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0053 MEADOW LANE
S� 10 1 ICF NO. 1,521/3 ORA MADE IN u.sa i ESSELTE ....r.._._ R,w:a,.,:,w,,., � �_ ,�if.ilf..MJ.-.. _.R-R•4-:a.r...� - .A� i al oFt r Town of Barest ke *Permit# • ires 6 nw hs rom issue date Building Department a �. , ree snaxsTABLA : Brian Florence,CBO MASS9eb , Building Commissioner SEP 1 Argo 200 Main Street,Hyannis, Q,1 4 z0�� www.town.barnstable. .m ��- Office: 508-862-4038 N���t��� �gc: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint 3/ 4 Map/parcel Number ( 00 Property Address 5-3 A64,00W I -AAlf— (A)e 5_3� 2't/, �1_� �M4 0e; Residential Value of Work$ 104 Mfinimum,,f/ee/of$35.00Lfor work under$6000.00 Owner's Name&Address �1�. /® n 4f'1G/�0 C ssp 3 �j iQ Dow L. &, Wt-sT �lAf 45 M&t `,� A oA6$8' Contractor's Name Agns",Q� TG �� T /tLL Telephone Number_ Home Improvement Contractor License#(if applicable) / Email: r/ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box)' ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value .�© (maximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of he Home Improvement Contractors License&Construction Supervisors License is re uire , SIGNATURE: QAWPPILESTORMS\building permit formAEXPRESS.doc 08/16/17 The CommompmUh ofMassad rusetts . D'epwbment qf1ndus&idAcdd=ft Q,fi"ace af$itveMigatians 600 Washington.S`h-eet Boston,CIA 02111 msnv mas,Lgov1dia Workers' Compensation InsIIrance Affidavit BuilderslContractarsMec dcians/Plambers Applicant Information n n Please Print F.e�'ily Name TCAA)S 11 io C A.ddgess �f 3� ►'� l J �T Cites �i �-� to . � � P Are you an employer?Check the appropriate box: ' Type of project(required}: 1.El am a employer with 4. ❑ I am a general contactor and I T ❑New � employees(full anYor part-time).* 'rave hired.the sub-contractors 6. 2.❑ I am a sale propfietor orpartaw- listed on the attached sheet. y- ❑Remodeling drip and have no-employees. These sub-contractors have 8..❑Demolition wodting for me in any capacity. employees and have wood ers' [No woda cs'comp.iustarance comp.msuranml 9. ❑Building addition required-] 5. We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions mysdf[No warkms'comp- sight of exempfion per MGL 12.❑Roof repairs insuzance regraired]Y c.152,§1(4k andwe have no employees-[No wormers' 13-0 Other COmp-insurance ] *Any appBcmLdmt chedm bo:ff1 toast also M cathe secdon below shuvdn then wm-kexs'compensatiaapa&yiufm=efaa 1 Hameaamen who submu t this sfiidmrd huMc dug they axe dmag all wadi sad then hire outside contmctaisamst mobmit a new affidadt mdi— sadi ZCaattsctotsf=chadrt]¢s box nbastaft rh anad&Hr 2l sheet slowing the--of@tesub-coumcon sndstffMwheibmor not lihoseentities emPlayees.Ifthe svb•ra�have empty%dwy nmst pmrvidedmi+wotkm'immp.policy- ez lam an eiiiployer tliat is prm iffng warkees'eoerpmsizdmi inmrarree,for my empioj em Retoev is cite pa cy acid job Sao inf ornzaiiam Insurance Company Dame: 'Policy ft cr Self-in, I.rc.; FBpirationDate: Job%ate Adrke= CriyJStatelzip: Attach a copy of the workers'cornpensationpo]icy declaration page(showing the policy number anti 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 anNor one-year imprisonment,as we11 as civil penalties.i°n the fog of a STOP WORK ORDERand a Rme of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of lu vestigations.of the DIA for insurance coverage verfficataion. Ido hereby ahizso 7ry Mat fheinfbrwra#imtptmirbedabat�eis / and correct Date: Phone 0-7 C 02kiai gee entp. Do etot write in Hera area,to be completed by taty artown offreraL City or Town: Perm tUcense;ff Issuing Anthorfty(circle one): 1.Board of$ealth 2.Bu2TEng Department 3.CitylTown Clerk 4.Electrical Fusgector S.Plumbing Inspector b.Other Conbct Person: Phone#: s� . 