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0056 ALDER BROOK LANE
I ' P I I I ?)-Ad NO. 152 1/3 ORA ESSELYE Town of Barnstable Building BAIL\^31'ABLB. Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept . ` Posted Until Final Inspection Has Been Made. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-19-2579 Applicant Name: Richard Tupper Approvals Date Issued: 03/23/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 09/23/2020 Foundation: Location: 56 ALDER BROOK LANE,WEST BARNSTABLE Map/Lot: 133-054 Zoning District: RF Sheathing: Owner on Record: SULLIVAN, PETER THOMAS& MICHELE Contractor Name: Richard S Tupper Framing: 1 Address: 1 MUSKET WAY Contractor License: CS=069058 2 FRANKLIN, MA 02038 Est. Project Cost: $4,699.00 Chimney: Description: Install R-39 fg and R-33 cellulose into open attic space,install Permit Fee: $85.00 ventilation chutes,install R-10 rigid board along common wall and } Insulation: kneewall slope,air seal home to restrict air leakage,installR-10 Fee Paid) $85.00 rigid board in crawlspace. Date: 3/23/2020 Final: Project Review Req: Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aftehssuance. All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. I 1 // Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Apr 01 2020 01:21PM Tupper Construction Co. 5087785010 page 1 TU PPE R ge" CONSTRUCTION CO.LLr 546A Higgins Crowell Rd.WEST YARMOUTH,AAA 02673 PHONE: 500-776-0111 FAX: 505-779-5010 EMAIL:admin@tupperco.com Date: Town of Barnstable Building Inspector 200 Main Street Hyannis, MA 02601r-� (508) 790-6230 fax Re: Insulation Permit at Permit# ? r I q � Issued On 3 (23 This affidavit is to certify that' all work completed for the above permit application has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, r Richard Tupper License # CS-69058 l�" w r , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V1. 5 Parcel Application # Health Division Date Issued P N Ilk R04, Conservation Division Application Fee Planning Dept. Permit Fee / 6 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 1150(o AId,er 3YO&Y- Lan-e- - Village WWeS+- 8al`r�S�ek Owner son@ :n tt'r Address Telephone -1"1L4- 410- 102 Permit Request d ecL I Zi( Square feet: 1 st floor: existing S Zv proposed 2nd floor: existing &.y proposed Total new Zoning District Flood Plain Groundwater Overlay Pro jecf Valuation '4 Ooo Construction Type C6d mahugo�,,�C5 P t. k Lot Size_ 146`v 7_4o'. 1(.6-r 7-GO ' aerZ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family & Two Family ❑ Multi-Family (# units) Age of Existing Structure ( I rS Historic House: ❑Yes 0 No On Old King's Highway: 0 Yes ❑ No Basement Type: ;d Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area°(sgyft)p . f~32Q� Number of Baths: Full: existing Z new Half: existing _ �� knew, Number of Bedrooms: 3 existing _new UCT 24 2016 TORN r,- Total Room Count (not including baths): existing S new First Floor-Room YCount 3 .�rH�t.E Heat Type and Fuel: ❑ Gas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes A 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:0 existing ❑ new size I Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use i2e5� (ice «I Proposed Use CIJ, 11 ,( APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -- Name sg4a Telephone Number -1 4j--i Ui�Z Address , -P-OP 9) License # l es'E' Huc�vug , AM UZeA2. Home Improvement Contractor# Email V-U1Uy1 ,. A+ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Nk I�eJfo4 (.eta , SIGNATURE DATE 10 2-4 140 E - FOR OFFICIAL USE ONLY k I APPLICATION # DATE ISSUED MAP/ PARCEL NO. n ` ADDRESS VILLAGE OWNER I . k DATE OF INSPECTION: f FOUNDATION 3 FRAME >r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH_ FINAL FINAL BUILDING; jF DATE CLOSED OUT ASSOCIATION PLAN NO. The CanuranrWeahh - ` Office Of &V W=h&glou,met fin,MA 02HI War mm' Cmgpensaf=Insm-ance#�aviL Rax,'triprzl(,'` Akan#IufnrMafann Please Prm Y SQn ford Addre= 7.0 80 cayrstau!a* PhCMg- T74• Are you as employer?Check the appro late ba= Type of project(regn-- L❑ I am a exnploger wift 4 ❑I am a ger=9 otter and I employees(fish ardfor part-time;* haft hiredS&e M ti ❑New oonstrndioa 2-❑ I am a sole prgmietx orpartmer- fisted anthe attached sheet I OR— deling s!ip and have no empIcyiees. snb-caorfsaclns.lrave 8. ❑Demol Emn. rwadting forme in aay capacity. andhave t4adiers 9. El Build ad3 on< [No '.