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HomeMy WebLinkAbout0022 THIRD AVENUE �+ a �� T r� �v.� aa. H � �� . �. _ M __ �. __ .�_ ���, ACTIVE i 1 e v� 0- x: t ,k i i 'j I � 1 . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � (� ) ► 3 Map b Parcel 2 D Application # Health Division Date Issued Conservation Division tAj Application Fee Planning Dept. Permit Fee 7� 0 Date Definitive Plan Approved by Planning Board P�— Historic - OKH _ Preservation/ Hyannis Project Street Address �S Terra (�Village Owner O�A C,10-l Address Frei wo -- /�Shy l le Telephone , I . ,?7 2 o f Permit Request I d ��.SIG' O� E t o yA� /On 1 ®Gr T 218 e Ob 4K k0cloe Square feet: 1 st floor: exitinlg �proposed 0 2nd floor: existing proposed Total new Zoning District Ac Flood Plain Groundwater Overlay ,Project Valuation d Construction Type Lot Size , 09 A Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 19� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes D4 No On Old King's Highway: ❑Yes No Basement Type: Full A Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing .3 new Half: existing new Number of Bedrooms: 3 existing Qnew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: was ❑ Oil ❑ Electric ❑ Other o Central Air: ZfYes ❑ No Fireplaces: Existing New Existing wo'_od/coal stg�v..e: LRYes U-No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn tjl existing A n o sizet_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ?a V Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' rp Commercial ❑Yes ❑ No If yes, site plan review# r Current Use Proposed Use APPLICANT INFORMATION `f (BUILDER OR HOMEOWNER) Name �.9n+ �.✓ Telephone Number � b� yo�g y9 as C�� Address � 46OX 7�0 License # CS_ ©7 000 �S-reAk lle /V1,9 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sqz SIGNATURE-L DATE E� - FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED S 'MAP/PARCEL NO. I .�' ADDRESS VILLAGE OWNER _ ' d l P DATE OF INSPECTION: FOUNDATION FRAME Ir INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT ASSOCIATION PLAN NO. _ ` , �Tte Et�nYrrtomcc�ecrlth of�assaeh.us�r - G�ce of estigaiioru • 660 Wm-*wgtba Street Bestan,MA 021H yVnw nasmgmildia Workers' CompensaiionInsuranceAffidavit_BmldersfContmctors/Bectricians/Humbers r Iira�#Infarmatian Please Print L&ibly Name ellt3smeas! . : lCe4 l c4,,,A We I C� Address Z I/ ia/l/ nH�I/C� Cit3,f5t at�elZip:o,S I,el lil l,e gLisr Phone:w-7 "l-- Ere you an employer?Check the appropriate box: T of o'ect r 4. I am a contractor and L 3� �• I �•egniretl}: L❑ Lam a employer with. ❑ �� 6- ❑New boa employees(full and/or part-time)* have hired the sub-cont aciors. 1❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sob contractors have 8. ❑Demolition working far me in any capacity. employees and have workers' ❑Buildmg addition [No.Warktrs'Camp_inmrranre Comp_mcnrancF I regnirt ] 5_ ❑ We are a corporationand its 10-0 Electrical repairs or additions _❑ I am a homeowner doing all work officers have exercised their 11-❑'Plumbing repairs or additions.nayse f.[No workats'comp- right ofe1mgfionperMGL 1 12Z]RDofrepairs c_152, § (4},and h wea�,�euo innrranre required_]F employees_[N 13_❑Other [Nil comp_insurance regtrired.] *Any appliamt Hut checks box 91nmst also Moutthesecfioab9awshnvria3Mrwadkm'eompessadwporwTenfnmut� Hnmeowness orho submit this�id�u insbcati�g they aze doing aIIlrc�c a�Hen 1me auuide contracts rest submit anew afd3uh in.twhnv ma tCaahacmrs Est check this box mast attached ma additional sheet dowsing the name of the saU-cm&2dM and state whether acnat thase em ivies have employees. Ifthe sohcontmdam have employees,theg meat pmvide their warless'Comp.po3ic3r munbez I am an employer that is prmridirtg tt,orkem'comperuahon irmiraace for my e.mp£ayess. Betnty is the pa&c}and fob site informatwIL lusarmceCompanyName:• aTTr l?fA �p a l�oficy 9 or Self-ice uc-�: GS ( OC4 Q ",5 Z;6- T Lj✓ Exptrati n-Date: —s— Job Site A.ddies .. V q 6 t �^ S t C1tyfSt1te(ZiP,0,S I V -VA �e ILIA Attach a copy of the workers' compensation policy decIiratiou page(showing the policy number mud ration date). Failure to secure c average as regniredunder Section25A o€MGL c:152 can lead to the imposition of criminal penalties of a fine up to$1,500.06 andlor one-year imprisonment,as well as civil penalties in.the form of a STOP WORD ORDER-and a fine- of up.to$250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to•the Office of Investigations of the DIET for insurance coverage veriffcation_ Ida here tinder titapains anhpenaWas afpedw y Mat$ta irrfornzafian protdded abuse is hue anrf.eorrect tatSe �' Date: a' L('Zt�( Phone# Official use wiTy. Do not writff in Otis area,to be completed by city or town official. City or Town: PermiVUcense# Issuing Authority(circle one): 1.Board of Health 2.$uildingIkp rtnaent 3.Cit`Trowa Clerk 4_Elect ical Inspector S.Plumbing hispector 6.Other Cotabct Person: Phone!#: 6 I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,'an employee is defined as"_._every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerificatc-(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of iasur a&coverage.. Also be sure to sign and date the affidavit The affidavit should be retuned to the city or town that the application for the pemait or license ls being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. ' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant that must submit multiple permit/license applications in any given year,need only submif one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be' provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etx.)said person is NOT required to complete this affidavit The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address;telephone and fax number. The Commonwealth of Massachusetts Department Qf bid-ustrial Accidents office of kvestigatioas 600 Washz gtoa Street B astort:MA G21 11 Tel.A 617�-727-49-00 ext 406 Qr 1-977-MASSAFE Revised 4-24-07 Fax#617-727-7749 w _mass,gov/dia I `,VDAC t1AATFMD , C WORKERS COMPENSATION _ x1AND _ • iEMP.LPYERS LIABILITY POLICY TYPE AR INFORMATION'PAGE,WC,00 00 01 ( A).- POLICY NUMBER: ((6S60UB=5033P43-5-1 4),_ RENEWAL OF (6S601.19-5.033P43-5-13) INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY �- NCCI-CO`CODE: 10456 INSURED: PRODUCER: KENDALL & WELCH-CONSTRUCTION MURRAY & MACDONAL-D' INS INC 550 MACARTHUR 'BLVD e� - ` PO BOX 490 ,, a BOURNE MAC 02532_v OSTERVILLE Mk,02655 art. Insured 1s A CORPORATIO �- ly Other Work place nLidentif ion numbers are: In the schedule(s)'attached.' 2. The policy per, d is fr =14 to 02-06-15 12:01 A:M."theured's iling address. 