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0215 SEA VIEW AVENUE
215' cSeaVi e o A ve.. I o i Town of Barnstable �t RR tt��pp�� pp ve�OPMf �F7HE T(lti" �r F1•'t�e' NSTABLE to Planning&Development Department Barnstable Historical Commisso, , » sARNSTABM i,,,, AM, M v MASS. 200 Main Street,Hyannis,Massachusetts'02601 ` +'� {`' Sr g 1639. A�0 Phone(508)862-4787 Fax(508)862-4784 r0 .� '�enMv� erin.logan@town.bamstable.ma.us "OF80115`P0 rlTVT C,T 0 N ' Elizabeth Jenkins,Director COMMISSION MEMBERS: Nancy Clark,Chair .r . Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk L • C7> George Jessop,AIA Z . Elizabeth Mumford Cheryl Powell OD rn•-D Frances Parks DECISION '�' m� N Xm Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Pro(Pties, Section 112-3 F Applicant/Property Owner: Thomas J.Swan,III Subject Property: 215 Sea View Avenue,Osterville Assessor's Map/Parcel: 138/017/000 Hearing Date: January 15,2019 Pursuant to the Barnstable Historical Commission receiving your notice of intent on December 20, 2018, a duly advertised and noticed public hearing was held on January 15, 2019 to determine whether the significant structure identified as a single family structure on this property is a preferably preserved significant building and whether demolition delay would be imposed for the partial demolition of this structure on the parcel addressed as 215 Sea View Avenue,Osterville. After review and consideration of public testimony; application and record file, the Commission by a unanimous vote, found that the actions proposed do not constitute a substantial alteration and would not jeopardize the historic structure's status as a contributing structure in a National Register Historic District as defined in§3 of the Cape Cod Commission Development of Regional Impact Review Threshold. In addition, after further review and consideration of public testimony, application, and record file accordance with Chapter 112F the partial demolition of the single family structure is not a preferably preserved significant building. In accordance with Chapter 112-3 F,the Commission determined by a unanimous vote that the partial demolition of the single family dwelling would not be detrimental to the historical,cultural or architectural heritage or resources of the Town. This decision applies only to the demolition described in the notice of intent submitted on December 20, 2018. No future demolition shall be permitted without application and approval from the Barnstable Historical Commission. Nancy Clark,Chair Date cc: Brian Florence,Building Commissioner a Ann Quirk,Town Clerk 'l„ q 200 Main Street,Hyannis,MA 02601(p)508-862-4787(f)508-862-4784 'i 367 Main Street,Hyannis,MA 02601(p)508-862-4678(f)508-862-4782 I ,w� r F 1F1E T ��-� Town of Barnstable *Permit�0 C 'L PR Expires 6 months from issue date Regulatory Services Fee sAaxsrAsre. v� 163 Thomas F.Geiler,Director Building Division N ®F BAR►4ST A��E'I om Perry,CBO, Building Commissioner Tow 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint � Map/parcel Number_� d�� Property Address 2_ Cj Seoyl w AU,.,--. Q ikrul 91 Residential Value of Work$ n Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l,l d V 1 1�`Q G✓'� 15 Sm V 1,eLL3 lir e-- aTU 04 0=V 05,5_ Contractor's Name CA Q�kd/ 6 IMM' `�M�S Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) f �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name ' 21 t Workman's Comp.Policy# k)a e= ylxa-4I ;w 13 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 (maximum.35)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is req fired. Q SIGNATURE: {J�Rd Q:\WPFILES\FORMS\b lding pe t forms\EXPRESS.doc Revised 060513 Town of Barnstable Regulatory Services ` snxivsTS. EMAS Thomas F. Geiler,Director 1639. p 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 rr �( !'I e- 'd , as Owner of the subject property hereby authorize Cat ZLkd- � to act on my behalf, in all matters relative to work authorized by this building permit (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. 4gnof Ow er S- a e f App cant ks'uj-.4ed A 3M > &hf6w q0V-Ck--5&- I4ey ( 4z."41e PrA Print Name Print 14arne `ao a®r3 Date Q:FORM&OWNERPERMISSIONPOOLS 62012 �IKE>b Town of Barnstable Regulatory Services 935nxx iE� Thomas F.Geiler,Director 16`0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towa.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: _ number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINTITON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner''shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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. C:\Users\demllik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 Client#: 1988 - 2ASSOCIIATEDAL ' DATE(MM/DDIYYYY) A-CORD. CERTIFICATE OF LIABILITY INSURANCE 08/2112013 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 endomement(s). PRODUCER CONTACT NAME: Dowling 8r O'Neil PHO 508 775-1620 AX No: 5087781218 Alc NNE E. ErR Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURERS)AFFORDING COVERAGE NAIC 0 Hyannis,MA 02601 INSURER A:Associated Employers Insurance INSURED INSURER B: Associated Alarm Systems,Inc. INSURER C 1047 Falmouth Road Hyannis,MA 02601 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD UB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MIDD M/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PRAEMISES EaErrDence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PR7 El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ �4EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1)ED RETENTION$ $ A WORKERS COMPENSATION WCC5004142012013 2/01/2013 02/01/201 X WCs7Ar1>LiMrrS_ ER RH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y l N E.L.EACH ACCIDENT $500 000 OFFICERIMEMBER EXCLUDED? � N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Associated Alarm Systems SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1047 Falmouth Road ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S115615/M715612 KKM n ' r �f Commonwealth of Massachusetts Department of Public Safety Security Systems.S.License License: SSCO-00008s3 ,. 1 I. TELLY A IEANE ' 1047 FALM s HYANNIS Mist Expiration: ComrWissioner 04/27/2015 IMMOM C AVI • �U FOEt�OWlNG A ,y G / y i r r L �� F ♦ f LYE T047 T sr ! 064i x234 = �' bmis j � s iN7 Fo-tmdv SMOKE DETECTORS REVIEWED s"^o Yee be.�*rs 0A14)5, C040v) mm(v ABLE BUILDING DEFT, DATE 13 :� FIRE DEPARTMENT DAT ❑ � 11T G BenchLj El c Q� v c v G7 a I I 0 s L L f.L �F.—I - i Fil , a oo � --1 till x Q u 00 00 ❑ II II o� w � x � (L 6 ;1 0 &"" Marchese Residence DATE:5,March 2013 Bolton, MA SCALE:Not to Scale , 02 f v� ,S-eGt�� ��— ©S`�eX'✓i� , ►M v�- 6�G�s k N W x a co J � BOldl x 2 CA)0. 5 .. T. o - S 91 n � e �bwE 00 _� =x x 0 0 o 0 a8 v9 T4"'`` �`' Marchese Residence DATE:05,March 7B Bolton, MA SCALE:Not to Scale i' socl04 AAO w `C-194A� r ON W W N D� r N R W 113 -------------------- . Q A Z . .. ------------------- O y P6 N A i 4 -'A'F - ol,6i s a. CooMl CD i �< Commonwealth of Massachusetts Sheet Metal Permit Date: ��3 X-PRESS PEPMIT Estimated Job Cost: $ 026 O O D 0 C T - 9 2 O Q�jrmit Fee: $ Plans Submitted. YES. NO Plans Reviewed: YES. NO 2,3j�UN OF BARNSTABLE Business License# Applicant License# `�f Business Information: Property Owner/Job Location Information: 'Name: Gl✓(.�!