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Home My WebLink About0059 JOSIAHS PATH UPC 12543 : � NASTIN09•ON ^r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcellbk 69 :pPA lication* _J Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Al d S Village , Owner G'f�,�Z� o &Ze✓z1 Address Telephone.0 P,T 5":Ore _42 Permit Request J &2,g gj��e �i�l ,�� 9 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation / a 4, construction Type ,/!, zoo'. 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 (0 No On Old King's Highway: ❑Yes ,&No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area f(sq ft) � ,_� -� Number of Baths: Full: existing new Half: existing rew Number of Bedrooms: existing _new — , Total Room Count (not including baths): existing new First Floor Room Count --r Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Otherrn I Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑. Commercial ❑.Yes ❑ No If yes, site plan review# Current Use Proposed Use I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Z44x, Telephone Number _ _ L5 a f Address ,/fir ,�2ArL��/ G//�i License # /D ev ma's Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO U SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED ' MAP/PARCEL NO. , ADDRESS VILLAGE OWNER ~ Rf DATE OF INSPECTION: i FOUNDATION r FRAME f INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL Y GAS: ROUGH FINAL FINAL BUILDING ` .1 DATE CLOSED OUT ' ASSOCIATION PLAN NO. ' of"�T Town of Barnstable �4 Regulatory Services �wt,�zeais, esess m Ricbard V.ScA,Director 061 $wilding Division Tom Periy,Building.Cominissioner f 200 Main Street.%wins,MA 02601 «tir-w,town.b arras table.ma.0 s Office: 508=86211038 Fax- -508-790-6230 Pxoperty Owner Must Complete,and;-S;ign This Section If Using.,Builder T, C1 N V{I'l UW{ I�S as 0%;mer of-dic:sub1j qrp , Prop 7'. hereby-authorize Cp :SU TI t+ act,on,mybehalf, in all matters.relarive,to war authorized bythis building permit application for. 5°1..� i�Sfah �f41►_�� l 61ainSknUtz iMi�- 6ZcPrlf� (Address b f-f Zb),�, ""Foal fences and alarms are t} e responsih iiiy ot`t e: plicant. P661s are.nor,to be filledj6r utilised'befare'fence;is installed and all final' inspections are performed and.accepted. a Siguan=of.Owner 'Sipature,.of.App' icant x0la.r-e, ti4ve41-310 Punt Name PiintNaive Date Q FORMS:014;1'F.RFMAJSS10NPOOI S r i. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY 8 SHED ROW t' I 1 Y, WEST YARMOUrH t 2' 5 1 5 )I 151 5• Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 . Type: Private Corporation p Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY -- 18 REARDON CIRCLE -- SO, YARMOUTH, MA 02664 Update•Address and return card, Mark reason for change. scA 1 20M•05r11 Address Renewal Employment R Lost Card .......................... �e�vomh�aooatuerr•�G/o�C%l/`�wo«c�crdeCGi \•-Office of Consumer•Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENt'CONTRACTOR before the expiration date, If found return to: egistratlon: •:1.53567 Type: Office of Consumer Affairs and Business Regulation ;j xpiration: ;;::1.2Z:1:5I20:1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATI'ON:;:,INC HENRY CASSIDY 18 REARDON CIRCLE' 4��4yBee SO. YARMOUTH, MA 02664 t= Undersecretary N valid wi ut sign e The Commonwealth of Massachusetts _ =_" ;..I Department of Industrial Accidents .'I Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers ApplicantInformation Please Print Legibly 1 r Name (Bus iness/organizatiori/Ind1vidual): f�,/ rx l Address: 9 City/State/Zip: & 4b Phone #: v �� IL Are you an employer? Check th appropriate box: Type of re I. .1 am a employer with '( 4. ❑ 1 am a general contractor and 1 yp project Ject (required): ) employees(full and/or part-dme).$ have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity, employees and have workers' insurance,# 9, ❑ Building addition (No workers comp,comp, insurance p, - required,] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ ( am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL 12.7 Roof repairs insurance required.) t c, 152, §1(4), and we have no employees. [No workers' 13,� Other , oo comp, insurance required,] // *Any applicant that checks box HI must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affiMit 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp. policy number, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site irrformatlon, ; insurance Company Name; ' i� � �W51kU&L`/ Policy # or Self ins. Lic. #; Expiration Date; Job Site Address:`9 a_71'ZZCity/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 insura coverage verification. I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct, i Si nature; D/V V %,- / ate: ��/ Phone#; ' LA- Official use only. Do not wrlte 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 Phone.