�-isaexa„r� Camp- f reqzked-] 5. ❑ We are a axparatsoa add is 16-❑Elul mpais or add. 3_( ] I am.a bameovmer doing of E work ofi"icers have wed their 1L❑Pbabingrepass or$d&ticM* mymdf • of MGL �aa� ugfiE ffi F� Mmance I t - c.>!52,§1(4k andwehweno �'❑ f < emTdoyem(No wmie=g 13_®Other I Lzr ZNCjL zoulp l y ap d�dsba�'l=stkImfficmI*emcfinab6vw &eirvulee mzt; +•palirgin as l ame�ea�zLesabotd=st ;g t$epim3aiu.-age=devMhiMbM=idecerTtTs MBMiitanesysM32-edmdics sorb. TCas 'Bzt eherlr bM Mt steed=addifi siren sbcaiag&MPn cf the xud sty vdzeds uraet'%nee a hs�e emplvpees 5€th�m�}resntmrtr,.e� �y-�Pmsidrfhea snd�'�-Palm met . .Tam Qa eutpIa�sr�i�isprmrcdir;g�r�ar&ets'cotrrperes�iarc ii2s�rasrs for earpla}�eraz Sefoev is tPrs p ip f ab sits fx�arm�na T,wmmnceCmmpazTNamL- Tolicyll'or Self-ins.Tic- Job SteAddre= MV/Staie�_ Attach a copy ofthe ss arkere comapensaflonpolicy demotion pap(showing the p'oRcY amber and expa-ation date). Failure to sec=caverage as regnuedunder Secimn 25A o€MGL c-M can lead tD Sic imposffi=of cuimiaal penalties of a fine up to$L50D Oa andfar sane-gearimppsismment,as WeR as dvd peaaltigs si fe foffi of a STOP WDRX CMMand a time of up toQi3O a dap ainsf ffie violator. Be advised flxd a copy of ties zbden2ent maybe farwazded to tlar Office of Rrves�p5iams of*e DIA for cavexap vedfica6ma_ I do hmwby Carb1y undw dw pares and psnabbks afy*jWy foots ir�forvnairaa prov&W abare is tree and cmrrzt Si D d �y Phone lk "1? -qV7— iOTSZ 02kid asaa ila arst a rite in ff�a q 5e csrripfet by arta>Fn t MY or Tasva: plcr e e;g Ewidng A flwrity(ca-de one): L Board of$cal& Dqm meat 3.Cdyfravm C3rk 4.Electrical Eraspectnv S.Plmhing aspedw Conbct Person: Phow 6 r i ir , rr . rr rIm r Mmrr �I:K ..1•..�•■- i!I i' .•:.I fi :•■Mal:+ 1 i•11■ •'i:R I/ •1 ■• •- •••7.1iR .•ll•l.illl:•t■1• 1a [■�Jl .f•tlr ••�w ■r _•Y-/■/ ■• 1•■i. 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DEFINITION OF HOMEOWNER Person(s)who.owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be 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 req ements d he/she will comply with said procedures and requirements. VA Sign of omeown Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire-to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a-licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certiftcation for use in your community. r Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable Regulatory Services j emu' Richard V. Scali,Director 16 Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,'MA 02601 i www.town.barnstable.ma.us i Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property, hereby authorize to act on my behA in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOI S A� DER 8 ROOK •. d...r. . .P..�Aid/-. -- --=- --:- �oc/9T/oN: .WEST. SARNs%ABLE ..:___ _ _ . S C A '� G DA T�'' ./off// S �Sw AFrjr;�. �o , -- - .._ ... j'LA�►! P.EF: 8 K z7.s PG s/...... ... ........._ ____ .. y• _ LLOYD - •io .y FOR: K,4RL t-vaH.4KE r, 1 HEREBy cERTIFY THAT 7)iE rxis7— /N6 90VNDA710AI 40CA7/01V /S CORRECT S S/yo w,v An/D DOES C o iV Fo.R ti w rrH . Bu1,LD/NG- SE7-8ACK REQVtRMENTS OF Tb'E •TowA/ of BAP\1! STAB[,,E. REG /LAivD 5uR VEyoR —' — --�.. FAL MOUTH 17P,5S., - `OFZHE Tp�y Barnstable Old Kings Highway Historic District Committee O,^ &UUisrABLE. ; 200 Main Street,Hyannis,MA 02601, TEL: 508-862-4787 Fax 508-862-4784 T MAG4 A �p i63q.s�0ro rF0 MAC APPLICATION, CiRTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition K Alteration 2. Type of Building: House 03 Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof 0 color/material change, of trim, siding,window, door 4. Ste: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign - 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE All applications must be signed by the current owner Owner(print): _ Sanfor6 - .Tyler Telephone#: 77y- q87' Q SL Address of Proposed Work: S(o A 1&er 7BfODK Lane r Village W.BaM5-)ctbl�, Map Lot# Mailing Address(if different) ?.0, gqdAlIt 4- NA OZ67 2- Owner's Signature Description of Proposed Work: Give particulars f work to be done: �VWe 211 W S dmr5,roc!b(ack SkWVS 40 �Il .rec�� wv\dcx,�s �'PDleIG2 oud,le� jl� w� eniOfl lte�+s,� �� ,S U.