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0128 GEMINI DRIVE
1 j a i i I Oxford NO. 152 1/3 ORA ESSELTE 10% - . Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 cy C' 2/1/16 .� -� Thomas Perry CBO f, Town of Barnstable Building Division 200 Main St. C v CO Hyannis,MA 02601 RE: Insulation Permit 16-23 Dear Mr. Perry This affidavit is to certify that all work completed for 128 Gemini Drive,W. Barnstable has been inspected by a third party Certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 3 1 Parcel 643 O Application #:9 Health Division ' > C.P Date Issued Conservation Division o Application F --i71 Planning Dept. Permit Fee r � Date Definitive Plan Approved by Planning Board m Historic - OKH _ Preservation/Hyannis Project Street Address 1 ai t CC'4t Village _ l►, as+ BoX04 It Owner r j�a(,k Address Telephone 568 361 11�� Permit Request Add �'3 S ^^d �-aB a c R- 19 1;�WAst and �' l0 ,g: l hj)A ,'on -I-� +Int, 6rtiw�i.ar ��r r sue► oc �6 nlai C Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ll 300 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑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: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes N(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q Name U L 6 ti-e, _3_0-c. Telephone Number 5-0 8 M 0p 0 3 l Address Kq�i Atha 0 License # —2-C to fkq 7 S, I nrn►o.n�� . Pr (7�� Home Improvement Contractor# t�-k 31 b Email Worker's Compensation # W vw t 313 6aJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �o.1�fr1�11� SIGNATURE DATE - FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. s ' I ADDRESS VILLAGE . OWNER - DATE OF INSPECTION: FOUNDATION "3 ' FRAME INSULATION ; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL L� FINAL BUILDING DATE CLOSED OUT " � ASSOCIATION PLAN NO. i ti ,per i \ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 .�' www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 20 employees(full and/or part-time).* 7. New construction 2.f7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.�I am a homeowner doingall work myself t 1 ❑Demolition y [No workers'comp.insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 O D Building addition ensure that all contractors either have workers'compensation insurance or are sole I l.[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.2✓ Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.) Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/09/2016 Job Site Address: 128 Gemini Drive City/State/Zip: West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 th pains andpenalties ofperjury that the information provided above is true and correct Sip-nature: Date: 1/19/16 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town official, City or Town; Permifticense# 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#: r AcoRV CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 10/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT COME: Colleen Crowley Risk Strategies Company PHx. Etw E (781)986-4400 FACNo: 1781>963-d420 15 Pacella Park Drive AD�ss:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAIC• Randolph MA 02368 INSURER A:Selec tive Ins. of America INSURED INSURERB Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INsuRER c.Wesco Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. I TYPE OF INSURANCE POLICY NUMBER MOUE EFF )POLWCY EXP LTR LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE To RENTEIT-- A CLAIMS-MADE 51 OCCUR PREMISES Ea occurrence $ 100,000 S1994480 10/16/2015 10/16/2016 MEDEXP one person $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT Fx]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE 00r— Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AWRA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per...dent X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION Bil 61994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y f N Coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED?C NIA (Mandatory In NH) VWC3136274 4/9/2015 4/9/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation 111E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Mai. Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Michael Christian/CLC '� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) i T Town. of Barustal�le Rgid tory Se ces "�8, : ltictterii V:Scab;b�rextor. Huss g Buailig Division Tom Perry,Buflding:Commissioner 200 Main Sheet,H*nis,-Wk 02601 nw+.to*mbarustabl.e.uia_ns Office: 508-862-4038 Fax.:. 508-790-67 0 Property Owner Must Complete znd S gn Tl is Section It Usi r .ABt�lde Y, 1 aw, �,S C �'g d'�!'UL�4. ;as Ownez•of the_siYbJecf propen . . .. 