3. A. WORKERS,CON�IiVSltRkhtel= -f Tt'8 pplies to'the Workers -. Compensation Law of.the states) lsted.here: - • _ ' MA �• :� , B. EMPLOYERS LIABILITY INSURANCE: Part Two;of the policy applies to work in each state listed in item 3.A. .The limns of our Ilability.underPart Twoiare: r O Bodily Injury by Accldent: $ 500060 Each,Accident _ Bodily Injury'by Disease: $ 500000, Policy Limit Bodily:lnjury, by Disease: $ 500000 Each Employee t„;�;' ` , • ' C: OTHER STATES,INSURANCE: Part Three of the policy applies to thestates,-if any,:listed-here: COVERAGE REPLACED, BY ENDORSEMENT WC 20 03 06A --r _ D. This policy-includes:these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium forthis policy will be determined by our Manuals of Rules, Classifications,'04tes'and-Rating Plans. All required information is subject to verification and�change by audit to be made;ANNUALLY:{ m— , DATE OF ISSUE- 02-03-14 SM ' �' ST'A_SSI GN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: MURRAY & MACDONALD INS s 75NHN 006504 L,.. y 'WET ti Town of Barnstable Regulatory Services MAgS Richard V.Scali,Interim Director ''�io;A{►��� 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 r Property Owner Must Complete.and Sign This Section If Using A Builder rJ C A V ,as owner of the subject property hereby authorize LG .4Na io%LCy LOnMJ�rtle o� to act on my behalf, in all matters relative to work authorized by this building permit 2-2 3 rJ 4 of OS�ErtVr ll{ (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. *21:11te of er Signature of Applicant 14 CI Print Name Print Name O/V Date Town of Barnstable Regulatory Services - 00 TOyyti Richard V.Scali,Interim Director Building.Division - a RARnic-rAAi.F. f - Tom Perry,Building Commissioner 9� i634, ��� 200 Main Street, Hyannis,MA 02601 QED µ0� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6210 HOMEOWNER LICENSE EXEM nON 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,eagage 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 hall 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 Appioval of Budding 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 16.1.1-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. Massachusetts -Department of Public Safety i " Board of Building Regulations and Standards i Construction Supervisor License: CS-070086 rs` DAMON L KEND�IL 48 KOMPASS DID FAL•MOUTH Mir 02S Expiration j Commissioner. 11/21/2014 \ J Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-083484 %.I RONALD W WEL,10R - r 85 BRIGANTMM11 HATCHVILLE NA 0� iJ Expiration commissioner 07/11/2014 _x fVlneVnr III igott•c - UriuirhllPnt nl' P11111ir Slffi%ty 6�� Vic Office of Consumer.Affairs and Business Regulation 10 Park Plaza - Suite 5170 ' Boston, Massachusetts 02116 Home Improvement Contractor-Registration Registration: 128405 Type: Partnership Expiration: 4/5/2015 Tr# 240091 KENDALL & WELCH CONSTRUCT;I°ONI: , DAMON KENDALL P.O. E30X 490 OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 0 2OM•05111 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: OME Iation: `1MENT Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Explratlorv:._°4Z5`L$Q1°5' Partnership Boston,MA 02116 KENDALL&WELCH;c:ONSTRU(sT1ON DAMON KENDALL `L 54 KOMPASS DR. ��-3_ FALMOUTH,MA 02536 Undersecretary Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Q v Application # Health Division Date Issued 3 t a Conservation Division ��'' Application Fee �(D Planning Dept. Permit Fee 3. a Date Definitive Plan:Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address ZZ Village Owner low 9-1 Address Sr A\ t� Telephone .��` " \{_ 10SY C�`� SK)B - vat ��� ® O'Z-��i3 $\ Permit Request - me b�_ Vko tAX c nn Square feet: 1 st floor: existin�- 1ZO proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations Construction Type F Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family; Two Family ❑ Multi-Family (# units) Age of Existing Structure ` o ' Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing 6 . new First Floor Room Count 3 Heat Type and Fuel: eGas . ❑ Oil ❑ Electric ❑ Other Central Air: ►/Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: &r 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 ►-r o 0 APPLICANT INFORMATION w _ (BUILDER OR HOMEOWNER)'-': : �� � 1 - ►-� ' rCO n Name Telephone Nu be ZZ 3o kk 0SAUW- ,-- co Address License # .,, A p (� w r' \� i �\Atoi)wA ` N'(�`ZDy� Home Improvement Contractor# m Worker's Compensation # ALL .ONST UCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .1 4 SIGNATURE DATE `Zoio FOR OFFICIAL USE ONLY ' APPLICATION# LATE ISSUED ; . . :;MAP/PARCEL NO... ADDRESS � VILLAGE OWNER R DATE OF INSPECTION: t ' � FOUNDATIOW.- � �+ FRAME ' INSULATION:.': FIREPLACE •• ELECTRICAL: ROUGH FINAL PLUMBING; ROUGH FINAL +GAS: ``, ROUGH FINAL t.abFJNAL-BUILDIN:.G 10,k.4�'-5fl?�S"llo hgam x: DATE CLOSED OUT ASSOCIATIONS PLAN.NO. r F The Commonwealth of Massachusetts Department oflndustrialAccideits Office of Investigations 600 Washington Street . t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 0S Phone #: 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 * have'hired the sub-contractors.. 6. ❑ New construction einployees(fitll and/or paid-tune . - -- -❑------ - -- •- • - - 2.El 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 an capacity. employees and have workers' g Y P h'� 9. ❑ Building addition ZIam workers' comp. insurance comp. insurance. W'or 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' l3.❑ Other comp.insurance required.] 'Any applicant that checks box#) must also fill out the section below showing their workcrs'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eontraetors'must submit a new affidavit indicating such. tContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and stale 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: 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 MOL 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 cerd der the n penalties ofperjury that the information provided a ve true and correct. Z01U Si ature: p� Q Phone#: v V y " -TO Official use only. Do not write in this area, to be completed by city or town official p City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Information and LustructzoDs ; Massachusetts Genera) Laws chapter 152 requires all employers to provide workers' compensalion for their employees. Pursuant to this statute, an emplo),ee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or morel of the foregoing engaged in a joint enterprise, and including the legal representatives of e a deceased employer, or th receiver or trustee of an individual, partnership, associaliob or•other legal entity, employing employees, However the owner of e dwelling house having not more tban IW7 apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constniclion or repair work on such dwelling house or on.lbe grounds or building appurtenant thereto shall not because of such'empJoyment be deemed to be an employer." J MGL chapter 152, §25C(6) also stales [bat "every state or local licensing'ag'ency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) stales "Neither the commonwealth nor any ofils political subdivisions shall enter into any contract for theperfofr>,ance ofpublic.