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0071 SHEEP MEADOW ROAD
I J4afqctso No.212534 153LOR HASTINGS.MM r Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 8/5/19 Brian Florence CBO Town of Barnstable Building Division 200 Main St. o� Hyannis,MA 02601 RE: Insulation Permit 19-1475 PS� Q. O��P it Dear Mr. Florence: .`O� This affidavit is to certify that all work completed for 71 Sheep Meadow Road,W. Barnstable has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey . ` Town of Barnstable Building ,, ' Post This Card So,That it is Visible From the Street-Approved Plans Must..be Retained on Job andahis Card Must be Kept unnisrwet.g, _ XAS& $ Posted Until Final Inspection Has Been Made. _ ► . 167P ,e Permit �► Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made.. Permit No. B-19-1567 Applicant Name: HIGGINS, DANIEL T&CAREY, ELIZABETH M Approvals Date Issued: 05/28/2019 Current Use: Structure —1 a 0.11 Permit Type: Building-Deck Expiration Date: 11/28/2019 Foundation K Location: 71 SHEEP MEADOW ROAD,WEST BARNSTABLE Map/Lot: 109-027 v �A Zoning District: RF Sheathing: Owner on Record: HIGGINS, DANIEL T&CAREY, ELIZABETH M - Contractor Name:`., Framing' 1 } �� Address: 30 DUTCHLAND DRIVE Contractor License: 2 YARMOUTHPORT, MA 02675 -`.---- ".._ "" ''T' _ Est. Project Cost: $5,000.00 Chimney: Description: repalceing two previously removed decks and replacing with one 'I Permit Fee: $ 110.00 I Insulation: large deck Fee Paid:? $ 110.00 Project Review Req: Deck only not enclosed underneath Date: f'r 5/28/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within.six months after,issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for 'public inspection for the entire duration of the Final Gas: work until the completion of the same. II I The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical er Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed - 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r O a Nft{/✓e�. I, 'Application Number............................................................. MAS& v 00 q ' Permit Fee.......................................Other Fee........................ Total Fee Paid.............................. ... — 1111 .111—.... ...... TOWN OF BARNSTABLE Permit Approval by... A.?.................Os-dl '..�q.... BUILDING PERNIIT ( 0 q Map........................................ParCel...........o...a:......................... APPLICATION Section 1 — Owner's Information and Project Location Project Address_ Shr.r p M-rarAow k) V-6 Village Vic** Y)O x n YwgT, Owners Name 120. :1� Q&r-Q w\6 W-\G c Ny-)s '. Owners Legal Address 1 S d a u3 O M` ♦ Y, City W e sk- State 1 ip �o ?. 02 Owners Cell# L� -99 L - 1069 E-mail Q 124. x-v"""a Cox e • cD" Section 2 —Use of Structure o Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use _ ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description oI a. rrA 1Wo ireyl6ms1U Y vvtoyed ck.(,k_s ex n-nd fp pla Civ1G 1KN tin i, � _.. ... ... .. ... .... .. ....'. ......... Application Number..................................................... Section 5—Detail Cost of Proposed Construction��0®o Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing ` ' Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom i Water Supply ❑ Public ❑ Private t Sewage Disposal t ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i T act mAct-4- 11/1 1q/7012 . ----------- - - - - ----- Application Number........................................... Section 9= Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 J CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date E Section 11 —Home Owners License Exemption Home Owners Name: \126.Y�t (1 CQ,�( �4,x1�C1 EGG j�S ' iTelephone Number `l`ly - 99 y - 10 517 Cell or Work Number �I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. 'Signature Date 5 201`I APPLICANT SIGNATURE Signature Date 5 2011 Print Name U\24.ht.Vh Cp„YQ� Telephone Number E-mail permit to: e CQ.r e to ��iy GyY�Gi.1 o CAYr) ------------ Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District E] Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval, Section 13—Owner's Authorization as Owner of the subject property hereby authorize 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 /3Of is _ 4 D r / L. + ` L� Al ' A _ APPROVED PLAN RECE '.a. MAY 1 0 2019 l \ LESCO NSERVATION BARNSTAB T X 5 h p 1 zo t ll \ l/ TOWN-OF BARNSTABLE OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE STATEMENT OF UNDERSTANDING As property owner/contractor/agent for the construction at: No. Street Village Map Parcel no. ` I Only minor changes may be approved by the Committee without a new application and a hearing. Minor changes include things like moving a single window or door or a minor change of color. All changes by amendment require the Committee's written approval. A request for change must be submitted to the Committee in writing. Approval must be obtained before incorporating the change into the project. For more than one revision to approved plans, a new application for a Certificate of Appropriateness must be applied for. Failure to comply with approved plans may result in the Building Department issuing a stop work order or denying an Occupancy Permit. I HAVE READ AND UNDERSTAND THE ABOVE STATE TS. o AM Signed: �Q CW , Date Owner/Contractor/Agent N Signed: Paul Richard,Chairperson,Old King's Highway 0 Q:IBoards and Com m issio ns I Old Kings Highway I OKH Applicatio ns Filedl OKH Apps Prior to 20171 OKH Statemen t of Understanding 07.doc • 11 Carty,Lucy,240 Carriage Lane,Barnstable,Map 297,Parcel 035 Install roof mounted solar panels on all roof elevations(front,back,and side) **Certificate of Appropriateness Approved as Modified with the elimination of all panels on roof section 4, adding four panels to roof section one, aligning the street side edges.Adding this house is not located on a well-traveled thoroughfare and there were no abutters present to oppose ** Carty,Lucy,1795 Phinney's Lane,Barnstable,Map 276,Parcel 032 Install roof mounted solar panels on the front,side,and rear elevations ***Certificate of Appropriateness Approved as Amended as follows: The panels on roof section 5 will be revised to 2 rows, eliminating the lowest 2 panels, alignment of the leading edge of all panels on the street side; and it is noted that while this property is located oil a well-traveled thoroughfare, the position of the home on the hill makes the panels less visible and there were no members of the public present to oppose *** Montero,Luis,in a lease agreement with Meldon,John J.Trust,Barnstable Inn Realty Trust, 3180 Main Street,Barnstable,Map 300,Parcel 048 Replace existing sign in-kind,same dimensions,material and colors;change of wording&design ***Certificate of A.ppropriateness Approved as Submitted*** Lambert,Matthew,81 Angela Way,West Barnstable,Map 133,Parcel 019 Move sections of stone wall and install gate ***Certificate of Appropriateness Approved as Amended-The stonewall shall not be moved but the gate is approved with the option to remove it*** Ferrante,Raymond&Varnerin,Ellen,26 Point Hill Road,West Barnstable,Map 136,Parcel 024 Replace all windows;replace front door;reside with white cedar shingles painted Cape Cod Grey ***Certificate of Appropriateness Approved as Submitted-confirming the windows grill pattern will be six over one with exterior applied grills and the azek trim:will be painted white*** Kaupp,Clement,2864 Main Street,Barnstable,Map 279,Parcel 010,Mulberry Cottage,built prior to 1856,contributing building in the Old King's Highway Historic District Remove 24 wooden,double hung windows,and replace with new Anderson Woodwright insert 400 series, double hung windows.Install PVC exterior trim and sills ***Certificate of Appropriateness Approved as Submitted-confirming the grills will be full divided lights(interior and exterior applied grills with spacer bar)*** Higgens,Daniel&Carey,Elizabeth,71 Sheep Meadow Road,West Barnstable,Map 109,Parcel 027 Replace two existing decks with one connected deck;enclose area under deck;color changes- repaint clapboard siding grey,trim white,and shutters black ***Certificate of Appropriateness Approved as Submitted*** The Commonwealth of Massachuset& Department of Indu&WAccidents Office of Investigations 600 Washington Street Boston,AM 02111 www mass gov1i is Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Piumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: -Al. VAMN&o\l� goo d City/State/Zip: Vet � S 1ti \-i Phone#: 11 Ll -99 y -)659 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/orpart-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheeL 7' ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor mein an act employees and have workers' Y capacity. ; 9. El Building addition [No workers' comp.insurance cold.