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Home My WebLink About0012 KRISTI WAY 11 0 .SO co UPC 12543 ' No.53LOR HASTINGS,MN .. pQ�.�.'. .i_ .�•_:a..:;.:uu"t�..' i�t..�..uti e�..:'�:-bin - - o ° v e n F„ Town of Barnstable Permit# Regulatory Services wee 6moaihsfrom issue date Richard V..Scali,Director 3& Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable1:11RF&V Office: 508-862-4038 Pj; 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIALW Not Valid without Red X--Press i4ri?dMAY 04 2017 Map/parcel Number n fl p i Property Address TOWN tJ��r�! r� B L E O� [ Tf esidential Value of Work$ .J, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ptl r '/C/ i / u6l,:.ek Contractor's Name �3Af l/UDU� Telephone Number 40 2 d Home Improvement Contractor License#(if applicable) / 3 - Email: /fie , Lyw ��'1K� Construction Supervisor's License#(if applicable)�•5�i`f �y []Workman's Compensation Insurance Check one: • 3-T am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance- Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) f ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 6 mtz /,,j ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side j,Replacement Windows/doors/sliders.U-Value ° g {maximum.32)#of windows #of doors: 'where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the-Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE. Q:IWPFTL.ES\FORMS\building permit formsMPRFSS.doc 01/25/17 I � ` Office COM-W&igartiaas 600 Wasagtott,S`reet Ba3WY4 MA 02M i-PionmaoLgepla7a Wurke& C In r mce AfFrlavi L BuRdpz-dCautractarsMectidau&Thmhers AypUcznt Infvrmatign Please Fret -Nm= - - l �a�S a Are you an employer?:tkeckthe appropriafe bare Type of project(required)_ L❑ I am a employes vd& 4. ❑I am a gmmral c=tracfar and I El N employees(f "advorpamt- =)* bavehuadtime satin-conbactm 6_ oonsfrur o.n 7..0 am a sole pivpmietos orpartmr- fisted onthe aftarhed sheet ?- ❑R— deling. ship and have no emrmplaywa These smb•-c=1ractc=hhave . 9_ ❑Demolition wording fornm in army capacity. enTloyees andbmm wod=e 9..Q Ba>ddmg addition [No wad3e&oomstp.isstmrance Camp-iawra co reTired j 5. Q We are a corpomafioa and ifs 10-0 Electrical repairs or adc5iions 3.Q I am a Imomeommer doing all wmk offcem have ew=- ed thieir 1L Q pluambsag repair or mrddiham ' my�[NO wDERBO'C=F. rigbt of per M4GL 17❑Roafrepais instaaace reguim�dj y c.M§1(4k andwe fime no eraploye:es.[No word eis' -Q Dtber �N/N/�a t✓-� commmp.kXM3M=required-] I-ea J4 coM 40 'Amoy Ypgg �thstchedsbaa fl mast also h�orsEthz�ctioabeIa�v �&eQwodcas`mmpeasstia�poT�cgiaivrmaQom �aames�osnmdrisaffiaimirx deysmdam-agw aAHim]vsaam&cufftmcrosamstsubmicaneacafdaEic-m sncb- =Couaacm68ast�eckflus boa must at>edse+�to additi�al street shau�g lhenaae of the sub-cam aa3 startex}�ih�arnatdruse eni�es]uee ampkyem if the sdb-c�sbace empIovw-%dLeymusrp®vide duir gyp•PGRU aM3ret lam an Below is time poficp rend job sds hz,jormadmL IasvraaceComnpanp�ame: 'Paficg�m Self�I.ic.� izD�e:' Job Sit�ABdressr Cifpl5tatt : Af#ach a•L�of the warlmrs'compensationpolicy dedara4ion page(showing the poTcy m:amber and expiration date}. Failnre to secure coverage as required under Sezti=25A of MJGL m 157-can lead to Ste imposifioa of aamimaal permalrses of a $mse up to$UOD iD indlor om iaye$rimpcisonmemt Bs wen asritd penalties is dine fbm m of a STOP WORK OBDERand a fime of up-to OQ a day against the violator. Be advised that a atpy of ihis_sWErueut maybe£warded to the Office of Investigations ofthe DIt4 for ins»rzace coverage on- Ma her aamdar dwpains andpenffi?z afperfiwrF f uEtA info mrafiauprvvidedabm a is true and correct LLEL Datp- Ply affiiaL arse anZy, Do not Ewite in mks amwar to be cmnp&Md by cify artmvn affi:&t Cky or Tatra: Perammatn A ease: LWAng Axdmrity(cbmk one): L Board of Health r.ling Dq=Imex t 3.Qtfmrosva Clerk 4.Electrical ruspector S.Pbm mhmg Inspector CL Mer ComAM&Persomm: ;9- fafO `nCla On an Instructions .r . . . .� Mace,rlr�Ge=rA Lmm 152 rues all eplgy=fn FCFVi&We campeasatim for fficir P = - p t to• is side,arL VIoy=,is defmcd as.=evmy pesoaia$ie service of ano8irr ender asy d Ofhirr, 's or inpljO4 oal or writb=f - assoc�ian;curpont iem or o$er legal e±idy,or any tWO or in= AIL�Iaym-is-defined as aaa iadrvidnaI,per, . of die fOregvmg aJ ,andmr�dmg tbzkgal=Fcs=tdi=ofadwzased=3playcrcirf= err or trash of as P�rP�aszoci�ian ar o�cr legal eo*ity'.�Io'Y��Ioy�- However� . hoasehavnignotmcre f3i=fm=apmtnents andwho residwtherein,erfim poem aftbe- ow a,dwelling air work cm such dwemng boric dwellM ingg hD•ase of anothear Who c�gloys paasons m do m or�p • or oa fe groaudg orbmi mg spgariEoaz¢fheirtD r1:anotbcc;an=ofsach employmentbe deemedfn Be an cavloyce MGL d2opt=-1ti2,§25C(6)also s[ s that¢every sfafL-or lbw T,rPncmg agency,shall wrfhold the issaance or retie w4 l of a license or pex�to operate a bvsmess or to c onstr'[Ic_t bmfldin$s iul tlic commonwe2ll3i for any applica n'E-who has not produced acceptable evidence of cdnipL_ ce ww,fixc Dance covexage rmgai red." Atonally,MM,cbaptw I52,§25t 7}sites=Nemec the nor a'ay ofits por�ical subdivisions shall e�t:r ii D any contract farthep ofyablio Wrs�m>irZ acceptable evld$ace of campli�ce7Ylfh the msm$nce• =quiz MtS ofthis chapteshavzbe=pr MdMdta the ganmoUL} Agpl?cxxrfs Please fill out the wO&=w cpmpeasation affidavit camPleftkn by g�booms that apply fn Y°�sifn�aa + nxessarY,supply s)naxne(s), es)adplu==mber(s)along Withthea s Of than the msRrance. I,imitcdLiab�y Companies(L q or Lm=tcdLiab�p'Par s(�)�no cMpIoyees mexmbss or parba=6'are not regrm-cd to cagy �P� >gsmmlce' Nan,LLC or LLP does have e3ployees,apolicyisrzgaice& Beadvisedffiatthisa$tdmVifmaybosabmitbdfatbeDepartmentofInd.serial Accirl for confmaa�offi=m ce coverages Also be sure to sign and date the afudavit The affidavit should be roamed to me city or Town that tbz application fur the perffit or licem se is being regaesbA not me D ep artmed of Ism A zr;dm-.E - Shoaldyon have nay questions regard'mg the Iaw or ifyou ate regairedia obtain a Wotio:[s' oomp=$afian PofieY,Please caIL f o Depmtmznt at fhe mmmbe r lsied below Self-ft=ed compa3ics should ew'�r their s elf-i astu..ce license number an the . City or Town OffieiaaL _ Please be sorefaatthe affidavit iscampleb,-a:ndpraftdle911y- TheDepartmmtbasprovideda Space attheboth= . ofthe affidavitf=youth fh fIl ont inc evert tbe Office has in yo¢*�mg thPF Iicant Please besrnz Ix)fminfiicpeMLbacrosenrnnberwhichwillbe used asarefz==minnbcr In.-addition,an.agplicant that mast submit raullipie pcm&Hcmm aPPIitzhu'm my gTvenyear;need only sahnit one affidavit mdicafmg cmn=Lt . policy iuforrnation (if naxssary)and IIadea`fob Om Address'°the applicant should write"all lo�atiDns in (�Y ear town)_"A copy of the affidavit fiat has be=officially sed Or mar1ced byth �'e or to maybe provided to fhe _ applicant as#oo-fthat a valid affidavit is an.Me for fime permits or licroses_ A nrw affidavitmaxsst be f Mud ovt each year.Vlhere a hDme owner or cftim=is obtaining a li=w or pemiitnntrrlated in any busincss or commercial.4&atu= (ie_a dog license orpennit to burn leaves etc_)sauipeman is NOT rcgtmzdto complete this affidavit TheOfficeofluvcsfig =woua13o-_tnihankyoninadvancefbryovrcooperaionandshovldyou.baveanY4LeSt0M--- please do not hesif o to give vs a caIL. The Depa tneafs amass,dome and;ffioc=m3bcV . the Cb=M twe81*of MassachnsettR - �c}f�Acoidents _ • f�tc�of��fio� �4 W $ostm 4 oil11 •Tel.4 61'- -490(9ft406 cu I-M-M&SSAFR Fag 617 72'r'749 Rz iscd4-2447 Town of Barnstable ` Regulatory Services • s"MAM • Richard V.Scab,Director - ►� Building Division. Paul Roma,Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-4038 Fax: 50&790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, <=k �l�V�_ ,as Owner of the subject property hereby authorize -��J /iU- 0 or) to act on my behalf; in all matters relative to work authorized by this building permit application for. (Address of Job) L�; **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date QTORMS:OWNERPERMISSIONPOOI S Town of Barnstable .0 Regulatory Services d pIF Richard V.Scali,Director Building Division Paul Roma,Building Commissioner z639• ►� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: .JOB LOCATION: number street Village "HOMEOWNER": - name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building oermit. (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"homeownee'certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code . Section 127.0 Construction ControL HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner.performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as itwould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 0620/16 - :.. �e 1panvrrzor.cueal//a�Cac/ivaeC�a Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:;ob'152773 Type: Expiration 8 DBA J GROUP �� jS gym• �_ DANIEL WOOD -_M 153 POWDER POINT•7k�( j:%' DUXBURIY,MA 02332 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards u1. License: CSFA-062822 Construction Supervisor 1 & 2 Family . DANIEL-C WOOD 153 POWDER POINT AVENUE, DUXBURY MA 02332 - rz License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 i • I Not valid without signature _ I Construction Supervisor 1 &2 Family Restricted to: Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS i r r ' l� -q-o� utf"� d UJ 334 Main Street, Hyannis, MA Map 327, Parcel 090 Represented by Jason Irving Replace existing signage on Main &Barnstable Road wi Please note that the committee may act on items Also, if it so votes, the commi Plans and information may be viewed at Town Offices, C Street,Hyannis, MA George Jessop, Chairman Updated 51612009 1 � J+ �- �, za i of > Town of Barnstable *Permit# o l D Regulatory Services F Expires 6 months fr Pm issue dat %4tMSTA 3j.X r MAC Thomas F.Geiler,Director ERMIT A o �'� 'R S Building Division 0.1 Tom Perry,CBO, Building.Commissioner DEC 200 Main Street,Hyannis,MA 02601 t 1�� ✓zn�C�T�tl -�-r� www.town.bamstable.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 G ? 