#! f CAPECOD-27 TQUIRP ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE4/271207izo/YYYYI_ `—� l s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s), PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FA 43 Rte 134 A/c x AJC No): (877) 816-2156 South Dennis,MA 02660 AIL A DRESS:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC t1 INSURER A:Peerless Insurance Company INSURED INSURER B:SafetY Insurance Company 39454 Cape Cod Insulation,Inc.: INSURER c:Endurance American Specialty Ins, Co, 18 Reardon Circle INSURER D:Atlantic Charter Insurance Group South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE LTR IN SD WVD POLICY NUMBER MMIDD/YYYY MMIDD� LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0C CLAIMS-MADE OCCUR CBP8263063 04/0112016 04/01/2017 PREMISES Ea occurrence $ 100,0C MED EXP(Any one person) $ 5,OC PERSONAL&ADV INJURY $ 1,000,0C GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,OC X POLICY JECT O- rLOC PRODUCTS-COMP/OPAGG $ 2,000,OC OTHER: $ AUTOMOBILE LIABILITY Ea aBINEDISINGLE LIMIT $ 1,000,OC B ANY AUTO 6232707 COM 01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED �( SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUUTOS NON-OWNED PR P RT DAMAGE $ Per accident $ X UMBRELLA LIAB kXN OCCUR EACH OCCURRENCE $ 2,000,OC C EXCESS LIAB CLAIMS-MADE R/O EXCI0006636000 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,0C WORKERS COMPENSATION I p R AND EMPLOYERS'LIABILITY YIN STATUTE ER D ANY PROPRIETOR/PARTNERIEXECUTIVE WCE00431901 06/30/2015 06/30/2016 OFFICER/MEMBER EXCLUDED? ElN I A II E.L.EACH ACCIDENT $ 1,000,0C (Mandatory In E.L.DISEASE•EA EMPLOYE• $ 1,000,OC Yes,tlescribe under und _ ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,OC T , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bill Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS. Brewster,MA 02631 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Assessor's office(1st Floor): ' Assessor's map and1ot.• mber _ '` THE Tto� Conservation Board of Health 3rd floor : e �. ��° Sewage"Permit number IL �e s"'��0 !' Engineering Department 14 (3r floor): _ '' ' � 6 ff �T E House number ^ ; �® Definitive Plan Approved by Planning Board — 4'7 19� TO ��U L C ®��® APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only , P �Tl®�� TOWN - OF BARNSTABLE BUILDING, INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 4 ff 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ` Location— Proposed Use Zoning District Fire District Name of Owner Address Name of Builder S /-?,v;,! & Address z7r, ",7 Name of Architect Address Number of Rooms . Foundation &Exterior /�// C Roofing Floors A Interior �T-< Heating �l Plumbing Fireplace Approximate Cost Area 1220 Diagram of Lot and Building with Dimensions Fee 3 �v H 70 � 1 06 �b S—G hf OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name oi— Construction Supervisor's License S BUILDING t' �'` No 35915 permit For 112 Story Single Family Dwelling Location Lot #57 , '59 Josiahs Path West Barnstable 10 Owner Nickulas Building Type of Construction Frame s Plot Lot Permit Granted June 1 , 9 93 Dat o nspectio -/I' �o � 19 r a fi 's t �0 1 ✓AT .: P x TOWN OF BARNSTABLE, MASSACHUSETTS L - 1 R .' A=088-006 DATE Jun 19 93 PERMIT NO. N° 35915 i APPLICANT Nickulas Building ADDRESS _ B;x 507, W. Barnstable #002265 a (NO.) (STREET) NUMBER OF - (CONTR•S LICENSE) t PERMIT TO Build Dwelling (11i STORY Single Family DwellinQDWELLING UNITS (TYPE OF IMPROVEMENT) NO.' (PROPOSED USE) ' ! AT (LOCATION) LOt 57 59 Josiahs Path W. Barnstable ZONING (N0.) DISTRICT— xF (STREET) I f BETWEEN AND (CROSS STREET) (CROSS STREET) i SUBDIVISION LOT LOT BLOCK SIZE i BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION 1 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #93-238 Bond AREAVOLUME 1220 SQ. ft. ESTIMATED COST $ 70 p 000. 00 FEEMIT 87 .50 (CUBIC/SQUARE FEET) OWNER _ Nidkulas Building ADDRESS BOX 507. W. Barnstable BUILDING DEPT. BY iFROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT REtEitE THE APPLICANT FROM TIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS edG vM�r.vF O� C, Z z pfo� �v,w6�.vt 2 moo ale HEATING INSPECTION APP OVALS ENGI ING D A ENT „^ B ARD OF HEALTH OTHER C J SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE.. NOTIFICATION. 