4enbpautliorize _ to-amon:mybehalf,, in all-matters relauv+e to work.a orized by this bwTding permit application for. (- ddress•-of-job) ""Poolfences and ahm=.ar+e ihe respons'l liiyof,t4t-applicailt. Pools axe uot:to'be.filled and L f vial inspections are ge d and accepted. a 7 A Q, T of-Owner Signatui�e.of Applicant `Print Name Print N nae Daze Q:EORMONVNERPERAIMIONPOOLS Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 " Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. ` WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 ---- - - -- - Update Address and return card.Mark reason for change. sCA i 0 2OM-05/11 Address Ej Renewal Employment Ej Lost Card �Tn�fnnrriuruueall�o`�l�ccl::nr�cc:��//? ._ • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only UVExpiration:;--3/44-/2' OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation 16 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE._ SOUTH YARMOUTH,MA 02664 Undersecretary Not vali ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards o uc�c-__i arev•a In. _ �unau uC`urrrr�iirrZi viSirT License: CSSL402776 WHXIAM J MC 1QtU 37 NAUSET ROAI) III ,-., IF West Yarmouth NSA Expiration Commissioner 06/28/2017 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map Parcel A i4o A Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee fl, (12h Date Definitive Plan Approved by Planning Board 4 Historic - OKH Preservation / Hyannis Project Street Address I a Village �G'`S Owner / J'`7�;� �� �/��C� Addressd4!'`I� Telephone O Permit Request L" L y !C � ! Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation CoConstruction Typed P Lot Size Grandfathered:' ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family di(_ Two Family ❑ Multi-Family (# units) Q ; . Age of Existing Structure Historic House: ❑Yes Cb�Alo On Old K Highw s ❑.No Basement Type: U&ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ���L� Basement Unfinished Area q.ft) Number of Baths: Full: existing new Half: existing chew' `y. Number of Bedrooms: existing —new o: r Total Room Count (not including baths): existing ��new First Floor Room Count Heat Type and Fuel: 71!Tas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes <Zft4o Fireplaces: Existing I New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:&kxisting ❑ new size _Shed: O existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INF ATION (BUILDER O HOMEOW > / Name V/y Telephone Number Address 'd b C L� /1?i/ h�i /��- License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE=ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: i FOUNDATION 41)oS Lo k FRAME INSULATION r _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING R E—T ,Ck OSED OUT A. OCIATION PLAN NO.'. ,.:_ .. ine c;ommonweau:n gimassacnuse.ur Deparbnent of Industrial Accidents 0.1Tlce of Invesfigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/0TmdzationM2dividuaI): Address: City/State/Zip:Vg1 ticOW GPhone#: lS 3e! 6) �7Cj 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 employees(fall and/or part-time).* have hired the sob-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees' These ors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers'comp,insurance comp.insurance required_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3. I am a homeowner doing all work ' 11.❑Plumbing repairs or additions self [No workers' comp. right of exemption per MGL 12.❑Roof repair insurance 1equired.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other R Z,0 Cr 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. Irr ntractors that check this box must attached an additional sheet showing the mane of the sub-contractors and stzf r whether or not these entities have cmployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that ispromfing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: - Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 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 under the pains enaltiPs of p 'ury that the information provided above is true and correct S' '/��G Date: ` Phone Official use only. Do not write in this area,to be completed by city or town of fficiaL 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 M Information and Instructions t Massachusetts General Laws chapter 152 requires all employers to provide worle:rs'compensation for their employees. Pursuant to this statute,an eWloyee 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(o 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 eater into any contract for the perfoffiance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting mifhority." 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 numbers)along with their certificates)of ;nm=Ge. 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 lime.' 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 pennit/license number which will be used.as a reference number. In addition,an applicant that must submit multiple purm t/hcense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should writs"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 firt=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 comm xcial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of lavestigatiom 600 Washingtan Stceet. ' Boston=MA 021 11 Tel.