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0160 SETH GOODSPEED'S WAY
1�L sell-) 6D14)F-ff1 ,y la A b .� a §. 4: F. �_ �, �� � ., FF�: F- 4 V �. � ,. - _ V i Fp - - [Y' I, � � �. f� o - - j. F `} .. � - _ 4. �. ,. � �> ° �;�. a �, e .� _ - _o L o F _ a - � _ - _. _ t - _ _. _ G - __ _ _ - - _ � _- _ -� . .. _ -. _ - - o - _ '� _c a _ _ a _ � - - _ -, __ � �` - __ � 1. .. - a- - _ - .� � s- - - a _ _ - � v' Town of Barnstable *Permit �622ED Expires 6 m nths from issue date Regulatory Services Fee aAartsrABM II MAM Thomas F.Geiler,Director 039. Building Division Tom Perry,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 7 / Not Valid without Red X-Press Imprint Map/parcel Number -7rp7 r( ff •� f I Property Address 1�D y S l�aa�s�xr� /VG�l O T c rj�,O G , kA dr �]Residential Value of Work �I I`InleS< 1O% Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J�'A" bi�eco�<<e I kA O>(,S-r Contractor's Name y;r\c e✓�Vv`G r o Telephone Number_ (50q ) -)q Z Home Improvement Contractor License#(if applicable) (o U C(C I Construction Supervisor's License#(if applicable) CS o'1\"„ M a C n a ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor APR 10 2013 ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Co `< kA'1�6\ 10—7 N o 3S1 a 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 #of doors Replacement Windows/doors/sliders.U-Value 0 (maximum.35)#of windows 16 ❑ 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 required. SIGNATURE: C:\Users\decollik\WppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 The Commonwealth of Massadtusetts Deparhnent of Industrial Accidents 'Office of Investigations 600 Washington Street Boston,MA 02111 wwry ntass.gov/dia Workers' Compensation Insurance Affidavit-Builders/ContractorslElectricians/Plumbers Applicant Information Please Print Leably Name(Businessiownizationitndividaal): I' aors, e- L,,, e Address: , I61-u ,<-S�. City/State/Zip: oX5-S-{ Phone ?%et--05 Go Are you an employer?Check the appropriate box: T project general contractor and I �e of Iecte P ( ��� 1. I am a employer with /3 O 4. ❑ I am a g 6 New construction employees(full and(or part-time)s have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 14 Remodeling ship and have no employees These sub-contractors have S. 0 Demolition w for mein an capacity. employees and have workers' orlcing Y � t3'• I 9. ❑Building addition [No workers'camp.insurance comp•insurance required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3111 am a homeowner doing all worts officers have exercised their I L❑Plumbing repairs or additions myself[No workers'comp right of exemption per MGL 12.[_1 Roof repairs insurance required]I c.152,§1(4),and we have no employees.[No worms' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 roast also fill out the section below showing their workers'co®pensationpolicy information. I Homeowners who submit this afiidat-t indicating they are doing all work and than hire outside contractors test submit a new affidavit indicating sack_ tConnactors that check this bus must attached an additional sheet showmg the time of the snb-contractors and state whether or not those entities have employees. If the subcontractors Dave employees,they most provide their trarkers'comp.policy number. I ant an etnploy'er Biat is prmzding taorkers'eonipensadoii irtsnranee for my employees. Below is the policy and job site information. Insurance Company Name: ,+ 1 ro.v L,e s nS 4 rG••c e Policy#or Self-ins.Lie.4: (p `�u 1�C9 to 0 5-� Expiration Date: 1 t 3 Job Site Address: Citv/StatelZip: 054 r✓r((, 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 S250.00 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 an tlr pains and penalties of pe►ynry that the information provided above is Mte and correct Sitmature: Date: 11 oZ ILI Phone#: Official use only. Do not write in this area,to be completed by city or town of eiaL City or Town: PermitUcense N 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 9: 3/8/2013 8:36:06 AM PST (GMT-8) FROM: 100005-TO: 15087716279 Page: 2 of 2 Rv® CERTIFICATE OF LIABILITY INSURANCE DAT31812 DMTYI) 013 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. H SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER Risk Strategies Company, co E•Clyistine Watson 15 Pacella Park Drive Suite 240 PHONE c e Randolph, MA 02368 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 9 risk-Strat ies.com NSURERA: INSURED INSURERB: Travelers Marine Lumber Operator,Inc. DBA Marine Lumber Co., Inc. INSURERC: 134 Orange Street NSURERD: Nantuckef MA 02554 NSURERE• INSURER COVERAGES CERTIFICATE NUMBER: 15686723 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. ID6R DLSUSR TYPE OF INSURANCE POLICY NUMBER MM/DDYEFF OLICTV�DIY IJIHITS LTR A GENERALLNABILITY 7140075780000 8/22/2012 6/30/2013 EACH OCCURRENCE $ 1000000 ✓ COMMERCIAL GENERAL LIABILITY RE I9 o a occur ed $ 50000 CLANS-MADE �OCCUR MEDEXP(An one non $ 5000 PERSONAL iADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG f 2000000 POLICYF—J PRO ✓ LOC $ A AuroMOBtLE LIABILITY ADN-8739221 8/22/2012 6/30/2013 Wa a I t i 1000000 ✓ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ✓ HIRED AUTOS ,/ AUTAUTOS O WINED Pe0eed ant G $ $ A U1"RELLA UAB ✓ DER 7140075780000 8/2=W 2 6/30/2013 EACH OCCURRENCE $ 10,000,00 EXCESS LAB CLAIMS.MADE AGGREGATE $ 10,000 000 DED RETENTION$ , $ S S B WORKERS COMPENSATION 6KUB0167N03512 12/18/2012 12/18/2013 ✓ oD M s �• AND EMPLOYERVUABIUTY YIN ANY PROPROTOR/PARTNERIEXECUTNE E.L EACH ACCIDENT ; 500000 OFFICER/MEMBER EXCLUDED? ❑N NIA (Mandatory in NH) E.L DISEASE•EA