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0114 PERCIVAL DRIVE
ImIsmEAD No. 53LOR UPC 12543 smead.com Made In USA ,� ��a9��1/ 3 �� � y �'� OL <C a � � i Town of Barnstable *Permit# ,6-16 -a b 7S- ,y�' Expires 6 months from issue date d Regulatory Services Fee • SARN9fAB1E. " Richard V.Scali,Director 'FD6UAA�•,� Building Division � �- a ` 6�► Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 OCT 0 3 2016 www.town.batnstable.ma.us 1 p 0 Wn' Office: 508-862-4038 l v OF g a � AQ- 230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �� Not Valid without Red X-Press Imprint Map/parcel Number ��L>� D&XCIPIAl- / Q�ZAf Property Address Il_T f'✓.GJ7 �7�/pi+i.G J / Yf Residential Value of Work$ 07S. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's NameA- ,(J co/aTJ (_ /V �d • Telephone Numbes.-"0 ' a•Is_,57 Home Improvement Contractor License#(if applic. :-C G�: `W/`!/l Email: O VDA/C n C 49x• /fel Construction Supervisor's License#(if applicable) Zworkman's Compensation Insurance Check one: ❑ I am a sole proprietor WIam the Homeowner have Worker's Compensation Insurance Insurance Company Name &�C d �T��/�► Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re st(check box) l [�Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken tome ❑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: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home rovement Contractors License&Construction Supervisors License is required. SIGNATURE: � �Ijd C:\Users\DecollikWppDataULocal\Microsoft\WindowslTemporary Internet Files\Content.Outlook\2PI01DHR\EXPRESS.doc Revised 040215 oFTME i s • BARNSfABU& Town of Barnstable " Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I (A //� / ,as Owner of the subject property l P P ttY hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: IN //wx -r��Xr) A�e b- /,�42. 9A z�1-1,15 8 4 Z (Address of Job) Signature of Owner Date )�,y/ S Tw,Tol Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigalions IF 600 Washington.Street Boston,MA 02111 x»vry mass.go►✓dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Pie Plew Print Le6bly Name(BasinewogF&za iozandieidud): Address: 0019 City/State/Zip .Z POIi Phone##_ d',z/.Z• AWf] ou an employer?Check the appropriate box: Type of project(required): 1. am a employer with_�_ 4. ❑ I a m a general contractor and I employes(full and/or part-time). s 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 g_ ❑Demolition wodcing for me in any capacity. employees and have workers' 9. ❑Building addition (No workers'comp.insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all wodc officers have exercised their I I.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12[iRoof repairs insurance required.]B c.152,§1(4),and we have no employees.[No workers' 13.0 Other comp-insurance required-] *Any applic am that checks boa#1® also fill oar the section below showing tbeu workers•compensation policy infotmatioa I Homeowners wbo submit this affidavit iafficating they ate doing all watt and then bire autsift coutrnctots tmmst submit anew affidavit indicat zig such. <Contractors that cbeck this boa must attached an addirioual sheet showing the name of the sub-cannect n and state whether or not tbase entities bare employees.If the sob-cantraetors harp employees,they musrprut=ide thm workers'comp.policy number. I am an employer Scat is providing workers'compensation insurance for my employees. Below is die policy and job site information. l/p Insurance Company Name: , eR D Policy#or Self-ins.Lic.#: f/Q i t 2000 Expiration Date: Job Site Address: I� ��Ci�A,��/A City/Stat Jzip Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requires 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 forwm-ded to the Office of Imvstigations of the DIA for insurance coverage verification.. I do hereby ce under eke pai ape es o eryrtry that the information provided above is true and correct S' tore: Date:/0.3 • /V Phone#: Official use only. Do not write in this area,to be completed by city or tmvn official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Heap 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:59612 PLANBCON ACORD. CERTIFICATE OF LIABILITY INSURANCE DATElYYY1� 8/o5/201/2o1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Andrew BOCCI Starkweather 8:Shepley PHONE 401 435-3600 FAX 4 AlC,No Ext: ac,No: 01 431-9681 PO Box 549 EMAIL Abucci@starshep.com ADDRESS: p•com Providence,RI 02901-0549 INSURER(S)AFFORDING COVERAGE NAIC# 401 435-3600 Mesa Underwriters Specialty Ins 36838 INSURER A: p • INSURED INSURER B!StarStone National Insurance Co 25496 Plan B Construction Company,LLC INSURER C Beacon Mutual Ins Co 24017 86 Blending Avenue Barrington,RI 02806 Peerless 24198 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRINS TYPE OF INSURANCE IIN RL WVD POLICY NUMBER SUB MOM/DDY EFF YM MPtO POLICY EXP UMRS A X COMMERCIAL GENERAL LIABILITY MP0038002000681 8/17/2016 0811712017 EACH OCCURRENCE $1,000000 CLAIMS-MADE X OCCUR pAMAGE 7 RENTED PREMISES Ea occurrence $100000 X BI/PD Ded:1,000 MED EXP Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $2,000,000 POLICY ECT LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accdent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS (P ) NON-OWNED PROPERTY t DAMAGE HIRED AUTOS AUTOS Per acciden $ B X UMBRELLA UAB X OCCUR 89525T160 8/0812016 08/08/201 EACH OCCURRENCE $S 000 000 EXCESS LI1B CLAIMS-MADE AGGREGATE s5,000,000 DED I I RETENTION S $ C WORKERS COMPENSATION 64380 8/13/2016 08/13/201 X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? � N I A E.L.EACH ACCIDENT $500000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 D Leased Equipment IM8969085 2/04/2015 12104/2016 $80,000 $500 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I Workers Comp Information'* Proprietors/Partners/Executive