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0089 MOCO ROAD
in'ldco S M EADR No. 53LOR UPC 12543 smead.com • Made in USA `Z FW USED N TMS PR=XT UNE SFI �� �S c�RnFieo SGURGNG W W W.StiVROGFUUA.ORG ® ri ba la nce Spray Foam Insulation ' • ' e 4 M (0 r o e - e o 0 0 o e a Company Name Cape Cod Insulation, Inc Phone Number 800-696-6611 Applicator Name Kevin Mercer Installation Date November 12th Jobsite Address 89 Moco Road West Barnstable A-Side Lot #'s D348E95704 Permit Number B-Side Lot #'s 3425502 Walls 5 1/2 24 200 sf Attic 9" 40 70 Demilec Blazelok TB. Attic 23 Mils Wet 15 Mils Dry 817-640-4900 • Info@Demilec.com • www.DemilecUSA.com c8DIEMILEC V-r r co G1� HEATLOET"(V ap - op� e SPRAY POLYURETHANE FOAM SOY=200+ WN.�2 7A(9 r 0 0maw e M Company Name Cape Cod Insulation, Inc Phone Number 800-696-6611 Applicator Name Kevin Mercer Installation Date November 12th 2014 Jobsite Address 89 Moco Road West Barnstable A-Side Lot #'s D348E95704 Permit Number B-Side Lot #'s 1429803 RGIMMM Chi UWAM Wd @J&ft Q. . . - RIO Walls Attic Cathedral Ceiling 5 1/2 R40 70 sf 817-640-4900 • Info@Demilec.com 0 www.DemilecUSA.com ; ® EMILEC LIJ r� CC) cn -K- �. m u r� C o ti 01/12/2015 MON 9: 43 FAX 12002/002 I Client CURTIS LUMBER Shipping COASTAL _.r romxTnawrrRs.:.sr. Project Name: SPENCELY Job#: Quantity 1 (2pCS.) Description: 12'HEADER BEAM 1 2.0E CP-LAM 1.750" X 7.250" 2-Ply - PASSED 1/12/2015 10:01 AM Page 1 of 1 Designer:MT >7".' ,;~s>:y'^yi.;w,:r`, 2(r ._:t::✓f:y,a:F"ai :-�r-r' �.y--•.-- .'•'..'r,.-,x� ny:r"'::�F`x+,✓v` £ .3,0:.. s .<.-. s: .� �.F'sc �� t��kl�^t:i�?�` ya� }4`�t".2 r`+v.'b Y{r c�S�D 5 s.':�,����,kxt, >3't�t't rc��c"�3�<t��S75r�xY,s'..r'• w�`���� �jM i 7�,,�t�q•�`". �E 5 rtin 5�+ 2�f 2,.,r�.u�9K,r'•N y r f C�<y r �'r�F�`ti� ? ( ><v;.;::�..w>_...i;.,_,y y��ii v� Fr fn 3 ,�,�f r )c'`rG r^ °`'.�• S T'1 4•.D> F,rni?.a� L YT tivf u � .� +. 'E J'3... �, t tq'�.sM�} +1' l �:7).X 3r'4� � dud 2. 'r^' -..�-.1 . -... �ti`•,:l .;?s fty t, '�., •'{,,.,n.�>r.. ,y r7�i'cJ�'!: ',�j�'"-'9r:;ia.�_}may{',dr-t,,< 4'4f.�;=c?;5:.:�_>,'>y,:; .?,;;.v,.:Y:';< .�i .J,ay �{6..Y..,:i.�^` .,,�n.A, :.e)J::'v;�.jji: ,.S,rr. ::{.v.o s•:-`. a+y,.,.. 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R C.:Y �-s�kya, I z ;xx�. „\ii;•:a,,y: 3 �.s ..3. - 'r,..� r-.x � ?t-�•. •.t. .cic... .:,:•<- :.c•`:SS �.'�ca ..,v.. sfu 3 y�r (JOtIS]'ACUASI�ILLa �w .,r',;;.....•..:... .....° '�;.,, ,.tom _°;.�,, u t,,...,,�' >.a:.,a _v' °s�h`�",. ` ''yr 't�-t- CQAS7A1 3,l:�-.....,:�{",. d� 7 J71/4" 1 SPF 2 SPF 12' H3 1/2" 12' Type: Girder Application: Floor Reactions Plies: 2 Design Method: ASD Brg Live Dead Snow Wind Const Moisture Condition:Dry Building Code: IBC 2012/IRC 1 0 845 516 0 0 Deflection LL: 360 Load Sharing: No Deflection TL: 180 Deck: Not Checked 2 0 1364 1337 0 0 Importance: Normal Vibration: Not Checked Temperature: Temp<=100°F Bearings Bearing Input In Cap. React D/L lb Total Ld,Case Ld,Comb, Analysis Actual Location Allowed, Capacity Load Comb.Ld.Case Length Analysis Moment 7925 ft-lb 8'6" 10075 ft-lb 0.787(79%)D+S L 1'SPF 5.500" 1.500" 61°h 8451516 1361 L D+S Unbraced 7925 ft-lb 8'6" 9684 ft-lb 0.818(82%)D+S L 2-SPF 5.500" 2.000" 91% 1364/1337 2701 L D+S Shear 2619lb 11'1/4" 5544 lb 0.472(47%)D+S L ILL Defl inch 0.323(L/418) 6'7 7/16- 0.374(IJ360) 0.860(86%)S L TL Dell inch 0.665(L/203) 6'5 15/16" 0.749(U180) 0.890(89%)D+S L Design OK. Design Notes 1 Girders are designed to be supported on the bottom edge only. 2 Multiple plies must be fastened together as per manufacturer's details. 3 Top loads must be supported equally by all plies. ID Load Type Location Trib Width Side Dead Live Snow Wind Const. Comments 1 Uniform Top 80 PLF 0 PLF 0 PLF 0 PLF 0 PLF 2 Point 8-6-0 Top 1175lb 0lb 1853lb 0lb 0lb Self Weight 7 PLF T? Notes cmrosi"chemicals a Fm flat cools prdede proper drainage to prevem ' Coastal Forest Products catuiatoo snudured oesions is rospodsibla only of Handling&Installation °ondmil • 451 SOU111 River Rd,NH the structural adequacy n d Ih;s mmpmroM bored on 1 LVA beams nv$l nol be cut m dulled USA the design karin and b"o,"—A II n thD 2 ndcr to nnnulxtwmt prodda immmmian responsbildy of the mnlonm andlor fM comractor to rogmdiey initadalion requirements, nwlti•ply 03110 enswe dm—APDnana u4obi4y of No imonded laslanmo delam,beam atrenglh vdtues.And cod° applicalion.Am to verdy the dnnonsions and loads. approvals , Lumber a.Damagod roams man not D used COASTAL 1 Ory sorvzo mruMmns,unbs5 natM atlpmisn d'DosignDesllntaa top edge Is laterally rostroiced $.LVL not l0 ba boated will: 14o rdardoM pr 5 P—d-IMmel."Pp°n at ooa-if pmnls to avoid rOAr]I RtM%CIS.IVC dimol drsp4ncenwnt and rotation •�� �•.t w:...... Pou'eredl by@ iStrud1q 14A.D53 "CMCU1A1[0S1RUCIU1i<:01}SCN5 } CO Q� Ct C3 .._, Zr CD •.