43 1h. V 14 v a r. 0 r pp, A 61 V0 z 'max LOT 57 / 45. 563 +/- s.f. 10 Al S6 i 33(,, /6.76 70 73- / `�/ s Qo'y y .� # 93-150 CERTIFIED PLOT PLAN LOCATION : JOSIAH'S PATH W. BARN PREPARED FOR: . SCALE : 1 " = 60' DATE : 05/21/93 REFERENCE : LOT 57 PB 489 PG 51 NICKULAS HOMES I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. �pL1r 0f t AFiNE rye IOJA down cape engineering Inc. p2. CIVIL ENGINEERS Af LAND SURVEYORS RTE 6A - YARMOUTH, MASS. -(DATe ND SURVEYOR Application to •P.. OPL`P,,,1. Old King's Highway Regional Historic District Committee -, . in the Town of Barnstable fora r gip` n15;1•. �i.�•,;. CERTIFICATE OF APPROPRIATENESS Application Is hereby made, iri triplicate, for the issuance of a Certificate of A << ppropriateness 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: i CHECK CATEGORIES THAT APPLY: `' t 1. Exterior Building Construction: f� New Building ❑ Addition ❑ Alteration Indicate t. ype of building: ❑ House 'Garage ❑ Commercial ❑ Other ' 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole' ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY . . LET E;,'j'. ' ToSlbl-It t'bn•l• DATE_� bK-G•k Zr7, CP)?7 :i ADDRESS OF PROPOSED WORK KIJSTb•$t-IF h1'b. CZ(,( ASSESSORS MAP NO. g }i '' �•. OWN Vt,"6Ln R NI G. ASSESSORS �;K ;, � >� ASSE S LOT N • HOMEADDRESSYo . $��(' Sb� °W; Kl.1STd13l TEL. NO �1P2 I(02�5k',.sn7� a :. . i 'lr t FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners(across any public street or way. (Attach additional sheet if necessary). Cad il'1-4 61--f 49 SoZ. bo s toI -416.E1 . 1'►ctE1G� W. �a}rQ e_1 A,B k_V, ).;I&. A CW. AGENT OR CONTRACTOR ALP-CLI-J -T1✓G{-I dSbG ADDRESS r tl IIT ir 4 �., �►1T "i 1 oZ 6 3 } DETAILED DESCRIPTION OF PROPOSED WORK:' Give all particulars of work to be done (see No. 8,other side), including:"'? materials to be used, if.specifications do not accompany plans. In the case.of signs, give locations of existing signs and:proposedt;'` �. locations of new signs. (Attach additional sheet, if necessary). ,a• ••� .' L� ! ) + .J ' i , �. r rl�J'GijJ�ij�+J �Sl Ill!§ L� J yrla,i`�'�IAl;�i7�b .fI•� ` 'i{•i'1 •'� .�.i.:�' ;2� .. '.I{li..' ' n S S r w i ��lr�¢i:irl r r,�gi�h''Y�•4 t€ j4t { t ,St: Itt {{ ;I�rk l,J-IZ 31 o . .•�r.'.n� ;.' ' 1' ,� � i I ! { �. ,� ",'�i1'1„1�;' T,'�•fI d'�o,�r.S I j Signed o w r• ntrac Agent 7�rI#1 '�� a;-••1' Space below line for Committee use. ertifica is ereby Date MAR 2 5 1993 1 By TMNN OF 1ARNSTAbLE LD KIN Ay Approved IMPORTANT: If Certificate Is approved,approval is subject to the 10 day appeal period , • .,, provided In the Act. Disapproved ❑ OLD KING'S HIGHWAY HISTORIC DISTRICT !.: ,> �f Spec Sheet Foundation Type Siding Type � ,�,—('lo Ie,- ' Chimney Type �,lagp — SP�!/5-7-�Q�l� Color �Ju Roof Material Color Pitch S• Windows S. Size s• . Trim Color - - - Doors S Color Shutters S• I Gutters Deck Garage Doors Color $�U Notes. Fill out1i':`y�,, completely, including measurements and materials/colors to be used.` ' Three copies of this form are required for sukmittal of an application, along with three copies each of the plot plant landscape plan and elevation . ' Plans, when applicable. Plot plan need not be "Certifie to scale. d but should show all structures .on- the 'lot. I ' 43,t:5&3 I � � -70 o �asl�f-f PATS SCALE APPROVED r v / TOWN OF BARNSTABLE 359.15 BUILDING DEPARTMENT Permit No. ... ........ TOWN OFFICE BUILDING Cash 9'�>p..r► HYANNIS.MASS.02601 Bond ........... CERTIFICATE OF USE AND OCCUPANCY Issued to N14ulas Building Address Lot 457, 59 Josiahs Path West Barnstable, Mass. USE GROUP FIRE GRADING --OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND.THE BUILDING'SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING JNSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. - ...... 19.......9.3..... ...................... Building Inspector 'I` •'.+�{ SF'-�� S r [:4: 'r'N,.�.`.;�{�y,• ��+ .fw,y� p (• N y, i •;l�. 5�' � _ J. �� •'.1' . L t.ir•'�°`!r '�,�C�.�� -•�.�..rx•:5'-tr1}i.ii �j"�°''k1��:!i�r1i•.-r'.�'f£+ �":'.. ��.. •,w TOWN OF BARNSTABLE BUILDING DEPARTMENT _ 11AR�iia TOWN OFFICE BUILDING HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit /�has been issued for the building.authorized by Building Permit #.. `.:�.`.�. f.:./ ..............:...............:..... _...... »........ .. .... w i issued to .,`�/ • .................. ......................................................»»...».... .....»_.. _.. _..