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Home My WebLink About0187 KETTLEHOLE ROAD 18�7 kE r U.S. HowE R"b Fy� f i NO. 152 ` /3 ORA 0% "r'''"•-- _ s+. ..sue ,-..�+...r.�^� .�--�..e -- - -Uommonwealth ol:Massachusetts 5_Z.I—r c-t iP Sheet Metal Permit Map „Parcel.. Date: 2� ly Permit�"� �� 0" Estimated Job Cost: $ N,000 MAY 19 2014 Permit Fee: $ �• Plans Submitted: YES NO ✓ Plans Reviewed: YES NO TOWN OF BARNSTABLE -Business License# Applicant;License# 35}2 Business Information: Property Owner]Job Location Information: Name: R.S IRnbarlo l` rAX_&vnycr,\ Name:'Pe-k �arbwc�ro. Street: i� b6e.Dr. Street: 11h+ Kr_�,Nc %1g\e'R,\ City/Town: h�a& K M t\ City/Town: 16 Telephone: Telepho f+y- b23-N4+3 Photo`I.D. required/Copy of Photo:I.D. attached: YES NO _ Staff Initial i J-1./(unrestricted license J-2/M-2-restricted to dwellings 3-storie8 or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family ✓ Multi-family. Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq..ft. ✓ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC ✓ Metal Watershed.Roofing Kitchen.Exhaust System. Metal Chimney/Vents. .Air Balancing. Provide detailed description of work to be done:: \nsk•.1\ new 6V \j ov%& avLt ftr +wo new �WNL INSURANCE COVERAGE: l haVe a current jay insurance:policy or its equivalent which meets the requirements`of M.G:L Ch. Yes Q No El If;you have checked.Xr�%:indicate the type'of coverage.by checking the appropriate box below: A liability insurance policy Other type of indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER:;lam aware that the.licensee does not have the insurance coverage required by Chapter 112 of:the Massachusetts:General Laws,.and that my signature on.this permit application waives this requirement. Gheck:One'Only Owner-El Agent E Signature of Owner or.Ownees Agent By checking this box(];I hereby certify that all of the details and information I have submitted(or entered)regarding this application and true and accurate fo the best of.my knowledge.and that all sheet inetal'Work and installations performed under the perrnit issued.for Misapplication will be' in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. .Duct inspection required pnbrto;insulabon,installation:YES: NO ProgMs:Iinspectioins Date Comments flnai Iuspection Date Comments. Type of Licenser 3y CKaster r 0 Master-Restricted :ity/Town OJoumeyperson Signature of Licensee 'ermii# .OJoumeyperson-Restricted License Number. 35�2 =ee S: � Check at www.mass.rovldnl nspector,Signature of Permit Approval i Department oflndustrial Accidents Office j`iee 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 omniaation/lndividual):.At.3: sober-'tp Mr_c nwm►_.\ C-o �Addresst City/State/Zip: Phone* Are you an employer?Check the appropriate box: -Type of project(required):; 1. 1 am a employer with _ to 4. i am a general contractor and I employees(full and/or part-time).* have hired the stab-contractors 6. New construction 2.❑ Lam a'sole proprietor or partner- ship listed on the'attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity.ac employees and have workers' comp.ins co insura—sp.t. [No worke 9. ❑Binding addition IS insurance �) 5. We are a corporation and its 10.❑Electrical repairs or additions requir3.El I ain a homeowner doing all work officers have exercised their ME]Plumbing repairs or additions myself. [No workers'comp. right of exemption per IVIGL 12.0 Roof repairs insurance required.]t c.152,§1(4),and we have no - employees.[No workers' 13.[►6ffier__Ny comp,insurance required.] •Any applicant that checks box#i rmist also fill out the section below showing then workers'compensation policy information. t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. YContracmrs 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,mey Must pamde their worlorrrs'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:-r tit V)l..,��w Policy#or Self-ins.Lic.# QbW ECEC-43'+Wp Expiration Date: IcA Lt ly Job Site Address: I t'i 160 -1&0-b 21 City/State/Zip: Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Faihue.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 line of up to$250.00 a day againstthe violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the.pains-and penalties of penury that the information provided above is true and correct Signature:. Date: 251 N Phone k 1506- 34s4-5CA1 Offu ial use only. Do not write in this area,to be completed by city or townofficial City or Town: PermtUcense# .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#: ROBER-4 OP ID:SD TE CERTIFICATE OF LIABILITY INSURANCE F DA05/0=0D 14 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 WANED,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: Berry Insurance Agency PHONE FAX 31 Hayward Street A/C No Ent): A/C No Franklin,MA 02038 E-MAIL House Producer ADDRESS: INSURERS)AFFORDING COVERAGE NAIL g INSURER A:Safety Insurance Company J39454 INSURED AJ Roberto Mechanical Co LLC INSURER B:The Travelers Insurance Co. 19038 8 Shire Drive Suite 2B INSURER C:The Hartford 29424 Norfolk,MA 02056 INSURER D: 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 POLICY NUMBER MOM/OD LICYEFF MM/DD EXP LIMITSPOLICY LT GENERAL LIABILITY EACH OCCURRENCE $ 1DAMAGE TO RENTEIT_ ,000,E B X COMMERCIAL GENERAL LIABILITY 6803A128008 07/0212013 07/02/2014 PREMISES Ea occurrence $ 1,000,00 +— . oww. 6". MED-EXP"(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1 2,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea MINED SINGLE LIMITacciden $ 1,000,00 A I ANY AUTO 6213014 04127/2014 04F27/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED " — PROPERTY DAMAGE $ AUTOS PER ACCIDEN X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,00 B EXCESS UAB Id CLAIMS-MADE CUP7B023210 07/02/2013 07/02/2014 AGGREGATE $ 3,000,00 DED I X I RETENTION$ 5000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY ORY LIMITS ER Y/N C ANY PROPRIETORWARTNER/EXECUTIVE 08WECEG3766 10/04/2013 10/04/2014 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 H yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Operations Usual to HVAC CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD _ . r OOMMO H.OF M1 I I SETkS OtQf}FiV SHEET N� TI[ 'WORKERS tl, IS'SUESLTHE FOLLOWING I.PENSE - xW . {� A AI tTER` UNRESTRICTED 9 igM .fit "`Jj ROBERTU _4 401 Gj1`LMORE A 'g sr „� 2 u 2�28%15 1,67532s � � . -F' - s awi c•a«!6- ��e6 7/i 3�1 Sr�teTE-� i N of ' �I�SFW�E-fit SZy'Ytr�5• , ,O 4 Regulatory Services s BAMWIM M FLq 8 Thomas F.Geiier,Director s6"5 �o ED A BU Rd ing DflVIsfloim Tom Ferry,Building Commissioner 200 Main Street,Hyannis,MA 0260.1. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79076230 Pfoperty Owner First Complete and Sign This Section _ —if UsLngA Builder - I, �� ,as Owner of the subject property hereby.authorize IIAN71014Y A�96� to.act on my behalf, in all matters relative.to work authorized by this building permit. lY-7 (Address of Job) *Pool fences and alarms are-the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are:not to be utilized until all.final inspections are performed and accepted. • I Signature of Owner Signature of.Applicant Print.Name. Print Name Date Q:FORMS:OWNERPERMS$IONPOOLS `pFISE ip� Town of Barnstable , BARM A--%. E. Regulatory Services V MASS. E'u 39. Building Division F 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location /87 AA Gt2 Permit Number 2 Owner 2 Builder 69 �!¢tY�� — J �zB�l�iC E One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ��j �L=✓k Eu G U NiU C-r-T �L �� /E'G� Pt/G /AJ !N/A�-T Z Y11're /{� - BUG Gc1 G,-- �"c G C' U7 Please call: 508-862-403$for-r.0-�.sypeetion. Inspected by Date G//� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map (�`� A p icat�ion � Parcel �f� �'I Health Division Date Issued Conservation Division Application Fee � Planning Dept. Permit Fee I/" �6✓L': oZ0 Date Definitive Plan Approved by Planning Board / Historic - OKH Preservation/ Hyannis Project Street Address 197 K ETTL E HO LE 9b, . Village Owner�t �-�S�y/U� � 'DuR-� Address I F7 : 1.61bzz-- 9,29 . Telephone 52>9 P a- ' 3 ! 500 Permit Request �L G ��s/�- ��//�S "ZD 26-/49- Z�*A-IAC4C65 JBCF oNf A3' C ®f3 rl o L.Loc:,J1eJ4 O Square feet: 1 st floor: existing proposed D 2nd floor: existing;T321 proposed O Total new o3060 Zoning District Flood Plain Groundwater Overlay :Project Valuation ODD Construction Type RZ 31o0-fVW 60" Lot Size ACIA E Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Z FRS Historic House: ❑Yes �No On Old King's Highway: ❑Yes JgNo Basement Type: X Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) /17 Number of Baths: Full: existing o2 new / Half: existing / new Number of Bedrooms: .3 existing e)new Total Room Count (not including baths): existing 7 new 0 First Floor Room Count Z Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: 2(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:;6 existing ❑ new size _ Other o 0 z ch.