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance requirIC&I t C. 152,§1(4),and we have no 13.❑Other employees.[No workers' 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 mast 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.Lie.#: Expiration Date: Job Site Address: City/Stste/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 certify under the pains and penalties ofperjury that the information provided above is true and correct, Si Date: 5 20) Phone#: T I y - —S H - 105 Oj,jScial use only. Do not write in this area,to be completed by city or town ofjiicial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person id 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 bran 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 appmtenaut thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addres (es)and phone number(s)along with their certificates)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 i nuance. 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 retuned 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 lime. 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 Investigations would Me 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 Cotnmanw"of Massa&USetts Department of Industrial Accidents Office of I,nvestigatieus 600 Washington Street Boston,MA 02111 Tel.#617 727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 wwwmaw.gov/dia L MAR ?.7 Y019 f'"IA, � _ 1Mis Barnstable Old Kings Highway Historic Distri iFrvr g 200 l Main Street,Hyannis,MA 02601,Tel 508.862.4787 Eml erin.lo a ""' aMs - 1639..� fMld APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)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: IR New ❑ Addition ❑ Alteration 2. Type of Building: House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other I Exterior Painting,roof ❑ new roof color/material change,of trim,siding,window,door 4. —Sign: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court [X Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date 3/26/2019 { NOTE AU appUcadons tnum be signed by the current owner f Owner(print): Daniel Hiqqins & Elizabeth Carey Telephone#: 774-994-1059 Address of Proposed Work. 71 Sheep Meadow Road village W. Barnstable Map Lot# Lot#13 ' Mailing Address(if different) 1 Owner's Signature Description of Proposed Work: Give particul work to be done: Replace two pre-existinq decks with one connected deck. Under the deck, enclosed area. Color change: trim to be painted,white, clapboards gray, shutters black.. Agent or Contractor(print): To be determined Telephone#: Address: Contractor/Agent'signature: For committee rise only This Certificate is hereby APP D / DENIED ����® Date Members si a _ A p APR 1`1. 2019 - Town of Barnstablehway Old Committge Conditions of approval 1 0Kt12017 Cert Appropriateness.doc r ERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 COpieS, t = Foundation Type:(Max. IT'exposed)(material-brick/cement,other) Siding Type: Clapboard x shingle_ other (painting original). . Material: red cedar white cedar other pine Color: Grey Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (specify on plans for new buildings, major additions) Window and door trim material: wood x other material,specify Size of cornerboards . size of casings.(1 X 4 min.) color white (painting original) Rakes Ist member 2 member Depth of overhang 4 F Window:. (makelmodel) material color (Provide window schedule on plan for new buildings, major additions) Window grills(please check all that apply_• true divided lights_ exterior glued grills_ grills between glass removable interior None 5 Door style and make:repaint existing (photos attached terial wood Color. . red; 5 Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Louvered Plastic (painting original) Color. black Gutter Type/Material: Color. ' Deck aterial: wood, other material,specify Composit Color: Gray Skylight,type/make/modelh material Color: Size: Sign size: Type/Materials: Color: Fence Type(max 6')Style material: Color. Retaining wall: Material: Reestablish existing walls with R.R. Ties to match existing Lighting,freestanding on building illuminating sign i OTHER INFORMATION: + XBE ATTACHED CHECKLIST MUST BE COMPLETED AND SUBMITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lampposts etc Signed: (plan preparer) Print Name Elizabeth Carey i 2 OKH 2O17 Cert Appropriateness.doc Legend E � Parcels "Town Boundary II !! 109025 ` Railroad Tracks 109033 Ij #1pp ^3 Buildings <. #98 P (3 Approx Building Ix •:% •::'. .y In �•:`•` — Painted Lines �.:.� „ Parking Lots 109024 0 Paved 109026 �� r}f #82 rJ Unpaved #�8 Driveways D Paved 109032 (R Unpaved #82 � Roads j O Paved Road 0 Unpaved Road 0 Bridge E Paved Median Streams / - Marsh 109023 !� �Water Bodies #66 #71 �.,.,. 132007 109031 '•' #60 #66 i 1 � 1 � 1 109028 109022 109030 I #49 #52 ..':'Z, #50 O 109029 t #15 Map printed on: 4/3/2019 This map is for illustration purposes only.It is not Parcel lines shorn on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi O 83 167 0 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 508-862-4624 reflect current conditions,and may contain such as building locations. Approx. Scale: 1 inch= 83 feet cartographic errors or omissions. gis@town.barnstable.ma.us iy r! Changes from 2014 Approved Permit/Plans: 1. Steps/Railing `to grade" on left side of house: extended the steps/deck to dining room to cover retaining walls 2. Railing Sty: changed from proposed wire system to a traditional spindle form 3. Decking Material: changed from P.T. decking to composite'. 4. Retaining: complete/re:-establish retaining wall with matching R:R. ties to existing retaining walls. 'i . . . . . .. . i e L • I� � cl y Z fl F_ z Y: _1 , t , ME O! RIX . Pi Owltr t o \ Z li �,-L 1 - • Ic � i y - t y �It at AUG flip xx i[ a P.T-,.d woad de*.ddit%..t Poo R�uva . mtr j e GARCEAU RESIDENCE • n SDEEVMEADow"AD•wny smisyme•MA 1 � P9 �e ELEVATIONS t � t t t r t r 1 ► .t t / ► t t 1 / t 1 t i { 1 � � i Y existing top of plate EXIST.HOUSE I - t 2x CONTINUOUS Hh\D ML ON TOP OF 4.4 POST55UPPOKrING TRADITI ONAL Wr9 TE 5PI NDLE RAI LI NG_ I xG DECKING(oy Gtmer)ON ezisftng P.T.2x,0 DECK JOISTS(g 16-O.C. ; first floor F , existing first floor I f3lDLtd::I ' -� w ----Y- BLOMPIG I BD. P.T.(3J 2XIO LEDGER 10 GANTILEVER DECK J015TS P.T. 2x10 %; ( . _ � .FUSE FRAME _ TO CREATE ARC EDGE I �I M 1/2'BOLTS 6.O.C. AS SmOWN ON FLOOR PLAN I 571ASGEP.E7 IN 2 ROW I BOLT TO EXI5T,'NG JOISTS ATTAC;i PC5T3 i'O P.T.(2)2x10 W/ APPROVED VIMP50N POST CM.i T A ..: exis(irttJ ENCLOSED AREA basement P.T.4xG POST5 ABOVE 50NCTLI5E5 ATTACH POSTS TC,5ONOTU5E5 Wr I ' APPROVED SIMPSON POST PASE5 basement floor ! EXIST.HOUSE I I-I —"I G4ADPJrLOOR FMFh aT OWNER — '- 0•DLA.CONCRETE 5ONOTJBE5 (CONCRETE PATIO or SIMILAR) ON CONCRM-24.O:A.'BIG FOOT PCG. I I F.NCLO5P.AREA UNDER PR,OP650 LrCK `MTH 2x4 STUD WALLS BEhVEEN P.T.POSTS. r" INSTALL C0025 a WINDO'N5 A5 511CWN. I/2-PLYWD. EXIST.HOUSE 5hEATH%-G AND W.C.SHINGLES TO MATC EXISTING °,•.i;•�^,' �-rt.r. - PROPOSED DECK ADDITION S1 TYPICAL CROSS SECTION utv �L% 1!4°=1'-0° - r existing top of plate EXIST.HOUSE F F05T5, S HAND RAIL ON TOP Or SUPPORTiNG TRADiTiDNAL SpiNOLE RAG existing first floor PROPOSED STEPS EXIST.HOUSE -• TO GRADE P.T.WOOD DECK FRAMP. SKIRT ARGWD^ELK PERIMETER //. •�-.....1.I..I.. .;._..... __._ —�_i,. CANTILEVER AS SHOWN J --1-t�7-1I.... . EUCLG DE AREA UNDER FINISHED GRADE ___ � r N15H RADE.ED G EXTEND TOP OP EXI5T: I I PROP. DC► I WALL;STE ADJUST TO i TOP OP LOtM1IER EXI5TING RECEIVEW EPS FRCMDe I I I J TP AW:NG WALL-SFYONO r I I ---- i----------------------i !, I basement floor --=_ • finished grade @ walk out REESTASUSHEo I — - - — --+—�5-------------LZ==-- 'II aI I I I I R2TAIN NG WALL •I• • I I - 1 i ' EXIST.HOUSE proposed LEFT SIDE ELEVATION PROPOSED DECK AMMON 114"=11-0. TYPICAL 101 DIA.CONCRETE 50NOTU13ES ON CONCRETE 24 DIA.-BIG FOOT•FTG., P.T.AxC P05TS ABOVE 50NOTUBES .. ATTACH POSTS TO SONMBE5 w/ S1 APPROVED 51WJ50N POST 5A5E5 2 ATTACH PO5T5 TO P.T.(2)2x 10%V/ ' OO C'WIDE CUSTOM 5UDING BARN DOOR' APPROVED SIMPSON POST CAPS /sT BUILD OUT ON TRACK TO CLEAR DM WINDOW a 51.1UTTER - E G —�UNE OF CANTILtiNEREC 9�K ASCVE �e9 REUSE EXIST.D=NnND &S y0 P.T.(3)2X10 Cropped o. g. ENCLOSED AREA �O a c < a: to P.T./ P.T.(2)2X10 ENCLOSE AREA UNDER FROP05ED DECK droppe WITM 2s4 STUD WALLS BETWEEN P.T.POSTS. r v^ 'NS°ALL DOORS a WNDO'W5 AS SHOWN. I/2'PLYWD. - 0 IF -$ C SHEATHING AND W.C.SKNGLES TO MATC EXISTING s , g N y Foy �\ C Y Y O REMOVE EXIST.DH WINDOWS ` ! ± a E REUSE IN NEW LOCATION AS SHOWN m h oP.T.(3)2x10 duo d O O opLU,f EXTEND TOP Or EXIST. OPEN AREA j o,`',, + cc WALL-SITE ADJUST TO a RECEME STEPS FROM - D_CK i { ni I - EXISTING RETAINING •i' L - WALL EXIST:STJD WALL,i , REESTABt.IBM { {' RETAINING WALLS �-— EXISTING ' ' FULL BASEMENT to remain rj N. O It ) o r �lj` h b lu O • �� FY•3 �T-`s! + a .'eJ V 4e �4 V � T.w:�r.