EMPLOYEEI$ 500.000 If es•deseraeunder DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarl[s Schedule,U more apace Is required) Certificate Holder Is additional Insured where required by written contract or agreement CERTIFICATE HODE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marvin Design.Gallery THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Bernard Gitlin �'V►� _- 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CE[tT NO.r 11606723 CLIENT CODE: MAAIN-2 Christine Matson 3/6/2013 0:32:36 AM Page 1 or 1 V 1 oo I ` Massachusetts -Department of Public Safety �✓ Board of Building Regulations and Standards Construction Supervisor License:CS-091884 �F.I...I.., VINCENT J 1VIARO 58 LIBERTY LAA MARSTONS MIII.S Expiration commissioner 01/24/2015 r ' Office:of Cogsumer ei[fairs&Suess Re utation g )(aten;ie oY reg�stratibn valydtfor indrvitinl use only OME IMAROWMENT CONrRl1GYOR` ;_ before the eapir lion dale. If fougd retulrn to: i i R .- Utfice afiCpnsumer Atf`a�rs pit�'$t sisides kt ulatlon is eg�strdtion r � 1' ;\ Typ g. !� s Explra f OR W: r SupplefrlenI rd i MARINE LUMBl± Fg $ .Boston,MAtOZ116 t t t 1 `:. °�IVANTUCIEET.MA�t)35� _ ��•K i.:...: ...,,.;.:,..,:.....�.: ...:..::,.: der 1 Un 2cretary �1�. �tof-V 13dwtthouEsignature:8 i. f MARVIN DESIGN GALLERY a complete window and door showroom by MHC Permit Authorization as Owner o f the subject . property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located,at 134 Orange St., Nantucket, MA and hereby authorize V,. ar. o to act on my behalf, in all matters relative to work authorized by this building permit application for: 60 l '0A% PA lAL' MA (Address of J ) 3 -zo-1.3 Sig ature of Ow er Date Print Name 73 Falmouth Road Hyannis,.MA026011(508)771-62781(508)771-6279(Fax) wwwmarvindesignga'llerybymhc.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map / Parcel �� Application # 613 Q a� Health Division Date Issued Ll Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address O Village 05—M12A) I u-E Owner �N�iPtN 5l N &UF� Address (b S R,Tnt rrozilbsf�t,` �L Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I &0b Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suianorting dQgumefi ation. H O �' •s Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King ghway: Yes ❑ No; Z-1 N rA 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 6 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: 7 Wing lo Board of Appeals Authorization ❑ ❑Appeal # Recorded mmercial ❑Yes ❑ No If p ,es site Ian review# Y Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameDZ. `v`C- ��y Telephone Number Address 9-0 Y_T� (Z D License # f D(UTI !S�N IC,4 AA b?15 US Home Improvement Contractor# ri t 2 S 1 Worker's Compensation # LA1 G _7 q� 66139 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `6 OU" SIGNATURE DATE Ir3 I; R s FOR OFFICIAL USE ONLY !' APPLICATION# DATE ISSUED MAP/PARCEL NO. '.2 ADDRESS VILLAGE S OWNER DATE OF INSPECTION: FOUNDATION t FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f OWNER AUTHORIZATION FORM 1, .�noel�.cM-, �►�e,� , (Owner' ame) owner of the property located at 1 0 Sekk GooJ'Gre-ej WU , (Property Address) Cs+e-v-v-,' o e,,, M A D a 655 (Property Address) C1 rage V 1 1 hereby authorize 10 (Subcontractor) -17 j an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. a/k, ryL �' Kown&hs igna ure i -O-L X Date l i CONSENE-01 MVAUGHAN CERTIFICATE OF LIABILITY INSURANCE 1 °A'3/261228/2 013 THIS CERTIFICATE 18 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: H the certificate holder Is an ADDITIONAL INSURED,the POUCy(ieS)must be endorsed. If SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy,certain Policies may require on endorsement. A statement on this Certificate dose not confer rights to the certiftcate holder In lieu of such sndorsemen s PRDOUCeR ,?MT Strategic Business Unit Romrs 6 Gray Ins.-Dennis Branch PHONE 608 398-7980 43f Rte 134 "AR N 677 816.2156 South Dennis,MA 02060 . INSURER AFFORDING COVERAGE NAIL e INSURER A:SeleCtlVO Ins.Co.of the Southeast INSURED • INSURER e- Con-Serve Energy,Inc. INSURERO: dba ConserVislon Energy 60l Main SL wSURER D: Hyannis.MA 02601 INSURER E: INSURERF• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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,LWWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR Tim rINSUIUINCE PgJCYNWISEiT M LIMITS GFWJMUMNM EACH OCCURRENCE a 1,000,000 A X CoMMERCMLGENERALLwwTY S2011299 NMO13 3/14/2014 E, $ 100,0 LIED EXP am eonl i 10,00 PERSONAL a ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 3,000,00 GENlLA613REBATEUMNTAPEUESPEFt PRODUCM-COMPIORAGG S 3,000, X1 PM= LOC s Nurrorasr?uAeaJrtr Ea aoaaen s ANYAUTO aODR.YINJURY(PWP"W) S AUTOS HIREOVWKED D 0AUTOS BDDSY INJURY(Psreoddent) S AUrOS �OSS p R S S UlleitEllA LIAR OCCUR EACH OCCURRENCE S 8=63UAB HCLAIM AGGREGATE S OED F I RAN SS MVObUR I COYIEIIIATION A O ANDeNRAYE--UAaaJTY A A "lummitpor RTNERJ&N�Ct1iNEYNN NY C7956639 3H4)2013 3/1412014 E.L.EACHACCIDENT S 600,0 OFPICEWUES�tEXCLUDED? a NIA a 91=11dwyhl" E.L DISEASE-EAENFLOYE S 600100 OE�ERAaONSOdIw ELOISFASSE-POLICYUMIT S 600,000I CESCRIPIM OF OPMUONe ILOrAlIONS I v 39CLES(Amra ACORD Ie6 AddMwwN Romm SchWus%s am*spats I,,spisc* CLUDED OFFICERS UNDER M)RKERS COMPENSATION CONOR 8 COURTNEY MCINERNEY"NOTE THAT BLANKET ADDITIONAL INSURED COVERAGE APPLIES TO THE COMINERCIAL GENERAL LIABILITY(IF A WRITTEN CONTRACT 13 IN PLACE(. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rise Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rise Elmwood Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,R102910 AUINORirED REPRESENTATIVE m 1988.2010 ACORD CORPORATION. All rights reserved. ^CORD 26(2010105) The ACORD nanw and logo are registered marks of ACORD i i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents - Office of Investigadons 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bus►ness/Organization/ludividual):Con-Serve Energy,Inc dba ConserVision Energy Address:376 Route 130 City/State/Zip:Sandwich, Ma 02563 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ 1 am a employer with 8 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* 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.❑ 1 am a homeowner doing all work officers have exercised their l l.❑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 13. ✓❑Other Weatherization 2013 employees. [No workers comp. insurance required.] *Any applicant that checks box#I 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. tContmctors 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:Selective Insurance Co.of the SouthEast Policy#or Self-ins.Lic.#:WC7956539 Expiration Date:3/14/2014 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required trader 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties o er'u that the information provided above is true and correct Si nattue: 1 Date ?J 2 2013 Phone#:508-833-8384 Ojjrcial use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CSS1_-102778. CONOR D MCINERNEY 39 SIASCONSET.DRIVE SAGAMORE BEACH MA 02562 08/19/2014 Ofrrice'of Consumer A(fairs&Business Regulation y z HOME IMPROVEMENT CONTRACTOR r,_•=__= Registration: 171251 Type: EzpiraGon: 3/1/2014 Partnership CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH.MA 02563 Undersecretary License or registration valid for.individul use only before the expiration date. If found return to: Office of Consumer.Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature. J Town of Barnstable *Permit# C3006 so /$ Expires 6 mon(hs from issue date Regulatory Services Fee , , aD Thomas F. Geiler,Director PERMIT Building Div' ' Es Tom Perry,CBO, Building Commiss 200 Main Street,Hyannis,MA 0A6 1 www.town.barnstable.ma.us F BARNSTABLE Office: 508-862-4038 TOWN O Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Imprint Map/parcel Number Property Address I V" w (a q 1 I I [Residential Value of Work4D, 0 U V n Minimum ee of$25.00 for work under$6000.00 Owner's Name&Address '` I6LLrM ` 1���5 •��y(� �(fin Contractor's Name v Telephone Number Iq -"1_JV Home Improvement Contractor License#(if a licable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che one: KrI am a sole proprietor ❑ I am the Homeowner x. ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) VRe-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maxiinum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope Owner must sign Property Owner Letter of Permission. H e rov n ontractors License is required. SIGNATURE: ' Q:Forms:expmtrg Revise071405 Town of Barnstable Regulatory Services EMWTABLF, v� MASS.. `� Thomas F.Geiler,Director 1639 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 bust Complete and Sign This Section If Using .A Builder I as Owner of the subject property hereby authorize a lid 1 l,� to act on my behalf, in all matters relative to work authorized by this building permit application for. �fU (Address o Job) ' Signature of Owner Date Makrun Print Name n Q:FORMS:O WNERPERMISSION The Commonwealth of'Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L,egiblY Name (Business/Organization/Individual): Address: 00 City/State/Zip: Iv ► 04U O � Phone#: � -1 � � `'�� Are you an employer? heck the-appropriate box: 'Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I �mployees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑'Building addition [No workers' Comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10•❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12,E] Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13•❑ Other *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 affi such tContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'camp.policy davit indicatininfg ng'sun. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up 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. l do hereb certify un the p ins a d penalties of perjury that the information provided bo'e is true and correct Si afore: f [ Date: Phone#: q 0 ` '"� 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6. Other Contact Person, Phone#: { L Board of Building g Regulations and Standards HOME IIHpOV Re is E CONTRACTOR License or registration valid for individul use only before the expiration date. Eon . i 00 Board of Buildia If found return to: g Regulations and Standards One Ashburton Place iWdual ' Rm 1301 Boston ames Curley — i ,Ma.02108 I- Imes Curley t'�'�' 17 Fuller Rd. �,� � mterville,MA 02632 5.. Administrator Not valid without signa re I I ' I , . g O t I L'VID� rq, Town of Barnstable *Permit# �DO& oa0 Expires 6 n.ionthsftom issue date NI Regulatory Services Fea_,�E MAE& Thomas F.Geiler,Director Building Division X-PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 "Q C T 2 ® 2006 www.town.barnstable.ma.us V Office: 508-862-4038 TOWfWFOBARNSDABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ❑Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address lJ \�Contractor's NaTelephone, Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U-Value (maximum .44) *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. ome Improvement Contractors License is required. 