�n o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , �+ ry w Commercial ❑Yes Jg."No If yes, site plan review# Current Use All--_3 1 flay Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �i9 �� Telephone Number LT0F' 3�)121_1113 Address X 7 US License# 7F>Aa TW L� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 01 1OWSM SIGNATURE DATE �- T— 7 h- FOR OFFICIAL USE ONLY APPLICATION# __DATE_ISSUED_ MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: � QU�I i ,N1J; tIt4 tr�JUPd�I�, ay . FRAME — . : y j Rf INSULATION=- t s FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING:— DATE CLOSED OUT ASSOCIATION.PLAN.NO. i �b Town of Barnstable Regulatory Services H" MASS. Thomas F. Geiler,Director 16.196 �� o�,► Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 598-790-6230 PLAN REVIEW # 2v/ ,Y ao ooZ Owner: Map/Parcel: Project Address/BTk,prrlb-i of F !� Builder: The following items were noted on reviewing: "6* E u e Cv�C- k C&-& 4 I,o�otrns �EAkA I1;-11=S �La -ra« Pam Vr 4% :F,pzr- P"wFT Reviewed by: . Date: ��d 6ZCf Q:Forms:Plnrvw • d The Consmopnuealth ofMassachusetts Deparknent ofT'idustrial Accidents Office of investigations 600 Washington&reet Boston,MA 0211I w F t'm m ass:go rld i s Workers' CompensationIusurance Affidavit:Builders/ContractorsMecfricianslPlumbers Applicant Information Please Print Lefibly Name aksmessldrganizationdndividaag: Address: l D 7 City/State/Zip , 111A © Phone 4: Are you an employer?Check the appropriate box: Type of project (r a. fire confractor and i ❑ 1.❑ I am a employer with 4 � I a � 6_ New oomstrirction employees(full and/or part-time)* havehiredthe 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 g_ ❑Demolition w for me in an capacity employees and have workers' orking y apa. ty. - 1 9_ ❑Building addition [No workers' comp.insurance comp-iasuiant req��] 5. ❑ We are a corporationand its 10_Q Electrical repairs or additions 3-,K I am a homeowner doing all work officers have exercised their I1-.❑Plumbing repairs or additions myself [No workers'comp- ring.ht.of e-sm lion per MGL 12.0 Roof repairs inntrance required.]F c-152, §1(4),and weha%mna employees-[No workers' 13,�Otirer comp-insurance required-1 *Any appUc=t that cheers boa W1 mast also till out the section below showing rhea warren'compensation policy infornmden_ I Homeowners who submit this affidavit indicstin g they are doing allwotic and then hire outside contractors==submit anew ai3sdsrit indicBtin stub tQmtractots that rbeck this boa mast sttached sa additional sheet showing the name of ftLe sub-hazy and state whether or not these emides have employees. If the subtontmdots hsse employees,they must provide their warke s'comp.policy number. lam an employer chat is prmadiirg it orkers'corrrpertsnrtion irrsurartce for my employes. Helots is Ste policy and f ob site information. Insurance Company Name: Polrry:9 or Self-ins.I.ic-:9-: 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 n 152 can lead to the imposition of t riminal penalties of a fine up to$1,500.00 andlor one-year imprisonment as well as civil penalties in the.form of a STOP STORK 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 Immutigations of the DIA for insurance coverage verfficatim I do hereby certi ender tha pajinn ad p/enn (ties .penury that the information prm ided above is huefand.correct Date: Phone# 01kial use only. Do not write in this area,to be completed by city or town ofJ4ciat City or Town: PeridtUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person. Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"_..every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificatc(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 retumed to the city or town that the application for the permit or license Is being requested,not the Depart rent 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 of the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be.sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submif one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves 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 CornmonwWtbL of Massachusetts Department of Indal Accidents Office of kwst gatiom 600 Washington Street Boston,MA 02111 Tel.#617-727-4M ext 406 or 1-977-MASWE Revised 4-24-07 Fax# 617-727-7749 w .mass-gov/dia 1 uw u vi y4-111 Regulatory Services , �1NE Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner BARNSTi IX % annis,MA 02601 NAM $ 260 Main Street, Hy ►�� www.town.barnstable.ma.us 'Fax: 508-790-6230 Office: 508-862-4038 0 HOMEOWNER LICENSE EXEMPTION ; ^ / p Please Print DATE: /a2-7 97/7.� village JOB LOCATION: street 1 7 number 1Vhj RA 15-0 "HOMEOWNER C)�7 ": work phone# home phone# name CURRENT MAILING ADDRESS: / S ,A fjM C state /"G zip code city/town of possess a license, rovided that the owner acts as supervisor. The current exemption for"homers".was extended not include owner-occupied dwellings of six units or less an oallow homeowners to engag E e an individual for hire who does ON OF HOMEOWNER s who owns a parcel of land on which he/she resides or intends use anreside,on m�es.there is, son who constructs,moreethan one Person() Official on a form family dwelling,attached or detached structures accessory to such use to the home in a two-year period shall not be considered a homeowner. for me wok erall sub itt d the buildingg ermit. (Section acceptable to the Building Official,that he/she shall be - 109.1.1) licable codes, ® ed"homeowner"assumes responsibility for compliance with the State Building Code and other app The undersign bylaws,rules and regulations. ' "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection The undersignedwith said procedures and requirements. proc es d req ' ments and tha he/she will comply Signature of Homeowner Approval of Building Official Code Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION i The Code states that: "Any homeowner performing w rk for f construction Supervn so permit );provided that if the homeowner from the provisions of this section(Section 109.1.1-Licensing o engages a person(s)for hire to do such work,that such Homeowner shall.act as supervisor." sors Section 2.15.) This lack of awareness often Man homeowners who:use this exemption are unaw tte t a they are assuming the responsibilities of a supervisor y. (see Appendix Q,Rules&Regulations for Licensing Construer Board results in serious problems,.particularly when the homeowner Supervisors The homeownte acting s Supervisor is proceed.against the unlicensed person as it would with a licensed ultimately responsible. onsibilities,many.communities require,as part of the To ensure that the homeowner is fully aware of his/her r sta n that the homeowner certify that he/she understands thendsand adopt such a form/certification on for use ins permit applicatiervis o , of this issue is a form currently used by several towns. You may care am your community. •. Q:\WPFILES\FORMS\building permit fbrms\EXPRESS.doc a. Revised 061313. :+�� oFTME' Town of Barnstable Regulatory Services e s639. Richard V.Scali,Interim Director �0 ► ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 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 (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 Narne Print Name Date ` Q:F0RMS:0WNERPERMISSI0NP00LS 10/13 . A TYC Guide to I-Vood Construction hi High Wind Areas:J10 111ph WindZofle Check Compliance 1.1 SCOPE 1.2 APPLICABILITY Number of Stories (a roof which exceeds 8 in.12 slope shall be considered a story) stories :9 2 stories 1.3 FRAMING CONNECTIONS 2.1 FOUNDATION 2.2 ANCHORAbE TO FOUNDATION"' 5/8'Anchor Bolts,imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only 3.1 FLOORS Maximum Floor Joist Setbacks � Supporting Lnodbeehng Walls:vSheanvoU.'............(Fig T)............. ...................................... __ft !�d Maximum Cantilevered Floor Joists Supporting LuadbnahngVVaU *xvSheonwaU-----.(Fig ............................................... ft :5d Floo!Bracing otEndwa�-----------------.(=�S)----------.------------ --_- � Floor She othingTypm .........................................................(per 7OOCMR Chapter 55)................................... Floor Sheathing Thickness ............:....................................(per TDOCMR Chapter 55)-._---. Floor Sheathing Fastening...................................................(Table 2).._7_d nails ad_ e-jn edge/ mfield � 4'1 WALLS ' � Wall Height � Loadbeahng walls......................................................... and Table 5)........................... __ft :51Cy � walls.................................................. and Table 5)...... ...................._�_ft.s 27 WallStud S ......................................................... and Table 5)................... in.!�24^uc WallStory Offsets ........................................................(Figs 7&8)............................................ ft !9d 4.2 E)aER|OR- ^ Wood Studs | Lnadboahngv�alls........................................................(Table 5)...............................2x_--'_--ft--_in. / Non-Loadbearing walls (Tabla5) 2x__ ft in. Gable End Wall Bracing' Full ........................ ----......(Fig /u)......................................................... ....... _--_ \0SP,�t�F�orLeng�-'__-.�:.---.----.-..��g11)_--------.----.- ��VW3 �Gypsum CeihngLength (if VVSP not used)....:...............(Fig 11)............................................___ft�O.SVV � and 2x4 Continuous Lateral 8rad»@G ft.o.c. .. (Fig 11)........................................................ or 1 x 3 ceiling fuming strips @ 16'spacing min.with 2 x 4 blocking @ 4 fL spacing in end joist or truss bays Double Top Plate � Splice Length ........................................ ..............ffiQ13 and Table G)....................................___ft � Splice Connection(no uf1Gd common nails)..............(Table G)........................................................._�_ AWC Guide to Wood Construction hi Hig1r 14"Md Areas: 110 rnph !-Vind Zolle Massachusetts Checklist for Compliance (7s0 CAI R530f.2.1.T)' 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) HeaderSpans ........................................................(Table 9)..................................._ft_in.5 11' Sill Plate Spans ..... able 9 Full Height Studs (no. of studs)....................................(Table 9)......................................----............. Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans....................................... .....................(Table 9).................................. ft_in.5 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 Simultaneously4 Minimum Building Dimension, W Nominal Height of Tallest Openingz ..............................................................................._5 6`8' 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 2........................................................................._5 6'8' SheathingType..............................................(note 4)..................................................... Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................ in. FeldNail'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) Roof Overhang ...................................................(Figure 19) .............. ft 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).............................................U= plf Lateral.............................................(T'able 12).............................................L= plf Shear............................:..................(Table 12)............................................S= plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= pff Gable Rake Outlooker..........................................(Figure 20) ............. ft_<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............................................(fable 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. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 f.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-gr6de. AI.VC Gidde to Wood Construction in High I4,7nd Areas: 110 nzph IVind Zone Massachusetts Checklist for Compliance (780 CNIR s301-2.1:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16" and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte. 28 or north of Rte. 6) b)vertical addition—not required unless there is extensive renovation to the first floor c)replacement windows—needs energy conservation compliance only(chap 93) 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. -WHEN THIS EDGE RESTS ON FRAMING USESd NAILS AT 6"ot --- • u II 11 1, 11 C)t�A I L' iz1'� FRAMING MEMBERSW : i i EDGE9frERMEMATE ,I �k�a u u �411SJ1 --- ----- -- --- -------- DOUOLEEDGE r "------- 1`' STAGGERED 3`MMJ NAIL SPAGRJG — _ NAIL PATTERN PANEL PANEL_ 1 1. � PANe_EDGE L'1 DOUHLE NAIL EDGE sPAGYJG DETAL See Detail on Next Page Vertical and Horizontal Nailing Detail `' for Panel Attachment Vertical and Horizontal Nailing for Panel Attachment t ` �nl5utsy-7� WBTWALL RI —WALL;- _ - - tL N R I J11TEO 1S . u I __-61d b � rsrlcSN* n1571}t(:TPe€+06U . ----- ® O o. -G46rn1_Er3 Cau3i>TDP_ - -�0 O - --- i . �.�PURNI�f t_jJs�(L P�AIIR- EPR[:2CE[LiN6Al CR.P.�� ----- _7_P��ST1tiN Gf/AUS_CBy..- _ _ - 1 �-f Lill �ARDW�i£ElhT��- ` .. fP 1 - - - - - v�J _M _ ` "I341TS• v0 REfRI�: a� __ Ta -J�NLL sit "1S�Uknitsh s1STgG4ukQin� _TNsu rr5 WIT7-/ 23 nif lh�a1 rum RM 27 BLU�SOAlLA t I � -------' �IMc_o_�±TCEJ�� VAN - $DPPD MRTp �L! W_ Al up - _. SULhTE_A1,L_I[1Rli6 wI.(LSt_W1 �. n7� I1M i grit � . 3_> EL �A�Rv_--. :_._-�. ------RNM 0I� SIN(9KE DT T R REVIEWED . s P,�inrr �t�kr ,ui 1 _�Jir►i_liirsn�wes�u� f1159rt26 0_ - - �M- IL ...EPT. I -. DATE rl; N`w_CLos a56A5n I / .o I'f BARN STABLE BU �06 'a._.F�!^�7_ALt_ lukus�'IJrJG rr To_I �Da�rJ ; 1 la7�N EkISI/NG I 'If,5T FLMRNOTES ------ --- - i - -------- I U - - - - - --• .• p FIRS DEPART 1 NT . . I DATE . 1 1 EhJ_RIR Ajf SNsui{npN�TEX7FP![02Lq - - - - IRED F0?PERMFTT/NG / -- - 7 LBIJM',_ 6HELvrNG r - K �'LoAP�#%lll ALL tuR[tS �Er�riJ -=_-�E_NEbJ HVLCouJ,GJ2��:Lba25,NR20uNit�7R[f_!�FTssrlli � . OTN SIGNATURES ARE R .. -:.__.. _.._...._. i I �• '' L NAT�#%-- � 1 .5• TRH CEJUnl6 �r4_Aa//J PCi-VHnIS .. I �� I io.�isinr.�.ReCo:V.o/T7JNE?> aAsrr fiusr.(.:'Ci1P�up3 - d-b" - 'I "T. -S�n/s73�ct. n/�[ � Pr+n/EL Pi^•�,a�o27o D�nun/G S7VCCa!oE'�72rn.�. I� _ : ,�_�. __ n/O //fi�'S'Ri�'n�Alii"e_.SNiJ��t�[n•,uJS .. '� , -- . I I ��TRLI. I -- - - - I 7T �r1<Tv[L CLoin1G_Sa9e0�bR i o I J FiN-NIS FI oa2SFA! -� ti� [�rr[�s. - - -� I- 1- /.ot t ByJain/ A �n✓u[ y!r f7 ! w � DE21fZLIS.H YNWRLL A2t�ND srATR. I r1 I _/_3_ o4-N?"3iA�on[D Or7i -one=u�ae Ry :�_�NFi Looms FRAMifJ�57 r7�� I I 2Et.r0..)WGROAtL �.._.FIRNY�HrtnIO�NsrRC�PL I I 1. r ME PR Q7Ch_1��2 CLOSET i l�ff1C�1A1W1�13\ - .._..._�TF�pwM..r4ND.gEmeooy �. N , 'r 3/j�aMMKA _ a F" _.. ... - �� . \ I r�•---3 G.��r_��gu 02 wA.us �._ _-.FIND✓f/bZViN6 riboD \ '� /5�=3"' -_ NsT3�L-� n1G IS.RE�w Fozu/Aitilscca4T .._ .. ---_ 7-Pk/nlT S STT?!til"l�cZ CE1[1uc5_ I` �0.vas�y \ - _�i/,9i[� L4�o25�T�✓�! '_T L S_: ivv[s<f tJN U4/7y PnlO e..a 1: UNTe� L0.9Z,��ls7�M -'— MAnFf;IXrS77n[4- GF Off- -` - o„ OR1Z'NsHin[GL�, - �l, RN�S/�}�1'i15�IJ2fi _ - - as r c G/7�k1n16_. in/ REP-iA-«[.(I��e��/C�- RE) T� 9F/�?Z� _ iiJ PaT E'MOVEVANI7'�-' rt/5 GL_. _�YXf/IRIL '. Fj� g/GCE3 R PoA� /D:_ <JR/VlT/fI/Cv�9tL TL .SBdJ��f:LJ /CLr :. Uro x _lcg. Z I :6 T ON It r T -) �.--T_Ili � �lo FI R ST FLOOR FLAN' -- r /40K<aZa �yZLCXIld�1`sOXE . HEATING SYSTEM - .. .. ,. Gas boiler Burnham/Well McLain or equal - . ... .. Indirect hot water heater Amtrol or equal Slant fin base board 2 heat zones /H611114ain/tbwS .. . - -- - - • i zone for hot water heater 2 thermostats Gas piping WA/ER '( Zone piping _ .. Flow valves,expansion tank pwip� -� � � • � �- � - � , Circulators for each zone and water heater : Dryer vent ductwork ; .: .. .. Bathroom exhaust ductwork .. .- All permits Alternate#1 Heat for new rooms/2nd floor Alternate 93 Alternate HVAC SystemUlm .: HeatlACcembined FBI= . ... Design Build :_ .. _ .. •:' . PLUMBING .. ... -. .. New laundry sink j Reset existing toilet in laundry room - Washer water and drain connection _ . . Kitchen .. ' Sink with disposal .. . . Dishwasher - Gas connection to stove Water to fridge First floor bathroom . . - . Rough to all foctures - Tub and shower valve . . ' New toilet New sink and faucet i . Second floor bathroom New tub w/fiberglas surround - - Tub and shower valve .. ' .. New toilet ... - . . New sink and faucet '' � '. � � �� _ _--_ _ _ t�4E, Altemate#1 New bathroom 2nd floor --- ------ ' : Owner to furnish bathroom sinks,kitchen sink,faucets,shower/tub valves .. : ---- ----- — Url�xi'kVfITED: ELECTRICAL .. New 200 AMP main panel New sub panel for emergency generator '. ' New circuits throughout the house - - J�-E'MO s-$EELA.C6QZ'ZiiilL ' Install light fixtures furnished by Owners _-VnlpgL Cable/phone/data wiring Circuits for boiler,water heater,water pump,irrigation.appliances,exhaust duct work ALTERNATE#t New rooms second floor : .. ALTERNATE#2 New natural gas emergency generator ..Nt=1tJ_�SHiN(,+5tlrl�rLF3 :..- ' ALTERNATE#3 Alternate HVAC systems Heat/AC combined .. Design build _, . .. .. .. AIR CONDITIONING .,. OJE-SXTER104t,5fot,�HZ .. .'. Replace AC tan in attic 2nd floor - - Replace AC compressor for 2nd floor at rear of house .�.�. 5 CS?'�!�Q?oN Clean duct work, replace as required � � � � � � � �� L Alternate#1 AC for new rooms 2nd floorAltemate#3 Alternate HVAC system Heat AC combinedRemove hydronic heat system complete and existing AC systemDesign build --------- ---- -- :alaeE'b aneE ' �wra�n F:25"T _ UP t•✓v — JnrJ _�/P- -- . _ uvt 2A6o,.-mst;:>!.Bsc�Cf- STRAfPW4 AS P84-tRE'O : — JE;J_ 77 .