--Work until acCeplab)e evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contraclor(s) name(s), address(es)and phone numbers)along with their certificate(s) of insurance, Limi C)led Liability Compabies (LL or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. if an LLC orLLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of lodustnal Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that•the application for the permit or license is.being requested,not the Department of Industrial Accidents. Should you have any questions regardi g the law or if you are required to obtain e,wo nrkers' compensation policy,please call the Department at the number listed beloW, Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space al 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 permi0license number which will be,used as a•refcrence number. Lnaddition,an applicant that must submit multiple permit/license applications in any given year, need only submit one, affidavit indicating current (city or policy information(if necessary)and under"Job Site Address" the applicant should write"al) ]gcahons in _ town)."A copy of the affidavit that has been officially stamped or narked by the city or townY be provid e d to the applicant as proof that a valid affidavit is on file for fu lure permits or licenses. A new affidavi t.musi be filled otl t each year. Where a home owner or citizen is obtaining a license OrpenMtnot related to any businesstyorcommereia] venture (i,e. a dog license of permit to burn leaves etc.) said person is NOT required to complete this aiffidavil. The Office of lnvesligahons WDUJO JLKC 10 i nnrratinn and shou➢d shave any questions, please do not besilate to give us a call. The Departmcnt's'address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 I j Tel. 4 617-727-4900 ext 406 or 1-877-NIASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia 9 r of Ytu:ram, . Town of Barnstable �.� Regulatory Services ` tttxstxsLF Thomas F. Geiler,Director r�tw.va • Building Division Tom Perry, Building Commissioner 200 Main-Street,_Hyannis, MA.02601 www.town.bzrns-table.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Q Please Print DATE: 1 ` ��\� JOB LOCATION: 22 3� .Q Sfetv� ,I�l number r� M street q` + village "HOMEOWNER": j+ -1 US S name 2G; M home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OP 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 constrycts more than one home in a two-year period shall not be considered a homeo wmer. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsib)e for all such work performed under the building permit (Section 109.1.1) T1,c undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that.be/she understands the Town of Barnstable Building Department minimum' cction pr educes and requirements and that he/she will comply with said procedures and require Si bur cowner 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 Constriction Control. HOMEOWNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building permit is required sha11 be cxrrnpl from the provisions of this scction.(Sccticn 109.1.1 -Licensing of.canatruction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." )v-any homeowners who use this rxmnption are unaware that they are assuming the re,sponstbilities of a supervisor(sec Appendix Q, Ru)cs&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 procccd against the unlicensed person as it would with a)icenscd Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitics,many communities rrquire,as part of the permit application., that the bnmet)Wner certify that Wshe understands the responnbilitics 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:for ns:homecxcmpt n Town of Barnstable o� f f Regulatory Services MA?f6TAsi.E, f MAS& Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 n'n'w.town.barnstable.ma,us I Office: 508-862-403 8 Fax: 508-790-6230 Propel ty Owner Must -Complete. and Sign. This C•Section. If Using ABuilder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) 4 Signature of Owner Date Pant Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form:on the reverse side. Q:FORMS:0 WNERPERMISSION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0.1 D Permit# Health Division _ � � �j (� ACM s' '�, �-'� Date Issued b Z Conservation Division I I ZG/ OZ _ Fee Tax Collector�o o 1�aa(da f) /J`- C Treasurer ©I� — IT' 0 NV Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH N/A Preservation/Hyannis N/A Project Street Address 22 3rd Ave. Village Osterville, MA i Owner David Hubble Address 30 Standish Rd. , Wellesley, 14A 02481 I Telephone 508-878-5932 Permit Request Construct shed dormer (4/12 pitch) on right side of cottage to create space on 2nd floor for new bathroom and closets for existing bedrooms; strip all existing roofing on right side of cottage and replace. Square feet: 1st floor: existing 732 sf proposednO chg• 2nd floor: existing 348 sf proposed 458 sf Total new 110 sf O Valuation Zoning District Flood Plain Groundwater Overlay Construction Type wood frame Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family n Two Family O Multi-Family(#units) Age of Existing Structure ' Historic House: ❑Yes 70 No On Old King's Highway: ❑Yes No Basement Type: 17 Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) not finished Basement Unfinished Area(sq.ft) 572 sf Number of Baths: Full: existing one new one Half:existing none new none Number of Bedrooms: existing 3 new none Total Room Count(not including baths): existing 6 new 0 First Floor Room Count 4 Heat Type and Fuel: ❑Gas LI Oil O Electric ❑Other Central Air: O Yes 12 No Fireplaces: Existing 0 New 0 Existing wood/coal stove: O Yes �j No Detached garage:O existing O new size Pool:O existing 0 new size Barn:O existing 0 new size Attached garage:O existing 0 new size Shed:0 existing O new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial Cl Yes ® No If yes, site plan review# Current Use single family residence Proposed Use same BUILDER INFORMATION Name West Barnstable Builders, Inc. Telephone Number 508-362-7647 Address 1170 Rt. 6A License# 023212 P. 0. BOX 516 Home Improvement Contractor# 120373 West Barnstable, MA 02668 Worker's Compensation# ITC3U,0007,00 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO On—site dumpster via Breivogel SIGNATURE DATE y'Z2'y + r' FOR OFFICIAL USE ONLY a PERMIT NO. DATE ISSUED MAP/PARCEL NO. i ADDRESS ' ,z VILLAGE ' OWNER 7 • DATE OF INSPECTION: FOUNDATION d; 1�' �7'j G � 4)7 FRAME INSULATION FIREPLACE. '. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. x 4 , J The Town of Barnstable >�`�'g Regulatory Services �p039. ��0 rfp,�,y Thomas F. Geiler, Director :Building Division , PeterF. DiMatteo, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 .: Fax: 508-790-6230 Permit no. Date -6 2 AFFIDAVIT. HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMrr APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation.repair.modernization,conversion, improvement.removal.demolition,or construction of an ad4ition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain;exceptions,along with other requirements. /.i 47 Type of work: Estimated Cost ZD Address of Work: ZZ 3 M Owner's Name: Date of Application: 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: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT FORK DO NOT HAVE. ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL.a 142A. SIGNED UNDER PENALTIES OF PERJURY 'I hereby apply for a permit as the agent of the owner. ll ,n V7 Date Contractor Name Registration No. OR Date Owner's Name q:fomu:Affi dav:re-v-070601 : RESIDENTIAL BUILDING PERNUT FEES. 5�n 2 I APPLICATION FEE New Buildings,Additions $50.00 �b v Altemtions/Renovations $25.00 Building Permit Amendment. $25.00 FEE VALUE WORKSHEET NEW LIVING ^^SPACE V square feet x$96/sq.foot= \DSIJ y x.0031— plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. , >120.sf-5.00 sf $35.00 >500 sf-750 sf 50.00 >150 sf- 1000 sf 75.00 >1006 sf- 1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x.0031= j STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= " (number) Fireplace/Chimney x S25.00= (number) Inground Swimming Pool'. $60.00 Above Ground Swimming Pool $25.00 RelocatiowMoving $150.00 (plus above if applicable) Permit Fee projcost / / 11 / / / a �n =_ � i � � r• l 1 1 1 11 1 1 1 / 1 1 1 1 1 I:n tom:11 . 1 ■ 11 1 t 11 �1 "1�1 t�1• t 11 1 ' 't /. 11 ' -/ ��, 11 1 :111 / • 1 . / 1 1 • '. •, •/ Illt,2$�11 '•:11 t 1 t 11 ' 1111/ 1 1 .,� 1 / 1 1 /. 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' 1 r•11111 wl .11 • l 1.11_• ..•. 1 1 ' .✓ e1s w•1 / • . . _1 1 .1 II . . / else • 1 • 1 •1 e 1 • t1I s 11 11 11 wll II r • 1 w. • •/;1• •11 jkfe cells Y. « •• 1 w•Y. sell ' U • s ✓111 r II 1• III 11 /• •-1.1111 rw1 •11111 I w • I / I ► �• �11�1 �'• 11/1.1 •w I •1 s I•. II • ••1•s • •. 111 -11• 1 • 11 •I 111 • 11 .1 • .11 • wl1 w11• / •_wl 11•: • •. • 1 w. • •J'.1• •11 • • • II .11 • 11 • ' .1• r • s 1 rI• •�1 .1• •II 1 1 1 • . • 1 •11 1 1 w • •/ 1 • Its w•1 •• w�1. e s •It .11 1 .:•' 11 Ill l�1 1 1 If II 1 1 1 1 A ' 1 •11 1 1 1 1 • 1 1 I 1 1 a11 1 1 1 1 r 1 1 1 1 . 1 1111 1 ' III II II 1 r Ll ONE INPROVENENT CONTRACTOR i Registration: 120878. - Eipiration:. 03/1312002 Type: Private Corporatio i. YES1 BARNSTABLE BUILDERS I , ::MItNAEI=�KIM6510k�'�.�r, �:h y�',,•°� ' �,.�.,.,,� �e•�d,3J�6'RT. 6A/PO BOX 9I6 ADMINISIRMR 'NEST BARNST T-' IE'1 BOAR' D OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 023212 c" Birthdate: 04/12/1949 ExPires:04/12/2002 Tr.no: 22768 1 : Restricted To: 00 MICHAEL L KINGSTON 1 9 GREAT HILL RD ru" SANDWICH, MA 02563 Administrator Town of Barnstable Regulatory Services oFtK Thomas F.Geiler,Director ti Building Division BARWSTABM = Tom Perry,Building Commissioner t�: 200 Main Street, Hyannis, MA 02601 e Office: 508-862-4038 Fax: 508-790-6230 August 11, 2010 Jesse P. Caprio 17 Open Trail Road Sandwich, MA 02563 RE: 22 Third Ave., Osterville, Map: 116 Parcel: 070 Dear Mr. Caprio: This letter is to follow up on permit number 84776 issued on or about June 13, 2005. To date, no final building inspection has been performed. As the contractor of record you are responsible to ensure all required inspections are successfully completed. You must arrange for inspection by August 25, 2010 to avoid further action taken by this office. Thank you for your prompt attention in this matter. I may be reached at (508) 862-4034 to arrange a final inspection or answer any questions. By Order, WL a zon Local Inspector (508) 862-4034 Qzoning5 I Jul 18 05 10: 27a COMM Water Dept. 508-428-3508 p. 2 Centerville-Osterville-Marstons Mills Water Department P.O.BOX 369- 1138 NTA1N STREET OSTERVILLF,NIASSACBUSET-CS 02655 `£ oST�pL OFF-ICE:oF a �P ROARD pF WMIR COMMISSIONERS ��WATER m WATER SC?ERINTr NDENT 3 DEPT. � TEL.No.50fi-d28-669! 9ASrOtiS FAX Nu.5uS-428-35(I July 15, 2005 Town of Barnstable Building Dept. 367 Main Street Hy, 601 Re: AccouqtA694 David R. Hubbell 22 Third Avenue Osterville. M entle On Friday, July 15; 2005 we disconnected the water service at the water main for the mentioned property d above. It Is our understanding that the owner plans to demolish the house, re-build and install a new warer sen-ice at a later date. if you have any questions; please call our office at 508-428-6691. Very truly yours, Craig-lCrocker Superintendent I i C'C/Jw PROM JEST BARNSTRBLE BUILDERS PHONE NO. 509 362 7647 Jan. 24 2002 01:51P°1 P1 Ublr JS=b( PfltviprMe Paciu�s.fordo.VAd TWw4 BdfQiea 8�r.rf►Fowl �mi1!' Fa.b MAXIMUM I MIlVQ1SOwing6'M i Gkzicg �►811 F1oae , . jlAb 6 .• Pae4rage., . l70t to 6500 QI angdong D Q 12% 0.40 3f 13 19 10 6 R 17% aS2 30 19 19 10 ' 6 boned t0. S 12%. U6 '38 i3 l9 6 Si AFVE i 6 . T' 1ST OJ6. is ZS WA 6 Atvrtnai . U . iS�i OA6 3i 1� 19 10 ii/A tlAFilE. V 15% 0,44 31t if 2t WA fS AFVE W 13% 0S2 30 19 19' 10 f X 1813 0.12 3S 13 Z7 WA WA NOresLi Y 19% 0,6z 3i' 19 25 WA �/A T�oaesal ., ra �� 0 90 AFM M' 1EiS 039. 30 ' 19 19 A 1. ADDRESS OF-PROPERTY: VVIIAV SO. 7 SQUARE FOOTAGE OF ALL OMMIOR WALLS: . SQUARE FOOTAGE'OF ALL GLAZrNG: 3 Q 4. -/r.GLAZING AREA(#3 DWMF.D BY#2): S. SELECT PACKAGE(Q:AA.-sae chart;b0dc): NOTE: OTHER MORE INVOLVED METHODS OF AErMUM (3 ENERGY REQU EMMM ARE AVAILABLE. ASK US FOR TMS INFORM.A'aON. SUILDTNG MPECTOR APPROVAL: YES: NO: gdbrms-f930333a I I i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,Map— Ra Parcel v� A Permit# 4 Health Division• 99- 4qcDf �` `! r f i _ Date Issued d% Conservation Division "r _ Application Fee �� U A 9: 41 Tax Collector Permit Fee—A CO) , Treasurer 'u k Q� pgy�NG C SYSTEM ffW Planning Dept. UMTO_�;�IOF Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 22— _Tk 1 c �_ AVeyWe- Village �)skg V t 6 Owner X:)aV-1Ck "Lkbell Address 20 &K 2A —05 ��yi_lZ Telephone �I Permit Requ st ��1C� � MA-Ibn 0 rbn 'x I r) _t� 0 bode Pf q g P P _�L� g �� proposed er S uare feet: 1 st floor: existing ro osed 2nd floor: existing Total new Zoning District R� Flood Plain C— Groundwater Overlay Project Valuation-$C l0 j1SU Construction Type 00 (04 t Lot Size Hx6 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure g g � Historic House: El Yes XNo On Old King's Highway: ❑Yes VNo Basement Type: PJ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) S�Z Number of Baths: Full: existing new` Half: existing new Number of Bedrooms: existing �' new f Total Room Count(not including baths): existing new First Floor Room Count " Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: XYes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage-.Xexisting ❑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 XNo If yes, site plan review# Current Use Proposed Use _ BUILDER INFORMATION �G Name P- 01 Doi Tel - o en Number 0 'Ct 7i9_'-52O 0 c Address J�r�'G2. License# AA ZS110 Home Improvement Contractor# ' E`)ug3O Worker's Compensation# O LW� 7-� L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �✓ SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - - MAI'/PARCEL NO. m ADDRESS T VILLAGE ` OWNER • e DATE OF INSPECTION: FOUNDATION 'z,On 6 y � FRAME INSULATION Q 9, FIREPLACE ELECTRICAL: ROUGH FINAL v i' 3 PLUMBING: ROUGH r FINAL GAS: ROUG3 FINAL ' FINAL BUILDING - n DATE CLOSED OUT N 1, ASSOCIATION PLAN NO.m - 4 " 7da of N F� • w • RESIDENTIAL BUILDING PERMIT + +ES APPLICATION FEE , NewBuftdings $100.00 Residential Addition $50.00 Alterations/ReMvations $50.00 - Building Pernnt Amendment $25.0.0 FEE VALUE WORKSHEET NEW LIMG SPACE 2 square feet x$96/sq.foot= x.0041= 2 1 4 , Plus fromeow ka app ALTERATIONS/RENOVATIONS omaSTING SPACE 2 U square feet x$64/sq.foot= 7 2 Z 0 x.0041= 7 plus frombelow(if applicable) 2. GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY$TRTTCTURE>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-Sun.as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (mtmbeI) Deck x$30.00= (number) Fireplace/Chlmnea► (number) Inground SwImmingPool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Vee �t' �"g � � • projcost :063004 no CMR Appends:! Table J=b(continued) prsaeriptive Packages for One and Two-Family Residential Buildings Heated*nth Foul Fuels MA7dMUM MINIMUM 131sun Glaring Ceiling wall Floor Basement Stab •Hesdug/Cooling g , wall paimeta Equipment Efficiency' Ate'(�o) U-value= R-value' R-value R-value' R-value' R valuo package 5701 to 6500 Heating Degree Days' 6 Nomtal Q 12% 0.40 38 13 19 10 6- Normal R 12% 0.52 30 19 19 10 683 AFUE S 12% 0.50 38 13 19 10 N/A Normal 13 25 N/A -----=6- -----._-Normal--- ----- ------ - U '15% 0.46 38 19 19 10 N/A 85 AFUE V 15% 0.44 38 13 25 N/A 6 85 AFUE w 15% 0.52 30 19 19 10 Normal X 19% 0.32 38 13 25 N/A N/A ' N/A Normal y 18% 0.42 38 19 25 N/A 90 AFUE Z 18% 0.42 380 13 19 10 6 AA 18% 0.50 3 19 19 6 90 AFUE 10 0- 1. ADDRESS OF PROPERTY. 