0 SIGNATURE: Q:Forms:expmtrg Revise071405 l_ C The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street U, Boston,MA 02111 f z, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,—, Please Print Legibly Name (Business/Organization/individual): Address: Zz� Q City/State/ ip: /1 ��, J Phone #: �U Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t �` Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3 VI am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.[J Roof repairs insurance required.] t 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 sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up 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 pains and penalties of perjury that the information provided above is true and correct. "Si aturer — Date: 0 G 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#: t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / 7-Z Parcel oqs- Permit# Wfl 3 f <�' " iTf,BLE 0 Health Division - ._ 'oG /����� Date Issued � � Conservation Division 2 J.. N _ j ,' 10. 2 j Application Fee ' Tax Collector A, Permit Fee TreasurerDIVISION I � ` Planning Dept. C T M Date Definitive Plan Approved by Planning Board JD-OKH Preservation/Hyannis LIMITED TO #OF BEDROOMS I Project Street Address 160 ski (94IZ91) S P ',S k/A y Village 05—rt—V_V/L 1 ,E' Owner /1Al]8EF iJ C`_ C/_'VEN Address 3Z4 M4E SB-b01F Da • L.L� Telephone -6 8' 4 Z? ! Permit,Request 1 eii' �'v Square feet: 1st floor: existing IZ6 proposed 1-46Q 2nd floor: existing 6qZ proposed 697- Total new /ate Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 5-l� Lot Size 0. 3 5 Az k0_IIE-5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) ' Age of Existing Structure 77 YEA-eS Historic House: ❑Yes YNo On Old King's Highway: ❑Yes YNo Basement Type: 2 Full ❑Crawl ❑Walkout Cil(Other -50Lkf14 CA-D Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 4$4 Number of Baths: Full: existing Z new Z Half:existing O new / Number of Bedrooms: existing :3 new Total Room Count(not including baths): existing "7 new `7 First Floor Room Count Heat Type and Fuel: ❑Gas & iI Q Electric ❑Other Central Air: 2Yes ❑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:C(existing ❑new size ZCAP-Shed:C(existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes YNo If yes,site plan review# Current Use Q tD z; Proposed Use e65 i bEkIZ6 UILDER IN ORMATION , } GT�lephone Number S"0d'_ 3e-O- y161(y Addres ense-# �1cS ,�o7 / 0Z-6 Home Improvement Contractor# /.2902!f Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 55.E and SIGNATURE DATE / h6/_Q ' !'��� C1. UA dvAiJ FOR OFFICIAL USE ONLY 3 PERMIT NO. :_DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - r a DATE OF INSPECTION: FOUNDATION ® �22IGK FRAME f I••I 6 2— O INSULATION FIREPLACE • 2; ELECTRICAL: ROUGH FINAL,co " PLUMBING: ROUGH F- FINAL ,- GAS: ROUGH +. FINAL rh cr FINAL BUILDING ►�- ';� > sir DATE CLOSED OUT r 9 r�- ASSOCIATION PLAN:•NO. aco 7$0 CMR Appwxfix J Table J=lb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM MINIMUM I• �Heatin Coolie Glazing Glazing Ceiling Wall Floor Basement Stab 8 Area,C/o U-value= R-value' R value' R-value° w� Perimeter Equipment EfEiciency' Package I R-value° R valuc 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Nomud R 12% 0.52 30 19 19 10 6 Noffnal S 120/0 0.50 38 13 19 10 6 8S AFUE al T IS% 0.36 38 13 25 N/A N/A Nom U 15% 0.46 38 19 19 10 6 NomW �al V 15% 0.44 38 13 25 N/A N/A 8S AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 25 N/A N/A Normal Y 19% 0.42 38 19 25, N/A N/A Noai Z 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 30 19 19 10 6 m�90 AFUE 1. ADDRESS OF PROPERTY: _ 1,60 S'Fl ��� tJA--/ 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 139�, �/ tc, 3. SQUARE FOOTAGE OF ALL GLAZING: 7� 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table J$.LM I Glazing area is the ratio of the area of the glazing assemblies (including sliding=glass doors, skylights, and basement windows if located in wails that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 fl of'decorative glass may be excluded from a building design with 300 fl of glazing area. 2 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 truss 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, Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include 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 cmwispaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as-above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described 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 J5.2.1a 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. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from.the door U-value in Table J1.5.3b. 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). -Y !b 43., ,. f(HE Town, of Barnstable • y° °� Regulatory Services :3 Thomas F,Geller,Director Building Division • Tom Perry,Building Commissioner" ' 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4038 Fax: 508-790-6230 Permit no. I Date APMAVIT ' ROME 1MPROYEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION M(lt,c,142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversiory -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied buiiding containing at least one but not more than four dwelling units or to structures which are adjacent to • such residence or buildingbe done by registered contractors,with certain exceptions,along with other requirements, • Type of Wo Estim4ted Cost l RUC)o Address of Work: 16 B SZ�A G�D•5 PEID'S UM .