#f 17-727-494Q ext 406 or 1-877-MASWE Revised 4-24-07 Fax#617-727-7749. VZWW Mass,gov/dia Town of Barnstable Regulatory Services P�oF raiyy Richard V.Scali,Director Building Division rt tST" Tom Perry,Building Commissioner 63 ��� 200 Main Street, Hyannis,MA 02601 AIFD �s www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �j/a T/ > J _ Please Print DATE:JOB LOCATION: j( CNI��� l `�' "�'C S"0. number / sstreet / _^, vill e1 "HOMEOWNER': >Q�FS ( p���1,�[� /T b y? name home phone#/� [_ work phone# CURRENT MAILING ADDRESS: S/rt 7 1 A 5 A71 G J O J� `6��O `� / city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be 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. _ dersigned` owner"ce at he/she understands the Town of Barnstable Building Department minimum inspection roc ores an quire ents t'he/she wi mply with said procedures and requirements. Signature of Homeowner - Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." •Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRFSS.doc Revised 06 13 13 r Town of Barnstable Regulatory Services BAMSTABM MASS. $ Ricbard V.Scali,Director oi 9 •�"�0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 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 Q:FORM&O WNERPERMISS IONPOOLS DECK- CROSS SECTION 4"Maximum spacing Handrail RESIDENCE 36"Min mum Height Height Rim Dimension Joist of Deck DECHING LEDGER ERISTING PAS' JOIST 6"above RIM JOI ' final grade minimum P I Bea &Post J�4�► E' AssemblyMinimum D R m y g n G'Y1j PG J Below Grade Diameter • 1 rya --1• ' 0 w-e to SIZE ^ri DECKING __ O FRA WG PLANLedger attached to � house HOUSE TO BEAM ., qq . —BEA1Li- SP &SIZES a x� POST&BEAM ASSEMBLY 11 e Iu Bate RIM J O IST CANTELEVER /� l0 P —"-- __ DEWENSIONS. (2 Ft.maximam) .. FILE ' 0558 ,,.. CLIENT: :CENSUS TRACT # C Glllnri Poem;re. DEED BOOK ' 3025 PAGE 274 OWNf°R.:. 'am..H�. � Priscilla D. Britton PLAN -BOOK..=..:233.. PAGE 19 LOT AP'PL I CANT:. - .'R.: & -Ann S. Craddock ASSESSORS :<PLAN:. PLOT. T G A G E I N S PE C TI I N BARNSTABLE SCALE: 1 R=60• JULY 18, 1986 iD ` M i 8: I - I CERTIFY TO P ESA ..: : ` ' '.ITS TFTLE: : INSURANCE COMP{ANl'9 �. FY i� .fin ,.. �F�.l �- At -RAl TS d.R: EASEM€NTS EXCEPT AS SHOWN ANDY . "�IY ' IMMEiI'IATE.::. :-SUPERVISION ..: ...:.... -: :; .THE LOCATION OF THE. �} EI_L:iti HEREON I.S IN COMPL LANCE �#` ' I-f T CAL :: ::` kON I:NG BYLAWS WITH RESPECT TO HOR I ZONE kL 4. ..'1 I MENS I ONAL REQUIREMENTS , -.THE: .DWELL ING SHOWN. He � ARE DOES ��:T FAl f ;. ':i•��' ►+•T in3 '� �a.l i_f�i Hi t=i fit f'1T ith'9�ri sT �e�.�r i i l.ai i .:.�1� _L..-_.:►. - fYl.-' !cam—._.. :>_-.:a ' - .. Town of Barnstable € Old King's Highway Historic District Committee 200 Main Street,Hyannis,Massachusetts 02601 (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXEMPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts,1973,as amended,for proposed work as described below and on plans,drawings,or photographs accompanying this application: l Date Address of Proposed work, Assessor's Map and lot# House# Street L`"// l' Rl`L Village: VY LS �i9/t7/7- s7�/5L L: This application is.for an exemption of the proposed construction on the grounds that work Will not be visible fiom any-way or public place i —Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: C Agent or contractor(please print): Tel:no. Address Owner(please print): G L G Tel no. Owners mailing address: Signed,Owner/Contractor/Agent For Committee Use Only This Certificate is hereby Approvi?' Hied Date: �p I Committee Members Signa SEp 1 U 2014 - stable TowI)of Bar.9hWay I � old�`ammdtee Any conditions of approval: C.(Documents and SettingsldecoMiLocal SettingslTemporary Internet Files10LK110KHEzemption Form 07.doc I rF # D1o55s :CE:NSttS TRAvT # T: Es re :::DEED;:<$fl4K: 3025. PAGE 274& Priscilla D. Britton::PLA{d: :BOOR- .233. PAGE I9 LOTCANT: S. Craddock ASSES$f3.R;S°:':`PLAN P:LU I-_ ..ORTG. 71' GE I N. SPEC I N . . BARNSTABLE : 1 JULY 18, I986 y. s: SEP 2014 .. town of Barnstable : � 5 e Old Ki s Hi hwa Committee. I CERTIFY TO PF.ui'.;:_" L` c: - emu �:. . . .I TS T-1-I LE. LNSURANCE CO�iPt': F r P T,�wr EASEMENTS .:,_: ::. EXCEPT AS I MMEI F ATE: THE LOCATION OF TNE..: -''_� <,. ...'::HEREON LS IN COMPLI.AtGE:: . �:I:.T :.::T BYLAWS WITH RESPECT- TO' HORIZONTAL : . I! MENS.IONAL DC I R:EhtEPdTs , ``` = DWELLING et }�± ii (� !� �[�+ tt- ,.� `=l,. ^;�.}{ r: E' DWELL f:YL3 Sr;t�i. HERE i'}�LJ fr'rCIT 7't .Lf i i; `i:: �I.+1 M "t - Z iD= ' of L1 :'tftT'\ F,ft S�R� i rc :1 Yip _ •: - _ .G l d �6 G�Lr�iiv � t Town of Barnstable *Permit# Expires 6 months from' re date Regulatory Services Fee X-P . RMIT . 163¢ ��� Thomas F.Geiler,Director E� S 2012 Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 �r " www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY . r ! Not Valid without RedX-Presslmprint Map/parcel Number Property Address �L� J / JJ / l��� � L Residential Value of rk aaal Minimum fee of$35.00 for work under$6000.00 Owner's'Name&Address S �J Contractor's Name fi L ✓ — Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ,ETI am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name- Workman's Comp.Policy# .Copy of Insurance Compliance Certificate must accompany each permit. Permit Re ue heck box) An Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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 departrnent regulations,i.e..Historic,Conservation,etc. ' ***Note: Property Owner must sign Property Owner Letter of Permission. A copy the, " mprovement Contractors License&Construction Supervisors License is requi . SIGNATURE: Q:IWPFILESIt U1tM building permit formslEXPRESS.doc Revised 053012 t The Commonweat?th ofMassackasetts Diepartxnent of Industrial Accidents Office of Investigations 600 Waskington,Street Boston,AA 02111 wn kmaw&govfdia. Workers' Compensation Insurance Affidavit: Builders/ContractarsfElectricians/Plumbers Applicant In#ormation Please Print 1,Mbly Name Address. �� �c/`�/ AZI- City/State/zip= Are you an employer?Check the appropriate boa: Type of project r 4_ I am a, contractor and i 3`Pe P '� ( ���� L❑ I am a employer with ❑ � 6. ❑New construction employees(fall andlor part-time).