�tl e,+ca I� S"A.� aaC,2je franf ad Satre torVY's a f qam-c6r-*(A TQtaa f /eQla�411 rl r�� qty . - add d¢r or �v� "barn dour Ca �a arc 2-{ryn�Cabl a dog 1' IA44 It u�y Agent or Contractor(print): �(d 71�(.Qr Telephone#: ;VeW Address: 1�.D Uje414qanAL50rY4 AM OZ(.072 CALXX IL tr Contractor/Agent' signature: For committee use only. This Certificate is here APPROVED/ Date Members signatures RECEVED tl� Q 7 ►l16 'R® i I+di �� JMENT i Cod 3,) c�l ic - BUILDING DEPT. OCT 24 2016 TOWR OF BARi Q:IBoards and Commissions101d Kings HiglnvaylOKHApplicationslOKH2O11 CertAppropriateness.doc X G - i 4 v-P v2' C*74 vl T t 'a v-c wc� ® / '� p o Vc✓_ r Q ALo 10.1 f 1 sowAt+z,;(es ��6)je � � j i �. �. �.. �. �.�� �, _l. a - _ - � �� �- :� �� ��� �. f � � - - � i _ J: �� I:. �.i � �� :� �I � . - � �, � � � � 'v - I � .,�-. r 3� ! +' M. r .� � J � - ._i.. _- �� �. ��- �_ - _. _�_..-,,...,_ _ _ - j r 1HE Town of Barnstable *Permit ok �a_V fee 6monthsfromissuedate Regulatory Services anaxsrwBt.s. Richard V.Scali,Direc�r �y, z63q. ,� o ;S, . f✓ BuildingDivision Imn Paul Roma,Building Commissioner �]l 200 Main Street,Hyannis,MA 02601P 012016 www.town.barnsta�����, Office: 508-862-4038 OFBqRN Fax: 508-790-6230 EXPRESS PERART APPLICATION - RESIDENTIAU LY 05 -65V Not Valid without Red X-Press Imprint Map/parcel Number A� Property Address rO AdCt_8fWk- LOW, U Q9 _ —7PWnd4C.b(2--, Residential Value of Work$ guy , Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P.o - -30� F-D j bjenk 4UVffiisAw4 AM 0&7?- Contractor's Name �f�of Telephone Number Home Improvement Contractor License#(if applicable) 773t'¢S Email: lei-GO e—v-crt7an.f1P� Construction Supervisor's License#(if applicable) CS ,0(60q 8Z- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A (c _) Ills . CO . Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side Gwo42 fiort' Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows K A't aei4 T3 SkAkS #of doors: 4 ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. i A copy of the Hom Improvement Contractors License&Construction Supervisors License is required SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 The Conzixs'ompeah*of Afawadrnse&s Department ofgndwizid Acciderrfr Of ce OfInIWA-aions. 600 washuWan sbwet Boston,CIA 02111 fvrvtmmas&gns►1dia Workers' C=43ensafranInsurance,Affidavit Bmlders/C nm&acbarsMeetric-ians/Phnnbers Applicant Inform,atr`:on Please Print Fee ly Na= - tee Address` ?cI—qk'1— Qi oKz Are YOU an employer?Check t6 appropriate box: Type of project(required): L❑ I am a employer with 4. ❑I am a general contractor and I 6- ❑New construction employees(full andfor part-dimes* liave hind the soar-cont actors 2.❑ I am a sole pruprietamr orpartner- listed on the attached sheet: I- ❑REmodeiiug. ship and have no employees . Tltese sub-contractars have g_ ❑Demolition warring for me in any rapacity. employees and have wod rss' 9..❑Budding adx ifion [NO wodm ,'comp-insur-.rnre comp.insuran l - regnired_] 5. ❑ We are a corporation and its M❑Electrical repairs or adddions 31 I am a homeowner doing all work officers have exercised their IL❑Phnnbing repairs or adtEtions oat er MGL thyself[Nowoslaers'comp- of L.❑Rflofrepairs i mmmance regEF red-]Y c_M §1{��dwe have nn employees.[No worms' 13.❑other comp.insurance mquired.) •AnyapglicmtHsatcheftbozfE1 must also Mlouttheswionbelowslwn die1rwm1e&oe®pensafianporicyin5=z5caL I ERmeawners w1w submit dm s$dseir-rk— -saciL ICdn=ctom tb=dbec3rtlds box mast atlarhed as sddi5ffna1 sheet sb=ing the name of the snb-r� smd state whe m or noR9we eoiitiesbm mwbyees.Ifthesnb-tkatn xshaoee pi dhey=xst•rmvidetheu wad—s'aemp.paIiosamabec I am an Below is fitepa cy and job site informaliars Insurance Company Name- 'Policy 14t or Self-ins,Lic- m�R� ?O[ 21�� �piratiaaDate: �I�I(� Job Safe Actress: .S(o Cityl5tawzio- Lje�r Af#ach acopp of the workers'coanpensationpolicy declaration page(showing the policy number and expiration date). FaRnre to secure coverage as requiredunder Section 25A of M—JGL m 152 can lead to the imposition of criminal penalties of a fine up to$UOD OD and for oni-geirinaprisonmeuf,as we11 as rim penalties is the farm of a STOP W0FX ORDER and a fame of up is$250.00 a day against the violator_ Be a&ised'thaf a copy of this stateme t maybe fmvarded to the Office of Investigations of the DIA for insurance coverage vedfication- Ida hereby esrtafp' under the and TO — MYI47 firatfha infarwxafrmtprmtrTed abo��a is true and carrel _afitrR- !` U ]�at8 Officiat nm airily. Do scat suite in dib area,to be cvmpTeted by city ortoirn ofrdat City-or Town: PermitUcense S LwaingA fharity(carckone): L Soard o#Health r.Bmifirmg Depart 3.C ty/rown Clrrk 4.13ectrical Enspector S.Pianbing Inspector 6.Other Contact Person: Phone#' 6 w . -Information and 11ns-rxcions hbmsach►ceifs General Lams chapter M req=es all employ CES to provide w06=e compensation fftheg e�Ioyees. porsuantto this sty,an a Ioy�'is defued as.¢.everypersonm the scrvice of another under any contract ofhirr, ' express err i[X3PHCd,oral err wrhfrn." i Au ezVkyer is dofincd as'ail iafi4idnaL Part=zhs P,assoc�an;corporation or ova Iegal entity,or.y two or mare ftefagn i zjoit efere,andmclo&ogtle ti =ms y o legal a the receiver or trustee of an individual,partnership,associafion or other legal entity,employing employees. However the owner of a.dwelling home,having not more than f3=apartments and who resides1herem,or the octet ofthm - dwelling house of anofher,who employs persons to do maiafenancc,construction or repair work on such dweIIiag b=a or on the grounds or buldmg appurtmaxrt ffiereto shall not because of mrh employment be deemed to be an employer." M($chaptCr 1:5 � Z,§25C(6)also states that: or local licensing agency shaIlwiffihold ffie issuance or renewal of a ficense or permit to operate a business or to construct bvildings in the commonwealth for any appUcant-mho has notproduced acceptable evidence of compliance with the b1surance coverage required." Additionally,MCx-L chapter L52,§25C(7)stars¢ldeithcr the co®011Wealih nor nay of its is poIrtical subdivisions shah enter min any contract for the performance of public work uatil acceptable evidence of compliance with 1he insoramr-6.. mq=emems of this aapter ,have been presented io the 00131�authority." Applicants PIease fill oht the woil=' compensation affidavit completely,by checkiag the boxes ffiat apply to your sifnation and,if necessary,supply sub��s)name(s), address(es)and phone,— er(s) along with their certd-acatr(s) of insurance. Linu6ed Liability Companies(LLC)or LimftedLiabRityPartnt ships(iT P)wi$rno c nployecs other than the members or pis,are not mquired to cant'wotice& compensation fnsmm2ce If an LLC or LLP does have =PJoyees,apolicyisregnixed. Be advised that this affidayit may besabmrttedto the Department oflndustrial Accidents fbrconfirmationoffi=rmce coverage Also be sire to sign and date the a0davit The affidavitshould be rz-t=(-,d to i`he city or town that the application for the permit or license is being requested,not the Departmed of ; Tsdr strial Ac ' c a:L- Should you have any gncstions regarding the law or ifyou Eire regan-ed to obtain a wori=' compensation policy,please call ibe Department at the mmmbez listed below. Self-fnsined cmTanies should enter their self msorance license number an the apprulzi-a u line City or Town Officials Please be sore that the afffiiavit is c amPlete and prod legiibly. The Departme t has provided a space at the both= of the affidavit for you to fM out in the event the Office of Tuvestigaiions has to coact you regarding the applicant Pleas a be sine to fill in the pe/license member which will be used as a refisence cr. In-addition,an applicant that must submit multiple pe=tj cM e,appli-cations in any gives year,need only submit one affidavit indicating ensent policy information(if necessary)and under`Job Site Address"the applicand should writ-"all locations in (may or town)"A copy of the•affidavit that has been officially stamped or marlmd by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for fuimre permits or licenses A new affidavirmust be filed oil earl year.Where a home owner or cfH—is obtaining a license or permit not related to any business or commercial venture Cl-I-,-a dog license or peonit to burn leaves etc.)said person is NOT required to complete this affidavit The Of i=of Invesiigadnms would lilM to tT1—k you im advance for your cooperation and shDrOd you have any gnesiicns, please do not hesiiEdm to dive us a call. The Dej aFbnx Ys a ddress,telephone and fax er. Depadinent cif Ydmtdal Amideata Of ra=of lnvestigatio= t�4�t�mgtc�n t $off MA Ed11F Fax#617 727 7M Revised 4-24-07 mr/dia . Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Paul Roma,Building Commissioner MASS, ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: q I 1 116 Please Print JOB LOCATION:_ S6 A number street village "HOMEOWNER": ,(6 (, r l 7 V— yk�— 9c7fs'Z name home phone# work phone# CURRENT MAILING ADDRESS: �� loilf so 6-5-7Z city/to,00 state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be 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 reuir that he/she will comply with said procedures and requirements. Si of Homeotf er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc 06/20/16 f Town of Barnstable Regulatory Services Richard V.Sca14 Director ►� Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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) **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. Signature-of Owner Signature of Applicant Print Name Print Name Date QYORMS:OWNERPERMISSIONPOOLS ,.. I - Town of Barnstable *Permit#0 it 6a 24 r7' 4n Expires 6 monthsfrom� date Regulatory Services Fee ye y� 16.19. ,0� Thomas F. Geiler,Director X-PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner 1; 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARMSTA$LE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3 3 4 L(3 Property Address jflG � residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address ,a-r7 L Contractor's Name,�-i:qS (,I Telephone Number '`Z') %56 L/" Home Improvement Contractor License#(if applicable)_ 14, t_ ( p Construction Supervisor's License#(if applicable) GS I (p g orkman's Compensation Insurance Check one: ❑_ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name AT yt Workman's Comp. Policy# i` C Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' Re-roof(stripping old shingles) All construction debris will be taken to A4•J-,) .� ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. IGNATURE: �-S� AWPFILES\ ORMSlbuilding permit formskEXPRESS.doc ! .evised 070110 Tl:e Commonwealth ofMassacltusetts �®Q ^; I Department of Industrial Accidents I q, Office of Investigations �; 600 Washington Street ; �j Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -Please Print LeLyibly Name (Business/Organization/Individual):_Wt c, �q�t L C , 6,-n 5 ` ✓S�YJ1 /j Address C f�( —T City/State/Zip: Cbtt '�-f/ d1 Phone #: 5 ©R-- 's Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t I Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity, workers' comp, insurance. 9. ❑Building addition [No workers' comp, insurance 5.�We are a corporation and its required.] officers have exercised their 10..0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 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' 13.0 Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box•nlust attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up.to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct._._,_ -_ Signature: I Date: /—tx? / t Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other- Contact Person: Phone#: i Doug Williams Custom Building Co. P.O. Box 1069 Centerville, Massachusetts 02632-1069 508-775-1500 866-524-0070 fax 508-775-1503 www capecodhomebOder.com e-mail homebuilda comcast.net v Office of Consamer Ai�f airs&Business Regulation . -� i CONTRACTOR HOME IMPROVEMENT Type: u �. > = - Registration: 102227 DBA :r's fi „ =: Expiration: 7J1/2012 Tln�ra"aNmawieiges thate reaipserthas sucxxsstuRy completed a �, ` +f 30 hour Occu�dorei Safeiv aid Healthfrairun9 Course m yt f O[)�; t�{S L WILLIAMS CUSTOiVI BUILDING Construction Sa etyand l{ealth # `� kk t a DOVErLAFSWII:LIAMS� f Oauglas V!rttiams G 4;.•w `i r ,�,i ,. v,hv:=a+..,2 sM1.c. .La yt US +._ rLm.h x. �.r' ^•r�-w.: •t!d� 222 PINE ST. ^,EN+TERvjL LE>MA 02632 Undersecretary �Tayloi S1kes ' � ��•S�,- ��5(25/2Uj'fl - is"�•;: :�'•�',t�u�.,y��a'.ram_Mr��"'6��f�F�'���a`ria`��'^''�s-: �et(Trainer name `print or iyae),f��. �„rt�,ra � 'lt(Course end dates) �. License or registration valid for individul use onh '? before the expiration date. If found return.to: -- --- - Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston.141A 02116 Dmig aYLam5 aim e:M•a C-. " c,.��:���zTs�—.r..��:�ti�s:�.�-�:�.�-.•t..-.=ram-_. Not valid without signature Intl�.rsti�;Sti�•�sa cs.—a---y:9 Cii P_-TS'y- EPA Aardtds:eted S2es Trd—'4 :tis afa8mualilEm=>cxxa�:eca�q::a 1a.917.<:5 Slns>achtr.ctt�- l)�)tar-tnunt „i'Public 1:rfct, ,�� ram, ? l3trar-tt uI-Buildiu+� Rc�ti(:[ti�m� and `tanti;trd� ms.�:o c�a w�tirii =ean—.— License: CS 16981 Restricted to: 00 - .. DOUGLAS L WILLIAMS SR ; PO BOX 1069 CENTERVILLE, MA 02632 Expiration: Y 2012 l ++ouui. i„nrt Tr=: 19320 `I,Richard'Kiotic grant permission toDoug"Williams CustomBuilding to.pull a roofing permit for 56 AlderbrookBarnstable Ma. 0266$. L.ANr R$K . l Richard Kiotic M -7 7 P The Town of Barnstable ? ~ dp tME Permit# U� Massachusetts ' Datee -2 SAWMnatZ *AM SOLID FUEL STOVE PERMIT 639. �•� Fee �a7� od This constitutes an official stove permit after inspection and approval by the building inspector. Owner Telephone no. Address of Property Village Location and Stove Type Date: Building Inspector The solid fuel burning stove at the above location passed: failed: inspection. C r/ P oFTH�poi TOWN OF BARNSTABLE e OFFICE OF ? Bea M BOAR® OF HEALTH �p 1639. 397 MAIN STREET ,gyp rr�Y�• HYANNIS, MASS. 02601 To : Building Inspector From:- Health Department Subject : Test hole and Percolation Test .y examination_ of the soil at (Lot) ,� ° (Address) ( . Village Y was made on ;7 . and found to be suitable for sub-sut face sewage, at site .of test hole. Building Permit will not be approved or sewage permit issued until Health Department receives two copies of plan showing building, sewage systems .and all other details listed in Board of Health instructions to sewage abplicants. This approval does not constitute a final decision concerning the installation .of a sewage system. .All State and loca-1 Health regulations apply. to' final approval . r (Signature) 6/20/75 A sor's map and lot number ....... - 1 ` SEPTA 8Y MMT INSTALLED I �, BE. �S ewag Permtit number ........ ...... ..........................:... WITH A€;TICLE II S�►9TI NCE Iy�' ° SkTITARY Coo �QyoFTNE.ro�,� :. TOWNOF BA� � &- ., Z BAB39TODLE, : 039. cm BUILDING INSPECTOR r APP,LICATION`!FOR- PERMIT TO �'0�'S.V4!/......A....../A....5��.,Y... TYPE OF CONSTRUCTION ...14V4P...FA.!.1..A .9....pw�. "z&4? ................................. ...............ova:.7 ...0� 19.1.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acco nn to ,the following information: Location,401.. rZ.....1-h.4.DC�.�I?a4�.....?4! &.... 7 ...,3i.1!`'vVSTi4�!31-�,� /`?�S`.�...... ProposedUseL- ...................................................... Zoning District .. .�. .�...........................................................Fire District �1 T.... /4ilR. .S.T/��. L. ................... Name of Owner heft.......�II-ttAt.AE.....................Address W 'ST..... .2.!'�11UT N�.-..M.../� S.S..:....... Name of Builder -.4".� iR �/ 1` �'!�A/U �$T ��}/�/�S4.d�' ............. .............F�....Address .. ................ ..................... Nameof Architect .... ........................................Address .................................................................................... Number of Rooms ...46...........................................................Foundation 1.�....GIJ K!����..lf T.L:............................... Exterior ..+11 ©: ....-5'!`��N4t ,,,5...............................Roofing Ar� .PZ.(4.1_ .................................................... Floors ....HA 10.9 4Q.0 A .........................................Interior .... tlif- &0.C./........................I................ HeatingQl.. !I"4................................................Plumbing 4...VArH-S `t... ........................... Fireplace ,t34Q l L'l�..........................................................Approximate Cost .Y.%'eZ ... ?" .................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .......... Diagram of Lot and Building with Dimensions Fee0. '�- iG ����w SUBJECT TO APPROVAL OF BOARD OF HEALTH �I�RAGL„ 3 5;1 36 ,j�l�, t� K 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam' ... .. . ... 7w. �A' ..:.... ...... ........ Karl Wohlke *wo .—..penn|t for --Wm ............ ^ � . —.--- -----------~----- ~���vw, Location '—.J_6wm&.Aldexbrook'Jamwa----'' ' W. --.�..�����������--------------- Owner ------..��WX.1..]��blke..................... | ��p� �rm�e ` Type ofConx�uchon --------______ _----.--------------------.. . ^ ` "Plot 1�2 �� Lot - ' ' ------. —. ----------' � � ' ^ ' . Permit G,onxe�W�,--. 3� 1975 Date of Inspection .....l�~~�` ' � . Dote Completed ... .. ...6xr..^^6,............... V ' ' � � � PERMIT REFUSED .................. lA --------------------------.. ^ .'------,.—.-----------_---- ' —.—.---.--.-----.—.--.�—.,~—.—.. ' --------..._---------.-.—.. ........... � Approved ................................................ lg � -------------'---------^---' � ` ------------------------'-- | ..- INSTRUCTION For making and filing application i i 1 . Chapter 470 of the Acts and Resolves of 1973 provides under Section six that no b;uilding, -s"tructure-;-"Wall or fence,' shall be built, con- structed, reconstructed, restored •a-ltered,. enlarged or-maintained within the defined "District" until an application for a Certificate of Appropriateness as to exterior architectural features. shall have been filed with the Commission, and either a Certificate of Appropri- ateness or a certificate that no exterior feature is involved shall have been issued by the Commission. - f 2. Section 6 ofthe Act further provides that no.building or structure shall be demolished or removed within the defined "District" without first obtaining a permit from the Commission. . 3. 'Mork on projects requiring approval shall not be started until :-the required Certificate of Appropriateness and a buildibg permit ( if required) have been received by the Owner, Agent or Contractor. 4. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the. Commissioh. " `r• - �-� 5. A separate application must be 'filed with each project requiring a Certificate of Appropriateness. 6. All applications to the Commission must be filed on this form in triplicate °AND must include the names and mailing'.addresses of all abutting owners to the property for which a certificate is sought. 7. All applicati,ons_must.be filed at least twenty-one (21 ) days prior to a regular meeting of the Commission, in order to be heard at such meeting.. ,-•;I�f not filed within such- time, applications cannot be heard until the-second regular meeting following such filing. 8. Check the appropriate bok-at the top of the application as follows: BUILDING CONSTRUCTION. - (new or existing buildings) : Any exterior j b*Uilding to be erected: or altered including windows, doors, E siding, roof, lights., etc. ,' that will be visible from any public ; ►_ street, way or publ_i,c .p_1_ace.. The• following scale drawings are requrred-wfith_ ap lication: . Plot Plan-- (if addition - show existing - - ' buildings in oMine) ,' floor plan and elevations. Also required are snap shots of:.existing buildings, where additicrns<-or. alterations are to be made. No plot plan is required for addition or 'alteration - which does not touch.tthe ground. PAINTING: Any7::portion of 'a building, structure, or sign to b,e painted that is visible from a public street, or public pla�ce:f"•',ColQrl samples must be attached to these applications. An application.-.,is not re- - quired` when repainting existing colors, changin.g ,:to white, or using �. d60gnatdd 'Barnsta le historic colors. a ,SIGNS OR BILLBOARDS: Any.vsign or billboard within the District except real estate-signs of not more than one square foot in area 'or one occupational sign in a residential zone of not more than 1 square foot in area. Required with application are scale drawings and color samples' fcH new signs. For existing signs, a colored snap shot is'.requi,red and a sketch indicating dimensions. STRUCTURE: Building or altering any structure within the District which isa combination of materials other than a building, sign, or billboard, but including --stone walls, flagpoles , hedges , gates, fences, etc. 9. Under heading of "Description of Proposed Work" A) Indicate type of work, for example: New construction Painting Alteration or repair Raze or remove building Restoration B) Designate whether: Dwelling Fence` Commercial Steps Garage C) Give detailed data on such architectural features as listed on applicationform. D) If insufficient space on application, attach supplementary sheet. OLD KINGS HIGHWAY APPLICATION REGIONAL HISTORIC DISTRICT for ' Mw BARNSTABLE CERTIFICATE OF COMMITTEE APPROPRIATENESS CUILDING F7 SIGNS OR ONSTRUCTION PAINTING❑ . BILLBOARDS❑ STRUCTURED Application is hereby made, in triplicate, for the issuance of a .Certi- ficate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts 1973 for proposed work as described below and on plans, drawings or photographs accompanying this application: Date OWNER ,e:L U.AebIAI , / TEL.NO.390h8P9d HOME ADDRESS �h4�/i S JJr.' SQt� zg mecy-A- ADDRESS OF PROPOSED WORK ko-- �0 ALd�rbeeok;(AA&: Xest�, � NAMES AND ADDRESSES OF ABUTTING OWNERS,SeOA- '.U2 ,9ejes �1eheSgg4, Rh&&beao,- Lo. lb-22gw.sw/,. /vo R-V-k )4--L*/ ��l�y/er— e— 914 j w 2maL°.W• , c�4 �ob "' 4' oe el7o /72*,, '� q 3 8r5-�96 AGENT OR CONTRACTOR WiIliArn� Ll L,w LSD S TEL. NO. -'7s-491376 I , ADDRESS Sb; ve0Uc,1L a4d Sf- enr>>5 DESCRIPTION OF PROPOSED WORK (See instruction sheet on .back) A. Type of Work: Aleut Oewz/aWL'A ,t7A1 B. Structure: __-_ -- C. Architectural Features : Foundation �j pveed 067X aAJ( ,6!211 w Chimney - -lLk- !,!seat- S i di ng F7 e)t�0�b6peo(. �,S;d e 13AeX&Afe S'hI�/yes i Roof ing6..& _ lhedAeeewt weed LgSehxWC k1- Roof pitch 16"' fWise. 40 ice " ;v,v Sash and doorsSASh ,L4 Aodg 4 pa4e-1 weo4� Window and door frames 1 )(,5 W.xe)v 0,9.sc.:zs Trim Sec- Gutters - Leaders uuS �os�o�y�ub<er � +P-�'3'�ydueAor'�pe Roof color Si/ver' �er;zy " P a i nt co 1 o r bm4d CAI yAl . Signed ' - Contractor - Ag@rt Space below line for Commission use. Received by H.D.C. The Committee hereby declares that the Certificate of Appropriateness is: Date _El )fz--::/j Not Required❑ Disapproved❑ Approved[ Time �/I�� /� r• C B y: By' .. ...__ .....AGO - ...__.. _....._ VII !4' yp ALDER 8 R OO K Z AIVE IV- <ocAT/o/y: WEST. 'SARNsiABLE S C A G 10 DA TE. LLOYD — :. -C KR R L H.L K E ly N.p XAT)MER, :C HERE By -CER?!FY THA—r THE r415T sTe /NG CO UNDA7/0IV AOCA7/01y /S CORRECT Sh'Ow,v AND . DOES CoNFoR./-/ cv rTy TNE' $o/4D/NG. 9E7-8ACK REG1v1 RMEN7`,S Of T//E TOWN OF �'A�N STABLE, RED /LAwp SuRvEyaR — FAL M0 TH 17P,SS..