(n15UiA710N_77 BEP�d. _3Q2L F.. Y(o Ft R JotsT _ _ :.,: ...... ... - ate • REN I �R �t�.e aX.SrJB-FtGbR/n/C� . TIO OVA N SMOKE D SE EN' / g7 KETT�t' tiL� b�D I QINnI 0 ) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 1<2TT L FH oL Village URSi 15 IKIVS zfi 6 L e-- Owner Pf o RA Address Telephone 7 ?R3' g q 7 3 Permit Request UIJ-r- Sf/ee-7- /R�Lc-k- ! N ,G9- A1d/L,t 4-,<61.4 4>u- 7-D fe Fe IP-e- Al o c7-1,4 2 e 12-G11i o t/44 �511-*LL.Aln Ua-I O?t- T�y /'S �le�iio Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $3-5-00 - Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 0 4 0 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King$1 ighway"T;❑Yes ❑ No -. o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq. -v s cn Number of Baths: Full: existing new Half: existing nw� Number of Bedrooms: existing _new 0 rn 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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t Ck Ph" t4 u 2 Telephone Number _ �� / ' Z� �- .�� 7;7 Address l L EA,K b 1Z - License # CS F A 0 S/ 7 d�F lt114- 0 Z -7v Home Improvement Contractor# NO Y a 7 ,E �� ° 'Z-TO A L N 0 y,4110D .C0AV Worker's Compensation # �©� `f S- .� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C(jNS7-1ZJ-ec770A) CcM P57-e� &W S 7-e SIGNATURE- DATE �" 7 q - 13 FOR OFFICIAL USE ONLY APPLICATION# _ `r - DATE ISSUED MAP/PARCEL NO. ' ADDRESS 1 VILLAGE OWNERlow " DATE OF INSPECTION: AF.O-UNDATIONtL)A�iiUVY!gDAF MINDPR[tl FRAME FIREPLACE ELECTRICAL: ROUGH FINAL ,f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. ?'�i1 e Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 +600 Washington Street Boston,MA 02111 wnmmass govIdia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectrtcianvT umbers Applicant Infarmation Please Print Legibly Name Busineffiro�a ):tionnn&vidual /n�iza It'l(,(LTI S L �2S('y/ti�l7 ter✓ Address: l" 'U' 6 a X City/Stat&Zip- H 41t,� re-e D , 6 `(9 phi �-�8 -ctZ Z Are you an employer?Check the appropriate boa: Type of project(required): 1.&—I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-ime).* have hired the sub-contractors 6- ❑New oomstn�ction 2.❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-oontractors have 8. RDemolition working for me in c employees and have workers' �'capacity.i .�`[No workers'comp.inswanre comp-��nce- I 9. []Building addition required_] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'camp. right of exemption per MGL 12.❑Roof repairs inm raneerequired,]I c. 152, §1(4),and we.have no employees.[No workers' 13.0 Other comp.insurance required-] •Airy applicaw that checks boa#1 rims'also fill our the section below showing their wotkes'compensation policy informstiati- I Homeowners who submit this affu1mv indicating they are doing all w o*and then hire outside contracmrs mn submit a am of dam indicating each_ tContractors that check this boot must attached an additionsl sheet showing the name of the sulb-ea onwton and stole whether or not those ernities have employees. If the sub-contractors have employees,they must:pmvide their workers'comp.policy number. I am an employer that is providing",orkers'compensafion insurance for my enrplayees. Below is the pdiey and job site information.Insurance Company Name: I � V co � G a n c /�� I- - Policy#or Self-ins.Lice.#: 1,4 Ce—Q D 3 D 3 17 Expiration Date: Job Site Address: / a 7 �k cr r Le W a Le City/Stawzip: W c 8 h 6t ) S%A le A-6q 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 NIGL 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 rider thepain andpenalties ofperjury that the information provided above is hue and correct Si e: Date: _2 Phone#: �z Official use only. Do not write in this area,to be completed by city or to"official City or Town: PermitUcense# 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#: 6 Client#:34309 MULTISTA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY() 9/2412013 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(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the'terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Starkweather Shepley PHONE Carla SBroka PO Box 549 FAX (A/C,No Ext:401 435-3600 IC,No): 401 431-9648 E-MAIL csaroka starshe com Providence,RI 02901-0549 ADDRESS: P• INSURER(S)AFFORDING COVERAGE NAIC# 401 435-3600 INSURER A:American Safety Insurance INSURED INSURER B:Beacon Mutual Ins Co 24017 Multi-State Restoration Inc INSURER c:Tower Group North Providence,RI 02904 Charles Street INSURER D:Hartford Ins Group 19682 Nort 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY� MM/DDYNYYY LIMITS A GENERAL LIABILITY ENV0307221302 1/01/2013 01/01/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $50 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY PRO- JECT LOC $ D AUTOMOBILE LIABILITY 02UENOT4762 1/01/2013 01/01/201 COMB NGLELIMIT Ea accidentdent) $1,000,000 D X ANY AUTO 02MCPHX6227 1/01/2013 01/01/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PROP X rive Oth Car $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$. $ B WORKERS COMPENSATION SO845 RI WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N 12/01/2012 12/011201 X ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $SOD OOO OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) C-WCCO030317 Eff Date:07/16/2013 Exp Date:07/16/2014 WC Each Accident Limit:$500,000 WC Policy Limit: $500,000 WC Each Employee Limit:$500,000 Job site: 187 Kettlehole Road,West Barnstable,MA 02668 CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S496349/M487468 JW MULTI-STATE RESTORATION, INC. i FIRE* FLOOD*WIND * SMOKE*HURRICANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT pj:'M BA A OADOM ,herein referred to as "Customer",authorizes MULTI-STATE RESTORATION,INC.,herein referred to as "MULTI-STATE",to perform any and alnecess�ai �an g and construction services on Customers'property at: / F l (�(/Ea "zjjgiQ,�l� LIE Telephone: 7�� i23'��c� and with respect to items that need to be cleaned at a remote location,to remove and clean such items as � necessary./ / Customer authorizes " 5 �",�" Insurance Company,herein referred to as "Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers'name,and to deposit Insurance Company checks or drafts for MULTI-STATE services. Customer agrees to pay Customers'deductible in the amount of$ that applies to this claim. If the loss is not covered by insurance,Customer agr e%e to am unt to MULTI-STATE upon receipt of the invoice. Signature of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Comp y. Insurance Company Name ce // ! ?f Policy Number CLA1,14 0��. Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. Additional remarks: — I have re ocument completely derstand and agree to same. � z3 i3 Signature Da Printed Name P.O. BOX 2210•MASHPEE, MA 02649.866-921-9111 •FAX 774-238-4422 ! Office of Consumer Affairs&Buiness Regulation,. License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration.date. If found return to: • .Office of Consumer Affairs and Business Regulation Registration140427 i Supplerro:( 10 Park Plaza-Suite 5170 Expiratio i,:1g-.15.l..2013 Boston,MA 02116 MULTI-STATE RE'$TO: l IONItf�.CAPE COD 4 ; l+ ip :;RICHARD LAURIA�FF 2210'. //f% d�-� P. 0.Box >.,, a/•i I M �8;: MASP,HEE,MA 02649�_; ,�' Undersecretar?+• i - Not VA-lid withou signature i - .0 Massachusetts -Department of Public Safety., Board of Building Regulations and Standards Construction Supervisor 1 & 2 Famih. License: CSFA-051184 RICHARD D LAUJtIA 1 LEAH DR Rockland MA 02. 70 Expiration / Commissioner 04/01/2015 R� „ 40 5'r , 15 2s NO BIAICI /fir roe Wole r 8 E �Ie1 h Z cI3S 1101 J Lr�u D Ivi 132 6 e� �`t CC lT� ZN J l5_3x / 37 0�7./k� Le MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108.1904 (617)723.3800 Ma Only(800)392-6108.FAX(800)851-8424 7/24/2013 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch,139,Sec.3B BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 � w Re: Insured: PETER AND LYNN BARBADORA Property Address: 187 KETTLE HOLE ROAD,WEST BARNSTABLE, MA 02668 ' r N Policy Number: 1148825 a Type Loss: Fire(including Fire caused by Lightning cn Date of Loss: 07/22/2013 w Claim Number: 316012 m Claim has been made involving loss,damage or destruction of the above captioned propert,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured,location, policy number,date of loss and claim or file number. MPIUA Claims Division WA00021 / L�5� L� I i .� • o t —�. Town of Barnstable BARNSTABLE.q'• Regulatory Services j 9 MASS. 0 t639 Building Division prEO MPS a r 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Ins ection ��— Loca£Io g7 �'1e��Z�= �v+C7 t _ _P Number Owner Builder One notice to remain on job site, one notice on file in Building Department. . The following items need correcting: C) Tr gA, �L s . 4d7-f-f-- Jr 0Cs E)=7 toA-( - G t � Please call: 508-862 AM for re-ins ection. t i Inspected by Date FD- 17/ r i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel A lication # a 0 Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee (CJ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Z?7 KE7'TL.