* have hired the sub-contractors 2..❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees T :sub-contractors have 8. ❑Demolition worming far the in any capacity. employees and have wodcros' 9. ❑Building addition [No workers'comp insurance camp..in '�.,""I regou.ed-] 5_ ❑ We are a corporation and its 10_❑Electrical repain or additions 3 a-L �rdoing'allwork officers hav"egercisedtheeir 1L❑Plumbing repairs or.additions of exemption MGL myself[No worloers'comp- fi& � 12_❑Roof.repairs insurance required.]T c. 152, §1(4k and we have no employees-[No workers' 13_0 Other comp.insurance required-] '?iny applicant mar cbecks boat#1 mast also fill out thie section below showing their wadkeie compensatiom.policy ndbrmirtim 1 Homeowners trho submit this affidavit in&catiug they are doing all wo&amd dum hue outside contractors ironer submit a new affidavit im&catmg mcb. FComtiactars thst check this boa must attached aa:additional sheet showing the name of the sub-cu=wA¢s and:state whether oruot fhnse entrties have employees...If the sub-contumrs;hose employees,dLey n=provide their wwkess'romp.policy number.. I am an employer thatis prvuidirg workers'comperrsh on.insurance for my omplio4es. Bdow is the policy and Job sde. information Insurance Company Name: Policy#or Self ins.11c.#: Expiration Date: Job Site Address: city/Statelzip: 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 imprisons as well as civil penalties in the form of.a STOP WORK ORDER and a Rae ofup to$250.04 a y against the vsolator_ Be.advised that a copy ofthis statement may be forwarded to the Office of Investigations off I A felrmmra„%,coverage verific:atiea I dv hereby and penabin ofpediffy that the informatton:proW&d aabova fss blare and correct &i Date: Phone ik`e 1 G� 4 / —7 Offirial use only. Do not orate in this area,to be completed by city or town official, City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.(StyfTown Clerk 4..Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 �t > Town of Barnstable Regulatory Services B" MASS. ` Thomas F. Geiler,Director pry 39.1 a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town..barnstable.ma.us. Office: 508-862-4038 Fax: 508-79&-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print /(/ > Q /� y Q JOB LOCATION: 14 0 � j [J (� / �T �. /' 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 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 igne meo r certifies that he/she understands the Town of Barnstable Building Department minimum inspection p ocedur s it ents and that he/she will comply with said procedures and requirements. Si re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code - Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION - The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such-work,that such Homeowner shall act as'supervisor." 4 Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see.Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor.'The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc "wised 051811 • BARNSTASLE • '"A3 1639. Town of Barnstable 9n `�� '�plED MIA A Regulatory Services Thomas F. Geiler,Director Building:Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m a.us 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) Signature of Owner Date. - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit fbrms\EXPRESS.doc . Revised 051811 i co TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map f® Parcel Za f Permit# Health Division i ho),)-z D to Issued _ � / — 6 3 Conservation Division )0 Zoo � - ,' ���� ��0 " 00 Fee Tax Collector ••' SLPTfC""(r^u E j 1.i SST CE Treasurer r INSTALLED IN COMPLIANCE WITH TITLE 5 Planning Dept. EWRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic OKH Preservation/Hyannis 3 du°"1� ,f• A)° at,41,Ab.+F/�f�/lt'vsor • /1N.��ion ii v��cr,�, r Project Street Address J � ����/ l�/ G —/gp/wo'u/ WAY VillageL �/j�/'J/��,�/31i�'✓ Owner I Address Telephone O � 3C� �77tl10 Permit Request A 0 11/ o d M Square feet: 1st floor: a isfing proposed 2nd floor: existing proposed Total new 0 c� Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family6& Two Family ❑ Multi-Family(#units) Age of Existing Structure D 7 Historic House: ❑Yes No On Old King's Highway: ❑Yes kNo Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: . Full: existing new O Half:existing new 0 Number of Bedrooms: existing 3 new 0 1►. Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel:Okas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing `,Q p g � New� Existing wood/coal stove; Yes 6NO Detached garage:❑existing ❑new size Pool: Cl existing Cl new size Barn:❑existing ❑new size Attached garage:Xexisting ❑new size a Shed:❑existing new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ANo If yes, site plan review# Current Use Proposed Use • n , r, II BUILDER INFORMATION Name Telephone Number �� ��2 -02774 Address License# ' Home Improvement Contractor# Worker's Compensation# _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE y - } FOR OFFICIAL USE ONLY PERMIT-NO. ' DATE ISSUED y� MAP/-PARCEL NO. � ADDRESS VILLAGE J OWNER' o DATE OF INSPECTION: FOUNDATION E 17 0 J� ���34 3 /V , FRAME � ;Ls O 3 104, INSULATION A/O f A)lAet7;lw A0j&C57fV .00f /1/ p; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH' FINAL FINAL BUILDING,,- i/t* DATE CLOSED�OU'T ASSOCIATION PLAN NO The Commonwealth of Massachusetts 1 --.•L Department of Industrial Accidents ��-�- �-� � OlflCe OI/OYCSI/gBIIOOS --' -- t 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: f-l—qz P !l aG� location. Ql city VEST— //�/�/% 5�f�f3 L/�,- phone# 7 I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worldug in aav capacity 1 er ravidin workers' co ensation for my employees worldng.on this job. _ ::: .:::::::.. I am an em g mP.. ............................ ::::::.........:.:::::::.::.......... :::.:::::::;:.;:.:.: ::: :. :::;:: ::.:::::::::.::.. P oY P..........................................:::.:::::..:.................::,.:::.::. ' ale :'::::; ::":;` ::::::: :::::<:;'::::':<s':::2:::';:;;:;<;i:::"'%':`:::::;:;:%;%::::>':`::.>::#:<:;:::::::;:;`:;;::{:';:;•::::;;::: :com >'sa v na g :a re ::'on h :;..:. nnce% ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have n workers'co ensation polices: :.::::::::::::::.;:.;;; <:::> ::;:::: follows mP P ::.:::.:.:.:::::.:'.;:.i:<.;i:.::<.;..:!.i:.:.:<.i:..i:.;i.:..:.i:. i:.;:.:.;::.::.::::::::::::::::::::::::::::::::::.:.:.:.. ::::::,:,.:•:,.,:.,:.:.:.:.: the g X. ::.::::.:...........,.:::::::::::::::.........:.::.:::::.:.......::::.::::::::.:::: .....::::::: :...::::::::::::.......;;.. ibm•'�aaveam ss... « `:> ................ ::::::...................... :::::::.......... ;::{:.:::«>:ai:;•i:•;::s»><•;':?#:»?::>:;<•;:•:;::is ii:!?::;ss::i:::•;x::::::!•;:;:;<•i M Ram: e'`tips ....................................................................................................... .. ..... ......v:.v.,....}•:........::::::::::::.�:::iiii:•i..ii.i};}i:Ci}i}..::...:. ..... ..... .....................................:.�:::::::::::•::::::::::::::: ..n:•.vv ...v...:.�:•:):^:i::4ii:+li:>iiii}:•......::::.:::::::::C4i:•::!:4i:"v:::•.ii... ............. ................................................ ...... ..................................:::: x:.v.•xnv:n. .,...}.r.n...v.,...... ....r... ,..};•r::4'v:r... ............. ....... .........4..... ....... ................ ....................................................� .r:.. ....,,..!........... ..............................................:..n n............................• ..............................n.�v.. ........................:::::::::r.: y .. .::•.:::::ii:4:•:iiii:•iY.�:iiiii::(!•i ii+iry'::.;':.::;iii}i:.i::!Si};::•.i--,:"' .... ... an:«'v siQ 'sdifesX. :::>::>:<:::>:<::::<>:::<:::»::>?:<:»::>:<::>::>::>:::::;::»»::::::::»::::>::<;:<>:::>::>:>::>::?::»>:<:::::»::»?:::::::: : :<:»:<:;;:>: :>:: :::: :. ens .::::::::::::.. ......:..,.... ... . .:::::.............................::. :;.;.............: :.::............:.... olicv nsnrance:cos::>:>::::!.:.::<:>:>.:::><:::::>:«;;<::< .............::::.:::::.:.... Failure to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal penartia of a Sae nil to 51,500.00 and/or out yam,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 eeKi under the pains enalties of 4hatthe-informadon provided above is trw and coned i Date Signatil J Phone# omcial use only do not write in this area to be completed by city or town offidsl city or town permit/License ' ❑Building Department ❑Licensing Board ❑Seleconen's Office ❑check if immediate response is required ❑Health Department contact person: phone#; - ❑Other (revised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of e, and including the legal representatives of a deceased employer, or the receiver of the foregoing engaged in a joint enterpns trustee of an in , partnership, association or otherl entity, employing employees. However the owner of a legal 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 o be awn dwelling �house or on the grounds or building appurtenant thereto shall not because of such employmentemployer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant the has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,p� 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplvin as g any names, address and phone numbers along with a certificate of insurance affidavits t may bne e and submitted to the Department of Industrial Accidents for confirmation of insurance coverag or town that the application for the permit or license is date the affidavit. The affidavit should be returned to the city estions regarding the'law„or if you being requested, not the Department of Industrial Accidents. Should you have any qu are required to obtain a workers' compensation Policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete,and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be