/1 C� ���C Name: Street:, 1-11 :�� S �G ' /�Street: �,5 �S,CG. V 6 Gc./ (/ _ City/Town: City/Town: S 7'G i!i d c_ Telephone: U / p � � IS 2 � SL�I(� Telephone: Photo I.D. required/Copy of Photo I.D. attached: YESAe- — NO Staff Initial J-1/gunrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family—k-, Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Zp Yl e S , i r- s ` INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the.insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only z4t�� �Z��� — Owner ❑ Agent ❑- Signature of Owner or Owner's Agent By checking this box0,I hereby certify.that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metalwork and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Tide ❑Master-Restricted City(Town ❑Joumeyperson Signature of Licensee Permit 9 ❑Journeyperson-Restricted �f License Number: Fee$ El Check at www.mass.govldpl Inspector Signature of Permit Approval COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS AS A BUSINESS i ISSUES THE ABOVE LICENSE TO. = � 1 :RODN(Y� N TAVANO ..•TAVANO;:.MECHANICAL SYSTEMS \° i... :201 CAPES TRAIL BARN-STABLE MA 02668-.0000. 3 0 g 3 33 COMMONWEALTH OF MASSACHUSETTS. PlUM SHEET METAL ER WORKERS ST TAT -URRCED ' • ISSUES THE ABOVE LICENSE TO.,* i RODNEY N TAVANO i� 4 201 CAPES TRAIL j` j W BARNSTABLE MA 02668- 1373 �. 3449 12/28/13 94294 i i. • NAM International New England, LLC To:Certificates 05083628098) 13:10 08/26/13 EST P9 3-6 Client#:281696 TAVANOMECH DATE(MMIDDfYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 812612013 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(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME: Anne Sanzo HUB International New England PHONE 508-888-2355 508-833-0680 A/C No En: Alc Nc 125 Route 6A E-MAIL ADDRESS: Sandwich,MA 02563 INSURERS)AFFORDING COVERAGE NAIC M 508 888-2244 INSURER A:Hartford Insurance Co INSURED Tavano Mechanical Systems LLC INSURER B:Safety Indemnity Insurance CO 201 Capes Trail INSURER C: W Barnstable,MA 02668 INSURERD: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDIYYY MWDDIYYY A GENERAL LIABILITY 08SBMZQ6456 D811412013 08/1412014 EACH �OCCURRENCE $1 000000 E X COMMERCIAL GENERAL LIABILITY PRMISES Es oFcM.. 000,000 CLAIMS-MADE Ex�OCCUR MED EXP Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG s2,000 000 POLICY PRO- JECT $ LOC B AUTOMOBILE LIABILITY 6210665 D812812013 08/28/201 Ea,cIN "eOtSINGLELIMIT s ANY AUTO BODILY INJURY(Per person) $250 000 ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $500,000 AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED Per.accident $500,000 s UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTIONS E A WORKERS COMPENSATION 08WECLG5272 811412013 08/14/201 WC STATU- OTH. AND EMPLOYERS'LIABILITYTORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $100 000 OFFICERIMEMBER EXCLUDED? a N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddlUonel Remarks Schedute,If more$Pace is required) "Workers Comp Information" Proprietors/Partners/Executive Officers/Members Excluded: RODNEY TAVANO,OT CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE h V4cZ .X ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S978054/M978046 CS008 I 1 The Commonwealth ofMassachusetts Department ofln&atnd accidents Office of Investigations- = '600 Washington Sttreet' _ BostOn,Ma 02111 w".mass.gav/dia Workers' Compensation Iusunn.ce Affidavit: B'uiIrlers/Contractors/Electddans/Plumbers Applicant Information / Please Print Leoibly Name(Bnsmess/organizHli„rt,/fTti;v;rh,an; �f/Gzf'LD i'YI�1/�(��!i e6, Phone.#` �f' Are you an employer? Check the appropriate bo= 1. I am a m3ployer whh _ 4. ❑ I am a general cofactor and I -fie of project(regnired): * have hired the sub-cofactors 6• ❑New construction . . employees(fiiIl.and/or pale timel. - . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7. Remodeling ship and have no employees Tie mb-conftactors have 8. F]Demolition working for me irt any capacity. employees-and have wozs' [No workers' comp.inarmiace comp.incUM=e.$• 9. El Bm7dmg addition required.] 5. [] We are"' orporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing aIlwork officers have excised their 1 L 0 Plmbing repairs a' additions niysel£ [No wad s' cam. right of exemption per MGL 12-❑goof repairs incrinuace required.]t c.152, §1(4), and we have no employees. [No workea' 13.❑ Other coMP.inSnrrnce required.] *Any appUcmt ffiat checks box#1 mmst also fill out the section below showing tbcsvud s'compcosahon policy mfarmation. t Hnmcawnca who sAnnt this atndavit mdcafing they arc doing all work and then bite outside coniracfars must submit anew aMdavit-mmcztmg such *Contractors that checl-this box mmst atfacbed an addifiomal sheet showing the narnc o f ffic sub-cont-atton and state whew ornot those mtitirs have employees. If the mb-con' Ior have cmploy=,they mnstpruvidr the wurizcs'comp,pobeyffimber. I am an employer that is providing workers'compensation insw-ance for my employees. Below information, is the policy and job site G ^D Iu m a=Company Name: Policy#or Self-ins.Lic.#ke2�l W%" CZ_6 51272 Expaation.Date:_ .Job Site Address: 2 `/ A.t/c_ Cay/State(Zip: (� �` ul t Attach a copy of the workers' compensation policy declaration page-(showing the policy number and expiration date). Failure to.secure coverage as retired under Section 25A of MQ,c. 152 can lead to the imposition of coal penalties of a fine up to$1,500.00 and/or one-year impri nnm mt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against file violafor. Be advised mat a copy of this statement may be forwarded to the Owe of Iuvestigations of the DIA for insm=e coverage verification. I do hereby c wzder the pains-and penalties of perjury that the vzform•ation provided above is true and correct S`iematrnp Dam: Phone# Offxid use only. Do not write in this area,tb be cou3pleted by city or.townoffiuial City or Town: PermitUcense# •Issuing Arfthodty(circle one): .1.Board of Health 2.Bmlding Department 3.City/Town Clerk 4.Flectrical Inspector S.Plumbing Inspector 6. Other Contart Person: Phone#: r 5, IKETown of Barnstable Regulatory Services F A�R1Jf.TAHf�„R i 1 9. g Thomas F.Geiler,Director i639. 1� +` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A.Builder I, / ►Ch�' / / " `�f C In G S L ,as Owner of the subject to �— - l P .Pay hereby authorize / Gi,l/6 do G C4 to act on tap bebA in all matters telative to work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not-to be filled-before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name 13 Date Q:EoxMs:OWN MERMSIorPoors 7KE `own of Barnstable t Regulatory Services ar►xxsr.�srt Thomas F.Geiler,Director . awes =639• ��� Building Division rFn lrw�" . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstAble.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:- JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as sdpervisor. DEFINTIION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work Performed under the building permit (Section l09.1.1) 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. ' I 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 care t amend and adopt such a form/certification for use in your community. Q:fonns:homeexempt I *' .O K ►►�q�o� r Town of Barnstable *Permit# c)Q6 I 0 Expires 6 monNrs from issue date O,O y � ,�A81� , Regulatory Services Fee a�a� MASS. Thomas F.Geiler,Director ' s639. � � Building Division ,p'- '�..