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HomeMy WebLinkAbout0330 WILLOW STREET r�► a 0 ce Town of Barnstable Final Inspection Affidavit Date: a Building Division 200 Main-Street Hyannis, MA 02601 RE: Insulation Permits Dean This affidavit is to certify that all work c� gr�-�pDIete at: W Street: a3O �?� l I p�A� S� � ) Village: has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit application number Issue date: 5- Sincerely, Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road , Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com BUILDIi14G DEPT. MAY 14 2019 -TOWN yr SABLE . ' , Town of Barnstable Building . . . r ... .. Post, his Cacti So That it is. ble'From the Street Approved Plans Must be Retained on Job and this Card Must be',Kept n �a {AEN'SMSM l a M" ¢ Posted Until Final Inspection Has'Been Made " r rt x y.m�� 163¢ L , ' Permit r ° Where a Ce`rtificate'of Occupancy is Required,such Building shall Not.6e Occupied.uritil a Final Inspection has been made <=w Permit No. B-18-333 Applicant Name: Francis Sheehan Approvals Date Issued: 02/09/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 08/09/2018 Foundation: Location: 330 WILLOW STREET,WEST BARNSTABLE Map/Lot: 131-025 Zoning District: RF Sheathing: Owner on Record: THORNTON,EDWARD L Contractor Name'-, RANCIS S SHEEHAN Framing: 1 Address: PO BOX 8220 Contractor License CSSL-105941 2 NEW ZEALAND, . �� Est. Project Cost: $3,100.00 Chimney: Description: Air Sealing,96 SQ Ft R-19 FGB, 106 SQ Ft R-45 Cellulose to attic,82 1, Permit Fee: $85.00 Sq Fr R-13 FGB+2"to kneewalls, 195 SQ Ft 10 ML poly;220 Sq Ft R- 1 ¢ Insulation: 21 closed cell to crawlspace Fee Paid: $85.00 Final: Date: 2/9/2018 Project Review Req: Plumbing/Gas Rough Plumbing: ---"�_aBuilding 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. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. r Final 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 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. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. 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 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 00 Fit Town of Barnstable P RECEIP � LsrM.atd.2�a -r.-aia %xt1+ eA""', ` 200 Main Street, Hyannis MA 02601 508-862-4038 ibs9 `0� Application for Building Permit Application No: TB-18-333 Date Recieved: 2/2/2018 Job Location: 330 WILLOW STREET,WEST BARNSTABLE Permit For: Building-Insulation-Residential Contractor's Name: FRANCIS S SHEEHAN State Lic. No: CSSL-105941 Address: Brewster, MA 02631 Applicant Phone: (774) 237-0410 (Home)Owner's Name: THORNTON, EDWARD L Phone: (508)774-7224 (Home)Owner's Address: PO BOX 8220, NEW ZEALAND,. . Work Description: Air Sealing, 96 SQ Ft R-19 FGB, 106 SQ Ft R-45 Cellulose to attic, 82 Sq Fr R-13 FGB+2" to kneewalls, 195 SQ Ft 10 ML poly,220 Sq Ft R-21 closed cell to crawlspace CY O ZE Total Value Of Work To Be Performed: $3,100.00 p O t -n Structure Size: 0.00 0.00 15�00 Width Depth Total Are.V ao I hereby swear and attest that 1 will require proof of workers'compensation insurance for every contractor,subcontractor,p_r_—rpther h rker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.;officers of a corporation and partners in a partnership may elect to be.excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued, it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Francis Sheehan 2/2/2018 (774)237-0410 Applicant Date Telephone No. Estimated Construction Costs/ Permit Fees Total Project Cost : $3,1.00.00 Date Paid 2/2/2018�Amount Paid Check#or CC# Pay Type -- $35.00__ �XXXX-XXXX-XX)FX-t Credit Card - Total Permit Fee: $85.00 : _ 3014 I Total Permit Fee Paid: $85.00 2/2/2018 $50.00 �� XXXX-XXXX-XXXX Credit Card 3014 THIS IS,N 1U . TERMIT M # TOWN OF BARNSTABLE BUILDING,PERMIT APPLICATION Map Parcel o Z5 Permit# ' ) rmwja Cf B1�F�t1ST�1a3LE Health Division `7— 3l-7 ,5/�6 Date Issued 5-- /-o (� �� Conservation Division Zt y-y 71Gs, �Y 6 r'R! 09 Application Fee 670 Tax Collector Permit Fee 0 t 76 Treasurer !?IMli SEPTIC SYSTEM MUST BE Planning Dept. IN'STALL9C 1[4 COMPLIANW-!z Date Definitive Plan Approved by Planning BoardWITH TITLE ENVIRONMENTAL5 CODE A,2 Historic-OKH Preservation/Hyannis T OWN A'=ICULATIONS Project Street Address 3?,o tt t Village Owner ga,+rG.lhn e U.1 k7, Address 53 co 'vJ I ka S-t. k13 Telephone 3 . 03 99 Permit Request r nAlaC AAA;. _ �� ajd o�e��c c,� SC fe-t✓1 took - i ,emc11 Square feet: 1st floor: existing — proposed — 2nd floor: existing — proposed — Total new Zoning District Flood Plain Groundwater Overlay Z ,6CO Project Valuation Construction Type w v o cA, 1,.cr1f e A_ Lot Size I A 5 &Cyc-S Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 4 Two Family ❑ Multi-Family(#units) Age of Existing Structure 'ti= t 00 Historic House: ❑Yes 0 No On Old King's Highway: Q Yes ❑No Basement Type: Cb Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half: existing _ new — Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas J0 Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes O No Detached garage:❑existing ❑new size Pool:❑existing ❑new size — Barn:❑existing ❑new size ~" Attached garage:❑existing ❑new size Shed:❑existing ❑new size — Other: anew ,aoyr 1, Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial O Yes No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone NumberD� 0 Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTINGFROM THIS (PROJECT WILL BE TAKEN TO �6t ry)S �t'!i 3 Y_6vvl SlfA SIGNATURE DATE -5-J �z o j FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. " t h • ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION OTC FRAME . (� - °,OS -lip Q INSULATION FIREPLACE r' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r• GAS: ROUGH TINAL, T r. D n FINAL BUILDING 4? DATE CLOSED OUT ` ASSOCIATION;PLAN NO. BEAM: Floor Girder PROJECT: Schultz PAGE of West Barnstable, MA Feet Inch Inches Load DL LL TL Spread TOTAiL LO SPAN 6 8 80 1st 15 40 55 5.10 280.5 \S�ERED Roof 10 30 40 6.0 240 v� 0 0 521 #/LF OFMF-1 pSSPG�JS 43.38 #/li BENDING - S Re 'd DEFLECTION - I Re 'd M=w12 34700 1/360 240 1/180 8 Allowable 0.22 .33333 0.44 Steel Wood LVL I Req'd *Fb 22000 1000 2800 Steel 4.00 ?..67 2.00 *E 26000000 1300000 2000000 Wood 80.09 �3.38 40.04 5=M/f 1.58 34.70 12.39 LVL 52.06 �4.70 26.03 ACTUAL - S & I b= 4.5 d= 7.25 Use: (3) W's S=bd2 Fb= (R petitive) 6 39.42 Fb= 1,000 Single) I=bd3 E = 1,300, i 00 12 142.90 i C r BEAM: Floor Joists PROJECT: Schultz PAGE 2 of West Barnstable,MA Feet Inch Inches Load DL LL TL Spread TOT i LOAI? SPAN 11 2 134 1st 15 40 55 1.2 66 0 a 0 0 �o $ G� 0 IN OF MPSSP 66 #/LF 5.50 #/li BENDING - S Re 'd DEFLECTION - 1 Re 'd M=w12 12345 1/360 �240 11/180 8 Steel Wood LVL Allowable 0.37 0.55833 10.74 *Fb 22000 1000 2800 I Req'd Steel 2.391.59 1.19 *E 26000000 1300000 2000000 Wood 47.72 1.81 23.86 FS=N-yf 0.56 T12.34 4.41 LVL 31.02 �0.68 15.51 ACTUAL - S & I b= 1.5 d= 7.25 Use: W's (14"+/ o.c.) S=bd2 Fb= 1,150 (Repetitive) 6 13.14 Fb= 1,000 (Single) I=bd3 E = 1,300, 00 12 47.63 BEAM: Roof Girder PROJECT: Schultz PAGE OF T West Barnstable, MA Feet Inch Inches Load DL LL TL Spread TOTAL LOA]? SPAN 4 10 58 Roof 10 30 r_ 6.0 240 �SSEREOq . 0 Q` a pUL D. q�y�� COq S 0 ,� Of MASS 240 #/LF 120.00 1 #/li BENDING - S Re 'd DEFLECTION - 1 'd w 8410 8 1/360 Y240 1/180 8 Steel Wood LVL �-24167 Allowable 0.16 0.32 *Fb 22000 1000 2800 I Req'd *E 26000000 1300000 2000000 Steel 0.70 9.47 0.35 Wood 14.07 �38 7.04 F�—m-jf 0.38 18.41 13.00 LVL 9.15 �.10 4.57 ACTUAL - S & I b= 3.0 d= 5.25 Use: (2) 2z6's (P. .) S=bd2 Fb= Repetitive) 6 13.78 Fb= 1,000 Single) I=bd3 E = 1,300, 00 12 36.18 BEAM: Roof Joists PROJECT: Schultz PAGE OF West Barnstable,MA A K 4Feettch Inches Load DL LL TL Spread TOTALLOADap SPAN2 134 Roof 10 30 40 1.33, 53.2 0 MAN 0 q� of MpSSP 0 53 F �I 4.43 #/li BENDING- S R 'd "DEFLEt' ON- I 'd- :. Mi�� 9951 1/360 1/240- 1/180 8 Steel Wood LVL Allowable 0.37 0.5583 0.74 + *Fb 2200Q 1000 2800 I Req'd Steel 1.92 1.28 0.96' *E 000000 1300000 2000000 VftW 38.47. 25.64 19.23 S=M/f 0.46 9.95 4.55 ` • LVL 25.00 16.67 12.50 ACTVL - S & I b= 1.5 Use: 2z8's (16" o.c.) d= 7.25 S=h2 Fb= 1,150 (Repetitive) 6 13.14 Fb= 1,000 (Single) jr"3 E = 1,300,000 �� 47.63 Town of Barnstable Regulatory Services 3 B=WABzs, Thomas F.Geiler,Director MASS Building Division lED MA'S Tom Perry,Building Commissioner j 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: "'r" " " ° "r" �� Estimated Cost Address of Work: 3�C� Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 (]Building not owner-occupied EOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPRGUARMEANNTY F ORKUNDERMGLjEc.142A. ACCESS TO THE ARBITRATION PROGRAM OR SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date O�wet'same i Q:forms:homeaffidav I� .:.. Regulatory Services .. . .. .. . M. _.. . . .. . . .. . . • . . . . 15JURNSPABMASS LE; y -; ;T#Jom�s�F::�.eIIer,•Director, �._. ,... _. . M.. . - ••� : . . . v Building Division �To'm Perry,t-fiildidg C"oinmi 1bile'r 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us c ' Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:U I Zo JOB LOCATION:_ 3 3 o I� 1 L'0.,.1- number street village 'HOMEOWNER': 'Aa ra&(el' home phone# work phone# CURRENT MAILING ADDRESS:_ t I I o1A S} LA) . LX/1 S}"C� le M-CA_ d uy e r city/town state yip ode 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 pot be considered a homeowner. Such - "homeowner"shall submit to the Building Official on a form acceptable to the Building*Official,thathe/she shall be responsible for all such work performed under the building permit. (Section l09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Tovy.of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Nk, 1 awl, I sci Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required-to comply with the State Building Code Section.127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for him to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor:The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt I I '��.►i.w.-ter' V 379 '�- , I ► 0 C N 73--�q ►ice �l W� I � I 1 � l r� � cB ► I certify that this property is located CERTIFIED PLOT PLAN in flood hazard Zone C (outside the 500 year flood) as identified by the Depart- LOCATION I,y��— B,q,2.vs'/ac�l.