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0020 HEAD OF THE POND LANE
�o YeA D of Th e 7i�nd tie I � t Town of Barnstable u w Building uaxsrwasE Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept . ' MASS. $ ;Posted Until Final Inspection Has Been Made: Permit - �t °�� ,Where'a Certificate of Occupancy is Required,such Building shall Not be'Occupied until a Final Inspection-has been made. j 1 l�Jll ><YIl Permit NO. B-19-4154 Applicant Name: MOSHER, EUGENE A&MARIANN A Approvals Date issued: 12/17/2019 Current Use: Structure Permit Type: Building-Stove Expiration Date: 06/17/2020 Foundation: Location: 20 HEAD OF THE POND LANE, MARSTONS MILLS Map/Lot: 030-099 Zoning District: RF Sheathing: Owner on Record: MOSHER, EUGENE A&MARIANN A Contractor Name: Framing: 1 Address: 20 HEAD OF THE POND LANE Contractor License: 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $0.00 Chimney: Description: vermoont castings insert Permit Fee: $35.00 Insulation: Fee Paid: $35.00 Project Review Req: Final: Date: 12/17/2019 `��li �--•�1�`-- Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. 14 f. -- _._-.___ �-- f Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:, Service: 1.Foundation or Footing 2.Sheathing Inspection _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Ste/ i Application number X.l...�..1...... ........ DEPT. Fee............ ............� .....:..................................... . a �.vsr�etE. = � 6 2019 ram, 1 Building Inspectors Initials.... .. ....................... i039. DF BARNSTABLE Date Issued....C..O .� .I. .� :l.q Map/Parcel........Gl.3it../.....�./..47 �.................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Zd �bo &C rbu I�(VV0 11#VC J¢25 V,4/5 .14u 5 NUMBER STREET VILLAGE Owner's Name: +la�.u(- �,SY fc,�L Phone Number 5yb -429- ??99 Email Address: TM IM U.51 t:tzt 9q Att- east Cell Phone Number Project cost$ ZS UV ✓`� Check one Residential V - Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK 0 Siding 'El Windows (no header change) # 0 Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration (if applicable) # (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFOREA PERMIT CAN BE ISSUED. r APPLICATION NUMBER............................................................ *For.Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# U6LVW0J -r 6 4;5TLUh 5 Model/I.D. /qa411'j7EZ-.:j�&✓L /utlC) TV3ES 0-T Fuel Type WOO Testing Lab 010AI-- -�5t L.,"oreA-wa".k5 C 0-I Offsets from combustibles: front back left side right side /Z HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 1!5q Telephone Number 51 -Y'li�— �/c��f Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the n of Barnsta Signature Date �� �6 1 APPL CANT'S-SIGNATURE Signature Date 17 All permit lications are subject to a building official's approval prior to issuance. Montpelier Medium Insert VE NT_ Homeowners Installation and Operating Manual. qASTINGS NATIONAL We recommend that our woodburning FIREPLACE INSTITUTE' hearth products be installed and serviced by professionals who are certified in the U.S. by the National Fireplace Institute®(NFI)as NFI Woodburning Specialists or who are. certified in Canada by 0 Wood Energy Technical CERTIFIED technlcrr/ralni„g „Ww„ficeltfled Training (WETT). --.- Tested& Portland Listed By . Oregon USA 1 O 1 C J�jj- us For Use in North America OMNI-Test Laboratories,Inc. 259-S-13-2 SAFETY NOTICE:IF THIS APPLIANCE IS NOT PROPERLY INSTALLED,OPERATED AND MAINTAINED,A HOUSE FIRE MAY RESULT. TO REDUCE THE RISK OF FIRE, FOLLOW THE INSTALLATION INSTRUCTIONS. FAILURE TO'FOLLOW INSTRUCTIONS MAY RESULT IN PROPERTY DAMAGE, BODILY INJURY OR EVEN DEATH. CONTACT LOCAL BUILDING OFFICIALS ABOUT RESTRICTIONSAND INSTALLATION INSPECTION REQUIREMENTS IN YOURAREA. The French language version of this manual is available online:www.vermontcastings.com La version fran�aise de ce-manuel est disponible en ligne:www.vermontcastings.com • Not Discard for 33a30004403'R18-1?J16" Montpelier Medium Insert Specifications MODEL: Montpelier Medium Insert EPA Certification Number: 696 LABORATORY: OMNI Test Laboratories, Inc EPA Certified Emissions: 2.9 g/hr REPORT NO. 259-S-13-2 *EPA Default Efficiency: 75.0% TYPE: Solid.Fuel Room Heater/Wood **Actual tested Efficiency: 68.5% Burning Type ***EPA BTU Output: 1 10,000-27,600 STANDARD(s): UL 1482-1996, ULC-S628-93 ****Peak BTU/Hour Output: 157.900 ELECTRICAL 115 VAC, 60 Hz Other IP m ortant nformation RATING: Vent Size: 6 Inch(152 mm) Area Heated................................1,000-2,300 Square feet Firebox Size: 2.1 cu.ft. Loading.......................................................................Front Max.Wood Length: 22" Maximum Chimney Connector:.......................................6" (150mm) Ideal Wood Length: 18" Flue Exit Position.........................................................Top Fuel Seasoned Cordwood (20/o moisture) Primary Air.............................•........................Manually Set Glass Panels........................... High-Temperature Ceramic *An efficiency based on EPA historical data: 63% for non- Weight......................................................335 lbs. (152 kg.) catalytic stoves. Blower Rating150 cfm. 115V, 60Hz `Maximum calculated efficiency using Douglas Fire """"""""""""""""" ( ) dimensional lumber and data collected during EPA Power Cord Lenght.....................6 Foot Useable Installed emissions test. ***A range of BTU outputs based on EPA Default Efficiency and the bum rates from the-low and high EPA tests, using Douglas Fir dimensional lumber. ****A peak BTU out of the unit calculated using the maximum first hour bum rate from the High EPA Test and BTU content of seasoned cordwood(8600) times the efficiency. This wood heater needs periodic,inspection and repair for proper operation. It is against federal regulations to operate this wood heater in' a manner inconsistent with operating instructions in this manual. 30004403 3 w zS. r� i NO • ZmFLEX THE - =ems s'Y _ O VAFLEX N iY GROUP i _ All FUEL x H I ER YLN _ C IMNE INSTALLATION GUIDE— _ - - 51, H us LISTED .. = ?U L 1777. ,y FOR SAFETY'S SAKE - Chi mney ne refining chimney repairs a done with the utmost o fcar . Please ensure before starting that the safety.aspect of the installation has been �I looked after. Secure your ladders and scaffolding,wear protective gear and the - - appropriate fo footw ear andglo ves es befor e startin g.. Avoid problems b1 ms throu gh h _ - proper sa e n meas ures e urin every installation taatlon is an accident free.inst allatlo n. � MOD EL L ccF S I Z-FLEX.SF CHIMNEY LINING SYSTEM - SF INSrAIJ_AnON GUIDE VER 1.1 US 10-12 d .�` ' . Town of Barnstable Building ? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept KAS& � Posted Until Final Inspection Has Been Made. Permit .eso Ma+' Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-2597 Applicant Name: Andrew Warburton Approvals Date Issued: 08/16/2019 Current Use: Structure Permit Type: Building-Shed-Residential-200 sf and under Expiration Date: 02/16/2020 Foundation: Location: 20 HEAD OF THE POND LANE,MARSTONS MILLS Map/Lot: 030-099 Zoning District: RF Sheathing: Owner on Record: MOSHER,EUGENE A&MARIANN A Contractor Name: SALT SPRAY SHEDS INC. Framing: 1 Address: 20 HEAD OF THE POND LANE Contractor License: 188352 2 MARSTONS MILLS,MA 02648 Est. Project Cost: $320,000.00 Chimney: Description: Install 8'x 12'Storage Shed Permit Fee: $35.00 t Insulation: Project Review Req: SHED REGISTRATION 96 SF. Fee Paid: $35.00 Date: 8/16/2019 Final: CQ,�''✓ A�y,.� Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT NT- MA CARTHY. RUCTION CO. s E esld^' ttaI and Commercial Builder ! ' W,EAYtIZATTON SPECIALIST .' �t QUAirrl3�sA •% ~ CCARTHYC It• ? -:C7 October 21, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Stret Hyannis, MA 02601 i RE: Insulation Permits ZY Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#0 at 20 HEAD 0 THE POND LANE has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements q 0% n7 Sincerely, i Michael McCarthy McCarthy Construction • I Common, eait sachusetts �r Sheet. a a� Map�3 ParcelAU 0�• � ���'� Date: 1 Ree4it�61 Estimated Job Cost:$ ISV O Towly®FS, ;' A Plans Submitted: YES NO Plans Reviewed: NO Business License# [ O Applicant License#_6��= -.1 Business Information: Property Owner/Job Location Information: &1Name: �� ! �G� Name: Street: �1 Gi, Street: i City/Town: City/Town: G Qq Telephone* — 7 Telephone:&� Photo I.D.required/Copy of Photo I.D. attached: YES ✓ NO Staff Iaiflal J-1/M-1-unrestricted license ! J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10*,000 sq. fI./2-stories or less Residential: 1-2 family ✓ Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other Square.Footage: under 10,000 sq..ft. V over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes U40❑ If you have checked Y.M indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ I OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insur-anStsoverage required by Chapter 112 of the Massachusetts General laws,and that my signature on this permit applicatio this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner er's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of:my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO pgogW IzisRections i Date Comments F I i Finial Inspection Date Comments Type.of License: 3y ride ❑Master-Restricted { :ity/Town ❑Joumeyperson Signature of Licensee i ?erttit# . ❑Joumeyperson-Restricted License Number. :ee$ O Check at www.maess_ aov/_M I nspector Signature of Permit Approval 't i .14 Deparfent of bndustrial accidents office oflnva*adorrs 600 Washington Sp-eet Boston,MA 02111 www massgovldia ' Workers' Compensation Insurance Affidavit:Bailders/Contra ctorsMectricians/P1IImbers AplAicant Information Pease Print Name(Bpsdorgaoiaatianitadividnal):. r Address: AM& MY/Sta#elZip:. V10 ou 0 L Phone.#--� 9() -Z(�7 Are you an emploW. &ecicthe appropriate box: -Type of pioj ect(required):: 1.4?�I"am a employer with 10 4• ❑ I am a general contswtor and I 6. ❑New construction . employees(full and/or part4h=).*, have hired the gab-contractors 2.❑ I am a•sole pmprittor orpart ur- listed an xhvattached sheet: 7. ❑Remodeling shin and have no employees - Thesc sob-conactors have & ❑Demolition Yea*and have worl=s ���,���` working forme in any capacity. t: 9. l�3 addition (No worker'coin.insurance. S. ❑ We comp.boa and its 10.[]Elul repass or additions regurred officers have exercised their 11.❑Phunbing repairs or additions 3.❑ I am a.horoeowner doing 4 work myself [go workars,comp right of exemption per MGL 1 Q Roof repairs inenrance.recprired]t c.152,§1(4),andwe have no 13.E]OEheC en:910yem[No workm, comp.msurm=regnaed.] 'Any. piir�t tbatebrj-M b=#i nv=also ffi oattbe=fian below showing ib=wo*='sensation Policy uffm-ation. ap t Home P=who submit tba affidavltin&m=g they are doing all work and then hi=outside contractors must submit a new sffidavit indic3fag steh tCo==tors that choc]c this box anut a--,bed an additional sheen showing the same of the sub-contractors and stair wbether ornot thou entities beve cmploy=. if a=sub-coanactors bave employs,Icy most provide their wod—)comp.policyn®ber_ I am an employer that isproviding workers'compensation insurance for my employees Below u the poky and yob site information. Insurance Company Name / Y � / _ Policy#or S if-ins.Lie.4h tJ��. lO Expiration Date: S /7 '� �" D Job Site Address: City/Swamp: Attach a copy of the workers,compensation policy declaration page-(showing the policy number and expiration date). FaRure,t o secure coverage as required—deT Section Z5A of MGL e. 152 can lead to the imposition of criminal penalfies of a. fine tip to$1,500.00 and/or one-year imprisonment,as well as civil pmvdf es in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violAw. Be advised that'a copy of this statemetit may be forwarded to the Office of Investigations of the DIA fdr Dance coverage veuftcaticn. -- I do hereby ceW r the p ea penalties of perjury that the information provided above is.true and correct Phone ,5DR- -7 ,0 of Official use only. Do not write in this area,to be completed by city or town offw.&L City or Town: Permitl cease# 'Issuing Authority(circle one): 1,Board of Health 2.Building Department.3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone Contact Person: # Town of.Barnstable Regulatory Services rear Thomas F.Geiier,Director Building Division Tom perry,Buildimg Commissioner 200 Main Street,Hymnis,MA 02601 w"Jown.barnstabie.maus Office. 