__»» Please release the performance bond. l r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION_ Map 0 66O f Parceh Application # 69 6 V Health Division , Date Issued tk 8e Conservation Division K.5- Application Fee Planning'Dept. Permit Fee 00 Date Definitive Plan Approved by Planning Board a �/ �� 07 Historic - OKH Preservation/ Hyannis Protect Street Address R �o rS�'a s a Village UJ _S cica S a 1�4 y 1 C Owner C (a re IV oVtl_ Address Telephone S 0 "3 7 S • 6 5 a d Permit Request 1 >, E ��, ® u� r uc.Y ` d c � f`a�. Square feet: 1st floor: existing proposed 2nd floor: existing P a 0 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t Construction Type h; ;s L Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. • Dwelling Type: Single Family . X Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes INo On Old King's Highway: ❑Yes UNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) N o V C Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new I Half: existing new Number of Bedrooms: i` existing L new Total Room Count (not incll g baths): existing _ new _First Floor Room Count Heat Type and Fuel- 0 AG as Oil ❑ Electric yp ec c ❑ Other Central Air: ❑Yes l�1 No Fireplaces: Existing f New Existing wood/coal stove: ❑Yes WNo Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: E existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: i « c Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Q v �' .� Commercial ❑Yes No If yes, site plan review # Current Use Proposed Use oCri APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W a ! C- Telephone Number y Address 25 N, License t Home Improvement Contractor# Worker's Compensation # —ram!D a 7 -3 d1 a 00� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO LALIALsa Ze"thJa`.f SIGNATURE DATE. 02 _Q rT ` FOR OFFICIAL USE ONLY I r APPLICATION#. DATE ISSUED MAP/PARCEL NO.- ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAMEYA0K1� SOG INSULATION ©KGB s4 Q �i .. . Sa FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDIN '�� ®O 2 (ivo s ue' IC— c<.3,mil rr4s•X,_« DATE_ CLOSED OUT r ' -ASSOCIATION,PLAN'NO: - a 14C e- rzA rN6 i II r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ►vww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p q Please Print Legibly Naive(Business/Organization/Individual): ��&tik Q 1 V)t r 2C bn Address: ^� A 5� City/State/Zip: a lPhone.#: 0p 7ire an employer? Checkthe appropriate box: Type of project(required): m a e to er with 4. 0 I am a general contractor and I mP Y 6: ❑New construction employees(full and/or part-tim.e).* 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 These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition - [No workers' comp.insurance comp. insurance.$ required] 1 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation 'nsurance for my employees. Below is thepolicy andjob site ' information. �d--, Insurance Company Name: r\`' Policy#or Self-ins. tic.#: d 9,60 Expiration Date: '' ,,—L a®� 1. Job Site Address: '�7_017, City/State/Zip: to)1 6 A 4 L Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER`aitd 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 un the par n en ies of perjury that the information provided above is rue and correct Sip-mature: Date: 6 _ Phone#: L use only. Do not write in this area,to be completed by city or town officraL own: Permit/License# uthority(circle one): of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector erson: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for-the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation-and, if necessary,supply sub-contractors)name(s),address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.' The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials. Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant •::that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"I.he.applicant should write"all locations in__(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves 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, telepbone-and fax number: ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel: #617M727-490:0 ext 406 or 1-977-NIASSAFE Fax# 617-727-7744 Revised 1.1-22-06 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY.FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: - o � u pfint Town: Applicant Phone: 1660 Applicant Signature: Date of Application: D8 NEW CONSTRUCTION: h se ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SI LR R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of 35 R-38 