� !�• went of Housing .and Urban Development(I:UD) . �,� 3 2003 SCALE . ... ... ... .. .... .DATE /` ' . .. . �. .. ... . Date /yi!%2. 3 Zoo 3 ���� °F a►4, PLAN REFERENCE EDWAa0 ti� D 'V a /, �� - ''; aim. G 8GG .�-• ZZ7 . . . . . . . . . . Re'' Zafd26g.Ur ;e,- 0 THE LOCATION OF THE ORIGINAL DWELLING e SHOWN HEREON , EITHER WAS IN COMPLIANCE I certify to its title insurance company WITH THE LOCAL APPLICABLE ZONING BYLAWS that there are no visible encroachments IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO HORIZONTAL DIMENSIONAL or easements except as shown and that this REQUIREMENTS ONLY) ,OR EXEMPT FROM plan was prepared under my immediate VIOLATION ENFORCEMENT ACTION UNDER M.G.L. supervision. TITLE VII ,CHAPTER 40A,•SECTION 7,UNLESS .^'l ,fZCAi2L'7^ t SC�,/UGT� �c�T. OTHERWISE NOTED OR SHOWN HEREON. The Commonwealth o Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street, 7t"Floor Boston,Mass. 02111 Workers'Com ens_ation Insurance Affidavit:Build in Y/Plumbing/Electrical Contractors 'HTdaniifo atn't +� a:� + �.1ee ' lel ,ii; ,E.4j�y• g ,, , ;;: P,^ name: AMC M(J0A0 � SILLU 'fz_ address: t) city _0 - tQJ_f 1 S"IQ state: 1 "�_ zin• (31J,69 phone# E36 M 3 —1 work site location(full address): 3 371 WAr7.() 1 W, CJ(�l.liyt��&�; y�/Z G�C— I am a homeowner performing all work myself. Project Type: L&New Construction❑Remodel ❑ I am a sole proprietor and have no one workingin any capacity. Buildirigg Addition `.il' %.� m•,y .. ,. .s Y . cy! .M emp. _: :'� i.. ,;ia�. ?j4, hc•, ::�. ."i'?F°�:•:'. a: x , c•_,.,. ..• .._^`iy' .^ u7'hr.: .,a.a1 �] I am fi.an loyer providing workers'compensation for m. y employees working on this job. company name: address:' city' phone 0: insurance co. policy# x.C�.' .� ... .1a^.�i':atJ:rld�u:.5'.b.k:tia:v5."d°g'i::..�:Yc'�`tn;4•t:c`n.�z'�uL,�+S::C':i.^.i•i�"it. C:l'ie�4:.,._.?5`!_}5�1'�§..+.F:.;"Ci-"u'h.rr,,..^& ::L�,_:a''.•:'. .'F>v�. t,;�uV ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address city' phone#• insurance co. 3olicy# •iTA';iw. ::�.:a1,;•. .a. ,!t; -°!':19,;. �!:q� au wp. ..�Fy.� ,�.r,: * :s: :..4::�..w y,r. v. •.x<�:�..;.,.... ��,, .._ .•�. ..,,y.>�'a.,.� .}r'!F.�E w.,,.•1.,._>!�••..;xt ?f T'.. r.?�3:�3:.:� - ,. . .1,;:.. •:k�.rn..•. a:5::..,:..:i':r^;.,. - -;r:, -company name' address: city: phone M insurance co. DolicV# .N Lh .SNP iiLe - Y--> .�. ::*. y}.M;^•i —'A'u—:^-�` e�`v...{..i ,i vyi7�' `.i F dd��io4"iaFs` tinges? Y�a 3i gas 'r: d � sc .+,a`�c ;-c Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$100.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a' copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains`an J and penalties !hies of perjury that the information provided above is true and correct. Signature GU A I I V (i Date 6-/.a"/U 5 Print name M ��/(►'P I' _�1 (( �l l Phone# 3 u)312, official use only do not write in this area to be completed by city or town official city or town: permitilicense# ❑Building Department ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office ❑Health Department ' contact person: phone# (rcAscd Sep[.2003) ❑Other r e. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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. 1�'@ �a�{�; y��y5s, pw,�{ .r '.x (p: ,� +6*u^., .4y'qes ^r {fir.?.TiG,:tA�iR+t#+P.fe'.`{�, 'tYe,.• t"'�.. i` �i;l��V.T' ).•"i'ry.i'"�b�F;Y."7P!W'R.. 'q)YS.! .r°7r;"!; .]�7N,- F��77��',R.. :t}( '!! ?t �...�'�C�•<r{,!,:'•N.v,.�.�Y -4�y 3 '�i��: �.. �k+.. •::�', '':�fi-; '.d is +�t,3�+ ,'�'h.,a?: .J�c;.f_'c `�i. Applicants I Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if you are required to obtain a workers' compensation policy,please call the Department at the number listed.below. �. T,'1'.'+6'g,v,fd:'G'•s kLr�,'-@ hfi;<Y. ��^m'ar_.' i. f�a^a,5`�.t p'.•�r'.°"+' i a �•r:�. �,,.. .(:i....�v..�.r.' '.^'P" r•F Y .7"i' �i"1e t:. s:�.rn:.f""...��[�' 7�"7:':b.ie;,?A',•..�'r,.; 'a.,,�•'.�... .i;: v".r.. !�': ,. ;.aq?fr r.ss��,r.P$:f��i.,'vi,2:?�. x�-a�r�. �.,n �., :.a:�� - lfFr�.,x'.�'a=' .; •'�',,,:j'...•._r, ��yr'F, ... ;s��+. .ti. ) 'q�' .� ,� � ,:j.,f,?� �r.,� _ r. ,n.y� ai -+Y :,: „ .���3.:._Y.,�o '•�..e�.a er.'.},�sF.;?4.;"-h�� .,- E:y`r.':: ?ra;�, L•y. [ 'r39ar adn. '�. 1.'w'�..s'� ''� '•':�S'`lY'tktf% c'K"��?��313; sY+.'�'+t�. :7.ii.F`�: 'L'V P � r.. F�•. i.1>. r i.yJ fe7i.r:'.} .$=.L'+'�.'!? City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .,,- :YU:. ..�..�;.vb:• :«4:' yt�,• �. '- _.�?' <•Yi.:7'- YrY i_'rt: qy'"+:k^..,�F�`,r,+ ,�ii:.o•�::"^':��:�t�i.".i`...tl!L.i';.r�%(`i'.:.C'•' Ste'Ott. 'r� 7'b'iii:"s�.r:d$$yy;:$n'ani`C r-ia}}��.. .t,�en.rt• ,t�....s�i;!±r�.: 'n ,.i..�"��., ..:«•:rye':•`-'1.,�'.�.r.,�ii. :'-�:..'3iF�? y�:te"' .,l:.;ft ;sr<-.a.-......�L.a, u"f .�:::. _:;�::.��yr�':iq�L�d �.�.��l+��S •M t �a�r�4J� R'Ox1`.,ur�}"••iw�e.�i.��r8a:#fit L����r�t'��"�'+�4 ��.� ��#�FFSt.�a�k7'.,, d�N�N�'Jrr ��`as ��,f�' ,� �.� '••.:..'a n�'t'_"�� �E��'2'S:i-ro. 'ia`�S The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 I ill � � II . 1 ► _ rn i I i 1 I ! � I rn ' < 'T� m rn m li p1 r om A �z o I mo, N i -lz z ih z z m E m 9 0 O z n T 70 A '' n 4-0 MIN I it I iI tn I� II i C� 1 rn o \ilmz ilia �a I \111i ! i + i� \ N PROPOSED SCREENED PORCH FOR > n p = PAUL DOUGLAS MINOR m � E m m PECK SCHULTZ ARCHITECT m z ° �� z 330 WILLOW STREET 191 sUDBURY ROAD tn O WEST BARNSTABLE, MA CONCORD. MA 01142 918-349-8448 m p 3 ` 0 1 2 3 4 5 10 _ 4U, 'A I g Oe. NO: 2509 DRAWN: PDM GALE: ATE: 4AII05 A/ m U� r 0 r m i z BOTTOM OF STRINGERS I (-- I I TO BEAR ON 4" TK CMU's ui - - - - - - - - - - J I i = 8"0 CONCRETE PIERS ci WITH BIGFOOT. BOTTOM / / I I '3 Inol OF CONCRETE MIN 4'-0" I 00 BELOW FINISH GRADE V ( — —. Q :3 0 to z � w U FOUNDATION WU � N z � Q - o LLI IL c<1 =3 SHEET NO. A r I, BOLT 2A0 P.T. LEDGER TO EXISTING -I BAND JOIST (USE 'LEDGER-LOCK' BOLTS). USE GALV. JOIST HANGERS_ U — — W - -- ---u I of STEPS: I �La 3 STRINGERS F ° - — — N � O __ _�� �� B. NO: 2509 S O `7• a / I— _ _ — — —I-- RAWN: PDM — -- — — t Q CALF: —v- — ATE: 1/II/O6 U ~ / STRINGERS 1 I a P.T. STAIR W a / / m 17 W W i oN o / co o � ►i F- _ (3) 2x8 P.T. GIRDER — — — W EXISTING - J � FLOOR FRAME REMAIN � � rc a Y E J j � r a of o'i z U 0 N G u N �- � w a :3 TYPICAL: W tf) < 4x4 POBELOW.STS W 0 B N WRAPPED W Z O IN CLEAR V vJ O PINE m Q e W FLUSH FRAME ROOF RAFTERS O O N (2) 2x P.T. HEADER INTO SIDE OF HEADER: BOX OUT SOFFIT ON OPPOSITE LLJ SIDE WITH 2x8 OUTRIGGERS IL (() fi� 00M SHEET NO. 0 1 2 3 4 5 10 0 1 2 3 4 5 10 oe. No: 2509 RAWN: PQM CALE: 1/4'= ATE: VIVO6 lL w p P C I i m W EXISTINI NDOWS --— — �� 3 U M TAL OOF �� Y _ 1rc -- CL [11 j LsEll -- XIST'G LEISTING S DCOIR I D,OR— I WIDOWS N z _ Tj/,P AND IOLLLL RAl�jj I H 3/ HICK EXIGLASS; Ij \ -- -------------- ul — OFjFSET F.R. POSS � r4ND IL WITH — ` — ------ — U uJ W AL M-GU�$ AVJNCr 15' P (OPEN -----"'—'- --- _j J AI ) ON Al1L -EDGES CLIP ' o/c. CL m ------ -- -- -— --- --- _,-_--- -- - --_--_ __-"____._.� W Lo — — --- --- —_ —NEW WOOD STEPS _ ,� -- ( W 3 cA —� — LJ I � r��J]L- J — �L — --- — �— NEW 8° 0 CONIC PIERS u i R E L E \ Y O / ~ l LLI IL IL m 9 SHEET NO. /42— I„ I 0 1 2 3 4 5 10 I I I I EXISTING O B. NO: 2509 WN: PDM KITCHEN �E:E: 4/11/05 I 1 _ -- -- I EXISTI G DOOR DORMER_-..AT_2._nd_.Fl.._OOR Ews ING DO R m (NO C ANGE) =CF (NO CHANGE) 1 ---- 1 — --------- - - _- 5 — DN 5 — -I - - - - - — � z v 1 \ 4 T--FINISH DECK FLOOR I l �—.--—.—TUCKED-IN-UNDER—--.— ---- e9trit _ —— —-..__— .—_ F r O I 2 3 — DOOR THRESHOLD \ Z vtte�_ __— — — _._ — — 7 I I cXn U 3'-0" 4 I f J 2 MAHOGANY 0 grade ! OXr p FLOORING / -- — ----- wises 1 I O .40 N PLYWOOD CEILING // area I ; rc Q ('WAINSCOTTING') I 1 � s af I I; 'm rc —L— - -- - - - - - - - - Q z e: I `� o Y. � c U SEE REAR ELEVATION FOR NOTES ON ;AILING '-8. 4'-II" Ev D Q IL � W EXISTING TREE d [n TO REMAIN W LU z ly u OJ Q ° a Lu O 0 d Q M =-3 SHEET NO. Application to ®fib Ringo ikigbbnap Regional Riotoric Osstrict Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four complete sets,for the issuance of a Certificate of Appropriateness under Section j B of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition Alteration Indicate type of builddiir g: House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: IXJ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wail ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE Aort ADDRESS OF PROPOSED WORK ASSESSOR'S MAP NO. 131 c c , OWNER (A rc a r 21 �u l�-z ASSESSOR'S LOT NO. C Z S t �,) I1�o0N . • VJ Ird1� li�I G TELEPHONE NO. 36Zb 3q9 HOME ADDRESS ��� -- c� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street orway. (Attach additional sheet If necessary.) z ►), G3 -L , i 40 c; U6 '-? vi B - AGENT Q CONTPMCTOR ;A!` ��C.hu��L __TELEPHONE NO. S&2_0':0q ADDRESS 2240 LOUD DESCRIPTION OF PROPOSED WORK Give particulars of work tp be done, including materials to be used. Please include locations of proposed signs. 0. rS• "t V , screCnwrv. Signed Owner-Contractor-Agent For Committee Use Cn1 Only � � A UTIII OVE Date G hisCerti fic yARRR `� Approved/ briled APR 2 1 2005 o rs'Sign a�t res: 14A,4 921e, TOWN OF BARN.TW LE HISTORIC PRESET Town of Barnstable ' Old King's Eighway Historic District Committee APR �(�'� SPEC SHEET Nspw/V 1 ZOOS TpR�4FBq FOUNDATION C r Q1 c;YS tiA- SFR�98�� v SIDING TYPE COLOR CHIMEY TYPE �- COLOR ROOF MATERIAL_ hn a COLOR g&.t o PITCH 'l Z- WINDOWS cl_ { ens► _- COLOR SIZE TRIM COLOR �-e- DOORS- W - W "d COLORS U �� 1 SHUTTERS - COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS ' SKYL=GErS SIZE !a �k COLORS SIGNS COLORS FENCE COT,OR NOTES yill out completely, including maesuraments and materials/colors to be used. lour copies of this Loma are required for submittal of an application, along with your copies of the plot plan, landscape plan and slevation plans, rhea applicable. r 4/ 12�- qpR� 1 2p Tp� \ H1�T�tiQ FE ps p / FRlrn el F__ 1 1 i I , Y fit citisT. 1 , 0 N 7 i�CaeG'3 � i WI �I CS i I certify that this property is located CERTIFIED PLOT PLAN in flood hazard Zone C (outside the 500 r BA,2.Vs>/aC3 !y�4• year flood) as identified by the Depart- LOCATION . ...� . ... .. ... ...... went of Housing and Urban DevelopmEnt(I:UD) . ��: �o� -rz 3� 2003 SCALE . ........... .... .DATE !� . .. .. .. . Date I . 3Zoo 3 �P`1H Of ,ygssq PLAN REFERENCE .B '!!G . . 