redmmed to the Department by mail or FAX unless other,arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have nay questions• please do not hesitate to give us a call. MEMO The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of IwBstNUN s 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406, 409 or 375 °FIKE r, . . ° The Town of Barnstable ;'"MHAS& 'g Regulatory Services 1659. `° Thomas F. Geiler, Director, eft)MAC� Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 t Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT 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 d elling units or to structures which are adjacent to such residence or building be done by regi ed con tots,with certain exceptions,alo�g�O40 other requirements. S. N lO:�aa�/ l Type of Work: �G 0(, �C-C Estimated Cost / Address of Work: O �� Owner's Name: �`S CrPlig Lo 06 G� 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 IMPROVEMENT DO NOT HAVE CONTRACTORS OR APPLI ABLE HOME PROGRAM OR UA NTTYWORK FUND UNDER M 142A. ACCESS TO THE SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name q:forms:Affidav:rev-070601 RESIDENTIAL BUILDING PERMIT-FEES APPLICATION FEE -CO, a. New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq. foot= -/ �7x.O.031= 7c/ / 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.ftj _>120 sf-500 sf $35.00 �P >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= I STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 , Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost "-" Application to egional �iotorit 0otrict Zommittee In the Town of Barnstable 2102 DEC 2 7 Ate 9: 10 CERTIFICATE OF APPROPRIATENESS _ �'- a Application is hereby made,with four complete sets, for the issuance of a Certificate of Appropriatenes's under Section 6 of Chapter 470, Acts and Resolves*of Massachusetts, 1973, for proposed work as described below and on plans;; wi dr ngs�or-p hotograThs accompanying t is T pli6ation for- 1 drawings, CHECK CATEGORIES THAT APPLY: rn 1. Exterior building construction: ❑ New Addition El Alteration Indicate type of building: House El Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign . ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: t ���► iy S i3! DATE �- ADDRESS OF PROPOSED WORK 1 r!r�/�1�1�� /Q r//'� ASSESSOR'S MAP NO. OWNER -'-5 C-";',_W Q DD 4- ASSESSOR'S LOT NO. HOMEADDRESS TELEPHONE NO. ��� J -77` FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) 7 CSC r lon*LG Lys, V �� ... Nt Y v a - -A/ +C/ f S L-L D Ot r / AGENT OR CONTRACTOR Sc� TELEPHONE NO. ADDRESS l S� 6E'/51/jY l PEN ln�,Z, IJi. �i�/�C�Z� /�/� C7 /. DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. �GxIG gor7�.i�o''� on /3)9 _-yam �— �? Al b7 • G � 7 � L j� x ��> 5 /�Zp Signed c yy� D Owner-Contractor-Agent For Committee Use Only FnThis Certificate is hereby Date 1� 1 Approv eni Committee Members' Signa r Town of Barnstable ` Old King's Highway Historic District Committee SPEC SHEET FOUNDATION C o I?�Cr['L O L � 1 1 C H. 13 y cc De SIDING TYPE E COLOR CHIMNEY TYPE '✓�� COLOR fa G ROOF MATERIAL S J/Ik l S COLOR PITCH 6E4gb /► / n G k: +C, 5'c A C i WINDOWS Oyc,Iyj E I-h1iy -- COLOR LV.N/f J SIZE 31 TRIM COLOR ('►�f / "� DOORS l 14' ������ COLORS SHUTTERS / VC/ COLORS GUTTERS COLORS . DECKS � MATERIALS /GARAGE DOORS IJV/ G COLORS 1/i 14 SKYLIGHTS SIZE COLORS. SIGNS y G� COLORS FENCE COLOR NOTES Pill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application;along with Four copies of the plot plan, landscape plan and elevation plane, when applicable. SPECSHT .,F.ILE # D10558 CENSUS TRACT # CLIENT:- paul C. Glynn, Esquire DEED BOOK 3025 PAGE 274 OWNER : William H. & Priscilla D. Britton PLAN BOOK 233 PAGE 19 9LOTAPPLICANT: . & Ann S. Craddock ASSESSORS PLAN PLOTMORTGAGE INSPECTION PLA. N OF LAN I N B A R N S T A B L E SCALE: 1"= 60" JULY 18, 1986 LD tc- P1 aq 1 e,—z/1/ I CERTIFY TO PAUL C. GLYNN, ESQUIRE, LOMAS & NETT"LETON, AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION, THE LOCATION OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS , -DWELLING SHOWN _HERE DOES NOT FALL - -THE. . r1 �:er;rl :`►��` �. .� ,. WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON'A MAP OF COMMUNITY #250001 DATED 8/19/85 BY THE F. I .A. o�Fs �GA ` L4 .,`' THE EXACT LOCATION OF THE BUILDINGS SHOWN CANNOT BE DETERMINED WITHOUT AN Land Surveyors Civil Engineers ACCURATE INSTRUMENT SURVEY, (91De Poston �ztnD $urbeg (go., � nc. 172 �illittm �4t. Vein �tbfora, 4kA 02740 GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, information, and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. (3) This plan was not made for recording purposes, for use in preparing deed descriptions or for con— structions. (4) Verifications of property line dimensions,--building offsets, fences, or lot configuration may be accompli0 pd only by an accurate instrument survey. i Town of Barnstable • Department of Health,Safety, and Environmental.Services t enx�vsznste. S 9. .