� �: :;: Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 0 S 2007 www.town.barnstable.ma.us Office: 508-862-4038 rO��/Naz3508=�720' �30C EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / Property Address P Vesidential Value of Work I Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �1 4i• a-� 0 ►�- s�.L/ L t(6 Ave- C ontractor's Name SY Telephone Number . sod,- 4oz-9v L b Home Improvement Contractor License#(if applicable) LS22 I vp, Construc 'on Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: �have sole proprietor e Homeowner Worker's Compensation Insurance Insurance Company Name Q Workman's Comp.Policy# too ` Copy of Insurance Compliance Certificate must be on file. Permit R;ze-roof heck box) (stripping old shingles) All construction debris will be taken t071-boyl B ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U.-Value (maximum.44) \ � I f *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc.' ***Note: Property Owner must sign Property Owner Letter of Permission. V ; Home Improvement Contractors License is required. j SIGNATURE: Q:Forms:expmtrg Revise071405 t r The Commonwealth of Massachusetts Department of Industrial Accidents -,-- _ Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): A CA RL I �. Address: i. rz- Mai G f b• 1'ty l`t j City/State/Zi e"f ' 'Phone#: — Mo Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with P 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑N construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling 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.❑ 1 am a homeowner doing all work officers have exercised their I I.❑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' 13.0 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. 2Contractors 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 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. �A Insurance Company Name: Policy#or Self-ins.Lic.#: A (¢1 " � I D Expiration Date: l9 D Job Site Address: ,91 .JrQ,U � ) Pve—, kT e—w kity/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains and penaldes of perjury that the information provided above is true and correct i Signature: Date: Phone# 56%`40"*(GA 0 — Cl q D 6() 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#: �lae �ainmioouveai o�,/ aoaac/i%uaelC' y a oard of Budding Regulations and Standards Const�uctlo'rt'Supervlsor License y"" i;- ' ,�� � ��aBiFfhdatet�1 311'962F�« ��•� i4Eitpir200 trl8Ya. r#�6886 Jz 1 tlor�i�0 C r T n SCOTT■ECROSBY_ s x l J c OSTERVILLE MA,02655 i COmmISSIOner y 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: Registration \51gg2 Board of Building Regulations and Standards -e One Ashburton Place Rm 1301. Expiration 77/. 3/2008 i ' Boston,Ma.02108 1 yam_ Y r T peGPrivate Corporation. SCOTT E CROSBY BW[ D.ER I,N_C SCOTT CROSBYA = 1112 MAIN ST UNIT --_.._....__._..._._.. . . . \� ,s' Not valid without sign OSTERVILLE,MA 0265' Deputy Administrator i 08/08/2007 10:54 FAX 5084283068 GERMANI INSURANCE g001 U MR ��^TM 114 PRODUCER THIS CER CATS IS ISSUED A A MATTER O I F RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTERED IRY THE POLIC(FA OSTERVILLE,MA 02656 COMPANIES AFFORDING COVERAGE,_ coMA SAFELY INSURANCE SCOTT E.CROSBY BUILDER, INC, g AIG-AMERICAN INTERNACIONAL GROUP 1112 MAIN ST.UNIT 7 — _. �_.. .. -• --__-- ANY OSTERVILLE,MA 02666 COMC c COMPANY D li {k1,j.✓!�• 5'F,S '� ;� :y ti � 1 ti ..,� y, . p�. 1 1, 11'' �, I...,,•h:; r. A._. ''�.�� I'• i � •X•,ry H�_ �• �r{'A I, '1 , ('�•5 ra .e.. �' i'' (°'�I.r " �,°i` .ea, il::r h ,� L -'dtik.:3;u:��h anted!�Glanti>w;:uw,�:...,.�.11.�.'6�►:.'�'nrb�"'�eu'7r'.�:..:�.:s...�•W(�.:,..hdiA.a�., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SII3LOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OpCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE'AFPORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMfrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFTS Yra POKY EXPBIATM LIMITS DATE(MMIDDIM DATE(MMMINIYY) GENERAL G�ASILITY GENERAL AGGREGATE 3 2,000 000 A x'COMMERCU afL GENERAL LIAl Y CP000011 b3 07/05/07 07105/p8 PRODUCTSC�/OP AGo f JCLAIMS MADE U OCCUR PERSONAL A ADV INJURY f OWNER$&CONTRACTOR'S PROT EACH OCCURRENCE 3- 1,000,000 FIRE DAMAGE(Any Qm faa) $ ---- MED EXP am p vmn) 3. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i ANY AUTO ALL OWNED AUTOS ILY ` SCHEDULEDAUTOS ��p.Irlp N 3 ) RY (Perpereon) HIRED AUTOS BODILY INJURY 3 NON-OWNEDAIITOS lPeraccldent) _... ... ... . PRO"A I Y DAMAGE' 3 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 3 ANY AUTO OTHER Tww AUTO OKY. _ .� EACH ACCIDENT •tt. -.....-•--- A MRSOAT11 S EXCESS LIABILITY EACH OCCURRENCE 3....- _._..._. UMBRELLA FORM AGGREGATE — 3 OTHER YHAN UMBRELLA FORM f B I� s HAND WC 687 70a 06R?J07 OBr228 BLEACH ACCIDENT f 0O,0OQ Tm P loPnlsrow IHCL EL DISEASE-POLICY LIMB $ 500,000 PARTNEMIXECUrNIS •- OFFMMARB: EXCL EL DISEASE-EA EMPLOYEE 3 100,000 OTHER DESCRIPTION OF OPERATIONSIL CCATIONSNENICLF.S/SPECWL ITEMS ,.�, .-. .,, , I .,v e., •J ( '� � wrr J�iwAtiX�i�� {I 1, �• >< y- SHOULD ANY OF INS ABOVE DESCRIBED POUC= 09 CAN=90 86FORB TNd EWMATION DATE TNPJIBOP, TH9=104 COMPANY WILL WMEAYOR TO MAIL 110 DAYS WAfTYLN N0110E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAR SUCH NOTICE SHALL WPOSB NO OBLLOATION OR LIABlLIYY ITS AGOMB OR R@Pff§MLA"V-la_ AUTOO REPRESENTATI ma WM JG�tOK� GofL�L p,IKE r, Town of Barnstable � ti Regulatory Services t E MASS. s Thomas F.Oeiler,Director y nss. g, qjA s6;y.�F1639. p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i �6 Q��1 I, , as Owner of the subject property hereby authorize �1 t UI' In - to act on my behalf, in all matters relative to work authorized by this building permit application for: seawecv noLe, (Address of Job) ignature of Owner Date er LCI,0—1*aet- I'*m V Print Name I Q:FORMS:O WNERPERMIS SIGN ART ° decal ergency Management Agency cy xOft. Washington, D.C. 20472 July 16 2014 Jessica Rapp Grassetti Case No: 11-01-0521V President, Town Council Community: Town of Barnstable, Barnstable County, Massachusetts Town of Barnstable Town Hall Community No.: 250001 367 Main Street Effective Date: July 17,2014 Hyannis, Massachusetts 02601 LOMC-VALID Dear Ms. Rapp Grassetti: This letter revalidates the determinations for properties and/or structures in the referenced community as described in the Letters of Map Change (LOMCs) previously issued by the Department of Homeland Security's Federal Emergency Management Agency (FEMA) on the dates listed on the enclosed table. As of. the effective date shown above, these LOMCS will revise the effective National Flood Insurance Program (NFIP) map dated July 16, 2014 for the referenced community, and will remain in effect until superseded by a revision to the NFIP map panel on which the property is located. The FEMA case number, date issued, property identifier,NFIP map panel number, and current flood insurance zone for the revalidated LOMCs are listed on the enclosed table. Because these LOMCs will not be printed or distributed to primary map users, such as local insurance agents and mortgage lenders,your community will serve as a repository for this new data. We encourage you to disseminate the.information reflected by this letter throughout your community so that interested persons, such as property