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OV lK4 aP `1 go}uaa &Q aqI 4on V4wnb=$maq sc asnao.I ao it®d aqI mg u°pmgdde ag4lmA wao4 i°1SI?o atp 04 Pa�4at.aq PIaO�4P�PII a�L P agp�zP P�u�rs°4 airs aq osjy ageraboo aaaems�;o uogeurmguoo mi s;=PPOV jEvgsrtpul�0.4� bQOip� ogA=�EP� �P�PeaS sc,SarlodE `saa.ioldma abEq swop=m DTI nE jI -_,jommsa�uoi}s=c±=m�smgioA&Lueo o4 pannbw Iou=c=uPEd m smq=m aqI uerg mglo=*XC)Idma ouggm(d'I'I)s :ed-gL_iqe.riPzqr�10(OTI)s*=dmoo L =Munsrq go(s)�4mB4=-umR tp?&-�f¢op(s)nga u auogd pas(s2)=47pe '(s) =a(s)mPR uw-q°s fgddns`Xmssaoau Il`pue ao4grqs rood o4 Llddz p:q�saxoq Qq. �.�q` Idmoa eEpare uOTT9=dmo°.srasgom aT 4no IIg a6Eald • �?IddY Aia°qpm 2mO° -q;(4p;4r=d uaaq aeEq s.rq;j°sp=Fml�a� mcrrr 2g4.g7.�aoujnjdtuoo_;o aouapua alge}da=e I•gm laoa oggnd.;o aomm=j gad o R XU 00 6u8 a4m ra1Qa III smm4i q I�?�?lod-col Sna ioa a�mtm d s4 ( bsz§ `LSI x 4�-m-W`XIIeIIowpp ' u-pa unbar a2Ez3a03 ao?Z M azll IP3R aouzgdmoa jo aouapW alggdaoaz paonpo-ld 4ou szq Ogai 4zJ u 'lddE due ao4�gleaaauounuon aq}u[s2mpLmq}=4=oo o}ja mmsnq E a4Erada o4 4imlad Io asuao�E 4o Iz3�aua1 ao a:)uznssc al}PI°iI9 A IIeIs dozaz-"nzsuao I=01.10 QMs dxadaa pngl sapxs OsIB(9)JSZ§`ZSI 2;4dnP' DFi MIKOIcb a use aq a4Pa�P aqp �I��jo osa mg4oaBegs ataraggp=m•�adde�rnpLmq io SFmio�ag7 ao io asmoq 2ugla�p tjons uo�oai medal m� u�`ahem OP a1 su =d sXolchm aq&mTg=Io asaoq 2mHa asp - ag4.�o pndmaoo all m`a a=T ,sop==ogaPue spina me as a �1 omm 4oII�oieEq asorJq�OaII�P Edo iauaao a�14raba�og •saadOldma Bold®S i n Ie�aIsaq}°mfosse`&q= d`fuapu aejo io M&F-nT M:g m'radoIdara paseaoap E Jo sae4�s21d=ICI MR 2mPnl°m F�` Hof$M. 0s JO amm m oA}.Sus m'SP-Pm legal m. m uor.Pnodmo t3ozl2mosse`drqsau}md tjpr�ue„se p=U9P sc 8fD1dtzv-aT �-azpua io lem Vqgdaq so ssa idY-a �O°�mp=�O=Jo=TrAMs GIR m uq=d Lraba•=9 sa paugap st aarfvl�ue`apzp s srg4 of d saadoldma saga UO=R'oadm°n�s o�aprdatd al.=&Id=Ile sabi.ZSI=Ampsa--Z I `J sWsn suolou4suq pu-c uonumaoim Town of Barnstable Building Department Services ` MAS& _ Brian Florence,CBO �`� Balding Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder I- "-� /'f �� e ,as Owner of the subject property hereby authorize fif-ASQa le-17-9 to act on ray behalf in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accept Signature of Owner a of Applicant Zee o Print Name Print Name 11117 Date QTORM&OWNERPERMISSIONPOOLS Rev:08/16/17 r Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 . �� www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE F.xEMPTION Please Print DATE: JOB LOCATION: number street village . . "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityAown state rip 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 sucli•yvork 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 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 it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of His/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFII.F.S\FORMS%uilding permit forms\EXPRESS.doc 006117 i 1 Town of Barnstable' THE r, Regulatory Services o Richard V.Scali,Director -naxxsresr.r:. Building Division II . M, 1MASS. Tom Perry,Building Commissioner '•TEn rr+at" 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: a Permit#: J6 h5 7)05& HOME OCCUPATION REGISTRATION Date: 2 -L/- ) S' i Name; EV-1 c L4e S'S-e G' ;1 1__e_n/CZC/O d$ Phone#: 5_Q'9 3 6 y I CV / Address: hr�Uc,) Laple Village: W. far? J 574b k_ Name of Business: _eA/gC 1QU S' WCA✓-16 C M r�-r,AJe Type of Business: C6MM. riSin/r✓ci / rgseanl,n MapA of INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersign ave read,and e with the above restrictions for my home occupation I am registering. PP A licant r /C�Z Date: r Homeoc.do� Rev.103113 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. rt- f - DATE: c2 —oZ )�� Fill in please: APPLICANT'S YOUR NAME/S: of �` rr 1i BUSINESS YOUR HOME ADDRESS: 6-0T3(01-(I100 44A 0Z616SZ TELEPHONE # Home Telephone Number f;—I Op, 3(1-1 1 I UU NAME OF.CORPORATION: e ric: AA c e 6 6LE IU G ovs E NAME OF NEW'BUSINESS TYPE OF.BUSINESS C"G•M ifn la IS THIS A HOME OCCUPATION? YES NO ADDRESS.OF.BUSINESS ft5 AG3dV� 1 3 I. MAP/PARCEL NUMBER OOCr�. [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd.& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individ al h s infor e o an pe it requirements that pertain to this type of business. RULE AND REGULATIONS. FAILURE TO orize ig tur * �� COMPLY MAY RESULT IN FINES. COMMENT : --'� 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parc d Application # � << 35 � el' O Health Division Date Issued ( Z- Conservation Division Application Fee Planning Dept. Permit Fee ��✓� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 'J�/�� ,^ M64 3 Village th! E 5T f�,, � �L Owner 4�_2 f G A A)6 f, fJ, -VIV &ddress . 7 i'YI Ddw 4 4WJ4_.._ Telephone 8 ^-�6 Permit Request �ril�wciz /�o�; �,��J �J<<-/f��� ��w ©�9 � �/.•ooiZ�' ,. �10�� uTiG•jIL-00 14 Square feet: 1 st floor: existing/proposed 2nd floor: existing 62proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati O 00•e7 Construction Type Z� �7/1 L 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 KNo On Old King's Highway: WYes ❑ No Basement Type: k Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) y00 !;'-•t- 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 T_new First Floor Room Count Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑Other - e Central Air: ❑ Yes No Fireplaces: Existing New Existing wood/.coal stove:3 Ybd U No 0 Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing 0 new ;size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ='= L� a CX, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �, _ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Ndme 1�7n !� 7?11 ---T—� N Telephone Number 4ddress o. t/ k g`v� License# C!5 1C2 y Home Improvement Contractor# 0 Z 5Tt 57AI 4- A 0106r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE �� FOR,OFFICIAL USE ONLY - APPLICATION# i - x -QATE ISSUED ::MAP/.PARCEL.NO. f ADDRESS.. VILLAGE OWNER DATE OF INSPECTION: s" 4: -FOUNDATION r: FRAMER/1? le .3�4 !Z FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - ROUGH �z�<z..d 4.. , FINAL ,., �FLNAL B=IJI�DLNG_�� :• , :0 � l �8(�—� •,. DATE CLOSED..OUT ASSOCIATION PLAN NO: The Commonwealth of Massachuseas Department of 1ndus&ial Acciderffs -- j ce(VUMeAgadons 600 Washington Street Boston,M4 02111 N"-ma&s gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Plumbers Applicant Information Please Print Le ' I Name pusiness owljzalionamdiviamD: (. LY'RNOA1 V C I)I,�� 1 A)C. Address: 500 /nAN -k_ S City/State/ZiP W• S7Al iylq o�b�Phane#: SC�` FT-1 an employer?Check the appropriate box: m a mriployer with 4. 0 I ama general contractor and I Type of project(required):ployees(hill and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet; 7. Remodeling ship and have no employees These sub-contractors have 8 LD �on working for me-in any capacity. employees and have workers' LLLIII � [No workers'comp.insurance insurance.t 9. ❑Building addition . required_] 5. P<W7E�eOe a corporation and its 10.0 Electrical repairs or additions 3.❑J am a homeowner doing all work rs have exercised their 11. Plrmmbin❑ g repairs or additions myself [No workers' comp. right of exemption per MGL insurance required 12]t C. 152, §1(4), and we have no ❑Roof repairs employees. [No workers 13.0 Other comp.in�ce required.] *Any applicant that checks box#1 Est also fill out the section below showing then wwkrm'compmmdon Policy information. t Hnmeowners who sobnzit this affidavit indicating they=doing an work and thin hire outside contractors must submit a new affidavit mdiaa�such. tCooh$ctozz that check this box must attacbcd an additional sheet showing the name of the sub-contractors and state whCthor or not those entities bave emPloyces If the sob-conlractocs have employees,they roost provide their workers' ccamP•PoficY number. I am an employer that is providing workers'comp znformadom ensation insurance for my employees Below is the po&cy mid job site Insrrranee Company Name: Policy#or Self-ins.Uc.