16 D ;'Residential Address Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address PATi / I GC, >'✓t%dc S/�ir�� Contractor's Name #0 0 Yam Se l.Nc. 3OSe /) 0VIV Ir- Telephone Number Home Improvement Contractor License#(if applicable) 30� Con ction Supervisor's License#(if applicable) 7 20 77 Workman's Compensation Insurance Check one: ❑ I a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance As Insurance Company Nameb-PIWpWin'! ��'e;1,NS `c<./ . Workman's Comp. Policy# 0 6, 9 / Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ ,Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ R side #of doors Replacement Windows/doors/sliders. U-Value a 2 (maximum .44)#of windows _ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATURE: �Z✓y�Gi' Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 The Commonwealth of assa chusetts _ Department of Ihdustria?Accidents 'R` >-=, j Office of Investigations 600 Washington Street Boston, MA 02111 avww.mass.gov/dia ,e..r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): D_ Address: gL15j Pc�e,s rep_&V City/State/Zip: (( r v 3z)339 Phone #: Are you an employer? Check the appropriate b Type of pro'ect(required): 4. I am a general contractor and I 1.( �;� i am a employer with �_,.' 6. ❑ N construction t j.Iployees(full and/or part-time).* have hired the sub-contractors .N..0 m a sole proprietor or.partner- listed on the attached sheet. 2.❑ I a 7. emodeling 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.t required.] 5• We are a corporation and its 10.❑ Electrical repairs or additions ❑ 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions Myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their-workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. fr Insurance Company Name: 4" 5 �j,t i'-� S - �C� Policy#or Self-ins.Lic. #: © � t to ! 3 o'-L Expiration Date: f I✓ ' ^ n 9 Job Site Address: `l` > 'v t/f� City/State/Zip: le- Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t ains and penalties of perjury that the information provided above is true and correct. Signature: Date: l �/ Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: n The Commonwealth of Massachaseft Dgarhnmt of Industrial Accidents Office oaf, Investigations 600 Washwgton Street Boston,MA 02111 . "m w.mass.gvwldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elec i7icians/Phimbers Applicant Information Please Print 'bh Name i): O S e . Up" Address: S W. 0(/✓ City/Stu A, /e /'O •�: 3 Ph.,, Eo e lcg�/Y A:E1 you employer?Check the appropriate box: 4. I am a contractor and i TYPe of proje (renired): 1. I a empoypr with ❑ 6. ❑Id coastnzction loyees-(full andlorpart-time).* the sub-contractacs2_ I am a sole proprietor or part=- listed on the attached sheet �. o g ship and have no employees These sub-contractors have S. ❑Demolition w for me in a employees and have worms' offing ��Y- 9. ❑Building addition [No wodcers' comp.insurance comp.insuratx e,I required.] 5. ❑ We are a corporation and its 10.❑Flectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised dwir 11-❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required,]r c. 152, $1(4),and we have no employees.[No workers' 13.❑other comp.insurance required.] ji 'Any app&caut that checks box#1 mast also fal out the section below showing they workers'compensation policy information ?Homeowners who submit this affidavit ini ireting they are doing all work and thm hire outside coalactors mast submit a new affidavit indicating such kzanaclars that check this boa must attached as additional sheet showing the name of the sub-corzowtm and stale whether or not those entities hate employees. If the sub-contractors have naplayees,(hey must.provide their workers'coatp.policy number. Taman employer that is providing worlrers'congw sah'on innirance for my emph4rem Below is the policy and job site information VCPIYVAI� A1�/c} 1 ��S1Insurance company same: lJ ' Policy-,ff'or Self--ins.Lic.#: 'J P / io),o Ea 0 Fapiration ime: 3 Job Site Address: l hi(Jil 11/ fi CityfStatelzip: w. P-,,v l j&U.A, Attach a copy of the workers'compensation policy declaration page(shoving 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..0.0 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 Investigations of the.DIA for insurance coverage verification. I do hareby ce mdBr the 'is and pen ' s of`ped that the informdion provided above is hue and correct s Date: Phone M Official use only. Do not write in this area,to be completed by cio or totwi official, City or Town: PermitUcen'e# Issuuing Authority(circle one): 1.Board:of Health 3.Building Department 3.City-frown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 office of Consumer Affairs and usiness Regulation 10 Park FIaL: - Suite 5170 Boston, Massac�psetts 02116 Home Improvement (;0ntiactor Registration -— Reglistration: 132349 Type: Partnw ship Exps;on: tn112013 me 2a73M J & J Remodeling Joseph Duarte ___ 15 Fall St. Wareham, ma 02571 Update Addl aad mftm cud.Merit reason dnaEs es Add►ass 01l:e.wd 0 Rrap lost a Lose Cud -cat o WM4Wa6a+01M License or Mound"valid w we only ojr= Wore thecipkatioadam If{0ued retwo W. SOME lklFROvEmENT CONTRACTOR Type. Omea orCesstotaer Affairs a.d Baai"as�� Ropfsdstlon: .:-13234910 Park Plana-Saft 5170 Expiration: 4/11013 Partnership Boston,MA 02116 Joseph Duarte 15 Fall St. ..-- Wareham,ma 02571 Under9eeretary of vdwaLh nt stare >ia u�hu:att•-,,If Puhlie j�afCf% 1 Brutrd of Suildin•�Reg °' Cortstruaon supetYisot lioenaa Lic~: CS 70077 JoSEPH C DUARTL 1S FALL ST WAREHAM.MA 02571 Eaps► 12 42 �t Tro: 700 - Z9LfiS6Z 119VZ6/10 ROME IMPROVEMENT CONTRACT PLEASE READ THIS ✓� Sold,Furnished and installed by: Branch Name: Boston Date: THD At-ltome Services,Inc. d/h!a The Hume Depot At-Home Services 345A Greenwood Street.Unit 2,Worcester,MA 01607 Toll Free(800)657-5182;Fax(508)756 8823 Branch Number:31 Federal in#75.26984W.ME Lic ft C'.02439:RI Cunt.lie#10427 CT Lie tl I ITC.0565522;MA Humc tmpmvcute V t Contractur R cR.#126893 Inctullatiou Addrettx: f�J y City state Zip I'urclrnscr(s): _ Work Phone: Ilome Phone: Cell Phone:_ CrGL kwc - Home 1 ��1,76f Address: 1{ _ (If different from Installation Address) City Slate zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the alcove installation address, tgrces to b y. and TiTD At-flume Services,Inc.(—rhe Home Depot")agrees to furnish,deliver and arrange for the installation("installation" of all materials described on the below anti on the referenced Spec$heats),all of which are incorporated into this Contract by this reference.along with any applicable State Supplement and Payment Summitry attached hereto and any Change Orders(colhx ti ely, "Contract"): .lob It: mutrwa t—t �co' tt: Spce Sheet(s)4. Project Amount ❑Rnntiog ❑Siding Windows ❑Ins�ilalitm_�_ ❑stutters/Cuv= ❑Entry r)mrs ❑ ❑RMlfing Siding Windows ❑Inculaliun u— I ❑Gutters/C'nverl (]Entry I)rM n Q. I I I Rooting ❑Siding ❑Windows ❑Insulsnivn � I $ I 00.rttus/Covert ❑Entry Uoors❑_. ❑R K)Gng ❑Siding ❑Windows ❑Insulation I ❑Uunem/Cuvrls ❑Frttry Mors ❑ $ Minimum 2596 Depnsit ud Contract Anrtmat due upon execution of this Coalract Q Total Contract Amount $ 66G, � 5 Maine Purchasers may not deposit more than mtathird of the f:mttnat ArratunL C.uslontcr agrees that,immediately upon completion of the work for each Product.Customer will execute a Completion Certificate (one for each Product as defined by an individual spec Sheet)and pay any balance due. As applicable.each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot rc,,rvcs the tight tot issue a Change Order or terminate this Contract or any individual l?nxiuct(s)included herein,at its discretion,if The Ilotne Depot or its authorized service provider determines that it cannot perform its obligations due to a stnoctural problem with the home.environmental hazards such as mold.ashestos or lead paint,other safety concerns,pricing errors or because work required to complete the jnh was nut included in the Contract. Payment Summary: The Payment Summary# LNL�L . ' , included tvi part of this Contract. sets forth the total Contract amount and payments rNuired for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Du not sign a Completion C;crtificate(note: there is(ut•.Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. in the event of termination or this Contract,Customer agrees to pay'Phe IIome Depot the costs of materials,lahar,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Alnrcment or allowed under applicable law. THE:HOME:DEPOT MAY WITHDOLD AMOUNT$ 0WFD TO THE HOME DEPOT FROM 'rHE DFPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THF.HWE DEPOT'S OTHER REMEDIB.SFOR RECOVERY OF'SUC I AMOUNTS. Accenttince and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Deprrt with regard to the.Products and Installation services and supemedes all prior discussions and agreements,either oral or written.relating to said Products and Installation.This Agreement catutot he assigned or amended except by it writing signed by Customer and The Home Depol.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. I � Acty ,: I sit li ed by; Customer's Signature Date Sales Ct nsultanl's Si nature a6aw �) X _ I 'felepho e No._�� CJ Customer`s signature Date. Sales Consultant License No. CANCELLATION: CUSTUMER MAY CANCEL THIS (oxnppGwhlr) AGREEMENT WTMOIiT PENALTY OR OBLIGATION BY DELIVF.RIN(,WRITTEN NOTICE TO TIIF HOME DEPOT BY MIDNIGHT ON THE 'THIRD BUSiNE&A; DAY AFTER SIGNING 3111S AGREEMENT. TUE STATE SUPPLEMENT ATTA(:HED HTRETOI CONTAINS A FORM TO USE IF ONE IS SPECMICALLY PRESCRIBED BY LAW iN I CUSTOMVKS STATE. NnTtC'K:AUt)t ITONAi.'173RM:i AND tY)NDITIONS ARM:STA'rv.D ON 71,RF;VER.SF.SIDE.AND ARE PART OP TH1.R CONTRACT LA d SHV 30d80 ewoH << hLLV56805 3NOHd'MoIX32 02 0£:£0 60-L L-L L02 e ... ��.J t GI?!•fiyi-lli.:tGGi� �.�•�fG::i-irk;:.�d+:i +4�• Circe of Ccam-urAflitirs&8asism Regutxrion .MOME MPROVEMENTCONTIRAC. 3 Y 'b t;�w Registrattws:.•126893 Tyre: Expiration, 43r*2 Suopien.eml t Ti,e Nome D" k4 ione Services UARREN QFMFkS 2690 CUMBERLA,VO PARKWAY S �S".