�V l''.J• �1' �. � y� .d ` w• itR� p (1'._�} hW �.fllt'.✓ L"F.:. , clT� ♦ ..�.` }_ �?Sz,�. �`'.•'•�_� �s` Tyr tialyy✓ •,s. }r mot' „_ t rvr ,+,�. 7M;!'1r �''t•fit, � �' .. •cry' ':? !. � .- ,� `r ': a' "�'•StY!•-y^�t �.� 4S�. 1 CC C Y�w,�r�`..�{,...���r _-S- T NL r"-'_ � ,. (L -4,L. "y i'(L�( '''tom ' ♦4 �, ���♦�♦ � �*'� .✓ .� .SU�,�`�,t,�,�r1�.- i.7'LP �615�. a �E . j aef � 4 � r t.l+�' r y°.,� 1'� }y �. '� +��ti; r� �e'•r�`�' J� .Ibl"k�'rSi!�°r1•��.7rf.i�r,}y;y ?,f�,}� `,.'., .. �A>°" •�`di',''By �t 1. f�^"'f,' J.± _ 'Y t 'pk'��i�h ,,,. ,,K`' �"•. •r:'4♦,'� '� 1,�► :"` '�+' '�, w an� ���5'�' x�i�•y♦ '�� �j \.} i?;:''• .♦ f�ry�• .Cj %�. lr"y.•. '�yr ,itil.� ^1s.. '!`.•'�rw. [ _.T'`r. �k`w �x�`�4'✓ �.R" _ `�. 'L't„��a�.'�st h ^y�,d�,fpei'` ',� ,,•�'L}fyr. c f. .r�. •'nc .1. _ ,�, �fy♦'..i y.rl+.a ', ! _ �;7,, � .yr+,$'�i- t,.'� -�.f����� - '? �Va� �,�•. ) ��Z.r � t S�, -. _'A •• d '��: ��1rf,'�[ r,/�,�y � !J'ry^'�„� .��� {• ,•r• �fi L�'�.e1„Ab '. � ��.�{�k"P •..rab -.�� ./. r .. " ti,�' a i _ a M � SCj-'�v` � ?� ! -t � ysea,�:� _'�Yc�'<." ��• r��'niy�'�.: •`i-°,F+., «. �L♦ wl�',FyH `w 4„e.,:aj� wi r��`'� •tom Jtr•".�,'i ♦� at � ' � �...' � � .�.r�ry�:.• r ,F�. - .. _ -�+{�"a 1'v�r"i.r< . - �;Y�M .�,;.•y+� x •�- � TIYS� rf•�•� _ r'j �• w � y'++i�:''"• . Aj�uw, ��, _ <�.� .` }y.?}'470'L•4-�� >>t. •� _ �-�,!'Si _ � {! �a�#r,+y� r r^..`�'�"• �� � - ^ •-'�' �t���. ' - - _~ �� 1 �'"�. `.w y�Yr•'� " �'� '!eft i {5 y '- �� ��, ,��` 1 , �;4'3..r• ,� ;i A mr. P,I fir- _ '.y'.ef - t��♦ 1 J%.. `a� .� > ~ems' fir' �' I _ I I� :` s tiro ;? :� t'1r t•. N"` "'^^r ,,, ,x7�.• • �,E. �� � i a,..... FF Ipm• ( �,-t�'.. �,,,.7•-• .. i' %�- ���'' Si'•1'•"',:�.-,�7�tt%4�tr',e '�''r-' 3. ,ya^ A.` "f�...�.r++„`- - '_ f '�i�•.�..��y,r� � gal '�" •.fit- � �. �� ••�i`t'''r�- a S t 'D� t7 a'Y�� ,S �'-^+' [�"K' ...Jr'f__- "ri"-'6�Sk 't'� ; .. � w►... �. _ �•Y x�. r4J'.r � ^�.^,..-.;�•�}a+"--�i� �. +�' jn �"e.yy+^yc� - �'f7* c`e`�" �,. ,�'y �� - � 1 -" �il"'�"� i�' }at 'ri+". ,. � ."�"� `.�i ♦ ui�.ra •$F•o'�.1, ,.r...•�� �".',l"'t;�f' �'_S".. „ {� r• „1 d 3`� Pik . ,i,,. � ,�'•ye--�.!~ '°}� t» �Y �� e,y hid♦ „r '' '7 .,` • ,.� �,.5,,'�•� •-��.~ +ice •�u.�-.+�.'a •+,� ~..� �' �-.�1� hr'�...rl� n4i.4„ _'S�. Lf �' f, 'F.. sf�� c _•••.1�a � `f� '� ,� �'r..�3'� Fo stir Nils ® �� J roe . 0 MMM x Ling r'etaim walls 'r Existing Retaining Walls = � ��► pau��s T IT \• ,}ti f•r�..r�,�M4�a ,f!^�':� r� o� � s•.� iA � r4tiLr11,+�[�flu:A�l -.i�;t� �'-i s `•�' ' '�•, w j J i MEN man eeza Y- z timeless Pl+� ! colonial I modern tudor Cl o { Tradition and elegance define the o classic color palette for these dignified homes. a 0- 0 Natural Twine S310-3- Camping Tent N320-410 M Sand Drift N310-1u I Whale Gray N470-6DO ULTRA PURE WHITE®I Ink Black N490-7D El 1 Tr�vv1 f Moonquake N450-410 Polar Bear 75u Snw�trS Adirondack Blue N480-510 ` Silver Polish BL-W13u I Tornado Season S450-60 Blackout N510-7D I No More Dramat P140-7D Swiss Coffee 12u I Sugar Beet§M130-70 Y — River Road N270-50 Livingston N330-5mO Open Canyon N300-4-0 Navajo White 22u I Aubergine N100-70 Ashen Tan N220-2u I Equestrian Green S410-70 Woodcraft N200-510 I Hematite N460-60 §This color may require multiple coats. t-his color requires multiple coats.Use with a custom tinted primer coat for improved hiding. Nmq F' NINE■ � �� u XMI Iva Y i�•�Ir:F +4• � F car,. I�, i I i I � `� .r M Rim \ Y i �, .� �� , , � ■ ,gip.,, .•a 1 I■ � •n,.�r 1 � I��t� � � s v r i american c�sUAl farmhouse I cottage I coastal Cr 0 G coxd S A palette of soft yet strong pastels _j - — offers the perfect color complements 0 for the country inspired style. a J a 0 Weathered Moss N380-3u0 Jungle Camouflage N350-410 a Il White 52u I English Custard M290-51 Authentic Tan N290-2u I Summerwood S290-4m I I � 1 { I Corn Stalk M290-3u Milk Paint N330-1u Liquid Mercury N510-510 Twinkling Lights M280-1u I Cliffside Park S390-60 Astronomical N450-70 I King Salmon§M180-5° Frost 57u I Resort Sunrise M180-2u I I � � Aspiring Blue S440-3uO Shiitake N220-00 Cinnamon Tea 5200-2. Sail Cloth N300-1u I Fresh Brew M330-5m Off White 73u I Washed Olive S350-310 Arid Landscape N310-2u I Night Flight S520-7° O One-coat hide guaranteed when tinted into BEHR MARQUEE®Exterior Paint. Limitations apply.For more information,visit www.behr.com/marqueeguarantee. i N �• lip i .p, front door Adding a splashof bright, vibrantcolor . your door is an easy, cost-effective way to update your home's exterior. Make that color pop even more . - decorative I N I NE ��.`t0 ■■ I m ez�,;eN rr .4Q i A� a � �1 Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept M"M P Posted Until Final Inspection Has Been Made. Permit i639. ti6' r ` Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. 1 Permit No. B-19-1475 Applicant Name: William McCluskey Approvals Date Issued: 05/02/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 11/02/2019 Foundation: Location: 71 SHEEP MEADOW ROAD,WEST BARNSTABLE Map/Lot: 109-027 Zoning District: RF Sheathing: Owner on Record: HIGGINS, DANIEL T&CAREY,ELIZABETH M Contractor Name: ,WILLIAM J MCCLUSKEY Framing: 1 Address: 30 DUTCHLAND DRIVE Contractor License: CSSL-102776 2 YARMOUTHPORT, MA 02675 Est. Project Cost: $2,100.00 Chimney: Description: Add R-38 fiberglass,R-22 cellulose,and R-10 rigid insulation to the Permit Fee: $85.00 attic.Air seal the attic plane with expanding foam.General Insulation: Fee Paid: $85.00 weatherization. Date: 5/2/2019 Final: Project Review Req: /y �' _ Plumbing/Gas // "°L Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 6hf�•�rE szjq- 1l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map > Parcel I / D Application Health Division �1 � Date Issued b la Conservation Division k- rn,n�v2 ac���• � Application Fee o Planning Dept. Per Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address eddOw Village Wes-7— Owner Owner r maw 6or ; a Address / x A Telephone Permit .2 .2� 0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new -Zoning District Flood Plain Groundwater Overlay Project Valuation Qoe7 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) .. -4 Age of Existing Structure 34 S Historic House: ❑Yes ❑ No On Old King'�s Highway:O Ye�❑ No Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other Basement Finished Area (sq.ft.) - Basement Unfinished Area (sqt)` Number of Baths: Full: existing_ new Half: existing new =? Number of Bedrooms: 3 existing new � r... Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas /Oil ❑ Electric ❑ Other Central Air: ❑Yes �(No Fireplaces: Existing l New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:Xexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization .❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Irl )r chi h`G�F�� Telephone Number Q ✓6O- S�� Address &4ee License# ('oe" rr 1��Pk.S-tZ e- Home Improvement Contractor# Email<=311 YMickd 113 I 52!�C/Lt4 C 4 6-or±7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE <V �/� J FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. •!t a ( ADDRESS VILLAGE _ OWNER ' DATE OF•INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL ` CAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASwSOCIATION PLAN NO. Town ®f Barnstable Regulatory Services MASS. za Thomas P. Geiler,Director n wu Building Division Thomas Perry,CBO,Building Comdiissiooer 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.as Office: 508-862-4038 Fax: 50.8-790-6230 PLAN REVIEW z o/ 7 Z r Owner: u" i2 Cat Map/Parcel: /09 0-�1-7 Project Address 7/ sHE6P4619ho,r = Builder: E The following.items were'noted on reviewing: K Vup'liaRTS /1�Ia52 �3E 6x 6 /°� OoSTS Z "051,6 . sPH /A)6- .,Rr-r�� �%'�a 1- . /LI�A X z j�� Rc�u-f KC—W C07;f- A) O!Q P1•t u 5 Z ��� W t�SGef2E �i��4'T� • . Reviewed by: G Date: /Dho, Q:Forms:Pln vw . r t 27te Camrrranfs_�of Massaehuseffr Ifepmftn t-ofhuhzs&-hd Accidents - - Office of lnvestagafions 600 Washington&reet $astorty A 102111 www.mass.gotMia W,-arkers' Compensation Insurance Affidavit Builders/Contractors/EiectricianMumbers Applicant Inferlmafion Please Print Legibly Kan3z Qksinetdo%mizationaadividnaq: PT nagj r—ee 9r/ A&ress: '7 4 ald 6b4l Z d A ez6 0- Gityl tairlZip:�(�SJ > �✓'4 s7a�� Phoneme �0 � `3 fir /�c Are you an employer?Check the appropriate box: Type of. ect(required): 4_��l'ana a,Beal contractor and I P�1 1_❑ I am a employer with 6- ❑New omstiix oa employees(full and/or part-time)-* haveb re the sub-contractors. 2.❑ I am a sofe proprietor or partner- listed on the attached sheet 7_ ❑Rrrnodelrng ship and have no employees These sub-contractors have g_ ❑Demolition. working for me in any capacity_ employees-and have workers' g_ ❑Building addition W,uworkers' comp_in¢trraiire comp_insurance l . Wired-] 5_ ❑ ale are a corporation and its 10.0 Rectrical repairs er additions 3_❑ I am a homsvAmer dbiag all work. officers have exercised flier 11_.