Officers/Members Excluded: Brian Patch,Vice President CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S846516/M846512 BAJ r Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-081256 Construction Supervisor BRIAN D PATCH 86 BLANDING AVENU BARRINGTON RI 02806' l� A '(� mmi_o Expiration: Commissioner 08/01/2017 r A • C-�/r�ni�oi�nirme¢l(�u%C'���aJJrir�uJeftJ Office of Consumer Affairs&Business Regulation �&IOME IMPROVEMENT CONTRACTOR egistration 184609 Type: xpiration ,2/16/2018 Individual BRIAN D.PATCH BRIAN PATCH 86-BLANDING AVE. - BARRINGTON,RI 02806 Undersecretary r TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION Map Parcel y C(3l-CL�i Application #�6m Health Division Date Issued Conservation Division Oki Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' ►V Historic OKH ft;te d Preservation/Hyannis Project Street Address 176961 AC d4,101f, Village Owner ��v� �- i!`'fD�f Address `�y pflLCi�IQt �I�iV Telephone Permit Request Z rlew 4401i lvtl k6rk 6AW-&27 Square feet: 1 st floor: existing proposed 1W 2nd floor: existing proposed Total new Zoning District Flood Plain /1L'D Groundwater Overlay NO Project Valuation a 666 Construction Type W66aoWdAh -400,t-/aA Lot Size Grandfathered: 0 Yes 2lo If yes, attach supporting documentation. Dwelling Type: Single Family Q< Two Family ❑ Multi-Family (# units) Age of Existing Structure 1g9l-f Historic House: ❑Yes R<o On Old King's Highway: ❑Yes &3 o Basement Type: &<ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) jr4 Number of Baths: Full: existing new I Half: existing new Number of Bedrooms: 3 existing I new Total Room Count (not including baths): existing knew _First Floor Room Count C.) Heat Type and Fuel: 1116as ❑Oil ❑ Electric ❑ Other C) o NJ n Central-Air: ❑Yes la4o Fireplaces: Existing I New Existing wood/coal stove:04'Yes°❑ No Pa Detached garage: Oxisting 0 new size Pool: ❑ existing ❑ new size _ Barn: 0 exi ting 0 rew isize_ N Attached garage: Vexisting ❑ new sizes Shed: existing ❑ new size _q& Other: v M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Cammercial ❑Yes ❑ No If yes, site plan review# Current Use -- *L4ta Proposed Use -� APPLICANT INFORMATION li (BUILDER OR HOMEOWNER) Name � - --N- Telephone Number I Address Ar&wAi, r)P l o[ License# wwff P>/J9 JY1WNLr�.,yla� GZ6G� Home Improvement Contractor# / i it Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i 1 SIGNATURE DATE r . <l FOR OFFICIAL USE ONLY r _ a. APPLICATION# s F7. "DATE ISSUED - MAP/PARCEL NO. AD�J.�RESS ' VILLAGE OWNER. DATE OF INSPECTION: ` FOUNDATION - FRAME 1' - ' am�re�T4eeQ - INSULATION ro/o'?/f o gyp h FIREPLACE ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH '" FINAL s GAS: ROUGH FINAL �y M FINAL BUILDING ll KK4 o 7 DATE CLOSED OUT ASSOCIATION PLAN NOS � tom• �', f v T. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � QD 1 Telephone Number l Address License# Home Improvement Contractor# 173 : , Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR e!5��290 DATE f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' U600 Washington Street 1 _ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 12,amt_1AJ/W Address: 10 4(V-0100_ t City/State/Zip: J Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2Z I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 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. Lie.#: 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 here eriify under the pains and penalties of perjury that the information provided above is true and correct. Si nat e: \ Date: �-9 Phone Al 7,0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I Y Information and Instructions , `7- 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 j of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license"or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." . Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(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 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of I.nvestigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia k - and Standards License or registration valid for individul use only I Board of Building ods g before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards Registration:on:�152773 One Ashburton,Place Rm 1301 1 Expiratipn=9/28/2010 Tr# 275598 . Boston,Ma.02108 j Type DBA� J GROUP DANIEL WOOD ` 38 EVELYN CIRCLE� " Not valid withoutsignature Administrator CENTERVILLE, MA 02632 e u a�on°S and tan arts 110'brtl f k, r Construc.4ion Superv�sor._License Upe se GS 62822 .� Tr# 221 Expi�aon3/2812010 25 9 1, DANIEL C WOOD . •>.4, ... .. I i 38:EVELYN CIR Commissidner � CENTERVILLE MA 02632 >'•'y0 � r Town of Barnstable Regulatory Services Thomas F_Geiler,Director �. fn 16 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 ABuilder Z Rut. 716 /'W , as Owner of the subject.property hereby authorize DA9 \1600 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) ` Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable F O� Trte rti y�P o Regulatory Services Thomas F. Geiler,Director MASS. 1659. A,� Building Division rEn M�+y Tom Perry,Building Commissioner 200 Maiu.Street; Hyannis,MA 026.01 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 pbone# CURRENT MAILING ADDRESS: city/town 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. DEFINTITON 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/sbe understands the Town of Barnstable Building Department rrnnirrrum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signaturc 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. HOMEOWNERS EXEMPTION .The Code states that "Any homeowner performing work for which a building perrrdt is required shall be exempt from the provisions of this section,(Sec6crn 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisar." 