'V'� 1197Z a EDWARQG Re £ csr o . . . . . . . . . . . . . . . . . . . . . . . . . THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON ,EITHER WAS IN COMPLIANCE I certify to its title insurance company WITH THE LOCAL APPLICABLE ZONING BYLAWS that there are no Visible encroachments IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO HORIZONTAL DIMENSIONAL or easements except as shown and that this REQUIREMENTS ONLY),OR EXEMPT FROM plan was prepared under my immediate VIOLATION ENFORCEMENT ACTION UNDER M.G.L. supervision. TITLE VII ,CHAPTER 40A,-SECTION 7,UNLESS MARZC,q,ed . SC�&4rZ " ��7r OTHERWISE NOTED OR SHOWN HEREON. O ' N ' 12-0" I � tn cp 1 i 0 L - - - - - - - - - - - I1 I � i I QD 0� I I i O I I I 1 I_I O r� D II I BOOS I I R,i�,pBq - . — II v+ \ II w II � I I u, I II I I I . II ' II O�mto I m m PROPOSED SCREENED PORCH FOR = AUL DOUGIL!A MINOR PEG C- — T— — - -ARC I— �® z 330 WILL - - �® O -� — "" -MI BYDBYRT-ROAD— WEST BA NSTABLE MA CoxcoRD.nA one cn8-Sc9-"40 $ p r . z I I I I I I I L - - - j-70 O � mDVEpiv z l � I OExD ii O •- O Oumr��� 1. p A-umm;p0 I O IG'd 1 i Oaa mlry0 i S+dO T.DECK 5T5 c =0pD ' m— in 70 70 �-t t 11 7 f �• 1 rn I 1 " � 1 II I 4 Aim ii FI ms z-{z mp I I I �O STSDECK I I qp N f 1 �?oOs 6 m PROPOSED SCREENED PORCH FOR = PAUL DOUGLAS MINOR D s s m M PEG SCHULTZ ARCHITECT ° �® z 330 WILLOW STREET 141 SUDBURY ROAD v �® v ' WEST BARNSTABLE. MA CONCORD.MA Ornts 9iS-3G4-8449 � I I O111h 111111111 - z !m � m Y m E O m IT A n o o = _ x G o . v x m A = N N W 9 - o 0 tisor� ©p�A��ga�. Oo PROPOSED SCREENED PORCH FOR �j"�'F�r x PAUL DOUGLA - qM<I OR n .. PEG SCHULTZ ARCHITEC ��o�'✓ io 330 WILLOW STREET m SUDBURY ROAD -0 �® WEST BARNSTABLE. MA CONCORD.PIA On42 via-M-8449 o S-sue I II z<Dmm m _ m" m z iX x0 y0 OA A 0 AO U'-01 M 0 �.. n D P O a z 0 m a LL 't�^q� Lam— B . rclk Mill1�tt I �� i IIIIIIIIIII OHi 0 i W 0 s tp PROPOSED SCREENED PORCH FOR "�%� = PAUL DOUGL 9, MI ORIM ' > fff PEG SCHULTZ ARCHIT /C ° ®® 1 0 330 WILLOW STREET MI SIMBURY ROAD a 0 "J WEST BARNSTABLE, MA coNCORD"HA on42 "e=ac1-IM40 $ 0 Oho Assessor's map and lot number ..... ........ ,Sewage Permit number . �`THEr TOWN OF BARNSTABLE 33AMST"LE. i p�"b 9 ,�� BUILDING INSPECTOR °•F0 M OF. APPLICATION FOR PERMIT TO ..CC�n7� 1...... .p �.( .....:�. ... ��-1ZT�.Y. �� f�!{G.... .. . TYPE OF CONSTRUCTION ........(/1'1`........ .. <. . l.•• TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information!: Location .�I... ........ L J.....sfl? .......... 1...... '.T... r-r.i .t'1 '5��-c /� .�,t�l /L' ProposedUse Z d d20 Q:!! . W...�. ......... :'..... ..... .... ...... ...... ..::............................../.1.................................................... Zoning District ........................................................................Fire District ............. Name of Owner 1!':. ......�e ,.�i...h:::........................Address G�.( 6 ......l..l.:.... .L .......: �j........:........ Name of Builder C � ..... ho a..'-,............Address ...... OJ.S'.!:,?q Name of Architect V....�1�� .1!Y� :�..............Address .�.l .Q ..:.. .a.`... �.1.1 �J`1t' ............... Number of Rooms ......... ...........................Foundation .. .... omm........ .aw ..: t .................. Exlerior W 1. ..:C ,,....` .i.!..L �.I�':.�............Roofing .�.'�pko ,...... V............................ al Floors6a✓�r`1... ......:...................... ............................Interior .: ... .!. CA .. .................. Heating o CST W. .............Plumbing................................ 0. ..., .c.e....... .......... Fireplace .Approximate Cost ..12. ...................................... ..5....Q.w...i..n....Definitive Plan Approved by Planning Board ________________________________19________. Area Z�d '............. .. ...... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' 4, W n 0y t 01 �i CJt fx b%14TI X/a �4dyd5-t U iS,j GL (Jw. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ ............................................................... Leeman, V. E. 17671 add to single No ................. Permit for .................................... ........fami.ly...dwelling..............................., #2 Location 3k:)&f0f Willow Street .......................................... West Barnstable ............................................................................... ........................................... ..................... Owner V. E. Leeman Type of Construction .........fr ...................... .................................................... ........................ Plot ............................ Lot Z............................ Permit Granted ..........144�y' ...5................... 75 ....... .19 Date of Inspection ... Date Completed 99 PERMIT REFUSED ...................... ................................... 19 ............................................................................... ..................... .......................................................... ................. ............................................................. .............I. ................................................................ Zr Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number .... /...f .................. SEPTIC sy&TW6 "T t -mot INSTALLED IN COMPLIAMCE. Sewage Permit number t-... '. "�..^. � (, -��. WITH ARTICLE 11 >T,��y'v SANITARY,C® . �Qyo*TNETo�o TOW OF BARIV�T ��,... , 1- i 89HHSTABLE. i "b 9 >•� BUILDING INSPECTOR O GN h• APPLICATION FOR PERMIT TO .. Q :�7�[ ... 4t��.�4(�N.. .. x�: ........ .... : .,. TYPE OF CONSTRUCTION �: �.?as .. .q' /.�. C)A.- /.' 4.y�y/�4, ! L. ................19.72 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor atioz Location '. .J� ....... .��. /......................� /J ProposedUse .. .................................................................................. ........................Fire District .!'�.� ..�Q: :�... �.Zoning District ............. 1................................ .. ............ .. Name of Owner V.E :..{ ��.V���� ........................Address.`..JA.,0 ...5t....I,eJ..!..F �.wtk— Name of Builder .. �..... .Y.l.d....... .......Address �� . `� ��•. ...................... . . Name of Architect ... ......� a .............Address ..`11.�. 1!i 3- �. .'�.Lu.�., :g . .. ..... ..... �I Number of Rooms �v"� ..Foundation .D.... ... �. 0 5� 11 ............Roofing . ............ . ......v...\..... !�"�`�. Exterior ... .. . .... Floors V -0 ................... r�. .. Bd................f,� ...............................Interior ! .. .......................,.................. "� !/!` .................Plumbing .W(: �� `. �!� 5 '�!l.✓ Heating .................... .... .............. ......... ...................... ....................... ..... . Approximate Cost S"-0 d Fireplace PP ................................ Definitive Plan Approved by Planning Board -----------_---,-----------19_______. Area .... .....���'�... Diagram of Lot and Building with Dimensions Fee � lr� ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH � `� o r CZ p� �o r 1 V � p��p a JIM ue w I ,r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .:.... ................................. Leeman, V. E. 4 . l767l �d8 �o alo�1e No -----.. Permit for ------------ ' family dwelling --------------^-----------'' ^ ^^~- lm= Street ^"`°."". --���-----------------. . r - ~----.~ West Barnstable --------------------- - ^ c Owner ---��..��—Ie�m��__________ -~ |' Type of,Construction ....... _------. - - . ---.-..��------------- .............. Plot ............................ Lot -----' ��---' / 5 ' 75 ' - PermitQionm*d '—`lV7TY Date �^// . ' ...... Dote /�����!.��.��----..�rlV . °. ' . �� . . , . PERMIT REFUSED ................ �V--------------- - ( ° �� — ~=' . -'. ------------------- ---.. .—.-----------------__,��____ � --------------------.------/ . . . . - - � ----.---------------------.. Approved ............................................... lA _______________,___________ ----------------------.--..... ' ' t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 Map 1 Parcel 6 ZS _ r ,r.-- R. Permit#* �1u 25 Health Division �q-36rl 10121.3 i �r�: ur E'r` P,;,ST�'�.BLE Date Issued 10�7��� Conservation Division /�IZ�Q'3 P 4'� P L ! G Application Fee (00 Tax Collector h Permit Fee IV Treasurer L t";SIi;�� SEPTIC SYSTEM MUST GE y&i Planning Dept. $]STALLED IN COMPLIANCE VM TITLE 5 Date Definitive Plan Approved by Planning Board EWRONMENTAL CODE AND Historic-OKH Preservation/Hyannis rOWN REGUU-TIONS Project Street Address 33 6 Q116b Village ( cS k �C,-rA e- Owner "Are+ sok'a I}Z Address 3-;;0 L&A(ow S+• � �. BarnSlatile Telephone 509-3G2b3aq Permit Request r-e rn oyiw 4-uro 4 c, &ac)r "d g*n!� 4wo L j vYo"x Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure l0O + Historic House: ❑Yes No On Old King's Highway: ( Yes ❑No Basement Type: 14 Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half:existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count q- Heat Type and Fuel: ❑Gas 0 Oil ❑ Electric O Other Central Air: O Yes 04 No Fireplaces: Existing 6 New Existing wood/coal stove: ❑Yes ®No Detached garage:O existing ❑new size Pool:O existing O new size Barn:❑existing ❑new size Attached garage:O existing ❑new size — Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial O Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name R w1n G./_ Telephone Number .Address- License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ha ry)SI-r We, SIGNATURE DATE i t FOR OFFICIAL USE ONLY r PERMIT NO. DATE ISSUED r3AP/PARCEL NO. s _ t ADDRESS , VILLAGE OWNER y DATE OF INSPECTION: FOUNDATION ` FRAME IW INSULATION 1`+ FIREPLACE s✓E /0 6 7 2vp ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH'r FINAL GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i' The Commonwealth of Massachusetts Department of Industrial Accidents w ' OfB yesti9atiafts _ _- ce aflu " 600 Washington Street Boston,Mass- 02111 Workers' Com ensation Insurance Affidavit / r : name; location: Wdlo W hone#C. tA I am a homeowner performing work myself I am a sole rietor and have no one worlan in ca acx ///%%%/%%/%%//%%%//G%%///%%%//G%%%%%%/%%%/%%//%///i%%/%////w//// g///n/%/t///////%his h//////%//G%/%%% ���� I5 CO ensation for IIIy :rQ: •,}: x• wYyr rtya• "n�r4r. 5G, tw.,. ?