� i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel �'© Application #06 Cl 1 Health Division Date Issued Conservation Division Application Fee ; Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -c Village Owner Address Telephone aoa q- f�62 52 1� n /� Permit Request !�cs Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s pporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) r o y= N Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:r0 Yeses❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other # - Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) e„ 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 t (BUILDER OR HOMEOWNER) Name Telephone Number a-&-0 ctSd 33��l Address License # Home Improvement Contractor# Email��-,�.� U �.Oc n-c �'!,n .�'y` Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ' ZV f 4 . FOR OFFICIAL USE ONLY APPLICATION# DAT€.ISSUED i MAP"/PARCEL NO. ADDRESS VILLAGE i.` OWNER DATE OF INSPECTION: 4' FOUNDATION FRAME IRW&r y t INSULATION.?�/Jrmw 'wic* FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDJNQ, �� ag _z ' DATE�,CLOSED OUT ASSOCIATION PLAN NO. t r 77ze ConinTmveaM o,f MhYsacJ;zudit Diparhawt o,f rudustritdAccudm& - OJT"afhImfigadom ' 600 Waskington Street Bastin*1A 172111 wrt ma=gvWdia Warners' Compensation Insurance Affidavit Builders/ContracinrsMechicians/Plumbers Applicant Inforn,atiou Please Priat Leeibly Name Address: COW( citYrStatrJzi.P: 9nrJ0/,,, i�,o 4?�62 Pho=4: ;o '11--0 Y3 Are you an employer?Check the app a b.ar' Type of project r � P� 1 F etlnired)c .❑ I am a employer with I a general confnic d 1 6- ❑New construction employees(full anzVor part-time)_* Xthetractors 2.❑ I am a sole proprietor•or partner- listesheet.strip and bane no employees The have &. Demolitionw Q for me in an c orlcers in Y amity 9. Building addition [No worioers'comp-insurance Comp-insura>cI d 5. �CTe are a corporation and its 10 Electrical repairs or additions = l officers have exercised their 3_ I am a homeowner doing all work 11_ Plumbing repairs or additions myself- [No Wo6mrs,gip- right of exemption per MGL 12- Roof insurance required,]i c.152,§1(4h and we have no �insurance employees`[No workers' 13-0 Other comp.insurance requited.I !Any myphcot @rat coeds Boa ml met also fill out the section below sbotria &&wor e&,compencati m policy in inn EEGmx4rwnEm who submit this af5dstit indicating they ace doing all want and then hire aatside contactors act snbm i a mw affidsvkt idicabng m L f C ut<acints thxt rharl this box must gttarbed as addiiioml sheet showing the name of the n&-ca�um and state whether armor t as¢entities Dane ernplayem IMP—mb-cnntnct-on have emp3Dytes,the}must pmuide their workers'ramp.policy ntmiber. I am an employer that is provfirmg workers'compensadon insurance far my employees Below is the policy and f ob site informa on. Insurance Company Name.- Ptnccy#or Self-ins-U4r #: F-kpiration.Date: Job Site Address: City/Stafelzip: Arch a copy of the workers'compensation policy declaration page(showing the policy number and elation date). Failure to secure coverage as required under Section 25A of MGL to 152 can lead to the imposition of criminal penalties of a fim up to$1,50D:00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of op to$250.00 a day against the-violeor. Be ad-vised that a copy of this statement may be forwarded to the Office of Tuvestigations of the DIA for insurance coverage verificatic>n_ d rho Hereby calib,zurder the ns and ofperjwy-that the information protmded a ve' brie and correct 'Simpiture- I Phone O,flcial use an y. Do rwt write in thb area,to be completed by city or town afficiaL City or Town.: PermitUcense# hsning Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: Town of Barnstable Regulatory Services Richard V.Scali, Director Building Division . sARNErMI , Tom Perry,Building Commissioner MAWL i63� `�$ 200 Main Street, Hyannis,MA 02601 ArEo A www.town.barnstable.ma.us 0ffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER INCENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village c� "HOMEOWNER": �.• c n / c '^ � o nam home phone work phone# CURRENT MAILING ADDRESS: LIP 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 buildine 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 at he/she understands the Town of Barnstable Building Department minimum inspection procedure and quirements and that he/she will comply with said procedures and - requirements. Sign ome ner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,'many communities require, as.part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. n •. MRNSrASM 16 9. ,e� Town of Barnstable ram ► Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO . Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 , Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,_ s Owner of.the.subject property, hereby authorize to act on my behalf, in all matters relative to work authorized b this uilding permit application for: (Ad ess of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAW MESTORMS\building permit fonmslsmokeembondetertors.doc. Revised 050412 cli studios.com q design packet CABINETRY ph: 800.576.7930 1 fax: 877.675.4394 www.cligstudios.com client Customer designer Jessica Hein Job Description Email: jheinQa cligstudios.com Date Direct Line: 952-241-8639 Rockford Cherry Russet T: 1..1,E (pry i t-. .... ...a -r nr) { \' f7 '�M&,r, w z I'FrJlt\\V411''1{'LJII` factory direct pricing ( all plywood construction built to order 1-W M1 X tth"Z B.th MWIA.al cligstudios.com. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel plicatiPAQ Health Division Date Issued Conservation Division Application Fee 5� Planning Dept. Permit Fee L Cy O Date Definitive Plan Approved by Planning Board (n Historic OKH _ Preservation/ Hyannis -� i Project Street Address Village- Owner 1. rn Address Telephone '.:Permit Request m5W W 14 rZ 4d Its k1&11 air "5&df f o Iq Squar ee . 1 s floor: eng proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �v�� Construction Type PV-946t hot, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family li;_er/ Two Family ❑ Multi-Family (# units) 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 0 Electric ❑ Other Central Pia: ❑ems ❑ No. Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No am J^° Detache'Lgarac : ❑ exis ing � ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attachearage: ❑ exis ng ❑ new size _Shed: ❑ existing ❑ new size _ Other: n �. ZoningRoard---of Appea thorization ❑ Appeal # Recorded ❑ cr Comrr*3-cial ]Yes o If yes, site plan review # Current Use ® Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Iva � G Telephone Number l ` Address f�ktl4lk License Home Improvement Contractor# ` Email Worker's Compensation # ' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS,QPROJECT WILL BE TAKEN TO SIGNATURE DATE I 1 FOR OFFICIAL USE ONLY tAPPLICATION# , DATE ISSUED MAR/PARCEL NO. r ADDRESS VILLAGE OWNER ` DATE OF INSPECTION: s FOUNDATION c FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ~ GAS: ROUGH FINAL FINAL BUILDING ; DAT&CLOSED OUT ASSt7%,$AFFION PLAN NO. _ r F Massachusetts -DepaP`tm'ont of Ppblic Safety �13oard of Building Regula#Ians"jalnd Standards Construction Supenisor -/ License: CS-100988 A HENRY E CASSIO 8 SHED ROW s WEST YARMOLFrH 2 i � 1 Expiration - Commissioner 11/11/2015 Office of Consumer Affairs and Buslness Regulation 10 Park Plaza - Suite 5170 . Boston, Massachusetts 02116 Home Improvement C6fitidQtor Registration C. .7Lti iti Registration: 153567 ,....._..1^.__h------------ i- ..,r `_:=-: :-,-I Type: Private Corporation r" - :- ix,-r Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY ; ,-was 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 Address ❑ Renewal Employment ❑ Lost Card pp�� T��Y//I/I7LlYIGCCrG'lLlr!o�G/Glaadac<uaetGi. �a Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Ux'VOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: .1`53567 Type: Office of Consumer Affairs and Business Regulation piration: 12'tT6/2G14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION r6INC :,_ HENRY CASSIDY ;-10 18,REARDON CIRCLE': SO.YARMOUTH, MA 0266d r. Undersecretary of val witho t sifnatkre ' The Corrrnlorl)vealth q,111assuchusetrs I lr 1 Depamieni of Industrial Accidents Ojj ice of Investigations SOU Washington Street Boston, JVJA 02111 www.rrtass.gov/dia Workers, 'C.olulpelJlsat•ioril )1Usuritace Affldavtt: B"ders/Cl➢YYfI.acdal's/1 lectyrlcinkisillfilillb,,.,, � rl�l�.':s1Y( g11.91)Y'llllJtt"1l1l1 1' ri.11t Le xll:ll \ .ill li tlllt�llr��,y,/UI"�'tl.x1L'Lil C1 o ki/Lodi VidL ill :2. I �_ :), ? Phone#: cmptoyei-? (-heck the uppropriute box: 'j Type ofprojeci (I-eilu.1red): t,l 1 J t •ui, .t cll, oyc.r 4Y,t11, 11 4. ❑ i and a general contractor and i ,Allpluyccs (roll allaloe Part-6.me).4 have hired the sub-contractors 6 ❑ Now const,uctiou sole proprietor OC parc7iGr- listed on 'be alt:ached sheet. 7. Rea-ioclel117b .hlp a,ld hltvc nu employees These sub-conolactors have w0tkU.1g fur 11.10 i11 a:rly capacity, employees and have workers' 8. El Demolition• JNr, workers' culnp. i.n u.raricc comp, insurance., 9, ❑ Building addition ,t:yulrcd.J 5. (] We are a corporation and its .10.❑ Electrical repairs or additions 1 .,nl a huxncowtier clonal; till work officers have exercised their el,-&.k ] Plumbing repairs or uddilions n,yst lt. [No worke"' comp, right of exemption per MGL r c. 152, §1(=4),and we have no 12•❑ Roof repaixs i u,:1u1a11Ct: t'CtlU.lt'Cla.) 1 ,•�.