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 east,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 respotuibilitics 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/ccrtification for use in your community. Q:fortns:homccxcmpt ; 1 t a A a N v I i TO THE BEST OF MY INFORMATION, "AS- BUILT" PLOT PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. "�a�.�v�no,✓ SHOWN ON THIS Lo��Z PLAN HAS BEEN L b N THE �� ' �� �� �G' 99 GROUND AS INDI�` r; . DATE lJG�fT�O,/9�� SCALE / " = S/o' Ass, Ro"iN '-s JOB 33�/— D U WILLIAnf s� CLI EN T `CO' SWEE'TSER E'NGINEEERING 235 GREAT WESTERN ROAD 8� P.O. BOX 713 DATE PROFESSIO SURVEYOR SOUTH DENNIS, MASS. -` 398-3922 02660 FAX 398-3063 r RtScheck Software Version 4.2.2 p �� Compliance Certificate y Energy Code: 2006 IECC /�J �O Location: Barnstable,Massachusetts Construction Type: Single Family Project Type: Alteration �\ Heating Degree Days: 6137 � V Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor. "O 114 Percival Road Paul&Sue Tilton Steven Cook West bamstable,MA 114 Percival Road Cotuit Bay Design,LLC West bamstable,MA 43 Brewster Road Mashpee,MA 02649. 508-274-1166 �6m0ance:Passes, Compliance:3.3%Better Than Code Maximum UA:90 Your UA:87 Door.y ont., Glazing UA' Assembly -Area or -Value R-Va'lue* dr Ceiling 1:Cathedral Ceiling(no attic) 552 38 0 0.0 15 Wall 1:Wood Frame,16"o.c. 646 19.0 0.0 35 Window 1:Vinyl Frame:Double Pane with Low-E 58 0.320 19 Floor 1:All-Wood Joist/Truss:Over Outside Air 540 29.0 0.0 18 Compliance Statement The proposed building design described here is consis nt with the building pi s,specifications,and other calculations submitted with the permit application.The proposed building h en designed to mee a 2006 IECC requirements in REScheck Version 4.2.2 and to comply with the mandatory requirements f in the RESc In ction Checklist. Name-Title Sign ure Date I i i Project Title: Report date: 07/01/09 Data filename:C:\Program Files\Check\REScheck\tilton.rck Page 1 of 3 L RgScheck Software Version 4.2.2 . Inspection Checklist Ceilings: ❑ Ceiling 1:Cathedral Ceiling(no attic),R-38.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16'o.c.,R-19.0 cavity insulation Comments: Windows: ❑ Window 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.320 For windows without labeled U-factors,describe features: ' #Panes—Frame Type Thermal Break? Yes—No Comments: Note:Up to 15 sq.ft.of glazed fenestration per dwelling is exempt from U-factor and SHGC requirements. i Floors: ❑ Floor 1:All-Wood JoistfTruss:Over Outside Air,R-29.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights are either 1)Type IC rated with enclosures sealed/gasketed against leaks to the ceiling,or 2)Type IC rated and ASTM E283 labeled,or 3)installed inside an air-tight assembly with a 0.5"clearance from combustible materials and a 3'clearance from insulation. Sunroodis: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: ❑ Vapor retarder is installed on the warm-in-winter side of all non-vented framed ceilings,walls,and floors;or it has been determined that ' moisture or its freezing will not damage the materials;or other approved means to avoid condensation are provided. Comments: Materials Identification and Installation: ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. ❑ Insulation is installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without'compressing the insulation. Duct Insulation: ❑ Ducts in unconditioned spaces or outside the building are insulated to at least R-8. ❑ Ducts in floor trusses above unconditioned spaces or above the outdoors are insulated to at least R-6. Duct Construction: ❑ Air handlers,filter boxes,and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and mechanically fastened. ❑ All joints,seams,and connections are made substantially airtight with tapes,gasketing,mastics(adhesives)or other approved closure systems.Tapes and mastics are rated UL 181A or UL 181 B. Project Title: Report date: 07/01/09 Data filename:CAProgram Files\Check\REScheck\blton.rck Page 2 of 3 i— 1. � Building framing cavities are not used as supply ducts. Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Additional requirement's fgr tape sealing and metal duct crimping are included by an inspection for compliance with the International Mechanical Code. Temperature Controls: Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Certificate: ❑ A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment. NOTES TO FIELD:(Building Department Use Only) Project Title: Report date: 07/01/09 Data filename:C:1Program Files\Check\REScheck\tilton.rck Page 3 of 3 f 2006 IEcc Energy Efficiency certificate Insulation'Rating Ceiling I Roof 38.00 Wall 19.00 Floor/Foundation 29.00 Ductwork(unconditioned spaces): Glass&D.. Window 0.32 0.34 Door .. Water Heater: Name: Date: Comments: 'FeW-t VA7—, �le�V W. �r sY���c� /�' A /sue Po;� AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Q Check Compliance 1.1 SCOPE ✓. WindSpeed(3-sec.gust).................................................................. ................................................ 110 mph WindExposure Category.................................................................. .............................................................B 1.2 APPLICABILITY Number of Stories(a.roof which exceeds 8 in 12 slope shall be considered a story) Z. stories 5 2 stories Roof Pitch ...........................................................................(Fig 2) ........... s 12:12 Mean Roof Height ..............................................................(Fig 2).................................................L ft `-33' �c Building Width,W...............................................................(Fig 3).................... ft 5 80' ............................ Building Length, L...............................................................