• `4 t o t "v`.;S3:Y'`/} .2R' ?;:r:ice.;,'.f.. 'C;,`y v°rv,.` `SR. ';J°: ;'S'•f„%+ D �]roux worke 1n� a}:w,vq:`.l}Sv;^::•Lrxty! 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EtLia2aa�eeoz<'Y.. �G�:).,,',.•.'• r:., .r oayonot�uilP��ofRffaeU�ptoS1ri00.Q0and/or Fie to srcm�covers;e ps regtdred smd�Section 25A o[MGL 152 eaalesd to the imp ettalties in the form of a STOP WOE ORD�"�a floe of 5100.00 a day against me. Iondetstsad that It one years'impxisonmes�t as tteII as civil p e veri>Zcation. copy of this statement may be for��to the O[Sce of Investigations of the DIA for coverap correct by certify under the pains and penalties ofpeluY that the information provided above is true an I des here d Date I n �' 0•� - Signature Phone# Print name Q' official use only do notwrite in this area to be completed by city or town official �Buig Department perudtJllceJi+e# UjAcensing Sow city or town: Osdectra&I Ofnce. check if immedlaie response is required ❑ ffi Departuent phone if; contact person: f Information and Instructions Massachusetts General Laws chapter152 section 25 requires allemployersoprovide in serviceworkers' rke s'anothe compensation sati n for heir employees. As quoted from the `law" , an employee is defined as every person 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 section 25 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;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 co�cacting authority. j Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation-and supplying company names,'address and phone numbers along with a certificate•of ins rance as all affidavits 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' enmpensatioa policy,please call the Department at the number listed below. PRI City or Towns 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 pemiitllicense number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investlgatlons 600 Washington Street Boston,Ma, 02111 fax#: (617) 727-7749 nhone#: (617) 727-4900 ext. 406, 409 or 375 �oFt►te,°,f� Town of Barnstable Regulatory Services zwxxsr� , ' Thomas F.Geiler,Director ns�ss. • q�b 161[9. °� Building Division . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508462-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c, 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which.are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. n Estimated Cost Type.of Work: t �y 6 r -t-�r�P�AC1Z ev &Cd►mot C�.trur -� Address of Work: 13n (A) llo-c,� �y`t2f (A��'r "�'ckt' ' � Owner's Name: WLL Sc�-tl l Date of Application: &Ck P "LlTd 3 I hereby certify that: Registration is not required for the following reason(s): (]Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ®Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c, 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. ORoJi'a'ag If natP Owner,0. ,ame Town of Barnstable GF SME T� Regulatory Services ,, Thomas F.Geiler,Director BARSTABIZ MA 9q, 0 9. ..�' Building Division prED � Tom Perry,Building Commissioner 200 Main Street,`Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 0. 1�T JOB LOCATION:. number street village . — name ff home phone# work phone# CURRENT MAnJNG ADDRESS: 3 3 0 V)(�l Diu S� ��c� r�nsau�le, �Aik OZ(1O(P9 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"homeowner"certifies that he/she understands.the Town.of Barnstable Building Department... minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Lk ��J , Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. _ HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forn/certification for use in your community. Application to (90 Rinq'o -bigbWap Regional �_)igtoric Miotritt Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATETI1,88'Sg -6 H 12' Cb Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness->arTer Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as d"escubedNbelow and on plans, drawings, or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition R Alteration ❑ Indicate type of building: House ❑ Garage Commercial Other CD 2. Exterior Painting: ❑ Fri 3. Signs or Billboards: ❑ New Sign El Existing Sign ❑ Repainting Existing Sign -v 4. Structure: El Fence El wall El Flagpole ❑ Other — TYPE OR PRINT LEGIBLY: DATE R L s 6 3 - r ADDRESS OF PROPOSED WORK vi 1&,,6 a ASSESSOR'S MAP NO. 1 cn 0 OWNER ` fir r e� �c kAA 1 f Z ASSESSOR'S LOT NO. _oZ5 HOME ADDRESS 310 W ilkoW S 1 4 �C�,Yr�S�2,10 l� TELEPHONE NO. oW 142 .639q FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners acr ss any public street or way. (Attach additional sheet if necessary.) -a `N\a.� Carte 32S t��Ilaw �-., InJ • �(Ma,s�alil-e.. O'?�668 - 1,0 . 50L.vH T�Ah le n 24&z C c�-t t z Cad a1,. �+, .w . -eon. s►-o� , o z6 >� AGENT OR CONTRACT r TELEPHONE NO. LU ,4 ADDRESS �o 6" Atred— DESCRIPTION OF PROPOSED.WORK: .Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. I _ Will - ra SttH S. •. l7 rn vn e 4. re-plr-c,Q �- Ssw.a,V1 wvvllk w a,r.Jt- nSt�W -Pt",4 WVV�l,e -- . 0V\ r Ge.a SSR --es Y, x,,,4-o n tw, , tJ_x n e v, d.z o r +�(lo l i�c i v: a�l D� w a O cti�kj_ c.o•1X-r. Signed Ak Ltu+Z, Owner-Contractor-Agent V i s i 61-0_ 4-M, a,, Sired, For Committee Use Only This.Certificate is hereby Date ' o�3 proved Denied Committee Members' Signatures: ' Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION N�Vk SIDING TYPE COLOR ye�laW CHIMNEY TYPE 5�A V\I"A Stu L COLOR ROOF MATERIAL { for COLOR PITCH Nl. WINDOWS COLOR SIZE Ar�nn,s/)G Zy X TRIM COLOR (AJ1%k�r a- DOORS /�� Y'� COLORS SHUTTERS Pj rv- COLORS GUTTERS COLORS DECKS N�� MATERIALS GARAGE DOORS ��� COLORS SKYLIGHTS IJ/ft SIZE COLORS SIGNS rd c COLORS FENCE � COLOR NOTES:' Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT Revised 11/98 i o000 • oDo � - 0000 • N z o Q . W • J i W W (n X X W ED NEW CHIMNEY FOR ZERO CLEARANCE FIREPLACE. 00°❑ 11E I oDo ❑❑aoo REMOVE EXISTING DOOR. INSTALL NEW 36" X 24" WINDC W. EXTERIOR ELEVATION 2 i - z 0 W J W 0 O O Z W C/) FIE] I- - X EW lil l ❑❑❑❑ o Li i,i N U w g 4i a 3 LL oW o w` ❑❑❑ 3 Z OOO Z 3 w 3 C0 O 3 w c�x Li Z z U �'c x W w ujj J NZ W gN O rr W X W PROJECT ' 380 WILLOW STREET RENOVATION WEST BARNSTABLE, MASSACHUSETTS 02668 CLIENT PEG SCHULTZ 380 WILLOW ST SCOPE OF WORK: WEST BARNSTABLE, RENOVATION CONSISTS OF INSTALLATION OF MASSACHUSETTS 02668 HEATILATOR FIREPLACE AND SHELVING AND TEL:508 362 0399 MODIFICATIONS TO WINDOWS AND DOORS. SEE DRAWING A101&A201 -0" ARCHITECT FRANCESCA RUSSO ARCHITECT NEW SHELVING AT 250 5th Avenue,Suite#400 York,New 10001 BOTH SIDES. Tel:212620 0563 ��iCCC P.O.Box 658 Barnstable,MA 02630 Tel: 508 362 7457 NEW HEATILATOR FRANCESCA 2�_ ' ACCELERATOR i-2 i/2 I RUS50 ICI A36R o � ARCHITECT o J� 3/4" LJt a ❑J❑C NEW HEATILATOR OPEN SHELVING =!- ACCELERATOR i A36R v Fz z z PLAN uj �a o REMOVE TWO EXISTING REMOVE DOOR AND DECORATIVE WOOD WINDOWS&INSTALL FRAME.INSTALL NEW FIREPLACE SURROUND NEW HIGH WINDOW.SEE WINDOW&FRAME.SEE _ INTERIOR&EXTERIOR EXTERIOR ELEVATION. ELEVATIONS. INTERIOR ELEVATION A PLAN DRAWING TITLE PARTIAL PLAN&INTERIOR ELEVATION PROJECT NO. 03155 DRAWN BY FIRMS SCALE ^a-1.01 DATE 09/24/03 I , PROJECT �l� • 380 WILLOW STREET RENOVATION WEST BARNSTABLE, MASSACHUSETTS 02668 SCOPE OF WORK: RENOVATION CONSISTS OF INSTALLATION OF HEATILATOR FIREPLACE AND SHELVING AND MODIFICATIONS TO WINDOWS AND DOORS. SEE DRAWING A101 &A201 CLIENT PEG SCHULTZ 380 WILLOW ST WEST BARNSTABLE, MASSACHUSETTS 02668 TEL:508 362 0399 I I NEW CHIMNEY FOR ZERO I NEW CHIMNEY CLEARANCE FIREPLACE. FOR ZERO I CLEARANCE E I I FIREPLACE. SEE PLAN I I I ARCHITECT I I I I FRANCESCA RUSSO ARCHITECT I I New Yo k,New York100010 - h Avenue,Suite# Tel:212 620 0563 P.0.Box 658 Barnstable, 30 Tel: 508362 7457 FRANCESCA RUSSO I I ARCHITECT LCC i � �C]ClC REMOVE 2 EXISTING L WINDOWS.INSTALL � NEW 18"X 18"WINDOW. PATCH SHINGLES. C=L===�' I I I REMOVE EXISTING DOOR. INSTALL NEW WINDOW TO MATCH EXISTING. PATCH SHINGLES. EXTERIOR ELEVATION 1 EXTERIOR ELEVATION 2 DRAWING TITLE EXTERIOR ELEVATIONS PROJECT NO. 03155 DRAWN BY FIRMS A SCALE _201 1/4"=1'-0" DATE 09/24/03 r Town of Barnstable *Permit# ' Regulatory Servicef� Fee 6monthsjrom issue date anxxsrnsLF _ �,� I l a •a nsass. � Richard V.Scali,Director 059. Building Divisi� /yqR 0 Paul Roma,Building Commis (�' � 200 Main Street,Hyannis,MA 0' D,J www.town.bamstable.ma.us �i9h7� Office: 508-862-4038 tS�q�J ax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL RLY Not Valid without Red X-Press Imprint Map/parcel Number 1,32 Q Property Address o 7 Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name—,��J/�/� ,�Xe Telephone Number Home Improvement Contractor License#(if applicable) (122L Email: 1,621VZ1/ �Y,*AW,Ge:99 Construction Supervisor's License#(if applicable) L9orkman's Compensation Insurance IIIIJJJJ���� Check one: ❑ I am a sole proprietor ❑ I am the Homeowner d21I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Cerfificate must accompany each permit. Permit Requ t(check box) VRe-roof(hurricane nailed)(stripping old shingles) All construction debris.will betaken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) (a°Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. i "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r- uired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc ' 06/20/16Y� I.. N4 ' The Commonwealth o,f Massachuse&s Depaabmm-tof2'uflr�str- Accidiemts Off we we ofLmws6,-wions. 600 Washhwfon meet Baston,MA 02111 . tv�vRu mas�gEovfdta . Workers' C Ins7nce Affidavit Bmlder-lCuntracWrs/EleL�n hm2bers APTAkan#Infor ration Please Print E.e�'bly -NameiP�l�1, < Address: CitgfStatel Phone - Are you an employer?t.lteckt3re appropriate boz: Type of project(required): m a contractor and I I employees 4. I a * ❑bave hired fhe snb�-contEactm 6_ ❑New construction o fall arpdfor art-time -��^ 2.❑ I am a sale prupAetoff orpartner- listed on the attached sheet; ?•�-2� deUmg. slip and have no employees . These sub-contractors have 9. ❑Demolition war-ng forme iu any capacity. employees and have wo&zrs' 9..❑Building acMitica [No wo now pomp-hwun are comp-inererarerp 1 regained-1 5. ❑ We are a corporation and its 16-❑Electrical repairs or additions 3-❑ 1 am a homeowner doing all work _ officers have exercised their ' 1L❑Plumbing repairs or$dons myself[No wod='comp right o§I( fdi a have no MY El Roofrepaim »a=e reed-]' employees.