# Expiration Date: Job Site Address: City/State/Zip: Attach'a copy of the workers' compensation policy declaration page(shopping the policy number and expiration date). Fare to secure coverage as regtured under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fie up to$1,500.00 and/or one—year imprisomme as well as civil penalties in the foan of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a c of thus statement may e Investigations of the DIA for insurance cove �y y b forwarded t0 the Office of rage verfficatitm. I do hereby c pains and pen ofPv7�'that the znformakon u�r�'�T�h� / provided above it true and correct atur Phone#: ^(� 6 2 _ ?/ y/ [6. dil use only. Do not write in this area, to be conwhied by city or town oficiaL or Town• PermitUcense# ng Authority(circle one): ard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspectorheract Person• Phone#: oFTMETati Town of Barnstable Regulatory Services • ,naxsrast.� , . MASS g, Thomas F.Geiler,Director 1619. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 50.8-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section IfIf Using A Builder Y7 c , as Owner of the subject property hereby authorize y-? to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Ai� tore of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0 WNERPERMISSION Town of Barnstable pFTHE 1py,_ P` Wo„ Regulatory Services Thomas F.Geiler,Director Bess 9W 1639. .0� Building Division pTEn �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 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 fang 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 perfomvng work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt +�•- iVlassachusctts - Depat•tinent of Public Safch Board of Buildim, Re!-ulations and Standards ( Construction Supervisor License License: CS 12414 1 STEPHEN W BRITTON PO BOX 897/500 MAPLE ST W BARNSTABLE, MA 02668 AA-I Expiration: 7/21/2013 i (lnnwi�siuncr Tr#: 345 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPRO MENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registratio6i-�, :3965568 10 Park Plaza-Suite 5170 Expiratidn—f3I2/2012 Tr# 293967 a Boston MA 02116 IL Fr ate o- oration i GRYPHON BUILDERS INC_:=- STEPHEN BRITT:ONa 500 MAPLE STRFSET j�� a WEST BARNSTABLE;`MA 02668 Undersecretary Not'valid without sig ature pp,HE T � Barnstable Old Dings Highway Historic District Committee 200 Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508462-4784 UAM �w rfOMA{a APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories that apply; 1. Building construction: ❑ New ❑ Addition Alteration 2. Type of Building: House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Paintiniz,roof ❑ new roof 19 color/material change, of trim, siding, window, door •4. Sig: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE AM app&cations must be signed by the current owner Owner(print): �L&`. � ��s Telephone#: g 8lf_Ar2- 9jNY Address of Proposed Work: '.S3/�/CJi. a Village � Map Lot# Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particulars of work to be done: Agent or Contractor(print): ' Telephone#: Address: Contractor/Agent' signature: For committee onll This Certificate is here RECEIVED b APP O D ENIED Date. ��—/ us / ' _` Members signatures 40V 2 3.20" GROWTH MANAGEMENT APPROVFD DEC 14 2011 Q.