•�-.o�. :a 7UV %CA 30339 Undersecretary License or registration valid rer individtd use only Wore the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ]0 Park Pia2a-Suite 3170 ;art± Boston,MA 02116 Not valid witbout signature TOWN OF BARNSTABLE_BUILDING PERMIT APPLICATION Map I Z6 Parcel .q. Application Health,'Division j' Date Issued t� O Conservation.Division , �� Application Fee Planning Dept. Permit Fee GO-' Date Definitive Plan Approved by Planning Board �G Historic - OKH Preservation/Hyannis Project Street Address 127. iZ t t t f Wft Village Owner C I (Q vU� ddress Telephone �--t{ �2( 34 n � F Permit Request C=Ck Re&L tc( Is« L I.f }- �it��I t lJl x Square feet: 1 st floor: existing ` LOproposed 2nd:floor: existing proposed Total newZi Zoning District Flood Plain Groundwater Overlay Project Valuation �-�� 0. o , Construction Type L)100-J Lot Size 0 - J Grandfathered: a Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .)W Two Family 0 Multi-Family(# units) Age of Existing Structure l q 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 8�Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 5U Basement Unfinished Area (sq.ft) 1 ,4,0-0 Number of Baths: Full: existing new Half: existing ? new J Number of Bedrooms: _ existing new Total Room Count (not including baths): existing / 1 © new First Floor Room Count- 6- Heat Type and Fuel: 5KGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes �No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes JfNo Detached garage: ❑existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: t o isting _Vjnev�8size_ Attached garage existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' ZE o I ---� co 2 N 'n co Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ CO -a ;7 Commercial ❑ es ' No If yes, site plan review# y w � Current Use 1 aeli&(!5— Proposed Usern APPLICANT INFORMATION D (BUILDER OR HOMEOWNER)- — - - Name rri Telephone Number I Address ,r's-ol-4- RI (Z License U-3 eC c O CT- tv Home Improvement Contractor# 1433 !;-9 Worker's Compensation # L. 45-7614-7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO C"��L4k- 1 SIGNATUREX DATE to Z Lo s{ 4 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' x ADDRESS VILLAGE i OWNER t 'I " DATE OF INSPECTION: = - � I FOUNDATION at`it FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ti PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED�OUT j ASSOCIATION-":PLAN NO: } 1 Town of Barnstable Regulatory Services IlARM3TA�L..� •. Thomas F. Geiler, llixector Building Division Thomas ferry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 0260I' www.town.barnstable.ma.us 'Office( 508-862-4038 Fax: 508-790-6230 PLAN REVIEW 4;!- 0 Owner: -f41E�A� Map/Parcel: 2 Q ©� Project Address�2 K�15V &4Y Builder: C/4-6��-C.�SZ�-� The following items were noted on reviewing: 7T/9 7'G A YCO W EiC>t" /`l E'Qc.e-l 0 e-6 G G vivC�e E � K��yc fCk.q-sic� . pGC 7'U Aff-S . C-o 60,75. 7o - K►4-wLL . Reviewed by: Date: / Q:Fot7m:Plnrvw 7'Jlie Commonwealth ojMassoclittsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dle Workers' Compensadon Insurance AMdavit: Builders/Contractors/Electricians/Plumbers AboUcant Idor`madon Please Print Le aibh► Name(BusinesdOrganizatiotvindividualy Cam'-r't✓Vl i)C �/Zr✓a�j?�S L`54-�-1� Address: 1n_ . y 763 CityiState/Zi p:_1 17 i �/�/�-01�(/J��phone AI: <_0 9 42,9 �l 2 k" Are you in employer?Cheek th appropriate bo:: Type of project(required): 1.P—! am a employer with 1 4. 0 1 am a general contractor and I 6 New construction employees Mil and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship.and have no employees These sub-contractors have 8. 0 Demolition working for Me in any capacity. enployees and have workers, (No workers'comp. insurance comp. insurance.$ 9. 0 Building addition required.) S. ❑ ,We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.(]Roof repairs insurance required]t c. 132, J I M,and we have no employees.[No workers' 13.M Omer �PLi4 , Oe _ CORP.insurance required.] Any appHant dot checb boa Nl rtwt also flg out the section below showing their workers'contpenudon poNcy infonnsdoa.• Homeowners who submit this a8ldevit indicating dray are doing an work sad then hire outside contractors must submits new aMdsvitindiating x dr. tContreetore dat check this box.. attached sn eddidanai sheet sbowin j the name of dye subconascton and stata whether or not those entides.have ergioyees. If the subcootnctorf have e11101yee N they must provide dm* workers'corm.policy number. !`gas an MWIdyer that is providing workers•coatepensedon Insnraatee fer my ernpbyees: Qetew b the poUry andlob"w injormadoat. Insurance Company.Name: Policy q or Self-ins. Lic. N: Cds—](p 14-71— Expiration Date: 0� � ) lob Site Address: /2- ILLS 7I U/,4y —City/state/Zip: ,(l L,& Attach a copy of the workers'compensation policy declaration page(showing the policy number and e:piradou date). Failure to:recurs coverage as.required under Section 23A of MGL c. 132 can lead to the invosition of criminal penalties of a fine up to;S 1,500.00 and/or one-year it prisonntent,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 thit_a copy of this staterment may be forwarded to the Mice of InvestiQatiorn of the.DIA for insurance coverage ve"cation. -1 do hereby cerd#ender the pales and peeeltles ojperlury That the injormaden provided above Is true and cor►ft% Rhone Offtclefuseanly. Do not write in thk area,to be contlr err c or town off klat City or Town: Permlt/Lkense 8 Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Pown Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone M: DATE(MMIDDIYYYY) .4CORD, CERTIFICATE OF LIABILITY INSURANCE 0411512009 PRODUCER (800)782-0251 FAX (781)261-2099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 77 Accord Park Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Unit Bl Norwell, MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED Capewide Enterprises LLC INSURER A: Hanover Insurance Co. 22292 PO BOX 763 INSURER B: ACE USA Centerville, MA 02632 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA 7DD'LTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY LBN5336555 0413012009 0413012010 EACH OCCURRENCE $ 1,000,00q [!�, MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,00 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $ 10,00( PERSONAL&ADV INJURY $ 1,000,00t GENERAL AGGREGATE $ 2,000,00t GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00t POLICY PRO- JECT ' AUTOMOBILE LIABILITY. TBD AUTO 0412012009 0412012010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,006 ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ . X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UHN5336545 0412012009 0412012010 EACH OCCURRENCE $ 2,000,O0 OCCUR CLAIMS MADE AGGREGATE $ A 2,000,000 $ 2,000,00 DEDUCTIBLE $ X RETENTION $ 10,0O $ WORKERS COMPENSATION AND C45761472 0411412009 0411412010 VbC STIATu M T OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,OO B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,OO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,OO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Barns tab 1 e 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Division BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main St. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ` Ronald C7eaves/KC1 ACORD 25(2001108) ©ACORD CORPORATION 1988 _......... ��e.�Dommzo?zureal!/ � � .\ Roard of Builds ftRegulations and"Standards MO1NE'IMPROIGEMENT CONTRACTOR 9'4335'8 -- 8/3010 TrJF 272627 se( iabiliri.Corpor - G`..",':�7`�t�925�5 Aiitnrnistra.tor . ---------------- i License or r. :rstration valid for individul use only before the ex p.►*00n date. If found return to: Board:of Buil.` g Regulations and Standards One Ashburtoi►Place Rin 1301. Boston,Ma.OUD8' iI. `lid with`uttt iviature • �. '✓,ze "C�om�7zo?u��,.�aaac�iudell4 E. . ' IIo'and off$uildrngRegplatl ns and?S�andands ,. 6onstra:ction S.upervisorttcense. Ube--se C:S '8.9273 y ;fix 1l2Z12009' Ti# 11t09D N. � � CQTbU;IT tya3A��02`6�35 "�-'" Co'mm•iss�ori'er . -. i ;� asua,dq siy;}o<uo►;eo�na.�.�o3,asnea s►: . I •' � �s asn,aesse,• � . - a.y�;o uo� i;'pa4uasa�na.a ssa'ssod.oq<anite�,y; ' sa:wgH:il!:ure3 Z T- )IT G • is - aaeds_pasola,aa �.QOU`9, A �oFTEr�y TOWn of Barnstable ' Regulatory Services r r BA NSTAEM y Mess $ Thomas F. Geiler,Director. TEoruc" - Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b a rn s to b le.m a.u s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign Thais'Section If Using A Builder 1. V . as Owner of the subject property hereby authorize I)6— 6/1 1LbUSE-75 to act on my behalf, in all matters relative to work authorized by this building permit application for. 2 l�IL15-7 �C-- (Address of Job �4. 10 12,7 U Signature of Owner D to p icl�` L T vL IW Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th'e reverse side. Town of )Barnstable �op THE rgyy . . y o� Regulatory Services Thomas F.Geiler,Director • aAHNSTABM M" Building Division Y� 16.19- Tom Perry,Building Commissioner . 200 Main Street; Hyaffiis, MA 02661 www.town.barnst2ble.ma.us face: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMMON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# ,• work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelEnl3s 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 Persons) who owns a parcel of land on'which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a fwo-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) i 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/sbe will comply with'said procedures and requirements. Signatvrr.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 Constriction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions -f this section (Section I D9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such 'lork,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption aim unaware that they are assuming the responsibilities of a supervisor(sec Appendix Q, .ules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly ,hen the homeowner hires unlicensed persons. In this ease,our Board cannot proceed against the unlicensed person as it would with a licensed upervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her art of the pa7nt app responsibilities,many communities require,as pilication, .at 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 r Waal towns. You may care t amend and adopt such a form/catification for use in your community. c— Teo Pasc_ �Gcl►t. 2t✓Pc.2c r,- EXf sT t ej 4:) -------- ��ctSnNC� Ut,C.K- L Z I��15ti1 w w slyA?sot3 1-1c4lawe es `7 i�q� Plrif dill I It I I IV J�'i LC: �cc) TUF3CS ``j� co NC Kt. ``z" c n Na b 6c kC ��F1KE Town of Barnstable '�Permiitt N Expires 6 months fran issue(tale ca Regulatory Services Fee l EBMRN rtisr..e. � M6� ,�$ Thomas F. Geiler, Director 1639, Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-770-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y Not Valid without Red X-Press Imprint Map/parcel Number / I tF Q 0 p Property Address / -Rtesidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address G- Ll k-c Contractor's Name y) ( an.S L Telephone Number 7;;7�-, fly Home Improvement Contractor License #(if applicable) Y1 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance �y Check one: X-PRESS PERMIT ❑ I am a sole proprietor ❑ dam the Homeowner JUN 2 9 2009 0/I have Worker's Compensation Insurance I TOWN OF BARNSTABLE. Insurance Company Name �iT . Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) P/Re-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. 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: , ty Owner must sign Property Owner Letter of Permission. ome Improv ment tractors License& Construct Supervisors License is required. SIGNATURE: , L2% U Q:\W PFILES\FORMS\Express\EXPRESS PERMIT.DOC Revise06O4O9 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLfibly Name(Business/Organization/Individual): Address: R/ City/State/Zip: i Phone.#: P F 776 F y/t° Are you an employer? Check the appropriate box: Type of project(required): 1.LJ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner-' listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y P tS'• t 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 11.❑Plumbing repairs or additions myself. [No workers' comp_ right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � P✓ Policy#or Self-ins.Lic.M Expiration Date: Job'Site Address: /p /` City/State/Zip: OE 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 statemetit may be forwarded to the Office of Investigations of the WA for insurance coverage verification I do hereby certify u er the ains and enalties of perjury that the information provided above is true and correct Si ature: /Iti✓t Date: —�— Phone#: 041 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instaructions ` 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 tiustee 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 N%zth 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-contiactor(s)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"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 lled out each applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fi year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of ln.dustri,al Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 ar 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia 01/26/2009_ 15:35 50842U44 r 4 """""- 2/002 Fax Server, RightFax C2-2 1/13I2009 4:00 :51 PM PAGE r::. DATE ilgoog is ,iG 'r cL4 ; Moe—, ;;.,-•,•,n ^:�2'�,oS.;.- pe%2•.: t2.::.''; �,•,:1.: ;y r;i;>.: :ti � �� w INFORMATION UNLY i i;o>!?j.2 t ;r,v \v,i... ,.?. �y CERTIFICATE lC 1CNED AS A'tNA7TFTIFICATF HOt DER THIS ANDCONFS..R-4NOR1Ft3TSUPONT[�.CER �,��r�„�RAGE PRU17UCkR CrRTtF1CA76DOESNOTAMEND N !q AFFORDED BY.THE POWC-II=•S WOOa M4PANTYb A RDWG COVERAGE EDWARD A GRA7,.U'LINSURANCr' DERWRITERS JNSU 125 ROUTE 6A COMPANY A F;,ARTpORD UN SANDWICI.I.MA 02563 IOR [}I''I corownNY B MF INRURED L.RZ rDR RLT CONSTRLICCION INC coMPANY C 31 MANNI.CIRCLE �R , coMPn.�n' D V1.IIE 02632 LETTER Y CP1`ITER M.A coMrAN E, R7T{EPO].1CYPERfAD is2 i:;::;:;:..:;:o:.:i;{:i::;::i;•::i;�•n:;i ':jf 5 LfiITL• VI., W 1CHTIl75 5 >�:::di:6;;.<::; `:.:::•:..:•:c•.>>:e•::;:.... Nm[RESYEc[TO H TERM OR CONDIT lON OP ANY CONTRACTOR OTHER DOC[JMt M THIS TO CPRTQ'Y TH AT TtiE PCIt.ICIL3 Or 1NSURA)vCR!LISTED RFTAW N BEEN 1g51IPD TO TH2 WS INDICATED.N07WRTIST�DINO ANY REpU1RI • THIS 13 ICA TH MAY RFS 1SSUEA OR MAY PERTNN, R DVSURANC=AFI'ORDtID BY THE 1?OLICIQ3 DESCRIBED N.t'RP�N is SUAI' TU ALL TILL TERMS• F\LCLUS[ONSANDGONDff1ONSOFSUCYTPOLIC)'%.UMtTSSHOWNMAYHAVEBEENR®UCEDAV Pm,CYTMS �n71T5 POLICY NUM. ER POLICY CO TYPE OP INS(JRANCL F•FFI.CTIVE DATA EXPIRATION DATE LTA 41YY Mtxf/DDIYY I oaNCRALAOORCDATf S FRODucn-COM17- ADD. GENERAL LIABO•TTY YflRSONA1.dApV•INIURY � (1 coMMBRCIN•DnvSRnl..LI nR11a7Y ¢ , mCn OCCURRE14a, 0 CLAIMS MADF 0 OCCUR. 0 OWNER'S?.CON TRACIOR'9 PROT. fIRS nAMADL(Airy Arc T(rcl MIID,gXPGNSE(A plr.Imon $ 0 COMBINED SINC(LQI.JMIr � AUT051013lLF•1 IAB[LiTY 1 yODIL,Y INJURY S 0 ANY AUTO (FoFcrxorj 1 0 ALL OWNEDAUTDS 1 BODILY INJURY 0 SCHEDULED AUT(K (Pr.r AccmcrM 0 III RPn ALTOS pRpIfRTY Dnntnou 0 KnN-OWNED AUTOS DnRAcs unB%JTy 0 BACH OCCURRQNCI' S EXCESS LIABILITY S ApORsantls 0 UMBRliLLA TORM arrtJQR T•JAN UMDRBLLA IORnI r STATUTORY LIMITS QACbt AOCIDGNT $100,000 WORKER'S COMPENSATION DlvtnseMIJCYI•JM(T 5500,000 " 6360U13- .12-24-2006 12-24-2009 AND 1051C045-08 DISEASE.fiAaEMPLOYES $100,000 EMPLOY.RR'S LIABILITY OTHRR THE SOLE PROPRICTORIPARTNLR(S)ARE. INCLUDED X EX-IIUDED OTI[ER 9TA1'E7 INSURANCE ENDORSv tVT AUJ•HORIIS9 TITI;pAYMaJYT OP REN'F•sT(S FOR CLAIMS nivgCiUOTION OT OP�RATION�((JCn710NSNI+i►C1 fSSFEC•tnL m(M9 9IN ANY STATr•OIttBR 7TIAN MA IP 711E TriE 1N5UR'n.&MA WORKERS COMPEWTION POLICY A,7D rt9 L1Pt[TiiD Rn.AT10N t9 OIVP;Y TO PAY C1AIA79 J*OR DET?;F1T A MA VWI MTJrlt IN STAMN OmIlI A THA_THIS FOLIC\'IIM NOT MOvmV.COV dRAGR FOR At, STAT(?OTIIRR THAN MA• MADERYTTI8INSURED I AFLOYEE9OUTSIDEOrNI INAMRD tt1RE9,OR HA9 HtitlJ>� JOB: AT 25'EIUCKINS NECK R1�CENTERWI-LE M.A Lo�nnv¢ GwoRtlIIlte tp covJ�r(n nflslte CRSANY CtSRntTc 1381fEDTD CKR11MCAT :t>:;`v.;2634 i�:4 ti :-c:iij:,:iP:��':`::;.��-.;;:y_S:t;:>.•,'•:•:��:�::::6. c•:6>:.:;: ;2;i:;>:?::`;�:;: ;;.:: 15 :.. ppuCIFg0SLANCSLLED0'I!rK RTrre A ' ?:�; ......... i`; ii n; SHOULnnNYOFTHrAnOvEDES(TUPtGD ANY WILL QNDrnvORTOMARR- • -•� - P TxBISSUINGC .,••••••• FX^MRAyT�IONDATH NOTCO . TOWN OF A ARNSTABLt� �y,�\vRri7EN NOTO(TO THE CTRTiF7CA1B-END NAMED TO THE,I.ICAT. R�pA'{,URCTaMAJLSUCH NUrflKSItALL IMPORR NO 08U R6PRESE TATIVRS 367 MAIN ST LIARn ITV OR ANY KM I-TON TII6 COMPANY ITS AGENTS, F(YANN[S MA 02"t Alml a, RBpRJa tisAnrs WMEM C4SML-031CL�2 fir, :5•,<•: •; r• .:o:. :o:��"rF:?�s:�?'%;�_: I License or registration valid for iridividuj rise onl before the expiration date. If found return Board OfBuildin g to: Y One Ashburton Place Rm 1301 and Standards % Boston,Ma.02108 • i } i of valdyithout signature 1 • ` it --- ;`"if�_--_ -- -- — -- '� airvireoouue o� Board, ' wilding Regulatiobs and Standards ,r • HOME IMPROVEMENT CONTRACTOR I Registration:, 134286 E•"xpi[afio.n=10/22/2009 Tr✓l 133426 Q A —Type:=DBA- RLT CONST. INC�R DERIA-111S, U. Sh`IIDING&ROOFIN RONNIE TAYLO �r ;+ 31`MANNGCIRCLEno�� CENTERVILLE,MA 02362 AdmiriistratdY ' rYl'"'"chusett-s- Dejru-tment of public Safet,1 Bo:tr d of Btiildin', Regulations and Standards Construction Supervisor Specialty License License: CS SL 99910 Restricted to: RF,WS RONNIE TAYLOR .31 MANNI CIRCLE _ CENTERVILLE, MA 02632 Expiration: 10/26/2011 ' ('unuiiissiuncr Tr#: 99910 I Island'Siding and Roofing a division of ELT Construction, Inc. 31 %anni Circfe Centerville, VA 02632 Richard Tucker �-`" f ! y� March 14 Ri , 2009 12 Kristi Way Cell j�rj�s—562 Y<< 291& W. Barnstable, MA 02668 We are pleased to submit the following specifications and estimates for reroofing: Remove existing shingles. Install aluminum drip edge and pipe flashings. Install 3 ft. ice shield to eaves, valleys, chimneys and interwoven with step flashing. Install 30 lb. paper to remaining roof. Install 30 yr. Certainteed Landmark architectural grade asphalt shingles. Install ridge vent to entire roof. Clean up and haul away all debris to landfill. We hereby propose to furnish material.and labor - complete in accordance with the above specification, for the sum of- Eight thousand five hundred dollars.....................................................$8,500.00 Other repairs: Replace rotten trim on cornerboard ...................................................No Charge Terms: No deposit required. Payment in full is due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction, Inc.carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature ` L Start Date: `t- Signature Telephone 508.420.5243 and 508.776.8914 'Facsimile 508.420.1776 Town of Barnstable "o Regulatory Services BMWffrABM Thomas F. Geiler, Director 1639. p Building Division jE0 MA'S Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 June 9, 2009 Mr. and Mrs. Richard H. Tucker 12 Kristi Way W. Barnstable, MA 02668 Re: 12 Kristi Way,128-008 Dear Mr. and Mrs. Tucker: We have received a report that you have a family member living in an apartment in the basement of the above-referenced property. Using a single-family residence as a two- family home is contrary to the Town of Barnstable Zoning Ordinance. To bring the property into compliance with the Zoning Ordinance, you may Apply for a family apartment Apply to the Amnesty Program Restore the property to a single-family home If the property is the year-round primary residence of the property owner and family member, applying for a family apartment might be your best option. Enclosed is a building permit application for a Family Apartment Without Construction along with the section of the Zoning Ordinance outlining the conditions and requirements for a family apartment. Please call me at 508-862-4039 to discuss the necessary steps towards compliance with the Zoning Ordinance. Sincerely, Lois Barry Division Assistant c: Robin Anderson Zoning Enforcement Officer falet Parcel Detail Page 1 of 3 THE ,f( 4 FAR1SEAn1 E. -- yw A• ArE aii J" i Logged In As: Tuesday, J� Parcel Detail Parcel Lookup Parcel Info Parcel ID 128-008 ( Developer LOT 12 Lo Location ,12 KRISTI WAY I Pri Frontage 206 Sec Road I Sec Frontage village WEST BARNSTABLE I Fire District W BARNSTABLE Sewer Acct I Road Index 0848 v Y ANI Asbuilt Septic Scan: Interactive 128008 1 _ Map �-,) � t rr- 1_ Owner Info _ owner TUCKER, RICHARD H & PATRICIA L I Co-owner streetl 12 KRISTI�WAY� I Street2 city�W BARNSTABLE I State MA zip 02668 Country SUS Land Info Acres!0.83 use Single Fam MDL-01 I zoning RF Nghbd 0105- Topography'Level I Road Paved Utilities Water,Gas,Well I Location Construction Info Building 1 of 1 Year---73 __ _I Roof Gable/Hip I Wood Shingle Built Struct' Wallall Effect f3083 I r,Asph/F GIs/Cmp I AC None Area Coveover Type Style Colonial I Wall Drywall I Rooms 5 Bedrooms Model Residential �I Int Hardwood I earn 2 Floor Rooms Full + 1 H Total Grade 'Average I Type Hot Water I Rooms 10 Rooms http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8199 6/9/2009 Parcel Detail Page 2 of 3 w" I" . i l$ 4 ` Heat Found- stories 2 Stories Gas Poured Conc. 