�rl�V 1 Owner's Name; /tom V � C • CAAV QJ Date ofApplication;• /d4 IL I hereby certify that: Iteostration is not required for the following reason(s); • []Work excluded bylaw ❑Jdb Linder S l,000 ' a ❑ ding not owner-occupied lZowner pulling own permit Notice fs hereby given that; • OWNERS PULLING MIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME ItOROYEMENT W ORS D 0 NOT HkVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDERPENALTIES OF PERMY I hereby apply for apermit as the agent of the owmer; IO�G/o�! • Date Contractor Name Re4isfzationl�Io. 0 OR Owner's Name i RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition �� Alterations/Renovations 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot— ��'�•.. � • plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&.detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041=. 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 j Relocation/Moving $150.00 (plus above if applicable) Permit Fee Pmojcost n_...nc�nne i °Ft Town of Barnstable Regulatory Services snsxsresie, Thomas F.Geiler,Director 0.19. 6 �0�' 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 HOMEOWNER LICENSE EXEMPTION ' Please Print DATE: JOB LOCATION: ��D SZ:'j}1 (s�8��`� ��� WAY 45'_ /L number street village "HOMEOWNER!':. �Zg!) ' �T°"SZt�d name A ' ,-1 homep/hone# work phone# CURRENTMAIIAVGADDRESS: 3 Z�I IV�c-1= Si-yD�� �j� �'►l L.L.S d�t� 6246.4 5�1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a.one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be responstble for all such work performed under the build in 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 Ieq etneIItS. ft 1 WA Si a 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 ov 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. V • The Commonwealth of Massachusetts Department of Industrial Accidents _ AICO emnawm 600 Finashinpon Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit General Businesses r ///.%%/ •r/� �^-..tit . address: �- \ ii T vhone Ff 60 state work site location fuill address -❑ I an a sole proprietor and have no one Business Type: []Retail[]Restaurant/Bar/Eating Establishment working in any capacity. ❑Office[]Sales(including Real Estate,Antos etc.) ❑I am an em loyer with etn 1 es full& art time). ❑Other ✓i�i�//�% C��mD 5%///n//fo//////Y/��P///// es working on this job. I am as employer providing viA ' r:••: .,.;'r..' • .: ;•'` '' ..�,; 'fir.-... : an name coat _ ,,.�•,.: .. ' ': ;. ; .r:. �, : _ .'•,;� ..',-♦ •� •,��a',.,'i r.. • h address• 4•. :w bone i!•• •;, ; ,;: olio.'.#-.: ' :'%' • <'.';:; j' gffi WMI I am a IN M sole proprietor and have hired the independent contactors listed below who have the following workers' .. comb®sationpolices: Comt ` 'i:+ .,:' ..�_ •r;.•: .n:,pate...: ,•: ... . ' . . 'r',"•' 't:: �.!•�: address' �. ,,,., .. it •„ �� city:. :*. -:�;.{�kr.•;`,'•- •.-t.,.• .,: �� :L;•;i: ' ..♦�- •t. . ...VI: •,-:'r�',.•t .�V�lr.,,'• 1•r. r inaiirence co ; • 01c / /// I// //// %/ :•T n. •r ,Y. ♦ //////� .. cbloVany, Zia _ . '� :,` .• 'honeDO icy #: 17 to of ia can-lead to he osition Failure to secure coverage as required mesltle�tion �i rmhof a STOP'WORK.OtRDERpand a fine of S oo.Oe dlay ngiiwtt me' I und�atand.that pr one years'lmprlsonmeat ss well p copy of this statement may be forwarded to the Office of Investigations of the DIAfor coverage i eriticatioa under thepains d pen I do hereby ce i ties of per ury that the information provided above ts trueand correL �'Signature • M� r \PAP Ph on # b. 2 Print name official we only do not write in this area to be completed by city or town official r permitfucense# ❑Buflding Department city or town: ❑Licensing Board ❑Selectmen's Office check if immediate response is required ❑Health Department , phone#; ❑Other contact person: (}evfeed 9epe 1003) t -- ---r• �,e*32�=tom"• - o Information and Instructions Massachusetts General Laws chapter 152 section 25 requires an employers to provide workers' compensation for their the"law", an employee is defined as every person in the service of another under any contract employees. As quoted from Iie oral or written. F • of hire,express or imp � An employer is dewed as an ndMaual,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 apartrnents and who resides therein,or the occupant of the dwelling house of another who employs pms=s 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 or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until of compliance with the insurance requirements of this chapter have been presented to the contracting acceptable evidence authority. ����� Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirm sur ation of inance 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-"lave' or if you are required to obtain a workers' compensation policy,please call the Department at the number listedbelow. City or Towns the affidavit is complete and printed legibly. The Departrnent bas provided a space at the bottom of the Please be sure.that o fill out in the event the Office of Investigations has to contact you regarding the applicant: Please... affidavit for you t be sure to fill the ill Out/hcense number which will b'e used as a reference num e affidavits ber. The may be returned to the Department by mail or FAX unless other arrangements havebeen made. t' thank you in.advance for you cooperation and should you have any questions, The Office of Investigations would like please do not hesitate to give us a call. HIM / MThe Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Of�co o[Ie>tes�Q�fons . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext.406 .f f� 4 F 13► , 3 ' I w Q3��. .o�. • _ y'ANK_ lU J MAN �o r_xr• t!