(� I aLU u hou'lcowncr acruz Y as a •� !, employees. [No worker l3.[�Other ,a_5,..•,�;r�. %� I �cnaul t:uuttactor (refer to #4) comp,insurance required.] 'j >JuPl'c utt tlur.chcL:Jct twx!Ft tnLtvl alp ' r 611 out the iccrioa below showing[heir worltcn'cotapcnsadod j alicy iafonnuaon. ,�llh:-1 crl who lubttut alix affi(jxvir izlWcuting they arc doing;all wort and then hire uwidc coarmtom[oust subunit u acw atlicLxvit wd.icating such. i.nru that ch-k-diii box rcLust um"bccl an udd ,Magn ioonal sheet showing the a of rhC YUl)loaaLt[0l7 and 3ww%VhC(hCr or not thQYC c411[Ica ttnvo ' u,n.ncc. Ir,hc su1)-call—c-3 have ccnployce3, they must provide their wurL-3'comp.policy number. 1 urrx ur,crrtpluyer that is pro►'idintg workers'cumlpertsation ut;uraace for my ensployecx V low iv the policy "rid job site rrfvr'wurrwc, nj:uaticc Colliptuly Nalaic: ��J%i✓r,L/,/L � ail `�/jG ---------- ExplydaoKt vine: Zzr r a uu 111r:1dt11'css:._ _ (✓ i W �`� �l'L IRA• City/StatelZip: �_ "t-:11 a,ups of the svockcrs' cotnlpeusatlOn policy declaration page(showing the policy utrimber andexpiradott date). ,duce to;�cwc•4uvt ra�C as rcquircd under Section 25A of MGL e. 152 can lead to tho unpos16on of Gt-I.r11ia14tl penalties ufa ' 1l!c.u1;to S I.M.00 and/or one-yelur irnpriaonrnent, as well as civil penalties iA the form of a STOP WORK OR.UER and a tine ;l q lu S 5U.UU a clay against the violator. Bc advised that a copy of this statement may be forwarded to the Office of n�csn tutus ufd-ic la1.A, for L11-1u17Lnl:e coverage verification. d4v ncreby c:crtlfy. rrufer the i ��' tY�i brru'prrralrrrr of perjury thug the information provided above is 'true and correct. I T.-......_ cldici,c/utc only. Do nut write in i/tint area, to be conxpleieJ by city or town official T^ <'itr or I'u1,u: Permit/License# I 11xu1„g.Aut4urity (circle one): -- --- i 1. Wi"d of llculth 2. Buildlug Depurtaieut 3. City/Town Clerk 4, Electrical Iuspector 5. Plumbing [uspector � f F T TOWN OF BARNSTABLE OWNER AUTHORIZATION FORM NN -7 AM 11' I I Z- o S 5 DIVISION (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's a e Date r I 1 a i CERTIFICATE OF LIABILITY INSURANCE CAPECOD-27 Ktyyyy) �iERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER DATE(MM/DO14 AW/IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD OLDS 014 . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT TIFICATE HOLDER.THIS :PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ED BY THE POLICIES CT BETWEEN THE ISSUING INSURER(S),AUTHORIZED' 'ORTANT: If the certificate .holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not con 'tificate holder in lieu of such endorsement(s). confer rights subject to ICER - fer rights to the s 8 Gray Insurance Agency, Inc, CONTACr to 134 NAME: Barbara DeLawrence Dennis,MA 02660 PHONE E-MAIL RESS• bdelawrence rogersgray.com A "° (877)816-2156 INSURERS AFFORDING COVERAGE ! D INSURER q:PE!erleSS Insurance COm any NAIL N Cape Cod Insulation Inc INSURER B:COMMERCE INSURANCE COMPANY 18 Reardon Circle INSURER C:Evanston Insurance Company South Yarmouth, MA 02664 INSURERD:ATLANTIC CHARTER INSURANCE GROUP I INSURER E: ' SAGES CERTIFICATE NUMBER INsuRERF: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMON ED N ATED. REVISI NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NUMBER: IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED ATH FOR THE POLICY PERIOD JSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. WITH RESPECT ALL WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, TYPE OF INSURANCE ADOL EIR COMMERCIAL GENERAL LIABILITY POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY MM/DD/YYYY LIMITS I .__I CLAIMS-MADE a OCCUR CBP8263063 EACH OCCURRENCE• $ 1,000,000 _- 04/01/2014 04/01/2015 DAMA p aT U PREMISES Ea occurrence $ 100,000 -'- — MED EXP(Any one person) $ 5,000 LAGGREGATE LIMIT APPLIES P PERSONAL&ADV INJURY $ 1,000,000 O POLICY PRO-CT LOC GENERAL AGGREGATE $ 2,000,000 OTHER:'MOBILE LIABILITY PRODUCTS-COMP/OP AGG $ 2,000,000 I $ \NY AUTO COMBINED SINGLE LIMIT \LL OWNED 14MMBCKVMK Ea accident $ 1,000,000 AUTOS X SCHEDULED 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ AUTOS TIRED AUTOS X NON-OWNED AUTOS BODILY INJURY(Per accident) $ AUTOS R MBRELLA LIAR yy O Eden DAMAGE Per $ (` OCCUR $ XCESS UA6 CLAIMS-MADE XONJ453514 I EACH OCCURRENCE 04/01/2014 04/01/2015 $ 1,000,000 =D' X RETENTION$ 10,000 AGGREGATE $ - :RS COMPENSATION Aggregate IPLOYERS'LIABILITY. $ 1,000,000 :PRIETOR/PARTNER/EXECUTIVE Y/N PER OTH- NO. UMEMBER EXCLUDED? WCA00525904 O6/30/2014 06/30/2015 STATUTE ER ory in NH) N/A E.L.EACH ACCIDENT $ 1,000,000 scribe under _'TION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ 1,000,00 e_ L E.L.DISEASE-POLICY LIMIT $ 1,000,000 I I . I �F OPERATIONS/LOCATIONS/VEHICLES (ACORD lol,Atldltlonal Remarks schedule,maybe attached if more space is required) ripensadon includes Officers or Proprietors. >ured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. i E HOLDER TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel c�plicati C # 656 l Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Q Historic - OKH Preservation/ Hyannis R i I, Project Street Address FS 1 zno o Village (Av. ��►ten l� /� )- / Owner cn I/ L 1-k c n Address �� Agog 4 46.0 ,, 144 ago?