-E l QLE Rb Village Owner � �r LVA#V OwzZMD_Address /►� l Telephone 0-29' C -7S 74 W Permit Request EJL4 DZA&AZ& R,4nQ/%1 _•� ' � Ce Square feet: 1 st floor: existing /A0 proposed 1,24 0 2nd floor: existing proposed 835v_� Total new 'i Zoning District Flood Plain r6�k# Groundwater Overlay Project Valuatio / DO Construction Type310 6q19fL Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 18':" Two Family ❑ Multi-Family (# units) 1 . -Age of Existing Structure a Historic House: ❑Yes _WNo On Old King's Highway: ❑Yes �6ZNo f Basement Type: N(Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) d Basement Unfinished Area (sq.ft) /oZ6 0 Number of Baths: Full: existing_ new Half: existing / new o Number of Bedrooms: _ existing Onew i Total Room Count (not including baths): existing new First Floor Room Count - Heat Type andFuel: eWGas ❑ 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 _ Others f,,r:' C ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # -n Current Use Proposed Use —� 03 � M w - -APPLICANT INFORMATION. , (BUILDER OR HOMEOWNER) l r Name pE=� 8/6M.'t,0044 Telephone Number Address �✓'� License # Home Improvement Contractor# Worker's Compensation # L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t ii SIGNATURE DATE �l 1 y. FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED s MAP/PARCEL NO. ADDRESS VILLAGE OWNER' f 7 DATE OF INSPECTION: ;r < FOUNDATION `x FRAME �/P/K r• INSULATION c: FIREPLACE ELECTRICAL: ROUGH FINAL <zt PLUMBING: ROUGH FINAL >' GAS: ROUGH FINAL z FINAL BUILDING DATE CLOSED,OUT f ASSOCIATION PLAN i i The Commonwealth of Massachusetts . Department of 1ndus&W Accidents t j Office of Investigations i� 600 Washington Street \�;! Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianstTlumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Address: Ci /State/Zi tS' P: ZN_4176 1_S�3 `Phone#:- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors �,/ 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 ?• LJ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its quired.] officers have exercised their 10.❑ Electrical repairs or additions 3.W I am a homeowner doing all work 'right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required] t. employees. [No workers' comp. insurance required.] 13.❑ Other *Arty applicant that checks box ll I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ace 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 their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for My employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under pains and penalties of perjury that the information provided above is true and correct Si ature:' Date: l 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: i Information and Instructions Y_ 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 employrr is.defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has uotprodaced 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 wotic 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•t, 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 permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city orw ton)."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 hlce to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents' Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-977,MASSAFE Revised 5-26-05 Fax# 617-727-7749 WWW.Mas&.gov/dia i ;y THE Town of Barnstatda Regulatory Services Thomas F. Geiler, Director a`ASS Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.t6wn.barnstable.ma.us Office: 509-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION 7/6bPlease Print DATE: /�} �� / 7 ��J /� JOB LOCATION: ` z5 z K_ l 1 [. 0 1.� 1 W �� /Q number street �/� street ��^,q/f�� village �} .•HOMEOWNER":At�.Jm gx�&""/ 56g &1S V—f�.l� .�69`75-0� name home phone# work phone# CURRENT MAILING ADDRESS: & RAO,,E, 1l A city/Wwn Jstate zip code The current exemption for"bomeowners"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 withrsaid procedures and , requir 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 EXEMPTTON The Code states that "Any hbrimcowncr perfnrming work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Liecnsing-of construction Supervisors);provided that if the homeowner engages a persoo(s)for hire to do such work,thaa such Homeowner shall act as supervisor." Many homeowners who use this exemption-am unaware that they arc assuming the responsibilities of a supervisor(sec Appendix Q, Rul&s&Regulations for Licensing Construction Supervisors,Section 2-15) This lack ofawarcncu oft=results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board eannol proceed against the unlicensed persoo 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 ecrtification for use in your community. Q:forrtns:homccxcmpt r 1HE r, Barnstable Old Kings Highway Historic District Committee BYO,' .A,.,BI ; 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 1(A&4 a �r bJq.'�0b APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made, with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition ® Alteration 2. Type of Building: ® House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof ❑ color/material change, of trim, siding, window, door 4. Sign : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 740/10// NOTE Ali applications must be signed by the currennttt owner Owner(print): �� AIAI q$4544::�,e� Telephone#: ,Q Address of Proposed Work: IT 7 ?T/ J,�d/� A Village&W 90 Lt1'Map Lot# O Mailing Address(if differe Owner's Signature Description of Proposed Work: Give particulars of work to be done: W U)[(-L lZ��ic,tl� �v✓ - �� E 4"'n "y 1'&/_ o�; a6�w A1G 41146 Gp�1/L.cJL% % ��'�f�l� �iO/�lE 7Z> 0//( 14A;;; Agent or Contractor(print): Telephone#: '6��5 Address: Contractor/Agent' signature: For committee use only. This Certificate is hereb APP VED/DENIED DateAll Members signatures r%EcENED JUL 2 1 2011 _ TOWN OF BARNSTABL- HISTORIC PRES`RVATION C AP P RO AUG, 14 2011 Old King's Highway Committee Q:\Boards and Commissions\OLd Kings Highway\OKH Applications\OKH DRAFT 2011 Cert Appropriateness DRAFT.doc 1 i CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 Copies Foundation Type: (Max. 12"exposed)(material-brick/cement, other) CO IV e'A'V-r� Siding Type: Clapboard_ shingle X' other Material: red cedar white cedar _ other Color: Chimney Material: 234/Cac. color:: Roof Material: (make&style) --�f Color: f1'� Roof Pitch(s): (7/12 minimum) (specify on plans for new buildings, major additions) Window and door trim material: wood V"- other material, specify Size of cornerboards /.►Y 5r size of casings(1 X 4 min.) color AeZ Rakes Ist member 2°d member /'.l' 3 Depth of overhang Window: (make/model)31&-95c0 material WD©4> color Cq AaA Ao fit' 1 2 (Provide window schedule on plan for new buildings, major additions) /U*1244�- Siwwly --iWazlol Window grills(please check all that apply_: true divided lights_ exterior glued grills_ grills between glass_removable interiors None Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: Deck material: wood other material, specify Color: Skylight, type/make/model/: material 7Aolor: Size: Sign size: Type/Materials: ^o�Bay ,,,"m Colo Q Q�1 - d K%ng'S 'g e p1d Commute Fence Type(max 6' ) Style material: Color: _AUG 0 2011 Retaining wall: Materi Town of Barnstable 2011 Old Kin g's ig way 2 � Lighting, freestanding JUL on building illuminating sign Committee OTHER INFORMATION YQ\NN OF$gcrcSU T10N THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name Q:\Boards and Commissions\Old Kings Highway\OKH Applications\OKH DRAFT 2011 Cert Appropriateness DRAFT.doc 2 I BOSTON Chart of Stock Sizes Layout LOW"E"INSULATING GLASS WINDOWS �® • r • �V 3'-6'/e" T-10'/2" 4'-6'/2" 5'-2'/2" T-10'/2" 3'-35/8" T-8' 4'-4" 5'-0! 5'-8' 353/4' 393/4" 473/4• 553/4• 633/4' 0 pPCS p5 *p3 Illustrations not to scale. v, ; 1 -� Windows shown with optional Wood 3'-8-x3'-1• 4'-4'x3*-1' Grille patterns. (16 Light (20 Light r m 0I.4T( Q ILI 19in CDj _' 3.8 x 3.9 4'-4'x 3'-9- 5%0'x 3'-9' S•8 x 3'-9- (16 Light) (20 Light) (24 Light) (32 Light) a ;�S o`J Mho - - ©, m m i m ; 6N o� " u t 1 Q e 1�=J L 1 �I �l _Il 1 a�1070 L��i (�d 3'-3 5/8'x 4*-1' 3'-8'x 4'-1' 4'-4'x 4%1' 5'-0-x 4'•1- 5'-8'x 4'-1' (16 Light) (16 Light) (20 Light) (24 Light) =�32�q © t- o _ m �m �a LJ 3'-3 5/8"x 4'-5' 3'-8'x 4'-5" 4'-4'z 4'-5' 5'-0'x 4'•5' 5'-8'x 4'-S' (16 Light) (16 Light) (20 Light) (2'4 Light) �,Q Ug_hlf;_.s *Glass sizes are approximate. 3'-8'x 4'-9' 4'-4'x 4'-9' 5'-0"x 4'-9' 5'-8'x 4'-9' Basic Unit Features: 06Light) (20 Light) (24Light) (32Light) •Frame- 41/4'Jamb,Treated and Primed.Composite Blind Stop. OPTIONAL CASING &OTHER OPTIONS •Sill- Composite Sill and Nosing. -PAGE BI-14(last page of this section) •Casing- Treated and Primed;Brickmould standard. •Sash- Treated,Primed Exterior,Clear Pine Interior. 