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as.listed below. I ❑ Option 2: �. REScheck Version 4.1.2 or later variant software analysis must,be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www.energycodes.gov/rescheeld J ::ADDITIONS OR ALTERATIONS TO`EXISTING.BUILDINGS:'OVER 5.YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b-a) Altll SF 100 x 27k�l 710k % of glazing (b) Glazing area equals. YA SF b a Y v If lazing is <:40% use.the chart below. If.glaziri is,,Ao% proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter 9 ® Fenestration Wall Floor Basement Wall . G U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). ❑ SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note:. Owner to fill out Consumer Information Form (found in Appendix 120.P) . ` . . � . . � r/PVC Guide k/ /-1/ood Coiistnictioii hi. f{�`6 /�/xd//runJ: //0 .ip' ��xdZouu � / ��1��X��hlI8�ff� ��h��k�of f«� ��8i rl^�Y��ce (00CK{R5301�2.i|) � � c� Check � Compliance 1.1 SCOPE ^ WindSpeed (]-soo gust).................................................................. ................................................ 110 mph Wind Exposure Category-_---'---------------- --_.-----------------8 / C � VNndExpooumCategory-----.Eng�oohngRaqu�odFor Enb�Pn�oo -----------.-' __-- | 12 APPLICABILITY Numbe/of Stories(a roof which exceeds 8in12 slope shall bo considered u story) stories :5 2stohoo � Roof Pitch ............................................................................(Fig 2)........................................... 1212 � � �%� Mean Roof Ha�ht --------------------'(�g2)----------------`--- M ��7 Building Width, YV ------------------''-'(�g3)---------------.' ___ � �80 8uUd�gLany�. L --------------------'�� u)----------------._-- �2L1 Building Aspect RaUo (UVV -.-.'------------(�g4)----------------�----- � 2 ��8^ Nom�� Ho�h�of�d�a Opan.n ---------'�-'(�g4)---------------'�_�_� / 1.3 FRAMING CONNECTIONS/ � ) General compliance with framing connections....................(Table 2)............................................................... --_- � 2.1 FOUNDATION Foundation Walls meeting requirements of78OCMR54O41 , Cuno/ete-------------..------'�--'------------------.' ConcreteMasonry .............................................:...................... ................................................................ /� ' 22ANCHORAGETQFOUNDATON 50"Anchor Bolts4mbedded or 5/8'Proprietary Mechanical Anchors as an alternative hn concrete only / ' BoKS,-- -ganor |-------------'�[Fu�e4)---------------' n� � - � � ��2^ - 8dt8padng�umend�ointof�ahn ---------' 5)'`----':-----'-_--_ � ' . � UEmbedment-oonor rd �e---'----------A�g ------------��-_-��-�� Bo T ' Bolt Embedment-masonry.................. ......................(Fig 5)............./......:........................ in. � 15^ / (Fig 5) �3^x3^x�� / Plate Washer _______________� 3.1 FLOORS Floor-framing member spans checked ..............`..................(per 78OCIVIR Chapter 55)................................... ��12' Maximum F�urOpon�gDknenu�n-'----------(�g8)------,-�-------_'�-�' Full Height VVa)S�duadFborOpen�go�uu�on��omEx�r�rVVaU(�gO)------------- Maximum Floor Joist Setbacks � �d Suppo��gLoadbeehngVVaUborSheanwaU-----.(�g7)-----'`-------�---... `-- � � Maximum Can0everadFloor Jo�� d Loadboar�gVVaUx.nrShoanvaU-_---.U�g -----------'.-----. -_ Fbu�Bmdngat Endwa/b-----------------.(�gS)................................................................... F�orSho�h/ngType '----------------.._' 78UC�RChap�r ................................... FloorShnoMhingThicknexu --------'.----- .....(per 78OCMR Chapter 55)........................ in. FkoprShoaMhingFqstoning----'--------. ..........(Table 2)' dnai�at___inuUge/___m/mm ' . � � ! 4.1 WALLS � � Wall Height .8� �LuadbeohngwuUu---.�--------------'U�g10undTab�5)---------___� � 1{Y � �,�+ � �aU�----------------(�g 1O and Tob�5)--_-----'. ft ��7 � VVaU - ----�---------'(�Q 1O and Tub�5)------`_ -_�. �24^�z� VVaU S�� ` ' .-------'(F�n 7&Q----------�----�__� �d ' \� � Offsets -----_----' -7-' 4.2 EXTERIOR-WALL8, VVoodSfud"s � Loodboaringwalls-'--- ........... .............................(TaWn,5)-_-,-_---_2x __� '___h___�. (Table � 2xL__ ft kn. Gable End Wall Bracing FuU --------------'�� /uY---.�-----.----------___ � WSP - F�urL�no�--`'�--�---------.