-� Telephone A9.7 ,�o Permit Request ,o/1 c� A t Aq c S/1 Z TIOW-IS4 G... / 1Y%A, dr Sc42 L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Toil neti- Zoning District Flood Plain Groundwater Overlay , 'AProject Valuation, Construction Type Q Lot Size •3`9 Ad-rc s Grandfathered: ❑Yes ❑ No If yes, attach sup orting docume^'--tatiori �n Dwelling Type: Single Family ,C Two Family ❑ Multi-Family (# units) Age of Existing Structure /57d o Historic House: ❑Yes ❑ No On Old King's ighway: -WYesrTQ No- Basement Type: XFull ❑ 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: a2 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: ❑YesANo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage)A-'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�� 7.A.I Proposed Use , APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number YS'Z) 2.39�J Address _tYf- /&-o License # /9 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE5:4 /t., FOR OFFICIAL USE ONLY ATI APPL IC 0 N# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER s - DATE OF INSPECTION: .r fFO.UNDATION r���: >a €y r:��� y�u�,• Y - S FRAME y INSULATION FIREPLACE ELECTRICAL:.. . .ROUGH. FIN MAL PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL FINAL BUILDING ' BFGIU 7Z DATE CLOSED OUT ASSOCIATION PLAN NO. The Commorattealth ofMassachusetls Department Hof ludustr al Accidents 600 Wayhingfo;nStreet Boston,MA 02111 Wn m inasmgasldia Workers' Compensation Insurance Affidavit:Builders/ContractorsfEiectricianMumbers Annikant Information Please Print Lep-ibly Name(I3tasin a organization& ividml): Z so e n Aaaress: Qty/Statr./Zip: �c -/j.►„ti- /6�/4 0 26 Phone 47 0/201 4?re 3-? y' Are you an employer?Check the appropriate box: r of o'ea(required): 4. I antis contractor and i � � I (� �- 1.❑ I am a employer with general 6- ❑New construction employees(full and/or part-time)* have hired the sub-coniractw 2_❑ I am a sole proprietor or partner- listed on the attached sheet; 7- ❑Remodeling ship and hate no employees These sob-contractors have g_ Demolition w for in an capacity employees and have wo:dcers' �/`L�J Ong Y � t5 I Building addition [No wor�PSs' comp.insurance comp.insurance. 3-❑ QTe area corporation and its 10.❑Electrical repairs or additions required] 3_ I am a homeowner doing all work officers have exercised their 11_Q Plumbing repairs or additions myself o workers' right.ofe-m-, xptionper MGL I20 Roof repairs innsurance required,]l c.152,§1(4),andwellaveno 13_❑Other employees-[No workers' comp.insurance required]; *Amy appUomt that checks boot#1 toast also fill out the section below showing their workeis'compere ation policy informatimL T Homeowners who submit this afiidx=mdkat h g they are doing atI uu k and then hire outade contmrctors test submit a new afdsvit inefirstin M L lCant mcrors thst check thrs bmt mast stuche d an additional sheet dowmg the nee of the sob•-camf3ctors and state whether ornot those elutLes have emrployees. If the sub-contmaurs have emtpIoyees,they must provide their wickets'comp.policy number- jam are employer tltat is prmidurg workerrs'compensation insurance}br my empivyees. BeIotr is Ste policy curd job s&a information_ Insurance Company Name: Policy:ff or Self-ins-Lit-#: Expiration Date: i Job Site Address: _ .,City/StatelZip: Attach.a copy of the-workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as regt iredunder 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-pear impr s nment,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 Imves#ptions of the DIA for insurance coverage verification_ I do hereby certify under theprrins a enattt s o irry Statthe information primided a �e u and correct Sumatore: Date: L Phone#: 7 11.re 21" Ic' 0.flkial use only. Do not write in this,area,to be completed by city or town of`iciaL City or Town:. Permit/Ucense It Issuing Authority(circle one): 1.Board of Health 2.Building Department I City./Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person. Phone#_ 6 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 lure, express or implied, oral or written_ An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be-deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI 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 aiay applicant who has not produced acceptable evidence of compliance with the insurance.coverage requ.ired." 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 rith the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their cerri..Jicatc-(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with Do employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Indu&Lrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit U e 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 of 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 Jill 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 add i aon,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new-affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number The Commonwealth of Massachusetts Depart lent of Industrial Accidents office of kwstigatians 6-00 Washington Street Boston,MA G2111 Tel.A 617-727-4900 ext 406 or 1-M-MA$ 'E Revised4-24-07 Fax# 617-727_7749 www.mass�,govldia r - Town of Barnstable , `- Regulatory Services �oFI'KE r, Richard V.Scali,Director Building Division samNSTABXZ Tom Perry,Building Commissioner iaass- °� .L639. ��� 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: ��/�/ui JOB LOCATION: number street village "HOI✓iEOwNER": 1 •� c n S'L 7 "fry 3�'%� �So �3 I c> - n c home phone# work phone# CURRENT MAILING ADDRESS: city/iown 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 oa 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 require nts t he/she will comply with said procedures and requirements. Signature of Ho 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,RuIes &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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 0 613 13 �TME T Town of Barnstable Regulatory Services �U MASS. Richard V.Scali,Director i639- .� � 639.cp Building Division 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.maxs 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 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O PJNERPERMISSIO'NTPOOLS L1.9 r'I !i�'i tJ nrq i•i :j i. Town.of Barnstable1:1„u_tp,.i ; ,l L T��1,iN. Rl Old King's Highway Historic District Committee 200 Main Street, Hyannis, Massachusetts 02601 ` 9. �� (508).862-4787 Fax (508) 862-4784 f0�, APPLICATION, CERTIFICATE OF APPROPRIATENESS FOR DEMOLITION OR RELOCATION OF A BUILDING OR STRUCTURE (including partial demolitions of buildings,structures;.outbuildings,stonewalls, etc.) Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date: Address of Proposed work: Assessors Map and lot# House# '') Street /0 eo /2A Village: � i Demolition of: ❑house ❑part of house Garage ❑ barn ❑stable commercial ❑stone wall ❑other Description of Proposed Work: jo �-- Please complete the following information: p! Square footage of footprint of building(s)to be demolished: Building 1: 024ns 7 2: Square footage of total floor area of building(s)to be demolished: Building 1: jz,-0 a 2: Owner(please print): ` t Tel#: ��(,�(p 5 Owner's mailing address: � Jj 1,2 �3- Signature of Owner D �. Note: All appli ns neus y the owner,or evidence i uthor' ct for the owner submitted Agent/Contractor(please print): Tel#: Address: Signature of Contractor/Agent: If application is for removal to a different location, state where: Note: A separate Certificate of Appropriateness is required for a relocation of a building or structure within the Barnstable Old Kings Highway Historic District. . Checklist APPROVE Application for Certificate of Appropriateness for Demolition or Removal,4 copies .�-sitcPIMI ies, S E P 2 4 2014 Photographs of all elevations of building(s),outbuilding(s)or stone walls being demolished. Fee according to schedule. Town of Barnstable Old King's Highway List of abutters,see staff Committee For Committee Use Only This Certificate is hereby Approved) Date: 24Y 11 e Members Signatures: RECEIVED AUG 2 8 ZO14 Conditions of Approval, if any ''�-- GROWTH,MANAGE ENT Town of Barnstable Geographic Information System August 28,2014 196014 #104 196016 195016 #76 /HOCO RO 196021 #103 195020 089 195019 076 ED 196024 #126 195029042 028 196029043 026 0 17 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:195 Parcel:020 Selected Parcel a boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner.MANNI,JANICE S Total Assessed Value:5259900 1'=100'may not meet established map accuracy standards. The parcel lines on this map tiv E are only graphic representations of Assesses tax parcels.They are not true property Co-Owner.