owners, local insurance agents, and mortgage lenders, may benefit from the information. For information relating to LOMCs not listed on the enclosed table or to obtain copies of previously issued Letters of Map Revision(LOMRs), Letters of Map Revisions Base on Fill (LOMR-Fs) and Letters of Map Amendments (LOMAs), if needed, please contact our FEMA's Map Information eXchange (FMIX),toll free, at 1-877-FEMA-MAP (1-877-336-2627). Sincerely, Luis Rodriguez,P.E., Chief Engineering Management Branch Federal Insurance and Mitigation Administration �o O Enclosure: Revalidated Letters of Map Change for the town of Barnstable, Massach s o cn �" -n cc: Community Map Repository =� Thomas Perry, Building Commissioner, Building Division,Town of Barnstable , F Page 1 of 2 j REVALIDATED LETTERS OF MAP CHANGE FOR TOWN OF BARNSTABLE, MA Case No- 11-01-0521V Community No.: 250001 July 17,2014 Case No. Date Issued Identifier Map Panel No. Zone 98-01-092A 02/04/1998 SQUAW ISLAND - LOT 49 - 19 ISLAND 25001CO564J X AVENUE 98-01-1020A 12/30/1998 LOT 1, LAND COURT PLAN 25001CO752J X 16194-N - 1623 MAIN STREET b 6� 99-01-244A 01/06/1999 PLAN_13687, LOT 5 -215 SEAVIEWI 25001C0776J X AVENUE.__:_) 00-01-0306A 03/28/2000 648 MAIN STREET 25001CO544J X 00-01-0998A 08/22/2000 291 BRIDGE STREET 25001CO757J X 02-01-0994A 06/05/2002 1300 CRAIGVILLE BEACH ROAD, 25001CO563J X CENTERVILLE 05-01-0804A 10/06/2005 COTUITHIGHGROUND, LOT 25001CO752J X 152B -- 220 CROCKERS NECK ROAD 07-01-0535A 03/29/2007 CENTERVILLE, LOT 9 -- 36 BROKEN 25001CO564J X DIKE WAY (MA) 11-01-1245A 03/31/2011 LOT B ---265 SEA VIEW AVENUE 25001CO757J X 13-01-0725A 02/05/2013 MAP 259, LOT 12 -- 116.SCUDDERS 25001CO554J X LANE 14-01-1368A 04/10/2014 LOT 18 -- 835 SOUTH MAIN STREET 25001CO563J X e Page 2 of 2 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION dA � D 83 Map Parcel Application # Health Division Date Issued 7,1 a )L_�5 Conservation Division Application Fee U Planning Dept. Permit Fee a-olto Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address P1� 5 sw7ew Village 051ce,Q ( ( I c- Owner Lai" rgra45e- Address Telephone 6�2y, n 01-441� / Permit Request WW W l h daos r ;��E p�i,d'F D Gi f'/UyYI lnti d�Z h 1J�C�C__. ,12,.4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new t Zoning District Flood Plain Groundwater Overlay v o o ; Project Valuation �IoO, 000 Construction Type LO m .-� ca Lot Size Grandfathered: ❑Yes Ell No If yes, attach:s pporting-elocu @ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway, ❑Y_e ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other co T Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ 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 I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1 /� Name 67J �'��"�-� , u I QZ . Telephone Number Address !12 License# 003-251 0 l�1 G,1 kt(�2, M 4 2,&o i Home Improvement Contractor# l 0 i • Worker's Compensation # 00053 S) 170/l I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS..FR. OJEqT WILL BE TAKEN TO ly : . ;: . SIGNATURE DiQTE hi id:NL.30.•:: S ' FOR OFFICIAL USE ONLY APPLICATION# ' DDATE ISSUED - MAP/PARCEL NO. ,1 ADDRESS VILLAGE OWNER J DATE OF INSPECTION: >> FOUNDATION � FRAME INSULATION } FIREPLACE 7 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT n. ASSOCIATION PLAN NO. The Commonwealth of 11Massachusetts 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): EJ JA-Y-7-2M-eZ, /A(C Address: °� 8 n 094� / /AA1 City/State/Zip: . 17�a rt,A/ S AM OW/Phone.#: C_Q$) 1717 S. Y11 Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with .3 d 4. ❑ I am a general contractor and I - ❑ * have hired the sub-contractors 6. New construction employees(full and/or part-tim.e). 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'comp. ❑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 anew affidavit indicating such. 1Contractors 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 and job site information. Insurance Company Name: AK 6ZZ4 Z A45 kt/fAl Policy#or Self-ins. Lic. #: =4_3 70111 Expiration Date: Job Site Address: oS l 5 Say/�&) l/1 4w— City/State/Zip: 05k�ryl I le Qa(o �K 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 the penalties of perjury that the information provided above is true and correct. Signature: Date: _ Phone#: Official use.only. Do not write in this area,to be completed by city or town official City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health'2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i ACCOR& CERTIFICATE OF LIABILITY INSURANCE DA�i(MWDO1"M) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the. certificate holder in lieu of such endorsement(s). PRODUCER CONTACT E, Erica H.O'Connor HART INSURANCE AGENCY,INC. 508 7 (508)759 7366 243 MAIN STREET PHONE ( ) 59-7326 AC Ne PO BOX 700 E-MAIL ADDRESS: BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE NAIC A INSURERA: ARBELLA PROTECTION INS CO 41360 I INSURED EJ Jaxtimer Builder,Inc INSURER B: ARBELLA PROTECTION INS CO 41360 I Hyannis,MA 02601 wsuRER c Rosary Lane ARBELLA PROTECTION INS CO 41360 H INSURERD: ARBELLA INDEMNITY INSURANCE COMPANY 10017 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER (MMIDDJYYYYl IMMIDONYYY1LIMITS A. GENERAL LIABILITY 8500042039 01/01/2013 01/01/2014 EACH OCCURRENCE S 1000000 COMMERCIAL GENERAL LIABILITY ' --UA—MAGE TO RENT D PRE I Ee occurrence) S `300000 CLAIMS-MADE OCCUR MEDEXP(Any oneperson) S 5000 PERSONAL&ADV INJURY $ 100000 GENERAL AGGREGATE a 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POLICY PRO-JFCT LOC S B AUTOMOBILE LIABILITY 21662400004 01/01/2013 01/01/2014 COMBINED aSINGLELIMIT 1000000 c ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident S AUTOS ' AUTOS � ) NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Peraccident) a i rD UMBRELLALIAB OCCUR 4600042040 01/01/2013 01/01/2014 EACH OCCURRENCE $ 2,000,000EXCESS LIAR CLAIMS-MADE AGGREGATE a 2,000;000 DED RETENTIONS S WORKERS COMPENSATION 0053890111 01/01/2013 01/01/2014 V WCSTATU• I I OTH- AND EMPLOYERS'LIABILITY - Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ SOO,000 OFFICERIMEMBER EXCLUDED? �. N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If es,describe under DESCRIPTION OF OPERATIONS below I I DISEASE-POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) Faxed to(508)790-6230 CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r Office of Consumer Affairs and vusness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 110609 Type: Private Corporation Expiration: 11/3/2014 Tr# 233027 E J JAXTIMER, BUILDER, INC. ERNEST JAXTIMER . 48 ROSARY LN HYANNIS, MA 02601 71 Update Address and return card.Mark reason for change. Address Renewal Ej Employment Lost Card )PS-CA1 0 50M-04/04-G101216 /zr_ VsumeIla4ffairCL& a• j%e� License or registration valid for individul use only Office of Consumer Affairs&Bu�nesy/�lation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: . 110609 Type: Office of Consumer Affairs and Business Regulation Expiration: 11/3/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 E J JAXTIMER,BUILDER;INC. ERNEST JAXTIMER . 48 ROSARY LN HYANNIS,MA 02601"' Undersecretary Not valid without signature Massachusetts - Department or Public Safety -- Board of Building Regulations and Standards C'()n.