'Fus Fuel ation Bias Permit History Issue Date Purpose Permit# Amount Insp Date Commei 03/01/1990 B33560 $12,000 01/15/1991 00:00:00 WB ADC 04/01/1973 B16067 $0 01/15/1974 00:00:00 MM 2 S1 - Visit History Date Who Purpose 02/22/2007 00:00:00 Paul Talbot Cyclical Inspection 02/10/2000 00:00:00 Paul Talbot Meas/Listed-Interior Access 01/15/1991 00:00:00 ML Sales History Line Sale Date Owner Book/Page Sale P 1 05/28/1998 TUCKER, RICHARD H & PATRICIA L 11459/149 2 01/15/1995 WNUCK, GEORGE P & LEOLA TRS 9528/247 3 10/15/1985 WNUCK, GEORGE P & LEOLA J 4740/328 4 TESSEIN, TERRY C 3014/199 - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parc( 1 2009 $267,600 $2,600 $900 $159,000 2 2008 $276,600 $2,600 $900 $165,700 4 2007 $272,400 $2,600 $0 $165,700 5 2006 $247,500 $2,600 $0 $180,100 6 2005 $221,500 $2,600 $0 $163,700 7 2004 $180,100 $2,600 $0 $163,700 8 2003 $158,500 $2,600 $0 $45,800 ; 9 2002 $158,500 $2,600 $0 $45,800 10 2001 $158,500 $2,700 $0 $45,800 11 2000 $111,300 $2,500 $0 $46,100 12 1999 $131,300 $2,500 $0 $46,100 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8199 6/9/2009 Parcel Detail Page 3 of 3 13 1998 $131,300 $2,500 $0 $46,100 14 1997 $134,100 $0 $0 $41,500 15 1996 $134,100 $0 $0 $41,500 i 16 1995 $134,100 $0 $0 $41,500 17 1994 $120,100 $0 $0 $29,000 18 1993 $120,100 $0 $0 $29,000 19 1992 $136,800 $0 $0 $32,200 20 1991 $128,200 $0 $0 $64,500 21 1990 $128,200 $0 $0 $64,500 22 1989 $128,200 $0 $0 $64,500 23 1988 $93,800 $0 $0 $29,700 24 1987 $93,800 $0 $0 $29,700 25 1986 $93,800 $0 $0 $29,700 i Photos i i ■ http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8199 6/9/2009 ; My File Edit Tools Help i Year/Type/Bill No. __ _. _. _. -._ ._.. Customer account information History :...�?' Detail TUCKER,RICHARD H&PATRICIA L _ - __ Propertyinformation. 12 KRISTI WAY i� Orig Bill Parcel ID 128.448 W BARNSTABLE,MA426s8 Aft arc Effective Date Prof Loc 12 KRISTI WAY p Lien/Sale ;� � rF((�Special Conditions/Notes (� Scan Bill - ` Quick Entry Int Dt Billed Abt/Adj Pmt/Crd Interest Unpaid bal tI — 48/42/48 784.60r_ Utility Acct ---- 11/04/48 -1� 784.aS1 _. _ _ 4 _ 784.-%'.I �� _ _ 44, Customer 42/43/49 838_75 `Of�� 838._ i - - 44 i — _04 838.74 .44i� 838.74'E 44 � 40 Name r_ _ -- - 04f _ - - —WF 04(� 04 Paroel� , fees/Pen - Totals 3,246.fi8 J _ 001i 3,246.68 44', r� Prop Code _ Notes/Alerts Due 46/09/2049 .00 Billing Dates Per Diem - .44 JAN 1 Owner: TUCKER, RICHARD H& Bill Audi Int Paid 04 Reprint , I�d ti fear prior unpaid tills { Preferences I . � ... (; r gg j 1 of 15 s Display transaction history for the current bill. Assessor's office(1st Floor): 7 P Assessor's map and lot number �a a a � r—• O*TEE>O Board of Health(3rd floor): Sewage Permit number /// f 7;? �n Engineering Department(3rd floor): SEP=i SYWEDA Mu S AXE /a� - fit' LO, _ • House number FJ� � ��`"'Il��"�-�® G��°e®�+�F � so. Definitive Plan Approved by Planning Board 19 WITH U ITLE J APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only '�if�� :MENTAL CZ, TOWN OF BARNSVNEVEE IGM,�� BUILDING, INSPECTOR APPLICATION FOR PERMIT TO --o r "f l 1,c, G-1 TYPE OF CONSTRUCTION \.,A,'^Q V �C-Cx.$AA {� 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: � Location y` Proposed Use �" �'C- 4 (� ,( Zoning District �1 � Fire District Name of Owner Wa tilCk Address .� t'e - 73 Name of Builder /� rc � `AiF ��6-,c- '2�< Address �v t'� k h = _�fsa_�Y►��J �'� I -;L- Name of Architect Address Number of Rooms r Foundation Exterior Roofing�1•��"` t Roofing A Floors ��i� C _t! C I.r-i�3 Interior (A,, u Heating t� �� ' Plumbing Aj O �1 Fireplace N Approximate Cost J. Area 3'01p� �d Diagram of Lot and Building with Dimensions Fee �- 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. ' n - Name Construction Supervisor's License 7 . �NUCK, GEO. & LEOLA / 'S 33560 No Permit For Add to F.xi st , Garage Accessory to Dwell ; nq Location 12 Kristi Lane - t S West Barnstable Owner = Geo. & Leola Wnuck Type of Construction Frame Plot' Lot Permit Granted March 13, 19 90 s Date of Inspection 19 Date Completed 19 I- u . r. . 4 _ . i Ia F JWNt`Q,$ K.c1D WN 52 So!57`,-: Tel e 3�, z 9P ( � l�7 5ep#-ic. •i+�.l,.. . ; •`�r�h^/�oQo4� .. ' , .• I 1 A , it c 'N •.1 �s �q�,3D. • ay �`Z J � k FG•$. • � � . ��`�H OF M,�s f9c GEORGE y� o J. • IANiDES H = No. 2.2723 Q AFCIST Ea�o 7'Se •h�t`+�r•.�`/ .S/S�K'!,} e1rlf �/1/s '/"in/'j ... �M,Q( �AR� iS �'JT /I) inG /ci00� !S!��arn'/ ,Q/�`!. � - • ,yUD CL�n?�rl�nr� P�i�c/ '��SaaO�� aoo.5'A •�; C"mf-orme,� 7�6 7'i e- Z6n��9 zews. D 72- wit o B�rns ►L!� wl3en Cdns�rUc�c� p o r �> Lf1N.D. .%N: u(/,EsT 8.IeAIS rA2C MA '. ore CAS 'Cat�UQ�i E Y !,15 BK 361-1 Yy• 19y 2 3 9. ,: /37 . _.' =o�T L�4x i Fs k. F�r�P ejt*VEro,Q )V.,.K1,.114kmew rj+ MA , Assessor's office(1st Floor): Assessor's map and lot number `'/�� Board of Health(3rd floor): fig 40 Al Sewage Permit number ,011/,f1 d Engineering Department(3rd floor): ,S ;DeaMAA&STA t J r/ua House number �O 2639. Definitive Plan Approved by Planning Board 19 �arrr s APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE rv. BUILDING INSPECTOR =_J ,,+� ff APPLICATION FOR PERMIT TO 14Jff f D E v f a rI A- TYPE OF CONSTRUCTION I or 19 �f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location o). r\S cc k/J, 6 aICI\A—J-Zk"L t= Proposed Use J t" Zoning District Fire District Name of Owner C,eo. A t-'e oL a W Il u Gk Address I f\S Name of Builder M is Address ��' 3 `� S 1.�C-L Name of Architect Address Number of Rooms Foundation � 11-- Exterior � F �s C �` ` `S (tS Roofing 5'�`C;J r � A Floors C 0 N c< �c. Interior L r` �^, t 5 t � � Heating Plumbing /\j t Fireplace jQ 11 Approximate Cost' l O o Area �� Diagram of Lot and Building with Dimensions Fees) �- 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 d WNUCK, GPO. & LEOLA A=128-y000 No 33560 Permit For Add TO EXISTING Garage Accessory to Dwelling Location 12' hristi Dane W. Barnstable Owner Geo. & Leola Wniic-k Type of Construction Frame Plot Lot Permit Granted March. 13, 19 99) Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/� t TOWN OF 'BARNSTABLE EARNSTAM ,639� am AV BUILDING . INSPECTOR APPLICATIONFOR PERMIT TO ................................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... . ........................ ...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... . .......... Proposed Use D.ale/.p 24.1 ... ........ .. ... ... .................................................................................................................... ......................... ZoningDistrict ........................................................................Fire District ................................................................................ Name of Owner C/....................Address ................................................. el Nameof Builder ....................................................................Address ............................................................................. 0 Name of Architect ..................................................................Address .......................................................... GL Number of Rooms ......... .......................................................Foundation /A........ U-1)............................................ Exterior ..... z t......................................./ .....................Roofing ............................................................... Floors ........ 19-e... .......................................................Interior ........ Heating .......................................................................Plumbing ....... r .1�. ................................................................ Fireplace .... .................................Approximate Cost ... ........................................... Definitive Plan Approved by Planning Board ----------- IS-7;1 Diagram of Lot and Building with Dimensions `% O �- SUBJECT TO APPROVAL OF BOARD OF HEALTH �2 W 1. i Ci W \J, .J a 0 7) L., > F- _j t= 5 0- U-1 re I hereby agree to conform to all the Rules and Regulations of the To /of Barnstable regarding the above construction. ... ... ... .. .................... Name .....):��.av--O�......................... Jackson, Lee !6067 P-e -for .....twO..st.017........... No ................. Tmit ....... .... ...... single family. dwelling .............. ..... . .......... ................................. -9 Location .............11!........ ......... ..... . ............. ....... .�.W Owner Lee Jackson...................... ....................................... Type of Construction ............f ram.6.................... CA ...................... ......................................................... Plot ............................ Lot ................#12................. -Api il 4 73 Permit Granted'.............. ........................19 Date of Inspection .....................................19 Date Completed . ...... ... �e.101to :'PERMIT"REFUSED V ...................... ............ .......................... 19 ................................................................................. ............................................ ............................................................................... ............................................................................... Approved ................................................. 19 . ................................................................................ ............................................................................... �f 2�io 6L, S/ZS�drL Assessor's ma and lot number ..1.` ...-..8.p SEPTIC SYSTEM MUST 0111, OF ?NE INSTALLED IN COMPLIaA Se,. dgArmit number . ,. .fir . ...... �o WITH TITLE 5 • ENVIRONMENTAL CODE 9TsnLE, House number ..:...................................................................... oo M63s � TOWN REGULATIONS a•� TOWN. OF BARNSTABLE BUILDING INSPECTOR • APPLICATION FOR PERMIT TO .60)!/VtU. !CIpe ... TYPEOF CONSTRUCTION ...........W06AL.........T.. .�r......................................................................... ........................ ........a.�.�....19.. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...I..2......./.l.lf i.S../..I..........WY.............-.—M' .fil g .....�I....��................................................ ProposedUse ...kr.kY1.f?�,i}........S.U.I...I. .......... ...........�r7� .�j!Q-................................................................................ Zoning District .....................R ..........................................Fire District .............. ............................................... Name of Owner ....