%SPENSLEY,LYNN B& Acreage:0.34 acres Abutters .. boundaries and do not represent accurate relationships to physical features on the map Location:89 MOCO ROAD Buffer f' such as building locations. �� 'r 4y r •' � • k • � i 31'°`'r •. r f I I • - J '1•... APPROVED / / Town • Barnstable • • Highway Committee R D • i v� 1� 1''P $�&�4 t• �r • r o t a r s � $ rr 4aF, i 4� 8 4 1 � #�4�9�# 41 0 IMF 10 ' APPROVED SEP 242014 Town of Barnstable Old King's Highway Committee RECEIVED AUG 2 8 Z014 GROWTH MANAGEMENT _,mow ............. APPROVED SEP 2 4 2014 RECEIV 1E"D Town of Barnstable }� 201 Old King's Highway Committee p Town of Barnstable II Regulatory Services 9 M 9. i639. Richard V. Scali,Director �0 '°Tfpt Building Division Tom Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 _ _.- --- www.town.barnstable:ma.us---. .- Office: 508-862-4038 Fax: 508-790-6230 Building Permit Procedure for Residential Addition Or Remodel Or Dock ❑ Determine map and parcel number and enter it on application. ❑ Historic District Commission,200 Main Street, approval required prior to construction/demolition for any properties located in a Historic District: • Old Kings Highway Historic District(north of the Mid Cape Highway) • Hyannis Main Street Waterfront Historic District(See map for boundaries) • Historic Preservation(if applicable). ❑ If ZBA relief(Special Permit or Variance is required for Project): ❑Copy of ZBA decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date ❑ Approvals from the following departments are required and can be obtained at 200 Main St.: ❑Health Department (8:00---9:30 AM&3:30—=4:30P_IVI {as of March 2°d,20051 ❑Conservation Department=(8:00 9 30_AIyI=&J3 30—_4:30 PM)R6~ ❑Tax Collector {can be obtained from-Building_D_ep went} ❑Treasurer {can be obtained from Building Department} ❑ Permit must contain complete owner information, full description of project, correct square footage of project, valuation of project (do not include hvac), building detail for Assessor's Office, complete builders information, including signature and date of application. ❑ 5 sets of reduced house plans measuring 11"x 17",scaled 1/4"= 1' & fully dimensionalized are required. Plans must include a foundation, cross section, framing schedule, insulation detail & floor plan showing location of smoke detectors(located with a Red`S'.) ****** IF USING ENGINEERED LUMBER AND/OR STRUCTURAL STEEL,ENGINEERING DATA MUST BE PROVIDED****** ❑ Plot plan or mortgage survey required for any addition. ❑ Workers Compensation Insurance Affidavit form must be submitted for any workers hired. In the event the homeowner takes out the permit, subcontractors hired must supply this. Copy of Insurance Compliance Certificate must be submitted. ❑ Mass Compliance Checklist ❑ Construction Supervisors License&Home Improvement Contractor's License OR ❑ Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. ❑ Property owner must sign Property Owner Letter of Permission. ❑. A NON-REFUNDABLE Application Fee must be paid upon receipt of application number. All checks should be made out to the Town of Barnstable ❑ CHIMNEYS: Need Home Improvement License,no plot plan required ❑ PIERS AND DOCKS:Need Construction Super License AND Home Improvement License. OWNER CANNOT PULL OWN PERMIT. ❑ Projects requiring the use of a crane must complete th6,forms issued by the Aeronautics Commission r i `L C shy Pkwaim•HFAnf7G•Ala Commaum 778 PWm SrREu OsnRYIL E,MA 02655 PH:(508)428.636S FAX:(508)420-0180 August 21,2014 Lynn Spensley 48 Booth Road Dedham,MA 02026 RE:89 Moco Road West Barnstable, MA 02668 C) To whom it may concern, , Carl F.Riedell&Son, Inc.has performed a visual inspection at 89 Moco Road,West Barns atyi and has '' determined that there is no water,waste,or gas piping in the area that is being demolished N ' ' If you have any questions,please feel free to contact the office. i Thank you Mark Razzano Plumbing Foreman i r qH August 22, 2014 Thomas McMillen 69 Dalton St Newton MA 02458 Bus Phone 508 733 7436 MA Electrical License#38717E To The Inspector of Wires: Property: 89 Moco Rd W Barnstable MA o Property Owner: Lynn Spensley& Erika de Papp, 48 Booth Rd DedharmF 0202C? I've inspected the attached garage/storage area and verify that there is no lectric,,g� , service running to the area to be demolished. ca 5 c� Thomas McMillen Y ^ Town.of Barnstable *Permit# Expires 6 monrhsLom issue date Regulatory Services Fee 3 S 0 o * =wxnisrnsr.E, MASS' Richard V.Scali,Director A 039. k rE0 MAC a (p Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 — Property Address/ 1;je( D /_nr^ ,�/1 Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I — 2,--0 Contractor's Name Telephone Number 10 7 3 395 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: JUN — 2 2014 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) ❑ 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 Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows /3 #of doors: / ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMS\building pe forms RES .doc Revised 061313 i C. k 37w Commor<rsctealth of Massachusetts Depaphnent ofhulacsftial Accidents 01Tce of nvest gations 600 Washington Street Boston,,MA 02L1I wnw.7nas&gor1dia Workers' Compensation Insnrance Affidavit:Builders/ContractorsfFiectricians/Plumbers Applicant Infarmation Please Print Legibly Na=(B1SR1P �on&&vidrtal): n I Address_ I 22C.