`� Conservation Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4093 Robert W.Gatewood FAX: 508-778-2412 Conservation Administrator MINOR ACTIVITY REGISTRATION 7. -:--">> C �)- ) 7 Property er ty Owner Telephone number Mailing address AS .MProject loca ' n ap cel# 12 a GensN; lPj In7CjJ ZN�� Project description The following minor activities will be reviewed,under Art. 27,by Conservation staff instead of the Conservation Commission, as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement,6"above grade * Conversion of lawns to decks,sheds,or patios that are accessory to single family homes, as long as: -house existed prior to August 7,1996 -alteration within the buffer zone is less then 250 sq.feet. -sedimentation and erosion controls are used during construction * Sto a (thi does nonclude to walls for retaining wall purposes;grading and/or fill) Date Reviewed by Date _GIS Plan Attached(fee charged for plan) minoract.doc XO9 AD313 0 310d 1H911 O 'sdow xal s)ozmy elgotswog 10 wtol EOOZAd woq pezN!B!p want seug lmtDd '.00I=.I to alox D to 'dow etN uo •alIms palbulue *133106=H)NI I = SPJDpuaS bwrory dow louoODN teaw W paddow want uo4Dta6an puD'AydmBodot a!Uew!uold •uouwodio) spelgo lm!sAyd of sd!gsuoyolar lonpo lueswdw tou op 910lD sprDpuolS bwrozy doyy louo!WN Qy oa U o M' a3M01 ❑ 310d Allllln 0039 Aq sydDJD%oyd loueD 6961 woq pataidiatw want uoyotaBan puo AgdmBodol-Auodwo)llwms,M puo'suoymol enq tou ero As91 sauopunoq Madad 10 teaw 1ON Aow puo dDw DIMS,001=.I sawol eyl Aq sydwBotoyd loltao S66I woq petaidiaru!warn(swMoal epDw-uow)Av<awluold :S3)SnOS VIVO suoyotueswdw nydmB Aluo DID Bawl learDd eql:31ON** D 10 tUMADlua uD s!dow s!yl 310N* 1331 NI'31V)S 031NI8d N NM O MO1S ® N91S 1 1 N n S W 3 1 S A S N O 1 1 r W b O A N 1 1 H d V a 0 0 3 'J 3 1 B v 1 5 N a V 8 A O N M O 1 31od WE di lsod 31OHNVW 00 3A1VA E) 1NVNOAH / \ a31d/M000 •1 rr Minus/Maling p `� O A)3a/H)Sod 100d 9NIWWIMS All3f 3NOls ° 11VM 9NINIV13M �- \ 8 Z 3)N3l -X—X- ` tttJJJ \ \+' 11tlM 3N015 k NOIIVA313 lOdS 6'b i -;r-\..--_.._ ` 6ZaA9N uo pesoq ue!tDA913 3N11 MAO)100J OL 3NI1 SnO1NO)1001 Z \ ° \ a39WfIN35nOH— Deer# / 83aWON13)8Vd3 LZ #dVW - 0ItOw \ \ 7 **3141113)aVd 11Vdl/H1Vd ----- atl08 03AVd 1019NIXSa AVM3AI - atlos 1a1a 331VM 10 3903 - •-= VINV HSM 533bi Sn0b311N07 i0 39a3 A n n n Ab3SanN 80 aaVH)a0 HSnso 10 3903 I S33NI SnonOD30 30 3903 �•-•��� AVMNIVJ 3S8n0)1109 dow o uo toaddo II!m slogwAs llD tou:31ON ON1931 ONdONd1S 3JLNfN r»> o d The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �i Please Print DATE: JOB LOCATION: number street/ /� p village "HOMEOWNER": 5s-N-7 L'-S C/ 9 /J b e:: �� 0 J ll 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 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 oce ures and requirements and that he/she will comply with said proc dunes • r quiiemen . i ignature of omeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. TOWN OF - BARNSTABLE BAE35TAILE, O6 UR 39. BUILDING . INSPECTOR APPLICATION FOR PERMIT TO .,IJ I.Z /........z .1-UP / .. TYPE OF CONSTRUCTION ..................... -41w ............................. 1 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ......... ........... ......... .. ....... ........ ......... ........... ProposedUse. /:i5y.................................................................................................................................................. Zoning District ......................Fire District .............................................. Name of Owner .../-6/sf -Address ........................ . ...... /0....f�`'� /G�.... ... d �/!/ f117�s Name of Builder V le"I, ....................... Address ...2��.A�elew....................... Name of Architect ...... ..............................6/......... Address ....... ................... Number of Rooms .......X!�......................................................Foundation ....... .. ..... ...... . ..... Exterior ...... . d .. I......................................................Roofing ... ............... .... ...... ......... Floors ........&1d4 .......................................................Interior Heating ...... .0 ....................................................................Plumbing ... ....... .......... Fireplace ............................. Cost .........................Approximate ............... Definitive Plan Approved by Planning Board ----------------------------- Diagram of Lot and Building with Dimensions 7 SUBJECT TO APPROVAL OF BOARD OF HEALTH _j LLJ Ln (D U*) 0 a- , 17- LO 00 0 Uj 0:1 wo \3; > Ld 0 (D rN LL_ LLJ Nr� 0 0 z: (5- :) LLI 0 N CL LU C1 ~ ct� ul tv LLj N Uj =) U=J _j _j Lo I _j < -e_ = _N 0 U, ui Ln U1 0 - z CL 3: cr- Cr'a- < LLI 70-00 < IqPOI- L C) I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... .. ................................ Wel}n, Construction Co. , Inc. . � ......—No ..15081.... Pernit for . I.~~—~/.~...e.t-o--'..... ^ single ~ ` _ family dwelling � � � 40cation .................................__ ............... West Barnstable � --~.---.---.------^-----............ . � . Cooatz�— —ztiooCo. , Inc.:. Owner —.—Welby——.—..: — --- ---.—,---, | � fraone � Type of Construction .......................................... ' } � � —.—.—.~----.----..------.----. | ' p� #o �Plot —..----.—.—. Lot -----��----. � .. � / ^�a Permit Granted ...........y Date o. [inspection .v^.. ...