� Fii�•tV lll. •1�1 z o' 1 ,Lb;,�,� 100 d 15 3 G"j t ui _7 _.. 1 iAll, • . - ��'•, '• �:;� � CERTIFIED p l.�T Pt_.!->1�l aTaa:r�:"•a S�GAL� Its-�C?�•r, bAT!< b%� :� � '7 � C6rZTIFY THAT .Ti-1E Fot_�NDAT4flti Su��� 1�1--41..1 R�F-cQE►.1GE Wr,_ZQcA4 G0AAPL%eS W ITN THE SiD�_Lt►-�� AWr.> SET$tiCK WC-4U0ZEAIA-EWTS OF -r"e LOT iu 'joWU OF �AktVTi>.C3'�-..1= • �S`jERV ; .. 1- E =..1 c , F1 r c^ DATE BQ yCTE1Z , IJ-,(E 11►1G- REGIStiZEtD TN iS LJOT ea 6E'O 0" A&.l OSTE2V11_ll= o I"Cr 7L]AA FLIT eio0\1tY t� Tlaf_:-._AF�S�T'S 'r;14OWLL7 A P]r2i a i-A --w- /~ n r' \ !8 ` Z S ` 1 T 1 14 ` E�FTEu��t7 i 8AT'�t sv o P.CVM B'ED ReoNt 1 Sa?e GLASS t � BAT14 ` 141 Z � '3�Q,�M — -- — — a r r•s r wsG QAo M q ` �. I �. _ 12 td` IFA r-i lLY &4M �lJtcJG Qoart 3 t? Existing Floorplan !s-r V c no P- Option 2 Ca rven Residence _ d N m � A U z N �4 A Z d N_ r 1 s N 6'-011 I NOTE 0 EXISTING WALL! ' l in I ► I; Fl D o� M- x ,_61 w 3'X3' SHOW w 6�_1 �� 3,_0„ It z '01 RELOCATE o m FIXTURES ,.,�„ POCKET n�oo EXISTING co BY OWNER 2�_9 �� DOOR N O° WINDOW (n i+n P 34" D, OR W/ 18" SIDELIGHT NEW I I 3' DOOR WITH 1' SIDELIGMT I I I I �— RELOCATE BULKHEAD f TO SIDE OFI HOUSE 1/4"=1'-0" Ca rven Residence �, n z :3 O n a O I9%&..)()6l: 9 —.. MTL FLASHING TYP TRIM BOARDT TO MATCH EXISTING PTD.WD FASCIA TO MATCH EXISTING GWB WITH VENEER COAT PLASTER H ------------ --6 MILL POLYETHELENE VAPOR BARRIER O __...._.__....---_----....-----------•----___2X6 WD STUD @16'O.C.TYP -.----.----_---..._------------------.._...__6"R-19 FIBERGLASS BATT INSULATION __...._..__......_._S/B"CDX PLYWOOD SHEATHING cl - —..._....._._...... ._..- .._.. - - -- ----CEDAR SHINGLES-PTD. — — 2X6 WALL PLATE-ON SILL SEAL TYP. PTD.BASEBOARD TO MATCH EXISTING HOUSE --—--— ----WD FLOOR TO MATCH EXISTING 1 --------------.------3/4"PLYWD SUBFLOOR j; TONGUE AND GROOVE GLUED AND NAILED TOP OF F.F. l- V.I.F. T: ' T:O.C:'- ° ° ic — ---------CONT.VAPOR BARRIER WARM SIDE TYP 10 C/l 10" Iij - P 1 �i -- -- ---------6 MILL POLYETHELENE VAPOR BARRIER ij _I SEMI-RIGID BATT INSULATION ..... .... _ ... ..-�SEALANT I a! t:.cry ` a r •,, f .4"CONCRETE SLAB r- 2'-0"TYP II �- O _LA n op '� J o , l f I f I� f J U C: - i , GO ........... -, POCKET DOOR ' TO BATHROOM i i i l . i S 1 i 1 i { 1 WD. BASEBOARD AND TRIM TO MATCH EXISTING ........:. .-__... . .. . ...... WD. BASEBOARD AND TRIM TO MATCH EXISTING Careen Residence I/4"=1'-0" ..--........._._....-..._..._._ -- -........_..._._....._..__ . -- _.. __ ' q� ____ .::= ..._.: _.__...--.--....._._.......__.._.., :...._._.. _._.....:..: -- ® FFH -- - 77 _. ff ff- -_._.._......-..... _.___._._....__..__._._._...._....__.._ _ ---- ........ - -- - - phi i _...._..__.._....._....- ---- ... - - -- -::::_-_::.._...----.......---....._....---�...__._......- ..._.__._.._..........._.. -...._......_- __....__... -_ -----..._._...._.._.__.....--------__----------------------------._....._................. ....._....__....... __:_:_�.__ - ..._. ..._..--._._.. ._....- - -- - - _ --... --._........_._....__....__----.--.---.------._.... ........-_...----....._.-........_............. __. --.._..------...._------.._.._....__..._....__.._....... _ -............ ....._..............._._......._ _____- ._....._......--_- __._._.._.._.---- �=-=- ----:_ ---- __'.:: :.-:-...._.-_---...._-_----_-; :_:::__...._.. _-- -.._._..__.__ , _ _...._...._......._ .................... ... ....._...._...._......._..__._.._........._ ........._..__._.......... 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G/i Z/77 1 C6-iZTIF14 TI_lAT TtdF-- Po�N.1DA'CION SUoticl►J -Q`� Q �c�c�1cE Wr--ZEo" COAAPLVS W ITN THE SIVr=_t_t► E-- AWD SETBACK W QUIiZeME: -tTS DF TNT -To w v OF bP. IV,S'C Ii t.sue,, O S T E RV t L t_ E H F-1 0 T.S DATE 1�• 7y= Alt-�--� �- `!� i REGtScc-SZ X> LA. 6U Va%f02S TIAIS VLAW US LJOT BASEID A&J o Ts=evtu�t o s5 - - tNs�'QUMENT �,vczvcY 4 TI-Ic- Ot=GSETS eI40uj .n tibT t3E.' uScc� To U�'TEP_M►�1C 1.oT Lif-l�5 � . p - ..... ..... 1 �. -- a® e/) 7 7 A esso ma and lot number a SEPTIC SYSTEM MUST 3E r. to .--Z s°NSTALLED IN COMPLIANCE Sewage,}Permit number .. .. ................................................... WITH ARTiCLE Ii STATE �t ` SAI IT RY C E AND-TOWN a Of,TNET� c•cl; TOWN OF •BARNSIFWA _s O ,DAENSTABLE 'i .� d t"6 9 w` rz BUUff-ING INSPECTOR i �OMPYa` R �7 t/ . 0 -1 !Jt P, t^, -'-1 61 a 4 _ qoi_Ae,-?AY r c� v APPLICATION FOR'PERMIT TO ...... ..................... +...... ............................. ................................................ TYPEOF CONSTRUCTION ......:........... . . .. ........... ..... ......................................................................:.... ..................... ..............19.. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ..... ... � R`` .......... � .......................... r ProposedUse ........... ' ............................................................................................................................ Zoning District .......E�- _�............ ...................................Fire District ............................�,/:: ............... ��-� " Name of Owner .,.�3 ./ ...........................�!.t/....�`.'�.............Address ......... �.......................................... r , Name of Builder .:....................... .............Address Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ..............................................Foundation axle— Exterior ..............� .G.?.'.:/.5 ............................................Roofing ... ........ ...... ................................................ ��,r Interior ...... . G.. Floors .....G //A ..e........................................ .......�............................................... Heating .... . ..1� v(� t1P1 ��.1......................Plumbing . Fireplace ...................................Approximate Cost ......../....................................................... Definitive Plan Approved by Planning Board -----------_------_------------19________. , Area ................... ...................... Diagram of Lot and Building with Dimensions Fee .........."7` SUBJECT TO APPROVAL OF BOARD OF HEALTH l • I hereby agree to conform to all the Rules and Regulations of the Town o�table Wgarding the above construction. Name ............ •••`•••• Capewide Development it .... Permit f6r .....one story ........... ...s. .. .ingle..fami.ly dwelling .. . .... . ...... . ... Locatior,\\ �..Seth..G.o.odsp.e.eds..Way................. .... .... ... . ........ . ...... .. .... Osterville ............................................................................... Owner ...........!;,�pewide Development ................................................. Type of Construction frame .......................................... ................................................................................. -Plot ............................ Lot ...........#:64................ Ma 16 77 Permit Granted .......... .7./........... ..........19 Date of Inspection ... ...............19 Cate Completed 2..........19 PERMIT REFUSED ..........................................................*....... 19 ............................................................................. ti ................................................................................. . ............................................................................... ............................................................................... Approved .................... ............................ 19 ............................................................................... ............ ...... ........................................................ Ar Assessor's map and lof number a;.y . . y.. ,,. .... " Sewage/.Permit number y ............................r.................... 7"ET°�� TOWN OF BARNSTABLE Z BJSHSTSDLE, i 1 "b DU-ILDING INSPECTOR 0 YPY a' �4 �-- APPLICATION FOR. PERMIT.TO ..........G...................................:............................ ............................................... TYPE OF CONSTRUCTION � .........19..-��. . 711, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �6 fro_ � r!..c�-a� .......... .. .......................... ....... ......... .................. ...... . ....................... . ProposedUse .......... •...r....����a......................................................................................................... Zoning District ......,...,..... .......................................................Fire Disinct ....... � Name of Owner�_ ...................... �-' `"�- Address � ' Nameof Builder .............:......................................................Address .................................................................................... Nameof Architect ..................................................................Address ...........................................:........................................ Numberof Rooms ................. .............................................Foundation ... ....... :.............................:............ Exterior �`@la�.ty��...........................................Roofing �.�s� , �l.ct ...................... �� Floors .........................." Interior:- y /ff . .... .................................................................... Heating �* .. ....... � :....... � ..............Plumbing �-. .......... Fireplace Approximate. Cost :�" Definitive Plan Approved by Planning Board ________________________________19_______ . Area ...... ............................... Diagram of Lot and Building with Dimensions Fees f SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable /regarding the above construction. Name ............ ir?... ................................... Capewldo Development A=123 No �u2l9 ' ' ' on mtmry -�.�---.. Perm' for.-----------.. ' �' l �fa�1lv ��� '—'' ll^—''=-----''�-----^��--'----'' / Location . et� neea ..Qoo� m � ..��y_____ ' . ........................ ------------------. Davml t ^ ' C�vvner --_��pew���____� ____. ' . Typo of Construction ----f����—'----.. -----...---~.---------- — ' ------.=--. Lot __ Plot ___ , ` . . ^ . �ay l6 77 ' i Permit Granted.--------_----]P Date of Inspection ---------.--..]g ' ' . ` Date Completed ------------..lP ^ PERMIT REFUSED � .----'--...------------. lV . ' ' . - ' ........................................ — v ........................ . ....... ........ -- ' V � � ' v . _ . —.------.�-��.�--.—. . .K------. ' ~~ �� —.----.---,_----.-----.-----.. � ^ . ' ' . . . . Approved ................................................. lV . . . ' --------------------------. . _ ' -----------'----''.-----'r—'—'. . ' ' ' . Assessor's map and lot number .. .... .................... .... . ....... o�TNETo Sewage:Permit number ...... . ..4P........ ... -.. _ w�' �+► t 33AWSTABLE i House number 11 a:.................:......... ...............................:........ ��O 39• N p' TOWN ' OF BARNSTABLE BUILDING x INSPECTOR . � APPLICATION FOR PERMIT TO . 4 .4t✓ ....... e.?-t»k> ...... 7�� 1f?.!�!...................... ................. . ........ TYPE OF CONSTRUCTION P .! /.................................................................................... ................. /. ..................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: J,�/ Location ..........1.(,.e......... ��4....4 1�4..k7��'. 7 ��1?.......V_j;.7............ `? ��!L l.lt ...... 4............. ProposedUse ............... ............................................................................................................................................ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ].... Address Name of Builder' 9;'.Gy.Address .2. �......LIA.r 0.S�i1...1.4. ?.<..9 N. lam. Nameof Architect .....................�✓.o!.✓.�..............................Address .................................................................................... Number of Rooms ..................................................................Foundation .... hIG,P.. ..��'1L`�/..il�.... �, iExilior .....Wl-l.T&.... r A.!Z.....?�.IJ�!�1�r 1�����1-....Roofing ..., !'? 1!. f..Ec .....1'1. w.w..6.t-6-'7.................. Floors .....`a/ ...VN. Gr?r.uom'i......Z.x.{ ....y ..4940nterior .. .i .�d�. --r../...k�l�W.. lam. ...`�(?.��©'r!'✓� HeatingA114...............................................Plumbing A�� ......................................................... // �d Fireplace .................................. ......................................Approximate Cost ..... ..5� r`?..... Definitive Plan Approved by Planning Board -----------_---—-----------19_______. Area ...... ...... .......................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t bo 4 N).Q511 taaa AVD���urJ c�Ar . oe�f�C_ a h 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. Nome ...� ..................................... _ ...........:... ...... .. .�1 . � DBLDDX, FRAJNCIS � ~ 24788 ADDITION ` ` �o ................. Permit for .................................... , Single Family Dwelling � � ----^----'----^^^^-----'—^--'''' ^ . . ^ Location .l00'Seth_Gm ..Road.. � \ OoterniIle . ^ ' ---.~.----.---,—.----'------.. _ � / Francis D�Loux ^ � ' Owner ---.------------------.. , . , . , �z Type of Construction --..�����-------- } ' —.----.--.—.-----..--.—.------ ^ � Plot ............................ Lot/ ................................ - ^ ^ < February IU, 83 � Permit Granted ------_----,—.]g ` ' Date of Inspection .....................................lg - ` Dote Completed � ^ ^ � ~' ' ' ` ^ Assessor's map and lot number �. *THEt Sewage Permit number ....... .i..i?......rc� ..::�..:�<�...�...1.,. Z BARNSTABLE. House number i r'aea :........ q00 i639. TOWN OF BARNSTABLE BUILDING INSPECTOR . . ..1�p.r? 4.......r ! b��S l .h?...........:. ' APPLICATION FOR PERMIT TO ................. . ....... . ry, ,,,,,,:,, TYPEOF CONSTRUCTION ....................................... ..;;/..................................................................................... ................ /.................,91 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: / Location .......... ........... ?1....... Z. .:...........Z� ........../1.(f ..............:........... ProposedUse ...............l a tZ....... ............................................................................................................................................ Zoning District .....................................Fire District ............ Name of Owner ...P k ORVX................Address ... ? ...'? Name of Builder' .Zw5.'....:r:.e:f�.r-t.�a �r ... :'�?.<..9.,,A y..N,t✓ I � , Nameof Architect .....................NOrla✓..............................Address .................................................................................... Number of Rooms ........................../.......................................Foundation ..../'�adall.? r .. ?� �L`�,/..{J.... � � • Exterior .....1,1 .. `....Ce. A.f?......d?.Pt.AA(::r.h,Fr'-,,�....Roofing ...�.h..f-z.r-l.!�..�T.......�....—A.{ .................. Floors .....F���`7�...t>�)r1�%:!>::.1.: s ......�.Kf j1.-,.'.?9, -Interior ..:��5 t `� Heating ..........................4J ..................................................Plumbing ..............4A.,)%....///..................................................... Fireplace ...................................AdA......................................Approximate Cost ..... ? 7: G' ....�✓.... . ..� .... Definitive Plan Approved by Planning Board -----------—__--___ Z�Z- ---�9 ----• Area ... ............................... Diagram of Lot and Building with Dimensions Fee ...�. SUBJECT TO APPROVAL OF BOARD OF HEALTH I ex i o I V r�,,a c> reypaSb� Ieiv4,> ✓ &At— i 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. ti Name ...`.y...F ...././ .......................... DELOUX, .FRANCIS A=122-95 24788 L/ITION No ................. Permit for .................................... single Family Dwelling ............................................................................... 160 Seth. Goodspeed Road Location ................................................................ osterville ............................................................................... Owner Francis Deloux.................................................................. Type of Construction ........Frame ..... ................. ....... .. ................................................................................... Plot ............................ Lot. ............... .................. Permit Granted ...February 19.ry 10 , 83 .. .... .. .... ...................... Date of Inspection .......19 Date Completed ........................................19 Y � t ' e tA y AL N %L 411 1 • f it , 1*2 • ti ` oo t t