13/e"Thick,Glazed with Low"E"Insulating Glass Set-up Unit Options Basic Low'"E" ADD for :RERLACEMENT Insulating Primed ADD 'ADD Low'E Unit Description Picture Unit Flat Casing 6-9116" Picture • D x si l'aling�Glass: `:XOpikement (Sash Opening) w/Brickmould Ph."x 31/: Ext.Jambs Wood Grille No Casing $ash,Only Q 3'-3118"x 4'-l" $528.00 $7.00 $44.00 $71.00 -$15.00 $338:00 © 3'-3%"x 4'-5" 547.00 7.00 44.00 72.00 -16.00 354:00 NOliVA83S3ad 01»OlSIH © 3'-8" x 3'-1" 525.00 9.00 69.00 67.00 -24.00 308.06 318d1SN�1Ff8 J0 NMOl 3'-8" x 3'-9" 561.00 12.00 ' 69.00 70.00 -25.00 336:00 © T-13" x 4'-1" 580.00 12.00 69.00 72.00 -26.00 354.00 Q T-8" x 4'•5" 598.00 12.00 69.00 73.00 -27.00 369.00 tioz i z inr Elf4'-4" x3' 555.00 19.00 69.00 78.00 -24.00 33800 0 4'-4" x 3'-9" 610.00 12.00 69.00 81.00 -26.00 369t00 03AI30`38 4'-4" x 4'-1" 628.00 12.00 69.00 84.00 -27.00 399,00 m 4'-4" x 4'-5" 628.00 12.00 69.00 84.00 -27.00 399;00 ® 4'-4" x 4'-9" 647.00 12.00 69.00 86.00 -28.00 415.00 ® 5'-0" x 3'-9" 622.00 12.00 69.00 94.00 -25.00 399:00 F-0" x 4'•1" 641.00 12.00 69.00 96.00 -26.00 415:00. ® 5'-0" x 4'-5" 659.00 12.00 69.00 98.00 -27.00 430.00 m 5'-0" x 4'-9" 677.00 12.00 69.00 100.00 -28.00 445.00 m 5-8" x 3'-9" 661.00 12.00 69.00 122.00 -25.00 436.00 m. F-B" x 4'-1" 679.00 12.00 69.00 124.00 -26.00 445.00 5'-8" x 4'-5" 697.00 12.00 69.00 126.00 -27.00 460:00 m 5'-8" x 4'-9" 730.00 12.00 69.00 131.00 -28.00 490.00 NOTES: Not Applied. 0 33/""Sill horns will be used unless otherwise specified. BI-10 Brockway-Smith Company AUGUST 2009 BOSTON LAYOUT Set-up Double,Hung Wood Windows Opening Ed EIH goo QtNleQf enter Sash combinations available. Contact your BROSCO Dealer for more information. o o 0 �_ ~~-_- -- Cc Lij E UJ Rough ul r° LL -� 0 Z Cr y 16 Light 16 Light 20 Light 24 Light | °Gkmx sizes are approximate. Hsxu PICTURE Picture window glass thickness iu��. + 4M6' HEAD STOP HEAD 41/,66 TOP Picture Window Unit Dimensions (with flankers) RAIL Width Height ' SILL oormm | Brickmould Casing = Rough Opening plus 11/4" 5/811 RAIL Cape Cod Casing = Rough Opening plus 61/8" T/8" SILL | Uhi[CVnqenaibhs, 'Other RoV.gh Openings. � and Unit Ooti �hg can -,-- Detail showing position of this BOST{}N Double-Hung Section. 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I ` t F '� Y �A}-r'�' tort, �{6!, � E:®5tao+''pp nr FA44�'��SI:�^.� ifi J 9 to � .. �S t 1 .y 1;.,+ , :L r3•# _, ,� �,ri+_'y� A a ,, Itlua ¢n'avt..•,,. w o sg�''•' T. LtM'Sut yy ' A ! Fdd�{r{l1 i ,F � I�'!a %•(11 d` ? ti r• � "L i ��rn{F shSz'i I �� 'tom-17� T �r �'�� . ;. ro `SY� t. �r I�: 1{gf,,5�!'�y;,1..�} E. �, -r,�, c•3 a' , ,a:,l.:�fr•'�. mall i .; r ,, t : . �114E r Town of Barnstable *Permit#rr Expires Ohoit is from issue date °^ Regulatory Services Fee S PERMIT Thomas F.Geiler,Director lE0 hAP� zG2 1'-Building Division OWN,OF BARNST om Perry, CBO, Building Commissioner O e 200 Main Street,Hyannis,MA 02601 X ' , wv w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Prope .Address Residential Value of Work" g Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address tu, l/I�� t U✓ $> Awz Contractor's Name 0�7 to S Q Telephone Number 502 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) r man's Compensation Insurance Chec e: r am a sole proprietor. - ❑ I am the Homeowner ❑ I have Worker's Compensation I/n'surance Insurance Company Name�rt V (� V 5 r Workman's Comp.Policy# 'j e�M A " Z Y gel02-4 Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box). O-Ke---roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof.(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/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 Owner must sign Property Owner Letter of Permission. A-cop of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXP SS.doc Revised 100608 iJ C ` '� ARLES - COR'E'Y ' . H, - 0 QA 'Is b r Roof-r i R *-)for TOTAL INVESTMENT with New Ridge Venting ------------------ $ 9,999.00 Supply and Install SMART SOFFIT VENT SYSTEM on the Main House and Kitchen Eaves. ftMftt-m7T7e—nt-Mm- TOTAL, INVESTMENT with New Ridge and Soffit:Vyenting --- $ �10,750.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 60.00 per Hour PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the. Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLES COBEY CHARL,ES COREY Warranties the Shingles and Labor for 10 years. CERTAINT'EE" D Warranties the shingles and labor 100% for the First 10 Years and the Shingles for 30 YEARS if the shingles becomes defective. CERTAINTEEII Warrants the Shingles up to a CATEGORY II HURRICANE-110 MPH WIND WARRANTY . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. This Proposal May Be Withdrawn By Us If Not Accepted & Deposited Received Within,Thirty Days Or Before The Next Price Increase In Materials CHARLES COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ®/ ACCEPTED BY: SUBMITTED BY: WILLIAM A.RTH C CO HOMEOWNER ROOFING CON CT Th� Loofarls, Roofer'' f,t it g: C ik p e, C o d S, 1970 1694 FALMOUTH RD #115,-CENTERVILLE, MA 02632 R 3: Q 77 2,4,0, 3- ,q A R,- R1 6� T E,C, T IV, R_^. L. S T Y L E November 20, 2008 R E R F 0 N Q; P R 0 P 0; 8 L WILLIAM ARTHUR 187 KETTLEHOLE RD. W. BARNSTABLE,MA 02668 CHARILES COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles from the Entire House. Re Nail All Board Sheathing as needed. Supply and Install CERTAINTEED LANDMARK/WOODSCAPE 30 AR: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, 10 YEAR STREAK FIGHTER WARRANTY-ALGAE RESISTANT,250 POUND EXTRA HEAVY WEIGHT, SELF-SEALING, 110 MPH WIND WARRANTY, STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLE with COPPER/CERAMIC STONES with a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT COLOR:: L4) 417W Supply and Install 8" BROWN ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD (lee& Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves,Bay Window,Entryways & Under the Step Flashing on the Skylight,Chimney and Gable Walls. Supply and Install ALPHAPROTECTOR-SUL SYNTHETIC UNDERLAYMENT MEMBRANE http://ivww.permarl)roducts.com/onlineforms/aiiihaprotector.od 'Supply and Install AIR VENT SHINGLE VENT 11 RIDGE VENT on the Main Ridge. Supply and Install C-OPPER& NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. ACORD CERTIFICATE OF LIABILITY INSURANCE104/08/2008 M- ( THIS CERTIFICATE AS ISSUED AS A MATTER OF INFORMATION CHLEGEL INSURANCE ONLY AND CONFERS . NO RIGHTS UPON -THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,' EXTEND OR 4 bl AIN.ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. EST. YARMOUTH,_M& 02673 INSURERS AFFORDING COVERAGE NAIC# ISURED - B•LSURER A: NORTHLAND INSURANCE aT>Ll Buckmiller wsBHER B:`TRAVELERS INSURANCE, ` BA BUCKMILLER ROOFING wsIRER C: INSURER 0: L yannis, MA 02601 eavRERE XVERAGES - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REDUIROutENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.•THE INSI wjcE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR OJSROWLI TYPE OF WWRANCE LIMITS POLICY MR&BER DATE 011MI IYY) DATEQOUDOMYI L �uLLUaeIUTY CP46859504 05/15/07 05/15/08 EACHOCCURRENCE s.1,000,000 X COMMERCIAL GENERAL LIABILITY PRE3MSES(Ea ccgvence) S 50,000 CLAIMS MADE I OCCUR I MED ExP(aro on-r e 1 s EXCLUDED PERSONAL d AOV RWRY S1,000,000 GENERALAGGREGATE s2,000,000 GEM.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMRIOP AGG $2,000,000 " POLICY �ELaT LOC —`— AUTOMOBILE UABIUTY CONIBMED SMGLE LIMIT s . ANY AUTO (En accident) ALL OWNED AUTOS BODILY INJURY s (Per perwn) - SC>t£OULED AUTOS HIRED AUTO - BODILY INJURY - (Peracelded) s NON1 OWNED AUTOS PROPERTY DAMAGE s (Peraeddel)' ' . GARAGEUABIUTY AUTO ONLY-EA ACCIDENT s --`-- A AUro OTHER THAN FA ACC S AUTO ONLY: AGG S t]CESSAAIBRELA UABILITf EACH OCCURRENCE s _ OCCUR F]CLAIMS MADE AGGREGATE $ s DEDUCTIBLE ` s RETENTION s s 31 VWFIXERS COMPENSATION AND 7PJUB-7430A7-07 04/11/07 04/11/08 X TORYLIMRS ER _ EMPLOrERTLIAMUTY 7PJUB-743OA7-08 '04//11/08 04/11/09 E.L.EACHACCID84T s 100,000 ANY PROPRIETORIPARINERIO(ECUIIVE OFFfCEUMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE s 100,000 If yes,de=r[be under YES SPECS PROVISIONS betw E.L.DISEASE-POLICY LIMIT s 500,000 OTHER 6daPnON OF'PER11MONS I LOCATIONS I YETLCLES 10=1U]90NS ADDED BY ENDORSEMENT I AL Pit(MMONS .HE WORKERS COMPENSATION POLICY DOES NOT PRIOVIDE COVERAGE FOR PAUL BUCKMILL21k. 1 :ERTIFICATE HOLDER CANCELLATION )OREY"&COREY I . SHOULD ANY OF THE ABO(IE�BW POUCFS C&WELLED BEFORE THE EXPIRATION 1694 FAIMOUTH RD 9115 GATE TNE(EOF. THE j ISS WG t!!>3 NMLL eNDEAVOR TO MAIL 21 DAYS' VYVTTEN ;.MA 02632 - f�'OCE To THElCr4nRcaTE Nrn.D6t tNkWEO TO THE LEFT, BUT FAIWRE TO 'DO SO SHALL MWILL3IMPOSE NO OBLIGATION OR UA® �rOF ANY IGND UPON THE INSURER ITS AGENTS OR REPRESEfTAT1V6 A j - AUTHOR® ATIVE . AX: 508-775-0155 LCORD 25(20MI08) O ACORD CORPORATION 1988 I x � `•L ��ie �ominoozulea�i .�aabac�ivaeka ( . 4; Board of Building Regulatimnita/s and Standards Construction Supervisor License Licei se CS 2881 UP-Ji5ation 2/14/2010 Tr# 18106 i �ResttiC ,{n a151 >� ,A CHARLES E'CORY'- }= 1694 FALMOUTH RD;#1. CENTRERVILLE,MA 0 6 Commissioned `-- (C�\. Board of=1di."nr R gu �p aaa��ivaeC! g Regulations and Standards. HOME IMPROVEMENT CONTRACTp Registrat o:, 136066 R E*71 6 6/2010 rYPe DBA Tr# 268785 COREY&C ='SS OREY.HOME IMPR01%EMENTS ♦,t CHARLES COREY - ter' 1694 CENT ALMOUTH "•. ERVILLE s=. MA 02632 __ Administrator •� r." Yes t d i --,_�_ . ] - f,J i 04 R-Al f ' .ivy ig x n tL ' MS • • mBoard of Building Regulatio s and Standards Construction Supervisor License License\CS 2881 Ex7pir`at14/2010 Tr# 18106 • � Restriction CHARLES E COREY 1694 FALMOUTH RD;# i- �J,.G CENTRERVILLE,MA 02632 Commissioner + r aan;eu2is Inogl!m pllen Iola ` 90IZ0-UN`uo;sog IO£I-u!a 33vid uojjnggsd aup spaepuv)S pus suopelntlag 3ulpling;o p.ieog :01 uanpi puno;,{I •a;ep uollendxa aqI aio;aq Aluo asn lnpinipui ao3 plies uopeals133'ao as upl-I f The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations ' 600 Washington Street Boston, MA 02111 " M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): w d Address: /49Y City/State/Zip: Phone.