.the event the Office of Investigations has to cont'ar-t you regarding the aPplicant Please be sure to fill in the pennit/licemse number which wdl be used as a reference number. In addition,an applicant: that must submit multrple p e=Wlicense applications is any given year,need only submit one affidavit indicating current PO inifb=nation(if necessary)and under`Job site Ad-ress"the applicant should v rite"aH locaticns is (city or town)-"A copy of the-affidavit that has b=n officially stamped or marked by tht city or town may be,provided to the applicant as prooftbat a valid affidavit is on file for fufmu'pennits or licenses'A new affidavit must be filled out each year.Where a home ain owner or citizen is obting a license or permit not vela�d to any business commercial vesii�. (i e_ a dog license or peunit to bum Ieaves etc.)said person is NOT regained to complete tins of d avat The Office of Tnvesfigafions would lBce to tick yoit in advance for your cooperation and should you have any questions, please do not heshatr to give us a call The Dep�rimeufs ad&ms,telephone and fax number- The C0MMGnW attic of Massachn&t:b Department cf 1udustcial ADDdenta (ice of jntveSfrg-atio= yQ' Rosto-r=MA 02111 TeL 617-' 4 cmt 4-06 W 14P7 IAA-SSAFR Fax 9 617 727 7M . xevised4-24-07 Town of Barnstable Air- Regulatory Services r � Richard V.Sc 4 Director Building Division Tom Perry,Building Commissioner MAM `a$ 200 Main Street; Hyannis,MA 02601 www1own.barasfable.—us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICM245E E EMMON Plmse Print J t ocATrolz 5 �UGc�llic.(� / 4;t H✓1'1�7k number st=d vinagc of�owl� /� .ahov ?4 �i.E�yo r �U� 'yam- iG„? I ' 4C-33 41a7 namc bomc phonc# worlc phouc# CURRENT MAnJNG ADDRESS: />> !os t cl y'f r7V GJ_2Ai. cityhovm rip cods 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_ DEFII•IMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which these 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 yerfotmed under the buiding permit (Section 109.1.1) The mrdersigned`.`homeowner"asses responsibility for compliance with the State Budding Code and other applicable codes, bylaws,roles and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection p cedures and re is and that he/she wiIl comply with said procedures and requirements. ZIA ignahsc ofHomcowncr Approval ofBuBdingOfficial Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State BmIding Code Section 127.0 Con_slructioa Control- HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall he exempt from the provisions of this section(Section 109-11=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_M 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 responsibSities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for nse in your community. Q:IwPFn.EMRIeM, i crmgparmitfoslERPRESS.doc Revised 061313 i BIKE Tgy Town of Barnstable a� Regulatory Services t Richard V.Sc4 Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town-b arnstable.ma.us Office: 508-862-4038 Fax: 508-790=6230 Property Owner Must ' Complete and Sign This Section 4 If Using A Builder rs v as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized bythis buildiag permit application for: (Address of Job) '"Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections.are performed and accepted. ;M' Signature of Owner Signature of Applicant Print Name Print Name Date . i Q:FORMS:O WIERPERML4SI01e0o1 S vCL out '715�1sxa P/9J-eo I" fidd&l Ij 3 � �ir�a/•�c�- ti71 , Plum � n S S U � i . oUZA � O l� X Aly 0 —�•_ 97Ob1SN'VO J /,a l7e�? �?� 6.'Al .r A-eAA1,✓� ,vi z f�$ '/ ��.r f vi.a.J /YIG�tncif�%0� �injs�../ /01 ,� .S'o Gam /ze o/f//z z/ ® 3� �Jfvlfs a�of, . 9 ce- .