(Fig 3)......................... 2 ft 5 80,........................ Building Aspect Ratio(L/VV) ...............................................(Fig 4)......................... ................... 1 O <3:1 Nominal Height of Tallest Opening2 ...................................(Fig 4)................................... 6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(fable 2)............................................... L� 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. X ConcreteMasonry.................................................................... ............................................................... X 2.2 ANCHORAGE TO FOUNDATION'.3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing-general..........................................(Table 4)............................................... in. X Bolt Spacing from endrjoint of plate.............................(Fig 5).................................... in.:5 6"-12" _ CX Bolt Embedment-concrete............:............................(Fig 5)................................................._in.z 7" X Bolt Embedment-masonry.........................................(Fig 5)............................................ in.z 15" _X PlateWasher................................................................(Fig 5)..............................................Z 3"x 37 x'/" X 3.1 FLOORS Floor framing member spans checked ............:..................(per 780 CMR Chapter 55)................................... ✓ Maximum Floor Opening Dimension.................:.................(Fig 6).................................................. Oft_<12' ✓� Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....................................... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).................................................... Oft <_d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... D ft <d FloorBracing at Endwalls....................................................(Fig 9)................................................................... Floor Sheathing Type ........................................................(per 780 CMR Chapter 55)........................ `. in Floor Sheathin Thickness ............... er 780 CMR Cha ter 55 1- in. Floor Sheathing Fastening..................................................(Table 2).. d nails at in edge/ in field 4.1 WALLS Wall Height Loadbearing walls........................................................(Fig 10 and Table 5)........................... ft :5 10' L�- Non-Loadbearing walls................................................(Fig 10 and Table 5)........................... ft 5 20' �1 Wall Stud Spacing ........................................................(Fig 10 and Table 5)................... in.:524"o.c. 4�- Wall Story Offsets ........................................................(Figs 7&8)............................................eft <d 4.2 EXTERIOR WALLS$ Wood Studs Loadbearing walls........................................................(Table 5)..............................2x 1a - Z ft in. [� Non-Loadbearing walls................................................(Table 5)..............................2x:K--ft in. Gable End Wall Bracing' FullHeight Endwall Studs............................................(Fig 10)................................................................. WSP Attic Floor Length................................................(Fig 11).......................... ........ o It zW/3 -A ..... ...... Gypsum Ceiling Length(f WSP not used)...................(Fig 11)............................................�Z 0.9W r/ and 2 x 4 Continuous Lateral Brace @ 6 ft..o.c... (Fig 11)............................................................. or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays T/ Double Top Plate Splice Length .......................................I................(Fig 13 and Table 6).................................... Splice Connection(no.of 16d common nails).... .. (Table 6).. ...... ...................................................... 'Fort otaEt Two ?WruvIcy 'Dwtzc["5 5ecnw `?30-9.a. ( , 1N IADDtna�� C' 0 r T K ig C HECAt5 A.c_ (Ncc ctDa� IN T>c.Aw w Nz_YL� Avet cr}acC, AWC Guide to Wood Constritction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common.nails)................................(Tables 7)..................................................... Z Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... L `' Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9)...................................�?_ft_T— in.s 11' Sill Plate Spans ........................................................(fable 9).................................. Z. ft-C in.s 11, - - Full Height Studs (no.of studs)....................................(fable 9)....................................................... Z Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans...... ....... able 9 ............... ft 6 in.s 12' ................ Sill Plate Spans.... .......................................(Table 9).................................. ft in.s 12" v Full Height Studs no.of studs able 9 ............... Z v Exterior Wall Sheathing to Resist Uplift and Shear SimultaneousV Minimum Building Dimension,W s 2 l M o Nominal Height of Tallest Opening ...............................................................:............lio F5 6'8 SheathingType..............................................(note 4)..................................................... � t� Edge Nail Spacing.........................................(fable 10 or note 4 if less).....:.................. Field Nail Spacing..........................................(fable 10)................................................. Q in. Shear Connection(no.of 16d common nails)(Table 10)....................................................... Percent Full-Height Sheathing.......................(Table 10)..................................................I1 /0 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts).................... ✓' Maximum Building Dimension,L ., Nominal Height of Tallest Opening2.......................................................................� s 6'8" y SheathingType..............................................(note 4)..................................................... v Edge Nail Spacing.........................................(fable 11 or note 4 if less)........................ in. v Field Nail Spacing..........................................(Table 11)...................................................;C7 in. y Shear Connection(no.of 16d common nails)(fable 11).......................................................& Percent Full-Height Sheathing.......................(Table 11)....................................................!K:!�% t/ 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) r/ Roof Overhang .................................................... ..................................................(Figure 19)............. .C=ft s smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U=&I of ✓. Lateral.............................................(Table 12).............................................L=.l*lr,pff _1G Shear...............................................(fable 12).............................................S 13 plf si Ridge Strap Connections,if collar ties not used per page 21... (fable 13)...............................T= l9 pff ✓ Gable Rake Outlooker..........................................(Figure 20 ft s smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(fable 14)............................................U=Zk-2 b. •/ Lateral(no.of 16d common nails)...(Table 14).......................................L=-IT&. .i Roof Sheathing Type...................................................(per 780 CMR Chapters 58 an sl 59)............ Roof Sheathing Thickness........................................... .............................................�n.z 7/16"WSP„ �. Roof Sheathing Fastening............................................(Table 2)......................................................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5361.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift.Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height-sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. -5 t'olt=w Coo 9. (fcw t i Flvy�>Es lC�) UC . c�Z3lo, AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(78o CMR 5301.2.1.1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment -W ENTHISEDGEREMSON F IAAENOOSESdNAILS AT6b.c ' —=-r==- -- 11 n u 91 n n 1 Y Y' 11 tl tl It t1 11 tl It 11 /t Il 11 tl Q t1 :i w 40 ro 11 u g a �Q7 II 11 Di 11 tl . u U It u ti 1 H u 11 OolrBLE EAGf ------- .. ' W&SPACWG i See Detall on.Next Page Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in Bigh Wind'Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7s0 CMR 5301Z.1.1)' pill EDGE MEFOWEMIE I RiAlkl m I Sw ' l Sw ; ; ..�. T � .....i. .1�.� STAB USA PATIEM PAM3. PIWL EDM DOUBLE M AR-HX,E SPACM DETAL Detail ' Vertical and Horizontal Nailing for Panel Attachment of , i's _s, `pFIME, . Barnstable Old Kings Highway Historic District Committee �. s �VSrAH , 200.Main Street, Hyannis, MA 02601, TEL: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS. Application is hereby made,with'four(4)complete sets,for the issuance of a Certificate of Appropriateness under SQtion 6 o,Li co Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawin�s;or o photographs accompanying this application for: � Check all categories that apply; 1. Buildiniz construction: ❑ New ❑ Addition ® Alteration rq 2. Type of Building: [2 House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other' rn 3. Exterior Painting .❑ new roof ❑ color/material change, of trim, siding,window, door,-,:;, 4. Sign :• _ El New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ tennis court ❑ Other I� 6. Pool . ❑ swimming Other man-made � _ , g ❑ Ot e an made pool Type or Print Legibly: Date: (0�� 1_ OJ Address of proposed work: House# Sweet: =e r6,-a i D e- Village W, avYl94_101 e_ Assessors Map Lot# Description of Proposed Work: Give particulars of work to be done: i p Agent or Contractor(print): Telephone#: Address: Contractor/Agent'signature: NOTE All applications must be signed by the current miner Owner(print): �aul s S:�un T; l�-rnn Telephone#: Sod — Owners mailing address: Owner's signature: For committee use only. This Certificate is hereby APPROVED/DENIED DE � V E Date la a a Members signatures JUN 0 2009 TOWN OF BARNSTABLE on HISTORIC PRESERVATION con itio f app v . A 'n ON J�N 2 4 2009 S0\11�°fi BaN'9hwa1 1 C.(Documents and SeuingsldecullikEucal Settings lTemporary Internet Files IOLKIIOK ertAppropriateness U7.duc Old Cpmm�nee Y ., Town of Barnstable Old King's Highway Regional Historic.District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 4 copies Foundation Type: (Max. 18"exposed) (material -brick/cement,other) Siding Type 16 ,��,1 a`(I:p1� trlmaterial: —�-� _ C e'er a Color: Chimney-Material: Color: Roof Material: (make &st)-le) yyj o,+r, J�, �� ��=� r`�c�� Color: C Trim material Color: Roof Pitch: (7/12 minimum) !�C ef 91CA,05 Window: (make/model) ��,; � material �-J,✓),A color Lj Size(s): tije(f V)S Door stele and make: material Color: Garage Door, Stele Size Material a or ShutterType/Material: Color. V _ 0 Gutter Type/Material: A �u�nI v,u rr, Co R \e Decks: material Size Color: 0t�5�'`��eea Skylight, type/make/model/: material Color: Size: Sign size: T?-pe/Materials: Color, Fence Type (max 6' ) Stele material: Color: D Retaining wall: Material: SUN E Lighting, fi-eestandin ON!N OF 8 ESERvp,�ION $ on building illuminatin si hlC PR Please provide samples of paint colors and manufacturers brochure of style of windows, doors,garage door, fences,lamp posts etc ADDITIONAL INFORMATION: Signed: (plan preparer) d print named�,l ~I 1't-cr) tel. no. Location of application: Street no. Lj Street �'� c.,' ,�a> >�;� Vill e £ ag ��GwVI�� 2 C:Duc•uments and Settings'decolliklLmal Sett;ngsWempurary Internet Fi1es1OLKII0KH Ce l Appropriateness7.Uduc '` '�. , • j "Z.: `~•ti- Ilk, _ rF r� mlt4k �itil it "I I"'I i I � .1 Tar►,- ,. ail TOWN OF BARNSTABLE HISTORIC PRESERVATION r `pFtNETp��� Town of Barnstable ' Regulatory Services BARNSTABLE. Y MASS. °639. Building Division pTED MPS� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 i Inspection Correction Notice Type of InsP ection � � \ Location c vim. c(Ja Permit Number 2007 r Owner Builder One notice to remain on job site, one notice on file in Building Department. I The follow'ng items need correcting: A / o.k l� Please call: 508-862-40-H for re-inspection. Inspected by 1 Date ._ _ " _ t_. . �-'- "',,,ter.• .. .. - .. . .."�' - -. _r ..... x. . `pFtME ip��� Town of Barnstable . • BARNSTABLE. Regulatory Services X MASS. 1639. Building Division prFD MP'�• 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 - a � Inspection Correction Notice 'Type of Inspection Location4/ IW'lr ,� i3y/t Permit Number Z aO Owner Builder One notice to remain on job site,"one notice on file in Building Department. The following items need correcting: I A-147 "P,C1t/itl 2 • o /3� i�Jls�� 2 Gc�FCN� Two o �T sf A E: Please call: 508-862- —for re-inspection. Inspected by ' � G , Date 5 r \l v - t ` y k� � � 'A � ���•e= � � 'gym and � i`"'nR� � r&b r� m y `n .v it T� m a 114 Percival Drive, W B 10/27/06 e M a. i w as f i 114 Percival Drive, WB 10/27/06 Submitted by: Submitted to: Date: 11,Al ti ,05 ° Name:. Ij—', 1)--. a LS i d-ell-I Street: i! �a�Gi✓p I City,State,Zip: Y�.ynS�a•�i'� a°✓ci"Tb�,.`� �►�I y 1 Fj A V 9 6 ' O Phone: s00oo - Ia6i x Job Description: TilI+Ve.- �- �.�s �,i� W jjd j±:!ve '►Al-o s �Vtn+ —To, � y�.ir �t./✓►')►�'Kti�G S � J'�/� �f�.l�✓k� ���� ►+�fi��,.I ��JI�� i(« ot-- 0 L GGI+h,�� —��u� Gg®,. L,Me✓ }n�",-410ye— mil" ke.er ie 121 ®Lti� r' O,✓i-}�� 1� �r✓'1_ �Ga'� 5V1 r �� iy) sj ►i/`s� uwu.(�... 4+^�► -�. r y►5 l-.Ily-�-r )M��S IV177 7 q v e'J+h e 5 f NOW Terms of Proposal: Amount/350 4I-75(f. !,p 5ro pao sa� o o d f o r days. Terms of Payment: �w.�����— / 4-i U - , hffrizecI Signature All material is guaranteed Fo be as specified.Alfwork will be completed in a substantial workmanlike manner according to the specifications submitted,per standard practices. Any alteration or deviation 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 are contingent upon strikes,accidents,or delays beyond our control.Owner is to carry fire,tornado,and other necessary insurances.Our workers are fully covered by workman's compensation insurance. Acceptance of Proposal: 41 Signature D to p P o r The Only Chimney lining Systems with the Forever Warranty TM AL �� as $j Zct -Zoo�� 4 10,-mvraftutet: ;A411. AS JOTUL AS - — j licx 1411 L-%- Fredrikstad,Nomay Serial no.: 2005 } _ � fRi:DRiKSFADAL i -- Product:i„tul F 400 SD Y-O635 t __ Certifi cate/ DIN 18 891 '� _ -- Country Classification kW Approved by: Norway Masse li stNTEF045�9 SINTEF `! - "'Sweden Inss TG nr 0109 SWEDCERT S *Germany Bauart 2 7,0 R0-910101 D M T Nederland N01-2795 T N O - Please read the instattation and operatng ff st xlm cardifily. Montage-and 6edWmmgsanf tng beachten Veinroez fire le manueld'inshuction et dutitisaation 7 02 2 3 W 5©7 59 t "Delar av kaminen kan bli varmare an 90 gr.C 220449 -o v a c-,•a a v I � o x N w •-� v a a � x 3 s m I r-•1 a C o c o m 3 3 r 3 I m fTl r 3 m m n m m -� � a •• � z I cn I--I — TI r' C Ep I O O M m 1 o M m m m �o v I •• �_ acnoa EO I m a Cn W I OJ 3 !TJ � z m cl G � m .� 1 1 CD O b 0 O W O G O O 1 I I I � I I I I I I I m a- m C7 a • O' a Z, 1 N O ¢ ¢r ca cn 1 m ~ r+ =a oc N ¢ m ! L q -L-- Q 1"+'L CS b 1 6 _rC co f rn m S CO 1 CO .�- /' 1 L - 1 1 r 1 + 1 r 1 Town of Barnstable ermit:ao6(o .3/cZ3 , �OtIMErW�ti Regulatory Services ate: Thomas F.Geiler,Director 1ARNSTABLE Building Division Fee:aJ OD y MASS. �Ar 1'639. a��� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: 5 � Phone: Install at: '' 0P;( i U cLQ - Village: VIP 6 ►M 5+CLb-1'e Map/Parcel: _ {"'/Q wl Qc?9 Date: Stove A. 0/Used B. Type: Radiant/ Circulating C. Manufacturer: Te4u t F— Lab. No. D. Model No.: FE yD Q C c h-k ne Chimney A. New/Existing (If existing,please note date of last cleaning) B. Flue Size C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined a . i Hearth A. Materials: 1�v B. Sub Floor Construction: -:. Installer Name: SC6�{- '�. Shl�� Address: 10 0, >6� Phone: 50g' `/9-0 °/a(D 1 21,q� -,oeation of Installation: l��f �� vrt.Q —. APPROVED BY: Please make check&llpayable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 w.;rv-=r.�'r.. ..,�•,x•det..Z.�15.,r•._+.s..-.a1X�riPF+��'�r�`o"?�:srJ�'irc:anli`++.,_ 'r'> `""hn.,. TOWN OF BARNSTABLE Permit No. .. 0....... BUILDING DEPARTMENT I ""'� I TOWN OFFICE BUILDING Cash � Yl ew ` '�ro..v► HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Paul and Susan Tilton Address 114 Percival Drive, West Barnstable. MA (Lot #52) USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH. TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .. . December. . .... . . ... . . 19..94........... .....................,,r, ............. Building Inspector , NQ SS4C`$4t1 19 •94 PERMIT NQ ennis ` }• �' .:x• DATE rea extern Kj • / �+ Q. (' InC. CL1St0111 .dr�ADDRESS' ppryryT(��5 1,FtENSE) . LICANT (NO.) (STREET) (�V�D4v NUMBER OF OWELLING UNITS build Dwelling (=1 STORY (PROPOSED USE) RMIT TO No. ZONING FtF (TYPE OF IMPROVEMENT) i_= �_i - T i�r1VG� �tiES� =% luLatiil DISTRICT yot #5�, li4 i3E~ruivuy . T (LOCATION) (N0.) (STREET) ' AND GROSS STREET) ETWEEN (4ROSS STREET) • LOT LOT BLOCK_ SIZE UBDIVISION `HEIGHT AND SHALL CONFORM IN CONSTRUCTION UILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN i BASEMENT WALLS OR FOUNDATION (TYPE) 0 TYPE USE GROUP Sewage #94-425 MARKS: Bond _ 110,000.00 FEEMIT $ 113. 00 REA OR 151L sq. ft. ESTIMATED COST OLUME (OUBIC/SO DARE FEET) Paul & Susan Tilton BU) IN WNER Dennis B t'ucx osa tcoac�, DDRESS HIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREEZ. ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR IS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS R ISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED ERM AN ENY LTHEEJU ENCROACHMENTS ON PUBLIC PROPERTY,•}JOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- ROVED B ROM THE DEPARTMENT DI PUBLIC WORKS. THE ISSUANCE OF TH F ANY APPLICABLE SUBDIVISION RESTRICTIONS. PERMITS ARE REQUIRED FOR T P T EI„ ELECTRICAL, PLUMBING -AND INIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE SPEC')NS RE-"'RED FOR CARD KEPT OS T EC UNTIL� AL INSPECTION HAS BEEN CUPANCY IS - MECHANICAL INSTALLATIONS. LL CONSTRUCTION WORK: MADE. WHERE A CERTIFICATE OF OC RE FOUNDATIONS OR FOOTINGS. PRIOR TO COVERING STRUCTURAL QUIIREO, SPECT BUILDING DIN BEEN MAOEBE OCCUPIED UNTIL FINALMEMBER-S(READY TO BEFORE INSPECTION STREET FINAL INSPECTION BEFORE OCCUPANCY. CARD SO IT IS VISIBLE FROM POSTT H S ELECTRICAL INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS w' � �A BUILDING INSPECTION ROVAL (� ��F 1 "Amyf low Ap/40 V 6 , 2 2 „orb �� S �►�P� C c%sc-�,, LJ�.a� sir 3 ����n��J T INEERIN DEPARTMENT MENT SEATING INSPECTION APPRO LS 4_2 7_ g BOARD OF HEALTH I THER SITE PLAN R VIEW PPROVAL PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN EF RK SHALL NOT PROCEED UNTIL THE INSPEC- WORK 1S NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED RRANG D FOR BY TELEPHONE OR WRITTEN NOTIFICHAS APPROVED THE VARIODUS STAGES Of PERMIT IS ISSUED AS NOTED ABOVE. STRUCTION. BurLzzlC- 7-R`uT NO. 7 O �= ASSESSORS PARCEL ro. I/'O CONTINUATION OF ROAD BOND The unde=signe3' ou.:ier/contractor hereby ag=ae tO ;MET'; t`ef— road bard i7— fo'ce unt_i the follo•.z a_a. cc=leta_ to the sat isfac:ion of the ccL_nee=+.:.� 'Sec:: -of the De�aT�e�t of P1D1Ic �:or_is: j/ Ioa_ and seen snculders z—!- soar. as he= pe—:ts: law ' /- 7 /LC, I The-.Town of-Barnstable Department of Health Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-90-6230 Building Commissioner u DATE: TO: Town Clerk FROM: Building Department RE: Bond Release An Occupancy Permit has been issued for the building authorized by Building.Pe.rmit.1 umber 90 ( �' issued to Please release the performance bond. . .r • \5 BOND �pF INE Tp� ti Town of Barnstable Planning Department BAMSTABLE. ' 230 South Street,Hyannis,Massachusetts 02601 9� 1639 ��Op (508) 790-6290 Fax (508) 790-6454 AlED MAC Date: August 02, 1994 To: fred Martin, Building Inspector From: r T c yk, Principal Planner fit -0802.doc Subject: Lot 114 Percival Drive - Lot #52 on a 1988 Subdivision "Weeks Crossing" I was contacted by Attorney Mike O'Brian concerning the above referenced parcel. The Attorney was seeking the history of zoning as related to the above subdivision and Grandfathering of the lot as buildable. This RF zoning district was established at 1 acre in 1973. The subdivision was created in 1988 and conforms to the existing 1 acre zoning. It is important to note that the subdivision is an Open Space Residential Development (Section 3-1.7) that permits the development of lots at a density ratio and not at a 1 acre size requirement. This 0.80 acre lots was created under 1 acre zoning and is developable under existing zoning regardless of any contiguous ownership of land. A title search of contiguous property is unnecessary in this case. _ - - : . TheTown of Barnstable �0�' Department of Health Safety and Environmental Services �E1659. ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION 114 96,Qc i vo 21? l yr �AIcs- Location of shed(address) Village 9Av( Property owner's name Telephone number g I L A W)6,l;dd oT d oo i-o L'9 Size of Shed Map/Parcel# i 7` Signature Date s Stree aterfro toric ct? Old King's Highway Historic District Commission jurisdiction?. Y Conservation Commission(signature required) ; VOL9 i-PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS;THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-tbrms-shedreg ve (/Lj R��T .l �^1 ,�� ► c.: ;�,•; ���\ E r. o -----��' •1�. J. �� o � cam.... - .. � e r i Assess is officg"(1st Floor): ( o U d I Q a 4 SEPTIC SYSTEM MUST BE Assessors map and lot number .I S INSTALLED IN COMPLIANT+ Board of Health(3rd floor): a wTH TITLE 5 Sewage Permit number � �»� ENVIRONMENTAL CODE ILUSTAILI i Engineering Department(3rd floor): riva House number. TOWN L`` �0 °o %639. � Definitive Plan Approved by Planning Board 19 V �p Y�Y b• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only APPROVED N OF B A R N S T A B L E �- ILDING INSPECTOR Date APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ` • 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applie for a permit according to the following/information: Location / w Proposed Use Zoning District f I Fire District Name of Owners/ �5 J 1 I Address Name of Builder 6 C,�o Address (� Address 06I .M C-R(�i Name of Architect i MAC�co Number of Rooms ! Foundation Exterior w P oofing _ n Floors A' Interior / �� /► Heating �+�C `P 8 !;, 's—,-Plumbing Fireplace /n Ll +�I L d" proximate Cost C/ Area �� S 4 Diagram of Lot and Building with Dimensions Fee fis ® — OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable eg ing the above c nstruction. Name Construction Supervisor's License TILTON, PAUL & SAN ado 37090 Permit r ca 2 Story Dwe1 g r Location Lot #51, ;, 11 Percival Dr., Western table . Susan & au Tilton Owner ' Type of Construction 1 am Plot Lot Oct. 5 , 94 Permit Granted 19 Date of Inspection 19 _ Date Completed 4— �-! 