204� . 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 2 .� 3. SQUARE FOOTAGE OF ALL GLAZING: JO 4. %GLAZING AREA(#3 DIVIDED BY#2): I O°`6- q qo 5. SELECT PACKAGE(Q--AA-see chart above). < a( NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303 a i 780 CMR Appendix J Footnotes to Table J9.2.1b: a Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and , basement windows if located in walls 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. s 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 o-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-fraarhe or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 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. 6 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 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 J5.23 a NOTES: 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. ater than 0.35.Door values must be tested b)Opaque doors in the building envelope must have a U-value no gre from the door U-value and documented by the manufacturer in accordance with the NFRC test procedure or taken fr 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). I 43 o�J(HE,of Town of Barnstable Regulatory Services i saaNsrABLA Thomas F.Geller,Director Building Division QED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERAET APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other • requirements. /�� --y Type ofWoxk: Remodel/Addition Estimated Cost s l,� 22 Third Ave. , Osterville, Mass. Address of Work: David 'H�ibbe11ll Oyyner's Name: Date of Application: 20 O 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: OWNERS PULLING THEIR OWN PERMIT OIlRYIDPROVEEMENT WORK DOG ING WITH tNREGO NOT HAVE CONTRACTORS FOR APPLICABSTERED LE HOME ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL a 142A, SIGNED UNDER PENALTIES OF PERJURY I hereb apply for a permit as the agent of er •� t �S 130930 "� on ctor Name Registration No. Date Jesse P. Caprio OR Date Owner's Name Q:fomis:homeaffldav ' i;'�:� fee '(Jvri��ravreeveull� v��/vLud:lctC/auJr�ld i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 076850 a Birthdate: 0712011973 E,xpirgs: 07/20/2005 Tr. no: 13476 Restricted; 00 JESSE P CAPRIO 333 SERVICE RD. SANDWICH, MA 02563 Administrator Board of Building Rqulatious and Standards HOME IMPROVEMENT CONTRACTOR ` t Registration, 130930 Expiration: 5/12/2006 Type: Individual JESSE P.CAPRIO JESSE CAPRIO 333 SERVICE RD. SANDWICH,MA 02563 ' Administrator - -— The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations N3 -- 600 Washington Street, 71h Floor -10 Boston Mass. 02111 Workers' Compensation Insurance Affidavit:Building/Plumbin /Electrical Contractors ;'� v 7, T�!^ tiA:. T^ r t'^Y' �w-.•C-r,�a vy i v-v f wi fc n inform lion: ' ' ;� i. I'easeaP I gw%r r : a name: tilde Cape Building Co. , Inc_ address: 333 Service Road zip:'City Sandwich state: Mass. 02563 phone# 408 428-3200 . work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition tt��....:-t'n��'°"' 2'r "hLk .... Y�1;..ek "+'tix3`.7r•^.':,C• ...�sA.ri: � '` S 1 y.:,... �..t:......._�•'.Cc .�..� -'b>x:&i.r..+: 4za'-�1�:�o..j..'� _. . ,.....`.t::. ._,'"-°.: ..c.... .. .. ___ :t';.. .. ,.-i.:...-.. "':17..'t.`. ® I am an employer providing workers' compensation for my employees working on this job. company name: Same as applicant address: city: phone#: insuranceco. Guard Insurance Grou policy# QLV ❑ I am a sole proprietor, general contractor,'or homeowner(circle one) and have hired the contractors listed belovr who have the following workers' compensation polices: company-name: address: city: phone#: insurance co. policy# fF -v s.D'�:: � x.F.y +v'+t:��' • sr �-� rr� > & yr asB sa. •�1��ii �. �'4��� n�-F�Ua .�t�i�l7"�n..•.�n•`y'v�`�,s�:�f$ ':.:v �Y�-�?.::d��::;�dd?._�!1'� 3's�.�,.,i }'.r yi'*°.:F�'�:'�f.."tltan'i!��.Y'�d company name: ' address: city: phone#• insurance co. olic # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u 7r1ains an_d penalties of perjury that the information provided above is tr(uee a't I corr ct. co Signature Date 1 C� ' 0 Print name es e P. Caprio Phone# 508 428-3200 official use only do not write in this area to be completed by city or town official city or town: permit/license# Building Department ❑check if immediate response is required []Licensing Board P 9 ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (rcviscd 5ept.:003) E Tows-of Barnstable ypF•IH Tpy�� r , . Regulatory Services uomas L GoDex .Director , 1d7s; k�0 Building Mv.18i0n, To%Oerrh Building Commissioner 200 Main Street, $Y=aiS,,MA'02601 YrW"Aown.barnstable.ma.us r Fax: 508-7,90-6230 ' pffiae: 508.862-4038 Property Owner Must Complete and Sign'TbIs Section if Using ABuilder as Owner of the subject property to act on behalf; • �hereby authorize: '1�,�,��_T���d.• -i N.� •. • my '. . �J,' hers relative to work authorized bytivs*bunding permit applica r, tion for' . Address of ob} • gignature of Owner Date ; Print T'�ame . . v C y TOWN .OF ARNSAB E 7 � B iI in D' A rtm nt F n i n P rmit u d "g epa a ou dat •o e kk .Date r. -,� z Permit # 6` �1 - Name �� - ��; �--- , a Location a +$n•_ *° `�i� ..... R Y t .`..v�-\ bJ �.t1,.'l.t'.s..:.w.�`" '•r 4 'nsp■ of; Bldgs■� t. _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map f!G Parcel D 70 Application # Zo Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Village Lt2!5 Owner .7-0—Ow C4L; Address Telephone Permit Request A >b A4 f ll 11 L OA Sty fXLSTiNL� *"�i( 6 Square feet: 1 st floor: existing �Lfo proposed 0 2nd floor: existing 0 proposed Q_Total new t9 Zoning District Flood Plain Groundwater Overlay Project Valuation 000g, Construction Type wou-0) Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. -� Dwelling Type: Single Family GY Two Family ❑ Multi-Family (# units) cj Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Nighway:w0 Ye"sT ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 1 '4.