� /ge,� �el�;lr�,.r.0 �A��.e�.r �•c, �GiJ�.r /�e.4z � "��%s�� 1� e� C U I � 3 aA c"166 �> Ae/n0 veet AlofIve- 3) 'gad ��Pl96?- s� IJR ° l � (A)OOP N/ / AietJ 2J ��m tiL h CoXd cI�� 1Lo�i/G Ip/RC 41?— Town of Barnstable *Permit#6* � ' Expires 6 moy�s ro �ustre date Regulatory Services � Fee I��'_� BARK"LE, Richard V.Scati,Interim Director Building Division Tom Perry,CBO,Building Commissioner tG ulju� 200 Main Street,Hyannis,MA 02601 APR 14 2016 www.town.bamstable.ma us Office: 508-862-4038 . .� Fax: 508-790-6230 TOWN-O Ri" APPLICATION - RESIDENTIAL ONLY Q Not Valid without Red X-Press Imprint Map/parcel Number IQ 7 QQ I R, I,s mxC--c Property'Address 16 vVQoA S<�Wesidential Value of Work$ ./ Q, 7�3 Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address i� UT Bkjgkt Contractor's Name t lSol✓ Telephone Number Qd!-ILr-f<ft Home Improvement Contractor License#(if applicable) /7-3ZY-lr- Email: Construction Supervisor's License#(if applicable) 0 S70 7 Morkriian's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 40,008ta- IP5 . c aM BAN Workman's Comp.Policy# W diQa O Q3 o .J7 Q--3 9 41 ` Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(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 .3v (maximum.35)#of windo / #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Whei i required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must.si'gn Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. _ SIGNATURE: Q:IWPFILESWORWbuilding permit formslEXPRESS.doc Revised 061313 . 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P.V3r3ljffieq ltenewi.by 0 - New.Sa.d Bagesfs) 8ayesis) - r e r l.�a/ ,d 1/ - /.f•�tr qua+Ps+rs ptinElzaue.d�ucB�fzragrr Ytmt\�amc P�t�ce YOUL Tag BUyWSj, b1AY C-ANU -.TMS T#A-.NMaCn_0k AT-ANY TU19 FOJOR TO Ulb-,4GE&OF TIM Ted BUSDaM&tY AFr=7AS DATE OFTHI TR&ti'3AMOX SMTHB 91MACME YOI`ICS QrUANC)SE3.4TI0N JFOP.M FORAXEMANAj"IONOF1MS'WGEM — �-- j.0—— — — F }t - - — —— - -_ "-- - - -- -:- - -- -N�¢'S?ECJ1P1'CtfLUlT10N-- - --� of Transition ,-40 ou may cano rt Ca otTrmawt on YOU main cuicsi his tr3t orry without any panQlty or o�6gsttv%.ritbin I this uansacti 4%witirout,-7 Peniri b�tioN wiffain am"brffiaea days hero dw a'bora data.If you CW%04 W iifxw'bitdnass 4W&am 0-abom dam iFyDu carwW.ally► proyerry traded in.W, payments made by you wWW the 1 property traded ,,Mt pair mnts mach by you wmkr tth. Contract or Sala,Brad-awry mil°insst+anerki executed t Cdntr*A or Slito and ny ttejotiabte insbwr►pt:emmeuted by you wig be retu"wd imr w tart busfnw*p tttdowtng I 'by,you wig be re with tea business 4W blowing by the Saff*r of your aw-diation nuance,and-T l receipt b i the Sdkr of your canceft,6cn nrobw,�d any r sec irtcarrwt 049Mg out of the tranaKdon � be ia t : euYit Ribst"t arkinlf otm of the .Gtlon wi© be canceted.Iffyou cane yyoouu must"Uj*ava&MQ to tfhe Setiff �k'&If cancel� �avalabb to d►e Seder at your reside ve,,is subetta aafy as good condition as when I at;your Moe,to Ss�ai ly M good ovn&dOn as when eecelred,any pods delivered to yeu under thb Cwttr=or I mvelVedr*"y goods delivered to you under this Cwtrad or $;+1e3 or may,if you*rW co with tht k-Vucdom of I taste;or you mart%, u wrfsity oompil►�tlt tba msbur�Eioen of t3►d i�trrr-��-i rr ,- t�"fof elrr giCe85 at tti a' `-tii2tScWft `raWY1'ptWipir+:e.t a'i flee goods at the Seater expense nerd ri L If you do nwam am 206da araaable X Scdler's 16 and r+ialu tf you do nVAM the avwtst le to the Seger and tile,Seim doe;not pick throw up wttfdn W the Seller and lire$el r doos riot pick them up wittdn � t:'s of the"�of eanaeftiON you t'fiatr rerun or I tvMtty days of the epee of (yyat0.You tom'�n or s�®of the roodr-ithotit mtlp der obtigatio�r.'K you I d ace of the gaoda without W7 further obliWnio a.It you f ; ��,kr file Scads Z%Ja a4ta to the Seller,or if you asree I fu'1_bu e=the goody:avatftbIa to tite bier.or If you agre6. to return afar>loods tv W swkr'aM fait to do sus der►you I to return the goodt to dtt:'Sdkr and fail to-do so.Own you rarnain tixblo ffaorr perfoVMWce of&I obligations under the I rerrialti fiablo floor feriomume of all owptiom under the Cor�actTo cancel tWs V__cttOrt.mall ar definer;s,gted t:ontnickTo canesl this h'a�se tiara,malt or daliver a signed owd dated copy of tb'ie cancdtWOn nonce or arty other I and dated copy of tills cancefladon notice or any Other writbm notice,or send aBela�amtooRencwalbyAnderscnof 1 writttr+nogce�ors*ndacei doPMtcrat Andersenof Southern New Ensland aC 2b Albion R 4-ZBbS, I Southe►t►IVew BtSd at 26 Albion Rood, ' �kvAJ 0264S, (N,0T)LATER THAN HMpOGHT OF � I (NDCIa�tT,eILAIU THANMIDNIGHT OE lFyrf HERf aY cANcElTHiSTRANSAcnOK (14PREBY CANCELTHISTRAMSACTION_ ftr—, prim tTL true owrq-N fi4aKvc kill"Mm 0=4 1bA Cgvr Y+Rt"+ &rjw CoVr Y0bw 8ltyrr Cpiy:� : Southern New England Windows d.b.a Renewal by Andersen of SNE 2_ Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Sapenisor License: CS.095707 SRIAN D DENMSbN 7 LAMBS POND- Charlton MA 01507 Expiration Commissioner 09/DVMIG . Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration RegIed ation: 173245 Type: Supplement Card Expiration: 9/1912016 SOUTHERN NEW ENGLAND VMDO.WS LL DENNISON BRIAN 26 ALBION RD -- --- LINCOLN,RI 02865 'Update Address and return card Mark reason for Chavge- • ❑Address C Renewal 0 Ewploywem p Last Card sru,a 2Dr.4)Sn, lGa of Caoremv Attain&Basioas Resalaava Lieeuse or registration valid for individul use only before the mpintioo date.if found return to: E OdPROYEMIENT CONTRACTOR Ofoo,orComatnv l ffa6s and Bomess Regohtioa . 173245 TYPa• 10 Park Phu-Suite 5170 - Exp�tlon 91192016 Sulrpfemerd_ard Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS U:C. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN.R1 02865 Not valid without signature i The Commonwealth of Massachusetts Department of IndustrialAccidents 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/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are yowpn employer? Check the appropriate bog: Type of project(required): 1.0 I a4 a employer with 20+ 4. I am a general contractor and 1 6 New construction employees(full and/or part-time).' have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.El I am a sole proprietor orpartner- ship and have no employees These sub-contractors have g• E]Demolition workingfor me in an capacity. employees and have workers' y p n'• 4 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions ,.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12•Q Roof repairs insurance required.] t c. 152, §1(4),and we have no Window Replacement employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 91 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 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 acid job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lie.#:WC 928058352394 Expiration Date:8/21/2016 0 Job Site Address: " 16� WOOL-S d�G City/State/Zip: W • ru '`i 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 25k:6-T GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for surance coverage verification. I do hereby cerzz:: d penalties of perjury that the information provided above is true and correct Sianafore: Date: �✓ Phone#: 4012289800 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 ane): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f SOUTNEW-01 SHETTYSHT DATE(MMIDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE 8119/2015 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). CONTACT PRODUCER NAME_ Willis Certificate Center Willis of New Jersey,Inc. PHONE //877 945-7378 C.Nor(888)467-2378 AIC No EXt:1 c/o 26 Century Blvd EMAIL � cates@willis.com P.O.Box 305191 ADDRESS: Nashville,TN 37230-5191 INSURER(S AFFORDING COVERAGE HAIL INSURER A:Selective Insurance Company of Southeast 39926 9 INSURED INSURER B:OneSeacon Insurance Company 19801 Southern New England Windows LLC INSURER C:Argonaut Insurance Company D/B/A Renewal by Andersen INSURER D: 26 Albion Road i'• Lincoln,RI 02865 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRR POLICY NUMBER POLICY EFF rP 0 EXP LIMITS TYPE OF INSURANCE INS WVD 1,000,00 A X COMMERCIAL GENERAL LIABILITY TO RFNI EACH OCCURRENCE S S 2029459 0811012015 08/1012016 S 100,00 PREMISES Ea occurrence CLAIMS-MADE OCCUR 10,00 MED EXP(Any one person) $ PERSONAL'&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 3,000,000 PRO- POLICY®JECT �LOC I$ OTHER: COMBINED SINGLE LIMIT S 1,000,000 IEa accdent AUTOMOBILE LIABILITY 0811012015 0811012016 BODILY INJURY(Per person) I S A X ANY AUTO S 2029459 ALL OWNED SCHEDULED ALL INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE is NON O NED Per accident HIRED AUTOS X AUTOS OS 5 EACH OCCURRENCE b 5,000,000 X UMBRELLA LUAB X OCCUR 08110/2015 08110/2016 AGGREGATE $ 5,000,000 A -21 EXCESS LIAR CLAIMSADE S 2029459 S DEO RETENTION$ X STATUTE ER WORKERS COMPENSATION 1,000,000 AND EMPLOYER5 LIABILnY 0000068028 08121/2015 0812112016 E.L.EACH ACCIDENT S B ANY PROPRIETOR/PARTNER/EXECUTNE Y� 1,000,00 OFFICERIMEMBER EXCLUDED? N NIA EL DISEASE-EA EMPLOYEE S (Mandatory In NH) 1,000,00 11 yes,describe Lmder' EL DISEASE-POLICY LIMIT S DESCRIP'1TONOFOPERATIONSbelow 08121/2015 08121I2016 See Attached C orkers Compensation C928058352394 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached ff more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD THE DATEV THEREOF, NP�O'ICE S BEWILL CANCELLED BEFORE IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE . Evidence of Insurance O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 0cC ���,s Y • �'_ ^ ,r-. . `{.n �t.'. r '� .l .,d r L ..t -_1a.; -�- �"J "�.—Yr r.,wC J'}• .+-✓ .•4�r�W..,..�.,+ �._.r^.��'!LY+ar;'�ee-..y` `pF THE)p�1. Town of Barnstable BARNSfABLE. Regulatory Services 9 MASS. t639. Building Division p)FO MP'A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection rl` VIA Location /S 5� G�/ 5/ c r /.�/� Permit Number &1-507O S-2) Owner f�, Yt fU G Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: P� I'L uP&C pq IN _84,-� �Q ..� �l/r mil-! Q��j Tlv7r/S • _ , . Please call: 508-8624M46 -e=ms= e4en. Inspected by Date /0(0 (S r aftlseCwcaft Double l-3/4° x 9-1/T"VERSA-LAM® 2.0 3100,SP Floor Beam\FB01 Dry 1 span No cantilevers I.0/12 slope October 30, 2015 15:17:39 BC CALC®Design Report Build 4137 File Name: Lewis Weldon 155 Woodside Job Name: Lewis and Weldon Description: NEW HEADER Address: 155 Woodside Road Specifier. J Madera City, State, Zip:West Barnstable, MA Designer: Customer. Company: Shepley Wood Products Code reports: ESR-1040 Misc: � I I BO 10-00-00 131 Total Horizontal Product Length=10-MOO Reaction Summary(Down/Uplift) (ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,300/0 698/0 B1, 3-1/2" 1,300/0 69810 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area(Ib/ft^2) L 00-00-00 10-00-00 20 10 13-00-00 Controls Summary Value %Allowable Duration case Location Pos. Moment 4,548 ft-Ibs 32.6% 100% 1 05-00-00 End Shear 1,565 Ibs 24.8% 100% 1 01-01-00 Total Load Defl. U768(0.149") 31.2% n/a 1 05-00-00 Live Load Defl. U999(0.09T') n/a n/a 2 05-00-00 Max Defl. 0.149" 14.9% n/a 1 05-00-00 Span/Depth 12.1 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2' 1,998 Ibs n/a 21.7% Unspecified B1 Post 3-1/2"x 3-1/2' 1,998 Ibs n/a 21.7% Unspecified Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Fastener Manufacturer: TrussLok(tm) i Page 1 of 2 ®Balsa Can=" DoubleI-3/4" z,,9A/2"4VERSA-LAM®. 2'0 3100,SP. Floor Beam\FB01 Dry 1.1•span I No-cantilevers 0112 slope _ October 30, 201515:17:39 BC CALC®Design Report _ Build 4137 ': File Name: Lewis Weldon 155 Woodside Job Name: Lewis and Weldon Description: NEW HEADER Address: 155 Woodside Road Specifier: J Madera City, State, Zip:West Barnstable, MA Designer: Customer: - IU Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure b d Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for • • • particular application.Output here based on building code-accepted design properties and analysis methods. • • • Installation of BOISE engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide ' or ask questions,please call a minimum=T c=5-1/2' (800)232-0788 before installation. b minimum=4" d=24" BC;CALCO,BC FRAMER®,AJST"' e minimum= 1" ALLJOIST®, BC RIM BOARD-,B" , BOISE GLULAMTM'SIMPLE FRAMING Calculated Side Load=390.0 Ib/ft - , , SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. VERSA-STRANDS,VERSA-STUDS are All TrussLok screws may be installed from one side of multiply Versa-Lam beams. trademarks of Boise Cascade Wood Connectors are:'FMTSL338 Products L.L.C. .•IrD TOWN.OF BARNSTABLE BUILDING PERMIT APPLICATION ev Map Z,2 7 Parcel py;�,„ OF BARfd°vTABLE Permit# Health Division, <J�g 4Z 2M G 4� Qlee Date Issued Conservation Division' FEB _4 AM g 4 ' Fee 1 u-=J Tax Collector A 0-v y q Treasurer 6lS1ON SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. VM TM S ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis .Project Street Address Village —�/QC V AO O-44 Owner Address /S-S lc%z-Ar",per Telephone d Y&o - zz r Permit Request Square feet: 1st floor: existing Z3 6V proposed 2nd floor: existing /- proposed '"Total new _-- Valuation 4/ �� Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatfiered: ❑Yes ❑ No If yes, attach supporting documentation. DwellingType: Single Family yp g y AY Two Family ❑ Multi-Family(#units) Age of Existing Structure I Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O No Basement Type: ❑ Full ❑Crawl �&Wlaa�lkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing YIe,7new First Floor Room Count Heat Type and Fuel: �G� ::o s Oil ElElectric ❑Other Central Air: ❑Yes 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 t BUILDER INFORMATION Name Telephone Number s "C) Address 4� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE . DATE v • y. FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4q FOUNDATION E, FRAME INSULATION t FIREPLACE , a Olt ELECTRICAL: ROUQIq FINAL PLUMBING: ROUG1;Ig" FINAL GAS: ROUGI ' FINAL FINAL BUILDING r $p44SY,.�YY', 1iiR•rr OV " r DATE CLOSED OUT ASSOCIATION PLAN NO. 'X~ r RESIDENTIAL BUILDING PERNIIT FEES. APPLICATION FEE ' New Buildings,Additions $50.00 o Alterations/Renovations $25.00 Building Permit Amendment. $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE ' square feet x$96/sq.foot= x.0031= plus from below(if applicable) . ALTERATIONS/RENOVATIONS OF EMTING SPACE 7'square feet x$64/sq.foot= 0® 9�� x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft >120.sf-5.00 sf .$35.00 >500 sf-750 sf 50.00 ` >150 sf-1000 sf .75.00 >1006 sf-1500 sf .100.00 >B00 sf-Same as new building perrdt: square feet x$96/sq. foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= ' (number) Deck _x$30.00= (numbE7) Fireplace/Chirnney a$25.00= • (number) Inground.Swimming Pool . $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost 1 . �� US , r aaaiaiaiaiaai��oaiiaaaaaaaiaoaaaaaii/ rE r, rr • ,. _ 1 I • Ir s J. . 1 1 11 1 1 1 1 1 1 1 1 • 1 . _. . •111 rI / . 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Frr.M. wlll 11 . • •. I 1 .11 'All 1 w t •I/ ..•%1 . 11 • .1 . • . 1 1 _. . . I r.111 ••1•.•w r•1111•wl�`.:1• •11 1 • 1 ✓• 1 •1 .•.•: •II w•I .1 /1 111111 •w 1_I 1 11 11 .I 11 :I . • 1 r•1111• ." .11 1 1 /1111_I w•1 1 1 � • I11 w11 1 • . . _1 • .1 11 . . . •111 . I 1 •1 r t • t-11 • tl u u wu •1 it • • 1 .. 1 •r.l• u1 1 n ru11•-. « •• 1 ..•r. •ue • tY r 1 ✓.n1MUOr • 7I Is 11 •w11111 rw1 111111 I .• • 1 / I • _• wIw wI 11/111 •.• 1 /• 1 IA 11 • •ii•1 _• • •11 wIl • • t1 •1 111 • II w • .11 • wI•w11A 1 • �.'1 11✓. • •/ • 1 ••� • •I:to 011 • 1 MIll • GeV I I • 11 • • .II r • •1 r•• • ./ .Ir •11 1 • 1• 1 • 1 .11 • 1 w • •• • 1••w11 r 1 _C4 • ••It .II 1 Y• 11 IN •.0 1 1 11 11 1 1 1 • 1 l 1 ' t . /11177TV 1 1 • 1 ' 1 I I 11 1 1 1 1 1 1 1 � 1 1 ' • 1 / _ 1 1 1 1 1 . . 1111 - 1 ` 11 II 1 ` 1 The Town of Barnstable Regulatory Services 1 59. �0 • �''°rfc►u•+• Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction..alterations,renovation,repair.modernization,conversion, improvemem 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: U ! Estimated Cost 0 Address of Work: /S , Owner's Name: G� Date of Application: Q I hereby certify that: Registration is not required for the following reason(s): []Work excluded bylaw []Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING T=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 a own r. o� c i Date n i� / ame Registration No. OR Date Owner's Name .,•vmrm-:Aifidav:rev-070601 Table JSZlb ' Prpnipttre Packages forOas aad Two-FaaW Rsaidaa&W Baildlap Hamad with Fooit Foeb MAXIMUM ( NQVQ UM. Glasurg Glazing Ceiling Wall Floor Bnmxm Stab 1lradn6caoliag (%) U-vdue2 R-value] R-value, Rrvalul, wall Plrsmea: Sopiscut EMd=sY Pacicaae. R.vaWet R.vabd 5"1 to 65001ieseta;Dues DeW. . Q 12!'• 0.40 31 13 19 10 6 Normal R 12% 0.32 30 19 19 10 6 Normal 1 12% 030 31 13 19 1 to. 6 95 AFUE T 15%- 0.35. 31 13. 21 WA . WA Normal U 15% 0.46 31 19 19 10 6 Normal v 1S'/8 0.44 31 13 21 WA WA U Ate. w 13% OJ2 30 19 19 10 6 ffi AFUE X Is% 0.32 31 13 21 WA WA Normal Y 19% 0.42 31 19 21' WA WA Normal Z li% 0.42. 311 13 .19. 10 6 90AFUE AA 18% 010 30 19 19 t0 - 6 90 AFVE L ADDRESS OF PROPERTY: �s S� �cr��s n 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): i � ' S, SELECT PACKAGE(Q:AA.-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERM KING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a I . ` o Is teoL, IW vo, f f -16 it i. , , , f , ae " ! Board of Building Regula ions and Standards ���- One Ashburton Place, - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 113239 Type: Individual Expiration: 05/27/2003 MICHAEL J. DINOIA MICHAEL DiNOIA -- -- - - - . 32 OUTPOST LN -- -- - - --- - CENTERVILLE, MA 02632 -- - - - --- - Update Address and return card. Mark reason for change Address "': Renewal Employment Lost Card .�_\ ✓/ze �!anvmcr���eal� c f�'ffna.;a�r�ael�C Board of Building Regulations and Standards License or registration Valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards g g Registration: 113239 Expiration: 05/27/2003 One Ashburton Place Rm 1301 Boston,Nia.02108 Type: Individual MICHAEL J. DINOIA MICHAEL DiNOIA 32 OUTPOST LNG S �� CENTERVILLE,MA 02632 Administrator Not valid wit out signature - �'•1' ✓fie'�anzi�xo�ucezcll� u�. 'b c>'iuve�Ca BOARD OF BUILDING REGULATIONS #License: CONSTRUCTION SUPERVISOR Number: CS 058441 B i rthdate: 10/15/1954 Expires:.10/15/2003 Tr.no: 6359 Restricted:- 00 MICHAEL J. DINOIA 32 OUTPOST LN CENTERVILLE, MA 02632 Administrator l . P; l E6\ SEE. ' 111 E- S AN