19 74 114 r 0 zl- F-j W J `yy A a N z8.� f co v al' , TO THE BEST OF MY INFORMATION, "AS— BUILT" AS- BUILT" PLOT . PLAN KNOWLEDGE, AND BELIEF THE BARNSTABLE, MASS. LCOU-J v19 no.,J __-- SHOWN ON THIS L0T�Z L. PLAN HAS BEEN L ,e M N 'THE DATE v� o - GROUND AS INDI ��= s�• r s ,sT 3 ./99� SCALE / - yU w�°A N . , JOB 336/-o a CLIENT l C. .Z�jc cox - ,SWEETSER ENGINEERING �� 235 GREAT WESTERN ROAD �P P.O. BOX 713 DATE PROFESSIOWAL =Az3W SURVEYOR 398-3922 SOUTH DENNIS, MASS. FAX 398-3063 ITH ail ... oil J rye L --- --- - -- ------- 7 •:4 01 ll��'•• �—. Ia �� � ■ '• QE iiii -- iiiy 1' � � u 'n . �tc�J`n, y l�.r��1' rA " �-• - 14�oX10-O c_='.L- ;�-'-'.�?•'is:.�o'e~-,Vti!:.-��a3.o.�: ..".�?. o- LAo-4z7. ID IT6FAO-1 I _ GAF-Al,E - - Ib'x19 .-- •i — 17BK2`9� 49r-AT R>-l• vnw�J LLl�. 4 19'x12° I7. 3 pIn11�iG RH. 'I A I t O2 FAD-7. J 13tx12'- 10L0110-FL.)'1 AA1 A3f,zq.pr I f--F 501 'enve smF. �lP.sT >Z PLAN 9�0s4.Fr. 1 I Iswit L-J L—J 50�O x Zl�O "S-�} Pam. GL't. MIAL. LO r' L Etna t+ad, 2o`1c. Sq.Fr L>✓.ARC _ oPe+ ro r,.A.teF "J96. SQ•F1- Gam.(=-. OevRM. OELIM4 140 Sq. T. 14v, 9rGK FOOD .TH1�7.FL, pLhN 229sq.F'r. card Y ailutatati►oas�issacurrce�! d OF ONE ASHBORTON PLACE MASSACHUSETTS , 60ST6m,MA 02108 -8a due®QtR State Building d®Ido®urisforr`�do�&grorP L X'C E N S t: tMII.Ncensc. EXPIRATION DATE i ;,b ��b j ✓r 0 NI S T R. ;:y!1 P! Rv 1 0R CAUTION i I /i 5/1 9 9 S ; FOR PROTECTION.AGAINST RESTRICTIONS EFFECTIVE DATE LIC NO. THEFT, PUT RIGHT THUMB NONE 0 6/'0/1 ?)3 006646 PRINT IN APPROPRIATE BOX ON LICENSE; GL.ENN W CRAFTS 7 2 C 0 U Ad T;2 Y C I R BLASTING OPERATORS. v +JFLPJd h1R iJ'bE 0MUST INCLUDE*PHOTO. PHOTO(BLASTING OPR ONLY) FE : • n I C T L/ 7 NOT VALID UNTI" IGNED BY LICENSEE AND OFFICIALLY -HEIGHT. s PED-O -SIGNATURE OF THE COMMISSIONER I :I THIS DOCUMENT MUST RE ,I SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF 'i SIGNATU^ OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. I r COMMISSIONER I f ' I f; i I I �L ° TOWN OF BARNSTABLE = BUILDING DEPARTMENT saute •Wl TOWN OFFICE BUILDING i639. HYANNIS. MASS. 02601 NMI MEMO TO: Town Clerk FROM: Building Department y DATE: i An Occupancy Permit. has been issued for the building authorized by Building Permit 1-`570 90 I 6 Lly-1 issued to 7_CLc�� Ct -o-� Jc� rx Please release the performance bond. \.1 L47• y.. .. .. �� � tffff U ETTSTOWN OF BARNSTABLE, MAS$' . , � . $ ,. FW11T r I A=110=001- 9 ►� October - 5, - - - ,r.;' .DA ��� �>xi sg: v ...9 •94 FERMIr NO �� gg7 Q ATE t1 /'O9'O "I APPLICANT G. E Inc-,- , Custom 131dr�ODRESs ` �� rea Western R . , S. Dennis (STREET) IC M R' SEI PERMIT TO Build Dwe-�ln7 � ( .2 1 STORY 'Single °''F'.amilyDweTlgER OF LING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) r . Lot #52, 114 Percival Drive,. ,West Barnstable. ZONING i AT (LOCATION) DISTRICT RF — . (NO.) .(STREET) ( BETWEEN AND (CROSS STREET) . (CROSS- STREET) ` SUBDIVISION LOT LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMAR KS: Sewage #94-425 ! - f i Bond AREA OR 151E SCI• ESTIMATED COST 11O PERMIT VOLUME ft. , 000. 00 ' FEE ,� 113. 00 i (CUBIC/SOUARE FEET) OWNER Paul & Susan Tilton i -. ADDRESS Tuckbosa Road., Dennis BU/LG BY ;�'.• ,y OLD RING'S HIGHWAY HISTORIC DISTRICT SPEC SHEET FOUNDATION 72d � Whi}e_ &do`�,j�n� .���FS� S1 �S ea SIDING TYPE C �(� '1 U , t-�'�(1�' COLORB.QMrY\iQMnr>�-e, VA gjq,5 CHIMNEY TYPE COLOREOC�oh ROOF MATERIAL r), , �7 COLOR l PITCH . 17 ' L WINDOW Z1 V SIZE TRIM COLOR DOORS 1 .. OLOR le �'1� - f V v SHUTTERS GUTTERS �i ),*Yl ► (, e)(1/1 Lj DECK GARAGE DOORS QX 7 COLO h NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be "Certified", but should show all structures on the lot to scale. SPECSHT Application to 1 9 9 4 1 O 3 6PE�NpPV,NPR' Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: dNew Buildi ❑ Addition ❑ Alteration Indicate type of buildin [House Garage ❑ Commercial ❑ Other 2. Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK &.ZZ PIY-41'1671 diVe- ASSESSORS MAP NO. OWNERI`� iL� ASSESSORS LOT NO. HOME ADDRESS � - l �+ �,J� TEL. NO. :7-60 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). M;c I l-oDn e �G� 3 Rai l �/ srngvl(�� _ l c-. n 11 i+ .n`}C�olcrc' - Spi- PLO . X 6, &D�M4Si��ee, _ /E I y� AGENT OR CONTRACTOR l -�� � I III PIS TEL. NO� ,� ADDRES <" g &al± DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8, other side), including materials to be used, if specifications do not accompany plans.. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary)- /)ins_ I_.•,, S' nniM , �y C.0 VJ(Xi 1 1 ) / dim iQ .�4- Con cx-eJee r�d 6J,0o Signed Owner-Contra cto Agent Space below line for Committee use. e v D - 9 to Certific a is here •ll1fV 2 91 199d d BT�QWN OF BARn�icT,n�t: /` I,CD r'?1�-,G'S HIGHWAY Approved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ 1 � _ p' COMMONWEALTH OF MASSACHUSETTS qw—ve� " DEFAK.-N ENT OF INDUSTRIAL ACCIDENTS _ 600 WASHINGTON STREET jarnes Carnooei: BOSTON, MASSACHUSETTS 02111 ,ornm ssione WORKERS' COMPENSATION INSURANCE AFFIDAVIT (I icensee/permirtee) with a principal place of business/residence at: Oq �)e��, i-n (City/Stare/Zip) do hereby certify, under the pains and penalties of perjury, that: U ' am an employer providing the following workers' compensation coverage for my employees working on this job. lho Hp �..W C , is )5L 7bIq �f Insurance Company-7AM(-Jt-1 M' Policy Number [ ] I am a sole'proprietor and have no one working for me. [ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sea. 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to Sl 500.00 and/or imprisonment of up to one yew and civil penalties in the form of a Stop Work Order and a Fine of S100.00 a day against me. 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