¢4 Basement Finished Area (sq.ft.) b Basement Unfinished Area (sq.ft) o w Number of Baths: Full: existing new Half: existing new <25 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 ❑ es OLO, If yes, site plan review # ! Current Use Proposed Use Ee J APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name v46/kN On �y�l Telephone Number Address Pe2 4�1 0 License ,S (�(/1 fe M��7�6 �� Home Improvement Contractor# Worker's Compensation # r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ✓GN /n�� r' SIGNATURE DATE 2 G 2' © � FOR OFFICIAL USE ONLY APPLICATION# _ DATE ISSUED - MAP/PARCEL N0. ADDRESS VILLAGE OWNER- DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE I: ELECTRICAL: ROUGH FINAL ` I PLUMBING: ROUGH FINAL. GAS: ROUGH FINAL' FINAL BUILDING 1011'1 1j ' oo, DATE.CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents h - � Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibI Dame (Business/Organization/lndivi dual): a Address: � c q�o r' City/State/Zip: . ? (/t �7 Phone #: 2— = �-/� t>y Are you an employer? Check the appropriate box: �, 4. ❑ I am a general contractor and I Type of project(required): I.�[am a employer with 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 shedt. 7. ❑ Remodeling These sub-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition • 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 I LEJ Plumbing repairs or additions myself..[No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.) t c. 152; §1(4), and we have no employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. LContractors 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. _ Insurance Company Name: (_-z !/w12FV-, Policy#or Self ins. Lic. #:C L( 6 Expiration Date: 2. Job Site Address: 1_4 (� ! ' City/State/Zip:Dj-?��, 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 S 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 yeFificat)on. do hereby nder the pains and penalfies of perjury that-the information provided above is true and correct./ S i aturt Date: Phone#: [Other only. Do not write in this area, to be completer)by'city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector son: Phone#: Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of,a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.' MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage'required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), addresses) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the'permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to filljn the permit/license number which will be used as a reference number. In addition an applicant that must submit multiple permitAicense applications in any given year, need only submit one affidavit indicating current policy information(ifriecessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a d6g license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Te4�#.617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia I of THE r BARNS A.B-E, . '"" Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO 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 NA, 611 e rT e , as Owner of the subject property hereby authorize $y/`4l l k2, ele1, 0oS to act on my behalf, in all matters relative to work authorized by this building permit applicadon for: 2- 2 %k*,,—J (Address of Job) n 2-01 Signature of Owner Date Print Name if Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\dccollik\AppData\[.oca[\Microsoft\WindowslTcmpomry Intemct Files\Contcnt.0ut1ook1DDV87AaZ\EXPRESS.doc Revised 0721 10 Town of Barnstable TF1E Regulatory Services tiAxrrsTnar E Thomas P. Geiler, Director '`� tr53q. Building Division q� ��� g Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.t6wn.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. 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 farm acceptable to the Building Official, that he/she shall be/ responsible for all such work performed under the building perrrut. (Section 109.1 A) 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 witlrsaid 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 hbmeowoer performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.).1 -Licensing-of construction Supervisors);piavidcd that if the homeowner engages a Verson(s)for hire-to:do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack ofawareness 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 pan 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/ccrtifieation for use in your community. Q:forms:homccxcmpt CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 2/8/2011 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 endorsements. IODUCER CONTACT NAME: Zach Lynkiewicz Urray 6 MacDonald Insurance Services, Inc. N NI: (308)540-2400 Nee(900)209-4111 50 MacArthur Blvd. EBRI ADMDAIL CLAMMER AO014460 C13ri1® MA 02532 INSURER 3 AFFORDING COVERAGE NAIC0 SURED INSURERA:Fireman t S Fund Ins CO INSURERB:SBPet Indemnit 361E 74 MaiRII A Street Welch Construction Inc INSURERCACe Property lE Casualt Ins 31 INSURER0! D Box 490 aterville MA 02655 INSURER E:IN RF: AVERAGES CERTIFICATE NUMBER:10-11 Master GL 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. R TYPEOF INSURANCE AWL.SUNK CPOLICY NUMBER MMlDOYIYYYY P KYY1/ LIMITS GENERAL LIABILITY EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO ES R e 5 50,000 X CLAIMS-MADE0 OCCUR LHB10000343 6/13/2010 6/23/2011 MEDEXP(Any one parson S 51000 PERSONAL&ADV INJURY S 11000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000 X POLICY EPRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS 6207210 E/4/2010 9/4/2011 BODILY INJURY(Per person) S BODILY INJURY(Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Pereceldent) S X NON-OWNED AUTOS PIP-Beale 6 8,000 Undertnsured matonst BI spill S 256,000 UMBRELLA LIA9 OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE DEDUCTIBLE S RETENTION S g WORKERS COMPENSATION WC STAYU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EX(!CUTIVE E,L,EACH ACCIDENT S 500 OOO WFICER/MEMBER EXCLUDED? N/A (Mandatory In NN) C46252512 /6/2011 /6/2012 II yyna�describe under E.L.DISEASE-EA EMPLOYE S 500 000 DESLtRIPTION OF OPERATIONS blow E.L.DISEASE-POLICY LIMIT S 500 000 ICRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AddlUonal Ramanre schedule,B more space Is esqulmd) ,RTIFICATE HOLDER CANCELLATION 08)759-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 200 Main at AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 S Harrington, CIC/SLei b•`�' ��` }% � ORD 25(2009/00) p 1888.2009 ACORD CORPORATION, All rights reserved. i025(200909) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Ausiness Regulation 10 Park Plaza - Suite 5170 Boston, Massa c f usetts 02116 Home Improvement Cctor Registration Registration: 128405 Type: Partnership z ; X Expiration: 4/5/2013 Tr# 211402 KENDALL & WELCH CONSTRUCTION w ' DAMON KENDALL J P.O. BOX 490 OSTERVILLE, MA 02655 %,, �< Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card S•CA1 0 50M-04/04-G101216 C,� Co�0d77�"A `ate '14`�s License or re � Office of nsumer Affairs&B siuess egulah�o� g'stration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,%3,128405 Type: Office of Consumer Affairs and Business Regulation Expiration: c4/5/2013 Partnership 10 Park Plaza-Suite 5170 Boston,MA 02116 FKA &WEXH COS STR OCT 10N DAMON KENDALL 54 KOMPASS R.'° •=' a FALMOUTH, MA 02536 Undersecretary Not valid without signature SZ96 :#Jl , .Guu�IsslunuoJ .o . Zl•OZ/6Z/ll :uoltendx3 ,�, i Zia}�SS`ddWO�i Sti a: t 7VON3�1 l NOINVO 9200L SO :asuaolj. asu831-1 JoSlAaadnS uo1jana;suo0` ' sp.rr.nurls-put!cuourin;�a� 14ulpiin9 jo p.rro9 d .' :cla.irC �ilun�l-l0 luatul.ncda9 -sllasnyir.