&e-- City/Statc-Mp: A Da o a Phone# �7 f F<; Are you an employer?Check the appropriate box: Type of o ect(required): y� Ps' 9 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6- 0 New omstructioa employees(full andlorpart-time)* have biredthe sub-contractors. 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- ❑Demoli{taa working for me m any capacity employees and have workers' g_ ❑Building addition Wo workers' comp.insurance comp-msurance`l required-] 5..0 We area corporation and its 10.0 Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11_.0 Plumbing repairs or additions myself [No workers'tromp_ right of esmtnp6 n per MGL 12_.0 Roof repairs insurance rewired_]I c_152, §1(4,and we ha-.m no employees [No workers' 13_.❑Other comp_insurance required.j *Any wpUcaut that checks boa#1 umst also fill out the section below showing ibex woiteas'compensation POUry infu[matiamL 1 llomeosvners who submit this affidavit indicating they are doing all croak and then hide outside contractors mast submit a new affidavit and-1—ing surb tCtMtnctnrs that check this bmc must st rJc 'aa,ddifi -A sheet showing the name of fe and ststP whether ornot those erfities have Employees. 1f tize sub-contractors have employees,they umst provide their workers'comp.policy number. lam an employer iliat is prmid kg tt�orkers'c-onWrLsalion irrseerance for my e-mpFnyess Belau is the policy and,job site information. Insurance Company Name: Policy 4 or Self-ins-Lie_ Expiration Date: /Stair! Job Site Address: Ci tar �P= Attach a copy of the workers'compensation policy declaration page(shoiving the policy number and expiration date). Failure tc)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 fins of up.to$250.00 a.day against the violator- Be advised that a copy of this statement may be forwarded to the Office of Imrestigations of the DIA far insurance coverage verification- I da hereby certify render th pruns idp allies ofperjury that the information provided a7/ 7 true and correct Si��e: Date: l Phone#: O,fzaial rise only. Da not write in this area,to be completed by city or town of,ficiaL City or Town- Permit/License Lssning Authority(circle one): 1.Board of$ealt h 2.Building Department 3.Citylfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9- 6 • 1. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their cer-f ificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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/Ecease number which will be used as a reference number. In addition,an applicant that must submit multiple permitlliwase 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,Tilled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Departmeat of Industrial Accidents Gffke of kvestjnfi m 600 Wash�oa Street Baston,MA 02 111 Tel.#617-727-4900 w 4-06 or 1-9 MASWE Fax# 617-727-7 749 Revised4-24-07 Town of Barnstable Regulatory Services ��°F1He tOyr Richard V.Scali,Director Building Division n snxrrsrnat s Tom Perry,Building Commissioner Mas& 9Q3 1639. ��� 200 Main Street, Hyannis,MA 02601 AIFo �n www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: i� /X V JOB LOCATION: f �B L D number street village "HOMEOWNER": Z n ^ cn 7 SO c naV home phone# work phone# CURRENT MAILING ADDRESS: 645 nn //11.1 �rY/Sn nn A b2-D a city/town st9te 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. 11 t 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`ihomeowner. 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"certi s that he/she understands the Town of Barnstable Building Department minimum inspection procedures and r irem is t he/she will comply with said procedures and requirements. Signatur meo r Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 •� �pFTHE T[f._� �T w r w w + BARNSTABLE, • ' ' ,� Town of Barnstable Regulatory Services . Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A uilder I, , as.Owner f the subje property hereby authorize to act on m ehalf, in all matters relative to work authorized by this building permit pplication for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 061313