\Boards and Commissions\Old Kings Highway\OKHApp(imtionAOKHDRAFp2011 CertAppropriaieness DRAFT.doc i O:'.Pn of Ei.rnst8bl8 1 Old Kind's Highway Commaitee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 copes Foundation Type: (Max. 12"exposed) (material-brick/cement, other) Ce~l- Siding Type: Clapboard_ shingle / other Ae4wlp�//� Material: red cedar white cedar - other Color: Chimney Material: Color: Roof Material: (make&style) _ OvAft. Color: Roof Pitch(s): (7/12 minimum) rw.t specify on plans for new buildings, major additions) i Window and door trim material: wood other material, specify Size of cornerboards Pg ✓ size of casings (1 X 4 min.)Ma�color 4/hA Rakes Ist member 2nd member Depth of overhang Window: (make/model) • material color (Provide window schedule on plan for new buildings, major ditions) i Window grills(please check all that apply_: jlrJl4C�1L true divided lights`/_ exterior glued grills_ gr s between glass JZremovable interior_ None Door style and make: 6Z2 material Color: diem'Vo r -#S44 Garage Door,Style in&2"a reZ2& Size of opening 7 X 9 " Material _ Color % Shutter Type/Style/Material: /yT�A Color: Gutter Type/Material: Color: �T Deck material: wood other material, specify Color: 2U Skylight,type/make/model/: material Colo: Size: n size: '��' '! RECEIVED Si g _� Type/Materials: - Color: Fence Type(max 6' )Style material:�V� Color: NOV 23.2011 Retaining wall: Material: GROWTH MANAGEMENT Lighting,freestanding A11A on building illuminating sign OTHER INFORMATION: 790 C-A'M :4 4-o�aY Mt'*V�sfira�, - THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name QABoards and Commissions\01d Kings Highway\OKH Applications\OKH DRAFT 2011 Cert Appropriateness DRAFT.doc 2 11/23/11 400 Series Tilt-Wash Double-Hung Windows I Andersen Windows y iderse .RuYAW Portfolio Where to Buy Contact Us Search: ® For Professionals wrxoowa.0000a WAS MAW IDEAS PRODUCTS LEARN SERVICE ABOUT ANDERSEN Home > Window > Double-Hung Windows > 400 Series Tift-Wash Double-Hung Windows 400 Series Tilt-Wash Double-Hung Windows Where to Buy • High-PerformanceTM Low-154®glass provides Save Product Summary q, exceptional energy efficiency • Nearly-invisible TruScene®insect screen optional Request a product • Traditional style brochure by download or • Rich natural wood interior -• Attractive low-maintenance exteriors by mail. • Convenient tilt-in cleaning • Variety of grilles and insect screen options • fine interiors available w ith factory-applied w hite Product Index finish " • FSC Chain-of-Custody Certified, y This product is available w ith Upon Request fl l Stornw etch®protection View more images Base Price:$395 What's in the price?j Size: 3'1-5/8"W x 4'8-7/8"H View more sizes,prices and configure your w indow OPTIO14S AT A GLANCE Options&Accessories Sizes&Shapes Performance Combinations Installation&Warranty For Professionals Printer friendly version Grille Patterns Standard Options ' Glass Options Grille patterns may be different than those shown below based on the size of the unit.See your Andersen dealer for more information. Grille Patterns +� Insect Screens Standard Patterns Frame Accessories Installation Accessories Exterior Trim Profiles Colonial Prairie A Diamond Specified Equal Light Pa4High* 2 s f lI 2 Wide 3 Wide Wide 4 Wide 3 Wide 4 Wide 1 High 1 High' High 2 High 3 High 3 High i Custom Patterns i Custom 1 Custom 3 F� Reese contact your Andersen dealer or contractor to create a custom 9 gritie�, Grille Types l andersenvAndows.com/serviet/Satellite/AW/AWProducV...11102951372825... NOV 2 3 2011 1/3 GROWTH MANAGEMENT 11/23/11 400 Series Tilt-Wash Double-Hung Windows Andersen Windows , � d FinelightT Removable Removable Permanent Permanent Grill es are Interior Grilles Interior Grilles Exterior and Exterior and ? installed with Permanent Permanent Permanent 11 between glass Exterior Grilles Interior Grilles Interior Grilles i panes with Spacer iGrille Finishes&Colors Interiors i I � I Pine Oak `L Maple �.:; ,_�_._.