(No wodcers• 13-❑Other conzp-insurance MTinA1 •Aapapg&czntd tchet1sbozRmastslsofiIlo=*esactiaaheTowshacsiag&ecsvo>icea'cmnpensatinupescyinfinm%ziaa- fi Sgmeemraea rho sabot dos daviE i g tLey ue dam,¢��co$and limn brie aatside caata�*+�mast sal mit a new sffida8t and orhmo=dL ZCavtmcfta t5st checkthis bat mast r t r'h as addWmd sheer showing the name of the s¢b c�sad state whethe<ar not those en ideshn e employees. i pmvidetheir xvrkas'�mp•PafcFa>zmhez .Taman Below is tfra pu cy and job sue information. Insua=e Company Name: Policy At,or Self--im Lio_#f a664� lxpind n Date: Job Site Addre AEtach a-copy of the workers'cozapensadonpoEcy declaration page-(shawiing the policy number and expiration date). Fair=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$1,50a OO andfor oni:yearimpsisonmevk as well as civd penalties n$ie fb=of a STOP WORT£ORDER and a fine of up-to$250-00 a dap against the violator. Be a&ised drat a copy of Phis statement may be forwarded f3 the Office of IaveWgations ofthe DL4 for insurw=coverage verification- Ida hereby cwtyy die pa m' s an ffim ofpedW y Sratthe informa6m prini&Aabovw is true and c orrrzt Signature- Date- affidef aw arse Do not wr&r in dib area,to be completed by city artown a,o7cial City or Town: Pernriffficense;ff Issming Auflmritg(c rle one): L Boazd a€Health 11uTding Dgmtment 3.f gown Clerk 4.FJectrical buquwtor S.Pttmbing motor 6.Ot'her Coact Person Phone it: - 6 laformation and last ructions M ss:ac�setts decal Lass chaps I52 rmparm an e9107ers to Provide wow'=33peasation fur fbefr rEployees. Pmsaantio is s ,an�Ivyee is defined as. n evmy persoin the service of under any confract ofhfir, • fhue expmm or hmplied,oral or written." An eznplayEr is de<fmcd as`pan iadividag.parfnersh�p,association;ccapmafion or affiaa legal entity,or any two or more of fh.e R=going magaged is a joint Vie,and i rhu:fmg the legal relneseufatives of a deceased employer,or fbe received or tust=of as b&vidnal,pmtim sbrp,associafion ar other Iegal enttY.=Ploying"'Ployees. However fhe owner of a.dwelling horse having not mare than fiir=apartments and who resides therein,or the occapant of the - dweIIing house of another who employs persons to do mainf=Laacc,raustra t on or repair wo&on such dwol mg house or on the groua ds or bmldmg sppur[uaaot lhemfo shall not because of such employment be deemed to be an employe-." MC3L cbaPtrr 152,§25C(6)also stems that¢every state or local licensing agency shall withhold fhe L43aance or renewal of a&cerise or permitto operate a business or to construct buildh3.gs inthe commonwealth for any applicantw•ho fins notproduced acceptable evidence of crimpUance'ePith the hLmrance coveJrage requi red." Addmonally.MGL chapter,152,§25CM states Nc f mthe nor Ly of ifspoIiiical snbdivi ins shall ffh info any contact for the performance ofpubhr,work uirfll acczpiable evidence of ccmPHaaace with the m Mrm2=-_ requn-r.ments of tb.is chapter have been presented in the confractiag aufhoi ty Applic�ats Please fill out the wows'compensation affidavit complete L by chug the boxes fhb apply to your situation anc�if necessa L amply snb-contracbar(s)name(s). addresses)and phone,nnmbet(s).along with their=tificate(s) of ice- I.imrU-,d Liability Companies(LLC)or Limited Liability'Pmta=sbips g-12)withno employees other than the members or partners,are not required to eany workers'compensation insurance_ If an LLC or LLP does have employees,a policy isregain4 Be advised that this affidayk maybe submith--dto the,Department ofIndustrial Accidents for coofinnatim of in=m=covexage Also be sine to sign and date the affidavit_ The affidavit should be ret=ed to the city or town that the application for the permit or license is being requesbA not the Department of Industrial A r-1-; mts. Should you have any questions rega<dmg the law or ifyou ate required to obtain a workers' - compensation pofiey,please call the;Department of the rmmbez listed below. Self-marred companies shouId ear their self-ins-arm=license number an the appropriate Iiae. City or Town OffIX6 T.c i Please be sore that the affidavit is complete and prhtcd legibly.*The Department has provided a space at the bottoms of the affidavit for you to fM outia the event the Office oflnvestigaiions has to c�ottfact you rcgadaig the appIicanf ! Please b e sin e to,f M in the pennWHcease rnm2ber which wdl be used as a mf==ce number In-addition,an applicant that must submit maniple pennWHcense appy-cations in any given year,need only submit one affidavit mdiraim�eurnt p olicy infoma lion Cif n=essary)and under'Job Sb-.Addicss"the applicant should write"aIl locations in (citY or town) "A copy of the affidavit that has been officially stomped or ma33md by the city or town may be provided to the - . applicant as prooYtbat a valid affidavit is on file for fat m perm!or licenses A new affidarhmust be ffile d out each. year.Where ahome owner or citizen is obtaining alicense orpermitnotr@z±rdto my business or co=ercW v&MtIre tie. a dog licen=or permit to bran leaves etc.)said person is NOT regnimd to Mete this affidavit The Office of Investigatous Would like to thank you in adva m for your coopm-adore and should you have any questions, please do not hestatr to give us a call. The Departmimf's address,telephone and&x number: T l.O=j Of Massac IIS�` . Dint cif hkasidd Accidents QM=of InVeg4ffktiQ= . �Q.4�as�mgban. t Roses 1GfA Oil 11 ' Tel.#617' -4900 QExt 4-06 Or 1-977-MAS F Fax#617 727 7M Revised4-24-07 g- gagAR& r �•+� Town of Barnstable Regulatory Services M AM ` Richard V.Scan,Director "9. Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder I, 411- I��4vlplol: ,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) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are perfomaed and accepted. Signature-of Owner Signature of Applicant (� Print Name Print Name ' Da Q:FORMS:OWNERPERMISSIONPOOLS t. Town of Barnstable Regulatory Services cIF Richard V.Scali,Director Building Division t � ' Paul Roma,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 4 work phone it 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 Rerformed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings_containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shalhact 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 Supervisoras ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,'as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit for<ns\EXPRESS.doc 06/20/16 �s Maasachuaetts Department of Public Safety Board of Building Regulations and StandaMe License, CS46M? Construction Supervisor 0"A)R COX PO SOX 401 s. SOU'fN YARMQF►Tl1 - .. ..tin Expl.ratton: Coir�missiortsr 1011tl1281T f e�IV'Pit n�i cv►/!!i��e°1� ,;acr4uxo/!J Licenst or registration valid for Indlvidal use uai ti Cutts of Coosawr Affairs&BoAAM Regulxtiun °g Y before the explratton date. It found return ee: Mfg I MPROYBMEWT CONTRACTOR 1 t00d97 type: Oftice of Consumer Affairs Sad BuslnM Regulation yiration: •3/25/2018 Private Corporatian 10 Park Plaza-Suite 5170 Bosto%MA 02116 OA1Ad COX,INC. , Osvlo Cox , 19 LAVENDER LN 'Il i W.YARMOUTH,MA 02673 11s6artocrstary Not valid without si$oat t� 1 A �® CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIOWYYYYI mo/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights tc the certificate holder In lieu of such endorsemen s). PRODUCER Kathleen Geddis NORTHWOOD ESHBAUGH INSURANCE AGENCY, INC. PHONS WE.go. 606 771-1632 tF ADDRESS, kgeddls.north24@insuremall.net 540 MAIN ST• INSURE AFFORDING COVERAGE NAICN HYANNIS MA 02601 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 250% INSURED INSURER a: DAVID COX INC INSURERC: INSURER D: PO BOX 401 INSURERS: SYARMOUTH MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER: 66977 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADOLSUOR POLICY NUMBER POUC IPC UP COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE 7 OCCURPREMISES g oecunanoaL s MED EXP(Any one on) S NIA PERSONAL 6 ADV INJURY S GEN L AGGREGATE LIMIT.APPLIES PER: I GENERAL AGGREGATE �jECT 3 POLICY LOC 'PRODUCTS-COMPIOP AGO = OTHER: S AUTOMOBILE W8WTY g ANY AUTO BODILY INJURY(Per pw M $ ALL AUTOS OWNED AACUkT�E�OULED NIA BODILY INJURY(Per aeoldenq f HIRED AUTOS pUTNOS"O R M $ S UMSReLLANAa OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-IADE NIA AGGREGATE $ OED R N S S WOMEN COMPENSATION I X AND EMPLOYERS'LL42LITY YIN T E I I -- ANYPROPRIETORIPARTNERIEXECUTIVE I E.L.EACH ACCIDENT S 100,000 A OFFICERMEMBEREXCLUDED? NIA NA NIA 6HUS91OX742216 07/16I2016 07/16/2017 (Msndstory In NMI E.L.DISEASE-EA EMPLOY S 100,000 It ae dt ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 16 W0,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AdMicnal Remarks Schedule,may be attachad It mon space Is rogWr*M Workers'Compensation benefits will be paid to Massachusetts employees only,Pursuant to Endorsement WC 20 03 06 B.no authorization Is given to pay claims for benefits to employees In states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of thls certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage VerificatIOP Search tool at www.mase.govAM/workers-compensafionfinvesfigatio..is/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02$01 Daniell M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD M Town of Barnstable *Permit P©1. 7-Dad t# Expires 6 months from is a dat Regulatory Services Fee * s • BARNSfABLE, MASS. Thomas F.Geiler,Director AlFO MAr p Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY I Not id without Red X-Press Imprint Map/parcel Number `� t Property Address Residential Value of Work 2�GU:��'`'� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �� (al - .o r)1 7,_Z; l 32 1-4 Contractor's Name ei j"" I t 1 Telephone Number S7f� T Home Improvement Contractor License#(if applicable) y4do Construction Supervisor's License#(if applicable) ZPFRUIT D .Workman's Compensation Insurance Check one: 2012 ❑ I am a sole proprietor MAY 1 1 ❑ I am the Homeowner I have Worker's Compensation Insurance TABLE Insurance Company Name TOWN OF BARNS Workman's Comp.Policy# %L 41 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value z7 (maximum .35)#ofwindows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of he Home Im ovement Contractor Licefise&Con truction Supervisors License is re uired 1 V SIGNATURE: C:\Users\decollik\AppData\Local\Microso Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 1 i J� -�Fl '- Office of Consumer Affairs and Business Regulation �I 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100110 Type: Supplement Card CAPE ASSOCIATES, INC. Expiration: 6/9/2012. RICHARD BRYANT 345 Massasoit Rd N. Eastham, MA 02651 Update Address and return card.Mark reason for change. DPS CAt 0 sona oaroa oioi2is JI Address C, Renewal (j Employment JI Lost Card ,,,, ✓�e i�o�nmzo�zrueall�. c�,..