+tructiun Superi isdi, License: CS-003251 ERNEST J JAXTMR 48 ROSARY rANE HYANNIS A 02601 Expiration Commissioner 01/14/2014 f Town of Barnstable Regulatory Seirvices Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town-barnstable.mn.us Fax- 508-790-6230 Office: 508-862-4038 Property owner Must Complete and Sign This Section if Using A Builder A,e c, e ie ,as own..er. o£the subject property hereby authorize . S J Ar�-�,,e� L'I 4ek .�.a to act on my behalf, in.all matters relative to work authorized by this building permit application for: 2 IS EeA V1cw Ave«vC VS-t41'1 I1Pl � A (Address of Job) S.ignatu rc of O ier Datc Print Narnc If Property owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Ucereldecollik\AppDats\Local\Mieroaoft\windows\Tcmpornty Intemct Files\ContcnLOu600k\DDV81AAZ\EXPRi SS.doe Revised 072.110 r CHALES T. BELLINGRATH • AIA A R C H I T E C T 215 SEAVIEW AVENUE•OSTERVILLE•MA 02655 (V) 508.428.9262 (F) 508.428.7494 TRANSMITTAL To Date 6 • Z 'O,S 1>6Q q C&W.A 4VvZ4k Job Number S Project CC- SC. Subject C`0 0�, ��s We are sending you A Attached O Under separate cover via the following items: O Shop Drawings O Prints O Originals O Samples O Copy of Letter O Change Order O Specifications O Other COPIES DATE NO. DESCRIPTION �' •0 5 . � These are transmitted as checked below O For approval )(As requested For your use O Approved O Rejected O For review and comment O Revise/resubmit O Approved as noted O Prints returned after loan to us O Return corrected prints O For bid due O Submit copies for distribution Remarks kA 7"( Copy to Signature �: :f f,r MICHAEL WALKER DESIGN/BUILDER, LLC MW500 Horseneck Road �. South Dartmouth, MA 02748 Tel: (508) 287-4313 Fax: (508) 300-6051 e-mail: mwdb@comcast.net BMichael Walker,AIA June 9, 2004 Mr. Tom Perry, Bldg, Commissioner 200 Main Street Hyannis, MA 02601 Cc: Charles=T. Bellingrath—AIA 215-Seaview-Avenue Ostervdle, MA 02655 Re: Shaft Enclosure in lieu of Ventilated Atrium Dear Mr. Perry: I have reviewed the concept of creating a shaft out of the atrium space and^have concluded that it is an achievable alternative interpretation that allows the abandonment of the currently proposed ventilation system required by referring to the space as an atrium. 1) A shaft is defined in 780CMR 702.0 as an enclosed space extending through one or more stories of a building, connecting vertical openings in successive floors, or floors and the roof. 780 CMR 710.3.requires that shafts be enclosed with a fire separation assembly complying with 780 CMR 709.0 and having a fireresistance rating of not less than 2-hours where a shaft connects four stories or more and 1-hour where connecting less than 4 stories. Other discussion in 780 CMR 710.0 generally require: The shaft must be continuous from the bottom of the building to the roof. If the shaft intersects a room, the walls of the room must be made into separation assemblies. There is no indication that the rooms cannot be within the shaft and there is no indication that habitable spaces can not be enclosed in the shaft—in fact the code implies that habitable rooms can be part of shafts. 2) The shaft shall be constructed of fire separation assemblies in accordance with 780 CMR 709.0 with fireresistance ratings prescribed by table 602. In this application, the building type is Type 2C—noncombustible, unprotected construction. Table 602 requires that Fire separation assemblies for shafts must be of 2-hour construction. The 2-hour requirement is footnoted with Note b (Note b allows a reduction in the fireresistance rating of shaft enclosures in accordance with 780 CMR 1014.11 and 710.3.) and makes reference to CMR 709 and 710.0. (Fire Separation Assemblies and Vertical Shafts.) 3) 780 CMR 710.0 requires that shafts be constructed with fire separation assemblies. The fire separation assemblies shall have fireresistance ratings of not less than the fireresistance rating required by table 313.1.2 based on the use-group of the fire areas which are separated. 3 In this building we have 2 use-groups. Use Group E (educational) and Use Group A-3 (an assembly space lecture room on the basement level). Table 313.1.2 requires a 2-hour fire separation assembly between E to E spaces and between E and A spaces. 780 CMR 313.1.2 Separated use groups allows that each fire area shall comply with the code based on the use Deliver on Time Focus on Quality Think Safety CCA Science Center 06/09/04 Page 2 group of that space. Each fire area shall comply with the height and area limitations of that space...Exception: Where the building is equipped throughout with an automatic sprinkler system the required fire resistance rating of fire separation assemblies separating fire areas shall be reduced from those indicated in Table 313.1.2 by 1-hour. In this application,where we propose to create a shaft encompassing the lobby areas separating the shaft from the other areas of the building,the fire separation assembly (separating E from E and E from A) is reduced to a 1-hour rated assembly because the building is fully sprinkled. 4) 780 CMR 1014.11 refers to interior exit stairway enclosures. The fire separation assemblies are required to be 2 hours except that in Use Group E, and A occupancies which connect less than 4 stories, the fire separation assembly can be reduced to 1 hour construction. In this application, because the exitway is 4 stories, the fire separation assembly remains 2-hours for the stair enclosures. 5) Openings in shafts other than those necessary for the purpose of the shaft shall not be permitted in the shaft enclosure. If openings are provided they shall be in accordance with 780 CMR 706.0 (Exterior opening protectives) Exterior separation distances are greater than 10 ft. so this reference doesn't apply) 780CMR 716.0 (Fire Door Assemblies)780 CMR 717 (Fire Dampers) and 780 CMR 718 (Fire windows and Shutters—which again does not apply because the exterior fire separation distance is greater than 10 ft.) 6) 780 CMR 709.3 discusses openings located in fire separation assemblies and limits the size of any opening to 120 sq. ft. Openings into exit enclosures shall be limited to those necessary for exit access to the enclosure from normally occupied spaces and for egress from the enclosure (shaft). Exception: Openings shall not be limited to 120 square feet where adjoining fire areas are equipped throughout with an automatic sprinkler system installed in accordance with 780 CMR 9. 7) In summary: We request a reconsideration to change the"atrium" concept and forego the exhaust system by creating a "shaft" connecting the 4 floors of the building from cellar slab to the underside of the roof. The shaft requires 2-hour construction that is reduced to 1-hour construction by the exception of table 313. All shaft openings will be rated openings in accordance with the various code requirements. The shaft can contain rooms with it. (Essentially we can think of the shaft and the other parts of the building as being areas of refuge separated by a rated fire separation assembly.) Even though the building is fully sprinkled, because the stairways are 4 stories, they require a 2-hour enclosure. Exterior glass requires no treatment because of the exterior fire separation distances. Interior glass openings are fully contained within the shaft walls and so require no treatment. Very truly yours, Michael Walker Design Builder, LLC Michael Walker, Architect, AIA Manager Deliver on Time • Focus on Quality • Think Safety RICHIE'S INSULATION INC. 111 OLD BEDFORD ROAD WESTPORT, MA 02790 508-678-4474 BUILDING DEPARTMENT TO WHOM IT MAY CONCERN: PLEASE BE A VISjFD RICHIE'S INSULATION, INC. INSULATED THE FOLLOWING JOB: ADDRESS: i5 Sep U+�✓ �Ut TOWN: �S-I tr V i Ile CONTRACTOR'S NAME&INFO: iA ies 'lA st411C J;2b THE FOLLOWING INFORMATION IS WHAT WAS USED ON THIS SPECIFIC JOB: MANUFACTUREA,1(f--kl TYPE���r,A Ce 1( THERMAL CONDUCTIVITY PER INCH: AREA THICKNESS R-VALUE CDP CEILING 5� 8 4, o WALLS c STAIRWELL ` BASE. CEIL ' GARAGE CEIL G.H. WALL w rs, CRAWL OVERHANG CATH. WALL CATH. CEIL W.O. WALL FOUND. WALL BLOCK/RUNN. SLOPES P/V THANK YOU VERY MUCH FOR YOUR COOPERATION IN THIS MATTER. IF YOU HAVE ANY FURTHER CONCERNS PLEASE CONTACT MY PHONE NUMBER. INSTALLER: Cat.. RICHIE'S INSULATION, INC. TOWN OF B.-ARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel Permit# _ T7:2 r� Health Division Date Is ed :2 2-2-—� Conservation Division �1� Gt. Fee I b Tax Collector 0 a I& 0'2 Treasurer �J Ia Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village C5��n V L—h;g s Owner),F_--D 96:1, ,i wzwzn :i Address cS;oVIeK) ,A V re Telephone �Z 1 Permit Request 9 b iil<- /S_�� ��C,710 N c:YF- I DA D &929eiAg teu A 1 L d pp aa-T tj-- f,-j& A M i C r n L19 I iv`� E- 6E:�! � ,✓7S Square feet: 1 st floor: existing proposed 2nd floor: existing ` proposed An5__Total new N OA1- Valuation C�9 S- o0 pa Zoning District Flood Plain Groundwater Overlay Construction Type Worms 1-_%nmg y Lot Size Grandfatfiered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure //0 yR-5 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes O No Basement Type: Full �3Crawl ❑Walkout O 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: Y as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Existing Fireplaces: p st g --- New Existing wood/coal stove: O Yes O No Detached garage:O existing ❑new size Pool:O existing O new size Barn:O existing ❑new size Attached garage:O existing O new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes b No If yes, site plan review# Current Use S1 J 6 Proposed Use 'A rnit_ ,,//�� � BUILDER INFORMATION Name !':nl 6_0 Gk� �(D�$ Telephone Number Address P-D •4so1E /,C'f License# O L/ �s��('U i L/.� ✓9��C1 D �tS L Home Improvement Contractor# Worker's Compensation# G ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ( ) . DATE O FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ; ADDRESS VILLAGE i OWNER , L DATE OF INSPECTION: o , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING~ DATE-CLOSED OUT ASSOCIATION PLAN NO. u The Town of Barnstable MAS& g Regulatory Services 16s9• .0 �'°TED►+a't� Thomas F. Geiler,Director, - Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION +• alterations,renovation,repair,modernization,conversion, ' MGL c. 142A requires that the reconstruction. existing owner-occupied improvement,removal,demolition.or construction of an addition to any pre building containing at least one but not more than four dwelling units or to structures which are adjacent to ertain exceptions,along with other such residence or building be done by registered contractors,with c requirements. . nrtsv rl o� Estimated cost 00� b Type of Work:J�112�2 o t1� Y Address of Work: ; Owner's Name Date of Application: vet 1 l I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: UNREGISTERED OWNERS PULLING THEIR OWN PERMIT OR DEALING IMPROVEMENT RK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME OR GUARANTY ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as a agent of the n Contractor Name Registration No. Date OR Date Owner's Name q:forms:Affidav:rev-070601 The Commonwealth of Massachusetts ==` = Department of Industrial Accidents aNce o/%st/ast/oas - 600 Washington Street 4ti;> Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit name location- r;[J'7- city 'Dz2m�r V LUG '�� ���L�- phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worker in a>1v acity I am an em 1 er roviding workers'compensation for my employees working,on this job. ❑ P o3' P COpBn aid `<>:;':''.:>. :«' >>:'`:`> — � Finne i , atV 6 r v r Rom- ::3i:�:�:�:::�:Y::?:� :c::i:�:� :c :::::���°�"+�:::�:::�:�i:v::�:� :�^i'a:'�:;?;�i:�::;�i:i;::;;�i:�::�:�::�ii:;;:::::�i:�::::�::;:::::::•:,•':�:;:"::::i;; �::-:�:::::::::':�:�:;::::�:�:: knsurance co:.: - 1 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followingworkers'compensation polices: .............................::::::::::::::.:::::.:::.;:.:-;;;;::;.:.:.;:.;;:;.:.:.:.:.:.:.;:.:.;:.;;:.:;.;:.::.:.;::.:;.:::.::.:.:.:.;;:;.> «:»> ..............: : �Y''name:;:`:" ` '+' ' ::: ::=' �; ':%: : r :: '•' :;:: 5::::::::>:;: :::`:;'>;::;:`::<.::::<;:;:;:+ ::':`:::::::::: ;;::2::::::;:::+::::...... :::: :;: ciiaban >..:>: :.........:.:....:.. 1 � mot„ Q•::�: iI:->::`;:y:::<::::::::+:�::`.:�:::::�::i:$:�:�:::;:;}:::;:::::�:�:�i>::::::::;;::::::%:�i_2:':i::::::;:::ter_•+';:i:�5:%;.`•�:::%'. env _.... :'tidies`a ci :::«: bit ::.......................... ............. ..............................................::::::::.�:::::::::::..........,:•. ::::::::ax>.......... •r:;•:::;•::;•:::;.>::::>:<.:<.>:-:>:•;:•. ..:.. .:: ME ll/'. Fai>n2e to sees coverage as required under Section 25A of MGL 152 can lead to the imposition of erfadnai penaltin of a fine up to S1,S00.00 and/or m one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I underst2nd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriIIatioa I do hereby c the pains penalties of perjury that-the-information provided above is tn.and correct Signature Date a 1 D-k Print name Phone# L1-P)s2--k official use only do not write in this area to be completed by city or town official sty or town: permit/license w []Building Department ❑Licensing Board ❑checkif immediate response is requited ❑Selectmen's Office ❑Health Department contact person: phone q; L ❑Other Um m 9195 PLy Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal en ', an'o ro or eceiver or or the foregoing engaged in a court enterpnse, and including the legal representatives of a deceasedemployer, trustee of an individual. partnership, association or other legal entity, employing employees. However the owner a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. . MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance who has of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been Presented to the contracting authority. PRI Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate-of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and or town that the application for the permit or license is date the affidavit. The affidavit should be returned to the city the slaw"or if you being requested, not the Department of Industrial Accidents. Should you have any questions regarding are required to obtain a workers'.compensation policy,please call the Department at the number listed below. /W' City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the p ermit/licease number which will be used as a reference cumber: The affidavits may be retnmed i^ the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE iF square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftt >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square.feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00 (number). Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) • Permit Fee V projcost f 710 CMR Appema! TablaJ3=b(eoedaa aa ed) 1'rtseriptive pack go for One d Te- wFamdy Reddaadd Saddler 940W with Food Fads MAXIMUM IYmY NUM ling Gla=g Gunng Ceiling I Will Floor Haaemms Slab = EMc Am (%) U-value 1t value' R-valuo' Rrvaiue? Wall Flsa�a �'°�=`°t Padcaa_e Rwabm? &valaar S101 to 6600 Headoa De6eee Dad Q I2% 0.40 3E 13 19 10 6 Normal R 12% 032 30 19 19 10 6 1 Normal 9 12% 0.30 3E 13 19 t0• 6 SS AFUE T 15% 036 3E 13 ZS WA NIA NormalNormal U. IS•/. 0." 3E 19 19 10 6 Normal V !S'/• FUE 0.44 3E 13 25 WA WA A FUE W 15% 0.52 30 19 19 10 6 ES Normal X 19% 032 3E 13 25 WA WA Norrmal Y 19% 0.42 3E 19 25 WA WA Normal Z 18% 0.42 3E 13 19 to 6 90 AFUE AA 1E9/0 030 30 19 19 10 6 90AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DE I U IINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. I BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a i 780 CMR Appendix J _ Footnotes to Table J5.2.1b: a of the glazing f the are assemblies (including sliding-glass doors, skylights, and �� Glazing area is the ratio o basement windows if located f walls that enclose conditioned space,but excluding opaque doors)to the gross wall glazing area may excluded from the U-value requirement. area, expressed as a percentage. Up to 1%of the total For example,3 fl of decorative.glass may be excluded from a building design with 300 ft of glazing area. = After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values.do not assume a raised or oversized trt ss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. f used Do not include 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing(t� )• exterior siding, structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. S The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. Tl:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mer: the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned bz.,ements must be included with the other glazing. Basement.doors must meet the door U-value requirement d-scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment,the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.la NOTES: a)Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. .3.Door Uen -vvalues l the mustb doorU tested and documented by the manufacturer in accordance with the NFRC test pm in Table J 1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 i� � omz/rrzorzca /�aaaczc�iccaetld :`.t { 5: #i BOARD OF BUILDING REGULATIONS ! �Llcense: CONSTRUCTION SUPERVISOR Number:-.',CS, 043556 tf . �2/1.3/.j9f2 Expires;.12/13/2002 Tr.no: 4782 Restricted To:'00 SCOTT E CROSBY-. i 62 CROSBY CIR OSTERVILLE, MA 02655 Administrator I ✓die �anrmearuuea� a�,%`la:iorzc�uaeCla Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:"l31378 Expiration: 07/13/2002 Type: PEACOCK&CROSBY BUILDERS, SCOTT CROSBY 1112 MAIN STREET UNIT 7 yam- OSTERVILLE,MA 02655 Adutiuistrator I BOISE CASCADE-BC CALL'" 2001 DESIGN REPORT-US Wednesday,February 06,2002 15:53' Double - 1 ,3144' x 16,' V-L SP 2900 Fits Name: Untitled Job Name Ted Bellen rath 9 Customer - Scott Crosby Address - Seaview Ave. .Specifier - Rick Lowe City,State,Zip- Osterville,Ma. Designer Rick Lowe Code.Reports -. ICBO 5512,BOCA 98-52,S13CC1 g852 -MCA Pony. _ 8otelb Lumber Co.Inc. ....... .. ..I Standard load-ao PSF I,?5 PSF ,Tributary oe-03.o0 r... �......_ -. 7_._.. -1n„ so "31/2 43 Ibs LL 51 34;Ibs DL 3054 Ibs LL JJJ.. Total Horizontal Length:15.O0 -2997ibs�L B 0 General Data Load Summary Version: US Imperial ID Description Load'lype -Ref- Start End Live Dead Trib. Our. S Standard Unf.Area Load Leff 00-00-00 15.08-00 40 PSF 15 PSF 06-03-00 1t10 Member Type: - Floor seam 1 deling joist 1st floor UnUln.Load Left 00-00.00 15.06 00 40 Pt.F 15 PLF Na 100 Number of,Spans - 1 2 2nd.floor wall Unf•Lln.Load Left 00-00-00 15.06_00 0 PLF 60 PLF n/a 100 Left Cantilever - No 3 roof toed Unf.Lin.Load Left 00-00-00 00-00-00 157 PLF 125 PLF n/a 115 Right Cantilever - No 4 roof beam load Conr-Pt.'Load Left -08-00_00 08-00.00 2109 Ibs 2386 tbs nla 100 Slope 0/12 5 cieling joist 2nd.floor Unf.Lin.Load Left 00-00-00 15-M-00 25 PLF 10 PLF Na 100 Tributary 06-03-00 Cole Summary Repetitive Na Control Type Value %Allowable Duration Loadcase Spin Location Construction Type n/a Moment 34619 It-Ibs 99.0% Q 100% 7 1-Internal End Shear 8020 lbs 55.6% @ 115% 2 1_Left Live-Load 40 PSF Total Deflection L1305(0.609") 78.6% 3 1 Dead Load 15 PSF Live Deflection U556(0.334") 64.7% 3 1 Part Load 0 PSF Max.Defl. '0--SW(limit 1") 60:9% 3 1 Duration 100 Span/Depth 11.6 1 Disclosure The completeness and accuracy of 80arinq Suaoorts the input moat be verified by anyone Name Type Dim.(L x W) Value %Allowed Case Material who would rely on the output as 80 evidence of sw7abllfty fora Post 3 1/2"x 3 1/2° 77971bs 79.69'0 3 pertiwlar application. The output $1 Post 3-1/2"x 3-li'2" 6851 Ibs 69.9% 3 Hem-Fir above is based upon building code-accepted design properties and analysis methods. Installation NOTES: of Boise Cascade engineered wood Design meets Code minimum(U240)Total load deflection criteria. Products must be In aceordanoe Design meets Code minimum(U360)Live load deflection criteria. with the current Installation-Guide Deslgnmeets arbitrary(11 Maximumload deflection criteria. and the applicable building codes. To obtain an Installation Guide or if you-have any questions.please call (800)232.0788 before beginning Product installation, Paj3e 1 of 1 SCID and Versa-Lam®are registered trademarks of Boise Cascade Corp. 10 'd 969ZLL090S 3380 0113108 Wd LMO 03M ZOOZ-90-83A W V^_ krXWEN _ PDT QEsk• i e)5E S ri —- _ .. �...._ YI N- ------------ iAs�>;wAa.1- his -- �" REUSE DOCK LAUN DRY Reu$F-WINOOwS � 1 1 1 l TOc, " NH-LLINGRA7H t. 24.02 Assessor's offioe (1st floor): ? oFtN¢ry Assessor's map and lot number ........�. ! i�2/ ......... Board of Health Ord floor): Sewage Permnumbee ...... ��. .L ..^ ,..w:...�.�............ ` t 3AS39TGDLL. : Engineering Department (3rd floor): moo rb3a• House number .............................��.....als........!/[. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00,;,200'rP.M. only w TOWN OF BARNSTABLE BUILDING INSPECTOR �z�� <>� GJi !� Cis�ev 4 1 �- APPLICATION FOR PERMIT TO .. ...... .....Cf'................/.�.��..........�............................................:.�:....................... M' TYPE OF CONSTRUCTION .....Cd4a0,........ ........................................................................... 47 2 .a; .............................03.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies �fforr�a permit acc'oirding to the following information: Location .. > .........I r' : �. ..!.9.y.....C�_.0. ,.....+................................................................................................. ProposedUse ................ ..........T./41 'd..,..... "fmS...................................................................................... -Zoning District ...............6....... .............Fire District ��/ /................................ ................ ....... .......... ....................................... Name of Owner 7.,... �-=. � .:............Address Name of Builder ..... U /. ..'�. ��.... 4 ./.................................. ��"!:..Address .�. _...... .................... Name of ArchitectL/: 5. . .(rn!"!16!11 ...Address ..••� �.... Ytl.