•-_._, i i White Pine is only available for permanently applied grilles. Removable interior grilles are available standard in maple,also available in oak. RECEIVED i Exterior Colors 2 3.2011 i NOV'Y Y d White Sandtone Tematone® Forest Green GROWTH MANAGEMENT Grille Widths f - ---- --- -------- —-------------------— -—------— — G i i Y tI FmelightTM Gilles i Available for 400 Series and Architectural w indow s and patio doors,in both 314"and 1"profile.Interior grille color matches the exterior color if the interior of the window or door is wood.If interior window or door color is prefinished white,interior grille color will be white.See your Andersen fdealer for more information. 1 Standard width for all windows0& '. f I I ! V i Available w fth w indow s,but more often used on patio doors a I I Available w ith windows,but more often used on patio doors ti I !i Used to simulate a check rail.Available only with permanently applied grilles. i i 2 14 " 1 I i andersenwindows.com/serviet/Satellite/AW/AWProduct/.../1102951372825... 2/3 RECEIVED NOV 2 3.2011 GROWTH MANAGEMENT NOTE: deck not shown but to remain as is all new windows TI T - ----------- -nj - --------- IL rt———— all new windowJ/front door PLAN VIEW - existing footprint to remain unc Lged new window locations shown Map/Parcel 133/006 AL1.DIMENSIONS AND SIZE ATE IDED FOR we ATJOON GRYPHON BUILDERS, INC. Efl,&Lee Ann Hesse FATRUSEBY-WE ORMIS.GeNT. C.-.165SEB OESIG NSSGIVEN ARE SUBIECT TO CATION ON AFL PO Box 282 West Barnstable,MA 02668 �53 Meadow Lane PUN REMAIN THE PRO-. -...- FIRM ANDCAN NOT BE USED OR REUSED JOB SITE AND ADJ�TMENT fax:508-362. V st Barnstable MA 'IT...T 01-14 TO FIT SITE CONDITIONS. 77n phone:508-362-1282 B .668] ——————————i— --®------ -------MW— _ �s I " —�— -- — —F------------ I W]Blp Il - JI WIB]BL .� \ I FAMILY 17'-I(r x 17'•S• I = I I I x I KITCHEN I � I I FFI ——————————+, �� I MbPDtwar ID, B71L W toIS-- 1 I I medreluNnp—, I \ I I F=• g m Ix I \\ I - -———— III I " A \ I I I -------------- " O :--sLesE�— — — ----- j I II ��NTBPPDd�FRx�B YBDDa I I I I I DINING fro- - ENTRYTILII N0 I x 6'•10'z B'- Nw H I ?O ) LO I wa Dnv r>�r 9'6' B'•5• I �� 3'6'z I I i +m+2 Dognm ESP-111 Far: I ALL DIMENSIONS AND SIZE NO. DEB[RIPDDN BY DgTF su,�; DATE: DESIGN PLANS ARE PROVIDED FOR THE CvtlflYd MembCF Hesse Residence FAIRUSEBYTHECUEMTOR NISAGE,;. DESIGNATIONS GIVEN ARE PLANS REMAIN THE PROPERTY OF TN IS SUBIECr TO VERIFICATION ON RTISAN ITCHENS LLC 53 Meadow Lane FIRM AND CAN NOT BE USED OR REUSED IDS SITE AND AD7USTMENf 9�2/2011 937A Main Street Osterville, MA 02655 508-428-8826 West Barnstable,MA W HDUTPERMISSION. TOFRSfTECONDRIONS. Ft T Town of Barnstable *Pt# 1 o ,y Q Expires 6 months from ' 'e at Regulatory Services Fee * snxxsTns[.e: "'"SS' Thomas F.Geiler,Director i63q. �0 ACED MA'I A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 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 Property Address `� ��" r'�( ✓ I Mesidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address t� �- . 5� L Q�jc�l/l�/►/► I Contractor's Name y��iV`_ Con,(2-V-- -- Telephone Number5 0--q- G I Cl 2-?V 7 7�Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C�-S C -j ❑Workman's Compensation Insurance XPRESS PERMIT C k one: MAY 18 2010 am,a sole proprietor ((❑ I am the Homeowner TOWN OF BARNSTABL ❑ 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) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side , 00 / #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows *Where required:_ Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. op the Home Improvement Contractors License&Construction Supervisors License is r quir d. SIGNATURE: Q:\WPFILES\FORMS\by ding permit forms\EXPRESS.doc Revised 090809 a am r- -,'-.... . .. . 0T p kf i ✓!ze Uaiir�naiz�ueall�i o� te i Board Of Building acfutCe '.� f g Regulations and Standards Viz`{ Construction Su pervisor License License: CS 95179 ' B�rthdate 6/•11/1953 a - .. Expiration"--*'-'6/:1172010 Tr#.95179 -_ Restriction pp STEVEN CECERE` 28 SQUIBNOKETT t i - DRIVE EASTF ALMOUTH, MA 02536 � c Commissioner . I 71. Board of Building Regulations and Standards - { License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration U9 date. If found return to: Registration: 152695 ffI Board of Building Regulations and Standards ExptratL 9/20/2010 I One Ashburton Place Rm 1301. ( ' . r_ " 'rj__= J, Tr# 276580 �TYPe DBA i. Boston,Ma.02108 1_! �'� I, 6 DONE RITE IMPROVEMENTS,} F, STEVEN CECERE I s, 28 SQIBNOKETT OR>.; E.:FALMOUTH,MA 02536' --- -- Administrator ithout si gnature . s —-- . 