•l�i�ac�rtse�s __._.�.. ._ Office of Consumer affairs&Business Regulation License or registration valid for individul use only �-1 before the expiration date. If found return to: ,[— riv a t'�iHOME IMPROVEMENT CONTRACTOR P r � h Office of Consumer Affairs and Business Regulation Registration: 100110 Type: 10 Park Plaza-Suite 5170 Expiration: 6/9/2012. Supplement Card Boston,MA 02116 CAPE ASSOCIATES;INC. RICHARD BRYANT PO Box 1858 g N.Eastham,MA 02651" Undersecretary Ndt vagrivithout signature Massachuscits- Department of Public Safeh' Board of Building- Re-ulations and Standards Construction Supervisor License License: CS 82435 i RICHARD M BRYANT u` 125 KETTLE HOLE RD ' EASTHAM, MA 02642 Expiration: 5/8/2012 ('uumis,inrci Tr#: 28127 N O C) N � 03 cd Ems?EN D 5315 9 0 19 i ...'2012.0'420 '--- .. -. (O• #' 0000130428 M �1 m 493 BOS-414376 I (VI CO'rJOT1'(i•IIT�:,37 10 illl•SIGt!!iELO'N;•IiIS LINE , � ..TiCS!':11V:.0 FCc{FUIl�haAL!tt5'lITl:7;vN U L•w VY >011000138< i N 0 I r�i9 CR PAYEE ACCT 1 o ^' LACK END 'GTD BANK OF AMERICA All cm cc N Gcc W¢UJ Q I a� w ° 113 Zr T II•�'�t' 7i� .:�r.e)'f:•�(e;t'.Y„L�It.•.':rr.tif,.::r,c::r:�'f1.:i; �' (• m. I _.: ..till.•:,r.LU!A.:rli:f'...M,,,ya4lctlp„ I. 03 N 1r•.:Ccf.:!i :1:is . :;;G^�DI rl::Sd9'n::.f:04:hir:: �. ram+ N W� 1'fl 1 I•:4:::P,1.1.- '1:',>..I.I:lip r i r nn a::.'. aGj� LL cC FO � C•:rr-•i:., i._.�ll;, l'�mc•:;:c:::rr.:o,::1;1.�.,•i.;m Op P{.J '�J.CJII'J�„t7-�,'I hCa••1•;d Cf'GS;:.::I(':•'.:.Ir St9' I Q l a0 �.' 1 .{';'FEU'_TIdL lil'ScRU�i:Uir�lU Cf•'uU'JL•NTiJI•:.i i:eG.CC Vi ct naw to umw amrm e. ' Q., + BAMSTABLF, + 9� MASS 9. ,�� Town of Barnstable QED MA'I� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, /'e G ho/A O✓C ,as Owner of the subject property hereby authorize 4/6-1,1_ �!7 - Ls 0¢SSO to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. i C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.0utlook\DDV87AAZ\EX PRESS.doc Revised 072110 Town of Bamstable Old King's Highway Historic District Committee 200 Main Street,Hyannis,Massachusetts 02601 (508) 862-4787 Fax(508) 862-4784 CERTIFICATE OF EXEMPTION 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# House# 7 G Street //f�i �C(� / ! � Village: fzrP ets l k This application is for an exemption of the proposed construction on the grounds that work: A Will not be visible from any way or public place i ❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission ❑ Other Description of Proposed Work: fxe 6/1 l,Le-1 1 D IV-/X_E?j ZA1:4J(,WS a."1. Lne_,T {L AJ-e`J ok)�/t %rvJe-S aMA Sized Agent or contractor(please print): 110e6l�Z A I y 4c 6.1Re. no. ,e)Z 6 "(9 7 Address 2_Q--,'> Wi/�C)0i ,ST1,"-,r 1/4 !.0 a Owner(please print): Gi phi e­ 7,ie)//r•Al�/k Tel no. Owners mailing address: 6 1,+ GJ p, XA— Signed,Owner/Contractor/Agent Cnm For Committee Use Only This Certificate is hereby Approve&Denied Date: q Gl0'O 1 Z Committee Members Signatures: RECEMD MAY -0 9 2012 Town.of Barnstable T s^:��AGEM NT Old corri Highway RQWTH lv Comm ee Any conditions of approval- C.-Documents and SettingsldecolliklLocal SettingslTemporaryInternet Files10LK110KHExemption Form 07.doc I -rt t _ � �> PP s MAY 0 012 - own of�r g Y f Id K,n9 Cornrnitt . r -" 1 �V 1 t k k a 4 I[ twa � _ l� wry.. �, �` • ' / �H•t•� is oll la r r_ - f s j i c, m cn ;;u � � N is Qo I� OD O _ cf) N � G� h _ CAI z N N CY7, 0 _ T, cu C� c O N -P 00IC PX MAC 09 2012 �� Barnstable Town°fi •s W9hWay pld Committee 00 I , cCA i 6= J cn z 001�I RECEIVED a o o MAY 042012 F GROWTH MANAGEMENT k ��2 0 0 4t ; yW ajgejsujeg is@M '1S Molii ':', o r, ;r E i the Commonwealth of Massachuseas Department of Indrestrial Accidents Ogwe of Investigations IF 600 Washington Street Boston,MA 02111 cowry mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Basmess/Ozganizaaon/lnaividual): Address: 2 C 3 li)l Aa.,J !C5 City/StawJZip: Va,/'ru_ad aZ Phone#:��j�b� .�G Z - 77 U Are you an employe . Check the appropriate box: T 4. am a general contractor an �of project' (required):1_ I am a employer with /U g ❑ I al d I g6. ❑New construction. employees(fhU and/or pad-time).* have hired the sub-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet_ 7. Remodeling ship and have no employees These sub-coutractors have g- ❑volition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.incnrance.1 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11_ Plumbing airs or additions 3.❑ I am a homeowner doing all work. ❑ g� myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance mod-]y c. 152, §1(4X and we have no employees_[No workers' 13_❑Other comp_insurance requi e&] ;Any Wbc=that checks box#1 mng also fal out the section below showing their waAers'campeasstion policy infarmeti@L l3omeowners who submit this affidaca indicating they are doing all wmI and then hue outside contracturs mast submit a new affidavit indicating snrh k,ontractms mat chect this box moat attached an addrnanal sheet shoving the namxe of the sub-couiwtoss snd state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'congmusation insurance for my employees. Below is the po&cy and job site information. Insurance Company Name: r ��✓�/�( ��SU/`��L� Policy#or Self ins_ Lic_#: f L/l ZOOt3 %�L�o zC�I Expiration Date: Job Site Address: 330 5TXg_,J_ - City/State/Zip.- C JC/'A 51-LI,10- i ktl� 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 ter d& the ens and pen 'es of [try a r—malion provide d above is brie and correcit Date: 3 Phone#: Official use only. Do not write in this area,to be completed by caty or town official. City or Town: Permit/Ucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _ 6 I .. Client#:43203 CAPEASS ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(M6VDDIYYYY) 1/04/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Denise DeLeo Rogers&Gray Ins.-So.Dennis P oNE 508-760-5745 ^ 877-816-2156 AIC No u • AIC No 434 Route 134 AnDR�, deleode@rogersgray.com South Dennis,MA 026604601 INSURER(S)AFFORDING COVERAGE NAic# 508 398-7980 INSURERA:National Grange Insurance Co. INSURED INSURER B.A.I.M.Mutual Insurance Cape Associates,Inc. wsuRlaR c P.0.Box 1858 North Eastham,MA 02651 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE NSR SWVD UB POLICYNUMBER M�DIYY EFF MMOIDDDYIXP LIMITS A GENERAL LIABUM MSO41163 1101/2012 0110112013 EACH �qO��CCC7URRRRENCE $1000000 X COMMERCIAL GENERAL LIABILITY M&AG1s ESOEe 9 E.ce $50 000 CLAIMS-MADE I Al OCCUR MED EXP VM one arson $5 000 X PD Ded:250 PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE s2,000 000 GENL AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMPIOPAGG $2000000 POLICY EC F—ILOC $ A AUTOMOBILE LIABILITY M9041163 1/01/2012 01/01/201 Ea n sINGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED N SCHEDULED BODILY INJURY(Per accident) $ XHIRED AUTOSAUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Par accident $ A X UMBRELLALtAB OCCUR CU041163 1/01/2012 01/0112013 EACHOCCURRENCE s3,000,000 EXCESS LIAR HCLAIMS-MADE AGGREGATE s3,000,000 DED I X RETENTION 10000 S B WORKERS COMPENSATION MCC2000186012011 0812412011 08/24/2012 X wa sTATvTs I lff" AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNEWF�CECUTIVE YIN N E.L.EACH ACCIDENT $500 000 OFFICER/AAOu(BFR IXCLUDE07 N/A (Mandatary In NH) EL DISEASE-EA EMPLOYEE S500 000 If yes,desrnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S759341M75791 MEE `r 5 e /t Ar r2 GC .GS ,�� Tio t u �1� i�,� � J . � r'�!� •_�'Si'F,��� y�b,._.4�'�y y��-�f.�tisa�y.� cdL'�y�•'�.. �i'; Assessor's office(1st Floor): y Assessor's map and lot number o�TNf To Board of Health 3rd floor): Sewage Permit number W r� 1 S d 13AS3s7ADLL i Engineering Department(3rd floor): rass House number Definitive Plan Approved by Planning Board 19 �a rpY d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INS PEC OR APPLICATION FOR PERMIT TO r Cow, t�e L� r •7'(a`Q TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following information: Location 3C1 VtJ t 0 t.(/ (;4 L c J' ►�f!/yl`� `Q . VV Q Proposed Use I�-f ��`� [Alu 1 1�- o i J Zoning District Fire District /U r ✓� �7�U Name of Owner IAA AIJ U �' Address Name of Builder 114 C�u V Address �`� l �Q« Name of Architect Address t 1 Number of Rooms I Foundation 1,16 C !� Exterior "" a ( i' 1 Roofing 1 Floors IA 14,V[AA, Interior �✓�'7 ,I/� Heating l �yc 'J �'U ��" Plumbing �l Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules•and Regulations of the Town of Barnstable regarding the above construction. g. Name 7�� Construction Supervisor's License ANDAC,. JIM A=131-025 No 33389 Permit For ADD DORMER Single Family Dwelling Location 330. Willow Street West Barnstable Owner Jim Andac Type of Construction Frame Plot Lot Permit Granted November 29 , 19 8,9 Date of Inspection 19 y, Date Completed 19 • Ay A�. / L ,B�/ate � PROJECT 38D WLLOW STREET RENOVATION WEST BARNSTABLE. MASSACHUSETTS 02NO I I CLIENT PEG SCHULTZ 380 WLLOW ST NEW HEATUATOR OPEN SNElwNG SCOPE OFNA7RIC WEST BARN ETTS , RENOVATION(REPLACE OFINSTALLATIONOF MASSACHUSE399 02668 ACCELERATOR HEATIIATORFlRFPIACEpND51�MNGAND TEL:soes62osaS A36R MODIFICATIONS TO WINDOWSANDODORS.SEE DRAWING A101&A201 Z J I o c �$ PLAN FLUSNDOOR DECORATREWOOD WMELF BEHIND FIREPLACE SURROUND - � ARCW7ECT ' FRANCESCA RUSSO ARCHITECT 250 5la Avenue•Sum M e00 New York New Yank 10001 INTERIOR ELEVATION A Tat:212 OM0583 ' P.O.B.S58 Bamete0le.MA02030 O — Tel:508 382 7457 ' FRANCESCA 3 RUSSO J ARCMTECT NEW NEAT4A' AACCEIEAAT0 OPEN FOR AIR i 1'-11 aRwunoN q LL m ® ® OPEN sNavwG L _ OREMOVE DOOR AND FRAME.INSTALL NEW WINDOW&FRAME SEE EXTERIOR ELEVATION, OPEN FOR AIR DRAWING TITLE CIRCULATION INTERIOR ELEVATION B PLAN PARTIAL PLAN&INTERIOR ELEVATION PROJECT NO. 03155 DRAwN BY SCALE FRIMS DATE 1.1 10 03 .*+— PROJECT 380 VALLOW STREET RENOVATION WEST BARNSTABIE, MASSACHUSETTS 02608 SCOPE OF WORK RENOVATION CONSISTS OF INSTALLATION OF HEATILATOR FIREPLACE AND SHELVING AND MODIFICATIONS TO WNDOWS AND DOORS.SEE " ORAVAP4A101&A201 CLENT PEG SCHULTZ NEW CNwPEY NEW CHIMNEY FOR ZERO FOR ZERO 3W WOAOW ST CLEARANCE WEST BARNSTABLE. CLEARANCE l i FIREPLACE I I SEE PLAN TEL:M�608W2 399 o26w SEE PLAN I III I III I I III I I ICI I I ARCHITECT ® ® FRANCESCA RU980 ARCHITECT 250 SN Arenue,511e•d00 Nwr YWK Nwr York 10001 Tel:212 8200503 P.0.B.am BBmefe0le.MA02630 Tel:508 082 7657 FRANCESCA RUSSO ARCH 7EC7 rrr� IT FF d u L-1 L iirF! EMOVE EWSTING STALL NEW WINCOV IYMr ASH AS SWl'rN PA rCH NGiES. EXTERIOR ELEVATION 1 EXTERIOR ELEVATION 2 DRAWING TIRE EXTERIOR ELEVATIONS . PROJECT NO. 03155 DRAWNSY • SCALE F' A.201 ; 1l4'S 1'-0' DATE 11 10 03 SCOPE OF WORK RENOVATION CONSISTS OF INSTALLATION OF HEATILATOR FIREPLACE AND SHELVING AND MODIFICATIONS TO WINDOWS AND DOORS.SEE DRAWING A101&A201. i i ui J W W = r w I NEW HEATILA m _p 1/2 • C LERATO A a W OPEN FOR AIR 3 = CIRCULATION I w lI o �Q I 3 L J � � Z W N 1 S y REMOVE DOOR AND FRAME.INSTALL NEW WINDOW&FRAME SEE EXTERIOR ELEVATION. PLAN I 0 NEW HEATILATOR OPEN SHELVING ACCELERATOR A36R i PLAN Zz w i Oa O FLUSH DOOR DECORATIVE WOOD W/SHELF BEHIND FIREPLACE SURROUND INTERIOR ELEVATION A OPEN SHELVING EJ 1E, 97 ME OPEN FOR AIR CIRCULATION INTERIOR ELEVATION B i NEW CHIMNEY i FOR ZERO CLEARANCE I SEE PLAN III Lu III III III I EXTERIOR ELEVATION 1 NEW CHIMNEY FOR ZERO CLEARANCE FIREPLACE. SEE PLAN ' I i I o ID o�o Ella AREMOVE EXISTING DC OR. INSTALL NEW WINDO WIN' SH AS SHOWN. P CH HINGLES. EXTERIOR ELEVATION 2 I l� .,Assessors office(1st Floor): 3 f — 0 �� SEPTIC SYSTEM MUST(t3 Asse sor's map-and lot number SINE To -B INSTAL,L�p!N e Board of Health(3rd floor): COMPLIAN Sewage Permit number •— �a) ) y�,� w Engineering Department(3rd floor): �* 8 = DAHDSTGDU S .330 �—S GCE A ��.s House number TOWN REGULATIONS }9 l Definitive Plan Approved-by Planning Board 19 �oDrr d•\ APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only A P P R 0 v'POWN OF BARNSTABLE � Barnstable Conservation CommiAUILDING INSPECTOR Ma1 a 4 UOPAUTION FOR PERMIlme (ou �� 2 l(Q� � Jl V TYPE OF IA/Kl4 (f 2 19 ;TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to thepfol wing information: Location 1��o �`Q W 7�- Proposed Use "u�a�� ( " ' fe Zoning District Fire District /W-7 ti6)f Name of Owner CAM i4n/nx�i� Address �_�O U/1 f 1011v W' P {rName of Builder Address �� �/(� " � ✓• �' Name of Architect Address '.Number of Rooms Z Foundation �D�CV�`G Exterior W�I f i Roofing g AP�o 0 5 C 4Floors �� �' L4,00 Interior fA *Heating `U Plumbing /V ~ treplace Approximate Cost E 000 Area 7 �O Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ` �� VJV Construction Supervisor's License "0 7 q 1 I =J CEM ANJAK ` Noy 3 4 3 5 permit Fo Bu ' I C;a .�c7a N A c,PGgar-y Location 330 W i t p W°I St r' e t tz West Bar stab e �T.. > 4 - - Owner Cem Andak 2 ,r C7 C) _ Frcame� r� Type of Construction .. Plot Lot Permit Granted May 22 , 19 91 Date of Inspection 19 ` Date Completed 19 co --' w s Assessors office(1st Floor): ' ' ,� r, 4 .�__,r.�„ „.� THE Assessor's map and lot number_�� MAO. r f���"T T�d LU c 1 o0 Tod Board of Health(3rd floor): �� i a J e������MENTAL CODE AND `� Sewage Permit number U/ TOWN AIU&MOM 1 b STGDLi Engineering Department(3rd floor): L'/ +moo IAS House number �0 1630- Definitive Plan Approved by Planning Board 19 �o Yav d• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Dow �a/ TYPE OF CONSTRUCTION �t '3 19 TO THE INSPECTOR OF BUILDINGS: ^'The undersigned hereby applies for a permit according to the following information: F2 Location y(J t.' l o w A. -ec,-" I`=�(1/✓I�j �j !<jt.� (� . D �6b `5 Proposed Use ��u � LA U �'" y be . [t . Zoning District ' ffF- 1'�Fire District�y6V c `� ALA �r/ Address L9/f`! 6 Ll/ G/ Name of Owner _ --�—Name of.Builder �"� J Address w (7 Name of Architect Address Number of Rooms I Foundation Exterior wool ( 1' 1 V1 Roofing Floors tAit 'V Interiort i �IlU� Heating � I � •'��� � Plumbing Fireplace V) q- Approximate Cost Area Diagram of Lot and Building with Dimensions Fee. Q� I 4 ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abb�ve construction. Name Construction Supervisor's License ANUiVC, J tM- ? No 3 3 3 8 9 permit For ADD DORMER Single Family Dwelling Location 330 Willow Street West Barnstable Owner Jim Andac ,Type of Construction Frame Plot Lot November 29� 19 89 Permit Granted ' Date of Inspection 19 Date Completed 19 _ �Ra 3 - U , �o � J • w � Y ) i 4p ' �04 I C a O • hR . •. ,� JCS 1 - 4 � 1� r• ��w p N Op O N ~ Application to Old Kings Highway Regional Historic District Committee �Jim in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ] Addition Q Alteration Indicate type of building: [ House ❑ Garage ❑ Commercial ❑ Other Bathroom Dorm Pr 2. Exterior Painting: WOO�dd` ck`%%f� 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation.and requirements), TYPE OR PRINT LEGIBLY DATE 10/1 7/89 ADDRESS OF PROPOSED WORK .330 Willow St o W_ Barn eta hl P ASSESSORS MAP NO. 1 3� . OWNER Jim_ An an ASSESSORS LOT NO. 025 HOME ADDRESS 330 Willow St_ W_ Barn Gtahl P TEL. NO. .3h?-5 407 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public' street or way. (Attach additional sheet if necessary). see attached sheet AGENT OR CONTRACTOR Mike Gardner TEL. NO. 362-2934 ADDRESS 66 Cap' n Jacs Rd. Centerville, Ma. DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). Adding on. Bathroom dormer and new wood deck. Signed Owner-Contractor-Agent Space below line for Committee use. P Received by H.D.C. RECEIVED W � � KNRHp� Date The Certificate is hereby U.'a to OCT 1 81989r Time - B,pLD KINGS HIGHWAY -� (� (�,,,�6� Approved i� IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with.application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: Ana application is required for an `'�' pp q y portion .of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not ., required when repainting existing colors, changing to white, or using colors,approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an.approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are removed within three days of the event. Certain other temporary signs that the Committee feels does not detract from the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental. of the premises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act*as a combination of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters —leaders, roofing and paint color. 9. Unless application incomplete and legible and all material required is supplied, application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall: t Fora "A-1- OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT BARNSTABLE HISTORIC DISTRICT CO2iITTEE _. 367 MAIN STREET, FIYANNIS, MA 02601 Spec Sheet Foundation Type R1 on - — Siding Type Whi t P n ad r — Chimney Type Rri nk Color Rri rnk Roof Material '..sihn i t thrPP to h Color Rl a nk Pitch 100 Windows phi t P wnnrl nn ci ag __ Size Trim Color 1Thi t P — Doors An(9Pr4nn �'+rovin'li�.rnr+A Color .61'0!!x 61811 Shutters R nk Gutters iimi nnm V E�. Deck P , T _ Q Garage Doors• Color fit(; E Fill E D _ completely, inc?uding• measurements and materials/colors to be used. w pies of this fora are required for submittal of an application, along UU� wi h two copies each of the certified plot plan, landscape plan and elevat_on OLD KINGSpF UjArn applicable. Michael J. Gardner, Builder 66 Capt. Jac's Road Centerville, MA 02632 (508) 362-2934 Jim Andac 330 Willow St.. W. Barnstabie, Na..' Bathroom Dormer All framing stock will be K.D. spruce. Bathroom walls 2x4 with shoe and two top plates , 2x8 rafters, 2x6 collar ties. 1 /2" CDX will .be. used for wall and .roof sheathing.. Asphalt three tab roof shingles (black)' white cedar extra clear shingles.. Anderson perma shibld window' with _pine casing (exterior, painted iahite) . Soffits will be pine painted white along with 'corner "boards . Aluminum white gutters . 'Deck acid 'Slider Slider will be Anderson wood Frenchwood door. All debk material will be southern yellow pine deck. framing 2x8. with 2x10 gert. Decking will be 5/4 x 6. One inch balusters with 4x4 supports. The entire deck will be painted gray. M VIP RECEIVED ,0,TC14RIA01-0 ` ul,I lmq OLD KINGS HIGHWAY TOWN OF BARNSTABLE - L' I.00ATIO14 3 C> Z/i�f/til ,S% SEWAGE # VILLAGE L;Ip;% ),��rais/r�/p _ ASSESSOR'S MAP & LOT INSTALLER'S NAME.& PHONE NO. SEPTIC TANK CAPACITY_11�/C�[j i LEACHING FACILITY:(type) �,'� ,(size) L NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:__ 9 -LI_ j DATE COMPLIANCE ISSUED: -a / I VARIANCE GRANTED: Yeah. ' No / ✓ i b5 by i RECEIVED .UL;I t 8 1969 OLD KING'S NIGMA -- - ---- _ _ Michael J. Gardner, Builder 66 Capt. Jac's Road Centerville, MA 02632 (508) 362-2934 Jim Andac 330 Willow St. W. Barnstable., Ma. 26> Harold C . Weekes 340 Willow S.t. W. Barnstable,' Ma.. 026.68 27-1 Wilfred Taylor 378 Willow St. W. Barnstable, Ma. 026.68. 23 James D. Crocker 298 Willow St. W. Barnstable, Ma... 02668 24 William E.. Maki 328 Willow S.t. W. Barnstable, Ma. 02668 30 Bernard F. Launquist 27 Hancock St. 31 Kevin .T. Werner 75 Park Ave. Centerville, Ma. 02 Q 2 I vE� ;aF24NOG RECEIYED UU I .I 81489 OLD KING'S HIGHWAY _ ..k � d fR}t, le j 17 ` - .. ' *� , �w.•..'�i f� i ✓ �"q fit.:. `` _ • of h'. et" kSs 17 VV 12 y�yl p W J i M ANAL SCALE:/4 I A "PROVED E C E I V DATE: E D lay _ 1�1' of yt� OCT 1 81989 Mll- - DRAYYIND NVMOEN 8 Ft "✓ - 4 - •i 1 . � S s t, �4(attT f>(�VA9�t3N OJ.dj. i { fla � �t f Lit APPROVED ' SCAIE AlY110VUK"D BY gq BV . DAM OCT 1 81969; , OLD lQWS HWAY `y VRAWM i ' • / r. ^ Y• . '_ f`� • ; . � .. '`1 y `' • •� ;" � .. �, 1. i S. r. ,r. 1�,• [, Y � • F i � �_ •i.+ .r is � �i � �� • �a t�� � r ' r .. �r• < � •S� .ri r 't r _ _ _ ,. �.i � .♦ r 1 , i ,;. , . J • ' i • ' � � A -_ ... ... � r _ r ._ �} -�. a-. `\7 t.r l • ;, • • • Y... r � . � �' • � ., i f - � � . } • r. ` •` -w• j... .�-e� �� + Y i'. a ��• r .til.'r � •. '�• .1 - .. e� I . i + 1.1 � 9 ��. .{-. S ',k` '•._ .F LL5 a '�^� a u-.'Lr3 ''i-yam �' -1 ' arT �Ssit'�'Y - a'Cx"f -x ,. 3 �_ NO ww . ..t� ��i $Zh'.k.:.��„h.,4 ^.s y�.-.!•°.�s�-R� i� 7 �•y.. ����;r s - f ... 1.��„ype+' "-���� � c � r ,. •�•�" zb, sL- v.b _ ..YrrF- �-�. �. Y.: rw__ J;;.�i ti�y{"_.. 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'19""2i14•!{- 5�^ Y _ " �"r '�'' any .r!� a: .x R i 3s-t �, 4 � � Y2� ✓¢ S S Y� { ' S �.i �° � � :3-y� ' w E3'�'L qS �- .{ 2 5.}k °` it'" t to i ;''"�e s ":.•'s� 'x'3k s° - t �'71 tI ANa N3a �zs-saga ev wit4 � F r aL drykp r 3 r xr tr 11Q ar C,ss��s� r , � nrP;�ovED T OKHRHQC tO APPROVED DRAWN BY SCALE: I`i fi l x MIKE CIA.RDNCE'. "f DATE: ocl I A7�- OLD 19IMS 110my ,1'-.. r,F. •• DRAWING NUM8E8 ' 1 _ i rr • ..yrc ,� 5 t. -. �.'+7• �.�K - 3 ..�.��-ems-, " � ,t Michael J. Gardner, Builder 37 Wintergreen Circle Osterville, MA 02655 (508) 428-4422 I January 25 , 1991 RE; Cem Andac 330 Willow St . W. Barnstable, MA 02668 Two car garage with inlaw apartment All framing will be k. d . Spruce. Walls will be framed in 2x4" = studs , floor joists will be 2x1011 , all rafters will be framed with 2x8" , collar ties will be framed with 2x6" . All wall sheathing will be done in i"cdx; all floor and roof sheathing will be done in 5/8" cdx. Exterior trim will be done in #2 pine. All siding will be done with white cedar extra clear shingles . Interior garage will be left unfinished at present time . Garage doors will be gray in color and will be th wood grain insulated doors (see attached brochure) . All concrete for footings , frost wall , and concrete pads will be a 3000 lb. mix. Addition will have 8" high by 18" wide footings . Concrete wall will be 8" thick by 42" high. Concrete garage floor will be poured in with a 2500 lb. mix and will be 4" thick. PLFV - � VA RECEIVE ® HB 2 0 1�91 OLO KICS H*1-"�Nky Application to BP OPt�opQP.EpN� > • ts`� Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition 0 Alteration Indicate type of building: ® House ® Garage ❑ Commercial ❑ Other Garage/inlaw apt . 2. Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE 1/25/90 ADDRESS OF PROPOSED WORK 330 Willow St . W. Barnstable ASSESSORS MAP NO. 131 _ OWNER Cem Andac ASSESSORS LOT NO. 025 HOME ADDRESS 330 Willow St . W. Barnstable TEL. NO. 362-5407 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). see attached sheet Mike Gardner 428-4422 AGENT OR CONTRACTOR TEL. NO. ADDRESS 37 Wintergreen Circle Osterville DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). see attached sheet Signed Owner-Contractor-Agent 'Space below line for Committee use. Receiv d y E E 1V9'D APPROVED Date The Certifiiccctte is hereby liI2,s-O VZI GKHRHD�Date ,I 9911 77'z:�7- ODD KiNG'S H Time ��--� By 19" � WU� Approved �Ez IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ Michael J. Gardner, Builder . 37 Wintergreen Circle Osterville, MA 02655 (508) 428-4422 Cem Andac 330 Willow St . W. Barnstable, Ma . 02668 Map# 131 lot# 025 Abutters 23 James D. Crocker 298 Willow St . W. Barnstable, Ma . 02668 24 William E. Maki 328 Willow St . W. Barnstable, Ma. 02668 26 Harold C. Weekes 340 Willow St. W. Barnstable, Ma . 02668 27-1 Wilfred Taylor 378 Willow St . W. Barnstable , Ma. 02668 30 Bernard F. Lanquist 27 Hancock St . 31 Kevin T. Werner 75 Park Ave . Centerville, Ma . 02632 APPROVED OKHRHDC RECEIVED I:EB 2 0 1991. 06,E 1 ING'S HIGHWAY Form "A-1" OLD KING'S HIGHWAY HISTORIC DISTRICT S p e c S h e e t Foundation Type Formed concrete Siding Type White Cedar extra clear shingles Chimney Type Color Roof Material Asphalt , three tab Color Black (match existing) Pitch 10 Windows Anderson (see door and window Size schedule ) Trim Color White Doors See attached door and window schedule Color white Shutters Black (will be installed at a later date) White, Aluminum Gutters Deck N/A Garage Doors See attached brochure for Grey Co Notes: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the certified plot plan, landscapes p�1�a d elevation plan, when applicable. R E C 0Fl t U FEB 2 0 599t OLD KING'S HIGHWAY :p Ny M G /J � 7•p 1 �� t� 1�gpv a 't � �i 1 s 1 20 e S �p s Apo► e 1 s b r t v •et Q, tiSwe�' J••e Vv +�e fib'�b to r i, 6,07A jo F0 YJ 1.14 rs ' `fJ tart to i t 7� /pt c aJaC.s RE-1 BY A1•,..7. ORIGINAI. M 81 .yam \ �. '•'. 11 log St i56 t 7.82,E �!�• •� :' .. t r•t' ALIL '�100! vJ ti" Ipe•I••• A„' y fv ll l� 16t �J ` r/• �. IaI taa M • / i•� •M M now. 15, FEB 2 019911 �� �� �ED KINC'S HalHtAY TOWN OF BARNSTABLE LOCATION Ui�l�i/L/ ,S % SEWAGE I/ � N VILLAGE L,I_ Ay SI��,�s j��/p ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ��,'� (size) 3�� k NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:__ DATE COMPLIANCE ISSUED: �_ 1 �v2 / VARIANCE GRANTED: Ye� _No /'✓ .� im vie����� • "� bs bF r ok i ® i991 1 ow KING S N- i DEPARTMENT OF PUBLIC SAFETY ',1010 COMMONWEALTH AVE. BOSTON,MASS.02215 y f ,I L.:I_I I'd<: ! Via„ _•I,_I C.ER V I EFFECTIVE DATE LIC NO. ICI?_1 I I'.fI_,y 1"I(C) (>..'1:69 ; - NOT VALID UNTIL SIGNED 8Y LICENSEE ANO OFFICIALLY , STAMPED OR SIGNATUR F THE COMMISSIONER AL SIGNATURE 1 r SIGNATURE OF LICENSEE I i +". tY •:r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 t . Parcel 0z5 Permit# Health Division Date Issued 1 �� Conservation Division Feeo� Tax Collector Treasurer w (,�ae�P 6 ' Planning Dept. Date Definitive Plan Approved by Planning Board i Historic-OKH / �a� Preservation/Hyannis Project Street Address 35 b w l<<o v3 Village W Q.S- ba_V Y"S rrkbk f_, Owner (tAff�)cAMC Address _ 330 Wt((,c ) &hMsk4hGe— Telephone 31a-� • Q 3al Permit Request 64,. t 1 CA t vt*,c. A VY1 mac""- K,"(.5 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation ?(0 5 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatfiered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 4 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes M No On Old King's Highway: ❑Yes 1�11\lo Basement Type: %Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) _ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new Half: existing new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count V,(a`Qoane, - Heat Type and Fuel: A Gas Oil ❑ Electric ❑Other Central Air: ❑Yes �d No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn: ❑existing ❑new size Attached garage:❑existing ❑new size Shed:' 9 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name C'm kor - Telephone Number 6$ Address Ci rd-e— A License# rr)-Lix-t( Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ���t of DATE 11 7 0-0 i • FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP[PARCEL NO. ADDRESS - VILLAGE OWNER _ J DATE OF INSPECTION - FOUNDATION FRAME j INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4 • PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING , DATE CLOSED OUT ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts ' __l.: "` • ` Department of Industrial Accidents Office of/aYesffoatloos - 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name V U L location city Yv\P phone# A Q I ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workiit in ca achy I am an em to fir providing workers'.compensation for my employees worlang on this job. aom an ram addres ..... M. ................... hop '` `'Lys �' >> 2 oli i>istirani e.c I am a sole proprietor, general contractor,, omeowner t:le one)and have.hired.the contractors listed below who have e followin workers' co ensation polices: the mp ::::.:.:::::.:.;;:.;;:.:;:.:.;::>;:.;:.;:.>:.;;:.:::.;:.;:.;:.;:.;;;;;:.;:.::.: ;: :.::.:::::.:>>;::. ... :.;:.:::. g............................. .........:::..::... .:::::::.::........ .......................... f com v ti . . ........ . ..eL ... . i : . : : : . .. : . : :: : .".ii i : i : : :: . : < ST^:<::i :>' .. :;i:; :}..............ir : : C�tY' bhtMe#. ::.::::•:.::::.::.:.......................................... :•:::::::::::::•:::•:: :::•:.::::.::.::::::::::::::::::::.:::::•::::::::::::: ::•::::::::::.::•:..:.:.:: :::.:...:::.......:::::::..........:......:.::.::.......... .....................:::::..;::::::::::•................::.::•:: ................................ _x hadianc :::::: opi tV ............. <;:::::::: ..... X. a«dares s 1f t�cll 7= .:: i:.}:v�:: : .'•:j.j!:j:>:::._.`titi.: ::: Q } if'+:<!'.v<;:,`:y,'%�:i>>:;i.:;:i�:j;:;::ii:{�:';: IItV/F nsntance c Fsflm a to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal penalties of a fine up to 51,mmoo and/or one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of pedury that the information provided above is tru.and correct Sigaatnre Yy\ (/��A �'y—L Print name �I�-U V G(ky �'A I I L�- Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checicifimmediate response is required ❑Selectmen's Office ❑Health Department contact person phone#; ❑Other Umsed 9195 PJA) ' i4 r ni Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their. employees. As quoted from the"law", 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 section 25 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,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. '..l.Applicants VIZ�.11' f � �Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and ` supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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 pernirt/Iicense number which will be used as a reference number. The affidavits may be returnedin the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Inllesuga"Ons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat 406, 409 or 375 The Town of Barnstable aAMSrABLF- - r `0$ Regulatory Services 16 9. Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax:• 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more thanfour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ��Y�t Estimated Cot Address of Work: 330 0 l 11 v1,J S� •� vJ �A sdu b�`Z Owner's Name: SL{_.u..(F!L Date of Application: -I UV I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law QJob Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: + Date Contractor Name Registration No. OR Date Owner's Name g1orms:Affidav The Town of Barnstable t3nxxsTAt3M M^ g Regulatory Services �p �es9• �0 IFDtJ1A�a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print' DATE: JOB LOCATION: 3,3o 11 LIZ number street village "HOMEOWNER": � S&A), 3(v , • 63C1 name home phone# work phone# CURRENT MAILING ADDRESS: �J 3b W WaII ) S'�1('e—L� V3 6cvwL.C7�6bLe . m A- ��6 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN