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Home My WebLink About0107 SEA VIEW AVENUE (9) f�7 �� vi�'� ��r� ___. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION..,.. Map- `Applicatioh :;;)17K`1,9__ Parcel:U !Y 77 Health'Division 'Date Issued Conservation Division .-..Apo�ibatiori Fee Planning Dept! Permit Fee Date Definitive,Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address f SF-ig A-u 221, Village Owner Address 2- t-bE,44i Telephone Permit Request Rsovt° cg 24t d d, U 30 uare feet: 1 st floor: existing 0 roposed 42r ' e2nd floor: xistinb roposed lf-10 p r TOtal hew ZQhing District, Flo6d Plain Groundwater'Overlay Aga Construction Type LA-)o6ck Project Valuation3o, 6M Lot Size Grandfathered: L3 Yes Ll No If yes, attach supporting documentation. Dwelling Type: Single Family .-.0 Two Family L1 Multi-Family(# units) Age of Existing Structure 136ye-5 Historic House: .XYes LJ No On Old King's Highway: U Yes mo Basement Type: U Full drawl �WWalkout Ll Other Basement Finished Area (sqft), Basement Unfinished Area (sq.ft) t GaAr Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new r"a Total Room Count (not including baths): existing new First Floor Ro rn CoLn Heat Type and Fuel: Ll Gas El Oil L1 Electric L3 Other 2 Central Air: Ll Yes JYINo Fireplaces: Existing New Existing wo /coal stave: El Yes;kj[No Co Detached garage: Ll existing El new size Pool: Ll existing EJ new size Barn: existin-.0 D new size gr Attached garage: U existing 0new size —Shed: Ll existing U new size Other: rn Zoning Board of Appeals Authorization Ll Appeal # Recorded LJ Commercial Ll Yes L3 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) .-Name S4f_uf_&.a a,kk:_ Telephone Number M.,s A Address License # Ll -9 A p4l, OD Home Improvement Contractor# 16&All Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO co 4SIGNATURE DATE f L FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED _ MAP/PARCEL N0: ADDRESS VILLAGE A OWNER E DATE OF INSPECTION: FOUNDATION . ;FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL µ`GAS: ROUGH FINAL FINAL BUILDING { DATE CLOSED OUT I ASSOCIATION PLAN NO. { t i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 4-e-V fi4,i --T - R, : , Address: I/ I-2t on ad City/State/Zip: b Sk-ez,2o 14 OQ S SThone.#: �'�E) `/go-3140 S Are you an employer? Check the a propreate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-tim.e).* have hired the sub-contractors 6. ❑New construction ..2.0 I am'a sole proprietor or partner- listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g,-❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'-comp.-insurance comp. insurance.x required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: V Job Site Address: 103- T,._ o XJ-Z City/State/Zip: (`�,-l'�iR.c at. M6 Oates Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the'Office of Investigations of the WA for insurance coverage verification. I do hereby certify t er the pai and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: Official use.only. Do not write in this area,tb be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),-address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town),".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of MassacbuseM Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 ar 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia tl6 Date: 4/7/2009 Time: 907 AM To: @ 9,15084284841 Page: 002 Client#: 12032 2BISHOPRICST ACORN. CERTIFICATE OF LIABILITY INSURANCE 04079°°"�") PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: National Grange Mutual Insurance StevenJ.Bishopric,Inc. INSURERB: Acadia Insurance 1112 Main Street,Unit 18 INSURER C: Osterville,MA 02655 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS NSR DATE MMIDDIYY DATE MMIDD/YY A GENERAL LIABILITY MST4295K 11/01/08 11/01/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAEm MAGE O R TENTED $250 000 CLAIMS MADE M OCCUR MED EXP Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO LOC JECT AUTOMOBILE UAB11M COMBINED SINGLE LIMIT ANY AUTO (Eaacddenl) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Peracddent) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-FA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIA13ILFTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC B WORKERS COMPENSATION AND WCA025879011 07/19/08 07/19/09 X QRY I IM D- OTH- rFS R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE - E.L.EACH ACCIDENT $5OO OOO OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE1 s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 UUU OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER VNLL ENDEAVOR TO MAIL In DAYS WRITTEN 200 Main Street NOTICE TO THE CERMCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. [AUTHORIZED R PRESENTATIVE ACORD 25(2001108)1 of 2 #56184 LS1 © ACORD CORPORATION 1988 I tT Town' of Barnstable ti Regulatory Services . 9="R'' t'E'� Thomas F_Geiler,Director 1619. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �vL subject.as Owner of the subjproperty I, J , 7`�'�� , �l SN�� to act on my hereby authorize behalf, in all matters relative to work authorized by this building permit application for. �9 � £ ("Address of Job) -7,. 