❑Plumbing repairs or additions myself [No workers'comp- right of exz-emption per MGL 12_.❑Roof repairs ramnmce required_] t c-1.52, §1(4} and we hz%m no employees_Wryworti•`ers' 13_❑Other r comp_insurance requlred_I °`may spp that checks boa fl roost slsn fill out the section below showing then wa&ets'coamensstion policy infnnmx ioa g4me0'R'IIfSS'PrfiD SUbmrt 7h1S�dyvr[lTx%i'rati:.g(�r 8rT doing all tia�C HUB Ihen haE oafztde COntIeCiD6 7ffi5150.b44ILH IEeR'E.t�d_4iTli inni�SUCH_ +Contrecmrs dW check this box mast sniched ma x6ditinnsl sheet shotriud tfie name oS a sub co or3�md state vrhether ornnt those b emphrjees_ If tfie s�contractum hsve employees,they must provide their worktts'comp.policy number I am an employer that Ls prmidiV t.t orke-rs'corfW?Lmtion iraruraaca for my emplr7yem Hdots is the pa&cp.raid job site information. lnsmance CompanyName: Policy 9 or Self-ins-Lic_;�_ Expiration Date: I• Job Site Address: CibfStatelZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number And expiration date). Failure to secare coverage as required under Sectioa 25A o€MGL c. M can lead to the imposition of rrirninal pmalties of a fine up to S1,500.OU and/or one-Yearimprisanmen as well as cirif 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 maybe forwarded to the Office of Rn estigatiom of the DIA for instranre coverage verification- I dri hereby certify `n trtpenaWas ofgerfaty that the information prcn idgd abi a is hue and correct Siamatace: Date:: Phone#: OfJz,c-iol use an[y. Da Trot write in this area,to be campieted by di( ar town offi'ciaL City or Town: Perooitucense# Issuing Authority(circle one): 1.Board of Health 2.ButT'ding Department I GitylTawn Clerk 4_Electrical Inspector S.Plumbing Inspector 6.Other Contact Persan. Phone g- 6 1, Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 as employer." MGL chapter 152, §25C(6)also stales that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings ia'the commonwealth for any applicautwho has not produced acceptable evidence of compliance with the insurance,coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority_" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their c:ertificale(s) of insurance. Limited Liability Companies(--LC) or Limited Liability Partnerships(L LP)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_ De advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of i lsurance coverage. Also be sure to sign and date the aftidavnt 'llic affidavit sboui_d be returned to the city or town that the•appl-ication 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;;corkers' compensation policy,please call the Department at tine number listed below. Seli insured companies should enter their self-insurance license number on the appropriate lore. 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 perm.it/license applications in any given year,need only submit one a -adavit 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 a$davit 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 futare 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 NTOT 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 oz Massachusetts Department of Industrial Accid.cnts Office of Iavestigatioas 600 wuljmgtan st=t B astou.MA 42111 Tel. A 617-727-49-00 W 406 or 1-977 MASSAFE Revised4-2407 Fax#617-727-7-749 ww _mas,-,,gov/dia Regulatory Services ' � r /P�oF Toiy,` Richard V.Scali,Director v/ Building Division * Tom Perry,Building Commissioner Mass. 1639• ��� 200 Main Street, Hyannis,MA 02601 HE'D MA'I A www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �p// Please Print DATE: G / ,�A /� r 1 r /� JOB LOCATION: PiPi/a /"c�iU Rc. Vl/ C�JS/ � I AIL S I cW lC • number�� �� �� //��� �-�, "sheet village fOMEOWNER":-4(-wcaY&,A C6&e,&_ _S De-3,9 Q name home phone# work phone# CURRENT MAILING ADDRESS:_ ��/ —� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes;. ,- bylaws,rules and regulations: _ The undersigned"ho wner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro ores nts and that he/she will comply with said procedures and requirements. Signature of m'eowner 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 169.1.1-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.\WPFILFS\FORMS\building permit forms\EXPRFSS.doc Revised 061313 • �IME� Town of Barnstable ' Regulatory Services -- ' sA MASS. Richard V.Scali,Director 1639. � 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 Sectio If Using A Builder I, r m w d '�%rCeALI ,as Owner of the subject property herebyauthorize have' t. P (I to act on my behalf, in all matters relative to work a orized bythis building permit application for: 7 ( (Ad s of Job) "Po o* I fences and are the sponsibility of the applicant. Pools are not to be f ed or utilized be e fence is installed and all final inspections a e performed and acce ted. Signature o er Signature of Applicant 9rtu,aiJ Garc., a LI Print Name Print Name Date Q TORM&O WNERPERMISSIONPOOLS i C'ER "IFICA E OF LIABILITY INSURANCE P4D000flR THIS C12RTIFICATG IS lS$U24 AS A MATTER OF INFORMATION ONLY nPSD CUtdFElac N;3 ttEG1475 UPON Ttfe: CERTIFICATE ClackiStone:L-IEUfanCO HO_DER•'rAiS CERTIFICATE QoaS NOT AMEND.EXTEND OR P ALTER THE:COVERAGE AFFORDS D By THE POLICIES BELOW. � O.box 3144 _�._. --- j Uvorcester, Mrs,01613 FN �) INSURERS AFFORDING COVERAGE AIC INyUREC INSURERS A"..A.E I.0 �M ..�. ..., Lianeli CnWrpdsas 59 Freeboard Lane Yarmouth,MA 02675 eV5'Jn=�E COVERAGES THE PO,.iCI_S OF iN5k;RAKCE LISTED EE14'01+v F1\l'E BEEN ISSJED TO THE INSVREC NAMED For•TMf;AC,L;CY�EFO)1)INDICATEC.I.•J_"t17THSTANCING ANY RE0L'IR9VENT,T@RPA OP.CCIVIT?'3KJJF AE4'I CON i Y.A.?'OR c7i H_i�C�3Ci.MENT th('P'Rt=q�aC_TC'Ars^.r.T:i: ']E2TiCECF+T V..Y 5=155U-C`OH MAY OE PIAW.T-E .SLIRAN::E A::FORDEO BY YHE PCLIC:E5 DESGRA3FG HERZ:?fl iS SUEJEC"'=ALL IriE T IMAS."Y.1 LLS•7tt d,hD CO(3']j h3My`T. SUr%I� �1 i'u'L)Ci&s.AGGREGATE L1.1IIT8 3HO)r+\MAl'PRAY-5EEht REDVcE0 5v rl'D C.Alms- or INBURfUiCC POOH 14UP10£R���??Ix Gr0kAL LIAOIUTY EALA 0CCURK%NI:E COe1LIEnt'AL OENF.RA1 I.IAS;LIYY i PRt S+leBcrc �{ i a CV.UNS W-vt �..J OCCUR MEE:EXP?Sny a.+r palaon) PERSON d AOV iNJURY s i GEAEFAL AGGREGATE 3 I (i F',NT AGGREGATE LIMIT rcrueS PER. I FAC•DUCTS•COMP+Cp AGG Y .� POLIO+ FwOjECT OC AUTOMO EUABILJTY C^nR�NE:�514:1•1L+ilr (Fh su[•,rrJ ANY AUYC •-- ALL OWN0 AUTOS NGOILY:1<JURY S E (Pei pe-w-Il 8C>1E�u:ED AUTOS MIRCOAIJTOR }ayD:LY:h'J:JnY a NOVJ)WNFD J-U':OS 0;6PERTY DAMAGE $ I a�T eca�ent, GARAOE UABILIT% AU 7l)QnIY EAACCIDE!!T 5 ANYALnc) O'M ATHAN EAAGC S I AL''i ONLY AGG FJLCF OCCURRENCE 11��GX11Ot9BlUMURr.L ,LIABILITY I 11 CCCL'li a CLAIrnk MACT AGGHLGA E�. l S 1 � s OCOLICTIDLU 5 PETE4T10N s o n t• {--, w-_,m A9EONPtt4 TIOn ANG EUIFLOvkas&zml r - g(}'201� h'1,2015 E.: S.,Cr,ACrtUENT L Tnt.J:D A A;)+a,�rpMEiGtvAtiFTNMEXEcunvE VdCC50GF00 4� 2 .4A OFFICE+71M5EM0S?EXCLUDED? N•any durta:6a urdal i:•E SSE PO-ICY LIM17 $ 500.JJ0 8f EGIA'_PROVISIJNS colorO OTHER rDrvio Unntel.13 coyereo by tho Workers compen3a wr,pclicj CERTIFICATE HOLDER CANCELLATION SHOULD AlIY OP THE A80VE DESCRIBED PDUCIES at 0AKCELA0 BEFORE THB RXPIRATION Town of Barnstable DATE THBRWF,THE ISSUInG I%SURFR WIL-ENDEAVOR TO NAIL 1: DAYS NRITTEII Bulling Department NDTICF TO THE GEHTWICA••:KV'-uf:R N4MC17 TO T4C LCPT,BUT pAU.UR!TO D080 SHALL 367 Main St. IM,0sa NC OeLiCr TICN OR L'A311-,YY OF ANY RIND UPON Wit INDORM ITS A:,0411 OR Hyannis,MA 02601 f cps ggENTAT'IV6S, .� • gUTkOR32ED kpPRE56�AiNE - :D AGORO CORPORATION lV8e ACORb 2512501/08) 0 Td Wd9Z:20 btiOZ SE -daS b6ZSZ9280S ON Xdd -I : W06A d g s g way kiistoncuistrict uo=nee 200 Main Street,Hyannis,Massachusetts 02601 �"`��~� (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXEMTPTION Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings, or photographs accompanying this application: Date Address of Proposed work, Assessor's Map and lot# 2 6,2 House# Street �fi '' ►G�'��� Village: This application is.for an exemption of the proposed construction on the grounds that work. Will not be visible from any way or public place El, Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Propo/s�ed Work: Agent or contractor(please print): 1 Tel.no. 608 3 yq.ggS Address Owner(please print): r m61 ' i Tel no. Owners mailing address: 7/ S h�-zI Ike"),c���. Signed;Owner/Contractor/Agent /���/r�� / �����i�'�/l/ j s Certificate is hereby pprovedlDenied Date:A For Committee Use Only This Committee Members Signatures: APPROVED 2014 Town of Barnstable i committee Any conditions of approval: C:lDocuments and SettirngsldecolliklLocal SettingslTemporary Internet FilesIOLU 10KHBzemption Form 07.doc i \ v ' Lo T 41/z 7 47- � N 3S 51 C -54>, FT- f- _.� ociSTiNG . i �uNL�177VN PR V. DRriF� Fps. 0-7 /y8¢ a�w o PGA /Z�f BE7N G Lo T E VOARD E. P�s� 99 KELLEY ^-I No.26100 v, O �G/STE'r'�e ND S U A V�Edo 1 CG-TLT/,Ory 77//+7- 771E- �7J SST/NG ►�1'*ct�`' L'&U,25A770A/ .SA4,WN ON TtfiS /�LR'�V S Lo c,q 7"-D OA✓ Tf,'&- G'2o v.✓p .4s ,S�,bW N �1b7Z6�D.v q- 7> 77/4'7- /7- CO NFv.PJb S 7 D 77-/�— .5&7- &A-uG 2v i2�77l3�r of 7716' rD1NN GT ...a.. wl.bm fr.:Yam fcr.wWtf ,4..4 W':i�bd.. fr- _ - _ I ; I I I I ma�x�«a• I I FHl Lj • }y }{ } oca<.r.<..me m:ac. }� �1 c. 'Fi 1p Fi } ••••, L_-i rfpaOYfD m:a[O[[a.Dw raafycfD nmoDF , REAR ELEVATION - RIGHT SIDE ELEVATION - J ` l9 N ® ® ® a VF ® ® c Cu m3� 'W p1 N CC ® I®I 1 m-(nE o=o a 125 Da � no i. W .. ' ::`rm:'.na«m:. — coo, e�:.o�r o•..m „ ,`,aC:.tir. ::.,, ..<,m.cw. . . 1 II II c_] LEFT SIDE ELEVATION aD.wfD.DDDDF�DwfD f af. [f „r.rd Al 2 existing top of plate EXIST.HOUSE 2x CONTINUOUS HAND RAIL ON TOP OF 4x4 P05T5 SUPPORTING HOTIZONTAL WIRE SYSTEM(4'GAP MIN.) I xG DECKING(by owner)ON P.T.2x I 0 DECK JOISTS @ I G'O.C. existing first floor E -- existing first floor aLOCIJNG aLOaaNG I x 10 SKIRT BD. —P—r20 P.T.(3)200 P.T.(2)2x10 P.T.2x10 LEDGER CANTILEVER DECK JOISTS FASTEN TO EXIST.HOUSE FRAME TO CREATE ARC EDGE ` W/ I/2'BOLTS @ 10 O.C. AS SHOWN ON FLOOR PLAN STAGGERED IN 2 ROWS BOLT TO EXISTING JOISTS ATTACH P05TS TO P.T.(2)2x 10 W/ i APPROVED SIMPSON P05T CAPS ` existing ENCLOSED AREA basement P.T.4xG POSTS ABOVE SONOTUBES i ATTACH POSTS TO 50NOTUBE5 W/ i APPROVED 51MP50N P05T BASES basement floor EXIST.HOUSE 11-I I F GRADF/FLOOR FINISH BY OWNER —III I I 1 O"DIA.CONCRETE 50NOTUBES LI= (CONCRETE PATIO or SIMILAR) ON CONCRETE 24'DIA.'BIG FOOT"FTG. —III ENCLOSE AREA UNDER PROPOSED WOOD DECK WITH 2x4 STUD WALLS BETWEEN P.T.POSTS, 1' INSTALL DOORS 8 WINDOWS AS SHOWN, 1/2'PLYWD. SHEATHING AND W.C.SHINGLES TO MATC EXISTING �(�e S j!� ® PROPOSED WOOD DECK ADDITION EXIST. HOUSE S1 TYPICAL CROSS SECTION I-nvjrtnb! yr , J0 gM,0j FRI I IFEMO 0 EHI I existing top of plate EXIST. HOUSE NTINUOU5 HAND PAIL ON TOP OF SUPPORTING HOTIZONTAL 3Y5T iYSTEM(4'GAP MIN.) FMI UA EXIST. HOUSE existing first floor PROPOSED STEPS - TO GRADE P.T.WOOD DECK FRAMF SKIRT AROUND DECK PERIMETER� - L — — - \ I' -r � 1 __ -= t _ CANTILEVER AS SHOWN -��•-�4— _______ . /, • ENCLOSED AREA UNDER FINISFIED GRADE I PROP.WOOD DECK FINISt1ED GRADE EXTEND TOP OF EXIST. REMOVE EXIST.STUD WALL I WALL-SITE ADJUST TO I FILL IN W/8'CONCRETE BLOCK ————— I TOP OF LOWER EXISTING 005 DECK FROM RETAINING WALL-BEYOND I t -----------------------I I. . BACK FILL EXISTING SPACE —_j basement floor inished grade @ walk out. — —— ————— —� I PPOP05ED RETAINING WALL I I I I I I I I r� r� proposed LEFT SIDE ELEVATION PROPOSED WOOD DECK ADDITION EXIST.HOUSE 1/4"=V-0" J Verified Mapped Drives (Y/N) Cor ;\ri b1001\usersl\N000000 \rib1001\epocshrd Verified Local Files from C drive to H drive (Y/N) Cor 'OM c:\documetns and settings\user profile\application data\microsoft\outlook TYPICAL 10"DIA.CONCRETE SONOTUBE5 ON CONCRETE 24'DIA.'BIG FOOT'FTG. P.T.4xG P05TS ABOVE SONOTUBE5 ATTACH POSTS TO 5ONOTUBE5 W1 Sol APPROVED SIMP50N P05T BASES ti ATTACH POSTS TO P.T.(2)2x 10 W1 O O OO WIDE CUSTOM SLIDING BARN DOOR APPROVED 51MP50N POST CAPS /ST BUILD OUT ON TRACK TO CLEAR DH G,Q WINDOW ESHUTTER LINE OF CANTILEVERED DECK ABOVE B9 _— ---- ----- do 114 �� REU5E EXIST.DH WINDOWS 9q Q ` o P.T.(3)2x10 dropped70 2 �a \ 3 3 { E ouq \ e� z z o ENCLOSED AREA / P.T.(2)2x10 ENCLOSE AREA UNDER PROPOSED WOOD DECK � dropped � WITH 2x4 STUD WALLS BETWEEN P.T.POSTS, \ Z z z H �v INSTALL DOORS 4 WINDOWS AS SHOWN. 112'PLYWD. \ N SHEATHING AND W.C.SHINGLES TO MATC EXISTING a 'S y W Y o 8 U o O x d 4 p F D REMOVE EXIST.DH WINDOWS ro r O o_ > 8 REU5E IN NEW LOCATION AS 0 O °' AS SHOWN ch > p I I P.T.(3)2x10 dropped aI i 1\ —-_-/'. OPEN AREA EXTEND TOP OF EXIST. Ln cc WALL-SITE ADJUST TO I I � � � I O O � RECEIVE STEPS FROM I i + I \ WOOS DECK I I I IOz I I T `n Ira I i-1 Lu Z) II OZ PROP.RETAINING USE P.T.WOOD TIES F" TO MATCH EXIST.R.WALLSLn w BACK FILL I ;Ii .' / / EXISTING SPACE REMOVE EXIST.STUD WALL i /+ ✓ FILL IN W1 8"CONCRETE BLOCK / REMOVE EXIST. I ,� ✓�� RETAINING WALLS I "I; i •F. ` L_ ---- ' —__ ✓ ' EXISTING FULL BASEMENT to remain 1 When you receive a case to rE user installed on the machine ti 1 Base image (XP/Wi 2 Adobe reader(10.( 3 PointSec- From \\( 4 Media Encryption- 5 Office Communicai 6 PC Anyware 12.5R: 7 VPN Software/Deg 8 Verfiy Altiris packs 1 (ex. Adobe XI STD) 2 (ex. Microsoft Projl 3 (ex. SAS) 4 5 6 7 8 9 a , 10 1 : 1 ex. \\wprsrib0000) '"r 2 �. 3 4 5 6 7 1 ex: H:\pst\*.pst t� TOWN OF BARNSTABLE Permit No. __-_--______ a -- --- - Building Inspector Cash 'Ob 1619 ----------------- 'rDir(*- OCCUPANCY PERMIT Bond Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. ....................................................... 19............ ................................................................................................................ Building Inspector -Commonwealth of Massachusetts Sheet Metal Permit w Map Parcel C SDate: 12—� aw�� x+11 2�I D _ Estimated Job Cost:.$ Slo 0® DEC ermit:Fee::$ ' 16 24 Plans Submitted: YES NO_A/TOWN OF 8 ' exieew-6d: YES NO Business License# -0 13 "b/S Applicant License# -ZIP- Business Information: Property Owner/,Job.Location.Information: Name: Name: }R NCI R N 9 &A R CbA U Street: Z(o 6�a�i l�Cs LrAti/� Street: r// �'K�P �cAflU1C1 � City/Town A/IJFST" y�12/Ii1dtJ7(� City/Town: fisi � i✓� �il Telephone: 77 q" g 3(o-2 S3 4 Telephone: Photo I.D.required/Copy of Photo.I.D. attached: YES NO srlirt ioifro . . S=1/�estricted.license i J-2/M-2-restricted•to dwellings3-stories or less and commercial up to 10,000 sq. ft. /.2-stories or less Residential: 1-2 family V Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept Approval histitwional_ Other Square Footage:-under 10,000.sq. ft.-A/— over 10,000 sq.ft. Number of Stories: l- Sheet metal work`to be completed: New Work: Renovation: HVAC_Z Metal Watershed Roofing. ' Kitchen Exhaust System j. Metal Chimney/Vents Air Balancing I Provide detailed description of work-to be done: (�1,9 0 1 L CgkJAU ANC 9Ye.�;r9014k.o k*5 EM6V6-9e S wit'` Ar,VP-A(- &-45 wbiAL& A-rfP AJ6*J 3066--f MCIM AA tAl 90C9_ AdP 6 coAi :-'T6 i .INSURANCE COVERAGE: I have a current liabiittv.insurance policy or its.equivalent which meets the requirements of M.G:L Ch.112 Yes[t] <o ❑ If you have checked ygg,.indicate the type of,coverage:by checkin.g4.he appropriate bok.below: 1 - " A liability Insurance policy [� Other type of indemnity ElBond ❑ I • OWNER'S INSURANCE WAIVEi2:'I am aware that the licensee does.not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my-signature on'this•permit application-.walves this requirement: Check One Only •Owner ❑ Agent ❑ I Signature of Owner or.Owners Agent I . By checking this.bo ,I hereby certify that all of the details and Information 1 have submitted('or entered)regarding this application are true.and accurate to the best of`my knowledge acid.that all sheet metal work and Instaiistions.performed under the permit issued for this,application will be In compliance with all pertinent provision of the Massachusetts'13 1ding Code and Chapter 112 of the General Laws, Duct Inspection required prior to insulation installation: YES NO ProgLress llaspections I .. Date Comments I Final Inspection Data Comments Type of License: 3y M Master r�tle ❑ Master-Restricted Al ,ityfTown ❑Joumeyper'son . Signature of Licensee 'ecmit.# ❑Journeyperson-Restricted Ucense•Nurntier =ee$ Check•at www.mass.dovldol nspector Signature of Permit Approval' ITt0!✓t7MflIQ roped d o�'.3lrccssaejiusezts �` 2��iT7'kfi�EZEt Z7��77Xf�],�F�?it��GQ.(�eli�S tCG� �UrTYS 600 Waskington S`treat Aostany MA 02M YV f l'W.7tI QSs.�,G�1�llI Workers' Cimpensaf onIusm-ance Affidavit Builders/conimctorsMeciricianMum*lers 1n ]ic�an�I�afin�afain Please Prinfi x Name cityfStat�J, Z�P- /• '" ',"1�U rlli}I7Ci '77q 93�r ZV V Are yora an employer?Check the appropriate ba,= I of��ect(r���- L❑ Iamaemployer with. 4_ I aria. �ccmfractor nd Z . 6- [-]New cwiszft c.a employees(full andlorpart-fine).