�sr.h� I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 01 "'Application # C 6 S Health Division - , `Date Issued 2 �-: l Conservation Division �.Applicatido Fee Planning Dept. Permit Fee- Date Definitive Plan Approved by Planning Board Coz2�i?�II Historic - OKH Preservation/Hyannis Project Street Address 1 Z 76 Ad A C ; • Village _ S"S'L-rz�; l� Owner o Address) 272`7 jsuortti ( cent, Bo, 64A TelephorielZ'�4 LOvi t` 5t ,,� 1=LA : 33y1�3 Permit Request �I,g r� Pki�4,,� 2oL� do z� ill®ye FJcjs�►no sdi 'AAO, Square feet: 1 st floor: existing 3aproposed 130 2nd floor: existing i ZI 2.- proposed i 2i I--Total new T(0 Zoning District Flood Plain Groundwater Overlay Project Valuatio4 -0- Construction Type Lot Size' Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure jgf16 Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes )<No Basement Type: Full Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 572 Number of Baths: Full: existing_ new --- Half: existing new 0 Number of Bedrooms: 3 existinga new Total Room Count (not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: (Gas ❑ Oil ❑ Electric ❑Other R Central Air: VYes ❑ No Fireplaces: Existing 1 New Existing wood_/coal stove*) ❑Yes 0 No 4 _ Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑-new= size_ rx ....,, Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ M Commercial ❑Yes U& If yes, site plan review# Current Use e Proposed Use Fe- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a"n F�Y/1 W� Telephone Number �CJ4 ���y goo Address F© r ,� ®S TV L t(L MIt License # / oo 6 Home Improvement Contractor# 2 P� Worker's Compensation # C NL 2- Z I Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �'L" oqgYfit, SIGNATURE .� ;� DATE V t tee: FOR OFFICIAL USE ONLY APPLICATION# 3.;DATE ISSUED.;-f.F _MAP./PARCEL NO::- j 'ADDRESS VILLAGE r OWNER ' DATE OF INSPECTION: FRAME itqlL2111 %,INSULATION: At I 3 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - ii r ROUGH FINAL �� �r 1 . i �riiFINAL BUILDINGi; wibl1�,IJl � z � F DATE CLOSED".OUT: _ ASSOCIATION PLAN NO. 1 , The Commonwealth of Massachusetts i I Department of Industrial Accidents 1. I Office of Investigations i �� < <`Y 600 Washington Street. Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bus iness/Organization/Individual): �( q Address:Fa, 1-1 01 City/State/Zip: C? -VA,I 0112f hone #: �(�,� L/2_F !iW 0 Are you an employer?Chec the appropriate box: Type of project(required): 1.[Q I am a employer with 4. W I am a general contractor and 1 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 officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.).t employees. [No workers' comp, insurance required.] 13.❑Other *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. 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:n CCp r(Pe -TI/ 4k oa5 ko�)1 V T4 c Policy#or Self-ins. Lic. #: C H L Z ri 2 ;S 11 Expiration Date: Job Site Address: LIS e— City/State/Zip:c., 26� s' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). . Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.06 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 paaiinss and penalties of perjury that the information provided above is true and correct. Signature: 1/W►A'1� /�Y Date: I -Lott 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#: J Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint.enterprise, and including the legal representatives of a deceased employer,or the receiver.or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely;by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(g)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,-a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant. . that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass..gov/dia oFTHET Town of Barnstable Regulatory Services r BAws-TABLE, 9 ALAas. $ Thomas F. Geiler,Director � m' 1639. a` Building Division rE0/.lA'I Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62 Property Owner Must Complete and Sign This Section If Using A Builder I, Awk cLoi y , as Owner of the subject e 1 , property hereby authorize 9pau &a �Pfc`, Cow to act on my behalf, in all matters relative to work authorized by this building permit application for. 21 AW (Address of Jo cool Z3 L11 Signature of Owner Date AYNE 1 `A Print Name If Property Owneris applying forpermitplease complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNE RPERMISSION Town of Barnstable �Op THE r�ti Regulatory Services � SARNSfABLE, � Thomas F. Geller, Director MASS. - `b rti79• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to A,n.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DA TE: 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. DEFINITrON OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEIITPTION 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 supenhsor." 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 ccrtify 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. 6/25/ 10 9 : 35 : 47 AM 4130 ® 02/02 ACCOR& CERTIFICATE OF LIABILITY INSURANCE D/25/l201Y10 625/ YYY) ��• 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 pollcy(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 endorsements . PRODUCER CONTACT NAME: Suzanne Harrington Murray & MacDonald Insurance Services, Inc. AHCNNo EM: (508)540-2400 FAX No: (508)289-4111 550 MacArthur Blvd. ADDRIESS:sharrington@mmisi.com PRODUCER 00014460 CUSTOMER ID 4. Bourne MA 02532 INSURER($)AFFORDING COVERAGE NAIC rx INSURED INSURER A:Fireman's Fund Ins CO INSURERB:Safety Indemnity 33618 Kendall & Welch Construction Inc INSURERC:P+Ce Property & Casualty Ins 874 Main Street INSURERD: PO Box 490 INSURER E Osterville MA 02655 1INSURERF: COVERAGES CERTIFICATE NUMBER:10-11 Master GL REVISION NUMBER: THIS IS TO CERTIFYTHAT 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. INS INSR TYPE OF INSURANCEADDLISUBK POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GCNCRAL LIADILITY PREMISES Ea occu once $ 50,00( A X CLAIMS-MADE OCCUR H510000343 6/13 22010 6/13/2011 MED EXP(Puffy uiie paisuiq $ 5,00( PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00( JEC X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT • (Ea accident) $ 1,000,00( ANY AUTO B ALL OWNED AUTOS 6207210 /4/2009 /4 accident) /2010 BODILYINJURY(Per ) $ X SCHEDULED AUTOS BODILY INJURY(Per aident) $ X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OVvNED AUTOS PIP-Basic $ 8,00( Underinsured motorist BI split $ 250,0011 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ HDEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION X I WC DRYSTATU- OTH- AND EMPLOYERS'LIABILITYFIR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,00( OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) 46252512 /6/2010 /6/2011 E.L.DISEASE-EA EMPLOYEE $ 500,00 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION (508)428-4907 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Suzanne Harrington, CIC '4� ) CERTIFICATE OF LIABILITY INSURANCE 8/19/2010 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. �rMPORTANT: 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 endorsements . PRODUCER CONTACT Zach L nkiewicz NAME: Y Murray & MacDonald Insurance Services, Inc. FACNE E , (508)540-2400 ac No: (50e)289-4111 E MAIL 550 MacArthur Blvd. ADDRESS: PRODUCER 00063498 Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER AArbella Protection Insurance 41360 INSURER B:Technology Ins Co Colony Insulation Inc. INSURERC: 28 Jonathan Bourne Road INSURER D: INSURER E Pocasset MA 02559 INSURERF: COVERAGES CERTIFICATE NUMBER:10-11 Master GL 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED X 100,00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR 8500028928 8/18/2010 8/18/2011 MED EXP(Any one person $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X I POLICY I I PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED AUTOS 49692400002 8/18/2010 8/18/2011 • BODILY INJURY(Per accident) $ X SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS Underinsured motorist BI split $ 20,00 PIP-Basic $ 8,00 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE—_ _ __$_.` _ A X RETENTION $ 10,000 4600028929 8/18/2010 8/18/20111 $ B WORKERS COMPENSATION X WC STATU- DTH- AND EMPLOYERS'LIABILITY Y I NTORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED' ❑ N I A (Mandatory In NH) TWC3250647 8/18/2010 8/18/2011 E.L.DISEASE-EA EMPLOYE $ 500,00 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is named as additional insured/contractor on Commercial General Laibility per CG2010. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kendall & Welch Construction Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO Box1478 North Falmouth, MA 02556 AUTHORIZED REPRESENTATIVE Massachusetts-Dep:►rtment of Public Safety Board of Building Regufations_and Standards Co,nstPuction Supervisor License License: CS 83484 RONALD W WELCH 85 BRIGANTINE DR HATCHUILLE, MA 02536 Expiration: 1/11/2012 Commissioner Tr#: 29231 Massachusetts- Depatiment of Public Safety Board of Buildin!-, Red„ulations and Standards Construction Supervisor License License: CS 70086 ---.--- ----,EE I DAMON L KENDALL 48 KOMPASS'DR FALMOUTH, MA 02536 Expiration: 11/21/2012 Commissioner Tr#: 9525 I I EX15TING WALLS 20 NEW WALLS ail ROOF A f,rA c 0 C 0 ACCA.'-Scr'Llf 1pff 59 10 A. • ............. .................................................... 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I a, D} ... ram Nu eP.cwS.............................rta4C n,...................................._w._aL SEE PAGE}OF J •, :,•' ;'•' : Tt%. 19B .~e•.,. rERcp,mu�mt>ur eue.MNG.. .' 2.2%1 2 .1 Ha !>.mromu w2.ruua raF.... m n mnemr....e•r oeenm YvrnD+re...................... .1. J]O n.xv>er Nltawr.dnptmmm,]t, • es.' r ....._. ....... ..................... �L ,' T1%B J 9 -2 I "--'---' a '"""""'-"...... ''�` MAXIMUM WALL STUD HEIGHT,STUD SPACING, e' o-2xn I ...... ...................._w.�L SEE PAGE 2OFJ 9' _ \ . '°• ::'• '!r ' RAFTER CONNECTION AND WALL SHEATHING w' i}%o {IB9 eeo '�••!�•�„',�. °'• nit;n..lP.cwa.............................rr.B.e I�,... ......... } eorwre,ION wo.w Re m,.n.I N.Ee,rr.Ble e,... mxeol,wt.Rlarr e.Ie.,,.wa rt.eLE n 11L4 If s-1%10 . 91. IIG •':•�: / maLL mL.Rwra .':•A• V R.rEn roR mro ea®t............................................................................... TABLE S, WALL OPENINGS-HEADERS ,. ,;,•' S.I ROOFS ' Rmw.R.nwa,(ReER,..N,aut:.:m,l•oP maF,:Q,a,e u:._eP.N root.>ee emmNre, y IN LOADBEARING WALLS •.'ei.'0i.er:'e::'e:�.'•• .R,.ert.]teR w Y r,e1.e oR R.rieR momr.�lnm!.r IA.mB.awnB m.HB Nord. ..e•. 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AROUND WALL OPENINGS LDER aOD ADDRE89 RE isoN oF:BY PeGE e<etE JB Des! ns KENDALL f WELCH CLAY RESIDENCE RENOVATE AND ADD JB •�OF�' u.•.ra• 91 22 THIRD AVE. SECOND FLOOR DORMER. OSTERVILLE MA. 5 .r.mn.a.Rrr. ,a •-< ,e..-r °^t .. ". -w "` isoei�sr-Es3. Town of Barnstable °^ Regulatory Services snRNSr"L& ' Thomas F. Geiler,Director Mass. Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: �— U l Map/Parcel: Q)`] h Project Address 2 2 -h i l-� Iry-Q- Builder: l ) C n f-e_ The following items were noted on reviewing: j Reviewed by: Date: NAME:CT E I SP CS ADDRESS: PERMIT# PERMIT DATE: Lcw) I u M/P• LARGE PLANS ARE FILED IN: BANKERS BOX 7 FILED ALPHABETICALY BY STREET INFORMATION SHEET FILED IN STREET FILE q/wpfi les/forms/archive/BANKERS B OX PROJECT j NAME: el yyNlp p ADDRESS: t1'rCt 111ye; PERMIT# �d l o d Ll SR PERMIT DATE: 1,6;"a I f M/P: l ! & O r7 0 LARGE PLANS ARE FILED IN: BANKERS BOX BOX FILED ALPHABETICALY BY STREET INFORMATION SHEET FILED IN STREET FILE q/wpfiles/forms/archive/BANKERSBOX PROJECT NAME: Dp. gD �L _ r . � 'is ADDRESS: r��i l y'� �4,►�, PERMIT# PERMIT DATE: MJP: cD LARGE PLANS ARE FILED IN: BANKERS BOX C)S }- FILED ALPHABETICALY BY STREET INFORMATION SHEET FILED IN STREET FILE q/wpfiles/forms/archive/BANKERSBOX PROJECT NAME: ADDRESS: a a 1±2 C ?& 17� PERMIT#__ PERMIT DATE: CC 113 G S Mrn: 11. (o ow LARGE PLANS ARE FILED IN: BANKERS BOX 0S+ 4 7 FILED ALPHABETICALY BY STREET INFORMATION SHEET FILED IN STREET FILE q/wpfiles/forms/archive/BANKERSBOX PLAN REFERENCE :BARNSTABLE COUNTY REGISTRY OF DEEDS PLAN BOOK 116,PAGE 133. 2.96' b I 40.00' I I I �I Existing _ PROPOSED 1% I Garage ADDITION (on sonotubes) I Ail 18.0 . I _ s.z_ I . I 5.6' Existing I 3 Bedroom I Dwelling Hse. #3 o Easement Plan OPOS recorded in Barnstable r , PRED', County Registry of Deeds Book 18527, Page 273. — _ _9.5' _ „1 ;D;DIT%LO' ',� _ _10.3'_ _ %c , %Mtub ',(,on,sonotubes-),' II ,' �'i', i',' i' I Existing I Septic I Tank s�� 18. 0' I � ' Ili 1 Existing I I I i Exist. I I Septic I I D-Box II Leaching la I I I I I I c N I PARCEL 70 I 4,000+/- S.F. I I I 6.11' I 40.00' THIRD AVE I hereby certify that this dwelling is located on the ground as shown, and that the dwelling is located in Flood Zone "C", as shown on F.I.R.M. 25001 0016 D, for the Town of Barnstable, revised to 07/02/92. 06/07/05 NORMAN GROSSMAN, PLS DATE HOUSE No:..... 22 j+ .af � ASSESS.MAP: 116 DWELLING LOCATION PLAN ` PARCEL:.......... 070 ZONING DIST.: R-C WMMAN PARCEL 70, #22 THIRD AVE FLOOD ZONE% C 1� No.12 f � OSTERVILLE, MA. ELEVATION:.... OWNER: sT`a�, SCALE : 1" = 10' Norman Grossman, P.L.S. David R Hubbell "� _F,y 93 Falmouth Heights Road, #4 P.O. Box 24 DATE : APR. 20, 2005� '`" Falmouth, Ma. 02540 Osterville,MA 02655 PLAN NO. : C - 909 508-548-1920 REV.: 06107105; Change Zoning District to R-C. rl ToAff 2;- GO It 0 D IVY,I- ol -po 40.0 f5A PAT10 -GROU -ofC, k LOCUS MAP _.. J�- A55E55OR5 ID: MAP I I G PARCEL 070 ol PARCEL AREA:4054± 5.1 . -tp: REFERENCE DEED: 24831-229 EX15TING ELEVATOR ADDITION RECORD OWNERS: JOHN W. *ANNE C. CLAY 9 LYNWOOD LANE NASHVILLE,TN 37205 ZONING DISTRICT: KC qWf UUMG OVERLAY DISTRICTS: AP, SALTWATER ESTUARY PROTECTION KPOD rn FEMA ZONE., "C"(NON-HAZARD) FIRM PANEL: 250001 001 G D MAP REV.JULY 2, 1992 � � 1 � , o I � I HEREBY CERTIFY THAT,TO THE BEST Of MY 0 KNOWLEDGE, BASED ON AN INSTRUMENT SURVEY, 0 10 20 THE STRUCTURES SHOWN HEREON ARE&5- Feet THEY EXIST ON THE GROUND. SCALE: I" = 10' S S—L TL HEN cn J. -H DOYLE 0.37559 S\ sl ROE CF 5TO f-9 PARCEL 70 "t u5tA oglvf PLOT PLAN Of LAND PREPARED FOR 40.001 #22 THIRD AVENUE 05TERVILLE, MA55ACHU5ETT5 DATE: APKIL 30, 2014 SCALE: I" = 10' PLAN REVISIONS: 35 M)f 5TEFHEN DOYLE AND A550CIATE5 42 CANTERBURY LANE EAST fALMOUTH, MA55ACHU5M5 0253G TELEPHONE: 505 540-2534 5JD5URVEY@AOL.COM