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ,as Owner of the subject property hereby.authorize � to art on my behalf, in all'matters.relative:to work authorized by this building permit (Address of job) ,/ k 3mvV �s� A44. C)z,& f 9 **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized.until all final inspections are performed and accepted. tore of Owner Signature of Applicant Print : Print Name Date QTORMS..OWNERPERMLSSIOWW S ' o COMMONWEALTH OF MASSACHUSETTS • • • - BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A MASTER—UNRESTRICTED ROBERT G BOURQUE ' 14 CROOKED CARTWAY c MARSTONS MILLS MA 02648-1008 ` 64 0 /28/16 208664 V l< t '``C6 CERTIFICATE OF LIABILITY INSURANCE 5/DATE(MM/DDlYYW) 22/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX�END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE Al CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED i 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 NAM ACT Debi James Leonard Insurance Agency, Inc PHONE (508)428-6921 a/c No:tsoel azo-saoe 683 Main Street i Aoo ESS:debi@leonardagency.com i Suite B I INSURE S AFFORDING COVERAGE NAIC# , Osterville MA 02655 1 INSOR'ERA:Travelers indemnity of America 25666__ INSURED j INSUAER13 Travelers Cas & Surety of IL 19046 Bourque Heating & Cooling Inc. INSURERC Travelers Indemnity Co. 5658_ _ B&L Equipment LLC INSuAERD: PO BOX 770 INSURER E: Marstons Mills MA 02648 INSURERF: ! COVERAGES CERTIFICATE NUMBER3Master 2015 i I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW,HAVE BE'EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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 BEE ► REDU CED BY PAID CLAIMS. i INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMI00 MM/DD OMITS --�` GENERAL LIABILITY I EACH OCCURRENCE S 1,000, X COMMERCIAL GENERAL LIABILITY i PREMISE Ea occurrence S 500,""'-1 A CLAIMS-MADE aOCCUR 68088790617 I /17/2014 /17/2015 MEDEXP(An one person) s 5,.30. PERSONAL&ADV INJURY S 1,000,0oc, GENERAL AGGREGATE 5 2,000,00Oj GENT AGGREGATE,UMIT APPLIES PER: PRODUCTS-COMPIOPAGG S 2,000_,OC-1 POLICY PRO- LO. S AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT Eaacdd 0 is 1C00 JG i ANY AUTO BODILY INJURY(Per person) S B i ALLOWNED SCHEDULED A-8B791085-14-SEL; � /17/2014 /17/2015 ` AUTOS X AUTOS I BODILY INJURY(Per accident) S NON-O MED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS f� Peracrid ent I Medical payrnents S -_--- LX��J'UMBRELLA LIAB OCCUR j EACH OCCURRENCE Is 3,000,000 C I EXCESSUAB CLAIMS-MADE AGGREGATE 5 3,000,000 �DED RETENTIONS -8B791269-14-421 /17/2010 /17/2015 S WORKERS COMPENSATION WC STATlTl OTH- AND EMPLOYERS'LIABILITY Y 1 N —" ANY PROPRIETOR/PARTNERIEXECUTIVE NIA 6S59U6-SB39530-A-14 /17/2014 /17/2015 E.L.EACH ACCIDENT S 1 000,or.,-,! D OFFICERIMEMBER EXCLUDED? °-'—`- (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE S 1 00.0110 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I 5 1 00 Q_ `o _ i i I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional RemaiiesScheduie,If more space Is required) 1 S i I I: CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR E THE! EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED It, ACCIORDANCE WITH THE POLICY PROVISIONS. Bourque Heating & Cooling Co. Inc. i B&L Equipment LLC i i --- PO BOX 770 I AUTHO IZEDREPRESENTATIVE Marstons Mills, MA 02648 I Tina Boulos/LEOTBI ACORD 25(2010/05) ( ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnsl m Thu ARnPn namu and Inn^2ru ran tamri marlre of ARnRn i i i , K 112fintranetjpropdatailoobjp,asp I� l? X< as Live Seardi �I File Edit Aeol Favorites - Tools Help Favorites ! �� - 0 (, - Page - safety - Tools - (Parcel Loolup L°il f �- ._. Y iiiE -10 714 �. �. 11 -� k a' ✓/_ 0 iLogged In As: Monday, August 18 �;Debi Barroviis Parcel Lookup l� Road L22ku Condo Lookup Multiple Address Looku Reports f/ ✓ir �l q Street# 20 ✓` Street head I� Name Village All Villages Search • - 0 <Prev Next> Page 1 of 1 RoNs!Page_ 10 � o Locafion Par el • ]Village - . p 030-099 20 HEAD OF THE POND LAME 7ryl OSHER, EUGENE A & MARIANN A MM 0682 030099 �o Local intranet �} ? -100% 1 Start E Inbox-Microsoft:..,' `'0 Amara A(Villiam-C...) Perry,Tom-Cale...`, Main System Men... � �ApplicatimEntry ., � �Parcel lookup TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �pplication # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee ig Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ®R Project Street Address (RdS, Village ��f> .., Pits Owner Address s -� Telephone Permit Request )w" re-l�,l.x •Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation p)Sid Construction Type ,Lot Size Grandfafhered: ❑Yes ❑ No If yes, attach supporting documesttation. Dwelling Type: Single Family Ly� Two Family ❑ Multi-Family(# units) = Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highway: 0 Yes No Basement Type: , ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) . Number of Baths: Full: existing new Half: existing new'-- -) Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing, ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 cST.-58633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3)1//Y 't FOR OFFICIAL USE ONLY .APPLICATION# ! . "DATE ISSUED MAP/PARCEL NO. J c } ADDRESS VILLAGE q OWNER - °- h.. 1. DATE OF INSPECTION: ._ FOUNDATION FRAME INSULATION FIREPLACE 4 ELECTRICAL: ROUGH. FINAL t PLUMBING: ROUGH FINAL S z GAS: ROUGH FINAL 4. FINAL BUILDING QA -E&CLOSED OUT �r ASSGO 'ION PLAN NO. OWNER AUTHORIZATION FORMA i (Owner's Name) owner of the property located at ("/-,� D+ r w (Property Address) (Property Address) hereby authorize O 2 (Subskctor) an authorized subcontractor for RISE Engineering, o act on my behalf to obtain a building permit and to perform work on my property. ef's Signature r t Z ;_ Date vDepartment of IndustrialAccidents Office of Investigations 600 Washington Street ` Boston,MA 02111 www mass.gov/dia j Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organi7afion/Individual): Mee McCarthy Construction PO Box 52 Address: West Dennis, MA 02670 e (5m) :zsu-6964 City/State/Zip: CSL-59 #:IIIC-169393 Are y an employer?Check the appropriate bog: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.a6ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lic.#: `1 Expiration Date: Job Site Address: d YK_ 'ice �'�4 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00.a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r par and penalties of perjury that the information provided above is true and correct Signature: Date: 3'7 j Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): j 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: a/�C�/�/laaaac/uaeCii License or registration valid for individul use only Office of Consumer Affairs&Business Regulation . g _ = OME IMPROVEMENT CONTRACTOR before the expiration date. I[found return to: a egistration: .,1'69393 Type: Office of Consumer Affairs and Business Regulation xpiration: :6/1'6L20,1.5., Individual 10 Park Plaza-Suite 5170 = Boston,MA 02116 MICHAEL MCCARTHY:=" ;!" -" MICHAEL MCCARTHY'`:=__ ._ SOUTH DENNIS,MA 02660•==} Undersecretary Not valid without signature i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC}�R PO BOX 52 W DENNIS MA 0267A.� J.•�.� �+ �"� Expiration Commissioner 04/10/2016 a AC n6 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1`% �- 1 011 6/201 3 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 01962-001 NAME: Bryden&Sullivan Ins Agcy of Dennis Inc 508 398-6060 FAxC. (508)394-2267 PO Box 1497 'EMAIL So Dennis,MA 02660 j ADDRESS: INSURER(S)AFFORDINGCOVERAGE NAILC ._... j INsuRERA: A.I.M.Mutual Insurance Company 33758 INSURED i Michael McCarthy Construction Inc INSURER B:.--------_-------....----'-------'--_----'----._..__._...-----.--_-- .- j -................ - P O Box 52 West Dennis,MA 02670 INSURER D;__„___--___ I 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 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 CONDIT!CNS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAMS. -rDDLrUBR ..--' --------- - ---( POLICY EFF�-PPOLICY EXP---.—...--- - ---- -"—---'- -' ' LTR_�. __. TYPE OF INSURANCE —_-- iINSSR WVDI POLICY NUMBER 1_(MM/D /YM) (M ).E---- — --^LIMITS —_-__.-- -- M/DD/YYYY GENERAL LIABILITY j j j EACH OCCURRENCE $ ! j;COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED j I I CLAIMS-MADE I OCCUR I. I j MED EXP(Any one person) $ I I PERSONAL&ADV INJURY :$ 1 j I i GENERAL AGGREGATE j$ GEN L AGGREGATE LIMIT APPLIES PER: j PRODUCTS-COMP/OP AGG $ I POLICY PRO- AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT ANY AUTO ; j j I BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED i Ir J AUTOS AUTOS ' I I BODILY INJURY(Per accident);$ ----- ............. HIRED AUTOS ; 1 NON-OWNED I j i PROPERTY DAMAGE i$ I AUTOS j :.(Per accide�--'-- -' ---'- '-----...-----"- I I $ - '--------._._..---'- --- -----' —'---- - — ---— ---'-' i UMBRELLA LIAB OCCUR I j EACH OCCURRENCE F$ EXCESS LIAB ; i CLAIMS MADE ! i ;AGGREGATE !$ DIED j RETENTION $ - - WORKERS COMP NSATION — j I X TORY LIMITS i OER AIJYD EMPLRO�YEETROS�LIgqABILIETRY/ L—�— — --- -— F E BE EX DE Y/N �— -----.00 AN PRR��pp R/P RTN E ECUTIVEF l'N/A i I E.L.EACH ACCIDENT $ SQQ,QQQ,QQ A OF ICERIM M R CLU D VWC-100-6017656-2013A 17/17/2013 7/17/2014 r- -'---'-'------'------'— ((fPAandaddton,In NH) € I ! E_L_DISEASE_EA EMPLOYEE$ _ 500,000.00 _. ..D�SCRIKIN VF VPERATIONS below--- j -'--- --- -_.LICY IM -� 500,000.00 j l s es l e r j _4..- _ _.. _i.._.._.._.—.._.__.._._-........__.._...._._._i.._. F.L.DISEASE-POLICY LIMIT $ SOO,000.00 I ' I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention:BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r� ©1988-2010 ACORD CORPORATION.All rights reserved. 'ORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ``application # Health Division i� . u�) 14Y.0WY mft,►?u,» Date Issued S 3 Conservation Division �or Application Planning Dept. z Permit Fee �v Date Definitive Plan Approved by Planning Board 6Q / Historic - OKH Preservation/Hyannis Project_Street Address 2--0 Village Owner �� �`- P, C r�(�� ddress one Per quest C �-L� X Z 16'X Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ProjecttValuafion 2 ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes-,'.C] No Basement Type: ❑ Full ❑ Crawl ❑Walkout '❑ Other I = Basement Finished Area (sq.ft.) Basement Unfinished AreaK"sq.ft) Number of Baths: Full: existing new Half: existing W �newca Number of Bedrooms: existing —new u� Total Room Count (not including baths): existing new First Floor Room Count ;;a Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other o :b Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use r " Proposed Use- - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name,/ VI 2 l QMV/ Number / ^ `, ;7 Address ���'�� )tV P0--,o/!63nRLicense# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 17 SIGNATURE_.,t ~`U J / <y ff FOR OFFICIAL USE ONLY APPLICATION# DATE ASSUED 'F MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: LiiL FQUNDATION._ . FRAME AfR 7 k INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:' ROUGH FINAL FINAL BUILDING f N DATE.CLOSED OUT '• ASSOCIATION,PLAN NO. Town of Barnstable Regulatory Services MASS ' Thomas F. Geiler,Director 6 q�-,►`� Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Za 3 a l Owner: GR S-f/y IllG i-1 Map/Parcel: 030 Project Address ZD hf wh f /40u, Builder: Yji-O.W.45 ACV— The following items were noted on reviewing: �-u�lAE 84f,5eJ on 7fie _rn-4V44-- �PS 1 Reviewed by: Date: 3 Q:Forms:Plnrvw i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02I11 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (,J Please Print Legibly Ndt e'(Business/Organization/IndividuaI): `�� Address: �=✓ � i W2__ t/ko-,6 City/State/Zip:-. ��Ld J-S � hone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition. working for me in any capacity. employees and have workers' 9.. ❑Building addition [No workers'comp. insurance comp.insurance.$ _ required] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ti—3. 5 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions / myself [No workers' comp, right of exemption per MGL 12.❑ Roof repairs msdrance required]t c. 152, §1(4),and we have no :. employees. [No workers' 13.❑ Other . comp.insurance required] *Any applicant that checks box#1•must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this dffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby..certyjy u der the pains/ en es of perjury that the information provided above is true and correct �Si afore 91 K` Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector 6..Other Contact Person: ti. Phone.#: Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or-written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any.two or more .. j of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing-employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on,such dwelling house.' i or on the grounds or.building appurtenant thereto shall not because of such employment be deemed to be'an employer. ! MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your situation:and, if. necessary,supply sub-contractor(s)name(s),address(es)and phone nurnber(s)along with their certificate(s)of incrance. Limited Liability.Companies(LLC)or Limited Liability Partnerships(LLP)with no-employees other than the-' it members or partners,are not required to carry workers' compensation insurance. If an LLC or LL P does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial' . Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please.call the Department at the number listed below. Self-insured.companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current. . policy information(if necessary)and under"Job Site Address"the applicant should write"all locations-in (city.or. ' town)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to the' . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled.out:ea6 year.Where a home owner or citizen is obtaining a-license or permit not related to any business or cominmial venture . . (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ilse to thank you in advance for your cooperation and sliourld you have any questions; please do not hesitate to give us a call. ! The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext.406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 w .m - wwass.gov/dia - - - ToNm of Barnstable Regulatory Services + RARNC1ARr.R, « Thomas F. Geiler,Director r�nss i639• ,0� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 " HOMEOWNER LICENSE'EXEMPTION \\ Please Print _ DATE: ' �J s- 1 i r JOB 1rCATIOTI"". (milW:A&. �1 4�Q✓� G 57 . - J ber street village '1 �` 1 (r, V� Jl Q name !/ home phone# work phone# cURRENT.MAILING_ADDRFS; S: city/town state zip code The current exemption for `homeowners'was extended to include_owner=occupiedsdw611 nos 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-inspeedon procedures and requirements and that he/she will comply with said procedures and requiter ` a •Z_ r a Sign re ,o � J�� ��--�•—•_.. Approval of Building Official Note: Thee-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constriction Control -HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions 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:forns:homeexenipt oFE r Town of Barnstable + Regulatory Services + snxxsrnsrs, • . MASS. Thomas F. Geiler,Director iDrE16 IN Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Sectio If Using A-Builder as Ow et-of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buil g permit (Address of Job #Pool fences and alarms are e responsibility of the applicant. Pools are not to be filled or utilize efore fence is installed and all final inspections are performed d accepted. Signature of Signature of Applicant not Name Print Name Date QF0xMs:0wrrExPEPIMSI0NP00Ls 6/2012 I ' '---'i'--+- -._..__.__ ..._... __.-.._..._.-......... .. ......_...__._.._.. _.___.._--._ .._ ..._..... ..___._............. ....... ........._.._._.-.. .__..._.--._'--_ _. __. e I ............. ... ___......i ..__. L -------------- 12 7 7 t I i .... .__-_._..._.-_.-._._.... ............. ..__. ......_.. ._..._. .._...__._.-_._. I - __._ �lX/Z . 2x�2 --- - --x�Z-- _- AA ------------ ----+ - - - i r ita i Eaai ie l MAY 162013 Town of Barnstable *Permit# Of iFiE F-vireS issue date TO STAM Regulatory Services Fee • 1MAsS, Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner .200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us i Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERMIT APPLICATION. - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number OL G) C2 9 Property Address Residential Value of Work C_,_z) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �l l k 5yovl C Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side. #of doors maximum.35 #of windows Replacement Window doo sliders.U-Value ( ) ❑. Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property-owner must sign Property Owner Letter of Permission. A copy of the'#aiftf Improvement Contractors License&Construction Supervisors.License is ,required. SIGNATURE: --------------- The OtrMMOMs�eal6of Massachusetts Iq rrrlrne w of lndm&ial Accidenft Office of In vestigrttions 600 WashhWon Street Boston,M4 #211.1 . wMvJmrs&g"1diu Workers' Compensation Insurance Affidavit:Beers/ContractorsMectricians/Phunbers Applicant Information � M( ( � Please Print Le ubIv Name(Bu iza imJn&ddwI): C•C /Z J a City/Stat Z p- I q*)LVJP},ue# Are you an employer?Check i1e.a. .• priate bon Type of projeet(required): 1.❑ I am a employer with 4. ❑ I am a genend cantraetor and I employees{frill and��par�me}. have Wired the scab-contact ors b ❑New construction 2_❑ I am a sake prolnietx or partner- lashed on the attached sheet: 7. ❑Remodeling ship anal have no employees These sub-cantractors have g_ ❑Demolition w Q for me i m a employees and have wodmrs' ot�inb any t5`- ,,��� g Buildin❑ g addition [No wodam' comp.insur-a ce comp., required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I'I am a homeowner doing all work officers have exnr+sed their I LE]Plumbing repairs or additions my [No works'comp- rightof exeemption per IvIGL 12.❑Roof repairs insurance required.]T c. I52, 1{4},and we have no 13.❑Other employ-(NO workers' comp.insurance required.}. 'Any VphcwA thzt check box#1 mast also fill out the sec6m beiaw showing the-s wale&compensation policy.infarmstion_ 1 Homeowners who submit this affidzvit and 0rtMg t4ey RMd=g za wa*Md rhea bum outsi&coUtacmis must submit a new af6dwk iodic=4 such_ tContradors tW check this box most etsched zn-aaitione,shm shaming the osme of the sob-caotrxtoa zed state whether or not(hose eniiEies bsv;e employers. Ifthe sob-cantrsaoa have employes dLey—Pmmide tbeir workers'ramp.policy number. I run ati employer tliat is prav g wortkers'congmwaliort in=rance for uzy euTtaj m Bloat is the podey acid jab site information. Insurance Company Name: Policy 4 or.eel€ins.I-ic. Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy,declaration page(showing the policy munber and expiration date). Failure to secure coverage as required under Suction 25A of MGL c. IP can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or one-year imprison,as'well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised drat a copy of this statement tnay be forwarded to the Office of Im-estigatiow of ih,e DIA for insurance cm-erage veaEtaticn. ' I do hereby Under the pains andpefnaWes ofpedkty A&the informotio n provided aba"is true�n/d correct Si Date: ^� `� Phone t#: . ©fficiat me only. Do not mrita in this area,to be compWad by cify or town qfficiaL . City or,Town: Peru itlUcense# Issuing rihthority(aide one): 1..Board.•of$�ealth Z.Budding Deparhment 3.Cat town Cleric' L Electrical Inspector S.Ph imbing Fnspector Phone ft e� ti 1ARNnABLF, s639• Town of Barnstable 9� �IED AM't A Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO Building Commissioner 200 Main.Street,' Hyannis;MA 0260.1 www.town.barnstable.ma.us I Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder` I yl I A�1 `'1 0 V C (4i 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) a 1,6 - S of OGner Date Y(4Y q j o�f . Print Name if Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the ;-- - reverse side. Q:\WPFILEST0RMS\bui1ding permit forms\E)PRESS.doC f °Ftt�ra,� Town of Barnstable Regulatory Services ` MUMST"EX Thomas F.Geller,Director MASS. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: O- • \ JOB LOCATION: 2—D n mber r Q streetQ 2 illage / ..HOMEOWNER"; 1 '\��D V l ���` .� name �� home phone# work phone# CURRENT MAILING ADDRESS: L _ t/2,7 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 ders'gned"h . eo r"certifies that he understands the Town of Barnstable Building Department minimum-inspection pr c du s and requir en that he/she comply with said procedures and requirements. wner Approval of Building Official Note: Three-family dwellings containing 15,000 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 ' cehify 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. . Town of Barnstable *PermitExpires Regulatory Services 6,nonrhs o�issae • BARWrABM • (` 1639. 1 �`�' Thomas F.Geiler,Director �. Building Division --1 Tom Perry,CBO, Building Commissioner 6AC 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us �v Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 0qqMap/parcel Number Not Valid without Red X-Press Imprint ,, Property Address 20 &e�,Z O /1,n . e,iO- S A,�115 Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,ei, Contractor's Name�M4�` 40: ,r C h�•-, Telephone Number(n<4_ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS D 6 9740'r X"PRESS "Ry.ILIA w eT ❑Workman's Compensation Insurance Q,eck one: MAY 15 2013 ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# - Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) f�] Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to A461„/Ay ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re SIGNATURE: C:\Users\decollik\AppData\L.ocal\Microsoft\Windows\T porary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 - • BARNMI" , 9. Town of Barnstable 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: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ll'P o , as Owner of the subject property hereby authorize &-/4� ��!•0 4, to act on my behalf, in all matters relative to work authorized by this building permit application for: a?D I-leaJ (Address of Job) I r I signafterof Owner Date Pridt Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 I I The Commonwealth of 31assachusetts yet Deparn►teut of Industrial Accidents a, Office of Investigatio►►s �r 1 .-4 600 Washbigion Street ' Boston,:324 02111 irit-otattas s.got/din Rork-ers' Compensation Insurance Affida-tit: Buildeit•s/Conti-actors/ElectiicianslPlumbei•s Applicant Information // Please Print Leaibly Nalue(Business:Oreauization••Indieidual): AZAZ_ (9—e CGia Al Address: oA , 7e 4--0 Cit}�StateZip: S� .C`i cc d Phone : Are you an employer"Check the appropriate box: Type of project(requited): 1.❑ I am a employer with 1. ❑ I am a general contractor and I 6_ ❑Dieu•construction employees(full anc or part-time).* have hired the sub-contractors ?. I am a sole proprietor or partner- listed on the attached sheet. '• Remodeling ship and have no employees These sub-contractors have S. ❑Demolition %vorLing for me in and•capacity. employees and have workers - 9. ❑Building addition [40 workers. comp.insurance comp.insurance.- required) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised ter 11_❑Plumbing repairs or additions �_El I am a homeowner doing all work officers id hi P myself. [No workers' comp. right of exemption per.N-IGL 12.❑Roof repair insurance required.]- c. 152, y 1(4).and we have no employees.[-No workers' 13_❑Other comp.insurance required.] •AUV applicant that checks box=1 must also fill out the section below shonine their workers compensation pohcv infortrtt:on. Homeowners who submit this affidavit indtcatme thev are doins all worts and then hue outside contractor must submit a wen•AEdaeit tndicatins such. :Contractors that check this box must attached an addinonaI sheet showms the name of the sub-contractors and state whether or not those entices have employees. If the sub-contrsaor have employees.they must protide their workers'comp.policy number. I attt ait eitiplorer tltat is prot•idiug rt•orkers'conrpettsatiott itrsnratice for nkr etitplot•ees. Beloit-is the polio•and job site inforutadon. Insurance Company Name: Policy#!or Self-ins.Lic. Expiration Date: Job Site Address: City State`Zip: Attach a copy-of the workers*compensation policy declaration page(shoeing 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 DLL for insurance coverage verification. I do herebt•cerrifi•wodep4jrepains attd penalties of perjnn•that the inforniation prodded above is trite and correct. Si true: ^- Date: Phone s:: ��� 1�2 6 Official rise otdt•. Do not so-rite in this area,to be completed bt•citt•or toil-it official City or Town: Permit/License 9 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitvdIot`n Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone M 6 V 1L6 0)7U/,LOOLC(f6 LO. .ddC(, LLLdBCY.()• � Office of Consumer.Affairs&Business Regulation License or registration valid for.individul use only MOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:egistration: 154921 Type: Office of Consumer Affairs and Business Regulation xpiratiorr 4/13%2015 DBA 10 Park Plaza-Suite 500 = — Boston,MA 02116 �.� �j?t ' MATT GAGNON ROOFING� �`a•'F_ ;'� MATT GAGNON � _;Yf=� ;.�; • 11 OLD COUNTY WAYc•'>, �.- "/.�• i ye,�� j E.SANDWICH,MA 02537`4•- � Undersecretary i Not valid without s' ature ' i ice_..... ._. .i .i t Massachusetts -Department of Public Safety Board of Building.Regulations and Standards Construction Supervisor " License: CS-069765 MATTHEW P GA�S`NO 11 OLD COLON7G WA East Sandwich MA 02537 �,. Expiration Commisssiio'nne'r` 02/28/2015 7 i /Tease VIEW 40 fu 1✓`�. ="a ':,. t"'.,'.' �Nw= l�rv>F:,,i.: '. � .. a � 1 -1 4 �`r � � Z �. Y� "---mod_ _ � �„ � �1`��\ /`� •� !� / - :, y 7 : .. Y Town of Barnstable Geographic Information System May 14, 2013 �- Will"! TOM Z. E o e. e f u ele At DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:030 Parcel:099 N boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:GIRSHOVICH,YURY 8 LYUBOV Total Assessed Value:$440200 1"=100'may not meet established map accuracy standards. The parcel lines on this map w� E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.89 acres Abutters �.{ boundaries and do not represent accurate relationships to physical features on the map Location:20 HEAD OF THE POND LANE II *0L5-r0, f µILLS such as building locations. Buffer Aerial Photos Taken April 19,2008 Parcel Detail Page 1 of 3 of IME tp`\ \� fAHltiSTABLE_ ��.i r tMJ9. •,Aa., �d-. Logged In As: Parcel Detail Tuesday, May 14 2013 Parcel Lookup Parcel Info Parcel ID 030-099 I Developer LOT 19Lo I Location 20 HEAD OF THE POND LANE ( Pri Frontage 125 I Sec Road I Sec I Frontage Village MARSTONS MILLS I Fire District C-O-MM Town sewer exists at this address No I Road Index 0682 I Asbuilt Septic Scan: Interactive � 030099_1 Map Owner Info Land Info Acres 0.89 I use Single Fam MDL-01 ( zoning RF I Nghbd 0107 Topography Below Street I Road Paved utilities Public Water,Gas,Septic I Location Lake/Pond Front,Excel View I Construction Info Building 1 of 1 Year 1983 I Roof Gable/Hip 1 Ext Wood Shingle Built Struct Wall Living 2073 I oveRoor Asph/F GIs/Crop T Ae None Area Cover ype i Style Cape Cod I Int wall Drywall ( Rooms Be 3 Bedrooms Int Bath Model Residential I Floor Carpet I Rooms 2 Full Grade Average Plus I Type Hot Water I Rooms Total 7 Rooms Stories 1 Story IHeat Fuel Gas I Found- Poured Conc. ation Gross 5046 Area Permit History FIssue Date Purpose Permit# Amount Insp Date Comments 1/1983 Dwelling IB15488 1$0 1/15/1984 12:00:00 AM MM 1 STOR Visit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1942 5/14/2013 Parcel Detail Page 2 of 3 Date Who Purpose 5/17/2005 12:00:00 AM Paul Talbot Meas/Est 8/24/2000 12:00:00 AM Martin Flynn Meas/Listed-Interior Access 1/15/1984 12:00:00 AM FIR - Sales History Line Sale Date Owner Book/Page Sale Price 1 10/15/1987 GIRSHOVICH,YURY& LYUBOV 5980/007 $214,000 2 6/15/1983 JOYCE,JAMES K 3775/130 $17,500 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2013 $178,700 $56,800 $4,800 $199,900 $440,200 2 2012 $182,700 $55,700 $3,800 $190,100 $432,300 3 2011 $233,700 $3,300 $0 $190,100 $427,100 4 2010 $233,200 $3,300 $0 $184,000 $420,500 5 2009 $230,700 $2,700 $0 $322,300 $555,700 6 2008 $246,300 $2,700 $0 $319,100 $568,100 8 2007 $244,700 $2,700 $0 $319,100 $566,500 9 2006 $222,600 $2,700 $0 $348,500 $573,800 10 2005 $202,900 $2,700 $0 $290,400 $496,000 11 2004 $165,200 $2,700 $0 $331,900 $499,800 12 2003 $150,700 $2,700 $0 $113,400 $266,800 13 2002 $150,700 $2,700 $0 $113,400 $266,800 14 2001 $150,700 $2,700 $0 $113,400 $266,800 15 2000 $116,500 $2,600 $0 $66,700 $185,800 16 1999 $116,500 $2,600 $0 $66,700 $185,800 17 1998 $116,500 $2,600 $0 $66,700 $185,800 18 1997 $130,400 $0 $0 $57,100 $187,500 19 1996 $130,400 $0 $0 $57,100 $187,500 20 1995 $130,400 $0 $0 $57,100 $187,500 21 1994 $114,700 $0 $0 $60,000 $174,700 22 1993 $114,700 $0 $0 $60,000 $174,700 23 1992 $130,500 $0 $0 $66,700 $197,200 24 1991 $131,400 $0 $0 $95,200 $226,600 25 1990 $131,400 $0 $0 $95,200 $226,600 26 1989 $131,400 $0 $0 $95,200 $226,600 27 1988 $92,600 $0 $0 $23,300 $115,900 28 1987 $92,600 $0 $0 $23,300 $115,900 29 1 1986 1 $92,600 $0 $0 $23,3001 $115,900 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1942 5/14/2013 ' -rtrain sse��v.r a........�� rr •,�-. � �. cy,,, _ " '�" -•` ,�- -'•a. m ..,�, qis �d ILIiF:1.'ft t w.�� $„ Jn" J�;uy�r�.� `L- 4 s d . / 1 i wit C T 2 Y S �i ff'+M��z4 i P 339 50r? 424 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse) Sentto 1 Street&Number Post Office,State,&ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee u� Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ co) Postmark or Date 0 LL U) I n. I Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the ko return address of the article,date,detach,and retain the receipt,and mail the article. N 3. It you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends it space perils. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of For 3811. li 6: Save this receipt and present it if you make an inquiry. a n The Town of Barnstable • anzerrsrnsis, - 9� 1Q .`�� Department of Health Safety and Environmental Services • �FDPAF►�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 12, 1998 Yuri Girshovich 198 Woodcliff Road Newton,MA 02161-1859 Re: 20 Head Of The Pond Road,Marstons Mills,MA Dear Property Owner It has recently come to the attention of this office that the chimney on the house that you own at 20 Head Of The Pond Road is in danger of falling. The top of the chimney is pulling away 2"-3"from the wall and the foundation is cracking to the right of the chimney. This needs to be corrected as soon as possible. If we can be of any assistance,feel free to call this office. Please let us know how you are going to proceed with this situation. Sincerely, Thomas Perry Building Inspector TP/km CERTIFIED MAIL P 339 592 424 R.R.R. Q980512A m SENDER: I also wish to receive the v ■Complete items 1 and/or 2 for additional services. :Complete items 3,4a,and 4b. following services(for an 0 ■Print your name and address on the reverse of this form so that we can return this extra fee): Wcard to you. j •Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. Z ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N •The Return Receipt will show to whom the article was delivered and the date a e 'delivered. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number 339 e 1), q a E E 4b.Se a Type m egistered O Certified °C N O2 �1 ❑ Express Mail. ❑ Insured s L N i er/1 r 161 ❑ Return Receipt foLMembaQ Qse ❑ COD c r .7 Date of Deli ` S � Re;eiv B (Print N m 8.Address ddre nlyt ested v� S and fee c 6.Si a re:(Addy ee or it) 0 NU PS Cl j Ps ivorm Ufl, december 1994 102595-97-B-0179 Domes eturn Receipt ®St 4fip ��� irstCI ail UNITED STATES POSTAL SERVICE `Postage ees Pad t -USPS c `Permit Nn:5'.C7— • Print your na4 - , and ZIP Code-in this box• Town of Barnstable Building Divislon 367 Main St. Hyannis, MA 02601 a ' 1 m v. Complaint Numher: 119O I akcn by: Louise Date ; I_Ii�)� Map/haiccl: ,O;jO-091) _ �. Refcrrcd to: Ralph Sl_B.JFCI' OF COMPLAINT Business/Occupan( Name: YIII-i (,11-�llm,lc1l-- -- Number 20 Street. I Ic,«1 ol'ilw I (md Ro,i(l Village: Nl:wrSTO\S COMPLAINT INFORMATION Complainant's Nanic: Scan DiCataldo Address: NIashpcc, MA-02649 Telephone Nunibcr: );N-I;N2 Co►nplaint. Description: Cliiinncy is detaching;from the House wall. Dangerous situation-when pushed on the chirriney rocks. °s Actions Iakcn/Results' SP P t 551 Date Closed: i- 'ti► A. a .'jl ,,y,,. ."�.; .3 *.- yi �� `: ''3j : `�: �fi'' �' l �.}�F c •~ a^'X. i 25488 TOWN OF BARNSTABLE Permit No. -______-_------------- 1 Building Inspector cash SAWITAm ------------------- •� ruyo OCCUPANCY PERMIT Bond _—_---_X Issued to James & Larry Joyce Address 1ott '41.9 20 Pead of the Pond Road Marstons Mills Wiring Inspector �� ��� —' Inspection date Plumbing Inspecto �� C> "� Inspection date Gas Inspector � Inspection date 11 7 Engineering DepartmentV ` ,� '-e,:,-�-4w-66�,M-I spection dater " ",Board of Health----6;;;�7,* Inspection date/t THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Nz— Buildingl ns ector le" 14 Assessor's map and+lot number .........Q...�1� ../.� .......... oFTNET ,Sewage Permit number ............... ../..V... ................ ~ 0 Z BARNSTABLE. i r ., 1 -House=number .............. ..... ...... .. 90 cane . i639 9� p MAY fry TO N OF BARNSTABLE BUILDING INSPECTOR ` APPLICATION FOR PERMIT TO .... sa.��.Q.......>a.l. VcS.............�`... ......I ``�. . ... TYPE OF CONSTRUCTION :!'d,�........................................................................... ...................7. .................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .... �...� ......A6..O ......4A .........&01 : ................................ Proposed Use ..... .;..1.�41 q- Sr°{........................: ..........:-.......................................................... .. Zoning District .........`�....... .....................................................Fire District ......�� ........... Name of Owner ... Q '+h. .... r � ...Address ...f. �'V/./....L?0?� .... !.. ... Ae 44 0 ,.... �.fr o c Ds Name of Builder ..... .. .�.rr.......................Address .......��.W.......... . . ....... .. .. .... ' Name of Architect ......... 11��1.... ................'........Address `../.1/ ......A.�..+!'.�....................... .... .... Number of Rooms ....... ....:............................ Foundation . ::.f/ ,,.E? .....�iC��'d1.4.ie-� c.:. ., .............. p,�,� dKoofi n .............Exterior .. .r�s•�r•�. .. � � ............ ...c g ...c�.�.�.�L '�1- Floors ..0��a.7..... :.�:J..l:'St. -.............................Interior ...... ..y. ?A .�......Q .... .... Heating ,.... .lf. ,.....c .d. ...Plumbing :; :..... ,� .� .. Qs � V� Fireplace `.. /E?'�'�✓.U ..., .. . 12�Er��. ..........................Approximate ............................. . Definitive Plan Approved by Planning Board -----------_______---------^ °l9_______ "` Area f ;7.......... .......................... . . Diagram of Lot and Building with Dimensions Fee ............../...X...... . ........ ` SUBJECT TO APPROrVAL.OF BOARD OF HEALTH r a, •1 Y - 3. 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 .... i?. �o C Iq 0 Construction Supervisor's e Licens .......:°.. ... ................... JOYCGE, JAMES & LARRY =30-99 n No .25488 :�2fmit for .One Story Sing Family Dwelling ............................................................................... Location ....LOf;...19........20...Jje.ad...af...t;b.s Pond Lr3. Marstons Mills ................................................................................ Owner .James & Larry Joyce Type of Construction ..Frame ................................................................................ 1 Plot ............................ Lot ................................ Permit Granted .....Aucjust...31............19 83 Date of Inspection 19 } Date Completed ......................................19 Looms , I-7( - Sam 2G�'Cs a(a o w.o i ` Assessor'st ma and lot number ....3. ...� .../ .......... �, �' "� SYSTEM MUST BE p / INSTAL of THE TOE LED l�! CC2t�Pl,IA� w Sewage Permit number 7..4?...02 .. WITH TITLE 5 ........................ ................ ` I ' 7-� ENVIRONMENTAL CO�� � 2 B9EaSTABLE. i j Mae& Y Hou number .... TOWN REGut_ATiaONS 9°o tb39• e�° .............. ................. ... ............................. . •• TO N OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... x,t.Q....... .i... �� ...... 1` 'kt, I.` .............. TYPE OF CONSTRUCTION .........L4. _.._........................................................................ ................. 1 ...........19..l�.? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: rt Location ..... .... .. ....../ . .. ...�..Pp -`..Q.....:hkt ......... :. .........S..S....... ProposedUse ....... . .... aC.Q ' €.............................................................................................................. ZoningDistrict ..........�... ....... ........................ ....................Fire District .......C'..4 ......................................................... � Name of Owner .. Address ..�. � ..!/'F..`'.W " .R.6....7,7.if es.9.......................Address Name of Builder ..... .. /.. �V+@�..a./......................Address �./.tl..Crr` Q ......1` !./.:.1........................ Name of Architect ......... .... Number of Rooms .......F.....................................................Foundation .....PO . ...... ................... Exierior .. .. ( T...........11�'.K,.LS0kfKoofing ...c�..�J47L0.....�.7. r llr.�..,................................. Floors ..:� 7.....aew. . �c..............................Interior ...... o.......0.......... .. ......... ...... -Heating .....—i: , ! . !...... ................................... "gybing .... ........;yam. •s.'...G 4WV.00.z6. ..!` U� '€ ,._,..._ �j Fireplace .......(V' `^'.u1ce....A-a4e-k........................... Q�roximate Cost ......... ..................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .....�.. .fl�.. ..... Diagram of Lot and Building with Dimensions Fee ' SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn tbble regarding the above construction. Name .... ............................`........................ Construction Supervisor's License ....................... -7o -JOYCE, JAMES & LARRY 2.5488 KY........... No ... ............,,.hermit for .911!�... ....Sincfle Family..Dwelling,,,,,,,,,,,,,,,„ pVq.11.i Single ..Ag................ Location Lot... ...Of...the Pond Ln. Marstons Mills ............................................................................... Owner ..J.ame.s...&...Larry...J.Ov.c.e.............. .. ....... .. .. .. .. .... Type of Construction .......Frame ........................ ... .. .. . ................................................................................ Plot ............................. Lot ................................ Permit Granted ...AU9.1xs.t;... .............19 83 Date of Inspection ....................................19 -7 Date Completed ..............I . - I . -, -,-,-- . �_ ,Z� t - -, ..7---.. 11 I I . �. I . 1. I ,:,, -__ _� -- - - I - . 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