^ ............ Date'Completed ......................................l� � . ^ PERMIT RBFUSED 1 ` '----'---.—.—.—.—..----..-- 19 ` `. ~^~~----~--'—^^----^^^---'—^--` \ [ ^—_----......~--.....''-._--.—.—...,' . � ^^^'^^---'~—'—~~^~----'~~^^^'-'—'--^ ______._.~_,__............................................ ^ � . Approved ................................................ 19 ---------'----'--'—'—'`—^'---^^— ' ............,.........'...........................,...,,,......,,,,... � � � v *THE TOWN OF BARNSTABLE 33ARNST" 1639 BUILDINV INSPECTOR ....................... APPLICATION FOR PERMIT TO Alg.k0.....�?Wjlf........601AA 1; L!?f................ TYPE OF CONSTRUCTION ..........WPO........F.'r R. ...................................................... .............................. ..............................197, TO THE INSPECTOR OF BUILDINGS: The undersigned h;reby applies for a permit according to the following information: . . . . Location .... . .......... ...... .............. ........ ................................ ProposedUse ..... ....................................................................................................................................................... I)ea-t Zoning District ...... . ................T V Fire District j........................................ .............................................................................. Name of Owner ....... .... .............Address ....U.0.1v.... Name of Builder A ........Address VAlfew.....6:.. �0 r Name of Architect �,AOIL(Ai............Address ... ..... .NA�q.............................. Number of Rooms ......... ....................... ......Foundation ...................... ................................................ Exterior ...........wz.70) ..................Roofing ........vlf4fh6...... ................................ Floors ...........V JAI...........................................................:.....Interior ........... D f/ Heating .......H.qA...... .W.&+R-X.........................................Plumbing ......S�-q .k CP.C.4 pe. . . ................. ..................... Fireplace ............. ........................................... .......Approximate Cost ... .4........0 a ................................................ Definitive Plan Approved by Planning Board ---------------------------- Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH is & jet/ Na- /goo I L 080 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ......................................... � � No ................. Permit for ------------ `------.----,---.—.------.--.. � . 4ocoton .--__._______.^________. � --..,,---..--.—..--.--~—.-----. '. � Owner .----.----.------------- � ' } Type of Construction .......................................... ' ` --.—.—..-------.---.---------... � Plot ............................ Loy ................................ / - . . ' . Permit Granted ----.------.--]A Date of Inspection ---..--------]A � Dote Completed ........................................ / ` ` � ^ � PERMIT REFUSED , ^'---'_'---.—..----.----' lQ ---''~^'~-----'`^~-----^^—^—'---'' � ~'--^''~'—^''—~'^--'—^^~'-'---^^—^—^^ - .---._.---.--....—_--....--~.--.. � --.—..—.---.,..--.-...--..--.----..' ' � � Approved ,--------------- 19^ � ------------~'--^~'-------'—'' � � ` ----------------------^^—'~~' � � T . pftKE T� Town of Barnstable *Permit# � 77 �3 Expires 6 months from issue date Regulatory Services Fee BARNSTABM � MASS.t639. •p Thomas F.Geiler,Director p ��0 � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X®PRESS PER.. ... .. Office: 508-862-4038 Fax: 508-7.90-6230 MAR Y 4 2003 EXPRESS PERMIT APPLICATION - RESIDENtIt*Qi•X RNSIA :�.` Not Valid without Red X-Press Imprint Map/parcel Number Property Address ❑Residential Value of Work r/OGD Owner's Name&Address ✓ C 5 �,�[ /� �� "7 . - �- Contractor's Name G Telephone Number -> 5- rJ d -7 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) I . Og-]�e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) -Cf-Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *** ote: P Own ust sign Prope Letter of.Permission. Signature Q:Forms: trg Revised121901 2 - f 2 Z l tJc,`. _ ,yyl y16 �r L 1 o rzc�F r es-. - -- - - - rz �,a +►.max. -N 12 ` x " .\ t:"�1t.4'CtTC'�` �! 1 - +� E�cts 1 c., VE1JT U E r Z L Nt4:-,-,\L 'De►P Enc,E ►":aQr_ i � � 1 �c, , R. (c,g\tt`w f tx il STt+ rjC �� " __ 1 �►.ES f"4aC,r t1 � 3/h 1 l I � llo __._.._....._ _... .....________---_ _..___------_--•-_______.—_ __..�......__--_.__-�.__ .._.., .-. •-•�,�.1�..Rtj,.,W,Wae,�.sa�.......r......»1�..' `a..�A.ban..va.3na.. ._.�.,,_ f . 71 -M- i t I ILLJ � z: A) - ! i 1 i' _2 l l.iT' E•l.._E�lQTI Or.� ��/, Q� �."��;",rr__ � '�L� E �� ('�� L c r-7- ELc l�`rI o" (la, ci j t I k • r_ , — __ -- — -- 7t bw 508 .4 2 8.6191 W. (Eevl i n THK. WALLS ON F=f;11-%1 L� - C�. t0 - - , � _t7l, �— � � W �� _5esigns copyright © 2 } - 002 ' 1 ' _ i _----- __.— -__---__-�..__ .__ All Rights -� Reserved — t1 AK. ccj4C, SLAB C4 3 1 9 + N � � ,`;�•:,to�:-«, — P:l 2-Ib T' C--L C)O iL P!."&►•..! ('/e A� ~7 9 S (2( `- Preliminary puns and IAVnut� by D C D are for the use of their customers only Any other use is striCtly prohtbite 1-1