��F� 11)---'-----------. _�eV�3 Gypsum Ceiling Length(if VVSP not used) (Fig11) ' ftuCiOVV � and�- '--'--------- - ^~ � -�� (Fig ' .ceiling furring strips @ * i 'with 2x 4 blocking @4 ft.spacing in end joist or ' huou bays Double Top Plate � Splice Lengih --�---��------^------ Table 0)---'`--------`__� / • t �161�C Cuirl�� to 6/%url Cor�strrrctinn r.'ir. Hizr/r 1l�iricl'f(rea : 1101/11 r P '1d ZoiI Massachusetts Checklist for Conip.hanee (780 04R 5301.2.1.1)� Loadbearing Wall Connections Lateral(no. of 16d common nails)..................:.............(Tables 7)..................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans ........................................:...............(Table 9).................................._ft_in.5 11' Sill Plate Spans ....................................:...................(Table 9).................................._ft_in. s 1 V Full Height Studs (no.of studs)....................................(Table 9).............................I...................,...... • Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9).................................. ft_in.s 12' Sill Plate Spans...........................................................(Table 9).................................. ft—in.5 12" Full Height Studs (no.of studs)....................................(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously Minimum Building Dimension, W Nominal Height of Tallest OpeningZ ..............................................................................._5 6'8" N SheathingType..............................................(note 4)....:................................................ Edge Nail Spacing.........................................(Table 10 or note 4 if less)........................ in. Field Nail Spacing..........................................(Table 10)................................................. in. Shear Connection (no. of 16d common nails)(Table 10)......................................................._ Percent Full-Height Sheathing...................:...(Table 10)...... ............................................_% 5%Additional Sheathing for Wall with Opening > 6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening ........................................................................._s 6,8,. SheathingType..............................................(note 4 ................................................. Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. Field Nail Spacing.....................:.................:..(Table 11)...............................................:.. in. Shear Connection (no. of 16d common-nails)(Table 11)....................................................... . Percent Full-Height Sheathing ..... Table 11 .............................................. 5%Additional Sheathing for Wall with Opening> 6'8"(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?............................................................... ............................................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) ilvl'd' Roof Overhang ....................................................(Figure 19) ............. ft 5 smaller of 2' or L/3 'T— Truss or Rafter Connections at Loadbearing Walls Proprietary.Connectors Uplift..........:...............................:.....(Table 12)......:......................................U= plf Lateral.............................................(Table 12)..............................................L= plf Shear...............................................(Table 12)............................................S= plf . Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= plf Gable Rake Outlooker..........................................(Figure 20 ft s smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no. of 16d common nails)...(Table 14)........:..............................L= . lb. Roof Sheathing Type................:.:.................................(per 780 CMR Chapters 58 and 59) ............ Roof Sheathing Thickness.....................................:..... ............................................._in. _>7/16"WSP Roof Sheathing Fastening............................................(Table 2)........................................................._. Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR.5301:2.1.1 Item 1: If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. i oFZHE ra,, Town of Barnstable Regulatory Services yB'aMASSai e$• Thomas F. Geiler,Director �A 1639. ♦�' lFOMA�A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder "'vex /0 as Owner of the subject property hereby authorize f -, :;, 'D [ p ,1 to act on my behalf, 1 in all!rmtters relative to work authorized by this building permit.application for: . CJ / ..L C (Address Of Job) O Piganature of ate Pant Name If Property, Owner.is,applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISS ION THE Town of Barnstable 1p�� Regulatory Services BARNSTABLE, Thomas F. Geiler,Director 9 MASS. g 1 39. Building Division TED MA'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as 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 requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official i 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 pen-nit 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,Section2.15) This lack of awareness often results in serious problems,particularly I 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 fon-/certification for use in your community. Worrmhomeexempt MAR-26-2008 WED 02:38 PM FAX -NO. 5089915461 P. Ol ACORD. CERTIFICATE F LIABILITY INSURANCE 3DATE 26"2008 PRODUCEIR (508)994-9606 FAX: (500)9 1-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY .AND CONFERS NO RIGHTS UPON THE CERTIFICATE FLAGSHIP INSURANCE AGENCY INC i HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 414 COUNTY STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEW A1rpLBORD Imo► 02740 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER&Peerless Insurance WaTap worx LLC I INSURER B Em to ere Fire Insurance 20648 25 Devon St INSURER c..American International ' INSURER M Mashpas MR, 02649 INSURER E: 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 CONTRAC T 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. kTE LNEM SHOWN MAY HAVE BEE 4 REDUCED INSR DIYL TYPE OF INSURANCE #GLICY NUMBER Q�YIPD 1N�N AMIDDD ATE CY M1I UMTTs GENERAL LIABILITY EACH OCCURRENCE s 11000,000 X C044NERCULLGENER(�AL LIABB.(TY DAMAGE TO RENTEro s 50,000 A tLAWSMAOE L_J OCCUR CCP63799158 2/3/2008 2/3/2009 MEDEXPIANOMOMMI 6 51000 S 1,000,000 a a 2,000,000 GEN1 AGGREGATE tIMITAPPIES PER S 2,000,000 X ICY LOC AUMMO=LIABILITY COMBINED SINGLE LIMIT = ANY AUTO (Ea eaieeml B ALL OWNED AUTOS M1202020 3/10/2000 3/20/2009 BODILY INJURY X SCHEOULEDAVTOS (PerP--) = 250,000 X HIREOALfrOS BODILY INJURY X NONANMFDAIITOs I (Peremwwo) 6 500,000 PROPERTY DAMAGE S 100,000 (Per eor�denl) GARAAE LIABILITY AUTO ONLY-EA ACCIDENT i i ANY AUTO OTHER THAN EAACC S AUTO ONLY: ERCEMUBRELUI UA80.RY EACH OCCURRENCE OCCUR F7 CLANS MADE AGGREGATE I s OEDUCTTBLE I C WORKERS C014PUMTM AND TfSTA'R} JFR OT" EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E FAC ACCIDENT s 500,000 OFFICERAIEMBEREXCLUDED? p pn7G 3/25/2008 3/25/2009 E.LDISEASE-EAEMPLOYE 6 500,000 B Qeer6e Meet DISEASE P0 ry s 500,000 OTHER i DESCRIPTION OF OPERATION&4AUMNUMMxMUCLUS104 ADDED BYENDORSEMEKMPWIAL PROVISIONS I CERTIFICATE HOLDER I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF HARNSTAwz EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 200 MAIN STREET 10 DAYS WRTTTEII NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT HYANNIS, MA 02601 FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTTIORIIED REPRESENTATIVE Bruce Kestenbaum/KMM Cw &CORD 26(2001/08) ®ACORD CORPORATION 1988 IN802b(oTael Dee i Pop I e►2 Board of Building Regulations and Standards ✓die Vo��vnxo�ua a�✓ti'aasac�ivael�a _- — BOARD OF-BUILDING REGULATIONS HOME IMPROVEMENT CONTRACTOR i License: CONSTRUCTION SUPERVISOR Registration 148430 Number C$ , 091511 Expiration 9/27/2009 Tr# 260014 _.Birthdate 06/08/1960 Type Ltd liability Corpor !r , Expires 06/08/2008 Tr.no: 91511 WAMPWORK LLC MARK HARDING C "..` MARK D HARDING 25 DEVON ST - 299 FALMOUTH RD, _: MASHPEE,MA 02649 Administrator MASHPEE, MA 02649 Commissioner ,t•M� TOWN OF BARN&ABLE 35915...... Permit No. ......:... ` BUILDING,DAEPARTMENT 1 ""'T 1 TOWN OFFICE BUILDING Cash ■Y� 6)0 v HYANNIS.MASS.02601 Bond .l1 CERTIFICATE OF USE AND OCCUPANCY Issued to Nic4ulas Building Address Lbt #57, 59 Josiahs Path West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE .00CUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETPS STATE BUILDING CODE. August 1A, 19 93 , ... ... ... .... , ...... ...... ....................I....................... Building Inspector Town of Barnstable *Permit#Z001 expires 6 months rom sss Regulatory Services Fee BAWM►BIA Thomas F.Geiler,Director ►39. Building Division a " 1-7 - o F Tom Perry,CBO, Building Commissioner vv 5 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY 088 00 4 oo Not Valid without Red X-Press Imprint • Map/parcel Number rr Property Address S 9 "ro S i s h S u Residential Value of Work �j S 0 D a Minimum fee of$25.06 for work under$6000.00 Owner's Name&Address Contractor's Name Ci o Z-1 '130'h S�, (� k Telephone Number 3 7 s Home Improvement Contractor License#(if applicable) l y9 y Cons ction Supervisor's License#(if applicable) S rY 5W Workman's Compensation Insuranceo� ��S PERMIT Check one: I' ❑ I ap a sole proprietor ❑ am the Homeowner DEC 1 2007 I have Worker's Compensation Insurance ,� TOWN ®F BARNSTA6LE Insurance Company Name "/ ix as r Workman's Comp.Policy# 6 01 2'7 3 t7 1 a`0 Copy of Insurance Compliance.Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re- ' e Replacement Windows/doors/sliders. U-Value , (maximum.44) 'Where required: Issuance of this permit does not-exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property OvGner must s grt\\� party Owner Letter of Permission. 1!. A copy. the a Impr9v ment Contractors License is r ��a fl� �l ``"=� - --• SIGNATURE: 80 :.I i 14 18 � 0 L401 rms:buildingpermitstexpress L:FoR�evise091307 "if. . .('� ��. .:i _ 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Ob l C1l. �( Address: P City/State/Zip: as PL Phone#: g' `4�o Ar e employer?Check the appropriate box: Type of project(required): 1. a L with employer 4. ❑ I am a general contractor and I �s have hired the sub-contractors 6 ❑ construction- employees New constructio employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working4or me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp.insurance.T required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;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. /^� 1A Insurance Company Name: /C>"L 0^( ✓� u ka/ Policy#or Self-ins.Lic.#: d a 'Z / o a Expiration Date: a S 6 8' Job Site Address: Stu 1 da,t�ef-jtlj� City/State/Zip: W CS sA 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 a a pai �tppenakes of pedury that the information provided above is true and correct Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i o Town of Barnstable s ,AR STABUE. : Regulatory Services ie39 �� Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L u GL, iy IV F 1'1—�'o(a�rf ,as Owner of the subject property hereby authorize �l6 ,t ► �o ��t ! kC to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of O er Date Print Name Q:Forms:buildingpermits/exp m Revise091307 Q:Forms:buildingpermits/express Revise091307 i /ae"Caomvaxan�a� a�✓�aaaacfivaelld + , Board of Building Regulations and Standards 1'•,•ry•-�,@�•. /lie TOomvnzoozusra�a�✓�aa�acfiucelta ; BOARD OF BUILDING REGULATIONS HOME IMPROVEMENT CONTRACTOR License: CONSTRUCTION SUPERVISOR Registrat on-.148430 Number CS'; 091511 Expiration 9/27/2009 Tr# 260014 i Birthdate 06/08/1960 Type Ltd liability Corpor } Expires: 06/08/2008 Tr.no: 91511 i WAMPWORK LLC' MARK HARDING Restricted 00 25 DEVON ST MARK D HARDING i 299 FALMOUTH RD o3, MASHPEE,MA 02649 Administrator MASHPEE, MA 02649 Commisslorier DEC-27-2007 THU 11 :44 AM FAX NO. 5089915461 P. 01 TAUG. 20, 2007 1.27PM ASSOCIATED BSURAN'CE NO. 5341--P. 5UE DATE 000/2007 THL4 CERTIFICATE l.S ISSUED AS A MA—MR OF MPORMATION ONLY AND R D l!4COUAty )>ip lesurmoc Inc CONFERS NO RIGHTS UPON THE CER [CATE HOLDER.THIS CERTIPMATF DOES NOT AI►IbND,li)C1�D OR ALTE THE COVERAGE AFFORDED 8Y THE 1 St POLICIES BELOW, Red",MA 02740 COMPANIES AFFORDING COVERAGE URFD I Wont LLC Devon Strcot COMpmy A A.I.M.Mutual IDsura Co LETTER We,MA 02W THIS$TO CERTiPY T}il►TTHfi OUC OF MIS 'LISTED SEW HAVE ISSUED TOT D NAMED ABOVE FORTNFs POLICY PE1U0D INDICATED,NOTWRI WIDINO ANY UmsmENT,TERM OR CONDTRON OF ANY CO CT OR OTHE[t DOCUMENT WtTA RJ3SPtiCT TO W"=TMS CERTIFICATE MAYBE ISSUED MAY PERTAIN,THE INSURANCE AFFORDED BY POUCMS DESCRUIRD,HEREW IS SUBJECT TO ALL THE TERMS BXCLUSIO S AND COND NS OF sg2j POUCIBS.LIMITS SHOWN MAY HAVgBM REDUCED OY PAID CLANS. co reUCYUmcws MUCV W114TW �drts vnc9vftwcx ro++4rx � DwTg(MwpcMl) o•nawmo'iM w.K.gia7e otalRau.uaatta*v r [�Cpr/oYICMLOtNY�wLLW6rtY it" a how.UMV �a,Mti 1Mo��OQ'tt� OOn1R�A1CY Q6WN�7��OTRIIYLTOR'd1e0T. 1ME 0!(AdorSd ' IArJo��+g1 mrm=mw=w wuurY Comm wt0 iD1O E A!{If A4Jf0 SDo Y rJav AIL Or►Ro avtD1 (Pro 1 •NeU "m Auras V r wng MADAM (Far M}M06W LIlY 21%7V M�IN7D f11�lY�ru!'f1f i aCL1Jw1dN�� u WJUAFQW OTIe3��Ye111de1a W�P�11 WO�II=COMPRIVSA-n0N AND A AY LIMITS awMaims LIArluw sL Ca AO ibm? 100,000 A ""v' as ® 6010�73012007 03/25/2007 03/25/2008 ZL 18wf� -�POL1C'Y L=MT 500.000 EL Vea EACH 100,000 COMMLNm VESUt1MON OF OCiRA7'IONS I2 LOCATIONS: O JFAA71'QM*n COVMW BY THE WORKOS'COMI'BMSAT70N POLICY. 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