� 4...Ki ..........!.e:J.S .b�.....Address .12..K0.54I. I!l�/3.y...."'..1.'!E��fd�,/��f.�.�S .... .... • .... .... Name of Builder' ..:L lt.1} mwf� ......��NS Ue t...Address ..............1.�� -e2 �1iJ S S ................ Name of Architect ..77.1. .A..t.. y.....Hcyoaob......Address ..�r...... ....5... f........ .............................. ...... Number of Rooms .. l�Yu.y�. �l....� ../........` !......Foundation .....��qe.L CQWCt4.T'�................. Exierior ...IMbaU ......S`.Ie ......................................:.Roofing ....... 5 .�.IrI'+'L S N Isv .................................. . .. ................ Ca,vc� Floors :/ VAJ ..............�C f2...........�� Y.Y. .Interior ......J.l. 1;F II Heating .l -D..D......O.ug-...Z®K'1!r�....0 1!Gtt° Plumbing .......f!`J�1-fCK. -/- �/4"� y�, .................................................................. Fireplace /�1 QI.C.. ......Approximate Cost �® Qo0° )o ,. ................................................ Definitive Plan Approved by Planning Board -----_--_---------___ j .Y................. - -------19-------. Area ............ ... Diagram of Lot and Building with Dimensions Fee Ell. Jr0 SUBJECT TO APPROVAL OF BOARD OF HEALTH -7 7 L �1 I b o � ,6o 60 . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of 4Tnof Barnstable4reding the above construction. Name . ... . . ..�--,--..... i. TESSEIN, TERRY 2. Remodel & Add Ga,rageNo !8!�0.7.7... ermorJ . ..................... ► ...... ing;kely...P��e�lling........... ..... ............. Location Way WP UA ........... J.•- .� •l— Owner ..T%r?;y...Tgssein ........................................... Type of Construction Frame ........................................ ............................................................................... f 4- Plot ............................. Lot ................................. 11 , May 25, 7— Permit Granted ........................................ 9 82 _q Date of Inspection ......................... .......19 Date Completed ........... .....nlaq 4z) 1004- n L -A 000? L.0-1 ' 41 ula Assessor's map and lot number .. .��.!�....'.. ................ r' Seww. QyO%TH E age - ermit number ��... f x :... � .. -/...... Z BJBHSTABLE, i House number roo V 9 ♦� ........................................................................ TOWN OF BARNSTABLE BUILDING INSPECTOR OIL vei+- r' 1. Gene ��►�. .� �9, S� c� � APPLICATION FOR PERMIT TO ........... ............... .. ................ ..................... ................................. TYPE OF CONSTRUCTION ...........ldf.M.A........ �..................................v.............................. ..... .......................J`r......`.. .a......19.. : TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...L?.......J ,�1.C. . ........W.v..... '........A v�'1� �. !? ..... ..../.5................................................. Proposed Use t t VI fit .......: .�,.m. F......... ...........L 7!?;C 1 .......................................................I......................... ..................... Zoning District � ►1 .............Fire District Name of Owner ........................Y... .....Address �� A�� S"1 /�y Name yof Builder' ... .!cf......�U�?!SJUC1,...Address ............................. ��E' e � ,�1. .5................... crr. Name of Architect ....IJ �3 f.......... ...... .......Address Le�F.... l�fi'1f 4 rS .( ................................................. Number of Rooms wr 1.; `t...A. .)........`.. t�it�.......Foundation ....�(jtj......�' Covc(z-e4.e:........................................ ........... Exierior ...!AkC *.A ....................................Roofing ........i.�.5.o. .� . ......... LI..!�d �r?........................ Floors n..? <'` c i L`t ...........L�.�.��t........ .......Interior ..... ),lll t�.�✓t3 r .................................................... f...... Heating ......... .... ............Plumbing ........ ................ .. ......... ....... ............................... Fireplace . .��....................................................Approximate Cost ....... Definitive Plan Approved by Planning Board ---------------____-----------19________. Area ........... .................. Diagram of Lot and Building with Dimensions Fee e....� 77' ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH Lld 140 dQ11 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 '��tr A�4 �� N U ,.j�. ................ TESSEIN, TERRY A=128-8 No ... Permit for ....Remodel & Add Garage ........................ .......... Location .1...2......K..r...i.s..t...i...Way..... ............ e .............. ........................ Owner .....T g.K r_y...Tessein .......................................... Type of Construction ..Frame............................... ....... .................... ............................................................ Plot ............................ Lot ................................ a 5 y 2 , 82 Permit Granted .....M...................................19 Date of Inspection, .................19 Date Completed ......................................19 5o -7,y 00 0 c.,:;) Cot?t'e-'-f �6—�702) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map • V Parcel ;O ob TOWN DF BARNS TABLE* Application I A . lication . Health Division °t� 7 Date Issued Jr �� / 7 !�fA Conservation Division Application Fee pp� Planning Dept. Permit Fee (J D,II g7.)�� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village AJG_&57- Owner �i�i� �&UMW MX0 Ao,#fWG/19 Address /z ��i�T/� l/►�,�' Telephone ) Permit Request/a22drle Z �.t„9GGS //ZST l�t� �Ot� L(/L, j�J/Shy f�/IxYL/� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes bdNo If yes, site plan review# Current Use_51A 15 Proposed Use 12� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number lD r /� Address 3.2 6,b�X �. ^G!l' i2.0, d License # Home Improvement Contractor# 7 3 Email -44e_> gl"yc�p ��ca57Z• Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE f -= FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION • FIREPLACE ELECTRICAL: ROUGH FINAL 'F PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT I f ASSOCIATION PLAN NO. 17ie Cozanzolriveaf h of Missachmeift Depcarfifferrf afrndasfrial Accielerdis - f3,Bite afInvets igalims 600 Washington Street Gaston,' 4 02111 WFVIf+Ma—Tsgm1dra Workers' Cmnpensat rm.Insurance Affidavit Bmlders/ContraciursJElect icianslPlumbers Applicant Iufcarmatian Please Print Le��dy_ Name,(g IganrzadonrI diviIual} e� e�2 D� Address A0- y��ex.,W— Olt Lf 12.& �ityl tateJ ig �vA'dU /�'yi9 A a. Phone Are you an employar?Checkthe appropriate be= ' Tppeof project(ret uired): L❑ I am a employes with. 4 ❑Z am a general contractor and I 6. ❑New consfmt tica employees(fish andforpatt�ime * liavehiredthe sub contractors 2. F am a sole propiietof orgariuer- listed on.the attached sheet. I ❑'Remodeling soup and have no employees -contractors hake 9..❑Demolition rltinQ forme in an employees andhave workers' wo b y r.�city- 9. ❑Building addition 'LNa d-azFo=is''camp.in umace comp.insuranm rewired-]' S. ❑ We are a eorpotafion and its 10_❑Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or additions. myself-[No kers'gip- tight of exemgfion per MGL 13_0 Roofrepaim insulanceretfuired]i c.152,§1(4kandwehaveno employees:[go workers 13-❑Other comp.insurance required_li *Any WIjcK t&2t ched6boa in mnst also Moutthe sectioaberowshntaag 6rerwar3'seie a=pevsatiaupeHcyi=urmsuaa I Eoraemners who submit dais affidatt iafcating they are&=--au vratk 2Md,&&him outside cont=Mrsamst submit a new affidaryt in&cf—sac3_ rCan=Ctorst7aat chwJ i]us baX must attachzd saaddiSaasl sheet shouwfng thenazae of the snlrca atxw -m and stute whether ornatthose eaddesbave ¢oployaes.Ifthesub-caatractorshzve empIgyt ,thgymmsYgmvi&their workEW camp.poRU number. I air[an eittpIvyvr trsat;ispraviding ivarkers caugm csti on L-mirimce for ary.emprvy�eas $elow it trie polity•and job site inforaradom Insurance Company 1fame: Policy 44 or Self-ins Tic_4 F xpiratiauDate: Job Site Addre= CitylStatelzip: Affxcla a COPY of&e.vy ark-ere comp ens ation p oli cy de clara tion page(shaving the gouty number aad expiration dafO FaRnre to secure coverage as requiredunder Section 25A of MCL c 1572 can lead to the impositioa of criminal penalties of a fine up to$l,50QOO andror one-year impriso—p-nt as well as civil penalties•ia the form of a STOP WORK ORDER and a fne of up to MO.00 a day against the violator. Be advised that a copy ofthis statement.maybe forwarded to the Office of It-estsgatiom of the DIA for insurance coverage yMdffeation. , I do Ft ere )jr ri ircfornzadau prat vied above is tru8 and correct Date- Phone ii O� I3feral use andy, Da not write in this area,to be raispreted by city artoira official. City or Town: Feru itflricense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.CftyJTuwa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: -- --- - 6 ormation and lastruefiolas Mac h=:fLs Geheral Laws fifer 152 regaires aU employers to provide worker'campeosatian for their employees_ p this sty,an ezrrplayew is defined as-"_.eveay person in.th a sm-yice of another uader any contact of hire, express or mrpllDd,olal or wr hmf An empkyel is defined as"an mdxviffiA partnership,associafivn,corporation or other Iegal= dy,or any two or more of the foregoing=gaged is a Joint etrgase,and incl ding the legal regrescOt'iives of a deceased employer,or the receivar or trustee of an individual,paxtnelshrp,MoMafi=or ofhcr legal entity,employing=3:Ployees. However th" owner of a dweflinghorse havmgnotmore tin.tbree.apadments mdwho resides therein,or the occt<pant ofthe- dwelfing house of another who employs perscm to do mai to an=.conshuction or repay work on such dwe:Mag house or on the grounds or bMVIng apPurfena t thereto shall not because of such emplDyme�t be deemed in be an eanployea. MGL c3apter 152,§25C(6)also staffs that"everysfata-or local licensing agency shall withhold ffie issuance or rercewal of a Been a or permit to operate a business or to construct bvfldiags in the com-Dnrwealth fot airy applir_nt Who bas not prodnced acceptable evidetice of compfianoe with tfte inn n ce coverage required Additionally,MGEr_chapter 152,§25CM s -Neither the nor�y of ifs po]iiical subdivisions shall� enter rnstD any contract for the,peifarmancd ofpublicwolic=±E ac cTtable:.evidence of compIiancewiih the ins rmc6. reTimemMfsof_di ffiapterhavebeenpr mfrdto the contacting arrtfioiityf AppHcan-& Please tip out the workers'compensation affidavit completEly,by checking the boxes that apply to your sitnafion and,if necessary,simply sub-cou actor(s)name.•(s), addresses)and phonennmber(s) along with their certificafe(s)of m==ce. Livat LiabiI4 Comp=cs(LLC)or L=&-dLiabiiity Partnerships(LI P)witlrno employees other than the members or pazbneas,are not rbquired to carry wDc3re&compesrsafioa msoi-aace If an LLC or LLP dDes have employees,a p olicy is regrdzed. 33e,advised that this afFtdayit maybe sobmfiind to the D eparfmmt of Indnstrial Accidents for confMnation of inSU-woe coverage. Also be sure to sign and date the 2J=davit The affidavit should beretrmmed to$e city or town that the application for-the permit or license is being re aersted,not the Department of I1jastrial A cddmts. Shouldym have any questions regarding the Iaw or ifyou are rcgoired to obtain a workers' compmsafionpolicLplmse call thdDepar[mentatthannmber listed below Self-ins carapainr-sslLonIdctartheir. self-insrzr-ance liee�se number on the approgaate Line. City or Town Officials PIease be sure that the affidavit is complete and prilfied legibly. The Depa imenthas provided a space of the•bot=n of the affidavit for youtD fill out in the ever¢the Office ofTnvestia ans has to coniactyotrregng the applicant Please:besuretof71mthepermot crosenvmbes which wMbe used asarefwmcennmber. In.addiion,anapplicm3.tnt mat must submit muMple pea aWhcense applications in any givear year,need only submit one affidavit indicating con p olicy fmfbrm lion Cif necessary)and under"lob Site Adders"the applicant should write-all locations in. (�Y Or town)-"A copy of the-affidavit thathas been officially stamped or m-dmd bytare city or to maybe provided to the " applicant as proof that a valid affidavit is on file for futm 'pelmiis or.IIceuses_ A new affidavh mist be fIleri o'Ct each year.Where a home owner or citizen is obtaining a license or peamit not re7aird to any business or commercial vet (ie_ a dog license or pe nit to bum Ieaves etc.)said person is NOT rcTiied to complete this affidavit The Of of I VMt gabMS would OM to thank you in advance for your cooperatnn and shDuld you have any qum'�Lam, plsase do not hesifatr.to givens a caIL The I?epartmenf's adfms,telephone and fax number: 'ner f.GMM WM. Ift of 11 amach_us� . �of Ind�zal Acci��ts ffjce ofkVeKtE,do--� laa MA 0�111 Tf,-L 61 7- -4 Qxt 4-06 or 147 MA.S� Fax 617 727 77D Rsvised424-07 g -gD,�! a J AWC Guide to Wood Construction in Ffigh Wind Areas:110 mph.Wind Zone Massachusetts Checklist for Compliance(790 CMR 5301.2•I.I.)1 Q Chock Comprumce 1.1 SCOPE WindSpeed(3-sec,gust)..._........._._..-_.........................................___........_............ 110 mph Wind Exposure Category_._.._...... .. _.._ ... ........ .................................. __.___..._.._.. 1-2 APPLICABILITY Number of Stories _ ........... _..........._.__._(Fiig 2)._..........__........... stories S 2 stories RoofPitrtt ....._.._.__..._._.__.._ _ .._........ ._....._......__.(Fig 2)_.................._. .._.._........_ 512:12 Mean Roof Height _.-----------_----__. _..._..............._._._..(Fig 2)-.'.._._...-__. ' .._.r.._._...._. ft 5 33 Building Width,W._ -.-_._-_---....__ : .. ___.._...(Fig 3).•._____..__._...._.._..- _._. —ft 5 8(Y Building Length,L •_. ..............._. _ Building Aspen Ratio(UW) _.(Flg 4)._......_..._......._. _..._._. ......... 15 3:1 Nominal Height of Tallest Opening2 (Fig 56.8. 1.3 FRAMING CONNECTIONS General compliance with framing connections._.--_:.__.._..(fable 2)........................................_..._. _....... 2.1 FOUNDATION' Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete...............•......................._................•.-..................................:...._....... ••-•---------- .... _ Concrete Masonry............._............._.............._....... _.....__._._.__.._..-.._...._..__.........__-_.�.__.. ... 2.2 ANCHORAGE TO FOUNDATION1a 5/8"Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an altemafive in concrete only . Bolt Spacing-general........... .................. (Table 4)............................_.._........._ in- Bolt Spacing from endrolnt of plate ........ (Fig 5)......... _._..._•...... in.5 6'-12" _ Bolt Embedment-concrete.._.. _...__ _.__._...._._..:.(Fig 5)..._-.---_._..__-_---._.._._...._in.z 7" Bolt Embedment- (Fig 5).__.__._._._.....__. 6 PlateWasher............_.........._........__.__..........___._(Fig 5).._.._.........._............._......._.2 Y x 3"x'/" 3.1 FLOORS Floor framing member spans checked ....._............_..._(per 760 CMR Chapter 55)..._................... ......_..• Maximum Floor Opening Dimension_..____.._.._. _.......:.(Fig 6)..__.._..._:.._.._._.,�ft 512'or U2 or W/2 Full Height Wag Studs at Floor Openings less than 2'from Exterior:Wall(Fig 6)................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig T)__.._____..___.................... _...__._ Maximum Canfilevered Floor Joists Supporting Loadbearing Walls or Shearwatl................(Fig 8)........................._......................._ft S d Floor Bracing at Endwalls........................._..............._._ .(Fig 9)..................-._.._.........:..........._.._.,._._ Floor Sheathing Type ......_.._......__..._....._.................._..(per 780 CMR Chapter 55)....... Floor Sheathing Thickness..._..._.__ ___.... -...._.._..__(per 780 CMR Chapter 55).._................... in. Floor Sheathing Fastening.__....................................(Table 2)__d nags at in edge/_in field 4.1- WALLS Walt Height Loadbearing walls......._...._._.-._._..._..................(Fig 10 and Table Non-Loadbearing walls.........=......._........-..._.-_..--_.(Flg 10 and Table-5)-_._.._...._.._......._ft 5 20, — Wag Stud Spacing ....................._-_............................(Fig 10 and Table 5)...--w...._..._in.5 24"o.c• Wan Story Offsets .....__............._._._...........__.......... .(Figs 7&B)_...._..___........................ ft 5 d 42 EXTEmIOR WALLS Wood Studs, . Loadbearing walls........... _ .(Table 5)...................._....... Non-Loadbearing walls .. __.(Table 5)_.._..._.._......__..___2x--ft—in. Gable End Wag Bracing i Full Height Endwall (Fig 10)..._.__.•_.._..__...�......... ..._............:... WSP Attic Floor Length----------------- _.__... .. . (Fig 11). ....._.....___._.._. ..... ft>W/3 Gypsum Ceiling Length(if WSP not used)...__-:.. _(Frg 11)...... .._.........__..__�._._.. _ft z 0,9W 2 x 4 Continuous Lateral Brace 6 tt ma..(Fig 11)........................_.... Double Top Plate Splice Length : .______.._._...._..._...._.,(Fig 13 and Table 6)_...__.._....._.__.....___ft Splice Connection(no.of 16d common narks):.._._.._.(Table 6}.__.,.:_.._.__._......_...._...__._.. AWC Guide to Wood Construction in Sigh W.Frnd Areas:110.Wh Wind Zone Massachusetts Checklist'for Compliance(7so cxR s3o1.2.1.1:)1 ' Loadbearing Wall Connections Lateral(no.of endnalled 16d common nalls)...__..._.{Tabie 7).;...__._.__..._....._ .. _..._....... Non-Loadbearing Wall Connections Lateral(no.ofendrailed 16d common nals)—__..._(Table 1�. . ........__......_.._._.__.__... _._. Load Bearing Wall Openings(record largest opening but check ail openings for compliance to Table 9) Header Spans _.. _...__,....._._. (Table 9):._._....................._ft_in.s 11' Sill Plats Spans _.._._...._ _. _._......:. ._..__._.(Table 9) _.....___....._......_ft rn.s 11' Full Height Studs (no.of studs)__._.._� ._..__._ (Table 9j._.._ .._..__. ..__. Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans._..._...__._......_....... .. _.._..._.....(Table 9)__..__»_..___»._...__ it In.s iZ Sill Plate Spans...._......_.�__.__._.. (Table 9)_.._.._..__..__._.. ft_in.s 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' Sheathing Type. __.___.__.._..._.._ (note 4)......... ..... .........._........._._..._ Edge Nan?Sparing._..._.__.__...-....-.___..(Table 10 or note 4 tf less)_.._...__._.._._ in. - Field Nall Spacing........ _...-.._........._..�..(Table 10).......»_..._. ..___.._..�..._._. in. Shear Connection(no:.of 16d common nails)(Table 10)_.________.._._..__._.._.._._-...._.._ Percent Full--Height Sheathing..__..._* _.....(Tablel0)__�:....._..__. ......._..-_.___..._`Y° 5%Additional Sheathing for Wall with Opening>6't3'(Design Concepts)_.-_--.____._. Maximum Bulidmg Dimension,L Nominal Height of Tallest Opening?.__....-+................. _.. 5 6'8' Sheathing Type. .._....... .__..._......_ __— (note 4). ......_..__. Edge Nall Spacing....... (Table 11 or note 4 if less)......_.......:....._. in. Feld Nail Spacing..._,.__:...._._....._...._..(Table 11)...._.._..---..._.�..__....__.---.__... in. Shear Connection(no,of 16d common nails)(Table 11)._...___...�__.___...._.-.__...--_... Percent-Full-Height Sheathing..........__.......(Table 11).___»�_.._._.._ _° 5`Y°Additional Sheathing for Wall with Opening>6'8'(Design Concepts).......... Wall Cladding Rated for Wind Speed?_.__.._..___-............... 5.1 ROOFS Roof framing member spans checked?.._. _.._.._.(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ....._...........................................(Figurs 19).............._ft_<smaller of Z or 113 Truss or Rafter Connections atLoadbearing Walls Proprietary Connectors - Uplift --__..(Table 12).......... ___...___.._U= pit Lateral . ._.._..___.. ....(Table ........._...._._ p if (Table S=_plf Ridge Strap Cormecdons,If collar ties not used per page 21_.._(Table 13)._ ....._..__........._.T= pif _ Gable Rake Ouflooker......................................(Figure 20). ......... _ft s smaller of 2'or 1_2 Truss or Ratter Connections at Non-Loadbearing Walls Proprietary Connectors (Table 14)...... _.. _U= lb. Lateral no.of 16d common nags able 14 Roof Sheathing Type...__ ...._.___...___..... .- _.....(per 7a0 CMR Chapters 58 and 59)............ Roof Sheathing Thick ess_._.............._... _ »:...___.. .-,_...... .....__.__.. _in.a 7/16'WSP Roof Sheathing Fastening_........__......_..___.__...»(Table 2)_.._.._ ......_...�. _.�. Notes 1. This checkfrst must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 53012-1.1 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 Gaga Straps per Figure 11 c. Uplift Straps per Figure 14 d.• All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 ft:shall be permitted when 5%is added to•the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom si[I plate In exterior walls shall be a minimum 2•in,nominal thickness.pressure treated#2-grade. { AWC Guide to Wood Construction in Sigh Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(790CMR130111.1)t' 4. a. From Table 10 and location of wan sheathing and Building Aspect Ratio,determine Percent FulkHeight Sheathing requirements b. Wood Structural Panels shall be minimum thickness of T/16'and be installed as follows: I. Panels shall be installed-with strength axis parallel to studs. n. All horizontal joints shall occur over and be waled to framing. i fl. 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 tap 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 Sd staggered at 3 inches on center per the Figure, Vertical and Horizontal Naming for Panel Attachment ' f � I • I AWC Guide to Wood Construction in Hi,- ,A WindAreas:Jig mph WirrdZaae Awsachusetts Checklist for Compliance(790 cMTr 5301.2.1.1)' WHEW Tme EDGE RESTS am FftkW G ElSESd MU4. AT 5 b= ' IL • 1 � _IL �1 LI 1 LA i-1 Y f • t �1 II / Ir It 6Y H so n n z „g o .� Lr lu SL LJ n 1 1 Its ii it � 1 1 � It rl d u v • p ii i I � 1 1— • H f 11 to � 1 1 tr 1 T • s-x - '1F«•,r r —L ' IM&SPACM i M Sea DaWl on Text Page Vertical and Horizontal Nailing for Panel Atfachmenf r DIME Town of Barnstable ti Regulatory Services BMtNSTABLE, Richard V.Scall,Director • i639 `0� yen 59 Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us i Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property he authorize�� W°�'° to act on my behalf, in all matters relative to work authorized by this building permit application for. JAIA1, Wets (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. ignature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS OTREUERMISSIONPOOLS Town of Barnstable Regulatory Services' pfrt rq Richard V.Scali, Director Building Division 3A NSTAMA Paul Roma,Building Commissioner MAM � 163q. �� 200 Main Street, Hyannis,MA 02601 arED t+ www.town.barnstable.ma.us. Office: 508-862403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAII.ING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFE14MON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or-intends to reside,on which there is,or is intended to be;a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other , applicable codes,bylaws,rules and regulations. . The undersigned"homeowner"certifies.that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35;000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor.. The homeowner acting as•Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towng. You may care to amend and adopt such a form/certification for use in your community. Swanson Structural, Inc. Paul W. Swanson,P.E. 92 Acre Hill Road Engineeridg Services ' conu►eer,yal t M Barnstable,MA 02630-1529 Phone 508446-1042 residential . PauPSivansonStructuraL cons heavy tin►ber _..... € F ..... ..._ ..... ...... ...... _.... ...... ..... .... E Fi i ....._ ...... ...._ ..... ..... ..... 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Swanson, P.E. City, State,Zip:West Barnstable, MA Designer: 4A4 P$L POSTS Customer: Tucker, Patricia Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 5716 E't vit" Siu2 64ow-+t WPx 2/ j= 5., ,-4 4 Zed vik 2 (79J1-,57S_').z ro 7.¢ew� �� s s®116 � I ji I I { ili3 I � III ili lip � i i 15-05-00 130�4x� ��t. �3y,•`�a") Totai Horizontal Product Length=15-05-00 Reaction Summary(Down 1 Uplift) (lbs) Bearing Total BO, 3-1/2" 8,418 B1, 3-1/2" 8,418 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90%, 115% 160% 125% 1 . Bedroom Unf.Area (lb/ft^2) L 00-00-00 15-05-00 30 12 14-00-00 2 Wall Unf. Lin. (lb/ft) L 00-00-00 15-05-00 60 n/a 3 Attic Unf.Area(lb/ft^2) L 00-00-00 15-05-00 20 10 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos, Moment 30,544 ft-lbs 71.8% 100% 1 . 07-08-08 End Shear 7,019 Ibs 44.4% 100% 1 01-03-06 Total Load Defl, U285(0.63") 84.2% n/a 1 07-08-08 Live Load Defl. Li445(0.404") 8u.9 io r';;a 07-,,8 Max Defl. 0.63" 63% n/a 1 07-08-08 Span/Depth 15.1 n/a n/a 0 00-00-00 .Squash Blocks Valid %Allow %Allow. Bearing Supports Dim (LxW) Value Support Member Material " ' BO Post 3-1/2"x 7" 8,418 Ibs 11.5% 45.8% Versa-Lam 1.7 ` f. ,: L B1 Post 3-1/2"x 7" 8,418 Ibs 11.5% 45.8% Versa-Lam 1.7Dal Notes Design meets Code minimum (L/240)Total load deflection criteria. Design meets Code minimum(U360) Live load deflection criteria. �,;,\t Design meets arbitrary(1") Maximum total load deflection criteria. �,� Calculations assume member is fully braced. Design based on Dry Service Condition. Fastener Manufacturer:Simpson Strong-Tie, Inca 5 714 ops Page 1 of 2 Boise Cascade Quadruple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 bP door tseamxrseamui �J Dry 11 span j No cantilevers j 0/12 slope April 21, 2017 10:33:55 BC CALL®Design Report Build 5837 File Name: BC CALL Project Job Name: Tucker Residence Description: Desig9s\Beam01 Address: 12 Kristi Way Specifier: Paul W. Swanson, P.E. City, State, Zip:West Barnstable, MA Designer: Customer: Tucker, Patricia Company: Swanson Structural, Inc. Code reports: ESR-1040 Misc: job 5716 Connection Diagram Disclosure .{ b d Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for particular application.Output here based on building code-accepted design ° properties and analysis methods. i m e e Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum= 1-1/2"C= 8-7/8" (800)232-0788 before installation. b minimum =6" d=24" e minimum=�1" BC CALC@,BC FRAMER®,A�S.TM' ALLJOIST@,BC RIM BOARD-,BCI@, Beams 7 inches wide will be assumed to be either top-loaded only, or equally loaded from BOISE GLULAM- SIMPLE FRAMING each side. SYSTEM@,VERSA-LAM@,VERSA-RIM Install Screws with screw heads in the loaded ply. PLUS@,VERSA-RIM@, Member has no side loads. VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Cascade Wood Connectors are: SDW22634 Products L.-L.C. 51I6 4 0� 5- Boise Cascade Triple 2 x 10 SPF #2 Floor Beamoeamuz Dry 3 spans No cantilevers 1 0/12 slope April 21, 2017 10:34:03 BC CALL®Design Report EXjSt' 6AKMENr Build 5837 File Name: BC CALC Project Job Name: Tucker Residence Description: Designs\Beam02 6CAA4 : ADD AVID Address: 12 Kristi Way Specifier: Paul W. Swanson, P.E. City, State,Zip:West Barnstable, MA Designer: �A&Ly V0,00 Customer: Tucker, Patricia Company: Swanson Structural, Inc. PO4PT LDAb . Code reports: NLGA Misc: job 5716 11 d7 ,. .` _l+. — ._�L ,iv ,. .t^•+'r'w,' ...'did.. c x Rt '� 4 _ -05-00 06-06-00 06-01-08 BOIL ex �j�i°sT t.Ati�`f B2 �, �KI"�i. I.Ae1.ey foXl`�9', ®Gk�l� 63 ADD LRa.Ly Total Horizontal Product Length=14-00-08 Reaction Summary(Down/Uplift) (Ibs) Bearing Total BO, 5-1/4" 9,130 61, 5-1/4" 5,446 B2, 5-1/4" 5,235 B3, 3-1/2" 1,999 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160%_126% 1 Standard Load Unf.Area (lb/ft^2) L 00-00-00 14-00-08 40 12 14-00-00 2 Beam01 at bearing ... Conc. Pt. (Ibs) L 00-00-00 00-00-00 5,396 3,022 n/a Controls Summary Value %Allowable Duration Case Location Disclosure Pos. Moment 2,270 ft-Ibs 44.1% 100% 2 11-03-14 Completeness and accuracy of input must Neg. Moment 3,028 ft-Ibs 58.8% 100% 5 07-11-00 be verified.by anyone who would rely on End Shear 2,295 Ibs 61.3% 100% 3 01-02-08 output as evidence of suitability for Cunt. Shear 2,430 Ibs 64.9°,� 100% 3 00-05-02 Particular application.Output here based Total Load Defl.. U999 0.03" n/a n/a 2 11-00-13 on building and alysis d design ( ) properties and analysis methods. Live Load Defl. U999 (0.025") n/a n/a 7 11-00-13 Installation of Boise Cascade engineered Total Neg. Defl. U999 (-0.007") n/a n/a 2 06-02-10 wood products must be in accordance with Max Defl. 0.03" n/a n/a 2. 11-00-13 current Installation Guide and applicable Span/Depth 8.4 n/a n/a 0 00-00-00 building codes.To obtain Installation Guide or ask lase call Squash Blocks Valid (800)232-0788 before installation. %Allow %Allow BC CALCS,BC FRAMER®,AJS-, Bearing Supports Dim (L x W) Value Support Member Material ALLJOISTS,BC RIM BOARD- BCIS, BO Post 5-1/4"x 4-1/2" 9,129 Ibs 0.8% 90.9% Steel BOISE GLULAM- SIMPLE FRAMING' 61 Post 5-1/4"x 4-1/2" 5,446 Ibs 0.5% 54.2% Steel SYSTEMS,VERSA-LAMS,VERSA-RIM B2 Post 5-1/4"x 4-1/2" 5'234 Ibs 0.4% 52.1% Steel PLUS@,VERSA-RIMS, B3 Wall/Plate 3-1/2"x 4-1/2" 1,999 Ibs n/a 29.9% Uns ecified VERSA-STRANDS,VERSA- T ®are P trademarks of Boise C c�a Products L.L.C. Notes Design meets Code minimum (U240)Total load deflection criteria. Design meets Code minimum (U360) Live-load deflection criteria. Design meets arbitrary1 Maximum total load deflection criteria. Cn Calculations assume me ber is fully braced. l Zot7 4_ No.3533�i Design based on Dry Service Condition. ��04 Gig r�P�G��4� The analysis of solid sawn wood members is in accordance with the NDS and is limited to the S/pIVALE� output shown above. All other support and design for these products, including but not -- limited to notching, connections, installation, and engineer/architect certification is the responsibility of the project's design professional of record. �7f 5, P s Page 1 of 1 � �, � �. ,-�' :. I /' i I i i I I I i e an�nanwe Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:,�352773 Type: Expiratiowar2- M 8. DBA J GROUP ®R DANIEL WOOD ' 153 POWDER POINTrp!'°'' �: x._�•...._ DUXBURY,MA 02332 Undersecretary J r Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-062822 Construction Supervisor 1 & 2 Family DANIEL C WOOD a" 153 POWDER POINT,AT-NUE DUXBURY MA 02332 An` CA Expiration: Commissioner 03/28/2018 License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I 10 Park Plaza-Suite 5170 i Boston,MA 02116 J J Not valid without signature I • i Construction Supervisor 1 &2 Family Restricted to: 7 Failure to possess a current edition of the Massachusetts jState Building Code is cause for revocation of this license: DPS Licensing information visit: WWW.MASS.GOV/DPS :. >; ,x . +, _. ,;:. ..,.s. .., �a. .,:h .r„. nr.v:.. e� ,a.,u«., ...a� un.:, , .,,, ,. ,u, ..r ..,. .ate..c.w, , , ..A'4 ,,,. .• as - . Y i i I ,r 2yC�p R2r CGCS __.. ... .__._ ..::.. .... ...v . , __.., E7� AIRAq Apt _ 4 / o.C. — - - ..: { N � _ e iR f� ao , IE I n r r' t X Gk t. « I r NEW N Ao\4z • 1 � r , Vbe A "d W J 02664 South Yarmouth P.O. Box 5008, S ,Mass. , ERTY i f DRAWING NUMBER .v