#: 50$ 77��a`Z�� Are you an employer? Check the appropriate bo • Type of project(required): 1.❑ I am a employer with 4• Wam a general contractor and I 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 g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its '10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. oof repairs insurance required.] t. c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *My applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing.all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1— (�}- L 61?5 Policy#or Self-ins. Lic. #: 7�y(J 2n;Qh7_,02 Expiration Date: Job Site Address: l2 7 &Z.A�co&_ly City/State/Zip: &A &FDI/ I 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 and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statemeritmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce der ains and penalties of perjury that the information provided above is true and correct Si afore: ( Date: "om 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): 6.L1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector . ther Contact Person: Phone#: Information and Insttuctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in.the service of another under any contract of hire., express or implied,oral or written." An employer is defined as`:an individual;partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased empToyei 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 dees 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 permiftlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitflicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"allaocations 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 io 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 mould like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 t Revised 11-22-06 www.mass.gov/dia SHED REGISTRATION location of shed(address) property owner's name size of shed l—��4 Zature date 1� Old King's Highway Historic District Commission jurisdiction? THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN i shed r t � Application to Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: . CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: MD New Building ❑ Addition ❑ Alteration �) / Indicate type 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 DATE ADDRESS OF PROPOSED WORK / � /� "`�/� ASSESSORS MAP NO. iG OWNER �i � �� Yt�VY ASSESSORS LOT NO. GC0 HOME ADDRESS AV- X� PC) TEL. NO. 3C t'5-a o FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name-of adjacent property owners across any public., street or way. (Attach additional sheet if necessary). J0Sr-P �. Or mar! Lh 0 c ' Yrr— �� t /VO,/� RC) f( , AGENT OR CONTRACTOR Or (Do` t r' BgrAl -TEL. N0. �60 � ® ADDRESS c7 7 ' �`rr+� U DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including t materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). P 'X /.9, Woo do CC)IL doo �.�. %dz C��n / �Sfb-� c�► Sr•� w ,=nCc�u. C�fS�i� 1�r,7" Signed Owner-Contractor-Agent Space below line for Committee usen. ve" / Date he C ficate is hyeby Date , JUL'- g 1997 ct;�. Time T%VN OF BARNSTARI F QLDXMG-5 HIGHWAY Approved ❑ IMPORT NT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. i ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATIOiV FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are'required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white, or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be.erected within the District, with the following exceptions: " a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an.approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are removed within three days of the event. Certain other temporary signs that the Committee feels does not detract from _ the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. . 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under. heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters —leaders, roofing and paint color. 9..Unless application is complete and legible and all material required is supplied, application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall.' rX r Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION Cd'h C Yrr/J'e- SIDING TYPE f3ol.kc) C� OLOR �. CHIMNEY TYPE COLOR ROOF MATERIAL l�J,,,./� C ar l GAEr9R 5�;4 Zr— PITCH WINDOW 2. ovcr 2 SIZE TRIM COLOR s� 7� DOORS COLOR ��6 0C a SHUTTERS COLOR GUTTERS no h *el DECK GARAGE DOORS COLOR �- 41 SIGNS np l �� COLORS FENCE �/ COLOR NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Site plan should show all structures on the lot to scale. SPECSHT � Oj �� . P 4 2 V 1 Co S t � h / ,, 12�5: ?ENE � F• . /cL.c o D ZO A/E: G THIS MORTGAGE = NSPECT T ON PLAN IS FOR BANK USE ON W.gA TABLE ' REGISTRY OWNER' MARTIN DeMARTINO TOWN:' ,,. DEED REF: BUYER: GATE: • l2.'l6/88 PLAN REF: -`:::i: .�.-,u� SCALE: 1 '=. 50 ere y certi y that t e ul dinS X`- „AO ..YANKEE SURVEY . shown on th A' ' is Jan is located on 4,,� the ground as shown and its CONSULTANTS : '� 11 70 RASPBERRY.LANE position does coanToro to the zoning law setback requirement of �F ;, o/ � MARSTONS MILLS oaf`a MASS 02648 BARNS TABLE ao and doe.s not lie within the special flood hazard :area as shown :on the h. u. d. ' flood map dated is plan not bade froia an .instrument r Paul A. Merithew, RPLS surve not to bc - used for fences et 487% •:.:":•:,, i Gam' GLn .�_� _ � 9'�,,i . i s� - r ,�-., �- �1��, . : �, � � L� 'J l�-�.. �'� __±:...: �� ''�-� .�.as�-r------Y� i � .. � I I 8' r �� 1Z�- _ � g c.c� low � kvoF C9y4 AFT " R 6RS '� O,G. Nord; ALL W000 /S F�LL ?iN&, n n i 4� `I k 4 Tbv P4a7ZS AFL SNE�S /�AvE 9xy" surpocr (ae.4 =.-W,--E 6110I-E END LDUVEP-S qyq �Ncrf /tarvN, LoRNCR (/ posr8 ix< GuRL I LU i �(f(mi,.,�� 1 t! PLrWOUD Pre5sw1trIV" _ 2r6 Soisrs IL"o.c .ur� g�oCkING uen 4 �rAssessr is map and lot number Av..?:... _ DESIGNING ENGINEER MUST SUI:::11 N'E;to Sewage Permit number ....... ��.. INSTALLATION AND CERTIFY IN ... ....�. . ....: d HE SYSTEM WAS INSTALLED II House number ...1.Q.,. �Yl,d.9 �'�`�DANCE TO PLAN. Z EABB9TODtE, .................. 90� t639. 0�. . RFD p�0 TOWN WN 'OF BARNS �/�M MU ■ PLIA C COIMIPL�A�I�E WITH TITLE 5 B U R D H G I N S P E C T URMiqMENTAL APPLICATION FOR PERMIT TO ........... ..... .... .. ...... . ... ..../.............. J. .... ............. ............... TYPEOF CONSTRUCTION' .......... . ..... .............."..........-s................................................................................. ............... .....�...........19.. y TO THE INSPECTOR OF BUILDINGS: The undersigned er by applies fora p rmit din to e f (lowing ' for tion: Location .. ... 1............ ..... ...... .... y 'n. / Proposed /ses�.!..4f i'�...L .. .....................................................�.....................�.............................................. Zoning Di 1 .... .... .. .................Fire District .........�.�:/.....Name of (��..r.�.. .... .. ...... . ..............Address ....�I...�......�:lU.C..I.\e.!'.....Name of 65@�u.ln..,/��. q.� ►!16............Address .................................................................................... Name of Architect ..............Address Number of Rooms .....r.........................................................Foundation .. .....TCtr 1!1 ... tl9�;d'. ... ...................... Exierior ceAa-r....J.0,r... ...............Roofing ...aS .h Qi.l. .....................................:.................. Floors ... XLr/Q.e4...4J....U1:�,Yf..............................Interior ...Q�.cc 4�.. A.c1�. ....6I.r ....�1.(AfS..t .e.l.'........... Heating &./.......F,44J...................................................Plumbing .... ......�1.` ....................................................... ./Fireplace .....E1.1.'t`�. �,...............................................................Approximate. Cost ....�.al.y..��........................ ..... ....... Definitive Plan Approved by Planning Board _______:_________19_______. Area , .!... Diagram of Lot and Building with Dimensions Fee /�D............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH t i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... .. .. ... . Construction Supervisor's License 01q1VL............... DeMARTINO, JOSEPH " � 2 11 Stor No -31526,�. ................. Permit for ........................y ............ Single Family Dwelling ...................................................................... Lot #47A, 189 Kettlehole Roa& ' Location ................................................................ W. Barnstable ............................................................................... Joseph DeMartino Owner ........................................... ...................... Type of Construction .................Frame......................... ............................................................................. Plot ............................ Lot ................................ Permit Granted .......pe.cem.b. e.r....2.3.f 9 87 .........December.... .. Date of Inspection ............................. .......19 Date Completed 1. 9 A', I 7f, '01-1<06ARNSTAkE, MASSACHUSETTS BUILDING PERM i,T DATE 1,:i 0 PERPA!7 TO L L. !7TREET. WSS STREET! 1:R Or,5 S T R 11 E I'l 13 1:3 10 N LOT IT P`J!L0!NG 1� Tt) Be FT, WIDE BY T. I G HT FORM li%; CONS!RUCT!O.N LOi'G SY IN W�. ANO ',,IiALL :;ON FORM Gq C,LP Ls 11E.MARKS: AREA OR VOLUME PER M:T E C! COS': S FEE (Cualc/srUARF. F!:F- OWNER Puil- DEPT. H!5 to E R 1,A i I' C 0 p I V J: j NQ RI i 1-1 T TO ^CCUr Y T R E E ALLEY OR 51 n IF W A LK R EI1'!y::R TF?nPORARILY OR PErMANEI,47LY. E:4CROAC:r'MF.IjTS ON -;'ERTY. N07 SF",-_(:IFIC',I_,Y PFRm;T rEL) UNDER THE. MUST BEAP- EY THE Ai. GRAOES AS WELL AS OEP:7H AND i OCATION Cr PUBL:C SEWER-, MAY BE OBTAINED STRHE"' DR Ai Y t-I THE FRA-ZTMENT OF PUB 1 W'_,VTKS. T! E I_f,'JANC,E OF TWS PERMIT DOES NOT P-ELFASE THE APFL.!'(,'AIIT PROM THE 0 S QF NY AF SUBC.'! :5!r; EST Q: T j .C, S. r4 OF T li I i`.E ..,VE N S 10 U S T :�,E R E.T A:N E.0 0 N .109 AN C, _r'Hl WHERE K R t N r,�:c QU!F,E c 6 t5EPAP ATE C 01"s"R Ur I KEPT ED ijtjTjL F:NA;_ lr,!!-,PE(::Tl(:)tj HAS F3EEN, I I"ER.MITSICARE F-.'F'.QljlF?FrJ FOR r:ONS I E E c T p Al . PL.'jW.F;NG ANO CEFl7f:F-'I-�TE OF 0(.Ct 2. OR TO C C, ,F.R f N G 5-r R L,c r UR L. U I R f_D F j C M EM 8 F.;'S I R;:A D� T 0 LAT W). _))N(� SHALL NOT BE OCCUPIECt LINT H_ I c-N"'L 1.1:5 Pt I-T:C).-j 9 E F 0 R E F-'INAL. INS-PEC71ON HAS BEEN MADE. C u P A.,:C Y. POST tr'-d'IS CARD SO IT IS '"ISIBLE FROM STIREET v CULDING,!NSPPCTI0N APPROVALS Pi.UMRING INSPECT UMAPPROVALS LFC.Tq'C:AL INSPECTION APPROVALS j", U /C li .. 1A HEATING INSPEC FION APPROVALS ENGINUMNG OF HEALIH � R;dF_ _A N01 UNTIL 7t.E PERXIOT ',V!LL BECOME 'q'JL.- AND VOID IF C()NSTRLCTIO�i In-R'w's/,F`P;iO'/C() 'HE VA.R!Ci IL::*, (')F it-0:CIVED ON rHIS CARD CAN BE WORK IS NOT STARTED WITHIN Sl,� MONTHS OF );.-E 'rH;: ARMINUD OR BY ,)q WR!TTEN PERMIT ;S ISSAD AS NOTE!? ABOVE. DATE CONTINUATION OF ROAD BOND BUILDING PERMIT 11 I The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of Public Works. loam and. seEdshoulders as soon as weather permits. other (explain) L7, - 72> LOCATION �p �'� F 7 NE Owner Contractor J EI GINE�YING AUTHORIZATION , t t _ -Qo-Q � o • _ � .PPR 0 . 3 Ar � P P 3 Z.o CuS'� 6 N C N i V 15a3�� FLcaD ZO/vG: F .0VN0ATL0N CFRTZFICA-rlC>?J -rouiN W. BaenS�ab 1e PLAN REF. 391 197 DATE !9:j?=► 87 SCALE "=5a' ELEVATION - I HEREBY CERTIFY THAT THE ABOVE FOUNDATION 1.5 LOCATED ON �ytN Of ,�q yd,��EE !FmpvE Li THE GROUND AS SHOWN, AND �� y� CO1'tSC,CLTd.nT'S ITS P05IT1Onl DOES PAUL A. . CONFORM TO THE ZONING- MEWHEWy 70 RAsP5sRSzy L.N, LAW SETBA(� K REQUIREMENT OF 8Al2 N STA BLE 'O�bFESS�ci�' MARs-roty 5 N1 )LLS., 1NA 9 ,, �qHo suRVFy° O Z C048 . a . PAUL A. MERLTHEW R•P.L.S. y..+--..-tom`i'"--..,wSyn.,....��,y,�...+,..-5'✓vim ••h,,�,..y- -"�-,.. .- --.3 -... OATH it TOWN OF BARNSTABLE 31526 Permit No. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 Yt ��auY HYANNIS.MASS.02601 Bond .....X... SO. CERTIFICATE OF USE AND OCCUPANCY Issued to Joseph DeMartino Address Lot #47A, 189 Kettlehole Road 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 INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. January 6, , I9...89.......... Lz' ..................... Building.Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT t SARNST U : TOWN OFFICE BUILDING rut '639. �� HYANNIS, MASS. 02601 , �o rnr r. MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has Gbeen issued for the building authorized by ) ( Building Permit #....._....»...:e»_. ..,._.... ..., /...""........................ ......................1�.....^.....................................».................. .. ......._ _. issued to ...... ....... %.......�C1 ............_._.........__......__. ......_..__ �- Please release the performance bond. �r ' ' f & / O „ THETO �. Assessors map and lot number............................................. Sewage Permit number Z BARNSTABLE, i Housenumber ......................:.................................................: _ 90� Mb q. _ 3 �0 i TOWN 'OF BARNSTABLE C BUILDING INSPECTOR APPLICATION FOR PERMIT :TO�:.. ....... ,....... .... ......... .. TYPE OF CONSTRUCTION ..... %v�lz' l,,,,..f '�/ ........................�.......................... ................. .............. .............................19.A4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit .according to.,fe following information: ` ��- - 1� ....... . ................... Location ..,�.,...................................................... ...� . .. .. V qProposed Use ...... n... .................................................................................................!'............................... r�� , J Zoning District ... y<t....��...... .........................Fire District ... ......:.............. Ccs.. ..�a.,..................... / l -•c�J� � .............Address .....�� ..... -•l.U<... P.r ...........�............................ Name of Ow er ..................,..............�.,..... ........,�. yQ ,. . Name of Builder ...>. S.P. �. ...:P.fije,14..r�.:.t0.15.............Address .....................................4............................................. 4 t Name of Architect Address .. ... Cta.n 1t r, ,,,ra f ., a ....... r Pcu.i ...... ................. Foundation Number of Rooms ..... ......... ..�!...L. n r sr�,t� ...0 anc,r .......................... Exterior (. ( .�GE,a Q! ...:?n.+.!1f. 1�,.................Roofing ... ......�. loors, � Intenor ............................................................' .--�- Heoting . ....:. ,'� ......... P.lumkiing�..j..:............. ...................................................................... Fireplace ...............................Approximate. Cost .... ..................................... Definitive Plan Approved by Planning Board ___ ------- _______. Area .......................................... •' Diagram of Lot and Building with Dimensions Fee. ............................................. f SUBJECT TO APPROVAL OF BOARD OF HEALTH I • fl r \ i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' s" I hereby agree to conform to all the Rules and Regulations-of the"Town of Barnstable regarding the above construction. Name .........� .Ll ................. i p tom/ Construction Supervisor's License-...�........[...�.................. DeMART' NO, JOSEPH A=1060 - ok A;r4ro� PX9- 31526 I..:.Story No ................. Permit for J� �......................... Dwelling ......... ........ ... .......... Location Lot #47 eholc't Road .......................A, .,.a Kettl ' ......................................... W. Barnstable ............................................................................... Owner ......Jose h D eMa r t i no .......................................... Type of Construction Frame .......................................... ................................................................................ Plot ............................ Lot ................................ December 23 87 Permit Granted ........................................19 Date of Insp6ction .......:............................19 Date Completed ......................................19 eo,01 eL d L21. OA tit, L -- �, Z4 17 ull ow -t7. ,W . 1. 1 i tt tx«T,� _42.;A4 u ►► ►i . t� c„ —�✓- �-{-�--�_�-�-- ✓-�- , . - _- ----- - ��r►� ,T lob �G �t�rx �.IG '► Tq �-- - — ......`Lal_ if ._� it ►► - �-14j '1" P J7 I Tyvf x ror, --tip�C —pt ILL FfA _ le i i • �/, C/K 1 TOWN OF BARNST.ABLE L�1 G► m 7011 JUL 18 Pfl 2* 12 _14 \114"L_�Vp DIVI'SION `L( � -- _ - NoA-7 ►Its _ _ MV4 7yvEx Allt 9 oZxF Q«"e/� k�F�AFr sC� �tiU. 6 ev /�lb� 8E19�►�tl(,, I �X4 �G6.�_/C '� -�� TOA ="YtsTer.1C 3,+T?4 Ra_nHLKmfHaj F(EC ENE® JUL 2 1 2011 -TOWN OF BARNSTABLE HISTORIC PRESERVATION 10 V10000 17 LETH IF JUIL H. AP V- -F.-- MA •pUG 10 201 _- �__ z t Town of Barg ay - - --... A Old Committ ee . l 1 --- 7&IL cL 4 l RECEIVED JUL 2 1 2011 TOWN OF BARNSTA.BLE 1 HISTORIC PRESER\�F1' ON APPROVED AUG 1 0 2011 - Town of Barnstable - — — Old C g's Highway Committee I � ,� � �� ► — _- �.4�.. :fin ---- rT � 41;r:44 Uzi 7" _ - 1 1� G� ►G�'t� A T P TTVEX. �_ _ RECEIVED ,1 F � . JUL 2 1 23 1 - ;u T TOWN OF BARNSTAE::-E HISTORIC PRESERVA00N APPROVED AUG 10 2011 - - _ .mot_..—.44a� Town of Barnstable Old King's Highway Committee -o _ . APPROVED AUG1 2011 Old King's Highway Ir � trcc � 8 \ 6") 4,3 \ r8ar-ns4ablc, Wass. - \ Sca /e . V, = 04 \ .p 718185 tu�lA4✓C.r.� H o v S� " � \ � \ 56, `1N OF PAULy J. JACpBIA. MERITHEW 814 •op Nu 32098 Z i �R gNATAR�P� VL 4,0 o 6 ✓ �� p ih 0. 8 r N 14 to -IK 138-03 41 �E0 o IF Ix 40, IX 410 ok IT! r . V � -_ � _ram--- ,,,,,,,,,,•- � �. � ,_� �V f.L:O 0 '1 00 o S4-sat JOSEPH DFMARTINO ZONE RF a