9,� of valid w r• 3% ,X i•� r(i.1 v 5 t rv.i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 wwfv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.,e2ibly Name (Business/Organization/Individual): Ci Zf e_ Address: —g /J v e City/State/Zip: r _ hone #: ?`� l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I 6• employees(full and/or patt-time). * have hired the sub-contractors,. . _❑New construction 2.fiV am a sole proprietor.or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 0 Building addition No workers' comp. insurance comp.insurance.t required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ran er the pains and penalties of perjury that the information provided is tr ce and correct. Si ature. Date: Phone Official use only. Do not write in this area,to be completed by city or town o�ciaL City or Town: Permit[License# Issuing Authority(circle one): 1.Board of Health 2. Building.Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: r , information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association', corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,.or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfofrhance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and pbone numbers)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.permi0license 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 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Industria]Accidents Office of Investigations 600 Washington Street - Boston, MA 021 l 1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia �"E� Town of Barnstable ~' Regulatory Services BAMSTAi s e MASS. Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize /22�-��c� to act on my behalf, in all matters relative.to,work authorized by this building permit application for. Address of Job) Signature-of-0w ier > Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O W N E RPERM IS S ION Town of Barnstable Regulatory Services BAMSTABM Thomas F.Geiler,Director !' A,O� Building Division RFD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: r city/town ate zip code The current exemption fo homeowners"was extended to include o /ei-6ccuvied dwellings of six units or less and to allow homeowners to engage�40ividual for hire who does not •ossess a license,provided that the owner acts as supervisor. ,,, , DEFINITION OF HOM OWNER Person(s)who owns a parcel of land on which he/she resides or ' tends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached struc s accessory to such use and/or farm structures. A person who constructs more than one home in a two-year, od shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a fo acceptable to the Building Official,that he/she shall be res onsible for all such work performed under the buildi errilit. (Section 109.1.1) The undersigned"homeowner"assumes responsibili for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. r The undersigned"homeowner"certifies that he/ a understands the Town of Barnstable Building Department minimum inspection procedures and requirem is and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family wellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Secti 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code stat at: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Sectio 9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Ho eowner shall act as supervisor." Man omeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires.unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC