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0564 OLD FALMOUTH ROAD
- 759 Town of BarnZab�EN �� , �(J G Fxpa�ec 6 ;froxissue dr¢e Regulatory Services Fee x"s • MAR 2 9 2016 Richard V.Scab,Director BundingDivisTQnWN OF BARNSTABLE b� Tom Perry,CBO,Budding Commissioner 200 Main Street,Hyannis,MA 02601 wwmtown..bamstablema ns Office: 508-8624-038 Fax:508-790-6230 EXPRESSPE APPLICATrON - RESIDENTIAL ONLY Not V&hd wA*out AaX-Press Isq=W Map/parcel Number Property Address �(D h r/15 ❑Residential Value of Work$ G i S00 Mamum fee of$35.00 for work under S6000.00 Owner's Name&Address /y) 'Is 4z as Contractor's Name r1As4d �i�n�i�;.i ��.:>I 1 Telephone Number 450!2; - Ze 7 rS' 9-7 q Z_ HomeImprovementContrar;torLicense�(ifapplicable)�j2_ .5 Email: !`.�:.� �t%i�c�,-��•2STr..rl��:�nc%���c�rl„ cc, . Construction Supervisor's License#(if applicable) 9 tG 6 rS D Z-W�ozkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner MI have Worker's Compensation Insurance Iusurance Company Name (,-7✓o��:�� �to�� Tst Sc�r.G.sir,! �.�. Workman's Comp.Policy# WC, � - �v 0© t Copy of Insurance Compliance Certificate must accompany each permit Permit RS (check box) C' Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over odsting layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum 32)4 of windows #of doors: ❑ Smoke/Carbon Monoxide.detectors 4 floor plans marked with red S.and inspections required. Separate Electrical&Eire Permits required. "Wnera require&Issuance of this permit does not exempt compliance with other tOwd department regulations,i.e.Mtn ie,Conservation,etc. —Note: Property Owner must sign Property Owner Letter ofPermission. A copy of the Home Improvement Contmctoirs License&Construction Supervisors License is required- SIGNATURE: Q\WMLM'\F0M,MQding p..rZmis Revised 040215 I i The Camwmnveakh ajfMassadi=etts DepartmetztefrndawiatActiderrts Office-0 gaawn. 600 Wavhbi m Street Boston,VA 02111 ' �vivs�.mas�govfdia . Workers' Caffipensaffian Insxn-mce Affidavit:B.�derslCantractucsJUecfdc ans/Phymbers AAp�icam#7Ufarm2fian Flease PriA E env Name -ir��✓ L d eJ.S�d'�ai_�:'nri � Adder 7 t✓ � ?,.r,4 1-4 cityistr ? 3 Phaat!x � Are you an employer?Checkthe appropriate box: Type of project(relmir•ed}_ 1.Q'I am a.emplayer with 10 4 ❑I an a general ronfractur and I employew �or P s have hiredfEm sub-contractors 6. ❑New cons6�fzau 2.❑ I am a sale proprietor orpartaer- Nsfed on the attached sheet I- ❑Remodeling strip and have no employees These sob-co ntmetcrs have S_ ❑Demolifioa wadies; forme in any rapacity. .playees audbzue wo%kess' [NO wodcamr comp.ir+vtrarre comp.imuranez., g- ❑B3BuilcEcg addition re px i ed.] 5. ❑ We are a corpordio .and its 10-❑Eleckiml repairs or a,dc tiow 3_❑ I am a homeowner doing all work officers have e=cised their 1L❑T?1umbFng repairs or addidoms myselt o workers'Comp- riot t of ex=460u Per MGL ❑Boofr�;m jm cee fegnired-j Y c.152,§IM andwe have n0 employees_IN-wodoe& 13-❑Other cop-msarance ] •3taymnEamt&stcheelm box 9lmostsUafs c=*esecfsoabgowshatdagf rwadea;amopensmfi=poycyinfamud= ;Any submit r'his atfd2ml ia3tt g dZy M da=-�age �hiie a�tside w ssmast mhmita asw�ndsrst is �sarSi rC-aarts,cros tits[cbeci�this box mast sit�he�as additi�$sheet shooriig the n�of the si¢b-cau�Csttas and stye whettu�ar aattbase e�aesha� ezqioyees.TYtbesah-rantmdars3arermployeas,they pmsideAeir wackamOa=p.poRcymrmbm IQttlmft!11[p�D�BTtJDtztisplatzdirtgtvDrliEfS7C0[If�7EttSr�iatlitLS7lfance,jOtAt�*ernpTvy�ees. $¢Iosvisthepaiicyartrijobsitu TQ Cones=7,Mame- C-7 erg n r�� �T Z / yl,�udor v�i_O ( Q - Pafit y ar Self�ns I ic_ ` ('1�Gi ?��l v RwisationDafe �/Z Job SifeAddress: old /, � ' —cityrstafel2 /2g054os ✓n lji NA 0 2- G yg' Bch a copy of the workm-e rnmapensationpoRzy declaration page-(showing the policy number and expiration date}. Failure to secure coverage as reciuiredunder Secticn 25A of MGI.m 152 can lead to the imposition of orimimai penalties o+f a fine up to$L,54000 andlor osie-year ssrtpasonmeat,as wig as civil peaalties in fhe form of a STOP WORT£ORDER and a:Sie of up to$250-00 a day against the violator_ Be adtrised'thd a copy of this skdemaA maybe fxwarded fa the f}Fice of Tavestegzfi e€the DIA for insurance coverage vesicatiam 1 rya&er,6p codify uudEr d i0 an pan ahfes oagerjrur}�that t1ia igbrmeaW*=provi&d ahm ff!s fare and correct PhoneiF SDy- 2 -Z-Z-Y Z Ojff&ial use ws££y. Da not ovules in this at m to be.cmnpl retc+d by tatp artmon ofic&Z: My or Ta n: Permiff icrose; Issuing Auffioi*y(tdr'de one): L Bo2Erd of$eal i I BueTcfing I3egartmeat I CStpTown Qerk 4`Electrical Ingmfar• S.Plumbing fnspeciar 6.01her Contact Person: Phone 6 GRANITE STATE INSURANCE COMPANY 0103090-00 WC 009-93-0601 13102 013-82-0915-50 PE N V FRASER CON RUCTION, LLC IAIGI P.O. BOX 02635-2443 An AIG company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE- WC990610 175 Water Street New York, NY 10039 I.D# 000190646 MA UI#: KEATING GROUP INC THE WORKERS COMPENSATION AND EMPLOYERS 144 TURNPIKE ROAD LIABILITY POLICY INFORMATION PAGE SUITE 150 OUTHBOROUGH MA 2-0000 S RLICY INSURED IS LIABILITY COMPANY E EWAL 0099 0601 OTHER WORKPLACES NOT SHOWN ABOVE SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE- WC990610 ITEM 2 POLICY PERIOD 12 Al A.M.standard time at the Insureds imailing address FROM 09/26/15 To 09/26/16 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident S 500,000 each accident Bodily Injury by Disease S 500,000 policy limit Bodily Injury by Disease $ 5001000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE- WC990612 ITEM The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated Classifications Code Number Total Remuneration $100 OF Re- R'�� aAnnual❑3Year munc ration X❑Annual ❑3Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE- WC7754 TAXES/ASSESSMENTS/SURCHARGES EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) MINIMUM PREMIUM $500 MA TOTAL ESTIMATED ANNUAL.PREMIUM If Indicated below.Interim adjustments of premium shall be made: ❑ Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM 08/2 /1 PARSIPPANY 5 5 82 Issue Date Iswing Office Authorized Representative WC 00 00 01A WJV(Wd 04103) I I Office of Cons�zmerl��s�d 3�ess tZe�3�?a� 10-Ra*Plaza-S-ce 5170 Boston,M-mchmets 02116 Ham 1Mpr07eMe r--Comlrador R 011 ?YAK SBA E�a�liorr 323120?7 Tf>2Fa..�7 FR.ASER CONS tTKiCT[ON Co. DEAN ;RASE` R F.G.BOX 4845 COTUHT,MA 02635 Epaxte Ad&==nd;ezz=cw&yak rtmet=or=h=s—. a maroon. f]Ad&— �ALznewk=] C"1 T�m�iops2-t �La!"-C-6 Qmlu �olU��lar _ 0:6m�°Cortarst,�SS�&�niafioa ic��ozoas3�idYoritaxvia'hToseorly . _ Ss�ROVET�74TCONi2AGTOP. befnrtfaeeYga�aad��{go�arG�an2r. 722>s8 Tye: OfCons®srl aittmn�xoacssSr�a ^a DSA 1C?2rkTl=-Sa¢e5170 " Boston.Mb.flI1I6• . �P.?«S�2CCNSTRUCL7Wi CO_ - MAN FRASEP 104-TVIIMVMJLANE E FALMOLrf K MAOZSW v Y �Eotv+IidW�tfiOn: e • � dP.assaenus=-<s-3eaarr2nr�'=u�iicSa�:ty • � oOs:�O�jJE�d;C-�1[=71.iio21Ji.5 Sn��s7�o.^,9;tl9 Concrrvcrian Supen•ieur :1C2ns2:CS-097668 ' DEAN C FRASER 104 TRrIr~iN VIEW LADM'?Y EAST FALMOUMMA.=t0 536 ✓� „� � 06107J2047 Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA 02649 s�X Email: info(i,fraserconstructioncapecod.com f www.fraserconstructioncapecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 HICL#112536 CS#97668 RE-ROOFING PROPOSAL DATE: December 17, 2014 PHONE: 5-0�88--428-6147 NAME: Mary Wyman -73-7 EMAIL: MAIL ADDRESS: P.O. Box 121 Marstons Mills, MA 02648 JOB ADDRESS: 564 Old Falmouth Rd. Marstons Mills, MA 02648 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications. and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Fraser Construction will include a 4 Star Upgraded warranty with the selection of any 30 year shingles or any Lifetime shingles. 4 Star Warranties have a 50 year Non-Prorated Coverage in case of any warranty repair,.labor and materials, shingle tear-off and disposal fees. CertainTeed SureStart Plus- The extra measure of protection when a credentialed company installs an Integrity Roof System. i ASK US ABOUT OUR OVERHEAD CARE CLUBI 1 i Roof Options Supply and Install - CERTAINT D LANDMARK AR TECTURAL ASPHALT SHINGLE - Lifetime, Limited Transferable Warran - Class A- Fire Rated - 240 lbs. per square - Two Piece multi-layered Laminated Fiber Glass Construction - Durable, Beautiful Color Blended Line to match any trim or sidin r - Manufactured with Self-Adhesive Strips and fastened with six nails in common bond, large nailing area - 10 year warranty against Algae containment causing discoloration and streaking - 15 year wind-resistance warranty up to 130 MPH Color: 4 P4r1A) PRICE-$6,500 Initial Supply and Install - CERTAINTEED LANDMARK PRO ARCHITECTURAL ASPHALT SHINGLE - Lifetime, Limited Transferable Warranty - Class A-Fire Rated - 250-270 lbs. per square - Two Piece multi-layered Laminated Fiber Glass Construction - Classic Shades and dimensional appearance of natural wood or slate - Max Def Color Selection offer a more vibrant, brighter appearance with a richer mixture of surface granules that provide a more profound depth of color - Manufactured with Self-Adhesive Strips and fastened with six nails in common bond, large nailing area - 15 year warranty against Algae containment causing discoloration and streaking - 15 year wind-resistance warranty up to 130 MPH Color: PRICE-$7,200 Initial I ' Supply and Install - CERTAINTEED LANDMARK TL ARCHITECTURAL ASPHALT SHINGLE - Lifetime, Limited Transferable Warranty - Class A- Fire Rated - 305 lbs. per square - Three-Piece multi- layered Laminated Fiber Glass Construction - Tough, patented 3-layer laminate design.provides ultimate durability and the dramatically thick roofing style of classic wood shakes - Random tab design and unique natural shadows give luxurious dimensional character to the shingles - Manufactured with Self-Adhesive Strips and fastened with six nails in common bond, large nailing area 2 - 15 year.warranty against Algae containment causing discoloration and streaking - 15 year wind-resistance warranty up to 130 MPH - Price includes supply and install of 16 oz. custom red copper open W-shaped valleys Color: PRICE-$9,100 Initial Roofing Product & Installation Details Supply & Install- (Soffit Venting) Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge with existing soffit vents. Smart vents over white drip edge. Protection against damage to the roofing materials and structure. The most effective system is a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is-equalized from top to bottom, supplying a uniform air flow along the entire underside of the roof deck. Supply & Install- Ice & Water shield Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Ice and Water Shield is a self-adhering roofing underlayment used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to protect roofing structures and interior spaces from water penetration caused by wind-driven rain and ice dams. Supply & Install- Surround Underlayment (A Typar Brand) A smart alternative to felt, it is water's toughest opponent, creating a secondary water barrier that reduces the incidence of leaks caused by storm damage, wind-driven rain, ice dams and worn roofing materials. It is a waterproof, synthetic polymer material that will protect your home against moisture intrusion. Supply & Install-CertainTeed Swift Start With self- adhering asphalt starter course on all eves, and rake edges. CertainTeed requires this product for Integrity Roof Systems and upgraded wind warranties. Supply & Install-Aluminum & Neoprene Soil Pipe Flashing Supply & Install-CertainTeed Ridge Vent High performance ridge vent with external baffle. 3 n+ - Supply & Install-Pre-Cut CertainTeed Hip & Ridge shingles Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of underlayment, shingles,accessory products and ventilation all working together. The.Integrity Roof System is designed to provide optimum performance--no matter how bad the weather conditions are. (As recommended by CertainTeed) Clean & Remove -Debris from work area daily. PAYMENTS ARE DUE IMMEDIATELY AFTER JOB COMPLETION. 1/3 initial payment, remainder to be paid upon.completion Payments accepted are: CASH - CHECK- MASTERCARD -VISA-AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon day of job completion. * Please note that roof prices reflect removal of(1) layer of existing roof unless otherwise indicated in contract. If additional layer or layers are removed additional charges will be assessed. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per'panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. FRASER CONSTRUCTION Warranties the labor for LIFETIME of roof. 4 FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 15 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties-the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Please note that all pricing is contingent upon current market pricing. If contract is not accepted within thirty days of date of proposal, change in price may occur due to deviation in material price. i Any deviation or alteration from above specification will be executed upon written orders and will become an,extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCE ANCE: o H eown Fraser Construction, LLC 5 �9 • ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION N 8ARNS` Map t' vl Parcel rr ` I�eation # ZI,o �� J Health.Division <>>'^ _ IatE kssued14 Conservation Division 3A -m - �_Q -50. O . ��,�►. wu1�k Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis i� Project Street Address Io G/ /: t"(/(47� 1241 Village Owner `� l� ��117AA" Address �C GI �®mil✓ Telephone Je l l Permit Request ZV /. �i ✓v�l� /� >'��i' 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 Historic House: ❑Yes Q No On Old King's Highway: ❑Yes AtNo 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: - L / 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 70 ����, / Telephone Number Address /7/e,-ale License #C1 Gee',2,3 y AW ®?e�q I Home Improvement Contractor# Email 7i2 0/' /_7 e 4Zr4�1 Worker's Compensation # 200110X/0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� —�� FOR'OFFICIAL USEONLY ,' APPLICATION# - DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: =- ' �o p S-� /nono _ . FOUNDATION n �a3,l.rxoh� •- FRAME INSULATION 0 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL'BUILDING '1 ��� ®� �20 Its �ha` " DATE CLOSED OUT ► " ASSOCIATION PLAN NO. Y, ' 1 ' , - The Cormnonwea&h of Massachusetts' Deparment oflnduYh-hdAccsdents 0jJc1ce of Inveyagations 600 Washington Street Boston,MA 02111 www.mass gov/dza Workers' Compensation Insurance Affidavit:,BtuZders/Contractors/EIectricians/Plmnbers Applicant Information � �J Please Print Le "b Name(Bnsineworganiz ima.,d vhivan: 1�Jo�NS /%`�i^+?`7 lt�Gl�l •mil `C(rio l Address: 212 City/Stawzip: Phone#: Are you an employer? Check the appropriate box: ' Type of project(requimd): 1.%I am a 4. I am a contractor and I . employer-with - ❑ �� 6. New constructionemployees(fall and/or part-time).* have hired the sub-contractnis 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. employes and have workers' [No workers'comp.insurance comp.insurance 9. ❑Building addition :. mquired] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12 Q Roof repairs insurance required_]t c. 152, §1(4),and we have no employees. [No workers' I3. Other,�t® comp.insurance regained.] *Any applicant that chocks box#1 most also fill ant the section below showing their workers'compensation policy inhrmabon_ t Homeowners who submit this affidavit indicating thcy are doing all wodc and then hire outside conhactors must submit anew affidavit iadicating such- #Contrachns that ebeck this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp.policy amnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy crud job site information. Insurance Company Name: 1 IXJ C!/�f�6� /✓JGt�Gt✓�l iP Policy#or Self-ins.Lic.# ADtJl k4.3 Ir-1O Expiration Date: /1-- Job Site Address: S `fz—o l�l�'�/{s'IUII�/1 At City/Statdzip: &At Attach a copy of the workers' compensation policy declaration page(showing the policy number and e Nation 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$1,50,0.00 and/or one-year imprisonment;as well as civil penalties in the fnaa of a STOP WORK ORDER and a fine of lip 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 insmance coverage vetcation. I do hereby certify under the pains and penalties ofpm j ay that the information provided above is true and correct Si " Date: Phone �V 7,;7—33w/'V Official use only. Do not write in this area to be completed by city or town ooi aC City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other I Contact Person:-- Phone#: r - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuant-to this statute,an m ployee 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"au individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho 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 ofpublie work imbl acceptable evidence of compliance with the inc��ranCC. requirements of this chapter have been presented to the contracting a uthoi*." Applicants Please fill out the workers'compensation affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of insurancB. Limited Liability Companies(L.LC)or Limited Liability Partnerships(LL.P)with no employees other than the members or partners,are not required to carry workers' compensation in sumce. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-irisuran ce 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 firture permits or licenses. A new affidavit must be filled out each year.Where.a home owner or citizen is obtaining a license or permit not related;to any business or commercial verdure (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. Tha CammoEnwealth-of Massachusetts Depaitmment of Indust aal Accidents office of Investigations GGO-Washivon Sbceet B oston,MA W.I I I TfJ.9 617-727-4900 ext 4€16 or 1--977-MASSAFE Fax#�617-727-7744 Revised 42407 v w v_mas5_gov1dia f CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDorYYYYI ARIAA I 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 pollcy(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 endorsements. PRODUCER CONTACT Mark Sylvia Insurance Agency,LLC NA Krls KO reski 404 Main Street P O Vie.E:rl•(508)957.2125 FAX Arc 41;508.957-2781 EMAIL Centerville,MA 02632 iMARIk B:_rnark@markSylvisins rance.com INSURER 3)APFORDINti COVERAOF _ NAIC e INSURER A:Farm Family Casualty Insurance INSURED Timothy Gray Building and Remodeling Inc INSURER a 68 K Nicoletta's Way INSURERC: Mashpee,MA 02649 INSURER D: - INSURER E: INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. INSR AopL LTR TYPE OF INSURANCE POLICY NUMBER POLI Y riY POLICY EX Y LIMITS A X COMMERCIAL GENERAL LIABILITY 2OO1XOS4O 2126/2D15 2 2612016 EAC14OCCURRENCE A 10000000 CLAIMS-MADE OCCUR PREMISES u(r.ence) S 100.000 MED EXP(Any one anon) S 5 000 PERSONAL&ADV INJURY S 1.000.000 GF.N'l AGGREGATE,LIMIT APPLIES r'F.R: GENERAL AGGREGATE S 2.000,000 X POLICY EI PRO- D „_ JECT LOC " PRODUCTS-COMP/OP AOO S 2,000.000 OTHER: — S AUTOMOBILE LIABILITY COMBINED SIN LE LIMIT R ANY AUTO ALL OhMEO SCHEDULEDBODILY INJURY(Poeporsml) is AUTOS AUTOS BODILY INJURY(Par 9ccIden() S HIRED AUTOS NON•OWNEO _. AUTOS PROPERTY DAMAGE S 0 0 � 8 - UMBRELLALIAB OCCUR EACH OCCURRENCE S _ EXCES6LIgB HCLAIM'6-MADE AGGREGATE ? BED I I RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 2001 W8340 10/15/2014 10/15/2015 oTrl. YIN T9TUT _ ANY pROPRIETORrPARTNER EXECUTI'JE E.L.EACH ACCIDENT t 1.000 OOD OFFICERIMEMBEREXCLUOED7 D NIA Iryes,dasco In Nl1) G.L.DISEASE•EA EMPLOYEE S 1.000.000 (ryes,eescrloo under DESCRIPTION OF OPERATIONS b9low F,I.,D18EASE•POLICY LIMIT I A 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addlllonel Remarks Schedule,may be anachad 11 more space is raqulrodl Carpentry Timothy Gray is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION (508)790.6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE' C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ��e (Cornraoreti�:•a�/�c�����u:;aC�c•�reJn.//< � • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only rOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 102634 Type: Office of Consumer Affairs and Business Regulation Expiration 762016-- Private Corporatic,', 10.Park Plaza-Suite 5170 .�._ Boston.MA 02116 TIMOTHY GRAY BUILD ING}B,REMODELING Timothy Gray (_ 68 K NICOLETTAS WAY Mashpee,MA 02649 Undersecretary Not vali ithout sign turd✓ Massachusetts -Department of Public.Safety Board of Building'Regulations and Standards Construction Supervisor 1 & 2 Family License: CSFA-M234 TIMOTHY GRAY 68K NICOLETTXS W MAS11PEE MA II 264i Expiration Commissioner 11/30/2016 Town of Barnstable Regulatory Services 9RAMMSTABM Richard V.Scali,Director 1639., Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize �moT�� ' � to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) ""'Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 6 lzwe ISignale—of4Own ignature j0rApplicani Print Name Print Name Date Q TORMS:O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ��oF crte roiyy Richard V.Scali,Director ' Building bivision t F • Tom Perry,Building Commissioner MUM 9�b 1639. ��� 200 Main Street; Hyannis,MA 02601 QED t'U'�A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRFSS: 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 &ReguIations for Licensing Construction Supervisors,Section 2.1S) 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:\WPFIIM\FORMS\building permit forms\EXPRESS.doc Revised 061313 Massachusetts Department of Environmental Protection X'77Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 sbssk�e4' and § 237-1 to § 237-14 Town of Barnstable Code DA- 15036 . A. General Information Important: When filling out From: forms on the Barnstable computer,use Conservation Commission only the tab key to move To: Applicant Property Owner(if different from applicant): your cursor- do not use the Mary E.Wyman return key. Name Name P.O. Box 121 ss � Mailing Address Mailing Address Marstons Mills MA 02648 City/Town State Zip Code City/town State Zip Code ,tea 1. Title and Date(or:Revised Date if applicable)of Final Plans and Other Documents: Plot Plan-Deck Reconstruction, by Thomas Jackson Bunker, P.L.S. 7/7/2015 Title Date Tile Date Title Date 2. Date Request Filed: July 9, 2015 B. Determination Pursuant to the authority of M.G.L.c. 131, §40 and§237-1 to§237-14 Town of Barnstable Code, the Conservation Commission considered your Request.for Determination of Applicability;with its supporting documentation, and made the following Determination. Project Description (if applicable): Remove existing deck; construct new,smaller deck to back of house. Project Location: 564 Old Falmouth Road Mars tons Mills Street Address Village 124 006 Assessors Map Number .Assessors Parcel Number wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Pagel or 5 Massachusetts Department of Environmental Protection p�4 Bureau of Resource Protection -Wetlands ' WPA Form 2 — Determination of.Applicability s;» Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code DA- 15036 o r B. Determination (cont.) The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of Resource Area Delineation(issued following submittal of Simplified Review ANRAD)has been received from the issuing authority(i.e.,Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act. Removing,filling,dredging,or altering of the area requires the filing of a Notice of Intent. ❑ 2a.The boundary delineations of the following resource areas described on the referenced plan(s)are confirmed as accurate.Therefore,the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b.The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ .3.The work described on referenced plan(s)and document(s)is within an area subject to protection under the Act and will remove, fill,dredge,or alter that area.Therefore,said work requires the filing of a Notice of Intent. i ❑ 4.The work described on referenced plan(s)and document(s)is within the Buffer Zone and will alter an Area subject to protection under the Act..Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone). ❑ 5.The area and/or work described on referenced plan(s)and document(s)is subject to review and approval by: Barnstable Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: §237-1 to§237-14 Town of Barnstable Code Chapter 237 Name Ordinance or Bylaw Citation %Wfmm2.doc•Request for Departmental Aatlon Fee Transmittal Form•rev.10/6/04 Page 2 of 5 i Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 mug; • and § 237-1 to § 237-14 Town of Barnstable Code DA- 15036 10 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s),which includes all or part of the work described in the Request,the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c.for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located,the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels,any adjacent parcels,and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably.be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability,work may not proceed on this project unless.the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department.Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described 'in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2.The work described in the Request is within an area subject to protection under the Act, but will not remove,fill,dredge,or alter that area.Therefore,said work does not require the filing of a Notice of Intent. ® 3.The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act.Therefore,said work does not require the filing of a Notice of Intent, subject to the following conditions(if any). I ❑ 4.The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone).Therefore,said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpafonn2.doc•Request for Departmental Action Fee Transntlttal Form•rev.1016/04 Page 3 of 5 Massachusetts Department of Environmental Protection opt ,e.to Bureau of Resource Protection -WetlandsLJ �pw WPA Form 2 — Determination of Applicability I D, n sKUL Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to§ 237-14 Town of Barnstable Code DA- 15036 B. Determination (cont.) ❑ 5.The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) ❑ 6.The area and/or work described in the Request is not subject to review and approval by: Barnstable Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. §237-1 to §237-14 Town of Barnstable Code Chapter 237 Name Ordinance or Bylaw citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on by certified mail, return receipt requested on JUL 10 2015 Date Date This Determination is valid for three years from the date of issuance(except Determinations for Vegetation Management Plans which are valid for the duration of the Plan).This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes,ordinances, bylaws,or regulations. This Determination must be signed by a majority of the Barnstable Conservation Commission.A copy must be sent to the appropriate DEP Regional Office(see http://www.mass.gov/dep/abouttreaion.findyour.htm)and the property owner(if different from the applicant). Sign res: Date wpafarm2,doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 4 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 '°� t6,10 8 and § 237-1 to § 237-14 Town of Barnstable Code DA- 15036 D. Appeals The applicant,owner,any person aggrieved by this Determination,any owner of land abutting the land upon which the proposed work is to be done,or any ten residents of the city or town in which such land is located,are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office(see http://www.mass.gov/dep/about/re.gion.findyour.htm).to issue a Superseding Determination of Applicability.The request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant.The request shall state clearly and concisely the objections to the Determination which is being appealed.To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations,the Department of Environmental Protection has no appellate jurisdiction. wpaform¢Aoc-Request for Departmental Ac0on Fee Transa ittal Forth-rev.10/0/04 Page 5of6 rr a Z ti EXISTING HOME EXISTING k HOME t EXISTING 1 PORCH EXISTING t OPENED a PORCH - OPENED UPf FRONT ELEVATION RIGHT ELEVATION a } z � o a a On al o r r � � ..�. ADD H7.5 TIES AT EVERY EXISTI EXISTING RAFTER W �• EXISTING 4-4X6 e O 5C4 CAP OR EQUAL (UPLIFT(SOO Q VV EXISTING EXISTING tL HOME PORGH p z � O NEW a'THICK 5A44 BASE OR EQUAL 0 CONCRETE FLOOR (UPsL{IFT(555) EXISTING ON LITHIC EXISTING PORCH PORCH ` OUR WITH ✓ - WITH DECK FLOOR. n 4 �;:-i .� 7 N DUG FOOTING/;':�'/ Q N UNDER POST. NEW CONCRETE v FLOOR 4 '� .p. 65888ABBA9988E86889686n XISTINC� PROPOSED CROSS SECTION DETAILS In � a FLOOR PLAN FLOOR PLAN tj F � Q ��✓�s�m) `44 z 11C,/4R Pry T I ► O.X &4t3eS ` oyi3k- l3Un�z-Ae�, '<l�� ZE OM G,eff-Dcal � � o m /YWR5��s p �d� .��r� _ /3�i1 ��9 ��P a�lc%��y � C, R LJ : riUt E� C7 r��t�j :sSo___=y77- 33��{T ��_ 1 ti 4 49 p i BSS *r t, D E S I G N ROUND POND __ �.., dLL °F POND s LOCUS a' ENGINEERING I• �: ^� &SURVEYING ., "a IriAREO 43 D• nasSme 4 AP�41/ _— it- R sI www.bssdesign.com t;rmaW----- _ �L BSS Design. Incorporated OtevwE _��� trtwtE 1 - - Q9. R£MOV££Jr1SIJNC DECK, -44•-- � O a ,Zi - , .� � 164 Katherine lee Bales Rd R£Y£C£TA>F AREA INI}/CRASS _----- L �^�'t `'� .. j ' PaIRDa Hassacbaetls 02540 SEED. PR01£CT SURROUNDING 45 �---_-- � 508.540.0805 FAX 50&54g0319 TREES FROM DAMAC£. 14'CHMY OQ tallAPlE —— — _ .. PRonos£D O. 1 a4,\ LOCUS MAP 12V2'DECK PIK410"E ,— �45\_iyOODEo SCALE: 1"= 2000' Z 115.8•, DECK / \ ♦ \ te'oAKp \-46._\ - O_ +/ t to LOCUST P U LOTF),300f/oo6 BODED i \ EXISTING O ED\ o N \ \ HOUSE 1- 1— ♦ UPLAND @564 z -0 ° � - FLOOR I \ \ ELEV TIA ON \ ® SEPTI TANKC N1 c v Z O U)LLJ \ T PUMP CHAMBER £ U Q = U Lli o toAPIE. \\\_ -- STEWOOP L tr (^ Q Cn o \ ---- - 48-- - Y w Q o `yAg D-BOX❑ \\- n ! 1 ¢ a 7 \J o- \\ w a: L, LL \\ DIRT DRIVEWAY 0 0 Q a- tY J FLOW °S. N C<C -J Q <;I m DIFFUSERS `L I G Q N METAL \ Z CD Z FENCE POST o J Q + 300' FRONTAGE PER DEED DESCRIPTION k CB FND L= 49.30' 0- m S 77'53'06" W 250.70' R= 980.79' O DMH J DMH 0 Q- 0 DMH DMH 0 EDGE OF PAVEMENT 0 scale � ATCH 1" = 20' OLD FALMOUTH ROAD BASIN date OIP FND JULY 7, 2015 drawn EJP, TJB j checked CB FND job number NOTES: 1. LOCUS IDENTIFICATION: 15102 HOUSE No. 564 OLD FALMOUTH ROAD revisions ASSESSORS No. 124/006 2. LOCUS IS WITHIN: LEGEND ZONING DISTRICT. RF FLOOD ZONE: X PROPERTY LINE BUILDING CODE WIND EXPOSURE CATEGORY: B �`�D �'a6 GROUNDWATER PROTECTION OVERLAY DISTRICT PROPOSED LIMIT OF WORK ZONE II OF A PUBLIC WATER SUPPLY THo I^ FIRE DISTRICT C-O-MM oHw OVERHEAD WIRES . RESOURCE PROTECTION OVERLAY DISTRICT ----$---- EXISTING CONTOUR _vc:.:,xs;a 3. LOT COVERAGE BY STRUCTURES: CB■ CONCRETE BOUND ,�- EXISTING: 1,330 SF 3.66% .v:•,,, ,;, PROPOSED: 1,187 SF 3.27% `'o> EXISTING UTILITY POLE 4. ELEVATIONS ARE FROM ON-THE-GROUND SURVEY EXISTING I BASED ON GIS MAP DATUM. STRUCTURES >t.I 5. SEPTIC SYSTEM WAS DRAWN AS OUR INTERPRETATION \ OF INSTALLER'S SKETCH. ® 0' 20' 40' 60' iPROPOSEO STRUCTURES drawing number B23-51 i TOWN OF BARNS-TABLE CAPE COD h� � � INSULATION PV 12: 90 ■�---�� mltdwss SfaNILSf ,.u.fOANI SYS.WO,D m S!�f �j� T��l,� u o.n•ms IMwutroM artmos � 1-800-696-6611 Town of G�'7/it3tS -9�j 1� Regulatory Services Building Division Address - Address 2 - Date: C� S Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute . (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner PropeM Addr ss r, Villa Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ®( ) ( ) ( ) ( ) Sincerely (9- .v.' 1.�c��� Jam- ��✓�wl ��ocAl/�e-�.4'`�,�i� S �CUc9 Hen Cassi Jr, President Ca e Cod Insulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp Ma Parcel Application p Health Division Date Issued IS Conservation Division Application Fee Planning Dept. Permit Fee 4;- ,35•00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Co Project Street Address Q� Village Owner Address Telephone45 . 147 -Permit Request rfv '�d��ZCPi(�W�d�° 6 v C dbU` .Square feet: 1st floor: existing proposed 2nd floor: existing proposed= Total neo 7Zoning.District Flood Plain Groundwater Overlay c1 �Project Valuation (71 - P) Construction Type (� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orting doFurrr tation. / r Dwelling Type: Single Family. O/ Two Family ❑ Multi-Family (# units) �J Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 3No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ��/� o Address �. License # l� V �VvM, '�V V , Home Improvement Contractor# Worker's Compensation # d I ALL CONSTRUCTION DEBRIS RESULTIN ROM THIS Zz T ILL E TAKEN TO SIGNATURE DATE ��/ ' FOR OFFICIAL USE ONLY • APPLICATION'# ` DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: -u�FOUNDAfrI.ONi0Ac?Mlj DAII&AuUAlkLl-_. s; s FRAME — — — — — — — �1NSULATION, ^,a ,,, w._ZWl A!A yt. FIREPLACE ELECTRICAL:. . ROUGH FINAL - . . .. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING ._DATE CLOSED OUT ASSOCIATION.PLAN NO. 4 ' Mas•suchusetts - 1316partment.of Public Safety :.:Board of Bullding Regulations and Standards Construction Superr•iscir License: CS-100988., HENRY E CASSII�V 8 SHED ROW WEST YARMOUTH ✓,�..• " '`� Expiration Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cdntra-,ctor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 1'rV 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE --- - "- SO. YARMOUTH, MA 02664 Update Address and return card, Mark reason for change. :CAI 4) 20M•0511t Address Renewal Employment Ej Lost Card ....... .._.....:._..... .. (9 e If miopwtweC/.&li 01Q122CrWdac/aae0 �C—\ 0ffice of Consume rAffalrs& Business Regulation License or.registration valid for indiviciul use only i OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: egistration: 1,53567 Type: Office of Consumer Affairs and Business Regulation xplration:,.--.121 5¢20:1.6 Private Corporation 10 Park Plaza .Suite 5170 136ston, MA 02116 ;APE COD INSULATI;Q;N:;;'INC'.: 1ENRY CASSIDY 18 REARDON CIRCLE";, 30.YARMOUTH,MA 02664 " Undersecretary IN valid wi ut sign e ! ' r I The Commonwealth of Massachusetts Department of IndustrialAccidents W Office of Investigations Y d 1 Congress Street, Suite 100 r- Boston, MA 02114-2017 www,mass,gov/ilia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbei-s Applicant Information ff Please Print Lelzibly Name (Business/Or 'zationAndividual); l;Z , �(, V V . Address; 60V UIbV �I City/State/Zip; ��,GL U�Vkkp' 011`1Phone #; Are you an employer? Check �he appropriate box; 1•�I am a employer with 4, ❑ I am a general contractor and I Type of project (required); 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 g• ❑ Demolition working for me in any capacity, employees and have workers 9, Building addition [No workers' comp, insurance comp, insurance•t ❑ g required.) 5• ❑ We are a corporation and its 10,0 Electrical repairs or additions 3•❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL insurance required.] t c• 152, §1(4), and we have no 12.❑ Roof repairs employees, [No workers' 13.[ Other comp, insurance required,] // f 'Any applicant that checks box#Imust also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this gfMavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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. #: 11� Expiation 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• 1 rlo hereby certify n r pains and penalties of perjury that the Information provided a ove Is true and correct. Si nature: Date: l r 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): 1. Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6, Other Contact Person: Phone#: ) � r r CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY INSURANCE DATE(r,irA/DD/YYYY) 6/13/2014 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(les)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 Rogers&Gray Insurance Agency,Inc. PHONE Barbara DeLawrence 434 Rte 134 A/c No: (877 816-2156 South Dennis,MA 02660 E-INAI� — ADOREss:bdelawrence a�rogers ra .com _ INSURERS AFFORDING COVERAGE __ NA_I_C__pV_ INSURER A:Peerless Insurance Company INSURED INSURERe:COMMERCI= INSURANCE COMPANY Cape Cod Insulation Inc INSURE RC:Evanston Insurance Company 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E: INSURER F: CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C RTIFICATE 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 A D BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY j ] EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR CBP8263063 04/01/2014 04/01/2015 pR NtISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,000 X POLICY PRO � GENERAL AGGREGATE $ _ 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B Ea accident $ 1,000,000 ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident X UMBRELLA LIAR X $ _ OCCUR — C EXCESS LIAR CLAIMS-MADE XONJ4S3514 EACH OCCURRENCE $ 1,000,000 04/01/2014 04/01/2015 AGGREGATE $ DED I X I RETENTION 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION _ NO EMPLOYERS'LIABILITY PER OTH- D NY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 STATUTE ER FFICER/MEMBER EXCLUDED? ❑ NIA 06/30/2014 06/3012015 E.L.EACH ACCIDENT $ 1,000,000 Mandatory In NH) As,describe under E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 CRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LINt,T $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certiflcatb Holder. CER IFICATE HOLDER CANCELLATION ��- HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I I / IA�'C f�• WA hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: 41) t,m 0 1)T1-1 LN G,AM inn/ S !L L s NIA 02 y� The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. 1 give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. j I have read the provisions of this agreement and give my consent. Home Owner(signature) DZA!!!�e Home Owner email: Date: 3 / ZL- Agent:(signature �: Date: Weatherizatio tractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement _...Building--Scienee--Con truction Resolution Energy Cape Cod Insulat on Tupper Construction I The Town of Barnstable 4 snxrrsrasM 9� ,639 `0$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner July 1, 1998 Mary Wyman P O Box 121 Marstons Mills,MA 02648 Re: 564 Old Falmouth Road,Marstons Mills Map/parcel 124 006 Dear Ms Wyman: Enclosed is the building permit application package you requested. I have reviewed the location of the above referenced property and find that it is not located within the 100 year flood plain. FEMA lists this site as a 500 year flood plain. This means we cannot require any flood plain criteria. However,you are free to build to the 100 year standard if you wish. If you have any questions regarding this,please feel free to contact me. Sincerely, Ralph M. Crossen Building Commissioner RMC/km g980701b V ti t fj it - F '`•r . O G } a •. 12_S \ 1 Ile VPIp.NO LI,� 1.96uPLA" —� Ro 29q� c Zt* A�A•. (lO 1 L Y~ f�•• y .IZ wer fA ISO q 62AL kq •G°° 1.01 ... • 13 m �o ro•.k. •. 11 S* Ora[•S 14 AL ra_, p i o-t4 12 l2'3 2.16uPuWo _ f IZ-1 t ® �a 16 2 i 3•d2 uP.iw0 a o,we r u ALA P\ANo oe WETT HD �• o Er •Z.aSK,� 2.08 may'. \a\ � •31ACTOTAa- "�.° •r. OT �. a ® \\ LOgA,cT�9L ' ' t Z.14Ar- Ton►, \\\ s eR __ qoAC © / \ ,%:ter' �� � M -1��\\• ' AD oS wE 1 � 'NAB a s 1.69,kc1A � 11-1 ,� 0^r u I / tt 1f i 1.32-WgT okc Aw � � • POND 5A ROliNO POND rN,• Loe►e \V !i 92" p 33f. 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