200q sigi6ture of Cwner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on'the reverse side. Q:F0RMS:0 WNERPERMISSION Town of Barnstable Regulatory Services ? SAnmgrABLE, : Thomas F. Geiler,Director MASS � t659. ..0g Building Division plFD Tom Perry,Building Commissioner 200 Main:Street,.Hyannis,NIA.02601 . vt'ww.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOh4EOWNER LICENSE EXEMTTION Please Print DATE: JOB LOCATION: numbs' street village "'"""HOMEQWNER name home phone# wori pbone# CURRENT MAILING ADDRESS: city/town state zip code The currentexemption 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. DEFINMON OF HOMMONWER Person(s)who owns a parcel of land on wbich 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_be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/sbe 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 of this issue is a.form currently used by several towns. You may cart t amend and adopt such a fom✓certification for use in your community. Q:forms:homeexcmpt Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 47928 Restriction 00 Name Steven J Bishopric City,State,Zip Marstons Mills,MA,02648 Expiration Date 9/29/2009 Status Current No complaints found for this Licensee. Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL47928 4/9/2009 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel..,,' 7(r Health-Division Date Issued Conservation Division .-'-Application Planning Dept. Fee Date Definitive Plan Approved by Planning Board Historic OKH. Preservation Hyannis w Project Street Address Village ACV-, 4u Owner YNO Address JC 4", Telephone Permit Request 1ZE_,0Ut3 A S.c C C1 PIz; �o LO �CA 0 U C ti-T S Square feet: 1 st floor: existing—proposed ;2nd floor: existing proposed Total new Zohing District: Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size— Grandfathered: U Yes �o If yes, attach supporting documentation. Dwelling Type: Single Family .-L3 Two Family Ll Multi-Family (# units) Age of Existing Structure 04 �42 • Historic House: XYe s Ll No On Old King's Highway: Ll Yes �No Basement Type: Q Full �rawl El Walkout - Ll Other Basement Finished Area(sq.ft.)- Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. new Half: existing I—VIA new 'LIA Number of Bedrooms: AJA existing Unew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: U Gas U Oil Ll Electric U Other Central Air: Ll Yes f®moo Fireplaces: Existing New Existing wood/coal stove: Ll Yes(,11110 Detached garage: Ll existing L] new size—Pool: El existing Ll new size Barn: 0'e. fisting E1 newer size_ A C:) Attached garage: Ll existing Ll new size Shed: Ll existing Ll new size Other— C) Zoning Board of Appeals Authorization Ll Appeal # Recorded Ll Commercial > 'es U No If yes, site plan review# _ _ - - - - - -�q 5:-, (�6r'rent Use V A c_A-,,a—\ Proposed Use NJ rn APPLICANT INFORMATION (BUILDER.OR HOMEOWNER) Name Sff_0E,1 �c Telephone Number Address 11 I 'D- vA A4,,u 5 7 License # A I Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (a-161(0 e FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: `FOUNDATION 3 - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING , DATE CLOSED OUT ASSOCIATION PLAN NO. E r The Commonwealth of Massachusetts /37 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information !� Please Print LeLribly Name(Business/Organization/Individual): � Address: T City/State/Zip: it , /114 9 696,5 S Phone.#: y 3/4 s Are you an employer? Check the appropriate bog: Type of project(required): 1.9I am a y emp to er with .S 4. Q I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ m I a a sole proprietor or'partner-' listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g. 'Q Demolition working for me in any capacity. employees and have workers' 9 Q Building addition [No workers',comp.-insurance comp.insurance.x required.] 5. Q We are a corporation and its '10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.] t c. 152, §1(4),and we have no 1 employees. [No workers' cbmp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy infomation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContractors 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. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AA6i'1wcz' 01„ 4--,J X,st,r"oe-, Policy#or Self-ins.Lic.#: v2.?4/Y 7 011 Expiration Date: 7/��/O Job Site Address: t0�- z�4 V� �-w l�U� City/State/Zip: D54z2,/ llg , 94,4- 6,X5'S' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a pai is an penalties of perjury that the information provided above is true and correct. Signature: Date: �R . 0 Phone# � Official use.only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Insttuctions i Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until.acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contcactor(s)name(s),.address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete*and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pennittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations• 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617427-7749 Revised 11-22-06 www.mass.gQvldia IKE 'Town of Barnstable 0 Regulatory Services . �$"xr'?&"& Thomas F_Geiler,Director 1619. fo, � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02661 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Own er.Must Complete and Sign This Section If Using A Builder I, . \ (Z Z)A7- as Owner of the subject.property hereby authorize 5 �€� -T-. ho p R,"e -.e to act on my behalf, in all matters relative to work authorized by this building permit application for. 1O - S��► (J�� (Address of Job) t/. .: /09 Signa e of Owner Date Print Name If Proped-y Owner is applying for permit please complete.the Homeowners License Exemption Form on the-teverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable tt+� Regulatory Services Thomas F. Geiler,Director Htass. Pq, 1b.1 ,0�' Building IYMsioia • prFo rtN'1 a . Tom Perry,Buildin'g`Commissioner 200_Maig,Street, Hyannis,NIA.02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village name home phone# work,.phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Persons)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);pfovidcd.that if the homeowner engages a person(s)for hire to do such wof e that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homoexempt Date: 8/6/2009 Time: 11:07 AM TO: ® 9,15084284841 Page: 002 J Client#: 12032 2BISHOPRICST ACORD,. CERTIFICATE OF LIABILITY INSURANCE oaos 009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insuranc StevenJ.Bishopric,Inc. INSURERS: 1112 Main Street,Unit 18 INSURER C: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR NSR DATE MMIDD/YY DATE MWDDIYY A GENERAL LIABILITY MST4295K 11/01/08 11/01/09 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DgEM SFTO RR ONTED $250 000 CLAIMS MADE 51 OCCUR MED EXP Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND BINDER294472 07/19/09 07/19/10 X WCRY STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $SOD OOO OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEEI$500 OOO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REESENTATIVES. AZOR ZED R PRESENTATIVE A ACORD 25(2001108)1 of 2 #S60260/M60259 LS1 0 ACORD CORPORATION 1988 ' I ✓fe 'C�o�izrnaniu lei o�,� Board of Building Regulsdode and Construction Supervisor Lim License: CS 47928 Birthdate: 9/29/194, / Expiration: 9/29/2009 J Tr# Sill Restriction: 00 ' STEVEN J BISHOPRIC'. PO BOX 656 MARSTONS MILLS,MA 02648 Cenlndssloner TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map G Parcel' v v Application # 96�P2 Z. Health Division Date Issued 14, 6a Conservation Division Application Planning Dept. ~ Permit Fee Date Definitive Plan Approved by Planning Board 0 Z/t//o9 Historic - OKH Preservation/ Hyannis Project Street Address i0 7 S (ftw kV _, Village Owner 1�1'l1�NN� Cku d,G�cl�S �,� Address 167 SM'I W AV& Telephone $- )41S7J 6qf5�1 Permit Request 5 I(JUuB1L Si IDS_' 2�'P �L1z'J2 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain 'Groundwater Overlay Project Valuation Construction Type Lot Size' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: LE(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 o Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Cour tp :t- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other " v Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoyg: LPYes ❑ No M 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. � � S(�I;S�/o D��c. u 316,y Telephone Number Address \1`1 J1�1�1N 51`• S(�IT� License # C-( � (jo�� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY k APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i OWNER DATE OF INSPECTION: _ FOUNDATION r FRAME i .INSULATION - R .:FIREPLACE K 4 ELECTRICAL: ROUGH FINAL "' PLUMBING: ROUGH FINAL GAS: ROUGH . FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. The Corntrtonwealth of.lVMassachusetis Departrnent of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 :�• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/individual): A/NYr`kL Address: ►1IV 5?'� .Sf 111 City/State/Zip: �1 -UILL`�- {�• Phone.#: Jam_— Are you an employer? Check the appropriate bog: Type of project(required): 1.Kr I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (fall and/or part-tirn.e).* have hired the sab-contractors ❑ 2"❑ I am a soleproprietor or'partt�er-' listed on the'attached sheet T. ❑ Remodeling ship and have no employees These sub-contractors have g, '❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'•comp.-insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other .SItDStUNL R4 (jkfufA�l' comp. insurance required-] "Any applieant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the sub-contactors 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:_ A)- c"'NA/(/-L• 6-W_ AU--I'Uhz- Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: CGS �t�vlfw �UL C�TYMQr_ City/State/Zip: AA�. d Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).' Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimiri4l penalties of a fine tip to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the'Office of Investigations of the DIA for insurance coverage verification .[do hereby certify under the ins anal penalties ofperjury that the information provided above is true and correct: Si afore: Date: 11 2 0 Phone#• Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other ('nntart Pnrcnn- Phone #: .__ Information and Instructions �K Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual, partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or tiustee of an individual,parnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 applicant who has not produced.acceptable.evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the Commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance RZth the insurance requirements of this chapter have been presented to the contracting authority.' Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contiactor(s)name(s),.address(es) and.phone number(s) along with their certificates) of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which Mll be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially'stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 D'eparf ment's address, telephone-and fax number: The Commonwealth of Massachusetts Departmmt of ladustri,al Aocidents Office of IuvGstigad.ons• 600 Washington Street Boston, MA 02111 Tct. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia F, Client#: 12032 2BISHOPRICST ACOR TM CERTIFICATE OF LIABILITY INSURANCE DATE(Zoo9) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insuranc Steven J. Bishopric, Inc. INSURER B: 1112 Main Street, Unit 18 INSURER C: Osterville, MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR Y TYPE OF INSURANCE POLICY NUMBER I'DATEM MID D/YYE PDATE MIVOLICY PDD/YY IRATION LIMITS A GENERAL LIABILITY MST4295K 11/01/08 11/01/09 EACH OCCURRENCE $1 000 000 MISX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED el $250 000 CLAIMS MADE a OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 ' GENERAL AGGREGATE $2 00O 000 M L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s21000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH- A WORKERS COMPENSATION AND BINDER294472 07/19/09 07/19/10 X WC LIMIT EEL EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $5OO OOO OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE c ACORD 25(2001/08)1 of 2 #S60260/M60259 LS1 © ACORD CORPORATION 1988 c► r Town' of Barnstable d Regulatory Services . M noes. Thomas F. Geiler,Director v g foa�� Building ]division Tom Perry, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Pax: 508-790-62 Property Owner Must Complete and Sign This Section If Using..A Builder as Owner of the subject.property hereby authorize �jT�v�u �(sKO Own C• tca act on my behaff, m all matters relative to work authorized by this building permit application for. l o Seek vIBw (Address of job) 4 It Z S o. Sig tune of Owner Date Print Name If Property Owner is applying-for permit please complete.the Homeowners License Exemption Form on the reverse side. r Town of Barastable o Regulatory Services Thomas F. Geiier,Director ' Building Division Prto 'y Tom Perry, Building Commissioner 200 Maiti.Sfreet,.Hyannis, NIA.02601 wNm.town.barnst2b1e.ma.us Office: SOS-862-4038 Fax: SOS-790-6230 ErOh EOWNER LICENSE E)CEMPTTON Pteare Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 st:tuc'tures'access*ory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall nt 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 responsibiiityfor 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 Homeowncr 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 FXEMv=ON The Code states that: "Any homeowner performing work for which a building pcmvt is required shall be exempt from the provisions of this section(Section 109.1.1 -Liecnsing of construction Supervisors);provided that if the homcowncr.cn gages 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 ofhis/hQ responsibilities,many communities require,as part of the permit application, that the homeowner certify that hc1she 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 forn/ccrtifncation for use in your community. Q:fomtis:homccxcrnpt Vlassachusetts- Department of Public Safety Board of Buildin-, Rcgmlations and Standards Construction Supervisor License License: CS 47928 Restricted to: 00 d STEVEN J BISHOPRIC 1112 MAIN ST UNIT 18 OSTERVILLE, MA 02655 Expiration: 9/29/2011 ( nnmis.i,;ncr Trtt: 4445 SZ- V ,per ✓/ce i�an�.rnom.�ura�I/ �./C�iaa�ivaeQa , \ Board of Building Regulatio_ris and Standard HOME IMPROVEMENT CONTRAC I istration: 106141 Expi • n: 7/22/20 Tr# 270447 Type: to Corporation STEVEN J. BISHOPRIC Steven Bishopric 1112 MAIN NIT 18 OSTE LLE, MA 02655 Administrator i a J TOWN OF BARNSTABLE-BUILDING PERMIT APPLICATION.,, Map � Parcel "t e ."Application # Health'Division Date Issued Conservation Division ; Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic = OKH Preservation/Hyannis Project Street Address Village A(f_ Owner l y i-wr✓`o G,a:. Address Telephone Permit Request r- n-..o /�e> t-�Yw•v'�-t. 0-2. ��v,a,�2S t,.� .l l ("J•� o�on� ca. .`-�,3 �ll....s • �/ Square feet: 1 st floor: existing&q proposed 2nd floor: existing/�O 11' proposed 4' Total new Zoning District Flood Plain Groundwater Overlay Project Valuation- Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure /30 5 Historic House: kYYes ❑ No On Old King's Highway: ❑Yes t�o Basement Type: ❑ Full Y. Crawl Y�-,-Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _ Half: existing new Number of Bedrooms: 142: existingV new Total Room Count (not including baths): existing ) a--- new - First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Otheru� Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stove: ❑Yes/CrNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑:new size _Shed: ❑existing ❑ new size _ Other: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , Cori�mercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use x :YK •• w APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name JT�v ry --� �`.s�oc��-ice Telephone Number Address 1 I i /.1 License # 'y 05�4 rz ;`l l� oA .4 . (3d-(,5_5 Home Improvement Contractor# Z6(a f yJ Worker's Compensation # Wc-4 o a5 2r 9o// ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - / / FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE 'OWNER - DATE OF INSPECTION: FOUNDATION FRAME INSULATION -• FIREPLACE PS ELECTRICAL: ROUGH FINAL ' `PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ ^ DATE CLOSED OUT ASSOCIATION PLAN NO. 4 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesribly Name(Business/Organization/Individual): S+`wclz�, Address: / 12- City/State/Zip: Phone.#: !/� - 316 S' Arse you an employer? Check the appropriate box: Type of project(required): 1.04-am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-ti.m.e).* have hired the sub-contractors 6. ❑New construction ..2.❑ I am a sole proprietor or partner-' listed on the attached sheet, 7.. ❑Remodeling ship and have no employees These sub-contractors have g• "❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'.comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its '10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: o -' c S L_,/ vs c ca- Policy#or Self-ins.Lic.M C-i1 l7 a c-;e 7-9 O// Expiration Date: -7 4��U Job Site Address: Cy 4-- 5`aA v,S c A-V 'r— City/State/Zip: 054—z( �,P.4-G13�ss' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde ains an enalties of perjury that the information provided above is true and correct. Signature: Date: _ Phone#: IC& ZG—S— Official use.only. Do not write in this area,tb be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructiong Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees: Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,.construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),.address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy bf the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license of permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia Client#: 12032 2BISHOPRICST ACORD- CERTIFICATE OF LIABILITY INSURANCE 04107/9°"'n"'' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR g y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. National Grange Mutual Insurance Steven J.Bishopric, Inc. INSURER B: Acadia Insurance 1112 Main Street, Unit 18 INSURER C: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS NSR TYPE OF INSURANCE POLICY NUMBER ODATE LICYMFFED VE DATE MM DLICY TION IM LIMBS A GENERAL LIABILITY MST4295K 11/01/08 11/01/09 EACH OCCURRENCE $1 000 000 N:—00:1M MERCIAL GENERAL LIABILITY DAMAGE TORENTEDPREMISES IE. $25O OOO CLAIMS MADE 51OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY jE a LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ AT B WORKERS COMPENSATION AND WCA025879011 07/19/08 07/19/09 X WC I IMITI OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $5OO OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL I0_ DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �,1 -27 a --'"'�"a► eDEP-MassDEP's OnlineFiling System https://edep.dep.mass.gov/pages/PrintReceipt.aspx MassDEP Home Contact Feedback i Tour I Privacy Policy MassDEP's Online Filing System Nickname:SJB1112 My eDEP I Forms My Profiles* Help Receipt Forms Signature Payment Receipt Summary/Receipt pdnti;ceipFl FjxTl Your submission is complete.Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. i DEP Transaction ID:236619 Date and Time Submitted:4/14/2009 9:30:45 AM Other Email: Form Name:AQ 06-Construction/Demolition Notification Payment Information DEP code:37645 Date:4/14/2009 9:28:15 AM Amount($):85 Payment Detail:William Schmitz--Card--2896 Contractor Contractor Number Name Address,, Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact i Feedback Tour Privacy Policy MassDEP's Online Filing System ver.8.5.11.0© 2008 MassDEP 1 of 1 4/14/2009 9:38 AM Massachusetts Department of Environmental Protection ■ L7�11 Bureau of Waste Prevention • Air Quality 1100087060 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 4/25/2009 5/8/2009 7. Construction or Demolition: a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving b. If other, please specify: ❑ wetting ❑ shrouding ❑ covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? F- a.Name of DEP Official b.Title c.Date mm/dd of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the IWILLIAM SCHMITZ —o above and that to,the best of my a.Print me o knowledge it is true and complete. The signature below subjects the b.Authorized Signature —�N signer to the general statutes PROJECT MANAGER �o regarding a false and misleading c.Position/ e =o statement(s). STEVEN J. BISHOPRIC INC. d.Representing ZY �: co e.Date( m/dd/ ) �o CO �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ L7�1Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100087060 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition (When fi ling out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?E]Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order to comply with the 2. Facility Information: Department of WIANNO CLUB"TIFFANY" BUILDING Environmental Protection a.Name notification 1107 SEA VIEW AVE requirements of b.Address 310 CMR 7.09 BARNSTABLE MA 02655 c. o State e ZO Code f.Tele hone Number area code and extension .E-mail Address(optional) 3900 r2.5 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ✓❑ Yes ❑ No k. Describe the current or prior use of the facility: SERVED AS SUMMER HOUSING AND HOTEL I. Is the facility a residential facility? ❑ Yes ❑✓ No _o m. If yes, how many units? Number of Units _° 3. Facility Owner: �N WIANNO CLUB �o a.Name �0 107 SEA VIEW AVE b.Address OSTERV14LE MA 102655 �(D c.Citv/Town d.State e.Zip Code 0 15084286981 f.Tele hone Number area code and extension .E-mail Address o tional I �a PETER DAVIES OQ h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection L7�1 Bureau of Waste Prevention . Air Quality 1100087060 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement:If B. General Project Description cont. asbestos is found during a 4. General Contractor: Construction or Demolition ISTEVEN J. BISHOPRIC BUILDING AND REMODELING operation,all a.Name responsible parties must comply with 11112 MAIN ST 310 CMR 7.00, b.Address Chap 7.15,and OSTERVILLE MA 02655 Chapter 21 E of the General Laws of c.Ci /Town d.State e.Zip Code the Commonwealth. 15084203165 1 lbschmitz@stevenjbishopric.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be WILLIAM SCHMITZ limited to,filing an asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat.of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. STEVEN J. BISHOPRIC INC a.Name 1112 MAIN ST b.Address OSTERVILLE MA 02655 c.City/Town d.State e.Zip Code 5084203165 f.Telephone Number area code and extension .E-mail Address(optional) WILLIAM SCHMITZ h.On-site Manager Name 2. On-Site Supervisor: WILLIAM SCHMITZ On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes ❑ No �N -0 4. Describe the area(s)to be demolished: �0 INTERIOR N �O -0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: �0 NONE �o �cy �Q aq 10/02 BWP AQ 06•Page 2 of 3 u s aad Standards Board of gullding Ytet HOME IMPROVEM04T CONTRACTOR Registration: 106141 Tr# 270447 FExpiration: 7122I2010 lug Tom: private Corporation STEVEN J.BISHOPRIC INC. Steven Bishopric 1112 MAIN ST UNIT 18 administrator OSTERVILLE.MA 02655 board of Building Reguiatjo�('-.d u- Construction SupeMsor LI License: CS 47928 Birthdate: 9/29/1948 Expiratlon: 9/29/2009 T►/ 5111 Restriction: 00 STEVEN J BISHOPRIC PO BOX 656 MARSTONS MILLS,MA 02648 Comte mluloner Town of Barnstable Regulatory Services . HARNSTAHce Thomas F.Geiler,Director i6396 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:.508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder I, C , as Owner of the subject property herebyauthorize �� l 0��1C --toactonmybehalf, in all matters relative to work authorized by this building permit application for: t o-7 SeA V1rdtj *VIS, (Address of Job) Oct. Sig tore of Owner Date -C- Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. fi Q:FO RM S:O W NERPERM IS S ION Town of Barnstable VE Regulatory Services RAR,Sr" Thomas F. Geiler,Director NU� p,0� Building Division Tom Perry,Building Commissioner 200 Mairi.Street,__Hyannis,MA_02601 www.town.barnstable.ma.us Office: 508-962-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINPTION OF HOMEOWNER Persons)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 bomeowner 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 heJshe 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 fomJcertification for use in your community. Q:forms:homeeaempt l�� /�� T t IV � � omo;o� am-. er F ezo2 rLPIV s ru4 •'i � liiil I I' a Sn)u, I! lil SX9 :3 ,910 110 t gang (-vzD 94 v a Ll It UP r X' Xi y . 'j, 0 1—. LcD -------------- . ' acts ��A o2210 Tdepb= 617.422.0952 Awe 617.422.0962 T.-7-WrtUrgir rarl Kgr rintl n 1 4 4 4 4 4 R H Wino Club a d t7-0F t.:at Otm�3q 16�e1p ROT RAM MAN lffl a � Ra.ir4 Sale • (DFIR.ST FLOOR PLAN 1/4' 1•—O' • ' SO= No Ww O a A-101 N - Data 0--ot- TAIEM1,T75 �51cf, \a-X►S j 2�S `3Xiy O 'T------------ ��6 2x7 w 49) - 30. Li----------- oil —7 ROOY 5 /A0 t i i ------------------- t }If` ------------------ ' b Axhbmu ti o221e Tdgb= .4-21.0-5 - -� lame 617.422.0962 124 �eT>�iq�1s seoo>sc Puw q SECOND FLOOR-PLgN RM .. DMIN sods W. moo, ASOWd Sit Re"" IMa„bar Dote OaacioUm .IIFIt? ZT 5� 7-5T H6M88t S I i I I I S I Iu`f I I 1 , I I 1 I ' I 5x 17 I I 1 I L / it --- „ I 1 I I or CID 1 I I I IM �b I� II II II + 1 imcal s54as Siam 01:10 02210 617.422.0952 PSOWe 617.422.0962 aub '�'„t Q�eu9,36utbf�ml CTHIRD FLOOR PLAN NO FLOOR KM mv*,g scow K.tO • >D000f Dane fraud; . A-10 3 C X7Ee l0P-L L LE Lie` 7-1 �, r dd'••��I, I ill' 1 -_�I ntffeantA III ryAlly, i - - I _FRONT ELEVATION t'-0 i ■ O r�J I . PARTIAL FRONT ELEVATION AT PORCH r-o- rlA ._� Dudlam+MrDo* Atti'htba� - DIGby.St� Idrp �lfrd.�ml TI Tipi�c a17.Is2.ifS2 t , •u�i� �� n;:7� � try u7.�s:.aas. Y -rh �rr� : - �i, - _ rxsr resort A nm aEan :n ou aro= / i% i / : / / /:.::y3�;' �,. l:r:•�r 1. �•- M-kv Sod. s 2 BACK ELEVATION CALL 1/1' - V-r , A-201 E7nT-7� �0� ��Lc 04T IO N S --- _ ---------------------- tHj - - All WITH 1 sxpc fsaath : I � .! • . _.� &fFT ELEVATION DocUmin+ ,_� 12211 ' ' Tipia f17.122.NS2 . - iboi�ie f17.122.Iff2. • = W,ffl TumClub WT CLEW" } 1' 1 �1 � LL 2 -TIL RIGHT ELEVATION } ow w.d: �OML 1/4' . t'—O' � Ac/J0f/00 A-202 LE BARON MODEL LF248-2 FRAEEBARON MODEL(TYP.) DRAINAGE ET EV AT 14"-`�- FRAME&GRATE(TYP.) RIM INVERT SIZE 8' T "ID (2) I-112'0 MORTAR SHIM AS LPI ---- Directions: HOLES <TYPJ7 REQUIRED (TYP.) LEACH PIT From 200Main Street, Hyannis go toward 600 GAL ____ 12. 0 HOPE PIPE LP3 -__- GALiE STONE (TYP.) Pleasant Street.. 4 4 LEGEND Continue on Main Street S.D' --_ Main Street becomes W. Main Street 3,0' } NOTE, ALL COMPONENTS LP6 TO H LOAD --'- E H-20 - CAPACITY Take left on Pine 'Street Pine Street becomes S. Main Street CATCH BASIN TRAP (TYP,> _ ---- Deciduous Tree Q Misc Manhole Turn Left on E. Bay. Road LPIO ---- 24.0 1000 GAL ' ® Catch Basin Turn Right on Bates Street DRAINAGE SYSTEM ---- �I• Turn Left on .Wianno Ave --- ® Catch Basin (round) SCHEMATIC � coniferous Tree r .,`� �` Wianno Ave becomes Sea View Ave _LP13.__.--- _.,.._. ._._.24 0_. ____600 GAL W�1_.QF_STON... Hydrant , A� Arrive at 107 Sea View Ave on left Not to Scale ® Iron Pipe �V Light Post Qi Dill Hole O Water Gate (round) El CB/DH © Gas Gate (round) ® SB/DH OHW Overhead Wires O Mog Nail ——25 Elevation Contour Guy Bor�y Al NSF ......G............ Underground Gas Line Q Utility Pole &' ✓Mier✓oye 115601154 N/F . . . . . . . . . . . . New Construction Wonno Club s47/321 Proposed Grade D N 18 Proposed Vegetaion (3: 1) Ratio Canno � / club aoo' (Plantings in Consultation With 347/321 ,ice^^• Conservation Commission Staff) .,. �• - .,r / _ a g .. ' Elev--26.5' NGVD e of Pave IBM Top CB/DH -- a" 1�- _ Existing Por �. \ _.:.2ti_- -- ,n• R �r kin Post g - .23' I Roil Fence Sea "� N/F .,„, •,,� , -. 694" 347w1onn%321 b R' e n { CR/N id a"�m. ", -_-__ — ola _- ._ear ,,,,. '"-'�,,,�-,. ._ ! � �� `" ••-...— ,, - Conc Ave Ede ll (40' Wide) Force Sting 3 1 r of Pa de PtrC \ --25- A Conc Sidewalk a ® public Way) s As Required ® � ve - -�.. A e/Rep/urnb N 45'45'50" E git Parking o (n •. o° Own i' -.•. 8:ac .`. ' _ 414.37 w /err r ® v R.n.4 ",.•" - - 52.J' f ® a 1Tt .......... .............. �'L -11 Conc C 1 on ® v / I p... ........... ............... :�...;:�••. p / 1 e at roPosed rbPose Gravel Gross 1: •.............. Ed ence S d 2 Har Covered � r" ` � o 1 tone ro dened . . j \ `\ ✓" Gote R Posed 1 I With Sin Access `- : j m I Pg �1 _�? sSki Wall p""posed Sidewo/k Sign a Per Con Cory�a& `� -oposed i : fl\ {{ i _. (n fb '•::::,i::':':•:: i -- �_ I a �ffo< Blueston :20 1 an dial ��uffer -mein �v-n O � t, Covere FF= .39....... 0 1100' Walk -- II Rernove `� 1 } Cb p / ;•.••` ` ? ' �t,?P'Bu �� d Porch 27•g L r l 206.2.1 LP i � E r t ___ 39.5' I CBJ i EL Existing .•• w ,,.�'�° C Porch xist�9 ;- 1 4»PV own { :tn fv '.•:•:•. . . .�.:;:;'•:;, B n Rffany Cover ,\ w t St uc ur m :•:•:•:•:•:•:+:•. :•:•i. f 1 (Cover L/'10 LPJ 11 oS"te _ / I g ed a �..� 1 --��- - Perch I' 4. �oPosed n? ► j o r ' t -J ,s Li, it d P "p 1 Lo I _____ _- -� •�4. � Areo ock I 1 So' "� ___-'d o°"` Lawn a I Existin Standpipe _�- 71ttog a � I \ \ I Tiffs Y f Structure _ , '•. LPJ2 :.•.;. 1. a CO ;:.::::: .FF er 27,s \ : 3 Sty w/ 0 1 Pro \ I 2f1 O �`l07 A Posed •, \\ I Pr r 5 Exi Ad al 0 ff�— I stT di ' \ u -- �� o B o L do s 50 3 ns \ I P ed �': P sed . awn / Cluo. V. 1': r ::.: . .. . \\ 1 kwo : mel/s I ",t . . . L p�: 1 = each ffer 2 _ - . awn _. �_ _ _ _ _ _. E La s._ .... e C _ Existing n 11 on S n _ \ _f _..._.I 0 9 r ,. --_ __,�- .�_ -, �_• ._,� -- .. ^__ -". .... �"` -- __ ,.w ne \ ... ,air. I - a 2 �� ro "i�S•' 1 7 _. o 0_ _ \ s 1 1 -f--- T o r 1 .. e V -•-�--'15 r �' n e l' \ `W5 .. o \ _ Z Pos 1 L•d ..r' ar \ t:' ... v \ D .. 1 S Sao r D - fiM v.. \ _o \ o __ 1 P / V _. B e _ / e\ S u t n o k"� t e \ --zone O 1 ww n \ \ d, _ e yB \ o/ s \ S' L _ 2L1 1 >e \ \ •0' n M' \ i -s`r \ n T \I e r m e -_= _ 1 o B _ / _ e e \ o _ T .•. .. T ry L ."- _ ... - ----••..,_ -"_ _ ___ ~--.-...~- __ _~ _.,,. -_..- --~ en• ,., . -- -_ "".°,w-• - -- •......-.. .,........,::e......... Lawn v awn r 0n ` . M ! tin Xls \ -=� = _ o . _. _ �»�,... 4" R f LP 3 o \. L- t o ",._�.iom ..M s_ t I � __ _. _ .._ _ .., --•"_'2" ..--- ~-•- "'� Ex• tin �--' � `,y � .,-:;.:�.;..• - Syr Li 2,000 .-•.-:.. _'-' one- VC P u. u_ B„- 1 __ - _ -- - s" 1 w p _ - ---- .._..�.. Exls Line Chornber ti el P �•^,. .. ......... .... .... .. ... •mr• O ".. .,� � -•- a,�y o � G l See 10 472 r __ tic I k T ,.-• e - ``... • _ :. -" ._- _wW- _"`._• --____0----_. �� ter. --"' FLOOD ZONE: Zones V11(el.17) & C Community Panel No, Revision M 14, D ASSESSORS REF.: Revision MAR 14, 2006 Per LOMR Case # � 05-01-0764P Map 162, Parcel '24 Nantucket SounPETER LOCATION MAP: d � � 9 ra® : Scale: 1" = 2000'f CML ZONE: , a " REVISION DATE: 12114106 Delineate Flood Zone Per LOMR Case # 05-01-0764P • ,�•� -_. ,k2141 RF-1 REVISION DATE: 12106106 ModifyVegetated Areas ." ab Area min. 87,120 SF RPOD • • • t (min.) ( ) REVISION DATE: 11 29 2006 Bldg. Footprint & Vegetated Areas '��` • x � Frontage (min) 20 ' " Width (min) 125' REVISION DATE: 812412006 Revise FD Access & Vegetated Areas 1 .•�� , Setbacks: REVISION DATE: 810812006 Revise FD Access & Standpipe Fran t 30' , Side 15 GENERAL NOTES: PREPARED FOR: PREPARED BY.• Title: - Rear 15' 1.) The property line information shown was Qc Proposed ImprolvImment compiled from available record information. WI Qln/1 O Club GV�,� 4 Sullivan Engineering, Inc. p � AR 7 Parker Road �. . . P. O Box 249 PO Box 659 Plan of The Wianno Club OVERLAY DISTRICT. 2.) The topographic information was obtained from ti- ' f Osterville, MA 02655 Osterville MA 02655 0 AP - Aquifer Protection District an on-the-ground survey performed by CopeSury r• i �• FJW Ub On or between 17/MAR/06 and 25/APR/06. OSfeI�VIII e, MQ. 020�� (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-39.95 fax ` . t y,' PSuIIPE®gol.com P P ca esurvOca ecod.net N (OsterBamstable ville) Mass. J. The datum used is NGVD '29, a fixed mean ^,_, sea level datum. > t 30 Draft DWB/JOD Field: WHK/JPM a� ` 0 15 30 60 120 � Comp Dote: D WB/PS Comp.. WHK/RRLJuly 14 20�6 Scale: rr=3� Review: ., 9 7039 Drawing. __ g # C515_4G1 --- ---7 77-7-7-7-777,,7 IiILE SAW UWM LP248-2i itAME GRATE WVtK WERT itNIII21.5 I R-9 t12" ..........litI12"1 III24,(20) T.pi IWil -tree t; Hyq,nn is go towor Iff i-0 iOFSTONE II 'Street........... I0 I0()6 oAt,wy! OE sj=j�1A 0 HDPE PxpE GALIWI,0 E SUM Con tin U,OP S.=F w Mdin "Str' el LP5 I25.0 A LEGEA ain )treet ,, b'IIIIt TEI�ALL cl�m 1066 bk�k1"OF STONE M BE H-W LOAD_ Tqkb'�GL W/ ............... ' be- 'Street LP7 'OESIONE ine ,:Stre'6t V I5 t7 2 -0. 1WO GALW111 QFS Idnhole IFu'rn��'Left,Oon y�`�Tei'c- lduo' u's' iRood, Oi75A n SION Iic' 266' s� in t ititTijrn Right,"7on:'Bot e'sO Stree 16DO GAL W/1 OF SMNt iTU UON "Catch e"'Basln, ve ej A A v, vus ree,IIran. ipe ifOl0 W/1 QF STON �i�H) rant d left C fj T, fflon n o 11,OF m Left;'�'pi lanno ,Ave IR I-0 ivin&n A r "ril I IIONRAINAG J.D Iur A comes 'Sea' V, -*, A ve 2 6 6AQ GAT-W _E m ve:: a t 1 0 7-�Se'GO Ave�D I0 e IINot to' IOfititGc te O(r6 6 El Ce IDH OW ter IGas', Ga t, SB/' V H Ires 00 of ly itIifII.47 Iew il;ons Iruc ion I:y JW 'Utilit y Pole IICPU'—,'OHW W1,Ele'1�6tlon `iC6htour UhderoroUnd 'Gas Vne�'A t IIIIrop ed, Grade,,INIF clu-4) Rd fo 0 w 52. 47/32 b egetdlori,(j.PrqpoSe'd V,vtl, C n in gs in onsol dtion With IIStaf 9!7 iServation ommission,:�if7B)W Top I0 IY=26.5 NG�w r 57 il7 I�,;;7777 69 IUb NO ..... .. won 'o�II77 I ...........C IIOilIitVC Iiff 6 Lin in 7? 45 I777-77 4. OR P o(71J#19d tIitCb-_wow Ite w itIfICon i0 I7—......... ZG;monc vroW H,7 I7 7 ,IPYT0,90 p IFD p t tD I777t�� p Exist'" TOU -,7, 7 I .......... -77777777i PQV&d I -7 Ist CottG OI Iitty w/f'7ropoS, P,I St a #V lIAcIdItion L(4Ubb r'i 1111COVY to it77-7 IfIIOW.........I�7 z 77 7)I I7_7 .......ZZ itit7 it1 77� -r 71� 77— p O. ...... 'stone -7 77 I2.it4 PVC mp Shm*77r,77,7 7� !"7 77. v ? r tic 7. OO1119 10_7� 77,i0 77'�7 7 __7 I -7 ttiifY, I7__IitI7� .........Ii ........... IIit7 itItliAPPRO .........iE B PLAN titIiifititIititIOilI 1A INOIitI6 7 0 itII ............IitOftFLICOUZONE DF IIzon e§ :in e ititP, IIi01 I N Iit-I 6 u I�'�250001 00 IIll.. .... ISuwvm, S', CO.297W.MAR 1 4; �2o66 ASSESSOR' REF8, IIIr 16MR '(;aSe ......... I7.4pr ItPe A460 1 62, iPdrc el!.2 4 I65��D 1�-,o IIOi0 11 OA ITION"'MA f itifIit.5 cote: 1 2pQ 0, I.- itOilZONE itiitfitJ?F 7 tIj ItItIArea' in. 8 7jl 2 0 iSFi�,(Rpoo) . ... ... REWSION DA 7E.- 1 11291RO06 Bldg, F66tprin ti,r,& Veget I a ed AreaSL I'n) Ion ag WI(I tp M 25 tWSION DA TE. i,812412006 Re' A in etated A' L Vise 01pe FD Acc6ss'r"& �Stand Se tb a cks.�t L SION DA TE. 0812006'Re- PREPAHWI GENERAL,NOTES Side li5 PREPARED w vd, q e recur if i ur rj IInc.el,r-,�;j�', , L r,, , ;" -a pl, u T ipro m E fbrMationfr"showi7 wo Rear I7 Iro oseu VLU f, mt 0 M N W d natibi ifWiC n r)6�: Cl b u En"gineering,O compi e roM ld fj t55 1,11&L,�MA WC from t er vill e, MA Us t er v :0265, I U I I0., 026 f i n e h,. f P6) jj 6�$'� d Thte to 0 2.) b t 249 w1anno 7 Roa P0 JB t S—' gro'und SurVeyr'per oun q Y ape urv� N'tion 0 i -.t he M Club an on strj� V ('508)42,6�_3J44 (508)4 31 1 5 fax an ;2�IAPRI MARI AP 'Aquifer:"L ro tec er Vil I 0265 (508) 420-3994 (506) 420-3995 fax"L':'O" �` ;� ",� O , 't, .,; I b e Ween or Iecodnet OilitPSUVEftol.obm IA p I (OS f6rvil UM:,Use IS itI:Me dat N(;vu, ,,29 a S Mass I'71 P6 t _,��Vftap e)meC itt ONsea eve a a um IU Draft-v 15 30 v WBIJOD 4" Field. 3 SC a/e 30 OilIUQ re.Iomp W.,R vie a Win g, C5 1r 5-��4.G if1 4 nt'06 J Dr I