� ! a"i ..!�-��. ,........ ..' , � ' Number of Rooms .......''",.---...Nlllcol'N f.............Foundation .r-........./W a.!!l K.`./....�... ..4:....:.. Exterior ..............""' / /./- ..1�...-......< �. ................Roofing ..........---....... ...0 IN / Floors Interior :./ off ,�,�1 Paw ......................... `... ................ Heating .............. ...:....................................................Plumbing ........... .,, Fireplace ,.�04`'�f"`.� ..........................................Approximate Cost ............� .. .� _ f u... Definitive Plan Approved by Planning'Board ________________________________19________ . Area ..................,...... Diagram of Lot and Building with Dimensions Fee �D�......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH uv 4 5�t i t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of ,Barnstable regarding the above construction. 4e Name ........... ........... ............ Construction Supervisor's Licensef.:.....Via... ... ........ i T. BELLINGGRATH F, 138-017 al t T No 31515 Permit for ..Replace,.W, ,Rdow & Add Chimney Single Family DwQ.1.I.in.g.......... Location .....215...Se,aview...4:VQ 3LiS�............. ..................Os ter.....l le.................................. Owner ...... ...... el.li. g?a4th....................... Type of Construction .....F.r.aIT e........................ ............................................................................... Plot ............................ Lot '................................ Permit Gran`ed ....December 18 87 ........................r.....19 Date of Inspection ....................................19 Date Completed ......................................19 V/Uv a /� AVa ` t� Assessor's offioe (1st floor): �. Assessor's map and lot number ........ . .......... a �+ ate'' .. ♦` Board of Health (3rd floor): SY 67f,.M Sewage Permit number ......IOZ."..1. ..^.g7...� ....................I c�.r�-%a, - Gi�`1 Co�,r8s�� \ +; t E,• HAHl4YODLL, • Engineering Department (3rd floor): / �g ��6'� �B�A-� rasa House number . . . . . . . . �j fig ��ee E� °o �6}9• Lai APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only?{j�`�4 RECIULAT ��" ' TOWN OF BARNSTABLE BUILDING hNSPECTOR a , APPLICATION FOR PERMIT TO ../�. P.� -:. �/�//��'`J.... .... !.....e1' �17!tN����..�".............. TYPE OF. CONSTRUCTION ....W. ........ A7✓J<!I ........................................................................... ...... ........................19B..� TO- THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a rpermit according to the following information: Location .. � .W..........:t' .I.....r................................................................................................. ProposedUse ................v./Ill. . ......... / 9.......��'i�s�.,................................................................................... Zoning District 4 ...........................................Fire District Ll:�S/AW Name of Owner ../.e...fLy.... T ...............Address 4/� S`� V iv .......................................!.... ....... ..I................ Name of Builder ...4IF ....., a2> .5..+. Q. ...Address .� �`� J Name of Architect equix, � �?"! � `1. .Address ..�a6��...., /'1�1./�r .. �:.......CT Number of Rooms ....... -N.. � L.............Foundation .. `....... ...Q....... ...�..,... ,...:.. Exterior "'�441..—......Y.'. ...........Roofing ..... ....W...QA /r.. ......,. Floors ....... ......t...........................................................Interior ............ .. .. ..... .. ... ... Heating ..............!•Y•. ..r....................................................Plumbing ........... ............................�...)......................... Fireplace .1..�.. . `�.............................................Approximate Cost............. .. . Definitive Plan Approved by Planning Board ________________________________19-------- . Area �-14L...... Diagram of Lot and Building with Dimensions Fee �a............................ SUBJECT TO APPROV L OF BOARD OF HEALTH • fi-fa� � 1 ^,n`; L OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable regarding the above construction. //�� Name ....... el.. ............ ........... .. �................. Construction Supervisor's License .01er.9-so'l........ T. BELLINGRATH No ...31515. Permit for ......Replace Windbw Add Chimney ...................... SinSificre l Family..P��i�ing......... gle..................... ..... Location .....2.15- Seaview Avenue .......................................................... Osterville ............................................................................... Owner ...T. Belli n. ........................... ....................... Type -of.Construction .....F..... ..ra.m.e........................ .. .. .................... Plot ............................. Lot ................................ Permit Granted .......D.e.c.e.i.nb.e.r...1.8.,..19 87 Date of Inspection ............... ........19 Date Completecl ................77 .........19 `f i t TOWN OF BARNSTABLE U C m — 1013 FEB 15 P11 .1 q8 Butler's Pantry DIVISIOIN 71_611 X 91_711 1 Powder Room 3'-11" x 11'-6" — — — /0 ;b DN 7r UP e F DNV L J 111 Kitchen / Dining Area Sitting Area 9'-2" x 20'-011 15'-1 If x 14'-511 Red- — — O. 0 — = O E�f ® W D Closet 4'-9" x 12'-T tdo UP Shower — Lundry Rc om7 9t11 " x 15 -2 0 Fenced Yard Workbench — C+oset- — 1� 11 (D 16 -3 x19 -6 UP r T4y4-e E0%4id D"+ DATE: 09 January, 2013 Bolton , MA -b. Marchese, KriAtchen SCALE: 1/4" = 1'-0" Sunroom 9'-211 x 38'-2" Family Room 14'=0" x 24'-3" Porch 10'-6" x 41-811 Terrace DN .0" x 16'-2" Porch .321-511 x 91-611 Foyer Dining Room UP y 14'-1 if x 18'-2" 18'-2" x 14'-3" Closet t DATE: 09 January, 2013 Bolton , MA Marchese, LR EX SCALE: 1/4 V-0" 2 4 Dressing Area 51_811 x 81_8 11 Master Bedroom Master 14'-0" x 22'-6" Bath . �. DO81_011.x 11 6 -4 U _ £-+ose� _ Bath 7,_o„ C—Fos 5'-5" DN Closet closet Bedroom 14'-2" x 10'-9" Bedroom 4 12'-0" x 13'-8" + UP ! r, _ki_ �'/'��� ���� • � � DATE:15 January, 2013 Bolton , MA Marchese Master EX SCALE: 1/4" = 1'-0" , a i D 0- I� 11 0 = 00 - - X� 0 - - - - - - - x CO .� (U o O 0 WN X n o X 0 � p z 0 p (D w3 00 0. D y Closet � 0 Cn x 0 I O0 (D I w � I � I Third Floor Plan Ceiling Height = 7'-311 T DATE:10 January, 2013 Bolton , MA Marchese Residence SCALE: 1/4 -1 -0 { L ` / n Game I V I n� Ro o I 1{�y�1/D i I n I i I e Room Table Bench/Table — — — — — — — — — — - - - - - - - - - - - - - - - - Game5t-Book5 0 o m I o t CZ 0 0 m Terrace DN 13'-0" x 16'-211 { T4 4---t &"b d N4, DATE: 15 January, 2013 Bolton , MA � `�` Marchese' Residence SCALE: 1/4" -1 5 t U C Lk Wine m Ref 18" DW o Pantry 0 - - - � Powder Room Ice � 3 -11 x11 -6 TV Stand • 130 Ref =5helve.5 I-- I DW ink cabol °I I I trash Kitchen 30"Wall O 00 Magic Ovens 000 OO II Corner i tdo Closet Shower — Laundry Rom 9'- 1 '' x 1 �-2 ICU L Fenced Yard c 0 Workbench — 40se� — 16'-3" x 19'-6" UP Garden'Sled DATE: 15 2013 January, Bolton , MA, Marchese Residence SCALE: 1/4" -1' 6 Master Bedroom New Porch Size TBD Full Height Doors- No Top a o Casing, Top and Bottom Hinge Soaking Tub i o OO Storage N W/D Hook up N O t o s W/Dl ' � F n Shelves . m � DN Drawers/ Closet Low flanging Kathy's Closet i Shelves Bedroom n �%��'✓1�1.C� DATE: 15 January, 2013 Bolton , MA Marchese Residence SCALE: 1/4 =1 -0