* havehimathe sub�co xrs. 2�I am a sole proprietor or partner- listed on the attached sbeet T- ❑Remodeling ship and hate no employees emploThegeyees ees a sub-contractors have g_ ❑Demolifiba woring for me is any capacity eusployees and have avorkets' 9- ❑Building addition PTL`�WQrkexs.COmp:is�a�rrxnr-e Comp_iamummf, 6 woiL] 5-❑ We area eorporationand its 10-0 Electrical repairs cr additions 3_❑ I am a homeowner doing all vva officers have esemsed(heir 1 L repairs or Pkmibing repa or additions, . myself [No work='camp- right of es�empfiosi per IvfOI, 12-0 Rmof repairs ain s%uance required,]1 t-152, §I(4),and we hmm no 13�other 0�/E� employees [Na wads' 10E-M Z_ comp_i mnmc a required,] "ttay�F ibis checks box R1 must also fl1 out the sectica below sLavrixcg flu&VD ce a eompensadon pariicy i ICWUR��wnHs vrho snbr�t this at3davif i�TCst1IIg they aie tiding sllttadC saai ffiea hire ostside cashactors umst,snIxiti2 auet¢afiind3rit]77d]r�a sIILZL ctnrs VW check this box must atieched as a'dditin i sheet d arwh3g the name of ibe saV--caakact a and state vrhethec ornat ith se wgiries hne etapbyees_ If the subcoatmctcas have employees,they most Provide& r—&-s'come.policy aurnbez �am arz e�rrplrryer that isprutddrtr�xrrorSrers'co�ion irtsttrrtrtce far m}'enxpiQysea Belau is fhe paTic}�rutdiob aits trtforrrriziio,n. • Inserance GompmyName: Po&y#or Self-ins Lim Fxp'irationDate: Job Sites Addfess- CifyfStatel : A-Aach a copy of the w-arkers'compensation policy declaration page(showing date). Failure t o secure:•coverage as required under SecEion 25A o€MGL c. IS2 can lead to the imposition of criminal penalties of a fine rip to$1,500:00 and/or one-yrrimprisonment;as well as civil gas m the fora of a STOP WORK ORDPP-and a fine of up to S250.00 a dEry against the violator_ Be advised drat a copy of this stateramt maybe forwarded to the Office of Iutestipdons o€the DIA for insurance coverage verification- Ida hereby cetitfp u dw ' s and penat#es of penury tftatfhe uefnrrnutiaa pratddsdnaheive is 6u$and correct Simnaftzre: Date- PhDpet ©fj`ttz aL use only. Eta not writs in th s area,tic be cor+rpleted by Gity or town o�`Icia� Cite or Towa: Ptrmituicense# hssmng Antharity(drele one)- L Saard cpf Health 2.BaUffing Department I CitpT'aw a Cleric 4.Electrical Inspector S.P•lambing rnspertor 6.O4:her Contact Pei-saw Phone##- 6 Information an.d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuanttto 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 stains that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)nane(s),address(es)and phone number(s)along with their cerfificat(-_{s)of insurance. Limited.Liability Companies CLLC) 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 sbould 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. Sells 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 peunit/Iicease 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 writes"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to.the applicant as proof.that.a valid affidavit is on file for f itare permits or licenses. A new affidavirt must be U(--d.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 afdda:\-it 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. no Coram;�mwealth of Massaahus�tks Depaztme,.ut of Iadustual Accidents Office of kvestigatiGm 600 Wasl=gtoal Street $astern,MA 02111 Tel.#617-727-4 W 406 err I-& MASSAFE Fax#617-727-�49 Revised 4-24-07 - , - W�w.mas�gov�dz'a - Town .of Barnstable Regulatory Services = RARNVfA [Z, s MAM Thomas F.Geiler,Director �D 59. 16 Building Division Tom Perry,Buildiag:Commissioner 200 Main Street Hyannis,MA 02601. wwwlown.barnstable:ma.us Office: 508-862-403 8 Fax: 5.08-790-6230 Property Owner Must Complete and.Sign This Section If Using A Builder z, A G � ,as Owner of the sub' l ect P -ro PerL9 hereby authorize ujayN7e- betWcmjS to a:ct.on mybeh4 Ar in all matters-relative.to work.authorized by this building.permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized.until all final inspections are performed and accepted. i Signature of Owner Ivsignature of Applicant Print Name Paint Name Date Q:FORMSDWN1 iPMMSSJONP0= ;<..<.w .; S... ..t..: ...OF Mp,SSA�HUSET�:-. 0NWHIM EpL'TH • • • E#`O:fr:: :; _•: ST<'AL wrl CENS� F DLLDW 1Cr T ' n SSUES THE STFtLC7E D�;��� a k �M"��yy,,M s � n 4 #0E, p EDWARDS, M. L 26 NT IB N �a s; �BU , 1 ,02613 lip'--::;,:, Yz>:r:" • . m- - � -- ::off r •� 0 . s ra BU�RING_LN- -- aEVIGY/kRMoul M__j'026i'3 f {�1�. 4 5'DD ZDi'901:7!Rev G7=52009: CONTRO IMPORTANT ed;is inaccurate,'for lost damaged or destroyed; d mass* .g°v/dP If your licenscorfect d,visit our Web of your Renewal needs to be the proper mailkng other correspondence. instructions to ensure Laws and Application and any subject to Massachusetts d General be tent eep this rivilege,and of law. This license Yourbi license is a P under penalty law and/or • regulations. person or entity d by assigned to any erson or posted as require license on Your p 1 regulations. Www:mass 99ovlrm`v d� r Jb09AS6g MA 1bobID11 Gam' B: Single vehkle 96A01 the or •i J BroaEecGVWR' r r r r r r r r r r r r s � ��• RESiRICilONS•' �- - ` `NONE the IL Comctiva I.Mal CHANGEDF ADDRESS..PRW BELOW.PFAMANENi I • J j Barnstable Assessing Search Results 'Pagel of 2 tv z Home: Departments:Assessors Division: Property Assessment Search Results . #4 71 SHEEP MEADOW ROAD Owner. Property Sketch Legend GARCEAU,ARMAND B e 4�e / Map/Parcel/Parcel Extension W PAA� P�'/�� 109 /027/ Mailing Address ti GARCEAU,ARMAND B 4 T !1 iMT b f � , �f t - 71 SHEEP MEADOW ROAD W BARNSTABLE, MA. 02668 - x 2004 Assessed Values: ,e Appraised.Value Assessed Value .................._................ .................._.................. Building Value: $ 145,200 $ 145,200 Extra Features: $6,300 $6,300 Outbuildings: $0 $Q Land Value: $ 138,900 $ 138,900 Interactive Property Map: ap requires Plud in: lackFo� Totals:$290,400 $290,400 I have visited the maps before Show Me The Mapx � April 2001 photosavailabfe Sales-History: Owner: Sale Date Book/Page: Sale Price: GARCEAU,ARMAND B 12/15/1993 8956/315 $ 135,500 BOULAY, DAVID PAUL 3/15/1984: 4051/047 $ 10,000 ' SHEPLEY, HAMILTON N TR 3/15/1984 4051/045 $9,000 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,919.54 - Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax W. Barnstable FD Tax $394.94 C.O.M.M. 1.10 Cotuit 1:52 Land Bank Tax $57.59 Hyannis 2.03 West Barnstable 1.36 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/4/2004 . Barnstable Assessing Search Results Page 2 of 2 Total: $2,372.07 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.82 Year Built 1984 Appraised Value $ 138,900 Living Area 1608 Assessed Value $ 138,900 Replacement Cost$ 161,356 Depreciation 10 Building Value 145,200 Construction Details Style Cape Cod Interior Floors Pine/Soft Wood Model Residential Interior Walls Drywall Grade Custom Heat Fuel Oil Stories 1 1/2 Stories Heat Type Hot Air Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,700 $2,700 BGAR Bsmt Garage 1 $3,600 $3,600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http:Hwww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/4/2004 .� q.0 7 CwLkelo � v ce LD �� . i Z TOWN OF BARNSTABLE` 262� Permit No. -------•---------------------- ,Building Inspector . .... Cash --------- .e�o. — x OCCUPANCY PERMIT Bond Issued to Dav-id P. soupy Address w 1 nt ltS 9 71 C}lpon Niftndrri Rnn& M°gt Barnstable . Wi;ing Inspector �2 Inspection date ` Plumbing Inspector ,!'� �, r, l Y Inspection date Gas Inspector Inspection date Engineering Department f tY t►Q e O d �► .� Inspection date f/ Board of Health. _ ���- �, - Inspection date 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. Iis..4....:�r7..... 19_. / 1J..... , .............................................._..................._.........___. . '_ Building Inspector .`?,;t r; .. .-.-�. wi. � .,r,��}.. .� .r I�_ tr' _ _,.;� .r h e v.� 'X• �f! .i .t a..;. -�- .� .y''4,, _ :7. f ;r 4; o��o °•°ew TOWN OF BARNSTABLE, • = BUILDING DEPARTMENT �»f • TOWN OFFICE BUILDING ab '631. HYANNIS, MASS. 02601 �OIIA'f 6" MEMO TO: Town Clerk FROM: Building Department DATE: June 20, 1985 An .Occupancy. Permit, has been issued for the building authorized;by Building Permit $k„.. ... ..._.26253 ..._...._w................._.............._...... . . _........_... ..._ David P. Boulay issuedto ...... ._M.._ __ ...w ._._ m.._ _.._ _ _ ........._................. ........... ..._.. - r l Please release the performance bond. David Boulay 21 Sheepmeadow Road Barnstable, MA 02630 June 7 , 1985 . Mr. Joe Daluz Building Inspector Town Office Building 367 Main Street Hyannis , MA 0260.1 Dear Mr. Daluz , I, David Boulay, owner of property located on Lot 12 , House 21 Sheepmeadow Road in Barnstable, MA hereby understand that my occupancy is contingent upon not using the basement of said property which has an overhead door for the storage of any type of motor vehicle. Sincerely, David Boulay �1 u a \ I • 19s�� Lo T ' /Z 4,7- i N La 7-"'1.3 � �1'V NA�bN 17.3� � y I • C'�?LT/F7��D �o T PL�4�v toC/!ri o N WE3 T �,2nls'7�g8C�' �1�9SS. scfrL� t 40� D,4r� Fes. 27 I%Y4 a� E�vaARD �y Sf-1oWAv oN PLC Boo �o E. KELLEY ^� No.26100 Z O 4No 8 u RI .T C672-7"/F7/ XIVA-r rNe- E77/ST/NC jSu,vDs}77o.t/ S/,/o W N ON 77 -/s /S Lo C-9 re-Z> o�v r � C2c v.vp A s • SISbWN �/�'72Ef'D.v �A'+✓7� 77��47 /T a VFvZ•h S 7D 77-/e S&7-- 04GIG 2&Veo 12&'7'7&-A.r 40,C 7;V Er TD1NA/ Pe77 T/O^/GdTZ '� Z�l/!`N¢ IZE�i G u�✓D .St//ZV470,p— Assessor's map and lot number ........, `.C. -. . C�� ... ... .... .. ....... Sewagd' Permit number �3 ...... ........... -......... ............... ..... 1 �. , t.,.• �v:3�,A,�.1.E�y� �9C 2 BJSa9TADLE, i House number ...........................���....... ....................... `� �p 90o rb a m� as Tti 039. `e riL L t� �OMAIAr TOWN OF BAR'NSTABLE BUILDING IHSPECTO` a. APPLICATION FOR PERMIT TO �w}.L '�. �. �os`�...�.. .� ....` /..� � TYPE OF CONSTRUCTION ...... . ............. ... .............................. .................. ............... 9...... E TO THE INSPECTOR OF BUILDINGS: ' ? t The- undersigned* hereby applies for a permit.'according to'`the following information: Location �� ° �l Ll...."�,.....� �... VV d ��./���............................. Proposed Use ............. .. .D......................:........................................................ ..:............................... r J �✓ Zoning District .........r ............:......................V..................F' e D'siri t ........!!" LVc/� t .... �.:................. f Name of Owner .....i ........Address . .......MASS t�2cac�' Name of Builder ... C.....�tY.....V.'.......9�!�-....!'........(.Address'...... ..: e f� .......................... ... I Nameof Architect ....... r ` ,.. t r........................................................Address ..........................�....:.......................................I............ Number of Rooms •.............................................................Foundotion t�t✓.� /j cY ,�.��CJ1..... c . ............ .................... ....... ....... ... . n Exterior ..... .........................................Roofing !....... _ V.. ............................... Floors .}J`(�.lrZaC..........................................................Interior ........ T 7.� ..... Heating ...... ....Plumbing i �-1.:..,......................................................................... ..:.................................................. Fireplace ..........:.............f......................:..................................Approximate. Cost ..........5 ,/.. '......... ,Definitive Plan Approved by Planning Board ___________--_________________19_______. Area /.. ................. Diagram of Lot and Building with Dimension's Fee ��� %.. ." 't ... ..... ...................... SUBJECT JO APPROVAL OF BOARD OF HEALTH, L i 6 t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree'to conform to all the Rules and Regulations of the Town of Ba table egarding the above construction. , Nam ........ .. ......................... . ..................... Construction Supervisor's License ..... . F... ../......... B,QULAY, DAVID P. ��No Permit for ... .,...S.tary.............. .......Single...F=ily....D.e-1,1ing............. Location ....7.I...S.heep...Meadow...Road........ L- ..................h?,....S.anst able........................... a Owner .......J,2avid..P-...BouJ ay................... f Type- of Construction ....FKAM........................ „ ................................................................................ Plot ............................ Lot ................................ April 5, - _ Permit Gran,ed 19 84 Date of Inspection Date Completed ......... �.. �...19 -- o�tm, Town of Barnstable *Permit# FVires 6 months from issue date T Regulatory SeiMces Fee 12 v 0�' Thom F. Geller,Director}` �V� = `I I i639' A� ' 'OTED MA't Building Division To Perry, Building Commissioner.._._ ®�RESS �J °° "'' 3 200 Main Street, Hyannis,MA WkY F E B. ® ? 2004 Office: 508-862-4038 Fax: 508 790-6230EXPUSS PERIM APPLICATION - RESIDENTIAZ�W BARNST, BLE Not Valid without Red%Press Imprint Map/parcel Number Property Address cui `f Residential Value of Work Owner's Name&Address Contractor's Noma_ a/� Telephone Number ,A Home Improvement Contractor License#(if applicable) ii d'd �) Construction Supervisor's License#(if applicable) N-/-A OWorkman's Compensation Insurance Check one: [� I am a sole proprietor I am the Homeowner —IKI have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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' I Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Ho m Improvement Contractors License is required. Signature Q:Forms:expmtrg omp r ov W ..2MWIMMI.AtllW— pro ��M—,�.. i1 C- c • r SHi1 .. 3?Ir AL As 1f - f ►, err `- 9 ��F�s (''�/�J �ii J � �•ih cD`..�vY.-.�. '.WWI- — m IIIIM ' illl. JONN DEERE ,� - ���cgap • Ky$ is✓1' �a�� _. sew" - _ Assessor's map and lot number.. /6��,. ..? �� a ........ �� — �.✓ SINE t0 o� 2� • P Sewage Permit.number !".. ......... �........... d� BARNSTABLE, i House number, ...................................... . ..!..... ........: v rasa GO 1639. 9P TOWN OF- BARNSTABLE BUILDINGINSPECTOR - .�.,t �, APPLICATION FOR PERMIT TO �'.......................... :............................ : U TYPE OF CONSTRUCTION ..... ....................................... .............................. .. . .�..................19W d TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: W Location �..Lte4 � �p ......................................... ..�.��.� -c�-cad....!.`�'�,.......... .�............ ................................... ProposedUse ............�..r... .......................................................................................................................... Zoning District .........1.`-. ...............................:.............�.Fi.re District ............................!.!....!.olTzt,.....t:C%...................... Name of Owner ('........Address .?!to....�!to¢^'�t ��Q. 4tyfl Dr- �Nn+ MSSi� ( r tw Name of Builder ..., ...................................... . ....... r� Aciclret_� ................ ... ....... ..... .................................. .................�.....................Name of Architect .......J� ' ...............Address Number of Rooms - ......................................................Foundation ..1 . .......................`..t� ..... Exierior ��. -C-�✓ ...Roofing v!_!1 ................... v �. ........ ....................................... i. .... Floors .......(,1.v'a�Z°J.:':.... ....... ....................................................Interior ...................................................................................... Heating .............Plumbin ( Fireplace .............:....................................................................Approximate. Cost .......... ............� Definitive Plan Approved by Planning Board -----------___-___-----------19-------. Area .. �.�.......................... Diagram of Lot and Building with Dimensions Fee j. ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........................................../ ........... .�. ..................... Construction Supervisor's license ....... ......... r. . BOULAY, DAVID P. A=109-27 Story v 2 6 2 5 3.. Permit for 1�2...No .......:....... ....... .......................... Single Family Dwelling ............................................................................... Location ....7.1...Sheep. ...Me.a.dow. ...Ro.ad.......... .. ....... ..... .... .. ....... ..... .... W. Barnstable ................................................................................ Owner ...Da.vi.d...P.,.....B.o.ul.ay.............................. .... .. ... . .. .. .... .... Type of Construction ...Frame.............. ............. .. ....... ..............................................:.................................. Plot ............................. Lot ................................. Permit Granted ........... .....19 84 Date of Inspection ........................... .....19 Date Completed .........................................19 53—0('5) Id l 4 . t oEE r : Town of Barnstable *Permit# �Z�( 6 Erpires 6 ontttS fr sue date Regulatory Services Fee BARNSTABI.EP.. Thomas F. Geiler,Director. ` plED MA't A t Building Division i 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 NO Valid without Red X-Press Imprint Map/parcel Number 1 v t U Property Address_ ��'_ (M1AE2�(6 PAJ W. �JCcrraJ �Qb �r° t /� Zesidential Value of Work1(g,0Q6 .of) Minimum fee of$25.00 for work under$6000.00 O,,vmer's Name & Address A r wit d"c• &rG PRV _-, t ��ep� �..(,o�io�o,,y Q.lJ Ly - (�a ten)S 1 q � �� �� • Contractor's Name LO 6.0: 2's I I u���� t�I Telephone Number_5Z:_? 1-lome Improvement Contractor License#(if applicable) l(o a—c 3 Construction Supervisor's I.,icense#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name T Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) Re-roof(stripping old shingles) All construction debris will be taken to El Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance ol•this permit does,not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner.Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q: WPFII..F.S`50RMSIbuilding permit forms%EXPRESS.doe 'Revised 100608 SHE, . Town of Barnstable Regulatory Services i 9 $ Thomas F. Geiler,Director �fo �a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder V,*-G e aC) , as Owner of the subject property tt hereby authorize @.!� .e V' Co K3s t lr u C- 0 to act on my behalf, in all matters relative to work authorized by this building permit application for: (A dress of Job) 0 ignature of Owner Oate Pant Name If Propea Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n.cnvz.rc•nun.rcDncnz.rrccrn>,i �oF z�r � Town of Barnstable y�P o„ Regulatory Services sAaxsresLe Thomas F.Geiler,Director MAss. 9� ,0� Building Division PlfD �a Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF BOMEONV ER 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 be/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"certitifies,that he/she understands the Town of Barnstable.Building Department minimum inspection procedures and requirements and that'he/sbe will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official e 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 perfoi-ming 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 ofhis/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:forins:homeexempt f The Comm onvealth of Massachusetts Department oflndustrialAccidents Office of Investigations a 600 Washington Street Boston,MA 02111' ,., www.mass.gov/dia ' Workers' Compensation Insurance Afddvit: Builders/Contractors/Electricians/Plumtbers _Applicant Information Please Print Legibly Name(Business/Organization/Individual): . V4 ewS , eG 0e 110 � Address: a? CK41.a Id �-►v City/State/Zip: ►�..lctrs 10 Ns' p.A.((s Phone.#: Axe.,.yyo am a employer with _J an employer? Check the appropriate box: :Type of project(required):, 4. I am a general contractor and I 1,LV 1 * have hired the sub-contractors 6• El New construction . employees (full and/or part-time). �,` Remodeling 2. 1 am a'sole proprietor or partner- listed on the'attached sheet. ❑ g ship and have no employees These sub-contractors have g, []Demolition 'working for me in any capacity. employees and have workers' 9 []Building addition [No workers'comp.insurance comp. insurance.$' required.] 5. [] We are a corporation and its 10.❑$lectrical repairs or additions •3.❑ I am a homeowner doing aA�work . officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4), and we have no 13.0 Other employees. [No workers' 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 ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.polidy 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.#:. C3rk�ie Expiration Date: lO Job Site Address: ELLS he-A p - `"� City/State/Zip: Attach a copy of the workers' compensation-policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage m required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK;ORDER and a fine of up to$250.00 a day against the violator.�Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the CIA for insurance coverage verification. I do hereby certify under the sins-and penalties ofperjury that the information provided above i true and correct. Si afore: Date; t L-0 —. Phone r0fJf1cia7le only. Do not write in this area, to be completed by.city or town officiaGr 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 Ph Contact Person: one#: 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 hiie, 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 ehapter..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 eo:npl%aaee 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-conti•actor(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 nuzgber 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 maybe 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 fo any business or commercial venture (i.e. a dog license or permit to.bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.The Department's address,telephone-and fax number:. e Commonwealth of Musaehusetts D1Q artM(-,nt of 1Adllst al Accidents Office of Investigations 600 Washington Street RostOa,.MA 0.2111 het, # 17-727 4900.ext 406 or 1-$77-�MASSAFE Fax#617-727-7749 Revised 11-22.06 . www.matss.govEdia F N 1 I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Old Cape Cod Insurance Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 296WInterStreet ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Hyannis,MA 02601 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Michael Meagher 97 Emerald Street Marstons Mills, MA 02648-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Do LTR 'ME OF INSURANCE POLICY NUMBER FOLIOYEFFECTIVE DATE POLIOY EXPIRATION DATE A MON ANDEMPLOYERS'LIABILITY LIMITS E PROPRIETOR/ PARTNERSIDCECUTFIE OFFICERS ARE: wcL o ExcL❑ 4520569 11/09/2006 11/09/2009 FATORYLIMITS THER CwerapeAppllaaIoMAOperddunaOnly. ACCIDENT S 100,00SE POLICY LIMIT $ 500,00SE�ICM EMPLOYEE $ 100,00 DESCRIPTION OF OPERATIONSIVEHICLESISPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR MICHAEL MEAGHER. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BLDG DEPT EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL IQ 230 SOUTH ST DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT HYANNIS,MA 02601 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i I I~ � �te �omvrrzom�uP-a�i o�✓�aava.�.lucaet[b. _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 162938 Expiration: .4/27/2011 Tr# 283438 Type: DOA MEAGHER BROTHERS CONSTRUCTION MICHAEL MEAGHER JR., 97 EMERALD LN MARSTONSMILL,MA 02648 Administrator �lassarhusetts - pcp;u-tmcnt id'Puhlic Safct� Boatrd of Buildim., Reatilatitms and Standards Construction Supervisor License License: CS 102260 •'?' Restricted to: 00 MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS MILLS, MA 02648 Expiration: 11/5/2012 Tr#: 102260 ( mmi.aincr , r From:Erica Barreh A;:Olce Cape Cod Insu.ance FwdD:7LDE CAPE COD INSURA To:Milcnaaj Da'e:511/2009 03:08 PN1 Page: ` of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE OF 10 Ev =iT_!,rn:DD YY, t4ICHA-.3 1 05/01/09 'R':DU'CER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Olde Cape Cod Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Martha Findlay HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTENC OR 296 Winter Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis Mh 02601 — - ---i�— Phone: 508_771-3300 Fax_508_775_3821 — _— INSURERS AFFORDING COVERAGE NAIC= Q—su-i D One Beacon Insurance 20621 _ tlichael Me- her 97 rmeraid Laae ------'--___-----.--__--- Marstons FLills t+A 02648 --._...__.—..- ----•----_--`-- ---.-•----•— -rcS.:EF E. COVERAGES !',_=C.'C'Ic:nF•`.aiM'. =iia;rr.� :ui H�'-._t' .._Lt=i:�.�(n_IN='1.t`cl ".FM_i?45G�E' R 7-E G:l l:,'�U.IJ,:':i.:;AT=C'":J:Y.IT-.r.al;ii!•� ?I.�'PE�U RErL -TEE'u'?R' :bT•.,,a r.p a. .. •7:F,?^ �tiEs COi::r•Ei:!:^1;;r:>PECT T^'4�!ii'';Tw?'.EC'!' c 4.=Y w=154 �-`CF i.1A•'�•-q-:=.Iv''nli r .;Rs:•n t JFG=.EC:-. -w P ':IE:JE$1,;1; E. f-_,K-T TO AL_T%+F.TERM--E.*<C-LZ.'';.�_=NC *Nz:F+s> .<::<?;�TFL'L';'SSl+G':vrd:•.:-'v.i°IlEE<RECUCED6-aDCc:M3 P0L1=Y Nu(4oEri _ i DATE t'pM'DDrM I DATE(tJM2•DrYY_I •`--_ LIMITS SSNERALLIAP--Lry ,7 1000 DOS P'S1U58260 04/25, 09 04/25, 10 PR2si5E2(EaJ 36 6 —L_ ICLA:;T '.zc- 't 1EN C:� --- 00 r--.......-_.._..--- ' x 204G000 •i'EN�L.3 ?c�; 2000000 1 1 I � >UT-•W.;6ILE:iABILI-f I ! iir_t;°_C'l1LF.r'?+�•`i:: { � 'Pe,xi�r! ,,I 1A- j GARAGE t•=.B':171' I I ^..ri'+t: -- :i:-_ �+ E?C5S6,UfteRELLA LIAt?IiJTY WORK-FRS COfltPENT:ATION AND EMPLJYEREt LIWOTi .---=-- -C--`_—_--__ •r+Y F'F =•F.'c C?,a,t- -:,J'E:•JT vc ' 1 •—1-I'---t''`_:_.....-' -------- -L"C-E1_F OTHER -�'-•------ ----._____._.__.,�-_ E :RiF'TI:d!OF JSERaT'Jf�19;LOCAT:it1S t VEHICLES/E CILS,h'_:S A DZD B'i ENWRSEMEI T ER•=1AS!0'q - - - -'•- zn'sured---has -workers_compensation policy-effective 9/25/09-4/-25/10. -- -Certificate has been ordered and will be sent to you directly. CERTIFICATE HOLDER CANCELLATION ~- TL-,m o1 SHOULD A:IY OF T7-4E ABO'.E DESCRIZED'OLI(;IEc 3E CANCELLED BEF•c_RE THE E}P:RATIJN DATE TeePE F THE*SSUING NSURER:,ViLL ENDEAVOR 1.5 MAIL 10 _DAY?viRITTF-. NnTICE TO T"-iE CEPTIFICATE HOL cR'dAWED TO THE LEFT,B!"P;&'jP.E TO DO SO SnA_L To-An Of Barnstable Building Department M?OSEf+v08L1oAT1Jf10RiLB:LiIIO=?17Yn9dGUPONT-:6!hSUReR.?S1GHdT5uR 230 South Street REPRESEMAn6'ES. Hyannis 1A 02601 AJTHOPI ACORD 25(2001!08) ACORD CORPORATION 198€ �����s / �,. gam, I' " • r Iw1 1 n , ' I ,_,r. .,.,, '( "i , " . p ,.i { i ,,,. it,y .. •qi! tll d 'p d. f ft.:S+ 4, 11'i •1 e • Imo`__ .T� ! L ' � -I �. I -5X '1'7 i I _ r MWIMUM 61JIL1; 1 l4 a 5C1fe00 y 1 _ n R VA R NCIA 1 OL- T ' fIN1541 GRADE. A4. 2% ,mil} . t, - t' • ---N.oT _, rrAIW ONE FOOT OF FI415H dRAVIm OVER LEACH AREA � -,' —� F•- %- Zof of P6A s-ro► IE Fag T 1_ , \ �- (101MIF4) I a* M. 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